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Lipsyc-Sharf M, Ballman KV, Campbell JD, Muss HB, Perez EA, Shulman LN, Carey LA, Partridge AH, Warner ET. Age, Body Mass Index, Tumor Subtype, and Racial and Ethnic Disparities in Breast Cancer Survival. JAMA Netw Open 2023; 6:e2339584. [PMID: 37878313 PMCID: PMC10600583 DOI: 10.1001/jamanetworkopen.2023.39584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/11/2023] [Indexed: 10/26/2023] Open
Abstract
Importance Black women in the United States have higher breast cancer (BC) mortality rates than White women. The combined role of multiple factors, including body mass index (BMI), age, and tumor subtype, remains unclear. Objective To assess the association of race and ethnicity with survival among clinical trial participants with early-stage BC (eBC) according to tumor subtype, age, and BMI. Design, Setting, and Participants This cohort study analyzed survival data, as of November 12, 2021, from participants enrolled between 1997 and 2010 in 4 randomized adjuvant chemotherapy trials: Cancer and Leukemia Group B (CALGB) 9741, 49907, and 40101 as well as North Central Cancer Treatment Group (NCCTG) N9831, legacy groups of the Alliance of Clinical Trials in Oncology. Median follow-up was 9.8 years. Exposures Non-Hispanic Black and Hispanic participants were compared with non-Hispanic White participants within subgroups of subtype (hormone receptor positive [HR+]/ERBB2 [formerly HER2] negative [ERBB2-], ERBB2+, and HR-/ERBB2-), age (<50, 50 to <65, and ≥65 years), and BMI (<18.5, 18.5 to <25.0, 25.0 to <30.0, and ≥30.0). Main Outcomes and Measures Recurrence-free survival (RFS) and overall survival (OS). Results Of 9479 participants, 436 (4.4%) were Hispanic, 871 (8.8%) non-Hispanic Black, and 7889 (79.5%) non-Hispanic White. The median (range) age was 52 (19.0-89.7) years. Among participants with HR+/ERBB2- tumors, non-Hispanic Black individuals had worse RFS (hazard ratio [HR], 1.49; 95% CI, 1.04-2.12; 5-year RFS, 88.5% vs 93.2%) than non-Hispanic White individuals, although the global test for association of race and ethnicity with RFS was not significant within any tumor subtype. There were no OS differences by race and ethnicity in any subtype. Race and ethnicity were associated with OS in young participants (age <50 years; global P = .008); young non-Hispanic Black participants (HR, 1.34; 95% CI, 1.04-1.71; 5-year OS, 86.6% vs 92.0%) and Hispanic participants (HR, 1.62; 95% CI, 1.16-2.29; 5-year OS, 86.2% vs 92.0%) had worse OS than young non-Hispanic White participants. Race and ethnicity were associated with RFS in participants with BMIs of 25 to less than 30, with non-Hispanic Black participants having worse RFS (HR, 1.81; 95% CI, 1.23-2.68; 5-year RFS, 83.2% vs 87.3%) than non-Hispanic White participants. Conclusions and Relevance In this cohort study, racial and ethnic survival disparities were identified in patients with eBC receiving standardized initial care, and potentially at-risk subgroups, for whom focused interventions may improve outcomes, were found.
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Affiliation(s)
- Marla Lipsyc-Sharf
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- David Geffen School of Medicine at UCLA/Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Karla V. Ballman
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Jordan D. Campbell
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota
| | - Hyman B. Muss
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
| | | | | | - Lisa A. Carey
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Erica T. Warner
- Clinical Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston
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Advani PP, Ruddy KJ, Herrmann J, Ray JC, Craver EC, Yothers G, Cecchini RS, Lipchik C, Feng H, Rastogi P, Mamounas EP, Swain SM, Geyer CE, Wolmark N, Paik S, Pogue-Geile KL, Colon-Otero G, Perez EA, Norton N. Replication of genetic associations of chemotherapy-related cardiotoxicity in the adjuvant NSABP B-31 clinical trial. Front Oncol 2023; 13:1139347. [PMID: 37305569 PMCID: PMC10248403 DOI: 10.3389/fonc.2023.1139347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Background The cardiotoxic effects of doxorubicin, trastuzumab, and other anticancer agents are well known, but molecular genetic testing is lacking for the early identification of patients at risk for therapy-related cardiac toxicity. Methods Using the Agena Bioscience MassARRAY system, we genotyped TRPC6 rs77679196, BRINP1 rs62568637, LDB2 rs55756123, RAB22A rs707557, intergenic rs4305714, LINC01060 rs7698718, and CBR3 rs1056892 (V244M) (previously associated with either doxorubicin or trastuzumab-related cardiotoxicity in the NCCTG N9831 trial of anthracycline-based chemotherapy ± trastuzumab) in 993 patients with HER2+ early breast cancer from the NSABP B-31 trial of adjuvant anthracycline-based chemotherapy ± trastuzumab. Association analyses were performed with outcomes of congestive heart failure (N = 29) and maximum decline in left ventricular ejection fraction (LVEF) using logistic and linear regression models, respectively, under an additive model with age, baseline LVEF, and previous use of hypertensive medications as covariates. Results Associations of maximum decline in LVEF in the NCCTG N9831 patients did not replicate in the NSABP B-31 patients. However, TRPC6 rs77679196 and CBR3 rs1056892 were significantly associated with congestive heart failure, p < 0.05, with stronger associations observed in patients treated with chemotherapy only (no trastuzumab) or in the combined analysis of all patients relative to those patients treated with chemotherapy + trastuzumab. Conclusions TRPC6 rs77679196 and CBR3 rs1056892 (V244M) are associated with doxorubicin-induced cardiac events in both NCCTG N9831 and NSABP B-31. Other variants previously associated with trastuzumab-related decline in LVEF failed to replicate between these studies.
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Affiliation(s)
- Pooja P. Advani
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Kathryn J. Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN, United States
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Jordan C. Ray
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, United States
| | - Emily C. Craver
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, United States
| | - Greg Yothers
- NRG Oncology Statistics and Data Management Center, Pittsburgh, PA, United States
- Department of Biostatistics, The University of Pittsburgh, Pittsburgh, PA, United States
| | - Reena S. Cecchini
- NRG Oncology Statistics and Data Management Center, Pittsburgh, PA, United States
- Department of Biostatistics, The University of Pittsburgh, Pittsburgh, PA, United States
| | - Corey Lipchik
- NRG Oncology/NSABP Foundation, Pittsburgh, PA, United States
| | - Huichen Feng
- NRG Oncology/NSABP Foundation, Pittsburgh, PA, United States
| | - Priya Rastogi
- NRG Oncology/NSABP Foundation, Pittsburgh, PA, United States
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Eleftherios P. Mamounas
- NRG Oncology/NSABP Foundation, Pittsburgh, PA, United States
- Department of Surgical Oncology, Orlando Health Cancer Institute, Orlando, FL, United States
| | - Sandra M. Swain
- NRG Oncology/NSABP Foundation, Pittsburgh, PA, United States
- Department of Surgical Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States
| | - Charles E. Geyer
- NRG Oncology/NSABP Foundation, Pittsburgh, PA, United States
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Norman Wolmark
- NRG Oncology/NSABP Foundation, Pittsburgh, PA, United States
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Soonmyung Paik
- NRG Oncology/NSABP Foundation, Pittsburgh, PA, United States
| | | | - Gerardo Colon-Otero
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Edith A. Perez
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Nadine Norton
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, United States
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Carter JM, Chumsri S, Hinerfeld DA, Ma Y, Wang X, Zahrieh D, Hillman DW, Tenner KS, Kachergus JM, Brauer HA, Warren SE, Henderson D, Shi J, Liu Y, Joensuu H, Lindman H, Leon-Ferre RA, Boughey JC, Liu MC, Ingle JN, Kalari KR, Couch FJ, Knutson KL, Goetz MP, Perez EA, Thompson EA. Distinct spatial immune microlandscapes are independently associated with outcomes in triple-negative breast cancer. Nat Commun 2023; 14:2215. [PMID: 37072398 PMCID: PMC10113250 DOI: 10.1038/s41467-023-37806-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/30/2023] [Indexed: 04/20/2023] Open
Abstract
The utility of spatial immunobiomarker quantitation in prognostication and therapeutic prediction is actively being investigated in triple-negative breast cancer (TNBC). Here, with high-plex quantitative digital spatial profiling, we map and quantitate intraepithelial and adjacent stromal tumor immune protein microenvironments in systemic treatment-naïve (female only) TNBC to assess the spatial context in immunobiomarker-based prediction of outcome. Immune protein profiles of CD45-rich and CD68-rich stromal microenvironments differ significantly. While they typically mirror adjacent, intraepithelial microenvironments, this is not uniformly true. In two TNBC cohorts, intraepithelial CD40 or HLA-DR enrichment associates with better outcomes, independently of stromal immune protein profiles or stromal TILs and other established prognostic variables. In contrast, intraepithelial or stromal microenvironment enrichment with IDO1 associates with improved survival irrespective of its spatial location. Antigen-presenting and T-cell activation states are inferred from eigenprotein scores. Such scores within the intraepithelial compartment interact with PD-L1 and IDO1 in ways that suggest prognostic and/or therapeutic potential. This characterization of the intrinsic spatial immunobiology of treatment-naïve TNBC highlights the importance of spatial microenvironments for biomarker quantitation to resolve intrinsic prognostic and predictive immune features and ultimately inform therapeutic strategies for clinically actionable immune biomarkers.
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Affiliation(s)
- Jodi M Carter
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Saranya Chumsri
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Yaohua Ma
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Xue Wang
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - David Zahrieh
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - David W Hillman
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Kathleen S Tenner
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Ji Shi
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Yi Liu
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Henrik Lindman
- Department of Oncology, University of Uppsala, Uppsala, Sweden
| | - Roberto A Leon-Ferre
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - James N Ingle
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Krishna R Kalari
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Keith L Knutson
- Department of Immunology, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew P Goetz
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Edith A Perez
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
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Chumsri S, Larson JJ, Tenner KS, He J, Polley MY, weidner MT, Arnold AN, Haley D, Advani P, Sideras K, Moreno-Aspitia A, Perez EA, Knutson KL. Abstract P4-01-17: Phase I/II study of pembrolizumab in combination with oral binimetinib in patients with unresectable locally advanced or metastatic triple-negative breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-01-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Previous studies demonstrated that activation of the RAS/MAPK pathway is associated with reduced tumor-infiltrating lymphocytes and poor response to neoadjuvant chemotherapy in triple-negative breast cancer (TNBC). Further in vivo study showed that inhibition of the MAPK pathway with a MEK inhibitor is synergistic with immune checkpoint inhibitors (ICIs). Methods: Patients with unresectable locally advanced or metastatic TNBC with ≤ 3 prior lines of therapy were treated with pembrolizumab 200 mg every 3 weeks plus an oral MEK inhibitor binimetinib. Treatment was started with a 2-week run-in period with single-agent binimetinib. There were 2 dose levels in phase I, including dose level 0 (DL 0) with binimetinib at 45 mg orally twice daily continuously and dose level -1 (DL -1) at 30 mg twice daily. A standard 3+3 design was used in phase I to identify the recommended phase II dose (RP2D) and Simon’s two-stage Optimal design was used in phase II. Results: A total of 22 patients were enrolled. The median age was 58 years old (range 37-77). 14 (63.6%) patients had no prior systemic therapy in the metastatic setting and 8 (36.4%) patients had 1-2 prior lines of therapy. There were 4 patients treated in DL 0. Dose-limiting toxicity (DLT) was observed in 2 out of 4 patients in DL 0 with grade 3 ALT abnormality in one patient and grade 3 flank pain together with grade 3 nausea and vomiting > 48 hours despite anti-emetic therapy in the other patient. Binimetinib dose was reduced to DL -1. In the next 6 patients, there was 1 DLT observed with grade 3 AST/ALT abnormality. Thus, DL -1 was the RP2D, and an additional 12 patients were treated with DL -1 in phase II. Overall, 18 patients were treated in DL -1 and were included in phase II efficacy evaluation. 17 patients were evaluable for response. Objective responses were observed in 5 patients (29.41% 55.96) with 1 complete response (CR) and 4 partial responses (PR). The clinical benefit rate (CBR) was 35.29% (95% CI: 14.21 - 61.67) with 6 out of 17 having had CR, PR, or stable disease >= 24 weeks. Since previous studies showed poor responses to ICIs in patients with liver metastases due to macrophage-mediated T cell elimination, we further conduct exploratory analysis to evaluate responses among patients with and without liver metastases. Among all 5 patients with liver metastases, no response was observed. The objective response rate (ORR) in patients without liver metastases was 55.56% (95% CI: 21.20 - 86.30) and CBR was 66.67% (95% CI: 29.93-92.51), when excluding 3 patients who discontinued treatment due to adverse events prior to follow-up scans. Median progression-free survival in DL 0 was 2.4 (95%CI: 0.5-NE) and in DL -1 was 8.3 (95% CI: 3.9-NE) months. Median overall survival in DL 0 was 7 (95%CI: 0.5-NE) and in DL -1 was 33.2 (95% CI: 10.3-NE) months. Among patients who responded, 3 out of 5 (60%) had a duration of response greater than 12 months and ongoing even after stopping treatment (range: 5.4 - 32.0 months). Adverse events (AEs) were mostly grade 1-2 including anemia, CPK increase, fatigue, diarrhea, nausea, peripheral neuropathy, acneiform rash, AST increase, cardiac troponin increase, and constipation. Additional correlative studies are ongoing and will be presented at the meeting. Conclusions: Pembrolizumab in combination with binimetinib at 30 mg twice daily appears to be safe with manageable toxicities. Promising activity with durable responses was observed with this combination without chemotherapy, particularly in patients without liver metastases. Future studies are warranted to further evaluate the efficacy of this combination.
Citation Format: Saranya Chumsri, Joseph J. Larson, Kathleen S. Tenner, Jun He, Mei-Yin Polley, Morgan T. weidner, Amanda N. Arnold, Dana Haley, Pooja Advani, Kostandinos Sideras, Alvaro Moreno-Aspitia, Edith A. Perez, Keith L. Knutson. Phase I/II study of pembrolizumab in combination with oral binimetinib in patients with unresectable locally advanced or metastatic triple-negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-01-17.
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Kang I, Forschmiedt JK, Loch MM, Barlow WE, Lew DL, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, Lin NU, Perez EA, Goldstein LJ, Rastogi P, Schott AF, Shak S, Sharma P, Miao J, Tripathy D, Pusztai L, Hortobagyi GN, Kalinsky K, Henry NL. Abstract GS1-04: Patient-reported cognitive impairment in women participating in the RxPONDER trial (SWOG S1007) by menopausal status. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-gs1-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Introduction: Breast cancer treatment is associated with cancer-related cognitive impairment (CRCI). However, the differential effect of endocrine therapy (ET) vs chemotherapy followed by endocrine therapy (CET), including the impact of menopausal status, on CRCI is not well understood.
Methods: Participants (pts) with hormone receptor positive, HER2 negative breast cancer with 1-3 positive lymph nodes and an Oncotype DX recurrence score of 0-25 enrolled in the RxPONDER trial were randomly assigned to ET alone versus CET. Until the health-related quality of life (HRQoL) accrual goal was reached, English speaking pts in the US were invited to complete HRQoL questionnaires including the 8-item PROMIS Perceived Cognitive Function Concerns (PCF) Short Form questionnaire shortly after randomization (baseline), as well as 6, 12, and 36 months after baseline. Analysis of measures of anxiety and fatigue is presented separately. Standardized T scores (mean 50; SD 10) for PCF were computed with higher scores indicating less cognitive impairment. The primary endpoint of this exploratory analysis was to compare mean PCF T scores by treatment arm and menopausal status. Separately by menopausal status, a generalized estimating equations (GEE) model was fit to the three timepoints adjusting for baseline to estimate the difference between treatment arms and whether there was a time trend over the three follow-up measures.
Results: The HRQoL accrual exceeded the goal of 500 patients, with 74% of pts participating voluntarily until the QOL invitation was removed from the protocol (Dec 1, 2012). A total of 139 pre and 429 postmenopausal pts completed the questionnaires at baseline. T scores were similar between ET and CET arms at baseline [Table 1]. In the ET arm, T scores decreased from baseline to 6 and 12 months but recovered to baseline at 36 months. In the CET arm, T scores decreased from baseline to 6 months and 12 months but did not return to baseline at 36 months. The mean score difference between CET and ET over time was -3.02 (p=0.01) and -2.36 (p=0.003) for pre and postmenopausal pts, respectively. Adjusting for baseline, there was no significant time trend over the three follow-up periods for either premenopausal (p=0.12) or postmenopausal (p=0.49) pts. Dropoff occurred over time with 79%, 76%, 60% of pts at baseline participating at 6, 12, and 36 months. Complete endocrine treatment adherence data are not yet available at each timepoint.
Conclusion: Chemoendocrine therapy has a greater negative effect on patient-reported CRCI compared to ET alone in both pre- and post-menopausal pts and it is sustained over 36 months. Interventions to prevent or treat CRCI are needed to improve the long-term quality of life of patients treated with CET.
Table 1. Comparisons of mean Cognitive Function score by treatment arm and menopausal status.
Citation Format: Irene Kang, Jamie K. Forschmiedt, Michelle M. Loch, William E. Barlow, Danika L. Lew, Julie R. Gralow, Funda Meric-Bernstam, Kathy S. Albain, Daniel F. Hayes, Nancy U. Lin, Edith A. Perez, Lori J. Goldstein, Priya Rastogi, Anne F. Schott, Steven Shak, Priyanka Sharma, Jieling Miao, Debu Tripathy, Lajos Pusztai, Gabriel N. Hortobagyi, Kevin Kalinsky, N. Lynn Henry. Patient-reported cognitive impairment in women participating in the RxPONDER trial (SWOG S1007) by menopausal status [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS1-04.
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Affiliation(s)
| | | | | | | | | | | | | | - Kathy S. Albain
- 8Loyola University Chicago Stritch School of Medicine, Cardinal Bernardin Cancer Center
| | - Daniel F. Hayes
- 9University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Nancy U. Lin
- 10Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Priya Rastogi
- 13UPMC Hillman Cancer Center and NRG Oncology, Pittsburgh, Pennsylvania
| | - Anne F. Schott
- 14Rogel Cancer Center, University of Michigan Health, Ann Arbor, MI
| | | | - Priyanka Sharma
- 16University of Kansas Medical Center Westwood, Westwood, KS
| | - Jieling Miao
- 17Fred Hutchinson Cancer Center, Seattle, Washington
| | - Debu Tripathy
- 18The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Kevin Kalinsky
- 21Winship Cancer Institute at Emory University, Atlanta, GA
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Chumsri S, Li Z, Norton N, Moreno-Aspitia A, Colon-Otero G, Knutson KL, Wolff AC, Perez EA, Thompson EA. Abstract P2-11-05: Effects of Intrinsic Subtypes and 21-gene Assay on the Early and Late Recurrence Risks in Patients with Early Stage HER2+ Breast Cancer: An Analysis of the North Central Cancer Treatment Group (NCCTG) N9831 (Alliance) Trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-11-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: We previously demonstrated that intrinsic subtypes were associated with prognosis for early recurrence risk in patients (pts) with early-stage HER2-positive (HER2+) BC treated with trastuzumab (H) in the N9831 trial. Here, we evaluated the prognostic value of Intrinsic subtypes and 21-gene assay and the risk of early and late recurrence in the N9831 trial. Methods: NanoString custom code set, which included PAM50 and housekeeping genes, was used to quantify mRNA and generated intrinsic subtypes and risk of recurrence (ROR) score from the N9831 trial in Arms A and C: Arm A chemotherapy alone and arm C concurrent H. Quantitative RT-PCR of 21 genes, calculation of the axis, including estrogen axis (ER, PGR, BCL2, SCUBE2), HER2 axis (GRB7, HER2), proliferation axis (Ki67, STK15, Survivin, CCNB1, MYBL2), invasion axis (MMP11, CTSL2), and recurrence score (RS) risk group assignment (RS group 1 and 2: RS < 31 and RS group 3: RS ≥ 31) were performed using Oncotype DX assay. Cox regression models for RFS were used for analysis. Early recurrence was defined as a recurrence that occurred at ≤ 5 years, and late recurrence was defined as recurrence at > 5 years. Results: A total of 783 patients (Arm A 409 and Arm C 374) were included in this analysis. Using multivariate Cox regression analysis to evaluate the risk of early recurrence in patients who received chemotherapy alone in arm A, both invasion genes (MMP11 HR 1.23, 95%CI 1.05-1.44, p 0.01 and CTSL2 HR 1.36, 95%CI 1.1-1.69, p 0.005) and invasion axis (HR 1.64, 95%CI 1.26-2.13, p < 0.001) were associated with a higher rate of early recurrence. CD68 was associated with improved outcomes (HR 0.56, 95%CI 0.38-0.83, p 0.004). For the risk of early recurrence in patients treated with trastuzumab in arm C, ER (HR 0.85, 95%CI 0.74-0.97, p 0.02), PR (HR 0.78, 95%CI 0.64-0.94, p 0.008), and estrogen axis (HR 0.7, 95%CI 0.57-0.87, p 0.001) were associated with improved outcomes. Invasion axis (HR 1.61, 95%CI 1.08-2.41, p 0.02), Oncotype Dx risk group (3 vs. 1 and 2, HR 8.89, 95%CI 1.27-1124, p 0.02), and basal subtype (HR 2.77, 95%CI 1.1-5.95, p 0.03) were also significantly associated with worse outcomes. For risk of late recurrence, in arm A, ER (HR 1.22, 95%CI 1.04-1.44, p 0.02), PR (1.26, 95%CI 1.05-1.5, p 0.01), and estrogen axis (1.39, 95%CI 1.09-1.77, p 0.008) were associated with worse outcomes. Oncotype Dx risk group (3 vs. 1 and 2, HR 0.4, 95%CI 0.16-0.98, p 0.05) was associated with improved outcomes. However, neither individual gene, axis, nor intrinsic subtypes were associated with the risk of late recurrence in patients treated with trastuzumab. Conclusions: For risks of early recurrence, the invasion genes/axis were associated with increased risks of recurrence in patients with early-stage HER2+ BC regardless of trastuzumab treatment. Among patients treated with trastuzumab, ER genes/axis, Oncotype Dx risk group, and intrinsic subtype were prognostic for risks of recurrence in the first five years. For risks of late recurrence, ER genes/axis and Oncotype Dx risk group were prognostic but only in patients treated with chemotherapy alone. The ER genes/axis were associated with less recurrence in the first five years but worse after five years, reflecting a higher risk of late recurrence in ER/PR+ HER2+ BC patients treated with chemotherapy alone. However, none of the individual gene, axis, or intrinsic subtypes were associated with the risk of late recurrence in patients treated with trastuzumab. Therefore, future studies are needed to identify biomarkers for the risk of late recurrence in HER2+ BC patients treated with adjuvant trastuzumab. Support: BCRF-19-161; U10CA180821, U10CA180882, Genentech. https://acknowledgments.alliancefound.org; Clinicaltrials.gov Identifier: NCT00005970
Citation Format: Saranya Chumsri, Zhuo Li, Nadine Norton, Alvaro Moreno-Aspitia, Gerardo Colon-Otero, Keith L. Knutson, Antonio C. Wolff, Edith A. Perez, E. A. Thompson. Effects of Intrinsic Subtypes and 21-gene Assay on the Early and Late Recurrence Risks in Patients with Early Stage HER2+ Breast Cancer: An Analysis of the North Central Cancer Treatment Group (NCCTG) N9831 (Alliance) Trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-11-05.
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Abdou Y, Barlow WE, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, Lin NU, Perez EA, Goldstein LJ, Chia SK, Dhesy-Thind S, Rastogi P, Alba E, Delaloge S, Schott AF, Shak S, Sharma P, Lew DL, Miao J, Unger JM, Tripathy D, Pusztai L, Hortobagyi GN, Kalinsky K. Abstract GS1-01: Race and clinical outcomes in the RxPONDER Trial (SWOG S1007). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-gs1-01] [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: 03/06/2023]
Abstract
Abstract
Introduction: Racial disparities in breast cancer (BC) outcomes continues to be a major health care challenge. The 21-gene recurrence score (RS) is an important tool to guide treatment (tx) decisions among women with early-stage BC. We report an analysis of clinical characteristics, survival outcomes and race in association with RS in participants (pts) in the RxPONDER trial.
Methods: We analyzed clinical outcomes with respect to race and ethnicity. Unreported race excluded 18.7% of the pts, with most due to privacy rules. The primary outcome was invasive disease-free survival (IDFS). Distant relapse-free survival (DRFS) was also evaluated. Analyses adjusted for assigned tx arm, RS, and grade were performed. There were too few events to include Native American/Pacific Islander (NAPI) women in the survival analyses.
Results: A total of 4,048 trial women with Hormone Receptor positive, HER2 negative (HR+/HER2-) BC, 1-3 involved axillary lymph nodes (LNs), RS ≤ 25 and known race/ethnicity were included in this analysis including the following: 2,833 non-Hispanic (NH) White pts (70%), 248 NH Black pts (6.1%), 610 Hispanic pts (15.1%), 324 Asian pts (8.0%), and 33 NAPI pts (0.8%). Asian and Hispanic women were younger than NH Whites (by 7.1 and 2.4 years, respectively) but NH Blacks did not differ in age. RS distribution did not differ among all racial subgroups (p=0.49). There were also no significant differences in tumor size (p=0.10) or number of positive LNs (p=0.26) across all racial groups. However, tumor grade was found to be significantly different with grade 3 tumors higher for NH Blacks (18.0%), NH NAPI (21.1%), and Hispanics (14.5%) vs. NH Whites (10.4%) and Asians (6.5%) (p< 0.001). Overall five-year IDFS was lower for NH Blacks (87.0%) compared to that for Asians (93.9%), NH Whites (91.5%), and Hispanics (91.4%) (Table 1). A multivariable Cox model adjusting for RS and tx arm showed worse IDFS for NH Blacks compared to NH Whites (HR=1.38; 95% CI 1.00-1.90; p=0.048), although Asian pts had better IDFS than NH Whites (HR=0.65; 95% CI 0.44-0.97; p=0.034). In a separate analysis by menopausal status the magnitude of the IDFS hazard ratios (HRs) for NH Blacks was similar, although no longer statistically significant (premenopausal HR=1.37; 95% CI 0.69-2.72; postmenopausal HR=1.38; 95% CI 0.96-1.98). While there was no statistically significant interaction between NH Blacks vs. NH Whites and tx arm for either premenopausal (p=0.99) or postmenopausal women (p=0.44), adjusting for RS, the small number of events in the NH Black cohort, particularly in premenopausal women (n = 9 IDFS events), limit power and inference about differences in chemotherapy benefit. Among postmenopausal women, NH Blacks had worse DRFS compared to NH Whites (HR=1.69; 95% CI 1.12-2.53; p=0.01), adjusting for tx and RS. A similar trend was seen among premenopausal women (HR=1.74; 95% CI 0.79-3.82; p=0.17), although not statistically significant. Data on tx adherence over 5 years was not mature, although NH Blacks were more likely to accept tx assignment compared to NH Whites at randomization (93% vs. 86%, p=0.004).
Conclusion: Black women with HR+/HER2- BC, 1-3 involved LNs and RS ≤ 25 have worse outcomes compared to White women despite similar RS results. There was no significant interaction between NH Blacks vs. NH Whites and tx arm, although this analysis was limited due to sample size. There remains an important need for novel approaches to improve clinical outcomes particularly for NH Black Women.
Table 1. IDFS by Race and Ethnicity.
Citation Format: Yara Abdou, William E. Barlow, Julie R. Gralow, Funda Meric-Bernstam, Kathy S. Albain, Daniel F. Hayes, Nancy U. Lin, Edith A. Perez, Lori J. Goldstein, Stephen K. Chia, Sukhbinder Dhesy-Thind, Priya Rastogi, Emilio Alba, Suzette Delaloge, Anne F. Schott, Steven Shak, Priyanka Sharma, Danika L. Lew, Jieling Miao, Joseph M. Unger, Debu Tripathy, Lajos Pusztai, Gabriel N. Hortobagyi, Kevin Kalinsky. Race and clinical outcomes in the RxPONDER Trial (SWOG S1007) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS1-01.
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Affiliation(s)
- Yara Abdou
- 1University of North Carolina, Chapel Hill, North Carolina
| | | | | | - Funda Meric-Bernstam
- 4Department of Investigational Cancer Therapeutics - The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kathy S. Albain
- 5Loyola University Chicago Stritch School of Medicine, Cardinal Bernardin Cancer Center
| | - Daniel F. Hayes
- 6University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Nancy U. Lin
- 7Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Stephen K. Chia
- 10British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Priya Rastogi
- 12UPMC Hillman Cancer Center and NRG Oncology, Pittsburgh, Pennsylvania
| | - Emilio Alba
- 13Hospital Regional Universitario y Virgen de la Victoria, Málaga, Andalucia, Spain
| | | | - Anne F. Schott
- 15Rogel Cancer Center, University of Michigan Health, Ann Arbor, MI
| | | | - Priyanka Sharma
- 17University of Kansas Medical Center Westwood, Westwood, KS
| | | | - Jieling Miao
- 19Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Debu Tripathy
- 21The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Kevin Kalinsky
- 24Winship Cancer Institute at Emory University, Atlanta, GA
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Graff SL, Wildes T, Duma N, Dizon DS, LoConte NK, Mitchell E, Murphy MC, Perez EA, Temkin SM, Kunz PL, Winkfield KM. Understanding Modern Medical Centers: Beyond Simone-Intersectional Maxims for a New Era. J Clin Oncol 2023; 41:1350-1358. [PMID: 36166718 DOI: 10.1200/jco.22.01060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stephanie L Graff
- Division of Medical Oncology, Lifespan Cancer Institute, Brown University, Providence, RI
| | | | - Narjust Duma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Don S Dizon
- Division of Medical Oncology, Lifespan Cancer Institute, Brown University, Providence, RI
| | - Noelle K LoConte
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Edith Mitchell
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Martina C Murphy
- Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Edith A Perez
- Department of Hematology/Oncology and Cancer Biology, Mayo Clinic Jacksonville, Jacksonville, FL
| | | | - Pamela L Kunz
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN
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Loch MM, Forschmiedt JK, Kang IM, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, Lin NU, Perez EA, Goldstein LJ, Rastogi P, Schott AF, Shak S, Sharma P, Lew DL, Miao J, Barlow WE, Tripathy D, Pusztai L, Hortobagyi GN, Kalinsky K, Henry NL. Abstract P6-05-06: Patient-reported anxiety and fatigue in women enrolled in the RxPONDER trial (SWOG S1007) by menopausal status. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-05-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Introduction: Anxiety and fatigue have been reported by women undergoing cytotoxic and endocrine treatment (tx) for breast cancer and can have lasting effects on quality of life (QoL). The differential effects of menopausal (meno) status, tx allocation and duration of symptoms are not well established.
Methods: Participants (pts) with hormone receptor positive, HER2 negative breast cancer with 1-3 positive lymph nodes and an Oncotype DX recurrence score of 0-25 enrolled in the RxPONDER trial were randomly assigned to endocrine therapy (ET) alone vs chemotherapy followed by ET (CET). A subset of English speaking pts in the US at the start of the trial were invited to complete health-related QoL (HRQoL) questionnaires shortly after randomization (baseline; BL) and 6, 12, and 36 months after BL until accrual goal reached. BL surveys were completed in clinic; cognitive function results presented separately. Standardized T scores (mean 50; SD 10) were computed for anxiety (PROMIS Emotional Distress – Anxiety Short Form 7a) and fatigue (PROMIS Fatigue Short Form 7a). Higher T scores indicate more anxiety or fatigue. The primary endpoint of this exploratory analysis was to compare mean anxiety and fatigue T score by tx arm by meno status. Separately by meno status, a GEE model was fit to the three follow-up timepoints adjusting for BL to estimate the difference between tx arms and whether there was a time trend over the three follow-up measures.
Results: The accrual exceeded the goal of 500 pts with 74% of pts participating voluntarily until the QOL invitation was removed from the protocol (12/1/12). A total of 139 pre and 432 postmenopausal pts completed the anxiety questionnaire at BL. There was no difference in anxiety between tx arms [Table 1]. Mean anxiety score difference between CET and ET over time in the premenopausal cohort was -0.63 (p=0.63) and in the postmenopausal cohort was 0.59 (p=0.45). Although anxiety scores decreased over the three follow-up times, the change was not statistically significant.
A total of 139 pre and 429 postmenopausal pts completed the fatigue questionnaire at BL. Fatigue mean T scores in both the pre and postmenopausal cohorts were higher over time in the CET vs ET arm [Table 2]. Fatigue scores were 2.85 points higher for CET vs. ET over time in the premenopausal cohort (p=0.02) and 1.82 points higher in the postmenopausal cohort (p=0.007). Fatigue scores decreased over time for premenopausal (p=0.01), but not for postmenopausal (p=0.62) pts.
Dropoff occurred over time with 79%, 76%, 60% of pts at BL participating at 6, 12, and 36 months. Endocrine treatment adherence data are not yet available at each timepoint.
Conclusions: CET had a clinically significant negative effect on mean fatigue scores compared to ET alone in both pre and postmenopausal pts over time. Scores improved over time but did not return to BL. Pts had lower mean anxiety scores during tx compared to BL, but differences in scores between CET and ET groups out to 3 years did not significantly differ. Future therapeutic studies must continue to include HRQoL assessments to broaden our understanding of the full impact of chemotherapy and for the development of preventative and therapeutic strategies to manage these toxicities.
Table 1. Comparisons of mean Anxiety score by treatment arm and menopausal status.
Table 2. Comparisons of mean Fatigue score by treatment arm and menopausal status.
Citation Format: Michelle M. Loch, Jamie K. Forschmiedt, Irene M. Kang, Julie R. Gralow, Funda Meric-Bernstam, Kathy S. Albain, Daniel F. Hayes, Nancy U. Lin, Edith A. Perez, Lori J. Goldstein, Priya Rastogi, Anne F. Schott, Steven Shak, Priyanka Sharma, Danika L. Lew, Jieling Miao, William E. Barlow, Debu Tripathy, Lajos Pusztai, Gabriel N. Hortobagyi, Kevin Kalinsky, N. Lynn Henry. Patient-reported anxiety and fatigue in women enrolled in the RxPONDER trial (SWOG S1007) by menopausal status [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-06.
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Affiliation(s)
| | | | | | | | | | - Kathy S. Albain
- 6Loyola University Chicago Stritch School of Medicine, Cardinal Bernardin Cancer Center
| | - Daniel F. Hayes
- 7University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Nancy U. Lin
- 8Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Priya Rastogi
- 11UPMC Hillman Cancer Center and NRG Oncology, Pittsburgh, Pennsylvania
| | - Anne F. Schott
- 12Rogel Cancer Center, University of Michigan Health, Ann Arbor, MI
| | | | - Priyanka Sharma
- 14University of Kansas Medical Center Westwood, Westwood, KS
| | | | - Jieling Miao
- 16Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Debu Tripathy
- 18The University of Texas MD Anderson Cancer Center, Houston, TX, Houston, Texas
| | | | | | - Kevin Kalinsky
- 21Winship Cancer Institute at Emory University, Atlanta, GA
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Yang J, Hou C, Wang H, Perez EA, Do-Umehara HC, Dong H, Arunagiri V, Tong F, Van Scoyk M, Cho M, Liu X, Ge X, Winn RA, Ridge KM, Wang X, Chandel NS, Liu J. Miz1 promotes KRAS-driven lung tumorigenesis by repressing the protocadherin Pcdh10. Cancer Lett 2023; 555:216025. [PMID: 36538983 PMCID: PMC9870713 DOI: 10.1016/j.canlet.2022.216025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/03/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
Targeting KRAS-mutated non-small-cell lung cancer (NSCLC) remains clinically challenging. Here we show that loss of function of Miz1 inhibits lung tumorigenesis in a mouse model of oncogenic KRAS-driven lung cancer. In vitro, knockout or silencing of Miz1 decreases cell proliferation, clonogenicity, migration, invasion, or anchorage-independent growth in mutant (MT) KRAS murine or human NSCLC cells but has unremarkable impact on non-tumorigenic cells or wild-type (WT) KRAS human NSCLC cells. RNA-sequencing reveals Protocadherin-10 (Pcdh10) as the top upregulated gene by Miz1 knockout in MT KRAS murine lung tumor cells. Chromatin immunoprecipitation shows Miz1 binding on the Pcdh10 promoter in MT KRAS lung tumor cells but not non-tumorigenic cells. Importantly, silencing of Pcdh10 rescues cell proliferation and clonogenicity in Miz1 knockout/knockdown MT KRAS murine or human tumor cells, and rescues allograft tumor growth of Miz1 knockout tumor cells in vivo. Miz1 is upregulated in MT KRAS lung tumor tissues compared with adjacent non-involved tissues in mice. Consistent with this, Miz1 is upregulated while Pcdh10 is downregulated in human lung adenocarcinomas (LUAD) compared with normal tissues, and high Miz1 levels or low Pcdh10 levels are associated with poor survival in lung cancer patients. Furthermore, the Miz1 signature is associated with worse survival in MT but not WT KRAS LUAD, and Pcdh10 is downregulated in MT compared to WT KRAS LUAD. Taken together, our studies implicate the Miz1/Pcdh10 axis in oncogenic KRAS-driven lung tumorigenesis.
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Affiliation(s)
- Jing Yang
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Changchun Hou
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Huashan Wang
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Edith A Perez
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Hanh Chi Do-Umehara
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Huali Dong
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Vinothini Arunagiri
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Fangjia Tong
- Department of Pharmacology and Regenerative Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Michelle Van Scoyk
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Minsu Cho
- Department of Pharmacology and Regenerative Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Xinyi Liu
- Department of Pharmacology and Regenerative Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Xiaodong Ge
- Department of Pathology, University of Illinois at Chicago, 840 S. Wood St., Suite 130 CSN, MC 847, Chicago, IL, 60612, USA
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Karen M Ridge
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Xiaowei Wang
- Department of Pharmacology and Regenerative Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Navdeep S Chandel
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Jing Liu
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, 60612, USA.
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11
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Blum LK, Pearson CI, Dulgeroff LBT, Gadkari R, Luo A, Luo A, Melrose JE, Nolin JL, Li H, Lee A, Zhou MN, Anand P, Sarma G, Henning KA, Chapin SJ, Ackerman SE, Kudirka R, Shen Y, Hug B, Perez EA, Kowanetz M, Alonso MN, Safina BS, Dornan D, Mallet WG. Abstract 2911: The CEA-targeted ISAC, BDC-2034, shows preclinical efficacy associated with innate immune activation, phagocytosis, and myeloid reprogramming. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-2911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Immune-stimulating antibody conjugates (ISACs) direct a TLR7/8 agonist into tumors through engagement of cell surface antigens to activate tumor-associated myeloid cells and initiate a broad innate and adaptive anti-tumor immune response. We are developing the ISAC BDC-2034 to target the tumor antigen, CEA (CEACAM5), which is expressed in many solid tumors. BDC-2034 comprises our proprietary antibody, CEA1, covalently conjugated to a potent TLR7/8 agonist via a non-cleavable linker. The strong pro-phagocytic capacity and slow internalization rate of CEA1 makes it an ideal antibody for the ISAC approach.
Methods: The ability of BDC-2034 to induce the secretion of pro-inflammatory cytokines was evaluated in vitro using co-cultures of tumor cells and primary immune cells (including monocytes and dendritic cells). Anti-tumor efficacy was demonstrated in vivo with xenograft and syngeneic mouse tumor models. In parallel studies, the mechanism of BDC-2034 action was assessed by quantifying intratumoral immune infiltration, cytokine levels, and transcript profile.
Results: In co-cultures of CEA-expressing tumor cells and immune cells, BDC-2034 induced the secretion of cytokines and chemokines that are essential for a broad anti-tumor immune response, including IL-12p70, CXCL10, and TNFα. These effects were accompanied by myeloid cell activation as demonstrated by elevation in costimulatory surface markers such as CD40. In vivo, BDC-2034 inhibited tumor growth in multiple xenograft and syngeneic mouse tumor models having CEA expression comparable to human cancers. Consistent with the proposed mechanism of action, BDC-2034 induced intratumoral immune cell infiltration, inflammatory cytokine secretion, and myeloid re-programming in a dose-dependent and CEA-dependent fashion. The constellation of BDC-2034 effects translated to durable therapeutic activity.
Conclusions: These preclinical findings demonstrate the potential of BDC-2034 to generate anti-tumor activity in CEA-expressing cancers through direct innate immune activation and the induction of adaptive anti-tumor immunity.
Citation Format: Lisa K. Blum, Cecelia I. Pearson, Laughing Bear Torrez Dulgeroff, Rishali Gadkari, Angela Luo, Andrew Luo, Jennifer E. Melrose, Jess L. Nolin, Hai Li, Arthur Lee, Matthew N. Zhou, Puneet Anand, Ganapathy Sarma, Karla A. Henning, Steven J. Chapin, Shelley E. Ackerman, Romas Kudirka, Yuyi Shen, Bruce Hug, Edith A. Perez, Marcin Kowanetz, Michael N. Alonso, Brian S. Safina, David Dornan, William G. Mallet. The CEA-targeted ISAC, BDC-2034, shows preclinical efficacy associated with innate immune activation, phagocytosis, and myeloid reprogramming [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2911.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hai Li
- 1Bolt Biotherapeutics, Redwood City, CA
| | | | | | | | | | | | | | | | | | - Yuyi Shen
- 1Bolt Biotherapeutics, Redwood City, CA
| | - Bruce Hug
- 1Bolt Biotherapeutics, Redwood City, CA
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Chumsri S, Shachner TR, Li Z, Norton N, Moreno-Aspitia A, Colon-Otero G, Perez EA, Thompson EA, Nassar A, Knutson KL. Abstract 5627: Functional tertiary lymphoid structure (TLS) and outcome in HER2-positive (HER2+) breast cancer in NCCTG N9831 (Alliance). Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5627] [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: Previous studies showed conflicting results regarding association between stromal tumor infiltrating lymphocytes (sTIL) and outcome in HER2+ breast cancer. While sTIL were not associated with outcome in patients (pts) treated with trastuzumab in N9831, immune functions genes are linked to outcome in these pts. TLS is an organized form of ectopic lymphoid aggregates (LA) with secondary lymphoid organ structure. Several studies showed that TLS associates with improved outcome in multiple cancers. However, distinguishing TLS and simple LA is challenging, particularly when germinal center is absent. In this study, we evaluated integrated pathological quantification and genomic data to assess functional TLS.
Methods: Pathological evaluation of LA in H&E slides from pts treated in Arm A (chemotherapy alone) and Arm C (chemotherapy with concurrent trastuzumab) in N9831 was performed. NanoString was used to quantify mRNA. Wilcoxon rank sum test, Chi squared test, Kaplan-Meier method and Cox regression model were used to evaluate association between LA and baseline characteristics as well as outcomes.
Results: LA was quantified in 1011 pts (526 Arm A, 485 Arm C). Greater number of LA was significantly associated with higher tumor grade, ER/PR negativity and increasing sTIL, but not age, tumor size or lymph node status. Increasing numbers of LA were associated with improved RFS in both arms combined (p 0.028). However, using multivariable Cox regression analysis in each treatment arm, LA (≥ 1 vs 0) was associated with improved RFS only in Arm A (HR 0.6, 95%CI 0.43-0.84, p 0.003) but not Arm C (HR 0.72, 95%CI 0.47-1.1, p 0.134). Further evaluation of expression of TLS-related immune genes including IFNG, ICOSLG, CXCL13, CXCR3, BCL6, IL21R, ICOS, PDCD1, CXCR5, CXCL9, TBX21, CD38, CXCL10, CLXCL11, IL21, CD200 was carried out among 252 pts in Arm C with LA ≥ 1. Among these 16 TLS-related immune genes, as a continuous variable, higher expression of BCL6 (HR 0.61, 95%CI 0.41-0.92, p 0.019) and IL21R (HR 0.78, 95%CI 0.62-0.98, p 0.03) were associated with improved RFS in Arm C pts with LA ≥ 1. However, these genes were not significantly associated with outcome in Arm C pts without LA with BCL6 HR1.07 (95%CI 0.67-1.71, p 0.776) and IL21R HR 0.96 (95%CI 0.71-1.29, p 0.775).
Conclusion: Similar to sTIL, greater number of LA was associated with improved outcome in HER2+ pts treated with chemotherapy alone but not chemotherapy in combination with trastuzumab. Using histogenomic integration with the combination of pathological LA and TLS-related immune genes, we identified that pts with functional TLS with LA ≥ 1 and higher expression of BCL6 or IL21R had significantly improved outcome when treated with trastuzumab. Future studies are needed to further confirm these findings.
Support: U10 CA180821, U24 CA196171, https://acknowledgments.alliancefound.org; Genentech;
Clinicaltrials.gov Id: NCT00005970
Citation Format: Saranya Chumsri, Tracy R. Shachner, Zhuo Li, Nadine Norton, Alvaro Moreno-Aspitia, Gerardo Colon-Otero, Edith A. Perez, E. A. Thompson, Aziza Nassar, Keith L. Knutson. Functional tertiary lymphoid structure (TLS) and outcome in HER2-positive (HER2+) breast cancer in NCCTG N9831 (Alliance) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5627.
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Affiliation(s)
| | | | - Zhuo Li
- 1Mayo Clinic, Jacksonville, FL
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Lipsyc-Sharf M, Ballman KV, Campbell JD, Muss HB, Perez EA, Shulman LN, Carey LA, Partridge AH, Warner ET. Abstract 494: Role of age, BMI, and tumor subtype in racial/ethnic disparities in breast cancer survival: A pooled analysis of four Alliance adjuvant clinical trials. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-494] [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: Previous studies have demonstrated poorer survival of Black women with breast cancer. We assessed whether race/ethnicity was associated with disease-free (DFS) and overall survival (OS) among women with breast cancer enrolled in clinical trials for early-stage breast cancer according to tumor subtype, age, and body mass index (BMI).
Methods: 10,011 women enrolled in one of four adjuvant chemotherapy trials: CALGB 9741, CALGB 49907, CALGB 40101, or NCCTG N9831. 9918 participants had available DFS and/or OS data and were included in the analysis. Cox models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between race/ethnicity and DFS and OS. We compared Non-Hispanic (NH) Black (n=871), Hispanic (n=436), and other race participants (n=283) to NH Whites (n=7889). We assessed associations within strata of age group (<50, 50-<65, or ≥65), tumor subtype (hormone receptor (HR)+/HER2-, HR-/HER2+, or HR-/HER2-), and BMI (<25, 25-<30, or ≥30).
Results: In multivariable-adjusted models, NH Black patients under 50 years of age had worse DFS compared to NH White patients (HR: 1.34, 95% CI: 1.10-1.62) and worse OS (HR: 1.64, 95% CI: 1.30-2.07). The differences in DFS and OS persisted in patients ages 50 to <65, though there were no significant differences in DFS or OS between NH Black and NH White patients ages ≥65. Among Hispanic and NH White participants, younger age at diagnosis was associated with greater DFS compared with older age overall while this was not true for NH Black patients. Among patients with HR+/HER2- tumors, NH Black patients when compared to NH White patients had worse DFS (HR 1.33, 95% CI: 1.04-1.70) but there was not a significant difference in OS (HR 1.35, 95% CI: 1.00-1.83). DFS and OS for other tumor subtypes did not significantly differ by race. Among patients with BMI <25, NH Black patients had significantly worse DFS (HR: 1.70, 95% CI: 1.25-2.30) and OS (HR:1.76, 95% CI:1.20-2.58) compared to NH White patients. There was no difference in survival between different race/ethnicity groups among individuals with BMI ≥25.
Conclusions: Our results identified subgroups that may contribute to the observed disparities in survival between NH Black and NH White women with early-stage breast cancer. The greatest disparities are among individuals <50 years of age, those with HR+/HER2-, and those with BMI <25. These differences exist even within clinical trial populations with similar initial therapy, suggesting that disparities may be influenced by inequities in survivorship care and long-term treatment, such as endocrine therapy adherence and persistence, and/or differences in tumor or host biology.
Support: U10CA180821 and U10CA180882; ClinicalTrials.gov Identifiers: NCT00003088, NCT00005970, NCT00024102, NCT00041119; https://acknowledgments.alliancefound.org
Citation Format: Marla Lipsyc-Sharf, Karla V. Ballman, Jordan D. Campbell, Hyman B. Muss, Edith A. Perez, Lawrence N. Shulman, Lisa A. Carey, Ann H. Partridge, Erica T. Warner. Role of age, BMI, and tumor subtype in racial/ethnic disparities in breast cancer survival: A pooled analysis of four Alliance adjuvant clinical trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 494.
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Affiliation(s)
| | - Karla V. Ballman
- 2Alliance Statistics and Data Center, Weill Cornell Medicine, New York, NY
| | | | - Hyman B. Muss
- 4University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | - Lisa A. Carey
- 4University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Blum LK, Ptacek J, LeBlanc H, Mallet WG, Hug BA, Alonso MN, Perez EA, Dornan D, Kowanetz M. Characterization of tumor antigen expression and myeloid immune profiles to inform the development of immune stimulating antibody conjugates (ISACs). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2557] [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
2557 Background: Immuno-oncology (IO) has historically focused on T cell-driven effects, but a growing class of myeloid therapies are under investigation. This class includes immune-stimulating antibody conjugates (ISACs), which comprise a tumor-targeting antibody conjugated to an immune-stimulating payload. ISACs may require both tumor-associated antigens and tumor-resident myeloid cells for activity. As new IO strategies such as TLR-activating ISACs are developed, understanding the myeloid landscape is relevant for cancer biology and drug development. Methods: Tumor microarrays with formalin-fixed paraffin embedded sections of breast (BC), colorectal (CRC), gastric (GC), head and neck squamous cell (HNSCC), and non-small cell lung (NSCLC) cancers were analyzed by immunohistochemistry for tumor antigens (HER2, CEA, PD-L1), myeloid cell markers (CD68/CD163/CD11c/BDCA2), and CD8+ T cells. Results: Tumor infiltrating myeloid cells and CD8+ T cells varied across indications (Table). Low densities of intra-tumoral CD8+ T cells (<100/mm2) were observed in CRC, with higher CD8+ T cell counts observed in other cohorts. In contrast to T cells, substantial myeloid infiltrates were observed across tumor types. While MSI status was associated with higher CD8+ T cell infiltration in CRC, myeloid cells were abundant in both MSI and MSS samples. Monocyte-derived (mDC) and conventional DCs (cDC), which respond strongly to TLR activation, were present in all indications, with highest numbers observed in NSCLC. HER2+ BC samples had high infiltration of plasmacytoid DCs, a key TLR7-responsive population. PD-L1 expression on immune cells was associated with higher CD8+ T cell and myeloid cell numbers. In contrast to HER2 and PD-L1, CEA expression was independent of immune infiltration. Conclusions: Abundant myeloid infiltrates were observed across solid tumors, independent of T-cell infiltration. The presence of myeloid cells in multiple tumor types offers broadscale therapeutic targets for ISACs and other myeloid-directed therapies that can activate the innate immune system as a bridge to adaptive immunity.[Table: see text]
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Chumsri S, Li Z, Serie DJ, Norton N, Mashadi-Hossein A, Tenner K, Brauer HA, Warren S, Danaher P, Colon-Otero G, Partridge AH, Carey LA, Hilbers F, Van Dooren V, Holmes E, Di Cosimo S, Werner O, Huober JB, Dueck AC, Sotiriou C, Saura C, Moreno-Aspitia A, Knutson KL, Perez EA, Thompson EA. Adaptive immune signature in HER2-positive breast cancer in NCCTG (Alliance) N9831 and NeoALTTO trials. NPJ Breast Cancer 2022; 8:68. [PMID: 35610260 PMCID: PMC9130150 DOI: 10.1038/s41523-022-00430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/19/2022] [Indexed: 12/14/2022] Open
Abstract
Trastuzumab acts in part through the adaptive immune system. Previous studies showed that enrichment of immune-related gene expression was associated with improved outcomes in HER2-positive (HER2+) breast cancer. However, the role of the immune system in response to lapatinib is not fully understood. Gene expression analysis was performed in 1,268 samples from the North Central Cancer Treatment Group (NCCTG) N9831 and 244 samples from the NeoALTTO trial. In N9831, enrichment of CD45 and immune-subset signatures were significantly associated with improved outcomes. We identified a novel 17-gene adaptive immune signature (AIS), which was found to be significantly associated with improved RFS among patients who received adjuvant trastuzumab (HR 0.66, 95% CI 0.49-0.90, Cox regression model p = 0.01) but not in patients who received chemotherapy alone (HR 0.96, 95% CI 0.67-1.40, Cox regression model p = 0.97). This result was validated in NeoALTTO. Overall, AIS-low patients had a significantly lower pathologic complete response (pCR) rate compared with AIS-high patients (χ2 p < 0.0001). Among patients who received trastuzumab alone, pCR was observed in 41.7% of AIS-high patients compared with 9.8% in AIS-low patients (OR of 6.61, 95% CI 2.09-25.59, logistic regression model p = 0.003). More importantly, AIS-low patients had a higher pCR rate with an addition of lapatinib (51.1% vs. 9.8%, OR 9.65, 95% CI 3.24-36.09, logistic regression model p < 0.001). AIS-low patients had poor outcomes, despite receiving adjuvant trastuzumab. However, these patients appear to benefit from an addition of lapatinib. Further studies are needed to validate the significance of this signature to identify patients who are more likely to benefit from dual anti-HER2 therapy. ClinicalTrials.gov Identifiers: NCT00005970 (NCCTG N9831) and NCT00553358 (NeoALTTO).
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Affiliation(s)
- Saranya Chumsri
- Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, USA.
| | - Zhuo Li
- Department of Health and Human Services, Mayo Clinic, Jacksonville, FL, USA
| | - Daniel J Serie
- Department of Health and Human Services, Mayo Clinic, Jacksonville, FL, USA
| | - Nadine Norton
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Kathleen Tenner
- Department of Health and Human Services, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Lisa A Carey
- The University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Eileen Holmes
- The Frontier Science, Perth, UK
- Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Serena Di Cosimo
- Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Jens Bodo Huober
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - Cristina Saura
- Vall d'Hebrón University Hospital, Vall d'Hebron Institute of Oncology (VHIO), SOLTI Breast Cancer Research Group, Barcelona, Spain
| | | | - Keith L Knutson
- Department of Immunology, Mayo Clinic, Jacksonville, FL, USA
| | - Edith A Perez
- Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, USA
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16
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Sideras K, Hillman DW, Giridhar K, Ginos BF, Tenglin RC, Liu H, Chen B, Tan W, Gross GG, Mowat RB, Dueck AC, Perez EA, Moreno-Aspitia A. Randomized Phase II Study of Two Doses of Pixantrone in Patients with Metastatic Breast Cancer (NCCTG N1031, Alliance). Oncologist 2022; 27:oyab065. [PMID: 35445723 PMCID: PMC9074972 DOI: 10.1093/oncolo/oyab065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anthracycline use in metastatic breast cancer (MBC) is hindered by cumulative exposure limits and risk of cardiotoxicity. Pixantrone, a novel aza-anthracenedione with structural similarities to mitoxantrone and anthracyclines, is theorized to exhibit less cardiotoxicity, mainly due to lack of iron binding. We conducted a randomized phase II study to evaluate the efficacy and safety of 2 dosing schedules of pixantrone in patients with refractory HER2-negative MBC. METHODS Intravenous pixantrone was administered at 180 mg/m2 every 3 weeks (group A) versus 85 mg/m2 on days 1, 8, and 15 of a 28-day cycle (group B). Primary endpoint was objective response rate (ORR) and secondary endpoints included progression-free survival (PFS), median 6-month PFS, overall survival (OS), safety, quality of life, and serial assessment of circulating tumor cells. A 20% ORR was targeted as sufficient for further testing of pixantrone in this patient population. RESULTS Forty-five patients were evaluable, with 2 confirmed partial responses in group A and 1 in group B. The trial was terminated due to insufficient activity. Overall median PFS and OS were 2.8 (95% confidence interval [CI]: 2.0-4.1) and 16.8 (95% CI: 8.9-21.6) months, respectively. Notable overall grade 3-4 adverse events were the following: neutrophil count decrease (62%), fatigue (16%), and decrease in ejection fraction (EF) (4%). CONCLUSION Pixantrone has insufficient activity in the second- and third-line MBC setting. It appears, however, to have limited cardiotoxicity. (ClinicalTrials.gov ID: NCT01086605).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rex B Mowat
- Toledo Community Hospital Oncology Program, Toledo, OH, USA
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Kalinsky KM, Barlow WE, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, Lin NU, Perez EA, Goldstein LA, Chia SKL, Dhesy-Thind S, Rastogi P, Alba E, Delaloge S, Martin M, Kelly CM, Ruiz-Borrego M, Gil-Gil M, Arce-Salinas CH, Brain EGC, Lee ES, Pierga JY, Bermejo B, Ramos-Vasquez M, Jung KH, Ferrero JM, Schott A, Shak S, Sharma P, Lew D, Miao J, Tripathy D, Pusztai L, Hortobagyi G. Abstract GS2-07: Updated results from a phase 3 randomized clinical trial in participants (pts) with 1-3 positive lymph nodes (LN), hormone receptor-positive (HR+) and HER2-negative (HER2-) breast cancer (BC) with recurrence score (RS) ≤ 25 randomized to endocrine therapy (ET) +/- chemotherapy (CT): SWOG S1007 (RxPONDER). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs2-07] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: We previouslyreported that invasive disease-free survival (IDFS), the primary outcome, and distantdisease-free survival (DDFS), a secondary outcome, differed by menopausalstatus in a pre-specified analysis. Here,we report updates on IDFS and DDFS with additional follow-up, as well as distantrecurrence-free interval (DRFI) and post hoc analyses in premenopausal women.Methods: Eligibilitycriteria included women > 18 years of age with HR+, HER2-BC and 1-3 +LN and no contraindications to taxane and/or anthracycline basedCT. DRFI was defined as time to distant recurrence or death from breast cancer.Analyses were intent-to-treat among eligible pts. We performed a post hocanalysis evaluating IDFS between treatment arms in premenopausal pts with pN1mi.In addition, we conducted a two-year landmarked IDFS analysis by ovarianfunction suppression (OFS) or not in the ET arm, as well as by regularmenstrual periods or not in both treatment arms.Results: Among the 4,984eligible pts, there were 553 IDFS events and median follow-up of 6.1 years.Postmenopausal women do not have any IDFS or DDFS benefit with CT; however, 5-yearabsolute benefits for IDFS and DDFS with CT for premenopausal pts were 5.9% and3.3%, respectively. In pre-menopausal pts, CT was associated with improved DRFIfor all RS values < 25, with an absolute improvement of 2.3% for RS0-13 and of 2.8% for RS 14-25. Among premenopausal pts, 12.4% (n=206) had pNmi)disease. In a post hoc analysis, there was a trend for CT benefit for thosewith pNmi [hazard ratio (HR)=0.44, confidence interval (CI)=0.18-1.08]. Therewere only 22 IDFS events. Only 17.2% of premenopausal pts assigned to ETunderwent OFS in the first 24 months and in two-year landmarked analysis, therewas no IDFS difference in those who underwent OFS or not (HR=0.88,CI=0.47-1.63). In premenopausal women assigned to ET, 58.9% stopped havingperiods within the first 24 months, and have anumerically improved IDFS compared to those who continued regular periods (HR=1.48,CI: 0.92-2.40). Among premenopausal assigned to CT followed by ET, 80.8%stopped having periods within the first 24 months and have a numericallyimproved IDFS compared to those who continue to have regular periods (HR=1.56, CI:0.85-2.86).Discussion: In accordancewith the differential IDFS and DDFS benefit based upon menopausal status inS1007, premenopausal pts with 1-3+LN and RS < 25 had a statisticallysignificant improvement in DRFI with the addition of CT. A small proportion of S1007premenopausal participants underwent OFS. The role of OFS as it relates to CTbenefit cannot be determined from this study. A future randomized trial should address the clinical question if OFScan replace CT in premenopausal pts with HR+/HER2-, node-positive breast cancer.Funding: Supported by National Cancer Institute grants U10CA180888, U10CA180819,U10CA180820, U10CA180821, U10CA180868, U10CA180863, and in part by Susan G.Komen for the Cure® Research Program, The Hope Foundation for Cancer Research,Breast Cancer Research Foundation, and Genomic Health, Inc.
Citation Format: Kevin M Kalinsky, William E Barlow, Julie R Gralow, Funda Meric-Bernstam, Kathy S Albain, Daniel F Hayes, Nancy U Lin, Edith A Perez, Lori A Goldstein, Stephen KL Chia, Sukhbinder Dhesy-Thind, Priya Rastogi, Emilio Alba, Suzette Delaloge, Miguel Martin, Catherine M Kelly, Manuel Ruiz-Borrego, Miguel Gil-Gil, Claudia H Arce-Salinas, Etienne GC Brain, Eun Sook Lee, Jean-Yves Pierga, Begoña Bermejo, Manuel Ramos-Vasquez, Kyung Hae Jung, Jean-Marc Ferrero, Anne Schott, Steven Shak, Priyanka Sharma, Danika Lew, Jieling Miao, Debasish Tripathy, Lajos Pusztai, Gabriel Hortobagyi. Updated results from a phase 3 randomized clinical trial in participants (pts) with 1-3 positive lymph nodes (LN), hormone receptor-positive (HR+) and HER2-negative (HER2-) breast cancer (BC) with recurrence score (RS) ≤ 25 randomized to endocrine therapy (ET) +/- chemotherapy (CT): SWOG S1007 (RxPONDER) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS2-07.
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Affiliation(s)
| | | | - Julie R Gralow
- University of Washington School of Medicine/Seattle Cancer Care Alliance (SWOG), Seattle, WA
| | | | - Kathy S Albain
- Loyola University Chicago Stritch School of Medicine, Cardinal Bernardin Cancer Center (SWOG), Maywood, IL
| | - Daniel F Hayes
- Breast Oncology Program, Division of Hematology/Oncology, Department of Medicine, University of Michigan (SWOG), Ann Arbor, MI
| | - Nancy U Lin
- Dana Farber Cancer Institute, Medical Oncology (Alliance for Clinical Trials in Oncology), Boston, MA
| | - Edith A Perez
- Mayo Clinic Jacksonville, Hematology/Oncology Division (Alliance for Clinical Trials in Oncology), Jacksonville, FL
| | | | - Stephen KL Chia
- British Columbia Cancer Agency, Medical Oncology (CCTG), Vancouver, BC, Canada
| | | | - Priya Rastogi
- Emory University Winship Cancer Institute (SWOG), University of Pittsburgh (NRG), PA
| | - Emilio Alba
- Hospital Clínico Virgen de la Victoria, UGCI Medical Oncology, IBIMA. GEICAM, Spanish Breast Cancer Group., Málaga, Spain
| | | | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Department of Medical Oncology; Centro de Investigación Biomedica en Red de Oncologia, CIBERONC-ISCIII, sM Spanish Breast Cancer Group (GEICAM), Madrin, Spain
| | - Catherine M Kelly
- Mater Misericordiae University Hospital, Department of Medical Oncology; University College Dublin (Cancer Trials Ireland), Dublin, Ireland
| | - Manuel Ruiz-Borrego
- Hospital Virgen del Rocío. GEICAM, Spanish Breast Cancer Group., Sevilla, Spain
| | - Miguel Gil-Gil
- L'Hospitalet de Llobregat, Medical Oncology. GEICAM, Spanish Breast Cancer Group, Barcelona, Spain
| | | | | | - Eun Sook Lee
- National Cancer Center-Korea (NCC-Korea), Goyang-si Gyeonggi-do, Korea, Republic of
| | | | - Begoña Bermejo
- Hospital Clinico Universitario de Valencia; Biomedical Research Institute INCLIVA; Centro de Investigacion Biomedica en Red de Oncologia, CIBERONC-ISCIII. GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - Manuel Ramos-Vasquez
- Centro Oncológico de Galicia. GEICAM Spanish Breast Cancer Group, A Coruña, Spain
| | - Kyung Hae Jung
- University of Ulsan College of Medicine, Ulsan Medical Center (Korean Cancer Study Group), Seoul, Korea, Republic of
| | - Jean-Marc Ferrero
- Centre Antoine Lacassagne, Medical Oncology (UNICANCER), Nice, France
| | - Anne Schott
- Breast Oncology Program, Division of Hematology/Oncology, Department of Medicine, University of Michigan (SWOG), Ann Arbor, MI
| | - Steven Shak
- Genomic Health/Exact Sciences, Redwood City, CA
| | - Priyanka Sharma
- University of Kansas Medical Center, Internal Medicine (SWOG), Kansas City, KS
| | - Danika Lew
- SWOG Statistics and Data Management Center (SWOG), Seattle, WA
| | - Jieling Miao
- SWOG Statistics and Data Management Center (SWOG), Seattle, WA
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18
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Ganz PA, Bandos H, Geyer CE, Robidoux A, Paterson AH, Polikoff J, Baez-Diaz L, Brufsky AM, Fehrenbacher L, Parsons AW, Ward PJ, Provencher L, Hamm JT, Stella PJ, Carolla RL, Margolese RG, Shibata HR, Perez EA, Wolmark N. Behavioral and health outcomes from the NRG Oncology/NSABP B-36 trial comparing two different adjuvant therapy regimens for early-stage node-negative breast cancer. Breast Cancer Res Treat 2022; 192:153-161. [PMID: 35112166 PMCID: PMC8979645 DOI: 10.1007/s10549-021-06475-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/02/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The NSABP B-36 compared four cycles of doxorubicin and cyclophosphamide (AC) with six cycles of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC-100) in node-negative early-stage breast cancer. A sub-study within B-36, focusing on symptoms, quality of life (QOL), menstrual history (MH), and cardiac function (CF) was conducted. PATIENTS AND METHODS Patients completed the QOL questionnaire at baseline, during treatment, and every 6 months through 36 months. FACT-B Trial Outcome Index (TOI), symptom severity, and SF-36 Vitality and Physical Functioning (PF) scales scores were compared between the two groups using a mixed model for repeated measures analysis. MH was collected at baseline and subsequently assessed if menstrual bleeding occurred within 12 months prior to randomization. Post-chemotherapy amenorrhea outcome was examined at 18 months and was defined as lack of menses in the preceding year. Logistic regression was used to test for association of amenorrhea and treatment. CF assessment was done at baseline and 12 months. Correlation analysis was used to address associations between changes in baseline and 12-month PF and concurrent CF changes measured by LVEF. RESULTS FEC-100 patients had statistically significantly lower TOI scores during chemotherapy (P = 0.02) and at 6 months (P < 0.001); lower Vitality score at 6 months (P < 0.01), and lower PF score during the first year than AC patients. There were no statistically significant QOL score differences between the two groups beyond 12 months. No significant differences in symptom severity between the two groups were observed. Rates of amenorrhea were significantly different between FEC-100 and AC (67.4% vs. 59.1%, P < 0.001). There was no association between changes in LVEF and PF (P = 0.38). CONCLUSIONS Statistically significant QOL differences between the two groups favored AC; however, the magnitude was small and unlikely to be clinically meaningful. There was a clinical and statistically significant difference in risk for amenorrhea, favoring AC. TRIAL REGISTRY NCT00087178; Date of registration: 07/08/2004.
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Affiliation(s)
- Patricia A. Ganz
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California at Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Hanna Bandos
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Charles E. Geyer
- NSABP/NRG Oncology, Pittsburgh, PA,Division of Hematology and Medical Oncology, Houston Methodist Cancer Center, Houston, TX
| | - André Robidoux
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Surgery, Breast Cancer Research Group (GRCS), Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, PQ, Canada
| | - Alexander H.G. Paterson
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - Jonathan Polikoff
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Research and Evaluation – Clinical Trials – Oncology, Kaiser Permanente - San Diego Mission, CA
| | - Luis Baez-Diaz
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Cancer Medicine, Puerto Rico NCORP/UPR Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Adam M. Brufsky
- NSABP/NRG Oncology, Pittsburgh, PA,UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Louis Fehrenbacher
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Oncology, Kaiser Permanente, Northern CA Region, Vallejo, CA
| | - Ann W Parsons
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Presbyterian Oncology, MBCCOP, University of New Mexico, Albuquerque, NM
| | - Patrick J. Ward
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Medical Oncology, Oncology/Hematology Care Clinical Trials, Cincinnati, OH
| | - Louise Provencher
- NSABP/NRG Oncology, Pittsburgh, PA,Centre des Maladies du Sein Deschenes-Fabia, CHU de Québec/Université Laval, Québec City, PQ, Canada
| | - John T. Hamm
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Medical Oncology, Norton Cancer Institute, a part of Norton Healthcare, Louisville, KY
| | - Philip J. Stella
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Medical Oncology, St Joseph Mercy Hospital, Ann Arbor, MI
| | - Robert L. Carolla
- NSABP/NRG Oncology, Pittsburgh, PA,CCOP, Ozark Health Ventures LLC-Cancer Research for the Ozarks, Springfield, MO
| | - Richard G. Margolese
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Oncology, Jewish General Hospital, Montreal, PQ, Canada
| | - Henry R. Shibata
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Surgery, McGill University Health Centre, Montreal, PQ, Canada
| | - Edith A. Perez
- NSABP/NRG Oncology, Pittsburgh, PA,Department of Hematology/Oncology and Cancer Biology, Mayo Clinic Jacksonville, Jacksonville, FL,NCCTG/ALLIANCE, Rochester, MN
| | - Norman Wolmark
- NSABP/NRG Oncology, Pittsburgh, PA,UPMC Hillman Cancer Center, Pittsburgh, PA
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19
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Kalinsky K, Barlow WE, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, Lin NU, Perez EA, Goldstein LJ, Chia SKL, Dhesy-Thind S, Rastogi P, Alba E, Delaloge S, Martin M, Kelly CM, Ruiz-Borrego M, Gil-Gil M, Arce-Salinas CH, Brain EGC, Lee ES, Pierga JY, Bermejo B, Ramos-Vazquez M, Jung KH, Ferrero JM, Schott AF, Shak S, Sharma P, Lew DL, Miao J, Tripathy D, Pusztai L, Hortobagyi GN. 21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer. N Engl J Med 2021; 385:2336-2347. [PMID: 34914339 PMCID: PMC9096864 DOI: 10.1056/nejmoa2108873] [Citation(s) in RCA: 313] [Impact Index Per Article: 104.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The recurrence score based on the 21-gene breast-cancer assay has been clinically useful in predicting a chemotherapy benefit in hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, axillary lymph-node-negative breast cancer. In women with positive lymph-node disease, the role of the recurrence score with respect to predicting a benefit of adjuvant chemotherapy is unclear. METHODS In a prospective trial, we randomly assigned women with hormone-receptor-positive, HER2-negative breast cancer, one to three positive axillary lymph nodes, and a recurrence score of 25 or lower (scores range from 0 to 100, with higher scores indicating a worse prognosis) to endocrine therapy only or to chemotherapy plus endocrine (chemoendocrine) therapy. The primary objective was to determine the effect of chemotherapy on invasive disease-free survival and whether the effect was influenced by the recurrence score. Secondary end points included distant relapse-free survival. RESULTS A total of 5083 women (33.2% premenopausal and 66.8% postmenopausal) underwent randomization, and 5018 participated in the trial. At the prespecified third interim analysis, the chemotherapy benefit with respect to increasing invasive disease-free survival differed according to menopausal status (P = 0.008 for the comparison of chemotherapy benefit in premenopausal and postmenopausal participants), and separate prespecified analyses were conducted. Among postmenopausal women, invasive disease-free survival at 5 years was 91.9% in the endocrine-only group and 91.3% in the chemoendocrine group, with no chemotherapy benefit (hazard ratio for invasive disease recurrence, new primary cancer [breast cancer or another type], or death, 1.02; 95% confidence interval [CI], 0.82 to 1.26; P = 0.89). Among premenopausal women, invasive disease-free survival at 5 years was 89.0% with endocrine-only therapy and 93.9% with chemoendocrine therapy (hazard ratio, 0.60; 95% CI, 0.43 to 0.83; P = 0.002), with a similar increase in distant relapse-free survival (hazard ratio, 0.58; 95% CI, 0.39 to 0.87; P = 0.009). The relative chemotherapy benefit did not increase as the recurrence score increased. CONCLUSIONS Among premenopausal women with one to three positive lymph nodes and a recurrence score of 25 or lower, those who received chemoendocrine therapy had longer invasive disease-free survival and distant relapse-free survival than those who received endocrine-only therapy, whereas postmenopausal women with similar characteristics did not benefit from adjuvant chemotherapy. (Funded by the National Cancer Institute and others; RxPONDER ClinicalTrials.gov number, NCT01272037.).
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Affiliation(s)
- Kevin Kalinsky
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - William E Barlow
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Julie R Gralow
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Funda Meric-Bernstam
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Kathy S Albain
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Daniel F Hayes
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Nancy U Lin
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Edith A Perez
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Lori J Goldstein
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Stephen K L Chia
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Sukhbinder Dhesy-Thind
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Priya Rastogi
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Emilio Alba
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Suzette Delaloge
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Miguel Martin
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Catherine M Kelly
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Manuel Ruiz-Borrego
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Miguel Gil-Gil
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Claudia H Arce-Salinas
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Etienne G C Brain
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Eun-Sook Lee
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Jean-Yves Pierga
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Begoña Bermejo
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Manuel Ramos-Vazquez
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Kyung-Hae Jung
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Jean-Marc Ferrero
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Anne F Schott
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Steven Shak
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Priyanka Sharma
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Danika L Lew
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Jieling Miao
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Debasish Tripathy
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Lajos Pusztai
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Gabriel N Hortobagyi
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
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Yang J, Do-Umehara HC, Zhang Q, Wang H, Hou C, Dong H, Perez EA, Sala MA, Anekalla KR, Walter JM, Liu S, Wunderink RG, Budinger GRS, Liu J. miR-221-5p-Mediated Downregulation of JNK2 Aggravates Acute Lung Injury. Front Immunol 2021; 12:700933. [PMID: 34899681 PMCID: PMC8656235 DOI: 10.3389/fimmu.2021.700933] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022] Open
Abstract
Sepsis and acute lung injury (ALI) are linked to mitochondrial dysfunction; however, the underlying mechanism remains elusive. We previously reported that c-Jun N-terminal protein kinase 2 (JNK2) promotes stress-induced mitophagy by targeting small mitochondrial alternative reading frame (smARF) for ubiquitin-mediated proteasomal degradation, thereby preventing mitochondrial dysfunction and restraining inflammasome activation. Here we report that loss of JNK2 exacerbates lung inflammation and injury during sepsis and ALI in mice. JNK2 is downregulated in mice with endotoxic shock or ALI, concomitantly correlated inversely with disease severity. Small RNA sequencing revealed that miR-221-5p, which contains seed sequence matching to JNK2 mRNA 3’ untranslated region (3’UTR), is upregulated in response to lipopolysaccharide, with dynamically inverse correlation with JNK2 mRNA levels. miR-221-5p targets the 3’UTR of JNK2 mRNA leading to its downregulation. Accordingly, miR-221-5p exacerbates lung inflammation and injury during sepsis in mice by targeting JNK2. Importantly, in patients with pneumonia in medical intensive care unit, JNK2 mRNA levels in alveolar macrophages flow sorted from non-bronchoscopic broncholaveolar lavage (BAL) fluid were inversely correlated strongly and significantly with the percentage of neutrophils, neutrophil and white blood cell counts in BAL fluid. Our data suggest that miR-221-5p targets JNK2 and thereby aggravates lung inflammation and injury during sepsis.
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Affiliation(s)
- Jing Yang
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Hanh Chi Do-Umehara
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Qiao Zhang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Huashan Wang
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Changchun Hou
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Huali Dong
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Edith A Perez
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Marc A Sala
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kishore R Anekalla
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - James M Walter
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Shuwen Liu
- Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou, China
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Simpson Querrey Institute for Epigenetics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - G R Scott Budinger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jing Liu
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
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21
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El Bairi K, Haynes HR, Blackley E, Fineberg S, Shear J, Turner S, de Freitas JR, Sur D, Amendola LC, Gharib M, Kallala A, Arun I, Azmoudeh-Ardalan F, Fujimoto L, Sua LF, Liu SW, Lien HC, Kirtani P, Balancin M, El Attar H, Guleria P, Yang W, Shash E, Chen IC, Bautista V, Do Prado Moura JF, Rapoport BL, Castaneda C, Spengler E, Acosta-Haab G, Frahm I, Sanchez J, Castillo M, Bouchmaa N, Md Zin RR, Shui R, Onyuma T, Yang W, Husain Z, Willard-Gallo K, Coosemans A, Perez EA, Provenzano E, Ericsson PG, Richardet E, Mehrotra R, Sarancone S, Ehinger A, Rimm DL, Bartlett JMS, Viale G, Denkert C, Hida AI, Sotiriou C, Loibl S, Hewitt SM, Badve S, Symmans WF, Kim RS, Pruneri G, Goel S, Francis PA, Inurrigarro G, Yamaguchi R, Garcia-Rivello H, Horlings H, Afqir S, Salgado R, Adams S, Kok M, Dieci MV, Michiels S, Demaria S, Loi S. The tale of TILs in breast cancer: A report from The International Immuno-Oncology Biomarker Working Group. NPJ Breast Cancer 2021; 7:150. [PMID: 34853355 PMCID: PMC8636568 DOI: 10.1038/s41523-021-00346-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/28/2021] [Indexed: 02/08/2023] Open
Abstract
The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved survival in several cancer settings. A subgroup of women with breast cancer (BC) has immunogenic infiltration of lymphocytes with expression of programmed death-ligand 1 (PD-L1). These patients may potentially benefit from ICI targeting the programmed death 1 (PD-1)/PD-L1 signaling axis. The use of tumor-infiltrating lymphocytes (TILs) as predictive and prognostic biomarkers has been under intense examination. Emerging data suggest that TILs are associated with response to both cytotoxic treatments and immunotherapy, particularly for patients with triple-negative BC. In this review from The International Immuno-Oncology Biomarker Working Group, we discuss (a) the biological understanding of TILs, (b) their analytical and clinical validity and efforts toward the clinical utility in BC, and (c) the current status of PD-L1 and TIL testing across different continents, including experiences from low-to-middle-income countries, incorporating also the view of a patient advocate. This information will help set the stage for future approaches to optimize the understanding and clinical utilization of TIL analysis in patients with BC.
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Affiliation(s)
- Khalid El Bairi
- Department of Medical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.
| | - Harry R Haynes
- Department of Cellular Pathology, Great Western Hospital, Swindon, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Elizabeth Blackley
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Susan Fineberg
- Department of Pathology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey Shear
- Chief Information Officer, WISS & Company, LLP and President J. Shear Consulting, LLC-Ardsley, Ardsley, NY, USA
| | | | - Juliana Ribeiro de Freitas
- Department of Pathology and Legal Medicine, Medical School of the Federal University of Bahia, Salvador, Brazil
| | - Daniel Sur
- Department of Medical Oncology, University of Medicine "I. Hatieganu", Cluj Napoca, Romania
| | | | - Masoumeh Gharib
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Indu Arun
- Department of Histopathology, Tata Medical Center, Kolkata, India
| | - Farid Azmoudeh-Ardalan
- Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Luciana Fujimoto
- Pathology and Legal Medicine, Amazon Federal University, Belém, Brazil
| | - Luz F Sua
- Department of Pathology and Laboratory Medicine, Fundacion Valle del Lili, and Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | - Huang-Chun Lien
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Pawan Kirtani
- Department of Histopathology, Manipal Hospitals Dwarka, New Delhi, India
| | - Marcelo Balancin
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Prerna Guleria
- Army Hospital Research and Referral, Delhi Cantt, New Delhi, India
| | | | - Emad Shash
- Breast Cancer Comprehensive Center, National Cancer Institute, Cairo University, Cairo, Egypt
| | - I-Chun Chen
- Department of Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Veronica Bautista
- Department of Pathology, Breast Cancer Center FUCAM, Mexico City, Mexico
| | | | - Bernardo L Rapoport
- The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, corner Doctor Savage Road and Bophelo Road, Pretoria, 0002, South Africa
| | - Carlos Castaneda
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
- Faculty of Health Sciences, Universidad Cientifica del Sur, Lima, Peru
| | - Eunice Spengler
- Departmento de Patologia, Hospital Universitario Austral, Pilar, Argentina
| | - Gabriela Acosta-Haab
- Department of Pathology, Hospital de Oncología Maria Curie, Buenos Aires, Argentina
| | - Isabel Frahm
- Department of Pathology, Sanatorio Mater Dei, Buenos Aires, Argentina
| | - Joselyn Sanchez
- Department of Research, Instituto Nacional de Enfermedades Neoplasicas, Lima, 15038, Peru
| | - Miluska Castillo
- Department of Research, Instituto Nacional de Enfermedades Neoplasicas, Lima, 15038, Peru
| | - Najat Bouchmaa
- Institute of Biological Sciences, Mohammed VI Polytechnic University (UM6P), 43 150, Ben-Guerir, Morocco
| | - Reena R Md Zin
- Department of Pathology, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Ruohong Shui
- Department of Pathology, Fudan University Cancer Center, Shanghai, China
| | | | - Wentao Yang
- Department of Pathology, Fudan University Cancer Center, Shanghai, China
| | | | - Karen Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - An Coosemans
- Laboratory of Tumour Immunology and Immunotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Edith A Perez
- Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Elena Provenzano
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paula Gonzalez Ericsson
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eduardo Richardet
- Clinical Oncology Unit, Instituto Oncológico Córdoba, Córdoba, Argentina
| | - Ravi Mehrotra
- India Cancer Research Consortium-ICMR, Department of Health Research, New Delhi, India
| | - Sandra Sarancone
- Department of Pathology, Laboratorio QUANTUM, Rosario, Argentina
| | - Anna Ehinger
- Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund University, Lund, Sweden
| | - David L Rimm
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - John M S Bartlett
- Diagnostic Development, Ontario Institute for Cancer Research, Toronto, Canada
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Giuseppe Viale
- Department of Pathology, Istituto Europeo di Oncologia IRCCS, and University of Milan, Milan, Italy
| | - Carsten Denkert
- Institute of Pathology, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg and Philipps-Universität Marburg, Marburg, Germany
| | - Akira I Hida
- Department of Pathology, Matsuyama Shimin Hospital, Matsuyama, Japan
| | - Christos Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Stephen M Hewitt
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - William Fraser Symmans
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Rim S Kim
- National Surgical Adjuvant Breast and Bowel Project (NSABP)/NRG Oncology, Pittsburgh, PA, USA
| | - Giancarlo Pruneri
- Department of Pathology, RCCS Fondazione Istituto Nazionale Tumori and University of Milan, School of Medicine, Milan, Italy
| | - Shom Goel
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Prudence A Francis
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Medical Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Rin Yamaguchi
- Department of Pathology and Laboratory Medicine, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Hernan Garcia-Rivello
- Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Hugo Horlings
- Division of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Said Afqir
- Department of Medical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
| | - Roberto Salgado
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - Sylvia Adams
- Perlmutter Cancer Center, New York University Medical School, New York, NY, USA
| | - Marleen Kok
- Divisions of Medical Oncology, Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
| | - Sandra Demaria
- Department of Radiation Oncology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sherene Loi
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
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22
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Perez EA, Jaffee EM, Whyte J, Boyce CA, Carpten JD, Lozano G, Williams RM, Winkfield KM, Bernstein D, Poblete S. Analysis of Population Differences in Digital Conversations About Cancer Clinical Trials: Advanced Data Mining and Extraction Study. JMIR Cancer 2021; 7:e25621. [PMID: 34554099 PMCID: PMC8498899 DOI: 10.2196/25621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/27/2022] Open
Abstract
Background Racial and ethnic diversity in clinical trials for cancer treatment is essential for the development of treatments that are effective for all patients and for identifying potential differences in toxicity between different demographics. Mining of social media discussions about clinical trials has been used previously to identify patient barriers to enrollment in clinical trials; however, a comprehensive breakdown of sentiments and barriers by various racial and ethnic groups is lacking. Objective The aim of this study is to use an innovative methodology to analyze web-based conversations about cancer clinical trials and to identify and compare conversation topics, barriers, and sentiments between different racial and ethnic populations. Methods We analyzed 372,283 web-based conversations about cancer clinical trials, of which 179,339 (48.17%) of the discussions had identifiable race information about the individual posting the conversations. Using sophisticated machine learning software and analyses, we were able to identify key sentiments and feelings, topics of interest, and barriers to clinical trials across racial groups. The stage of treatment could also be identified in many of the discussions, allowing for a unique insight into how the sentiments and challenges of patients change throughout the treatment process for each racial group. Results We observed that only 4.01% (372,283/9,284,284) of cancer-related discussions referenced clinical trials. Within these discussions, topics of interest and identified clinical trial barriers discussed by all racial and ethnic groups throughout the treatment process included health care professional interactions, cost of care, fear, anxiety and lack of awareness, risks, treatment experiences, and the clinical trial enrollment process. Health care professional interactions, cost of care, and enrollment processes were notably discussed more frequently in minority populations. Other minor variations in the frequency of discussion topics between ethnic and racial groups throughout the treatment process were identified. Conclusions This study demonstrates the power of digital search technology in health care research. The results are also valuable for identifying the ideal content and timing for the delivery of clinical trial information and resources for different racial and ethnic groups.
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Affiliation(s)
- Edith A Perez
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Elizabeth M Jaffee
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States
| | | | - Cheryl A Boyce
- Ohio Commission on Minority Health, Columbus, OH, United States
| | - John D Carpten
- Institute of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Guillermina Lozano
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Sung Poblete
- Stand Up To Cancer, Los Angeles, CA, United States
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23
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Yang J, Perez EA, Hou C, Zhang P, Van Scoyk M, Winn RA, Rong L, Liu J. Identification of the SARS-CoV-2 Entry Receptor ACE2 as a Direct Target for Transcriptional Repression by Miz1. Front Immunol 2021; 12:648815. [PMID: 34305888 PMCID: PMC8292894 DOI: 10.3389/fimmu.2021.648815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/18/2021] [Indexed: 01/16/2023] Open
Abstract
Multiple lines of evidence have demonstrated that cigarette smoke or Chronic Obstructive Pulmonary Disease upregulates angiotensin-converting enzyme 2, the cellular receptor for the entry of the severe acute respiratory syndrome coronavirus 2, which predisposes individuals to develop severe Coronavirus disease 2019. The reason for this observation is unknown. We recently reported that the loss of function of Miz1 in the lung epithelium in mice leads to a spontaneous COPD-like phenotype, associated with upregulation of angiotensin-converting enzyme 2. We also reported that cigarette smoke exposure downregulates Miz1 in lung epithelial cells and in mice, and Miz1 is also downregulated in the lungs of COPD patients. Here, we provide further evidence that Miz1 directly binds to and represses the promoter of angiotensin-converting enzyme 2 in mouse and human lung epithelial cells. Our data provide a potential molecular mechanism for the upregulation of angiotensin-converting enzyme 2 observed in smokers and COPD patients, with implication in severe Coronavirus disease 2019.
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Affiliation(s)
- Jing Yang
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Edith A Perez
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Changchun Hou
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Pin Zhang
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Michelle Van Scoyk
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Lijun Rong
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Jing Liu
- Department of Surgery, College of Medicine and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
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24
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Chumsri S, Li Z, Shachner T, Advani P, Sideras K, Moreno-Aspitia A, Colon-Otero G, Knutson KL, Nassar A, Perez EA, Thompson EA. Outcome and immune landscape of HER2-positive invasive lobular carcinoma in the North Central Cancer Treatment Group (NCCTG) N9831 (Alliance) trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
535 Background: Invasive lobular carcinoma (ILC) is a rarer form of breast cancer, accounting for 10% of the disease cases. HER2 overexpression in ILC is infrequent and limited data exist regarding clinical characteristics and outcome of HER2-positive (HER2+) ILC patients (pts) treated with adjuvant trastuzumab. Methods: Patient characteristics were compared between ILC and invasive ductal carcinoma (IDC) using Wilcoxon rank sum test for continuous variables and Chi-square test for categorical variables. Kaplan-Meier (KM) method was used to estimate the freedom from mortality and recurrence. Cox regression model was used to evaluate the association between ILC and outcomes adjusted for other characteristics. NanoString technology was used to quantify mRNA to develop immune-related gene signatures. Results: From a total of 3,304 pts, 122 (3.7%) pts had ILC. Pts with ILC were significantly older (median age 54 vs. 49 years), had larger tumors, lower grade, more ER and PR positive tumors, and more lymph node involvement (25.4% had N3 disease compared to 12.7% in IDC). Overall, with KM analysis, pts with ILC had significantly worse overall survival (OS, p = 0.005) and recurrence-free survival (RFS, p = 0.046) compared to IDC. The 15-year freedom from recurrence was merely 57.67% in ILC compared to 72.68% in IDC. A significant number of hormone receptor-positive (HR+) ILC pts developed late recurrence with cumulative event rates increasing from 23% at 5 years to 42% at 15 years. Nevertheless, in multivariate Cox regression analysis adjusting for other clinical characteristics, including age, tumor size, grade, ER/PR, and lymph node status, lobular histology was not significantly associated with worse outcome for OS (HR = 1.19, 95%CI 0.67-2.1, p = 0.55) and RFS (HR = 1.5, 95%CI 0.9-2.5, p = 0.12), as compared with IDC. However, ILC pts appeared to have similar degree of benefit from trastuzumab, with RFS HR = 0.58 compared to HR = 0.67 in the entire population. For immune landscape, there was no significant difference in gene signatures related to CD45, CD8, B cells, or cytotoxic cells. However, ILC had more enrichment in mast cell gene signature and fewer macrophage, NK CD56dim, and regulatory T cell signatures compared to IDC (p < 0.05). Conclusions: HER2+ ILC has distinct clinical characteristics and immune landscape compared to IDC. ILC pts appeared to have worse outcome compared to IDC likely because ILC pts often presented with more locally advanced disease. However, similar benefit of trastuzumab was observed in ILC pts. Due to high risk of late relapse in HR+ HER2+ ILC, extended adjuvant endocrine therapy should be considered in this group of high-risk pts. Clinical trial information: NCT00005970.
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Affiliation(s)
| | - Zhuo Li
- Mayo Clinic, Jacksonville, FL
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25
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Sharma M, Carvajal RD, Hanna GJ, Li BT, Moore KN, Pegram MD, Rasco DW, Spira AI, Alonso M, Fang L, Husain A, Perez EA, Dumbrava EE. Preliminary results from a phase 1/2 study of BDC-1001, a novel HER2 targeting TLR7/8 immune-stimulating antibody conjugate (ISAC), in patients (pts) with advanced HER2-expressing solid tumors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.2549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2549 Background: BDC-1001 is a novel ISAC consisting of an investigational trastuzumab biosimilar chemically conjugated to a TLR 7/8 agonist with a non-cleavable linker. BDC-1001 was designed to activate the innate immune system, eliciting antibody-mediated effector functions (eg, antibody-dependent cellular phagocytosis) and a durable adaptive immune response. In preclinical tumor models resistant to anti-HER2 treatments, BDC-1001 demonstrated potent and durable immune-mediated antitumor efficacy. Methods: A 4-part, phase 1/2 dose-escalation/expansion study was initiated to evaluate BDC-1001 ± PD1 inhibitor pembrolizumab in pts with HER2-expressing solid tumors who had progressive disease on standard of care (NCT04278144). Preliminary results of the monotherapy dose escalation (Part 1) are reported. Pts with advanced metastatic HER2-expressing (IHC2/3+) or amplified solid tumors received BDC-1001 IV q3w in a 3+3 design w/ 12 pts/cohort backfill allowed. Primary objectives were to evaluate safety, tolerability, dose-limiting toxicities (DLTs) and determine a phase 2 dose; secondary objectives were to assess pharmacokinetics (PK), pharmacodynamics and preliminary anti-tumor activity. Results: As of Jan 29, 2021, 20 pts w/ a median age of 65 (46-85) have enrolled in 4 dose levels (0.15mg/kg to 5 mg/kg). Cancer types include breast, biliary, cervical, colorectal (CRC), lung, gastroesophageal, salivary, urinary tract and endometrial. Pts had received a median of 4 (1-7) prior therapies; 65% received >1 prior anti-HER2 therapy. All pts completed the 21-day DLT period; no DLTs or drug-related serious adverse events (AEs) have been observed. AEs deemed related to BDC-1001 have been mild to moderate including infusion-related reactions. The MTD has not been reached (treatment duration 5-17+wk); enrollment is ongoing. PK evaluations showed Cmax levels consistent with predicted modeling based on non-human primates (NHP). One pt with microsatellite stable (MSS) HER2+ CRC with lung metastases had a confirmed partial response after 4 cycles and remains on study; 2 additional pts with metastatic MSS HER2+ CRC had stable disease (SD) and a pt with heavily pretreated MSS endometrial cancer with lung metastases had confirmed SD and remains on treatment 17+ wk; 3 of these pts had received 2 prior anti-HER2 therapies. Conclusions: In this first-in-human study, BDC-1001 appears to be well-tolerated up to the dose tested to date (5 mg/kg), with Cmax levels achieved as predicted by NHP modeling. Evidence of clinical activity have been observed, including in pts previously treated with anti-HER2 therapy. Dose escalation is ongoing and will be followed by combination dosing with CPI and the phase 2 component in selected tumors. Clinical trial information: NCT04278144.
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Affiliation(s)
| | | | | | - Bob T. Li
- Memorial Sloan Kettering Cancer Center, New York, NY
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26
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Jackisch C, Cortazar P, Geyer CE, Gianni L, Gligorov J, Machackova Z, Perez EA, Schneeweiss A, Tolaney SM, Untch M, Wardley A, Piccart M. Risk-based decision-making in the treatment of HER2-positive early breast cancer: Recommendations based on the current state of knowledge. Cancer Treat Rev 2021; 99:102229. [PMID: 34139476 DOI: 10.1016/j.ctrv.2021.102229] [Citation(s) in RCA: 6] [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: 03/11/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 01/05/2023]
Abstract
Treatment of HER2-positive early breast cancer (EBC) continues to evolve with neoadjuvant (pre-operative) and adjuvant (post-operative) HER2-targeted therapies as standard of care. There are two important decision points. The first involves deciding between neoadjuvant therapy or proceeding directly to surgery. Neoadjuvant chemotherapy (NACT) plus pertuzumab-trastuzumab is appropriate for patients with high-risk HER2-positive EBC (tumour diameter ≥2 cm, and/or node-positive disease). Patients with node-negative disease and tumour diameter <2 cm are candidates for upfront surgery followed by paclitaxel for 12 weeks plus 18 cycles of trastuzumab, with the option to add pertuzumab (if pN+). The second decision point involves the pathohistological result at surgery after neoadjuvant therapy. Total pathological complete response (tpCR: ypT0/is, ypN0) is associated with improved survival endpoints. Patients with tumours ≥2 cm and/or node-positive disease at diagnosis who have a tpCR after dual blockade should continue pertuzumab-trastuzumab in the adjuvant setting to complete 1 year (18cycles) of treatment. For patients with invasive residual disease, 14cycles of post-neoadjuvant trastuzumab emtansine (T-DM1) therapy significantly increases invasive-DFS compared with trastuzumab. Extended adjuvant therapy with neratinib is an option in selected patients (HER2-positive and oestrogen receptor [ER]-positive) who have completed adjuvant trastuzumab-based therapy. Less aggressive chemotherapy regimens are recommended in populations with a lower risk of recurrence (patients with small tumours without axillary involvement; patients unlikely to tolerate anthracycline-taxane or taxane-carboplatin regimens). Ultimately, treatment recommendations should be consistent with local and international guidelines. Further studies will guide optimisation of treatment for patients with HER2-positive EBC according to the risk of disease recurrence.
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Affiliation(s)
| | | | - Charles E Geyer
- NSABP Foundation and Houston Methodist Cancer Center, Houston, TX, USA
| | | | - Joseph Gligorov
- Institut Universitaire de Cancérologie, APHP-Sorbonne Université, Hôpital Tenon, Paris, France
| | | | - Edith A Perez
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Sara M Tolaney
- Dana-Farber Cancer Institute, and Department of Hematology-Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Untch
- AGO-B and HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Andrew Wardley
- Outreach Research & Innovation Group and Manchester Breast Centre, Division of Cancer Sciences and University of Manchester, Manchester, UK; AstraZeneca PLC, UK
| | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Dumbrava EI, Sharma MR, Carvajal RD, Catenacci D, Emens LA, Gadgeel SM, Hanna GJ, Juric D, Kang YK, Lee J, Lee KW, Li BT, Moore K, Pegram MD, Pohlmann PR, Rasco D, Spira A, Tan AR, Ackerman SE, LeBlanc H, Dornan D, Kowanetz M, Alonso MN, Perez EA. Abstract OT-03-02: Phase 1/2 study of a novel HER2 targeting TLR7/8 immune-stimulating antibody conjugate (ISAC), BDC-1001, as a single agent and in combination with an immune checkpoint inhibitor in patients with advanced HER2-expressing solid tumors. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ot-03-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: To date, no immune-based therapies beyond anti-HER2 monoclonal antibodies are approved for treating patients (pts) with HER2-driven or -expressing cancers. However, pts still develop progressive disease, and new treatment options that could achieve durable antitumor efficacy are needed. Recent studies indicate that intratumoral delivery of immunostimulatory adjuvants such as toll-like receptor (TLR) 7/8 agonists can activate tumor resident antigen-presenting cells (APCs), driving uptake, processing, and presentation of tumor neoantigens to T cells that mediate antitumor immunity. To overcome limitations associated with intratumoral delivery while leveraging superior preclinical biology, BDC-1001, a novel, systemically delivered ISAC was developed. BDC-1001 consists of an investigational biosimilar of the humanized monoclonal antibody trastuzumab that is chemically conjugated to a TLR 7/8 agonist (payload) with an intervening non-cleavable linker. BDC-1001 activates human myeloid APCs while retaining antibody-mediated effector functions such as antibody-dependent cellular cytotoxicity/phagocytosis (ADCC/ADCP). Xenograft and syngeneic tumor resistant models indicate that trastuzumab ISACs elicit potent and durable immune-mediated antitumor efficacy including complete tumor regression in a TLR- and Fc receptor-dependent manner (Ackerman et al. Cancer Res. 2019:79 [13 Suppl]; Ackerman et al. J Immunother Cancer. 2019;7:283). Importantly, BDC-1001 did not induce interstitial lung disease, cytokine release syndrome, or thrombocytopenia in non-human primate studies. A four-part phase 1/2, first-in-human study has been initiated that evaluates BDC-1001 with or without (+/-) an immune checkpoint inhibitor targeting PD-1 in pts with HER2-expressing or HER2-amplified advanced/metastatic solid tumors.
Study Description: This phase 1/2 dose-escalation and dose-expansion study is enrolling up to 390 pts with advanced solid tumors that are HER2-expressing (IHC2+ or 3+ protein irrespective of gene amplification) or HER2-amplified (by in situ hybridization or next-generation sequencing) and ineligible for approved anti-HER2 treatments. The primary objectives of the dose-escalation phase are to define safety and tolerability and to determine the recommended phase 2 dose of BDC-1001 as monotherapy (Part 1) and in combination with an immune checkpoint inhibitor (Part 2). Primary endpoints of Parts 1 and 2 include incidence of 1) adverse events and severe adverse events graded according to NCI CTCAE v5.0; 2) dose-limiting toxicities within a 3+3 design; and 3) potential immune-related toxicities. BDC-1001 is administered IV over 60 min q3w at increasing doses. Once safety data are available for BDC-1001, initiation of the immune checkpoint inhibitor combination is planned. The dose-expansion phase 2 portion of the trial will evaluate preliminary antitumor activity of BDC-1001 alone (Part 3) and in combination with an immune checkpoint inhibitor (Part 4) using RECIST v1.1 and iRECIST. The primary endpoint of this dose-expansion phase is overall response rate, with secondary endpoints of duration of response, disease control rate, and progression-free survival. Exploratory objectives will evaluate pharmacokinetic parameters and pharmacodynamic biomarkers associated with drug exposure. These exploratory studies will help elucidate the mechanism of action and seek to identify biomarkers to improve selection of pts most likely to benefit from treatment with BDC-1001 +/- immune checkpoint inhibitor. This global study is currently recruiting pts. For further information, visit ClinicalTrials.gov (NCT04278144).
Citation Format: Ecaterina Ileana Dumbrava, Manish R. Sharma, Richard D. Carvajal, Daniel Catenacci, Leisha A. Emens, Shirish M. Gadgeel, Glenn J. Hanna, Dejan Juric, Yoon-Koo Kang, Jeeyun Lee, Keun-Wook Lee, Bob T. Li, Kathleen Moore, Mark D. Pegram, Paula R. Pohlmann, Drew Rasco, Alexander Spira, Antoinette R. Tan, Shelley E. Ackerman, Heidi LeBlanc, David Dornan, Marcin Kowanetz, Michael N. Alonso, Edith A. Perez. Phase 1/2 study of a novel HER2 targeting TLR7/8 immune-stimulating antibody conjugate (ISAC), BDC-1001, as a single agent and in combination with an immune checkpoint inhibitor in patients with advanced HER2-expressing solid tumors [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-03-02.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jeeyun Lee
- 10Samsung Medical Center, Seoul, Korea, Republic of
| | - Keun-Wook Lee
- 11Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea, Republic of
| | - Bob T. Li
- 12Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Paula R. Pohlmann
- 15Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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Kalinsky K, Barlow WE, Meric-Bernstam F, Gralow JR, Albain KS, Hayes D, Lin N, Perez EA, Goldstein LJ, Chia S, Dhesy-Thind S, Rastogi P, Alba E, Delaloge S, Martín M, Gil MG, Arce-Salinas C, Brain E, Park IH, Pierga JY, Lluch AH, Vasquez MR, Borrego MR, Jung KH, Ferrero JM, Schott A, Shak S, Sharma P, Lew DL, Miao J, Tripathy D, Hortobagyi G, Pusztai L. Abstract GS3-00: First results from a phase III randomized clinical trial of standard adjuvant endocrine therapy (ET) +/- chemotherapy (CT) in patients (pts) with 1-3 positive nodes, hormone receptor-positive (HR+) and HER2-negative (HER2-) breast cancer (BC) with recurrence score (RS) < 25: SWOG S1007 (RxPonder). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-gs3-00] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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
Funding: Supported by National Cancer Institute grants U10CA180888, U10CA180819, U10CA180820, U10CA180821, U10CA180868, U10CA180863; and in part by Susan G. Komen for the Cure® Research Program, The Hope Foundation for Cancer Research, Breast Cancer Research Foundation, and Genomic Health, Inc. Acknowledgement: The authors wish to thank Dr. Ana M. Gonzalez-Angulo, MD, for her invaluable contributions to the design and implementation of this study. Background: The clinical utility of the RS to determine CT benefit is well established in pts with HR+, HER2-, axillary lymph node (LN)-negative BC. Retrospective analyses from SWOG S8814 support the potential prognostic and predictive role of RS for CT benefit in postmenopausal pts with LN+ BC. SWOG S1007 is a prospective, randomized trial of endocrine therapy (ET) vs. chemoendocrine therapy (CET) in women with 1-3 +LN and a RS < 25 (NCT01272037). Methods: Eligibility criteria included women > 18 years of age with HR+, HER2- BC and 1-3 +LN and no contraindications to taxane and/or anthracycline based CT. Women with a RS < 25 were randomized to receive ET or CET in 1:1 randomization using 3 stratification factors: (1) RS (0-13 vs.14-25); (2) menopausal status; and (3) axillary nodal dissection vs. sentinel node biopsy. The primary objective was to determine the effect of CT on invasive disease-free survival (IDFS) and whether the effect depended on the RS. The primary analysis was to test for a significant interaction of the treatment arm and continuous RS using a Cox regression model for IDFS, adjusting for treatment, RS, and menopausal status. A total of 832 IDFS events were expected for the final analysis. Secondary objectives included overall survival (OS). The protocol specified that interaction between treatment and the stratification variables was to be tested and, if significant, separate analyses performed by stratum. Annual interim analyses were planned starting at 24% of events. At the third interim analysis with 410 IDFS events, the Data and Safety Monitoring Committee recommended reporting results, with a decision by the NCI’s Cancer Therapy Evaluation Program, the study sponsor. Results: Of the 9,383 women screened from 2/28/11-9/29/17, 5,083 pts (54.2%) were randomized. With a median follow-up of 5.1 years, 447 IDFS events have been observed. For the primary analysis, the interaction test for CT benefit and continuous RS was not statistically significant, p=0.30. In a model with CT, RS, and menopausal status (no interaction term), higher continuous RS was associated with worse IDFS [HR 1.06, 2-sided p<0.001, 95% Confidence Interval (CI) 1.04-1.07], and CT was associated with an improvement in IDFS (HR 0.81, p=0.026, 95% CI 0.67-0.98). In a pre-specified analysis, a significant interaction was identified between CT and menopausal status (p=0.004), necessitating separate analyses by menopausal status. In postmenopausal pts (N=3350, 67%), adjusting for continuous RS, the HR for CET vs. ET was not significant (HR=0.97, p=0.82, 95% CI 0.78-1.22; 5-year IDFS 91.6% vs. 91.9%) indicating no benefit from CT. In premenopausal pts (N=1665, 33%), the HR (0.54) was statistically significant (p=0.0004, 95% CI 0.38-0.76; 5-year IDFS 94.2% vs. 89.0%), indicating CT benefit. In premenopausal pts, ovarian suppression was performed in 15.9% vs. 3.7% (ET vs. CET), and 47.9% vs. 26.4% reported menstruation after 6 months of treatment. Although the number of events is limited, the HR for treatment adjusted by RS for OS in premenopausal pts was 0.47 (p=0.032, 95% CI 0.24-0.94). At this time, there is no differential effect with CT in regard to other stratification factors. Conclusions: There is a significant differential treatment effect of CT benefit based on RS for premenopausal vs. postmenopausal women requiring separate analyses. While only 54% of the protocol specified events are recorded and pts will be followed for 15 years, the current data show that adjuvant therapy can be de-escalated to ET alone in postmenopausal pts with a RS < 25 and 1-3 +LN. However, there is a strong IDFS benefit for CET in premenopausal pts, with an early indication of an OS improvement.
Citation Format: Kevin Kalinsky, William E Barlow, Funda Meric-Bernstam, Julie R Gralow, Kathy S Albain, Daniel Hayes, Nancy Lin, Edith A Perez, Lori J Goldstein, Stephen Chia, Subkhbinder Dhesy-Thind, Priya Rastogi, Emilio Alba, Suzette Delaloge, Miguel Martín, Miguel Gil Gil, Claudia Arce-Salinas, Etienne Brain, In Hae Park, Jean-Yves Pierga, Ana Hernandez Lluch, Manuel Ramos Vasquez, Manuel Ruiz Borrego, Kyung Hae Jung, Jean-Marc Ferrero, Anne Schott, Steve Shak, Priyanka Sharma, Danika L Lew, Jieling Miao, Debu Tripathy, Gabriel Hortobagyi, Lajos Pusztai. First results from a phase III randomized clinical trial of standard adjuvant endocrine therapy (ET) +/- chemotherapy (CT) in patients (pts) with 1-3 positive nodes, hormone receptor-positive (HR+) and HER2-negative (HER2-) breast cancer (BC) with recurrence score (RS) < 25: SWOG S1007 (RxPonder) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr GS3-00.
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Affiliation(s)
| | | | | | - Julie R Gralow
- 4University of Washington School of Medicine/Seattle Cancer Care Alliance/SWOG, Seattle, WA
| | | | | | - Nancy Lin
- 7Dana Farber Cancer Institute/Alliance for Clinical Trials in Oncology, Boston, MA
| | - Edith A Perez
- 8Mayo Clinic Jacksonville/Alliance for Clinical Trials in Oncology, Jacksonville, FL
| | | | - Stephen Chia
- 10BCCA-Vancouver Cancer Center/CCTG, Vancouver, BC
| | | | - Priya Rastogi
- 12University of Pittsburgh/NRG Oncology, Pittsburgh, PA
| | - Emilio Alba
- 13UGCI Medical Oncology Hospital Virgen de la Victoria. IBIMA, Malago, Spain
| | | | - Miguel Martín
- 15Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | - Etienne Brain
- 18Institut Curie-Centre Rene Huguenin Saint Cloud, Saint Cloud, France
| | - In Hae Park
- 19National Cancer Center-Korea, Goyang-si, Korea, Republic of
| | | | | | | | | | - Kyung Hae Jung
- 24Universitiy of Ulsan College of Medicine, Seoul, Spain
| | | | | | | | | | - Danika L Lew
- 2SWOG Statistics and Data Management Center, Seattle, WA
| | - Jieling Miao
- 2SWOG Statistics and Data Management Center, Seattle, WA
| | - Debu Tripathy
- 3University of Texas MD Anderson Cancer Center/SWOG, Houston, TX
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Chumsri S, Carter JM, Ma Y, Hinerfeld D, Brauer HA, Warren S, Nielsen TO, Asleh K, Joensuu H, Perez EA, Leon-Ferre RA, Hillman DW, Boughey JC, Liu MC, Ingle JN, Kalari KR, Couch FJ, Knutson KL, Goetz MP, Thompson EA. Abstract PS6-02: Spatially defined immune-related proteins and outcome in triple negative breast cancer in the FinXX trial and Mayo Clinic cohort. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps6-02] [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: Growing data established the pivotal role of preexisting immune response in triple negative breast cancer (TNBC). Conventionally, preexisting immune response can be evaluated by quantifying tumor infiltrating lymphocytes mainly in the stroma or gene expression analysis from the whole tumor section. Due to technical challenges with these conventional methods, limited data regarding specific subtypes and spatial distribution of these immune infiltrates are currently available. Methods: NanoString IO360 gene expression analysis and Digital Spatial Profiling (DSP) were used. DSP was used to quantify 29 immune-related proteins in stromal and tumor-enriched segments from 44 TNBC samples from the FinXX trial (NCT00114816) and 335 samples from the Mayo Clinic (MC) cohort of centrally reviewed TNBC (Leon-Ferre BCRT 2018). In FinXX trial, 22 patients with recurrence and 22 patients without recurrence were included. In MC cohort, 217/335 patients received adjuvant chemotherapy while 118 patients had surgery only without adjuvant chemotherapy. Regions were segmented based on pancytokeratin staining. The general linear model was used for statistical analysis of differential expression with recurrence free survival (RFS) as a categorical variable (recur yes or no). Kaplan-Meier (KM) estimates and Cox regression models were also used for analysis. Results: In the FinXX trial, there were 12 out of 29 proteins in tumor epithelial segments (intraepithelial) which were significantly expressed at higher levels among patients who were free of recurrence. These proteins include Beta-2 microglobulin, CD11c, CD20, CD40, CD56, CD8, Granzyme B, HLA-DR, ICOS, PD-L1, PD-L2, and TGFB1. In contrast, merely 5 out of 29 proteins in stromal segments were significantly differentially expressed in these 2 groups of patients. Granzyme B, IDO1, PD-L1, and PD-L2 in stroma were significantly higher and SMA was significantly lower in patients without recurrence. Using Cox regression models, intraepithelial CD56, CD40, and HLA-DR were significantly associated with outcome. When comparing between highest and lowest intraepithelial protein expression by tertile, intraepithelial CD56 (HR 0.12, 95%CI 0.03-0.39, p < 0.001), CD40 (HR 0.13, 95%CI 0.04-0.46, p = 0.002), and HLA-DR (HR 0.24, 95%CI 0.06-0.89, p = 0.032) were significantly associated with improved outcome. However, expression of these same proteins in stroma was not associated with outcome. Using KM estimates, intraepithelial CD56 (p < 0.0001), CD40 (p = 0.0006), and HLA-DR (p = 0.013) were also significantly associated with improved outcome. Nonetheless, RNA expression of these proteins by IO360 from whole tumor sections were not significantly associated with outcome (CD56 p = 0.27, CD40 p = 0.21, HLA-DR p = 0.48). Similar findings with DSP were observed in MC TNBC cohort. Comparing between the highest and lowest quartiles, there were significantly fewer patients who developed recurrence with high protein expression of intraepithelial CD56 (p < 0.001), CD40 (p = 0.002), and HLA-DR (p = 0.006). Conclusions: Using an in-depth analysis with spatially defined context, we identify that there were numerically more intraepithelial immune-related proteins associated with outcome compared to proteins in stroma. Specifically, intraepithelial CD56, CD40, and HLA-DR were significantly associated with improved outcome in both FinXX and MC TNBC cohorts. However, neither expression of these proteins in stroma nor RNA expression from whole tumor were associated with outcome. Our study highlights the impact of spatial biology and the importance of evaluating each potential biomarker in a spatially defined manner. Support: W81XWH-15-1-0292, BCRF 19-161, P50CA116201-9, P50CA015083
Citation Format: Saranya Chumsri, Jodi M. Carter, Yaohua Ma, Douglas Hinerfeld, Heather Ann Brauer, Sarah Warren, Torsten O. Nielsen, Karama Asleh, Heikki Joensuu, Edith A. Perez, Roberto A. Leon-Ferre, David W. Hillman, Judy C. Boughey, Minetta C. Liu, James N. Ingle, Krishna R. Kalari, Fergus J. Couch, Keith L. Knutson, Matthew P. Goetz, E. A. Thompson. Spatially defined immune-related proteins and outcome in triple negative breast cancer in the FinXX trial and Mayo Clinic cohort [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 PS6-02.
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Affiliation(s)
| | | | | | | | | | | | | | - Karama Asleh
- 4University of British Columbia, Vancouver, BC, Canada
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Khaki AR, Shah DP, Lustberg MB, Accordino MK, Stover DG, Nagaraj G, Rivera DR, Perez EA, Tolaney SM, Peppercorn J, Grivas P, Warner JL, Painter CA, de Lima Lopes G, Peters S, Thompson MA, Choueiri TK, Rini BI, Lyman GH, Kuderer NM, Vinayak S. Abstract PS7-01: Characteristics and outcomes of SARS-CoV-2 infection in patients with invasive breast cancer (BC) from the COVID-19 and cancer consortium (CCC19) cohort study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps7-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Overall, patients with cancer experience a greater risk of adverse outcomes following SARS-CoV-2 infection; however, little is known for those with BC.
Methods: CCC19 (NCT04354701) is an international cohort study aimed at investigating the impact of COVID-19 in patients with a history of or active cancer using de-identified data on patient demographics, cancer history, clinical course and outcomes of COVID-19. The current analysis includes patients from U.S. and Canada with invasive BC and laboratory-confirmed SARS-CoV-2 entered between March 17, 2020 and July 2, 2020. Co-primary outcomes were hospitalization during COVID-19 illness and 30-day all-cause mortality. Frequencies for categorical variables and medians (range) for continuous variables were estimated. Final presentation will include bivariable and multivariable Cox proportional hazards regression analysis to identify risk factors (including BC subtypes and therapies, for which data collection is ongoing) associated with 30-day all-cause mortality and severe COVID-19 illness (composite of any hospitalization requiring supplemental oxygen, admission to an intensive care unit [ICU], use of mechanical ventilation, or death).
Results: During the study period, a total of 2683 patients with cancer and COVID-19 were accrued in the CCC19 registry including 529 (20%) with invasive BC. Among patients with BC, 352 (67%) were 60 years or older; 518 (98%) were women; 275 (52%) non-Hispanic White, 116 (22%) non-Hispanic Black, 70 (13%) Hispanic, 56 (11%) in other categorizations; 178 (34%) had a smoking history; 75 (14%) ECOG performance status ≥2; 191 (36%) with >2 active comorbidities; 64 (12%) with AJCC stage IV disease at BC diagnosis; and 267 (50%) were on anti-cancer treatment including systemic therapy, radiation, or surgery within 3 months of COVID-19 diagnosis. At least 323 (61%) patients with BC had 30-day follow-up after COVID-19 diagnosis, and 35 (7%) had 90-day follow-up. COVID-19 illness at initial diagnosis required outpatient care in 288 (54%), inpatient care in 193 (36%), and ICU care in 40 (8%). Overall, 247 (47%) were hospitalized and 30-day all-cause mortality was 9%. 30-day all-cause mortality rates by receipt of major BC treatment modalities (within past 3 months) were: 10% for those on cytotoxic systemic therapy vs 5% and 12% for noncytotoxic systemic therapy and local therapy, respectively. The table shows hospitalization and mortality outcomes by major demographic and BC treatment strata. The final presentation will incorporate the latest patient accrual and evaluate independent clinical risk factors associated with serious COVID-19 outcomes in patients with BC.
Conclusions: This represents the largest study to date of COVID-19 outcomes in patients with invasive BC. Nearly half of the patients with BC required hospitalization during their COVID-19 disease course and we observed a 9% 30-day all-cause mortality.
Submitted on behalf of the COVID-19 and Cancer Consortium (ccc19us.org)
Table 1. COVID-19 related hospitalization and 30-day all-cause mortality for all patients with invasive BCNAny Hospitalization30-day all-cause MortalityN% [95% CI]N% [95% CI]Total population52924747 [42-51]499 [7-12]Age<601774425 [19-32]21 [0-4]60-691155144 [35-54]87 [3-13]70-791206655 [46-64]1714 [8-22]80+1178674 [65-81]2219 [12-27]ECOG PS0-132212238 [33-43]165 [3-8]2+756181 [71-89]1621 [13-32]Active Comorbidities0741014 [7-23]00 [0-5]1-22239442 [36-49]178 [5-12]>219112968 [60-74]2915 [10-21]Treatment IntentCurative1866434 [28-42]95 [2-9]Palliative743953 [41-64]1216 [9-27]Cancer StatusRemission/NED33115447 [41-52]247 [5-11]Active disease, stable or responding to treatment1194840 [31-50]76 [2-12]Active disease, progressing372773 [56-86]1130 [16-47]Treatment Modality (within 3 months)Cytotoxic chemotherapy833542 [31-54]810 [4-18]Noncytotoxic therapy1856435 [28-42]105 [3-10]Local therapy (surgery or radiation)341750 [32-68]412 [3-27]
Citation Format: Ali Raza Khaki, Dimpy P Shah, Maryam B Lustberg, Melissa K Accordino, Daniel G Stover, Gayathri Nagaraj, Donna R Rivera, Edith A Perez, Sara M Tolaney, Jeffrey Peppercorn, Petros Grivas, Jeremy L Warner, Corrie A Painter, Gilberto de Lima Lopes, Jr, Solange Peters, Michael A Thompson, Toni K Choueiri, Brian I Rini, Gary H Lyman, Nicole M Kuderer, Shaveta Vinayak. Characteristics and outcomes of SARS-CoV-2 infection in patients with invasive breast cancer (BC) from the COVID-19 and cancer consortium (CCC19) cohort study [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 PS7-01.
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Affiliation(s)
- Ali Raza Khaki
- 1University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Dimpy P Shah
- 2University of Texas Health San Antonio, San Antonio, TX
| | - Maryam B Lustberg
- 3The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Daniel G Stover
- 3The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | | | | | - Petros Grivas
- 1University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | | | - Brian I Rini
- 10Vanderbilt University Medical Center, Nashville, TN
| | - Gary H Lyman
- 1University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Shaveta Vinayak
- 1University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
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Vargas CE, Thorpe CS, Dueck AC, Tenner KS, Davidson NE, Martino S, Pisansky TM, Hwang ES, Halyard MY, Pockaj BA, Perez EA. Impact of adjuvant trastuzumab on locoregional failure rates in a randomized clinical trial: North Central Cancer Treatment Group N9831 (alliance) study. Cancer 2020; 126:5239-5246. [PMID: 32931029 DOI: 10.1002/cncr.33154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The goal of this study was to assess the impact of trastuzumab on locoregional failure. METHODS The analysis included 2763 patients with HER2-positive (HER2+) breast cancer who were randomly assigned to adjuvant doxorubicin (A), cyclophosphamide (C), paclitaxel (T) and trastuzumab (H) (arm A, AC→T [n = 922]; arm B, AC→T→H [n = 988]; arm C, AC→T+H→H [n = 853]). Radiotherapy was given after AC→T concurrently with H. Radiotherapy was given after lumpectomy (L) or after mastectomy (M) with ≥4 positive lymph nodes but was optional for 1 to 3 positive lymph nodes. Locoregional failures at 10 years (LFR10) as first events were compared using competing risk analysis. RESULTS The median follow-up was 13.0 years. The first site of failure was local-only in 96 cases, locoregional in 16 cases, regional in 32 cases, and not specified in 2 cases; LFR10 was 4.8% (95% CI 4.1%-5.7%). LFR10 was 5.5% (95% CI 4.3%-7.2%), 4.9% (95% CI 3.7%-6.4%), and 2.8% (95% CI 1.9%-4.1%) in arms A, B, and C (B vs A: hazard ratio [HR] 0.91, P = .62; C vs A: HR 0.72, P = .12). For estrogen receptor-positive patients, LFR10 was 3.7% (95% CI 2.8%-4.8%) and for estrogen receptor-negative patients, it was 6.1% (95% CI 5.0%-7.4%; HR 0.61, P = .004). Local treatment included L+RT (n = 1044 [38%]), M+RT (n = 1025 [37%]), and M (n = 694 [25%]). LFR10 was 6.% (95% CI 5.0%-7.8%), 3.0% (95% CI 2.1%-4.3%), and 5.5% (95% CI 4.0%-7.4%) for L+RT, M+RT, and M, respectively (M+RT vs L+RT: HR 0.43, P < .001; M vs L+RT: HR 0.88, P = .57). For 1 to 3 positive lymph nodes, LFR10 was 6.5% (95% CI 4.8%-8.9%), 4.1% (95% CI 2.4%-7.0%), and 4.3% (95% CI 2.9%-6.5%) in L+RT, M+RT, and M, respectively (M vs L+RT: HR 0.68, P = .14; M vs M+RT: HR 1.2, P = .6). CONCLUSION Low 10-year LFRs were seen regardless of trastuzumab use. Differences in local therapy in patients with 1 to 3 positive lymph nodes did not appear to improve local control. Local therapy studies for HER2+ and other tumor characteristics are important as the role of local therapies continues to evolve.
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Affiliation(s)
- Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Amylou C Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, Arizona
| | - Kathleen S Tenner
- Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, Arizona
| | - Nancy E Davidson
- Division of Medical Oncology, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Silvana Martino
- The Angeles Clinic and Research Institute, Santa Monica, California
| | | | - E Shelley Hwang
- Department of Surgery, Duke University, Durham, North Carolina
| | | | | | - Edith A Perez
- Department of Hematology & Oncology, Mayo Clinic, Jacksonville, Florida
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Jaeckle KA, Dixon JG, Anderson SK, Moreno-Aspitia A, Colon-Otero G, Hebenstreit K, Patel TA, Reddy SL, Perez EA. Intra-CSF topotecan in treatment of breast cancer patients with leptomeningeal metastases. Cancer Med 2020; 9:7935-7942. [PMID: 32885617 PMCID: PMC7643683 DOI: 10.1002/cam4.3422] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/24/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
Background There are few treatment options for patients with leptomeningeal metastases (LM). Methods We report a case series of patients with breast cancer and LM treated with intra‐CSF topotecan (TOPO). Outcome was assessed by clinical exam and MRI at baseline, at end of induction (4‐5 weeks), then every 3 months; CSF cytology was determined at baseline and with each treatment. Results Thirty‐one women [median age, 58 (37‐81); median KPS 60 (40‐100)] received treatment. At baseline, 68% had positive CSF cytology, and 90%, leptomeningeal enhancement on MRI. 84% of patients also received focal RT (not during TOPO) and 77% received concomitant systemic hormonal or chemotherapy. Median number of TOPO treatments was 14.5 (range, 3‐71); median duration of treatment, 11 weeks (1‐176); and median OS, 6.9 months (range, 0.9‐48.8). Patients remaining progression‐free during 4‐6 weeks of induction (81%) had a median OS of 11.5 months (range, 1.8‐48.8). Overall neurologic PFS at 6, 12, and 24 months was 39%, 26%, and 6%, respectively. Clearing of CSF malignant cells for >3 consecutive samples occurred in 10/21 (48%) patients with positive CSF cytology at baseline, remaining clear for a median duration of 15.9 months (range, 1.4‐34.5). Grade 3 adverse events included headache or vomiting (3pts), T2 hyperintensity surrounding the ventricular catheter (2 pts), and meningitis (2 pts). Conclusions Intra‐CSF TOPO, with focal RT as needed for symptomatic areas of enhancement produced durable clearing of CSF malignant cells in 48% of patients positive at baseline, with promising median PFS and OS.
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Affiliation(s)
| | | | | | | | | | | | - Tejal A Patel
- Houston Methodist Hospital Cancer Center, Houston, TX, USA
| | - Samarth L Reddy
- Hematology Oncology Associates of Boca Raton, Boca Raton, FL, USA
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Carter JM, Chumsri S, Ma Y, Wang X, Kachergus JM, Hinerfeld D, Brauer HA, Warren S, Joensuu H, Perez EA, Thompson A. Abstract 1004: Quantitative digital spatial profiling reveals novel prognostic intratumoral immune signatures in triple-negative breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1004] [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 intrinsic immune response in triple negative breast cancer (TNBC) has both prognostic and predictive utility, and immune-related biomarkers are now actionable targets in TNBC. Current modalities for immune profiling are limited by lack of spatial context and precise quantitation. We used quantitative digital spatial profiling (DSP) to 1) characterize the immune architecture of tumoral and stromal regions in TNBC and 2) identify prognostic immune signatures.
Methods: From the FinXX trial of adjuvant capecitabine therapy, tumor sections (FFPE) matched for patient characteristics, treatment arm and RFS-based outcome (N=44) were assessed with Nanostring GeoMxTM DSP. Briefly, with 3-plex immunofluorescence (pan-cytokeratin, CD45, CD68 with SYTO-13 dye for nuclei), spatially-defined CD45-enriched or CD68-enriched stromal segments and adjacent tumor segments (N=950) were selected for digital quantitation (NanoString nCounter) of 39 immune proteins (e.g. immune cell profiling proteins: CD3, CD4, CD8, CD11c, CD20, CD56, CD68, HLA-DR, PD-1, PD-L1, Granzyme B), immune drug targets (e.g. VISTA, STING, IDO1), and activation status-related proteins (e.g. ICOS, PD-L2, CD40, CD40L, CD44). Normalized, differentially-expressed (DE) proteins were evaluated, and weighted gene co-expression network analysis (WGCNA) was performed to identify modules of highly co-expressing immune proteins, and association with RFS as a categorical variable was determined.
Results: 20 DE proteins in tumor segments were associated with RFS. Among them, those with the highest RFS-associated fold changes (FC) included CD20, CD40, CD56, HLA-DR, Granzyme B, and PD-L2 (FC): 2.1-4.4) (p < 0.05). In contrast, only 4 DE proteins were associated with RFS in stromal segments (Granzyme B, IDO-1, PD-L1, and PD-L2 (FC: 1.5-3.3) (p < 0.05). By WGCNA, 2 tumor-based immune modules [IM1 (lymphocyte infiltration) and IM2 (lymphocyte activation)] were identified based on their co-expression. The top three co-expressed proteins in IM1 were CD4, CD40, and CD45 (r >0.9). The three top co-expressed proteins in IM2 were PD-L1, PD-L2, and Granzyme B (r > 0.85). Together with CD56 expression, IM1 and IM2 comprised a set of 3 intratumoral immune features that associated with RFS. For recurring tumors, all 3 immune features clustered with low scores . Among non-recurrent tumors, two distinct, non-overlapping clusters with inverse characteristics were identified: high IM2, low IM1, low CD56 vs. low IM2, high IM1, and high CD56. Overall, across all 3 immune features, PDL2, CD40 and CD56 expression most strongly associated with RFS.
Conclusion: With spatially-defined, precise quantification of immune proteins, we identified 3 immune features, including two distinct immune modules, IM1 and IM2 that correlate with durable RFS. These immune modules of highly co-expressing proteins were associated with RFS only when present in the tumor compartment but not tumor-adjacent, immune cell-rich stroma.
Citation Format: Jodi M. Carter, Saranya Chumsri, Yaohua Ma, Xue Wang, Jennifer M. Kachergus, Douglas Hinerfeld, Heather Ann Brauer, Sarah Warren, Heikki Joensuu, Edith A. Perez, Aubrey Thompson. Quantitative digital spatial profiling reveals novel prognostic intratumoral immune signatures in triple-negative breast cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1004.
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Pai T, Gil A, Ma Y, Li Z, Advani P, Moreno-Aspitia A, Colon-Otero G, Perez EA, Thompson EA, Chumsri S. Value of clinical treatment score post-5 years (CTS5) for late relapse risk assessment in patients with early-stage HER2+ breast cancer (BC) in the north central cancer treatment group (NCCTG) N9831 (Alliance) trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.529] [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
529 Background: Multiple prognostic models exist to predict late relapse risk in early stage hormone receptor-positive (HR+) breast cancer (BC). The CTS5 is one such model that has been validated in HR+ HER2-negative BC. The value of this model in HR+ HER2+ has not been established. Here, we assessed CTS5 in patients (pts) with early stage HER2+ BC treated in the NCCTG N9831 (Alliance) trial. Methods: Pts with stage I-III HER2+ HR+ BC who survived ≥ 5 years were included. The online CTS5 calculator was used to determine CTS5 score and risk group (low, intermediate, and high) based on age, tumor size, grade, and number of involved nodes. Kaplan-Meier (KM) estimates, Cox regression models, and C index were used for analysis. Results: From 3,130 pts, 1,204 pts met the criteria and were included. Median age was 49 (22-79) years and median tumor size was 2.4 (0.1-12) cm. 63.6% had grade 3 tumors, 33.6% grade 2, and 2.8% grade 1. Median follow up was 10.89 (5.01-15.32) years. Based on CTS5, 821 (68.2%) pts were classified as high risk, 289 (24%) as intermediate risk, and 94 (7.8%) as low risk. Overall, using univariate Cox regression analysis, there was no statistically significant difference in recurrence free survival (RFS) among pts with intermediate vs. low (HR 0.47 95%CI 0.18-1.22, p = 0.12) and high vs. low (HR1.23 95%CI0.57-2.67, p = 0.6) with the C index of 0.58. Among pts who received concurrent trastuzumab (H) with HR+ BC, there was also no statistical difference in RFS between high vs. low (HR 0.68 95%CI0.24-1.97, p = 0.48) with the C index of 0.55. Paradoxically, pts with intermediate risk had better RFS than low risk (HR 0.18 95%CI0.03-0.97, p = 0.05). As a continuous variable, there is also no significant improvement in RFS per 1 unit increase in CTS5 score (HR 1.19 95%CI 0.73-1.96, p = 0.49) with the C index of 0.54. After 5 years, 7.06% (n = 30/425) of HR+ pts treated with concurrent H recurred. Conclusions: The CTS5 model is not prognostic in pts with early stage HR+ HER2+ BC receiving adjuvant H. While most HR+ HER2+ pts are classified as high risk by CTS5, the recurrence between years 5-10 was low in pts who received adjuvant H. This study highlights the need to develop a new predictive model for risk of late relapse in this specific group of pts to enable clinicians to determine which pts would benefit from extended adjuvant endocrine therapy. Support: BCRF-19-161, U10CA180821, Genentech. https://acknowledgments.alliancefound.org Clinical trial information: NCT00005970 .
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Affiliation(s)
| | | | | | - Zhuo Li
- Mayo Clinic, Jacksonville, FL
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Chumsri S, Carter JM, Ma Y, Hinerfeld D, Brauer HA, Warren S, Nielsen TO, Asleh K, Joensuu H, Perez EA, Leon-Ferre RA, Hillman DW, Boughey JC, Liu MC, Ingle JN, Kalari KR, Couch F, Knutson KL, Goetz MP, Thompson EA. Role of intratumoral NK cells in triple-negative breast cancer in the FinXX trial and Mayo Clinic cohort. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.510] [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
510 Background: Several studies have established the critical role of preexisting immune response in triple negative breast cancer (TNBC). Most studies evaluated the tumor infiltrating lymphocytes in stroma. However, limited data are available with regards to the importance of specific subtypes and spatial distribution of these immune infiltrates. Methods: NanoString IO360 gene expression analysis and Digital Spatial Profiling (DSP) were used. DSP was used to quantify 39 immune-related proteins in stromal and tumor-enriched segments from 44 TNBC samples from the FinXX trial (NCT00114816) and 335 samples from the Mayo Clinic (MC) cohort of centrally reviewed TNBC (Leon-Ferre BCRT 2018). In FinXX trial, 22 patients with recurrence and 22 patients without recurrence were included. In MC cohort, 217/335 patients received adjuvant chemotherapy while 118 patients had surgery only without adjuvant chemotherapy. Regions were segmented based on pancytokeratin staining. The general linear model was used for statistical analysis of differential expression with recurrence free survival (RFS) as a categorical variable (recur yes or no). Kaplan-Meier estimates and Cox regression models were also used for analysis. Results: In the FinXX trial, using global gene expression analysis with IO360, there was no signature significantly associated with RFS. However, using DSP, high protein expression of CD56 in the tumor-enriched segments was associated with significant improvement in RFS (HR 0.26, 95%CI 0.09-0.78, p 0.01). Nevertheless, CD56 expression in the stroma (HR 0.66, 95%CI 0.29-1.53, p 0.33) and all segments (HR 0.53, 95%CI 0.23-1.25, p 0.14) was not significantly associated with improved outcome. We further validated these findings in the MC TNBC cohort where intratumoral CD56 expression was associated with a significant improvement in RFS (HR 0.23, p 0.002) but not stromal CD56 (p 0.79). Interestingly, when evaluating the MC TNBC cohort according to receipt of chemotherapy, intratumoral CD56 was associated with improved outcome only in patients who received chemotherapy (p 0.02 vs. 0.07). In both cohorts, higher expressions of intratumoral PD-L1, HLA-DR, and CD8 were associated with improved outcome. Conclusions: Using an in-depth analysis with spatially defined context, we identify that intratumoral CD56-positive NK cells are associated with improved outcome in TNBC. Our study highlights the potential role of NK cells in TNBC and future implications for biomarkers and therapeutic targets.Support: W81XWH-15-1-0292, P50CA116201-9, P50CA015083. Clinical trial information: NCT00114816 .
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Affiliation(s)
| | | | | | | | | | | | - Torsten O Nielsen
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karama Asleh
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heikki Joensuu
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | | | | | | | | | | | | | | | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Chumsri S, Hinerfeld D, Kachergus JM, Ma Y, Brauer HA, Warren S, Wang X, Nielsen TO, Asleh K, Joensuu H, Perez EA, Thompson EA. Abstract PD5-06: Digital spatial mapping of the immune landscape of triple negative breast cancer reveals novel features of immune-tumor cell interaction. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-pd5-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Growing evidence supports the critical role of preexisting immune response in triple negative breast cancer (TNBC). However, there are limitations with current evaluation approaches: inability to functionally assess the type of immune infiltration with traditional pathologic evaluation and loss of spatial distribution in conventional high-plex gene or protein expression analyses from the whole tumor section. Here, we report the initial analysis of immune protein expression as a function of spatial distribution and clinical outcomes in TNBC samples. Methods: NanoString GeoMxTM Digital Spatial Profiling (DSP) was used to quantify 39 immune-related proteins in stromal and tumor segments from 44 TNBC samples from the FinXX trial. Samples were matched for patient characteristics, treatment arm (capecitabine vs. 5-fluorouracil), and outcome based on recurrence-free survival (RFS) with 22 samples from patients who recurred and 22 samples from patients with durable RFS. Regions of interest (ROIs) were selected based on expression of cytokeratin (tumor), CD45 (leukocytes), or CD68 (macrophages). Each ROI was segmented into tumor (pancytokeratin-positive area) and stroma (pancytokeratin-negative/nuclear SYTO13-positive area). The general linear model was used for statistical analysis of differential expression with RFS as a categorical variable (recur yes or no). Results: A total of 950 tumor and stroma segments were included in this initial analysis. In both tumor and stroma segments, over-expression of T cell activation markers (CD137, GITR) was associated with better outcome, whereas T cell markers (CD3, CD4, CD8) were not significantly associated with outcome. In tumor segments alone, improved outcome was significantly associated with increased protein expression [> 2-fold change (FC) at p<0.001] of CD56, PD-L2, HLA-DR, CD137, GITR, and CD40. In CD45-enriched stroma, improved outcome was associated with elevated expression (FC>2.0, p<0.001) of PD-L2; whereas durable RFS was associated with elevated PD-L2 and IDO1 expression in CD68-enriched stroma. In contrast, macrophage/dendritic cell markers CD68 and CD11c were not associated with outcome. In tumor cells adjacent to CD45-enriched stroma, durable RFS was associated with increased abundance (FC>2.0, p<0.001) of PD-L2, CD56, CD27, GITR, CD20, HLA-DR, and IDO1. Similarly, in tumor segment associated with CD68-enriched stroma, proteins associated with RFS included PD-L2, HLA-DR, CD56, GITR, and CD137. Among 39 immune function proteins, only elevated CTLA4 expression in CD68-enriched stroma was associated with recurrence (FC=0.55, p<0.001), whereas tumor-segment CTLA4 was associated with RFS. Conclusions: Using an in-depth analysis to precisely quantify the abundance of multiple immune function proteins in a spatially defined manner, we observed that PD-L2, IDO1, and T cell activation markers were robustly associated with durable RFS in both tumor and stromal segments. In contrast, MHC components (HLA-DR, beta-2-microglobulin), B cell markers (CD20), and NK cell markers (CD56) were strongly associated with favorable outcome in tumor but not in stromal segments. Our study highlights the conclusion that the immune landscape of TNBC is far too complex to be encompassed by any single molecular marker, and more detailed analyses of the DSP data reported here are ongoing with a view towards using quantitative multiplex analyses to refine our understanding of how therapeutic outcome is influenced by interactions among immune cells and between immune and tumor cells. Acknowledgements: Supported by the Breast Cancer Research Foundation (BCRF18-161), Bankhead Coley (6BC05 Florida Department of Health), 26.2 with Donna Foundation, US National Cancer Institute (CA15083), and the Canadian Cancer Center
Citation Format: Saranya Chumsri, Douglas Hinerfeld, Jennifer M. Kachergus, Yaohua Ma, Heather A Brauer, Sarah Warren, Xue Wang, Torsten O. Nielsen, Karama Asleh, Heikki Joensuu, Edith A. Perez, E. A. Thompson. Digital spatial mapping of the immune landscape of triple negative breast cancer reveals novel features of immune-tumor cell interaction [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 PD5-06.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Karama Asleh
- 3The University of British Columbia, Vancouver, BC, Canada
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Perez EA, de Haas SL, Barrios CH, Eiermann W, Toi M, Im YH, Conte PF, Martin M, Pienkowski T, Pivot XB, Burris HA, Lambertini C, Hoersch S, Patre M, Ellis PA. Abstract PD5-11: Association of immune gene expression with outcome in the MARIANNE phase 3 clinical trial in HER2-positive metastatic breast cancer (MBC). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-pd5-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Although HER2+ breast cancer (BC) is considered a moderately immunogenic tumor, several studies have shown a role of pre-existing immunity associated with favorable long-term prognosis and better response to treatment. In this study, we performed exploratory analyses to assess whether the efficacy of HER2 targeted treatment in the MARIANNE trial correlated with immune gene expression. Methods: MARIANNE (NCT01120184) is a phase 3 study in patients (pts) with centrally confirmed HER2+ local advanced/metastatic BC naïve to prior treatments in the advanced disease. Pts were randomized (1:1:1) to trastuzumab+taxane (HT), T-DM1, or T-DM1+Petuzumab (P) and the trial showed noninferior PFS of T-DM1 and T-DM1+P vs HT. Gene expression (RNA) analysis was performed on tumor samples by a custom 800-gene codeset on the nCounter platform. PD-L1, CD8 expressions and immune gene signatures (sign) analyses were assessed by multivariate Cox regression models using median (cut-off) as categorical variable and adjusted by prior HT, presence of visceral disease, world region, baseline ECOG, measureable disease at baseline, therapy setting, HER2 mRNA expression, PIK3CA mutation status. Results: MARIANNE randomized 1095 pts (HT, n=365; T-DM1, n=367; T-DM1+P, n=363). Gene expression results were available for 671 pts (61.3% of the intent-to-treat [ITT] population) which was representative of ITT. In ITT, HR below 1 was observed when comparing pts with high (>median) vs low (≤median) immune gene expression by clinical outcome suggesting a potential association of high immune marker expression with improved PFS (Table 1) and to some extent with OS (data not shown). This association was primarily observed in the T-DM1 arm where the HR suggested a risk reduction of disease progression(PD)/death especially in the high Teff, high PD-L1 and high CD8 subgroups, and to some extent in the HT arm (Table 1). When assessing the predictive impact on PFS by comparing T-DM1 vs HT, HR below 1 was observed especially in pts with high Teff signature, high PD-L1 and high CD8 expressions (HR 0.67 (95% CI (0.47-0.95)), HR 0.68 (95% CI (0.48-0.97), and HR 0.64 (95%CI 0.44-0.93), respectively). When comparing T-DM1+P vs. HT, HR below 1 was observed especially in pts with low Teff signature and low PD-L1 expression (HR 0.70 (95% CI (0.50-0.99), and HR 0.68 (95% CI (0.48-0.96) respectively). No clear differences between immune gene expression subgroups was observed when comparing treatment arms in regards to OS (data not shown). Conclusions: In the exploratory analysis from the MARIANNE study, high immune gene expression, especially in the high PD-L1, CD8 and Teff subgroups, showed an association with improved clinical benefit with HRs reflecting for a risk reduction of PD/death for PFS and partially for OS. This association was less obvious in the T-DM1+P arm. When comparing the treatments effect, the data showed a potential impact of high Teff signature, and high CD8 and PD-L1 expressions on T-DM1 and less on HT. The potential opposite association of low Teff signature and low PD-L1 expression with improved benefit in the T-DM1+P arm was unexpected and needs further investigation.
Table 1: Prognostic biomarker effect on PFSBiomarker by categories (>Median vs ≤Median)HR (95% CI) ITT n=671HR (95% CI) HT n=220HR (95% CI) T-DM1 n=227HR (95% CI) T-DM1+P n=224Teff sign0.89 (0.73-1.09)0.97 (0.68-1.38)0.64 (0.45-0.91)1.09 (0.75-1.58)Th1 cytokine sign0.91 (0.74-1.11)0.92 (0.64-1.31)0.78 (0.55-1.11)0.96 (0.67-1.36)Checkpoint inhibitor sign0.95 (0.78-1.15)0.91 (0.64-1.29)0.90 (0.64-1.26)1.02 (0.71-1.47)PD-L10.80 (0.66-0.98)0.79 (0.55-1.13)0.62 (0.44-0.87)1.07 (0.74-1.55)CD80.91 (0.75-1.11)1.10 (0.77-1.57)0.66 (0.46-0.93)0.98 (0.68-1.41)
Citation Format: Edith A Perez, Sanne Lysbet de Haas, Carlos H Barrios, Wolfgang Eiermann, Masakazu Toi, Young-Hyuck Im, Pier Franco Conte, Miguel Martin, Tadeusz Pienkowski, Xavier B Pivot, Howard A Burris III, Chiara Lambertini, Silke Hoersch, Monika Patre, Paul Anthony Ellis. Association of immune gene expression with outcome in the MARIANNE phase 3 clinical trial in HER2-positive metastatic breast cancer (MBC) [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 PD5-11.
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Affiliation(s)
| | | | - Carlos H Barrios
- 3Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | | | - Masakazu Toi
- 5Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Young-Hyuck Im
- 6Samsung Medical Centre, Seoul, Korea, Democratic People's Republic of
| | - Pier Franco Conte
- 7Department of Surgery, Oncology and Gastroenterology, University of Padova and Istituto Oncologico Veneto, Padova, Italy
| | - Miguel Martin
- 8Instituto de Investigacion Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain
| | | | | | - Howard A Burris
- 11Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | | | | | | | - Paul Anthony Ellis
- 12Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
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Chumsri S, Polley MY, Mathur P, Reis A, Tenner KS, Weidner M, Advani P, Moreno-Aspitia A, Perez EA, Knutson KL. Phase I results of the phase I/II study of pembrolizumab in combination with binimetinib in patients with unresectable locally advanced or metastatic triple-negative breast cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.5_suppl.78] [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
78 Background: Previous study demonstrated that activation of RAS/MAPK pathway is associated with reduced tumor infiltrating lymphocytes and poor response to neoadjuvant chemotherapy in triple negative breast cancer (TNBC). Further study showed that inhibition of MAPK pathway with a MEK inhibitor is synergistic with anti-PD1/PD-L1 therapies. Methods: Patients with unresectable locally advanced or metastatic TNBC with ≤ 3 prior lines of therapy without prior anti-PD-1/PD-L1/PD-L2 therapies were enrolled. Treatment was started with a 2-week run in period with single agent binimetinib. Dose level 0 was binimetinib at 45 mg oral twice daily continuously and dose level -1 was 30 mg twice daily. Pembrolizumab was given at a fixed dose of 200 mg every 3 weeks at both dose levels. Phase I study was based on the standard 3+3 design. Results: A total of 12 patients were enrolled and treated in the phase 1. Five patients were enrolled at dose level 0, 1 patient withdrew prior to treatment and 1 patient was not evaluable for dose limiting toxicity (DLT). Among 3 evaluable patients, 2 patients experienced DLT with grade 3 flank pain and ALT abnormality. Additional 8 patients were enrolled at dose level -1. Out of 6 evaluable patients for DLT, there was 1 DLT observed with grade 3 AST and ALT abnormality. However, this particular patient had liver metastasis with grade 1 AST and ALT abnormality at baseline and her liver function test (LFT) normalized in 3 weeks after treatment discontinuation and oral prednisone. Other grade 1-2 common AEs included rash, LFT increase, abdominal pain, mucositis, nausea, cardiac troponin T increase without EKG change. The efficacy data will be presented at the meeting after the phase II interim analysis. Conclusions: Pembrolizumab in combination with binimetinib at 30 mg twice daily appears to be safe based on the initial cohort. Phase II part is currently ongoing with binimetinib 30 mg twice daily and pembrolizumab 200 mg every 3 weeks with a total of 23 patients planned where the safety and efficacy of this combination will be further evaluated. Clinical trial information: NCT03106415.
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Chumsri S, Li Z, Serie DJ, Mashadi-Hossein A, Colon-Otero G, Song N, Pogue-Geile KL, Gavin PG, Paik S, Moreno-Aspitia A, Perez EA, Thompson EA. Incidence of Late Relapses in Patients With HER2-Positive Breast Cancer Receiving Adjuvant Trastuzumab: Combined Analysis of NCCTG N9831 (Alliance) and NRG Oncology/NSABP B-31. J Clin Oncol 2019; 37:3425-3435. [PMID: 31622131 DOI: 10.1200/jco.19.00443] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Recent trials have shown potential benefit of extended adjuvant endocrine therapy and relatively high risk of recurrence (RoR) after 5 years in hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) breast cancer. Although risk of late relapse in HR+ HER2- breast cancer is fairly well defined, the risk in HER2-positive (HER2+) breast cancer treated with adjuvant trastuzumab-based chemotherapy remains largely unknown. METHODS We included 3,177 patients with HER2+ breast cancer treated with adjuvant chemotherapy alone or with trastuzumab from the North Central Cancer Treatment Group N9831 (ClinicalTrials.gov identifier: NCT00005970) and National Surgical Adjuvant Breast and Bowel Project B-31 (ClinicalTrials.gov identifier: NCT00004067) trials. RESULTS Overall, HR+ breast cancer was significantly associated with improved recurrence-free survival (RFS) during the first 5 years (hazard ratio, 0.65; 95% CI, 0.56 to 0.77; P < .001). Among patients treated with trastuzumab, cumulative hazard for RFS was lower in patients with HR+ HER2+ breast cancer during the first 5 years (10.96% v 17.48%; hazard ratio, 0.60; 95% CI, 0.45 to 0.79; P < .001). However, there was no significant difference in RFS based on HR status during years 5 to 10 (hazard ratio, 1.32; 95% CI, 0.93 to 1.88; P = .12). A comparable degree of trastuzumab benefit was observed in HR+ and HR- breast cancers ( P for interaction = .87). Furthermore, we observed low RoR in years 5 to 10 among patients with HR+ HER2+ breast cancer: 3.23% in patients without lymph node involvement (N0) and 6.39% in patients with involvement of one to three lymph nodes (N1). CONCLUSION The benefit of adjuvant trastuzumab persists for a long time. A distinct pattern of recurrence was observed between HR+ and HR- HER2+ disease but with similar degree of benefit from adjuvant trastuzumab. RoR in years 5 to 10 in HR+ HER2+ breast cancer is low, particularly in patients with N0 or N1 disease.
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Affiliation(s)
| | - Zhuo Li
- Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | - Soonmyung Paik
- NRG Oncology, Pittsburgh, PA.,Yonsei University College of Medicine, Seoul, Republic of South Korea
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Muss HB, Polley MYC, Berry DA, Liu H, Cirrincione CT, Theodoulou M, Mauer AM, Kornblith AB, Partridge AH, Dressler LG, Cohen HJ, Kartcheske PA, Perez EA, Wolff AC, Gralow JR, Burstein HJ, Mahmood AA, Sutton LM, Magrinat G, Parker BA, Hart RD, Grenier D, Hurria A, Jatoi A, Norton L, Hudis CA, Winer EP, Carey L. Randomized Trial of Standard Adjuvant Chemotherapy Regimens Versus Capecitabine in Older Women With Early Breast Cancer: 10-Year Update of the CALGB 49907 Trial. J Clin Oncol 2019; 37:2338-2348. [PMID: 31339827 DOI: 10.1200/jco.19.00647] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Older women with breast cancer remain under-represented in clinical trials. The Cancer and Leukemia Group B 49907 trial focused on women age 65 years and older. We previously reported the primary analysis after a median follow-up of 2.4 years. Standard adjuvant chemotherapy showed significant improvements in recurrence-free survival (RFS) and overall survival compared with capecitabine. We now update results at a median follow-up of 11.4 years. PATIENTS AND METHODS Patients age 65 years or older with early breast cancer were randomly assigned to either standard adjuvant chemotherapy (physician's choice of either cyclophosphamide, methotrexate, and fluorouracil or cyclophosphamide and doxorubicin) or capecitabine. An adaptive Bayesian design was used to determine sample size and test noninferiority of capecitabine. The primary end point was RFS. RESULTS The design stopped accrual with 633 patients at its first sample size assessment. RFS remains significantly longer for patients treated with standard chemotherapy. At 10 years, in patients treated with standard chemotherapy versus capecitabine, the RFS rates were 56% and 50%, respectively (hazard ratio [HR], 0.80; P = .03); breast cancer-specific survival rates were 88% and 82%, respectively (HR, 0.62; P = .03); and overall survival rates were 62% and 56%, respectively (HR, 0.84; P = .16). With longer follow-up, standard chemotherapy remains superior to capecitabine among hormone receptor-negative patients (HR, 0.66; P = .02), but not among hormone receptor-positive patients (HR, 0.89; P = .43). Overall, 43.9% of patients have died (13.1% from breast cancer, 16.4% from causes other than breast cancer, and 14.1% from unknown causes). Second nonbreast cancers occurred in 14.1% of patients. CONCLUSION With longer follow-up, RFS remains superior for standard adjuvant chemotherapy versus capecitabine, especially in patients with hormone receptor-negative disease. Competing risks in this older population dilute overall survival benefits.
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Affiliation(s)
- Hyman B Muss
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Donald A Berry
- Alliance Statistics and Data Center, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Heshan Liu
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | | | | | - Ann M Mauer
- Advocate Illinois Masonic Medical Center, Chicago, IL
| | | | | | - Lynn G Dressler
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | - Antonio C Wolff
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Julie R Gralow
- University of Washington Seattle Cancer Alliance, Seattle, WA
| | | | | | | | | | - Barbara A Parker
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | | | | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Duarte, CA.,Deceased
| | | | - Larry Norton
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Lisa Carey
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Perez EA, Barrios C, Eiermann W, Toi M, Im Y, Conte P, Martin M, Pienkowski T, Pivot XB, Burris HA, Petersen JA, De Haas S, Hoersch S, Patre M, Ellis PA. Trastuzumab emtansine with or without pertuzumab versus trastuzumab with taxane for human epidermal growth factor receptor 2–positive advanced breast cancer: Final results from MARIANNE. Cancer 2019; 125:3974-3984. [DOI: 10.1002/cncr.32392] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 11/11/2022]
Affiliation(s)
| | - Carlos Barrios
- School of Medicine Pontifical Catholic University of Rio Grande do Sul Porto Alegre Brazil
| | | | - Masakazu Toi
- Graduate School of Medicine Kyoto University Kyoto Japan
| | | | - Pierfranco Conte
- University of Padua Padua Italy
- Veneto Oncology Institute Padua Italy
| | - Miguel Martin
- Hospital General Universitario Gregorio Marañon, Complutense University, CIBERONC, GEICAM Madrid Spain
| | | | | | - Howard A. Burris
- Sarah Cannon Research Institute and Tennessee Oncology Nashville Tennessee
| | | | | | | | | | - Paul Anthony Ellis
- Guy's Hospital and Sarah Cannon Research Institute London United Kingdom
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42
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Chumsri S, Serie DJ, Li Z, Pogue-Geile KL, Soyano-Muller AE, Mashadi-Hossein A, Warren S, Lou Y, Colon-Otero G, Knutson KL, Perez EA, Moreno-Aspitia A, Thompson EA. Effects of Age and Immune Landscape on Outcome in HER2-Positive Breast Cancer in the NCCTG N9831 (Alliance) and NSABP B-31 (NRG) Trials. Clin Cancer Res 2019; 25:4422-4430. [PMID: 30808774 DOI: 10.1158/1078-0432.ccr-18-2206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/18/2018] [Accepted: 02/21/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Young age has been shown to be an independent predictor of poor outcome in breast cancer. In HER2-positive breast cancer, the effects of aging remain largely unknown. EXPERIMENTAL DESIGN A total of 4,547 patients were included [3,132 from North Central Cancer Treatment Group (NCCTG) N9831 and 1,415 from National Surgical Adjuvant Breast and Bowel Project (NSABP) B-31]. Pathologic stromal tumor-infiltrating lymphocyte (sTIL) and molecular tumor infiltrating lymphocyte (mTIL) signatures were evaluated. RESULTS In NCCTG N9831, comparable benefit of trastuzumab was observed in all patients [age ≤ 40; HR, 0.43; 95% confidence interval (CI), 0.28-0.66; P < 0.001; and age > 40; HR, 0.56; 95% CI, 0.45-0.69; P < 0.001]. Similar results were observed in NSABP B-31 (age ≤ 40; HR, 0.45; 95% CI, 0.29-0.68; P < 0.001; and age > 40; HR, 0.42; 95% CI, 0.33-0.54; P < 0.001). Among patients who received chemotherapy alone, younger age was associated with poor outcome in the hormone receptor-positive subset, but not the hormone receptor-negative subset, in both trials. Although there was no association between sTILs and age, a small, but significant increase in mTIL CD45 and some immune subset signatures were observed. Among patients who received chemotherapy alone, patients over 40 years of age with lymphocyte-predominant breast cancer had excellent outcome, with 95% remaining recurrence free at 15 years. CONCLUSIONS Among patients treated with trastuzumab, there was no significant difference in outcome related to age. Our study suggests that trastuzumab can negate the poor prognosis associated with young age.
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MESH Headings
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/drug therapy
- Breast Neoplasms/immunology
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Chemotherapy, Adjuvant
- Cyclophosphamide/administration & dosage
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Lymphocytes, Tumor-Infiltrating/immunology
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/immunology
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Paclitaxel/administration & dosage
- Receptor, ErbB-2/metabolism
- Survival Rate
- Trastuzumab/administration & dosage
- Young Adult
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Affiliation(s)
- Saranya Chumsri
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida.
| | - Daniel J Serie
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Zhuo Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Katherine L Pogue-Geile
- National Surgical Adjuvant Breast and Bowel Project (now NRG Oncology), Pittsburgh, Pennsylvania
| | | | | | | | - Yanyan Lou
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Gerardo Colon-Otero
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Keith L Knutson
- Department of Immunology, Mayo Clinic, Jacksonville, Florida
| | - Edith A Perez
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
- Genentech Inc., South San Francisco, California
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Perez EA, de Haas SL, Eiermann W, Barrios CH, Toi M, Im YH, Conte PF, Martin M, Pienkowski T, Pivot XB, Burris HA, Stanzel S, Patre M, Ellis PA. Correction to: Relationship between tumor biomarkers and efficacy in MARIANNE, a phase III study of trastuzumab emtansine ± pertuzumab versus trastuzumab plus taxane in HER2-positive advanced breast cancer. BMC Cancer 2019; 19:620. [PMID: 31234810 PMCID: PMC6591955 DOI: 10.1186/s12885-019-5831-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Edith A Perez
- Mayo Clinic, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA.
| | | | - Wolfgang Eiermann
- Interdisciplinary Oncology Center, Nussbaumstrasse 12, 80336, Munich, Germany
| | - Carlos H Barrios
- PUCRS School of Medicine, Av. Ipiranga 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Masakazu Toi
- Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Young-Hyuck Im
- Samsung Medical Centre, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea
| | - Pier Franco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Istituto Oncologico Veneto, Via Gattamelata 64, 35128, Padova, Italy
| | - Miguel Martin
- Instituto de Investigacion Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Avda. de Séneca, 2, 28040, Madrid, Spain
| | - Tadeusz Pienkowski
- Postgraduate Medical Education Center, ul. Marymoncka 99, 02-813, Warsaw, Poland
| | - Xavier B Pivot
- Paul Strauss Cancer Center, 3 Rue de la Porte de l'Hôpital, BP 30042, 67065, Strasbourg, France
| | - Howard A Burris
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, 250 25th Ave N, Nashville, TN, 37203, USA
| | - Sven Stanzel
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Monika Patre
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Paul Anthony Ellis
- Guys Hospital and Sarah Cannon Research Institute, Great Maze Pond, London, SE1 9RT, UK
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44
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Garrison LP, Babigumira J, Tournier C, Goertz HP, Lubinga SJ, Perez EA. Cost-Effectiveness Analysis of Pertuzumab With Trastuzumab and Chemotherapy Compared to Trastuzumab and Chemotherapy in the Adjuvant Treatment of HER2-Positive Breast Cancer in the United States. Value Health 2019; 22:408-415. [PMID: 30975391 DOI: 10.1016/j.jval.2018.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/17/2018] [Accepted: 11/17/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The APHINITY trial assessed the effectiveness and the safety of adding pertuzumab to trastuzumab and chemotherapy (THP) compared to trastuzumab and chemotherapy (TH) in the adjuvant management of human epidermal growth factor 2-positive (HER2+) breast cancer. We performed a study to project the potential cost-effectiveness of THP vs. TH. STUDY DESIGN Trial-based cost-utility modeling analysis. METHODS We performed an economic evaluation from a payer perspective using a Markov model with six health states: invasive disease-free survival, non-metastatic recurrence, remission, first-line metastatic, subsequent line metastatic, and death. We parameterized the model using data from both arms in APHINITY extrapolated to a patient's lifetime horizon. Estimates of health state utilities were based on EQ-5D trial data and the literature, and costs were estimated from government sources and the published literature. The primary outcomes of the model were life-years (LYs), quality-adjusted LYs (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed via univariate and probabilistic sensitivity analyses. RESULTS For the intention-to-treat population, the model projected improved outcomes (by 0.50 LYs and 0.45 QALYs) and increased costs (by $74 420) for ICERs of $147 774/LY gained and $167 185/QALY gained for PHT vs. HT patients. In the node-positive patient population, the model projected improved outcomes (by 0.86 LYs and 0.76 QALYs) and increased costs (by $66 647) for ICERs of $77 684/LY gained and $87 929/QALY gained. For the hormone-receptor-negative patient population, the model projected health gains, increased costs, and ICERs of $147 022/LY gained and $166 518/QALY gained. The results were sensitive to changes in the model time horizon. CONCLUSION The addition of pertuzumab to the available regimens for HER2+ early breast cancer is likely to be cost-effective for patients in the U.S. at high risk of recurrence.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/economics
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/economics
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/economics
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/economics
- Breast Neoplasms/enzymology
- Breast Neoplasms/mortality
- Chemotherapy, Adjuvant/economics
- Cost Savings
- Cost-Benefit Analysis
- Disease Progression
- Disease-Free Survival
- Drug Costs
- Female
- Humans
- Markov Chains
- Middle Aged
- Models, Economic
- Neoplasm Metastasis
- Neoplasm Recurrence, Local
- Quality of Life
- Quality-Adjusted Life Years
- Randomized Controlled Trials as Topic
- Receptor, ErbB-2/antagonists & inhibitors
- Receptor, ErbB-2/metabolism
- Time Factors
- Trastuzumab/administration & dosage
- Trastuzumab/adverse effects
- Trastuzumab/economics
- Treatment Outcome
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Affiliation(s)
- Louis P Garrison
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA; VeriTech Corporation, Mercer Island, WA, USA.
| | - Joseph Babigumira
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | | | | | - Solomon J Lubinga
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
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45
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Norton N, Fox N, McCarl CA, Tenner KS, Ballman K, Erskine CL, Necela BM, Northfelt D, Tan WW, Calfa C, Pegram M, Colon-Otero G, Perez EA, Clynes R, Knutson KL. Generation of HER2-specific antibody immunity during trastuzumab adjuvant therapy associates with reduced relapse in resected HER2 breast cancer. Breast Cancer Res 2018; 20:52. [PMID: 29898752 PMCID: PMC6000975 DOI: 10.1186/s13058-018-0989-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/15/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Resected HER2 breast cancer patients treated with adjuvant trastuzumab and chemotherapy have superior survival compared to patients treated with chemotherapy alone. We previously showed that trastuzumab and chemotherapy induce HER2-specific antibodies which correlate with improved survival in HER2 metastatic breast cancer patients. It remains unclear whether the generation of immunity required trastuzumab and whether endogenous antibody immunity is associated with improved disease-free survival in the adjuvant setting. In this study, we addressed this question by analyzing serum anti-HER2 antibodies from a subset of patients enrolled in the NCCTG trial N9831, which includes an arm (Arm A) in which trastuzumab was not used. Arms B and C received trastuzumab sequentially or concurrently to chemotherapy, respectively. METHODS Pre-and post-treatment initiation sera were obtained from 50 women enrolled in N9831. Lambda IgG antibodies (to avoid detection of trastuzumab) to HER2 were measured and compared between arms and with disease-free survival. RESULTS Prior to therapy, across all three arms, N9831 patients had similar mean anti-HER2 IgG levels. Following treatment, the mean levels of antibodies increased in the trastuzumab arms but not the chemotherapy-only arm. The proportion of patients who demonstrated antibodies increased by 4% in Arm A and by 43% in the Arms B and C combined (p = 0.003). Cox modeling demonstrated that larger increases in antibodies were associated with improved disease-free survival in all patients (HR = 0.23; p = 0.04). CONCLUSIONS These results show that the increased endogenous antibody immunity observed in adjuvant patients treated with combination trastuzumab and chemotherapy is clinically significant, in view of its correlation with improved disease-free survival. The findings may have important implications for predicting treatment outcomes in patients treated with trastuzumab in the adjuvant setting. TRIAL REGISTRATION ClinicalTrials.gov, NCT00005970 . Registered on July 5, 2000.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/immunology
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Biomarkers, Tumor/genetics
- Breast Neoplasms/drug therapy
- Breast Neoplasms/immunology
- Breast Neoplasms/pathology
- Chemotherapy, Adjuvant/adverse effects
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Humans
- Kaplan-Meier Estimate
- Middle Aged
- Neoplasm Metastasis
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/immunology
- Neoplasm Recurrence, Local/pathology
- Receptor, ErbB-2/immunology
- Recurrence
- Trastuzumab/administration & dosage
- Trastuzumab/adverse effects
- Treatment Outcome
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Affiliation(s)
- Nadine Norton
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Nicholas Fox
- Department of Pathology, Medicine and Dermatology, Columbia University Medical Center, New York, NY 10032 USA
| | - Christie-Ann McCarl
- Department of Pathology, Medicine and Dermatology, Columbia University Medical Center, New York, NY 10032 USA
| | - Kathleen S. Tenner
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905 USA
| | - Karla Ballman
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY USA
| | | | - Brian M. Necela
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Donald Northfelt
- Department of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ 85259 USA
| | - Winston W. Tan
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Carmen Calfa
- Sylvester Cancer Center, University of Miami, Miami, FL 33136 USA
| | - Mark Pegram
- Department of Medicine, Stanford University, Stanford, CA 94305 USA
| | - Gerardo Colon-Otero
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Edith A. Perez
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Raphael Clynes
- Department of Pathology, Medicine and Dermatology, Columbia University Medical Center, New York, NY 10032 USA
| | - Keith L. Knutson
- Department of Immunology, Mayo Clinic, Jacksonville, FL 32224 USA
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46
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Chumsri S, Serie D, Mashadi-Hossein A, Kachergus JM, Warren S, Colon-Otero G, Partridge AH, Carey LA, Hilbers F, Van Dooren V, Holmes E, Di Cosimo S, Werner O, Huober JB, Baselga J, Sotiriou C, Perez EA, Dueck AC, Moreno-Aspitia A, Thompson EA. Association between adaptive immune signature and outcome in HER2-positive breast cancer treated with trastuzumab and lapatinib in the NCCTG-N9831 (Alliance) and NeoALTTO trials. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.577] [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)
| | | | | | | | | | | | | | | | | | | | | | - Serena Di Cosimo
- Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Jens Bodo Huober
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
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Rugo HS, Cortes J, Awada A, O'Shaughnessy J, Twelves C, Im SA, Hannah A, Lu L, Sy S, Caygill K, Zajchowski DA, Davis DW, Tagliaferri M, Hoch U, Perez EA. Change in Topoisomerase 1-Positive Circulating Tumor Cells Affects Overall Survival in Patients with Advanced Breast Cancer after Treatment with Etirinotecan Pegol. Clin Cancer Res 2018; 24:3348-3357. [PMID: 29618616 DOI: 10.1158/1078-0432.ccr-17-3059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/10/2018] [Accepted: 03/26/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Preplanned exploratory analyses were performed to identify biomarkers in circulating tumor cells (CTC) predictive of response to the topoisomerase 1 inhibitor etirinotecan pegol (EP).Experimental Design: The BEACON trial treated patients with metastatic breast cancer (MBC) with EP or treatment of physician's choice (TPC). Blood from 656 of 852 patients (77%) was processed with ApoStream to enrich for CTCs. A multiplex immunofluorescence assay measured expression of candidate response biomarkers [topoisomerase 1 (Top1), topoisomerase 2 (Top2), Ki67, RAD51, ABCG2, γH2AX, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL)] in CTCs. Patients were classified as Top1 low (Top1Lo) or Top1 high (Top1Hi) based on median CTC Top1 expression. Correlation of CTC biomarker expression at baseline, cycle 2 day 1 (C2D1), and cycle 4 day 1 with overall survival (OS) was investigated using Cox regression and Kaplan-Meier analyses.Results: Overall, 98% of samples were successfully processed, of which 97% had detectable CTCs (median, 47-63 CTCs/mL; range, 0-2,020 CTCs/mL). Top1, Top2, and TUNEL expression was detected in 52% to 90% of samples; no significant associations with OS were observed in pretreatment samples for either group. EP-treated patients with low C2D1Top1+ CTCs had improved OS compared with those with higher positivity (14.1 months vs. 11.0 months, respectively; HR, 0.7; P = 0.02); this difference was not seen in TPC-treated patients (HR, 1.12; P = 0.48). Patients whose CTCs decreased from Top1Hi to Top1Lo at C2D1 had the greatest OS benefit from EP (HR, 0.57; P = 0.01).Conclusions: CTC Top1 expression following EP treatment may identify patients with MBC most likely to have an OS benefit. Clin Cancer Res; 24(14); 3348-57. ©2018 AACR.
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Affiliation(s)
- Hope S Rugo
- University of California, San Francisco, San Francisco, California
| | - Javier Cortes
- Ramon y Cajal University Hospital, Madrid, and Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Ahmad Awada
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Joyce O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, Texas
| | - Chris Twelves
- University of Leeds and Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | - Lin Lu
- Nektar Therapeutics, San Francisco, California
| | - Sherwin Sy
- Nektar Therapeutics, San Francisco, California
| | | | | | | | | | - Ute Hoch
- Nektar Therapeutics, San Francisco, California.
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48
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Chumsri S, Sperinde J, Liu H, Gligorov J, Spano JP, Antoine M, Moreno Aspitia A, Tan W, Winslow J, Petropoulos CJ, Chenna A, Bates M, Weidler JM, Huang W, Dueck A, Perez EA. High p95HER2/HER2 Ratio Associated With Poor Outcome in Trastuzumab-Treated HER2-Positive Metastatic Breast Cancer NCCTG N0337 and NCCTG 98-32-52 (Alliance). Clin Cancer Res 2018. [PMID: 29530935 DOI: 10.1158/1078-0432.ccr-17-1864] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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
Purpose: p95HER2 is a truncated form of HER2 that confers resistance to trastuzumab in vitro, but clinical results have been conflicting to date. Given that p95HER2 levels correlate with total HER2 expression levels, which confer better outcomes, we sought to evaluate the p95HER2/HER2 ratio in the North Central Cancer Treatment Group N0337 and N98-32-52 trials.Experimental Design: The HERmark assay and VeraTag technology (Monogram Biosciences) were used to measure total HER2 and p95HER2 expression levels in 91 patient samples.Results: In the multivariate model, increasing total HER2 level was significantly associated with longer (OS; HR, 0.33; P = 0.002) and decreasing p95HER2 level was significantly associated with longer OS (HR, 4.2; P = 0.01). Total HER2 expression level was significantly associated with longer progression-free survival (PFS) (HR, 0.57; P = 0.04), whereas p95HER2 level was not (HR, 1.7; P = 0.25). However, there was a positive association between p95HER2 and total HER2 expression levels (R2 = 0.48; P < 0.001). Consistent with our hypothesis, the ratio of p95HER2/HER2 was significantly associated with worsening PFS (HR, 1.7; P = 0.04) and OS (HR, 2.8; P = 0.002). Patients with the highest tertile of p95HER2/HER2 values had significantly less favorable PFS (HR, 1.8; P = 0.06) and OS (HR, 2.3; P = 0.02).Conclusions: A high p95HER2/HER2 ratio identified patients with metastatic breast cancer with poor outcomes on trastuzumab-based therapies. Further investigation of the p95HER2/HER2 ratio as a potential prognostic or predictive biomarker for HER2-targeted therapy is warranted. Clin Cancer Res; 24(13); 3053-8. ©2018 AACR.
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Affiliation(s)
- Saranya Chumsri
- Center for Breast Health, Mayo Clinic, Jacksonville, Florida.
| | - Jeff Sperinde
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Heshan Liu
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Winston Tan
- Center for Breast Health, Mayo Clinic, Jacksonville, Florida
| | - John Winslow
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Christos J Petropoulos
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Ahmed Chenna
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | | | | | - Weidong Huang
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Amylou Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, Arizona
| | - Edith A Perez
- Center for Breast Health, Mayo Clinic, Jacksonville, Florida
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Andersson M, López-Vega JM, Petit T, Zamagni C, Easton V, Kamber J, Restuccia E, Perez EA. Efficacy and Safety of Pertuzumab and Trastuzumab Administered in a Single Infusion Bag, Followed by Vinorelbine: VELVET Cohort 2 Final Results. Oncologist 2017; 22:1160-1168. [PMID: 28592618 PMCID: PMC5634765 DOI: 10.1634/theoncologist.2017-0079] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/05/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND VELVET Cohort 1 demonstrated the applicability of pertuzumab, trastuzumab, and vinorelbine as an alternative first-line treatment regimen for patients with HER2-positive locally advanced or metastatic breast cancer (MBC) who cannot receive docetaxel. Co-infusion of pertuzumab and trastuzumab may reduce clinic time and medical resource utilization. We report results from Cohort 2, in which pertuzumab and trastuzumab were co-infused, followed by vinorelbine. PATIENTS AND METHODS During cycle 1, patients with HER2-positive locally advanced or MBC received loading doses of pertuzumab (840 mg) and trastuzumab (8 mg/kg) on consecutive days, followed by vinorelbine (25 mg/m2) on days two and nine. From cycle 2 onwards, patients received a co-infusion of pertuzumab (420 mg) and trastuzumab (6 mg/kg) on day one, followed by vinorelbine (30-35 mg/m2) on days one and eight (or days two and nine). The primary endpoint was objective response rate (ORR) in patients with measurable disease. Secondary endpoints included progression-free survival (PFS) and safety. RESULTS Cohort 2 enrolled 107 patients. The ORR was 63.7% (95% confidence interval [CI] 53.0-73.6) in patients with measurable disease (91/107; 85.0%). Median PFS was 11.5 months (95% CI 10.3-15.8). The most common adverse events [AEs] were diarrhea (57.9%), neutropenia (57.0%), and nausea (41.1%). Grade ≥3 AEs occurred in 85 patients (79.4%) and serious AEs in 44 patients (41.1%). Eighteen patients (16.8%) had AEs suggestive of congestive heart failure. CONCLUSION These results support the feasibility of pertuzumab and trastuzumab co-infusion from a safety perspective and support Cohort 1 conclusions that vinorelbine offers an alternative chemotherapy companion for pertuzumab and trastuzumab. The Oncologist 2017;22:1160-1168 IMPLICATIONS FOR PRACTICE: Combined treatment with pertuzumab, trastuzumab, and docetaxel is the standard of care for first-line HER2-positive metastatic breast cancer. However, some patients cannot, or choose not to, receive docetaxel. VELVET Cohort 2 results support the results from Cohort 1 that suggest that pertuzumab plus trastuzumab and vinorelbine is a suitable alternative for these patients. In addition to this, results from Cohort 2 support the feasibility of administering pertuzumab and trastuzumab together in a single infusion bag, which has the potential to offer greater patient convenience and reduce active health care professional time and medical resource utilization compared with administering them separately.
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Affiliation(s)
| | | | - Thierry Petit
- Department of Medical Oncology, Paul Strauss Cancer Center and University of Strasbourg, Strasbourg, France
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50
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Cortés J, Rugo HS, Awada A, Twelves C, Perez EA, Im SA, Gómez-Pardo P, Schwartzberg LS, Diéras V, Yardley DA, Potter DA, Mailliez A, Moreno-Aspitia A, Ahn JS, Zhao C, Hoch U, Tagliaferri M, Hannah AL, O'Shaughnessy J. Erratum to: Prolonged survival in patients with breast cancer and a history of brain metastases: results of a preplanned subgroup analysis from the randomized phase III BEACON trial. Breast Cancer Res Treat 2017; 166:327-328. [PMID: 28884461 DOI: 10.1007/s10549-017-4482-3] [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: 11/25/2022]
Affiliation(s)
- Javier Cortés
- Ramon y Cajal University Hospital, Madrid, Spain and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Hope S Rugo
- University of California, San Francisco, CA, USA
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | - Chris Twelves
- Leeds Institute of Cancer and Pathology and St James's University Hospital, Leeds, UK
| | | | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | - David A Potter
- Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Alvaro Moreno-Aspitia
- Ramon y Cajal University Hospital, Madrid, Spain and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Jin-Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Carol Zhao
- Nektar Therapeutics, San Francisco, CA, USA
| | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA, USA
| | | | | | - Joyce O'Shaughnessy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center/U.S. Oncology, 3410 Worth Street, Suite 400, Dallas, TX, 75246, USA.
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