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Taylor C, Dodwell D, McGale P, Hills RK, Berry R, Bradley R, Braybrooke J, Clarke M, Gray R, Holt F, Liu Z, Pan H, Peto R, Straiton E, Coles C, Duane F, Hennequin C, Jones G, Kühn T, Oliveros S, Overgaard J, Pritchard KI, Suh CO, Beake G, Boddington C, Davies C, Davies L, Evans V, Gay J, Gettins L, Godwin J, James S, Kerr A, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Nakahara M, Read S, Taylor H, Ferguson J, Scheurlen H, Zurrida S, Galimberti V, Ingle J, Valagussa P, Veronesi U, Anderson S, Tang G, Fisher B, Fossa S, Valborg Reinertsen K, Host H, Muss H, Holli K, Albain K, Arriagada R, Bartlett J, Bergsten-Nordström E, Bliss J, Brain E, Carey L, Coleman R, Cuzick J, Davidson N, Del Mastro L, Di Leo A, Dignam J, Dowsett M, Ejlertsen B, Francis P, García-Sáenz JA, Gelber R, Gnant M, Goetz M, Goodwin P, Halpin-Murphy P, Hayes D, Hill C, Jagsi R, Janni W, Loibl S, Mamounas E, Martín M, McIntosh S, Mukai H, Nekljudova V, Norton L, Ohashi Y, Piccart M, Pierce L, Raina V, Rea D, Regan M, Robertson J, Rutgers E, Salgado R, Slamon D, Spanic T, Sparano J, Steger G, Toi M, Tutt A, Viale G, Wang X, Wilcken N, Wolmark N, Yu KD, Cameron D, Bergh J, Swain S, Whelan T, Poortmans P. Radiotherapy to regional nodes in early breast cancer: an individual patient data meta-analysis of 14 324 women in 16 trials. Lancet 2023; 402:1991-2003. [PMID: 37931633 DOI: 10.1016/s0140-6736(23)01082-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 03/22/2023] [Accepted: 05/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Radiotherapy has become much better targeted since the 1980s, improving both safety and efficacy. In breast cancer, radiotherapy to regional lymph nodes aims to reduce risks of recurrence and death. Its effects have been studied in randomised trials, some before the 1980s and some after. We aimed to assess the effects of regional node radiotherapy in these two eras. METHODS In this meta-analysis of individual patient data, we sought data from all randomised trials of regional lymph node radiotherapy versus no regional lymph node radiotherapy in women with early breast cancer (including one study that irradiated lymph nodes only if the cancer was right-sided). Trials were identified through the EBCTCG's regular systematic searches of databases including MEDLINE, Embase, the Cochrane Library, and meeting abstracts. Trials were eligible if they began before Jan 1, 2009. The only systematic difference between treatment groups was in regional node radiotherapy (to the internal mammary chain, supraclavicular fossa, or axilla, or any combinations of these). Primary outcomes were recurrence at any site, breast cancer mortality, non-breast-cancer mortality, and all-cause mortality. Data were supplied by trialists and standardised into a format suitable for analysis. A summary of the formatted data was returned to trialists for verification. Log-rank analyses yielded first-event rate ratios (RRs) and confidence intervals. FINDINGS We found 17 eligible trials, 16 of which had available data (for 14 324 participants), and one of which (henceforth excluded), had unavailable data (for 165 participants). In the eight newer trials (12 167 patients), which started during 1989-2008, regional node radiotherapy significantly reduced recurrence (rate ratio 0·88, 95% CI 0·81-0·95; p=0·0008). The main effect was on distant recurrence as few regional node recurrences were reported. Radiotherapy significantly reduced breast cancer mortality (RR 0·87, 95% CI 0·80-0·94; p=0·0010), with no significant effect on non-breast-cancer mortality (0·97, 0·84-1·11; p=0·63), leading to significantly reduced all-cause mortality (0·90, 0·84-0·96; p=0·0022). In an illustrative calculation, estimated absolute reductions in 15-year breast cancer mortality were 1·6% for women with no positive axillary nodes, 2·7% for those with one to three positive axillary nodes, and 4·5% for those with four or more positive axillary nodes. In the eight older trials (2157 patients), which started during 1961-78, regional node radiotherapy had little effect on breast cancer mortality (RR 1·04, 95% CI 0·91-1·20; p=0·55), but significantly increased non-breast-cancer mortality (1·42, 1·18-1·71; p=0·00023), with risk mainly after year 20, and all-cause mortality (1·17, 1·04-1·31; p=0·0067). INTERPRETATION Regional node radiotherapy significantly reduced breast cancer mortality and all-cause mortality in trials done after the 1980s, but not in older trials. These contrasting findings could reflect radiotherapy improvements since the 1980s. FUNDING Cancer Research UK, Medical Research Council.
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Nguyen HL, Geukens T, Maetens M, Aparicio S, Bassez A, Borg A, Brock J, Broeks A, Caldas C, Cardoso F, De Schepper M, Delorenzi M, Drukker CA, Glas AM, Green AR, Isnaldi E, Eyfjörð J, Khout H, Knappskog S, Krishnamurthy S, Lakhani SR, Langerod A, Martens JWM, McCart Reed AE, Murphy L, Naulaerts S, Nik-Zainal S, Nevelsteen I, Neven P, Piccart M, Poncet C, Punie K, Purdie C, Rakha EA, Richardson A, Rutgers E, Vincent-Salomon A, Simpson PT, Schmidt MK, Sotiriou C, Span PN, Tan KTB, Thompson A, Tommasi S, Van Baelen K, Van de Vijver M, Van Laere S, Van't Veer L, Viale G, Viari A, Vos H, Witteveen AT, Wildiers H, Floris G, Garg AD, Smeets A, Lambrechts D, Biganzoli E, Richard F, Desmedt C. Obesity-associated changes in molecular biology of primary breast cancer. Nat Commun 2023; 14:4418. [PMID: 37479706 PMCID: PMC10361985 DOI: 10.1038/s41467-023-39996-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/06/2023] [Indexed: 07/23/2023] Open
Abstract
Obesity is associated with an increased risk of developing breast cancer (BC) and worse prognosis in BC patients, yet its impact on BC biology remains understudied in humans. This study investigates how the biology of untreated primary BC differs according to patients' body mass index (BMI) using data from >2,000 patients. We identify several genomic alterations that are differentially prevalent in overweight or obese patients compared to lean patients. We report evidence supporting an ageing accelerating effect of obesity at the genetic level. We show that BMI-associated differences in bulk transcriptomic profile are subtle, while single cell profiling allows detection of more pronounced changes in different cell compartments. These analyses further reveal an elevated and unresolved inflammation of the BC tumor microenvironment associated with obesity, with distinct characteristics contingent on the estrogen receptor status. Collectively, our analyses imply that obesity is associated with an inflammaging-like phenotype. We conclude that patient adiposity may play a significant role in the heterogeneity of BC and should be considered for BC treatment tailoring.
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Affiliation(s)
- Ha-Linh Nguyen
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Tatjana Geukens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Marion Maetens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Samuel Aparicio
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ayse Bassez
- Laboratory for Translational Genetics, Department of Human Genetics, KU Leuven, Leuven, Belgium
- VIB Center for Cancer Biology, Leuven, Belgium
| | - Ake Borg
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
- Lund University Cancer Center Lund, Lund, Sweden
- CREATE Health Strategic Centre for Translational Cancer Research, Lund University, Lund, Sweden
- Department of Clinical Sciences, SCIBLU Genomics, Lund University, Lund, Sweden
| | - Jane Brock
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Annegien Broeks
- Departments of Core Facility, Molecular Pathology and Biobanking, Antoni van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Carlos Caldas
- Cancer Research UK Cambridge Institute and Department of Oncology, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Maxim De Schepper
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Mauro Delorenzi
- Department of Oncology, University of Lausanne, Epalinges, Switzerland
- SIB Swiss Institute of Bioinformatics, Bioinformatics Core Facility, Lausanne, Switzerland
| | - Caroline A Drukker
- Department of Surgical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | | | - Andrew R Green
- Nottingham Breast Cancer Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Edoardo Isnaldi
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Jórunn Eyfjörð
- BioMedical Center, School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hazem Khout
- Department of Breast Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Stian Knappskog
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sunil R Lakhani
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Pathology Queensland, The Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Anita Langerod
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Ullernchausseen, Oslo, Norway
| | - John W M Martens
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Amy E McCart Reed
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Leigh Murphy
- University of Manitoba and Cancer Care Manitoba Research Institute, Winnipeg, MB, Canada
| | - Stefan Naulaerts
- Laboratory of Cell Stress & Immunity, Department of Cellular & Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Serena Nik-Zainal
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- MRC Cancer Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ines Nevelsteen
- Department of Surgical Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Martine Piccart
- Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Coralie Poncet
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Unit, Leuven Cancer Institute and University Hospitals Leuven, Leuven, Belgium
| | - Colin Purdie
- Department of Pathology, University of Dundee, NHS Tayside, Dundee, UK
| | - Emad A Rakha
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Histopathology, Nottingham University Hospital NHS Trust, City Hospital Campus, Nottingham, UK
| | | | - Emiel Rutgers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Anne Vincent-Salomon
- Diagnostic and Theranostic Medicine Division, Institut Curie, PSL Research University, Paris, France
| | - Peter T Simpson
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Christos Sotiriou
- Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium
| | - Paul N Span
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kiat Tee Benita Tan
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
- Department of Breast Surgery, National Cancer Centre, Singapore, Singapore
| | - Alastair Thompson
- Department of Surgery, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Stefania Tommasi
- Molecular Diagnostics and Pharmacogenetics Unit, IRCCS Istituto Tumouri "Giovanni Paolo II", Bari, Italy
| | - Karen Van Baelen
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Marc Van de Vijver
- Department of Pathology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Steven Van Laere
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium
| | - Laura Van't Veer
- Department of Laboratory Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Giuseppe Viale
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alain Viari
- Synergie Lyon Cancer, Plateforme de Bio-informatique 'Gilles Thomas', Lyon, France
| | - Hanne Vos
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | | | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Unit, Leuven Cancer Institute and University Hospitals Leuven, Leuven, Belgium
| | - Giuseppe Floris
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Abhishek D Garg
- Laboratory of Cell Stress & Immunity, Department of Cellular & Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Diether Lambrechts
- Laboratory for Translational Genetics, Department of Human Genetics, KU Leuven, Leuven, Belgium
- VIB Center for Cancer Biology, Leuven, Belgium
| | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) "L. Sacco" & DSRC, LITA Vialba campus, Università degli Studi di Milano, Milan, Italy
| | - François Richard
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium.
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Desmedt C, Nguyen HL, Richard F, Linn S, Metzger O, Poncet C, Wesseling J, Hilbers F, Aalders K, Delorenzi M, Delaloge S, Pierga JY, Brain E, Vrijaldenhoven S, Neijenhuis PA, Van Baelen K, Maetens M, Rutgers E, Piccart M, Van ’t Veer L, Viale G, Cardoso F. Abstract P5-14-01: Transcriptomic insights into lobular breast cancer biology: a retrospective analysis of the MINDACT clinical trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p5-14-01] [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
Background: Invasive lobular carcinoma (ILC) represents the second most common subtype of breast cancer after invasive breast cancer of no special type (NST). In this retrospective analysis of the MINDACT trial, we aimed at identifying/refining the transcriptomic differences between: 1) estrogen receptor positive/HER2-negative (ER+/HER2-) ILC versus ER+/HER2- NST, 2) classic and non-classic ER+/HER2- ILC, and, 3) recurring and non-recurring ER+/HER2- ILC in the subgroup of patients with a low clinical and low genomic (cL/gL) risk (as defined by a modified version of Adjuvant Online! and the 70-gene signature). Patients and methods: Central pathology review was performed for histological subtype, grade and Ki67 (G.V.) for 5929/6693 (88.6%) of the patients included in the MINDACT trial (NCT00433589). Analysis of transcriptomic data adjusted for age and grade was performed using the R/Bioconductor package ‘limma’ to identify differentially expressed genes (DEGs). DEGs having absolute log-fold change (logFC)≥ 0.2 and FDR-adjusted p-value (q-value) < 0.05 were considered. Gene set enrichment analyses (GSEA) of MSigDB hallmark gene sets were performed. Adjusted Cox regression models were used to evaluate the association of these hallmarks with disease free survival (DFS) and distant recurrence free survival (DRFS). Results: After central pathological review, 464 patients with ER+/HER2- ILC and 3798 patients with ER+/HER2- NST were identified. Patients with ILC were significantly older at diagnosis, had larger tumors, less axillary nodal involvement, more grade 2 tumors than patients with NST. At the transcriptomic level, we observed a high number of DEGs between these 2 subgroups, confirming their distinct phenotype. CDH1, the gene coding for E-cadherin, was as expected the most highly overexpressed gene in NST versus ILC. We further observed an increased expression of leptin (LEP), leptin receptor (LEPR), lipoprotein lipase (LPL), and the fatty acid transporter CD36 in ILC. This could suggest that ILC relied on increased lipid uptake thanks to the increased contact of ILC tumor cells with the adipocytes. IGF1 was also overexpressed in ILC versus NST, as a potential consequence of high LEP and high LEPR expression. Differences were also evident with regard to the extracellular matrix (ECM), with many collagens, matrix metalloproteinases (MMPs) and other key enzymes (e.g. LOXL1) being differentially expressed. We confirmed a decreased ER-signaling and increased PI3K/Akt signaling in ILC versus NST. Out of the 464 ER+/HER2- ILC tumors, 253 (55%) were classic ILC and 211 (45%) non-classic ILC. There were more grade 3 tumors, more highly proliferative tumors and more nodal involvement in patients with non-classic versus classic ILC. At the transcriptomic level, differences were subtler than the differences seen above. Still, a significant enrichment of the hallmarks related to cell cycle in the non-classic ILC, and of the hallmarks related to epithelial-to-mesenchymal transition, hypoxia, adipogenesis and IL6/JAK/STAT3 signaling in classic ILC was observed. Finally, 216/464 patients with ER+/HER2- ILC (47%) were assigned to the cL/gL risk group and did not receive chemotherapy. 28/216 of these patients (13%) relapsed (DFS, median FU: 8.7 years). Enrichment of hallmarks related to apoptosis, inflammatory response, hypoxia and oncogenic signaling (PI3K/Akt, Ras, c-Myc) was associated with worse survival. Conclusion: This represents, to the best of our knowledge, the largest set of gene expression data for patients with ILC, issued from a clinical trial where histology was reviewed centrally. These results could be used to personalize treatment for patients with ILC. This project is funded by the Breast Cancer Research Foundation.
Citation Format: Christine Desmedt, Ha-Linh Nguyen, François Richard, Sabine Linn, Otto Metzger, Coralie Poncet, Jelle Wesseling, Florentine Hilbers, Kim Aalders, Mauro Delorenzi, Suzette Delaloge, Jean-Yves Pierga, Etienne Brain, Suzan Vrijaldenhoven, Peter A Neijenhuis, Karen Van Baelen, Marion Maetens, Emiel Rutgers, Martine Piccart, Laura Van ’t Veer, Giuseppe Viale, Fatima Cardoso. Transcriptomic insights into lobular breast cancer biology: a retrospective analysis of the MINDACT clinical 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 P5-14-01.
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Affiliation(s)
- Christine Desmedt
- 1Laboratory for Translation Breast Cancer Research/KU Leuven, Belgium
| | - Ha-Linh Nguyen
- 2Laboratory for Translational Breast Cancer Research, Department of Oncology, Leuven, Vlaams-Brabant, Belgium
| | - François Richard
- 3Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Sabine Linn
- 4Netherlands Cancer Institute, Amsterdam, Netherlands, Netherlands
| | - Otto Metzger
- 5Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Coralie Poncet
- 6European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium, Brussels, Belgium
| | | | | | | | | | | | | | - Etienne Brain
- 13European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | | | | | - Karen Van Baelen
- 16Laboratory for Translational Breast Cancer Research, Department of Oncology, Leuven, Vlaams-Brabant, Belgium
| | - Marion Maetens
- 17Laboratory for Translational Breast Cancer Research, KU Leuven, Leuven, Belgium, Belgium
| | - Emiel Rutgers
- 18Department of Surgical Oncology, Netherlands Cancer Institute
| | - Martine Piccart
- 19Institut Jules Bordet – Université Libre de Bruxelles, Brussels, Belgium, Anderlecht, Brussels Hoofdstedelijk Gewest, Belgium
| | | | - Giuseppe Viale
- 21European Institute of Oncology IRCCS, and University of Milan, Milan, Italy, Milan, Italy
| | - Fatima Cardoso
- 22Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal, Lisbon, Portugal
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4
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Nguyen HL, Geukens T, Maetens M, Van Baelen K, De Schepper M, Poncet C, Delorenzi M, Schmid MK, Rutgers E, Van ’t Veer L, Piccart M, Cardoso F, Viale G, Bassez A, Vos H, Neven P, Nevelsteen I, Punie K, Wildiers H, Floris G, Lambrechts D, Smeets A, Biganzoli E, Richard F, Desmedt C. Abstract PD4-06: PD4-06 Obesity-associated changes in transcriptomic profile and immune landscape of primary breast cancer revealed by bulk and single-cell gene expression data. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd4-06] [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
Background: Breast cancer (BC) is one of the cancer types recognized as an obesity-associated disease. Current understandings of molecular mechanisms underlying the BC-obesity connection however largely came from experimental models while systematic investigation of the impact of obesity on BC biology in large patient series is still lacking. The purpose of this study is to discover changes in the transcriptomic profile of primary BC according to patients’ body mass index (BMI). Data and Methods: Bulk and single-cell gene expression data from treatment-naïve primary breast tumors from non-underweight patients were retrieved from the MINDACT trial (NCT00433589; N = 1481) and the pre-treatment cohort of the BioKey trial (NCT03197389, N = 36), respectively. Three categories were considered for BMI: lean, overweight and obese. The main analyses focused on the invasive carcinoma of no special type (NST) estrogen receptor-positive/HER2-negative (ER+/HER2-, N_bulk = 735, N_single-cell(sc) = 10) and NST ER-/HER2- (N_bulk = 118, N_sc = 15) subgroups. The bulk expression data was subjected to differential gene expression analyses according to BMI which was adjusted for menopausal status and tumor grade, then followed by gene set enrichment analyses. Clustering and cluster annotation were performed on the single-cell profiling data before differentially expressed genes according to BMI were identified for each of the present cell types. Results: Obesity-associated differences in the transcriptomic profile of breast tumors, which were subtle but potentially indicative of a biological relationship, were revealed by the bulk data. In both investigated subgroups, tumors from obese patients were shown to be enriched in cell cycle hallmarks. In ER-/HER2- tumors, adiposity further increased MYC signaling. We also observed different obesity-associated changes according to the ER status. Among ER+/HER2- tumors, those from obese patients were enriched in hallmarks related to inflammatory response compared to those from lean patients. In contrast, these hallmarks appeared to be enriched in the ER-/HER2- tumors from lean patients. Our investigation of the single-cell data further revealed shifts in the cell composition of tumor tissue and cell type-specific transcriptomic differences according to BMI which were more pronounced than those detected from the bulk data. ER+/HER2- tumors from obese patients have a higher frequency of immunosuppressive and pro-tumoral cell subpopulations such as dendritic cells (DC) enriched in immunoregulatory molecules (p = .03), LYVE1+ macrophages (p = .02) and myofibroblasts (p = .03) than those from lean patients. Overexpression of Cyclin D1 and CD24 was found in cancer cells in ER+/HER2- tumors from obese patients. A reduction in anti-tumor immune responses was evident with downregulation of multiple interferons in CD8+ and CD4+ T cells as well as B cells. We observed in the ER-/HER2- subgroup increased infiltration of plasmacytoid DC (p = .01), CCL2+ macrophages (p = .01) in tumors from obese versus lean patients, while fibroblasts showed an opposite tendency. Additionally, significant obesity-associated downregulation of major histocompatibility complex (MHC) molecules class I in cancer cells and MHC class II molecules in B cells could be suggestive of deficient antigen presentation and activation of cytotoxic and helper T cells. Conclusion: We highlighted the impact of obesity on the remodeling of tumor and tumor microenvironment which might generally lead to a suppression of anti-tumor immune responses, albeit potentially via diverse axes according to the ER status. Although investigation on a larger cohort is warranted, our current results suggest that obesity-associated transcriptomic changes in BC could be highly cell type-specific, hence we recommend single-cell approaches in addition to spatial multi-omics analysis to further elucidate the interplay between obesity and BC.
Citation Format: Ha-Linh Nguyen, Tatjana Geukens, Marion Maetens, Karen Van Baelen, Maxim De Schepper, Coralie Poncet, Mauro Delorenzi, Marjanka K. Schmid, Emiel Rutgers, Laura Van ’t Veer, Martine Piccart, Fatima Cardoso, Giuseppe Viale, Ayse Bassez, Hanne Vos, Patrick Neven, Ines Nevelsteen, Kevin Punie, Hans Wildiers, Giuseppe Floris, Diether Lambrechts, Ann Smeets, Elia Biganzoli, François Richard, Christine Desmedt. PD4-06 Obesity-associated changes in transcriptomic profile and immune landscape of primary breast cancer revealed by bulk and single-cell gene expression data [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 PD4-06.
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Affiliation(s)
- Ha-Linh Nguyen
- 1Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Tatjana Geukens
- 2Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Marion Maetens
- 3Laboratory for Translational Breast Cancer Research, KU Leuven, Leuven, Belgium
| | - Karen Van Baelen
- 4Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Maxim De Schepper
- 5Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium & Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Coralie Poncet
- 6European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | | | - Marjanka K. Schmid
- 8Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital
| | - Emiel Rutgers
- 9Department of Surgical Oncology, Netherlands Cancer Institute
| | | | - Martine Piccart
- 11Institut Jules Bordet – Université Libre de Bruxelles, Brussels, Anderlecht, Brussels Hoofdstedelijk Gewest, Belgium
| | - Fatima Cardoso
- 12Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Giuseppe Viale
- 13European Institute of Oncology IRCCS, and University of Milan, Milan, Italy
| | - Ayse Bassez
- 14Laboratory for Translational Genetics, Department of Human Genetics, KU Leuven
| | - Hanne Vos
- 15Department of Surgical Oncology, University Hospitals Leuven, KU Leuven
| | - Patrick Neven
- 16Universitair Ziekenhuis Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Ines Nevelsteen
- 17Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Kevin Punie
- 18Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute and University Hospitals Leuven, Belgium
| | | | | | - Diether Lambrechts
- 21Laboratory of Translational Genetics, VIB Center for Cancer Biology, KU Leuven, Leuven
| | - Ann Smeets
- 22Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Elia Biganzoli
- 23Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) “L. Sacco” & DSRC, LITA Vialba campus, University of Milan, Milan, Italy
| | - François Richard
- 24Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Christine Desmedt
- 25Laboratory for Translation Breast Cancer Research/KU Leuven, Belgium
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Hagenaars S, Ravesteijn B, Dekker L, Verhoeff L, Aalberts J, Meershoek-Klein Kranenbarg E, de Vries J, Witkamp A, Schenk K, Keymeulen K, Menke-Pluijmers M, Dassen A, Kortmann B, Rutgers E, Cobbaert C, Luider T, Mesker W, Tollenaar R. Early detection of breast cancer in high-risk women based on longitudinal changes in serum-based proteins: the TESTBREAST study. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lopes Cardozo J, Veira S, Ait Hassou L, Uwimana A, Božović-Spasojević I, Bogaerts J, Cardoso F, Schmidt M, Rutgers E, Poncet C, Drukker C. Agreement on risk assessment and chemotherapy recommendations among breast cancer specialists: a survey within the MINDACT cohort. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01521-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bradley R, Braybrooke J, Gray R, Hills RK, Liu Z, Pan H, Peto R, Dodwell D, McGale P, Taylor C, Francis PA, Gnant M, Perrone F, Regan MM, Berry R, Boddington C, Clarke M, Davies C, Davies L, Duane F, Evans V, Gay J, Gettins L, Godwin J, James S, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Read S, Straiton E, Jakesz R, Fesl C, Pagani O, Gelber R, De Laurentiis M, De Placido S, Gallo C, Albain K, Anderson S, Arriagada R, Bartlett J, Bergsten-Nordström E, Bliss J, Brain E, Carey L, Coleman R, Cuzick J, Davidson N, Del Mastro L, Di Leo A, Dignam J, Dowsett M, Ejlertsen B, Goetz M, Goodwin P, Halpin-Murphy P, Hayes D, Hill C, Jagsi R, Janni W, Loibl S, Mamounas EP, Martín M, Mukai H, Nekljudova V, Norton L, Ohashi Y, Pierce L, Poortmans P, Pritchard KI, Raina V, Rea D, Robertson J, Rutgers E, Spanic T, Sparano J, Steger G, Tang G, Toi M, Tutt A, Viale G, Wang X, Whelan T, Wilcken N, Wolmark N, Cameron D, Bergh J, Swain SM. Aromatase inhibitors versus tamoxifen in premenopausal women with oestrogen receptor-positive early-stage breast cancer treated with ovarian suppression: a patient-level meta-analysis of 7030 women from four randomised trials. Lancet Oncol 2022; 23:382-392. [PMID: 35123662 PMCID: PMC8885431 DOI: 10.1016/s1470-2045(21)00758-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND For women with early-stage oestrogen receptor (ER)-positive breast cancer, adjuvant tamoxifen reduces 15-year breast cancer mortality by a third. Aromatase inhibitors are more effective than tamoxifen in postmenopausal women but are ineffective in premenopausal women when used without ovarian suppression. We aimed to investigate whether premenopausal women treated with ovarian suppression benefit from aromatase inhibitors. METHODS We did a meta-analysis of individual patient data from randomised trials comparing aromatase inhibitors (anastrozole, exemestane, or letrozole) versus tamoxifen for 3 or 5 years in premenopausal women with ER-positive breast cancer receiving ovarian suppression (goserelin or triptorelin) or ablation. We collected data on baseline characteristics, dates and sites of any breast cancer recurrence or second primary cancer, and dates and causes of death. Primary outcomes were breast cancer recurrence (distant, locoregional, or contralateral), breast cancer mortality, death without recurrence, and all-cause mortality. As distant recurrence invariably results in death from breast cancer several years after the occurrence, whereas locoregional recurrence and new contralateral breast cancer are not usually fatal, the distant recurrence analysis is shown separately. Standard intention-to-treat log-rank analyses estimated first-event rate ratios (RR) and their confidence intervals (CIs). FINDINGS We obtained data from all four identified trials (ABCSG XII, SOFT, TEXT, and HOBOE trials), which included 7030 women with ER-positive tumours enrolled between June 17, 1999, and Aug 4, 2015. Median follow-up was 8·0 years (IQR 6·1-9·3). The rate of breast cancer recurrence was lower for women allocated to an aromatase inhibitor than for women assigned to tamoxifen (RR 0·79, 95% CI 0·69-0·90, p=0·0005). The main benefit was seen in years 0-4 (RR 0·68, 99% CI 0·55-0·85; p<0·0001), the period when treatments differed, with a 3·2% (95% CI 1·8-4·5) absolute reduction in 5-year recurrence risk (6·9% vs 10·1%). There was no further benefit, or loss of benefit, in years 5-9 (RR 0·98, 99% CI 0·73-1·33, p=0·89) or beyond year 10. Distant recurrence was reduced with aromatase inhibitor (RR 0·83, 95% CI 0·71-0·97; p=0·018). No significant differences were observed between treatments for breast cancer mortality (RR 1·01, 95% CI 0·82-1·24; p=0·94), death without recurrence (1·30, 0·75-2·25; p=0·34), or all-cause mortality (1·04, 0·86-1·27; p=0·68). There were more bone fractures with aromatase inhibitor than with tamoxifen (227 [6·4%] of 3528 women allocated to an aromatase inhibitor vs 180 [5·1%] of 3502 women allocated to tamoxifen; RR 1·27 [95% CI 1·04-1·54]; p=0·017). Non-breast cancer deaths (30 [0·9%] vs 24 [0·7%]; 1·30 [0·75-2·25]; p=0·36) and endometrial cancer (seven [0·2%] vs 15 [0·3%]; 0·52 [0·22-1·23]; p=0·14) were rare. INTERPRETATION Using an aromatase inhibitor rather than tamoxifen in premenopausal women receiving ovarian suppression reduces the risk of breast cancer recurrence. Longer follow-up is needed to assess any impact on breast cancer mortality. FUNDING Cancer Research UK, UK Medical Research Council.
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Hagenaars S, Ravesteijn B, Dekker L, Verhoeff L, Aalberts J, Meershoek-Klein Kranenbarg E, de Vries J, Witkamp A, Schenk K, Keymeulen K, Menke-Pluijmers M, Dassen A, Kortmann B, Rutgers E, Cobbaert C, Luider T, Mesker W, Tollenaar R. Identifying a protein panel for early cancer detection for women at high risk for breast cancer; first results from the multicenter TESTBREAST study. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2021.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van Huizum MA, Hage JJ, Russell NS, Rutgers E, Woerdeman LAE. Combined skin-sparing mastectomy and immediate implant-based breast reconstruction: Outcome following mantle field irradiation versus outcome following whole-breast irradiation. J Plast Reconstr Aesthet Surg 2021; 75:94-103. [PMID: 34483080 DOI: 10.1016/j.bjps.2021.08.003] [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: 06/24/2020] [Revised: 04/13/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mastectomy may be needed in the context of previous radiotherapy in cases of breast carcinoma following mantle field radiotherapy for Hodgkin lymphoma or in cases of local relapse or second primary tumours after breast conserving therapy including whole-breast irradiation (BCT). The outcome of combined skin-sparing mastectomy and immediate implant-based breast reconstruction (SSM-IIBR) has been reported to be unfavourable in these cases. PURPOSE To compare the outcome of SSM-IIBR after mantle field radiotherapy to that after BCT and to compare both to the outcome observed in non-irradiated breasts. METHODOLOGY The prevalences of short-term events, device loss, long-term corrections and secondary reconstructions, and reversion to autologous tissue techniques of 42 SSM-IIBRs performed after mantle field irradiation were compared to those of 47 salvage SSM-IIBRs following BCT. Both outcomes were compared to the outcome in the contralateral, non-irradiated breast of the subgroup of 23 women in the BCT group. RESULTS The groups were comparable in terms of patient- and procedure-related risk factors, except for time lapse after previous therapy, intraoperative device weight, and the fraction of immediate use of a definitive implant. The outcome of SSM-IIBR after mantle field irradiation significantly differs favourably from that after BCT. It matches the outcome observed in non-irradiated breasts. CONCLUSION Skin-sparing mastectomy combined with immediate implant-based breast reconstruction is a fully justifiable option for women who previously underwent mantle field irradiation for Hodgkin lymphoma. We feel that the unfavourable outcome observed in women who previously underwent BCT necessitates an alternative reconstructive modality.
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Affiliation(s)
- Martine A van Huizum
- The Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - J Joris Hage
- The Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
| | - Nicola S Russell
- Department of Radiotherapy at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Emiel Rutgers
- Department of Surgical Oncology at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Leonie A E Woerdeman
- The Department of Plastic and Reconstructive Surgery at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
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Bradley R, Braybrooke J, Gray R, Hills R, Liu Z, Peto R, Davies L, Dodwell D, McGale P, Pan H, Taylor C, Anderson S, Gelber R, Gianni L, Jacot W, Joensuu H, Moreno-Aspitia A, Piccart M, Press M, Romond E, Slamon D, Suman V, Berry R, Boddington C, Clarke M, Davies C, Duane F, Evans V, Gay J, Gettins L, Godwin J, James S, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Read S, Straiton E, Wang Y, Crown J, de Azambuja E, Delaloge S, Fung H, Geyer C, Spielmann M, Valagussa P, Albain K, Anderson S, Arriagada R, Bartlett J, Bergsten-Nordström E, Bliss J, Brain E, Carey L, Coleman R, Cuzick J, Davidson N, Del Mastro L, Di Leo A, Dignam J, Dowsett M, Ejlertsen B, Francis P, Gnant M, Goetz M, Goodwin P, Halpin-Murphy P, Hayes D, Hill C, Jagsi R, Janni W, Loibl S, Mamounas EP, Martín M, Mukai H, Nekljudova V, Norton L, Ohashi Y, Pierce L, Poortmans P, Raina V, Rea D, Regan M, Robertson J, Rutgers E, Spanic T, Sparano J, Steger G, Tang G, Toi M, Tutt A, Viale G, Wang X, Whelan T, Wilcken N, Wolmark N, Cameron D, Bergh J, Pritchard KI, Swain SM. Trastuzumab for early-stage, HER2-positive breast cancer: a meta-analysis of 13 864 women in seven randomised trials. Lancet Oncol 2021; 22:1139-1150. [PMID: 34339645 PMCID: PMC8324484 DOI: 10.1016/s1470-2045(21)00288-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Trastuzumab targets the extracellular domain of the HER2 protein. Adding trastuzumab to chemotherapy for patients with early-stage, HER2-positive breast cancer reduces the risk of recurrence and death, but is associated with cardiac toxicity. We investigated the long-term benefits and risks of adjuvant trastuzumab on breast cancer recurrence and cause-specific mortality. METHODS We did a collaborative meta-analysis of individual patient data from randomised trials assessing chemotherapy plus trastuzumab versus the same chemotherapy alone. Randomised trials that enrolled women with node-negative or node-positive, operable breast cancer were included. We collected individual patient-level data on baseline characteristics, dates and sites of first distant breast cancer recurrence and any previous local recurrence or second primary cancer, and the date and underlying cause of death. Primary outcomes were breast cancer recurrence, breast cancer mortality, death without recurrence, and all-cause mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, oestrogen receptor (ER) status, and trial yielded first-event rate ratios (RRs). FINDINGS Seven randomised trials met the inclusion criteria, and included 13 864 patients enrolled between February, 2000, and December, 2005. Mean scheduled treatment duration was 14·4 months and median follow-up was 10·7 years (IQR 9·5 to 11·9). The risks of breast cancer recurrence (RR 0·66, 95% CI 0·62 to 0·71; p<0·0001) and death from breast cancer (0·67, 0·61 to 0·73; p<0·0001) were lower with trastuzumab plus chemotherapy than with chemotherapy alone. Absolute 10-year recurrence risk was reduced by 9·0% (95% CI 7·4 to 10·7; p<0·0001) and 10-year breast cancer mortality was reduced by 6·4% (4·9 to 7·8; p<0·0001), with a 6·5% reduction (5·0 to 8·0; p<0·0001) in all-cause mortality, and no increase in death without recurrence (0·4%, -0·3 to 1·1; p=0·35). The proportional reduction in recurrence was largest in years 0-1 after randomisation (0·53, 99% CI 0·46 to 0·61), with benefits persisting through years 2-4 (0·73, 0·62 to 0·85) and 5-9 (0·80, 0·64 to 1·01), and little follow-up beyond year 10. Proportional recurrence reductions were similar irrespective of recorded patient and tumour characteristics, including ER status. The more high risk the tumour, the larger the absolute reductions in 5-year recurrence (eg, 5·7% [95% CI 3·1 to 8·3], 6·8% [4·7 to 9·0], and 10·7% [7·7 to 13·6] in N0, N1-3, and N4+ disease). INTERPRETATION Adding trastuzumab to chemotherapy for early-stage, HER2-positive breast cancer reduces recurrence of, and mortality from, breast cancer by a third, with worthwhile proportional reductions irrespective of recorded patient and tumour characteristics. FUNDING Cancer Research UK, UK Medical Research Council.
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Rutgers E. Neoadjuvant chemotherapy. How to work together – the coordination of the multidisciplinary breast team: a logistical challenge. Breast 2021. [DOI: 10.1016/s0960-9776(21)00083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Tilanus-Linthorst M, Geuzinge A, Obdeijn I, Rutgers E, Mann R, Saadatmand S, de Roy van Zuidewijn D, Oosterwijk J, Tollenaar R, Ausems M, van 't Riet M, Margrethe S, Hooning M, Wesseling J, Kristine K, Luiten E, Verhoef C, Heijnsdijk E, de Koning H. FaMRIsc trial shows: MRI breast screening for women with ≥20% lifetime risk is also cost-effective in Europe. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Metzger O, Cardoso F, Poncet C, Desmedt C, Linn S, Wesseling J, Hilbers F, Aalders K, Delorenzi M, Delaloge S, Pierga J, Brain E, Vrijaldenhoven S, Neijenhuis P, Rutgers E, Piccart M, van ’t Veer L, Viale G. Clinical utility of MammaPrint testing in Invasive Lobular Carcinoma: Results from the MINDACT phase III trial. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30542-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jacob L, Witteveen A, Beumer I, Delahaye L, Wehkamp D, van den Akker J, Snel M, Chan B, Floore A, Bakx N, Brink G, Poncet C, Bogaerts J, Delorenzi M, Piccart M, Rutgers E, Cardoso F, Speed T, van 't Veer L, Glas A. Controlling technical variation amongst 6693 patient microarrays of the randomized MINDACT trial. Commun Biol 2020; 3:397. [PMID: 32719399 PMCID: PMC7385160 DOI: 10.1038/s42003-020-1111-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/03/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022] Open
Abstract
Gene expression data obtained in large studies hold great promises for discovering disease signatures or subtypes through data analysis. It is also prone to technical variation, whose removal is essential to avoid spurious discoveries. Because this variation is not always known and can be confounded with biological signals, its removal is a challenging task. Here we provide a step-wise procedure and comprehensive analysis of the MINDACT microarray dataset. The MINDACT trial enrolled 6693 breast cancer patients and prospectively validated the gene expression signature MammaPrint for outcome prediction. The study also yielded a full-transcriptome microarray for each tumor. We show for the first time in such a large dataset how technical variation can be removed while retaining expected biological signals. Because of its unprecedented size, we hope the resulting adjusted dataset will be an invaluable tool to discover or test gene expression signatures and to advance our understanding of breast cancer.
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Affiliation(s)
- Laurent Jacob
- Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | | | - Inès Beumer
- Agendia NV/Agendia Inc, Amsterdam, The Netherlands
| | | | | | | | | | - Bob Chan
- Agendia NV/Agendia Inc, Amsterdam, The Netherlands
| | - Arno Floore
- Agendia NV/Agendia Inc, Amsterdam, The Netherlands
| | - Niels Bakx
- Agendia NV/Agendia Inc, Amsterdam, The Netherlands
| | - Guido Brink
- Agendia NV/Agendia Inc, Amsterdam, The Netherlands
| | | | | | - Mauro Delorenzi
- University Lausanne, Lausanne, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | - Emiel Rutgers
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Terence Speed
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Laura van 't Veer
- Agendia NV/Agendia Inc, Amsterdam, The Netherlands.
- Helen Diller Family Comprehensive Cancer Center, University California San Francisco, San Francisco, CA, USA.
| | - Annuska Glas
- Agendia NV/Agendia Inc, Amsterdam, The Netherlands.
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Delaloge S, Piccart M, Rutgers E, Litière S, van 't Veer LJ, van den Berkmortel F, Brain E, Dudek-Peric A, Gil-Gil M, Gomez P, Hilbers FS, Khalil Z, Knox S, Kuemmel S, Kunz G, Lesur A, Pierga JY, Ravdin P, Rubio IT, Saghatchian M, Smilde TJ, Thompson AM, Viale G, Zoppoli G, Vuylsteke P, Tryfonidis K, Poncet C, Bogaerts J, Cardoso F. Standard Anthracycline Based Versus Docetaxel-Capecitabine in Early High Clinical and/or Genomic Risk Breast Cancer in the EORTC 10041/BIG 3-04 MINDACT Phase III Trial. J Clin Oncol 2020; 38:1186-1197. [PMID: 32083990 DOI: 10.1200/jco.19.01371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE MINDACT demonstrated that 46% of patients with early breast cancer at high clinical but low genomic risk on the basis of MammaPrint may safely avoid adjuvant chemotherapy. A second random assignment (R-C) compared docetaxel-capecitabine with an anthracycline-based regimen. PATIENTS AND METHODS R-C randomly assigned patients 1:1 between standard anthracycline-based regimens, with or without taxanes (control) and experimental docetaxel 75 mg/m2 intravenously plus oral capecitabine 825 mg/m2 two times per day for 14 days (DC) every 3 weeks for 6 cycles. The primary end point was disease-free survival (DFS). Secondary end points included overall survival and safety. RESULTS Of 2,832 patients, 1,301 (45%) were randomly assigned, and 97% complied with R-C assignment. In the control arm, 29.6% only received taxanes (0.5% of N0 patients). DFS events (n = 148) were much less than required (n = 422) as a result of a lower-than-expected accrual and event rate. At 5 years of median follow-up, DFS was not different between DC (n = 652) and control (n = 649; 90.7% [95% CI, 88% to 92.8%] v 88.8% [95% CI, 85.9% to 91.1%]; hazard ratio [HR], 0.83 [95% CI, 0.60 to 1.15]; P = .26). Overall survival (HR, 0.91 [95% CI, 0.54 to 1.53]) and DFS in the clinical high and genomic high-risk subgroup (86.1% v 88.1%; HR, 0.83 [95% CI, 0.58 to 1.21]) were similar in both arms. DC led to more grade 1 neuropathy (27.1% v 11.2%) and more grade 2 hand/foot syndrome (28.5% v 3.3%) and diarrhea (13.7% v 5.8%). Serious cardiac events occurred in 9 patients (control, n = 4; DC, n = 5). Fifty-three patients developed second cancers (control, n = 32; DC, n = 21; leukemia: 2 v 1). Five treatment-related deaths occurred (control, 2 [0.3%]; DC, 3 [0.5%]). CONCLUSION Although underpowered, this second randomization in MINDACT did not show any improvement in outcome or safety with the use of DC compared with anthracycline-based chemotherapy.
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Affiliation(s)
- Suzette Delaloge
- Gustave Roussy, Villejuif, France.,Unicancer Breast Group, Paris, France
| | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Emiel Rutgers
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Saskia Litière
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Laura J van 't Veer
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | | | - Etienne Brain
- Institut Curie-Hôpital Rene Huguenin, Saint-Cloud, France
| | | | - Miguel Gil-Gil
- Institut Catala D'Oncologia-Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet, Barcelona, Spain
| | | | | | - Zaman Khalil
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Susan Knox
- Europa Donna-The European Breast Cancer Coalition, Milan, Italy
| | - Sherko Kuemmel
- Breast Unit Kliniken Essen-Mitte, Westdeutsche Studiengruppe, Mönchengladbach, Germany
| | | | - Anne Lesur
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | - Jean-Yves Pierga
- Institut Curie-Hôpital Rene Huguenin, Saint-Cloud, France.,Institut Curie Paris Sciences et Lettres, Université de Paris, Paris, France
| | - Peter Ravdin
- The University of Texas Health Sciences Center, San Antonio, TX
| | - Isabel T Rubio
- Clinica Universidad de Navarra-Site Madrid, Madrid, Spain
| | | | | | | | - Giuseppe Viale
- University of Milan and European Institute of Oncology-Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gabriele Zoppoli
- University of Genoa and Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Peter Vuylsteke
- Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
| | | | - Coralie Poncet
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Jan Bogaerts
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Fatima Cardoso
- Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
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Piccart MJ, Poncet C, Cardoso F, van't Veer L, Delaloge S, Pierga JY, Brain E, Vrijaldenhoven S, Neijenhuis P, Aalders K, Rutgers E. Abstract GS4-05: Should age be integrated together with clinical and genomic risk for adjuvant chemotherapy decision in early luminal breast cancer? MINDACT results compared to those of TAILOR-X. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-gs4-05] [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: A secondary analysis of the TAILOR-X trial, based on the integration of a “clinical risk” - as defined in the MINDACT trial - on top of the Oncotype Recurrence Score (RS) revealed that women aged 40 to 50 years with either a RS between 16 and 20 and a high clinical risk (cH) or a RS between 21 and 25, independently from clinical risk, derive non negligible benefits from the addition of chemotherapy to endocrine therapy, in terms of distant recurrence rate at 9 years (J.A. Sparano et al., N Engl J. Med 2019; 380).
Methods: We decided to run a similar (unplanned) analysis of the MINDACT “cH” patients with “luminal” breast cancers (hormone receptor-positive, HER2-negative by local pathology) classified as “low” genomic risk (gL) using the 70 gene signature MammaprintTM (F. Cardoso, N. Engl. J. Med. 2016; 375). Analysis is done as per treatment arm allocated (chemotherapy or no chemotherapy) by randomization. MINDACT primary endpoint was used (5-year distant metastases free survival, DMFS). Of note, the comparison of outcomes with or without chemotherapy was a secondary objective in MINDACT.
Results: Among 6693 enrolled patients, 5402 (81.7%) had luminal breast cancers. Within luminal breast cancers, 1358 (25.1%) had cH/gL risk and were aged <40 (n= 53), 40-50 years old (n= 411), >50 (n = 894). There were too few DMFS events (n = 2) in the <40 year old group to display further results. The analysis population included patients randomized to receive chemotherapy or not (399 patients aged 40-50 and 865 patients >50 years old). Median tumor size was 2.2 cm in both age groups (40-50 years old group: 35.9%/58.4% patients hadT1/T2 tumors, respectively; >50 years old: T1/T2: 41.2%/55.5%). Half of the patients had negative nodal status (40-50 year old: 50.9%; >50 years old: 51.8%). Majority of patients had grade 2 or grade 3 tumors (40-50 years old: 63.9% grade 2 and 26.6% grade 3; >50 year sold: 66.6% grade 2 and 26.9% grade 3).
Luminal cH/gL, 40-50y old patients N = 399Luminal cH/gL > 50y old patients N = 865Events / total5-year Kaplan Meier DMFS estimate (95% CI)Events / total5-year Kaplan Meier DMFS estimate (95% CI)No chemotherapy16/19692.6% (87.7; 95.7)23/44095.4% (92.8; 97.1)Chemotherapy8/20396.2% (91.5; 98.3)23/42595.2% (92.4; 97.0)
Conclusions: While postmenopausal patients primarily received aromatase inhibitors, adjuvant endocrine therapy consisted mostly in tamoxifen in younger women with only 7.0% of them also receiving an LHRH analog.
This unplanned analysis, limited by a small number of events and large confidence intervals, nevertheless shows the same « trend » as seen in Tailor-X and also suggests that women aged 40 to 50, classified cH / gL risk and presumably premenopausal, might be undertreated with tamoxifen alone. It is probable but not proven that this age-dependent chemotherapy effect is due to ovarian function suppression (OFS). The added value of chemotherapy in case of optimal endocrine therapy (i.e. OFS + tamoxifen or aromatase inhibitor) cannot be evaluated in MINDACT nor in TailorX and should be further studied. Possibly, optimal endocrine therapy, e.g. ovarian ablation in addition to tamoxifene in the 40-50y age group cH could be adequate. This reinforced message is important for practicing oncologists and patients.
Citation Format: Martine J Piccart, Coralie Poncet, Fatima Cardoso, Laura van't Veer, Suzette Delaloge, Jean-Yves Pierga, Etienne Brain, Suzan Vrijaldenhoven, P.A. Neijenhuis, Kim Aalders, Emiel Rutgers. Should age be integrated together with clinical and genomic risk for adjuvant chemotherapy decision in early luminal breast cancer? MINDACT results compared to those of TAILOR-X [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 GS4-05.
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Affiliation(s)
- Martine J Piccart
- 1Institute Jules Bordet, Université Libre de Belgique, Brussels, Belgium
| | - Coralie Poncet
- 2European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Fatima Cardoso
- 3Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | | | | | - Jean-Yves Pierga
- 6Institut Curie Paris & St Cloud, Université Paris Descartes, Paris, France
| | - Etienne Brain
- 7Institut Curie - Hôpital Rene Huguenin, Saint Cloud, France
| | | | - P.A. Neijenhuis
- 9Rijnland Ziekenhuis-Alrijne Zorgroep, Leiderdop, Netherlands
| | | | - Emiel Rutgers
- 11Netherlands Cancer Institute, Amsterdam, Netherlands
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Geuzinge A, Saadatmand S, Rutgers E, Obdeijn IM, de Roy van Zuidewijn D, Tollenaar R, Margrethe SV, Riet MV', Hooning M, Wesseling J, Mares-Engelberts I, Ausems M, Keymeulen K, Zonderland H, Heijnsdijk E, Luiten E, Verhoef C, Oosterwijk J, de Koning H, Tilanus-Linthorst M. Famrisc, a RCT comparing mammography with MRI in screening for familial risk. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bosma SCJ, Leij F, Vreeswijk S, Maaker MD, Wesseling J, Vijver MVD, Scholten A, Rivera S, Bourgier C, Auzac G, Foukakis T, Lekberg T, Bongard D, Loo C, Rutgers E, Bartelink H, Elkhuizen PHM. Five-Year Results of the Preoperative Accelerated Partial Breast Irradiation (PAPBI) Trial. Int J Radiat Oncol Biol Phys 2020; 106:958-967. [PMID: 31987957 DOI: 10.1016/j.ijrobp.2019.12.037] [Citation(s) in RCA: 11] [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: 09/02/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE In this multicenter phase 2 feasibility study, we investigated the impact of preoperative accelerated partial breast irradiation (PAPBI) on local control, breast fibrosis, and cosmetic outcome. METHODS AND MATERIALS Women aged >60 years with an invasive, unifocal (mammography and magnetic resonance imaging), nonlobular adenocarcinoma of the breast were treated with PAPBI. Six weeks after radiation therapy, a wide local excision was performed. Radiation therapy consisted of 10 × 4 Gy (2010-2013) or 5 × 6 Gy (after 2013) to the tumor (gross target volume) with a 25 mm margin (20 mm from gross target volume to clinical target volume, 5 mm planning target volume). RESULTS One hundred thirty-three patients treated between 2010 and 2016 were analyzed with a median follow-up of 5.0 years (0.9-8.8 years). Seventy-eight (59%) patients were treated with 10 × 4 Gy in 2 weeks and 55 (41%) patients with 5 × 6 Gy in 1 week. Eighteen postoperative complications (14%) occurred in 15 patients (11%). The proportion of patients with no to mild fibrosis in the treated part of the breast at 2 years and later time points was around 90%. Cosmesis improved over time in several patients: excellent to good cosmetic score as rated by the physician was 68% at 6 months and 92% at 5 years. Seventy-seven percent (6 months) to 82% (5 years) of patients were "satisfied" or "very satisfied" with their cosmetic outcome. Three recurrences were detected in the biopsy track and 1 recurrence in the ipsilateral breast. CONCLUSIONS PAPBI is a feasible method with a low postoperative complication rate, limited fibrosis, and good to excellent cosmetic outcome. The local recurrence rate was 3% at 5 years; however, no local recurrences were observed since removal of the needle biopsy track.
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Affiliation(s)
- Sophie C J Bosma
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Femke Leij
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sandra Vreeswijk
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel de Maaker
- Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Astrid Scholten
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sofia Rivera
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Celine Bourgier
- Department of Radiation Oncology, Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France
| | - Guillaume Auzac
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Theodoros Foukakis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Lekberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Desiree Bongard
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands
| | - Claudette Loo
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Emiel Rutgers
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Harry Bartelink
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paula H M Elkhuizen
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Gray R, Bradley R, Braybrooke J, Liu Z, Peto R, Davies L, Dodwell D, McGale P, Pan H, Taylor C, Barlow W, Bliss J, Bruzzi P, Cameron D, Fountzilas G, Loibl S, Mackey J, Martin M, Del Mastro L, Möbus V, Nekljudova V, De Placido S, Swain S, Untch M, Pritchard KI, Bergh J, Norton L, Boddington C, Burrett J, Clarke M, Davies C, Duane F, Evans V, Gettins L, Godwin J, Hills R, James S, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Read S, Wang Y, Wang Z, Fasching P, Harbeck N, Piedbois P, Gnant M, Steger G, Di Leo A, Dolci S, Francis P, Larsimont D, Nogaret JM, Philippson C, Piccart M, Linn S, Peer P, Tjan-Heijnen V, Vliek S, Mackey J, Slamon D, Bartlett J, Bramwell VH, Chen B, Chia S, Gelmon K, Goss P, Levine M, Parulekar W, Pater J, Rakovitch E, Shepherd L, Tu D, Whelan T, Berry D, Broadwater G, Cirrincione C, Muss H, Weiss R, Shan Y, Shao YF, Wang X, Xu B, Zhao DB, Bartelink H, Bijker N, Bogaerts J, Cardoso F, Cufer T, Julien JP, Poortmans P, Rutgers E, van de Velde C, Carrasco E, Segui MA, Blohmer JU, Costa S, Gerber B, Jackisch C, von Minckwitz G, Giuliano M, De Laurentiis M, Bamia C, Koliou GA, Mavroudis D, A'Hern R, Ellis P, Kilburn L, Morden J, Yarnold J, Sadoon M, Tulusan AH, Anderson S, Bass G, Costantino J, Dignam J, Fisher B, Geyer C, Mamounas EP, Paik S, Redmond C, Wickerham DL, Venturini M, Bighin C, Pastorino S, Pronzato P, Sertoli MR, Foukakis T, Albain K, Arriagada R, Bergsten Nordström E, Boccardo F, Brain E, Carey L, Coates A, Coleman R, Correa C, Cuzick J, Davidson N, Dowsett M, Ewertz M, Forbes J, Gelber R, Goldhirsch A, Goodwin P, Hayes D, Hill C, Ingle J, Jagsi R, Janni W, Mukai H, Ohashi Y, Pierce L, Raina V, Ravdin P, Rea D, Regan M, Robertson J, Sparano J, Tutt A, Viale G, Wilcken N, Wolmark N, Wood W, Zambetti M. Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials. Lancet 2019; 393:1440-1452. [PMID: 30739743 PMCID: PMC6451189 DOI: 10.1016/s0140-6736(18)33137-4] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/11/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasing the dose intensity of cytotoxic therapy by shortening the intervals between cycles, or by giving individual drugs sequentially at full dose rather than in lower-dose concurrent treatment schedules, might enhance efficacy. METHODS To clarify the relative benefits and risks of dose-intense and standard-schedule chemotherapy in early breast cancer, we did an individual patient-level meta-analysis of trials comparing 2-weekly versus standard 3-weekly schedules, and of trials comparing sequential versus concurrent administration of anthracycline and taxane chemotherapy. The primary outcomes were recurrence and breast cancer mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, and trial, yielded dose-intense versus standard-schedule first-event rate ratios (RRs). FINDINGS Individual patient data were provided for 26 of 33 relevant trials identified, comprising 37 298 (93%) of 40 070 women randomised. Most women were aged younger than 70 years and had node-positive disease. Total cytotoxic drug usage was broadly comparable in the two treatment arms; colony-stimulating factor was generally used in the more dose-intense arm. Combining data from all 26 trials, fewer breast cancer recurrences were seen with dose-intense than with standard-schedule chemotherapy (10-year recurrence risk 28·0% vs 31·4%; RR 0·86, 95% CI 0·82-0·89; p<0·0001). 10-year breast cancer mortality was similarly reduced (18·9% vs 21·3%; RR 0·87, 95% CI 0·83-0·92; p<0·0001), as was all-cause mortality (22·1% vs 24·8%; RR 0·87, 95% CI 0·83-0·91; p<0·0001). Death without recurrence was, if anything, lower with dose-intense than with standard-schedule chemotherapy (10-year risk 4·1% vs 4·6%; RR 0·88, 95% CI 0·78-0·99; p=0·034). Recurrence reductions were similar in the seven trials (n=10 004) that compared 2-weekly chemotherapy with the same chemotherapy given 3-weekly (10-year risk 24·0% vs 28·3%; RR 0·83, 95% CI 0·76-0·91; p<0·0001), in the six trials (n=11 028) of sequential versus concurrent anthracycline plus taxane chemotherapy (28·1% vs 31·3%; RR 0·87, 95% CI 0·80-0·94; p=0·0006), and in the six trials (n=6532) testing both shorter intervals and sequential administration (30·4% vs 35·0%; RR 0·82, 95% CI 0·74-0·90; p<0·0001). The proportional reductions in recurrence with dose-intense chemotherapy were similar and highly significant (p<0·0001) in oestrogen receptor (ER)-positive and ER-negative disease and did not differ significantly by other patient or tumour characteristics. INTERPRETATION Increasing the dose intensity of adjuvant chemotherapy by shortening the interval between treatment cycles, or by giving individual drugs sequentially rather than giving the same drugs concurrently, moderately reduces the 10-year risk of recurrence and death from breast cancer without increasing mortality from other causes. FUNDING Cancer Research UK, Medical Research Council.
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Bosma S, Leij van der F, Vreeswijk S, Vijver van der M, Rivera S, Foukakis T, Bongard van den D, Rutgers E, Scholten A, Bartelink H, Elkhuizen P. OC-0592 5 year results of the Preoperative Accelerated Partial Breast Irradiation (PAPBI) trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rutgers E. Is prophylactic mastectomy justified in women without BRCA mutation? Breast 2019. [DOI: 10.1016/s0960-9776(19)30087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Rutgers E, Balmana J, Beishon M, Benn K, Evans DG, Mansel R, Pharoah P, Perry Skinner V, Stoppa-Lyonnet D, Travado L, Wyld L. European Breast Cancer Council manifesto 2018: Genetic risk prediction testing in breast cancer. Eur J Cancer 2019; 106:45-53. [PMID: 30471647 DOI: 10.1016/j.ejca.2018.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/26/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 12/17/2022]
Abstract
European Breast Cancer Council manifesto and supporting article on genetic risk prediction testing in breast cancer, presented at the 11th European Breast Cancer Conference in Barcelona, Spain.
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Affiliation(s)
- Emiel Rutgers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Judith Balmana
- Medical Oncology Department, University Hospital Vall D'Hebron, Barcelona, Spain
| | | | - Karen Benn
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - D Gareth Evans
- Department of Genomic Medicine, Division of Evolution and Genomic Science, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Robert Mansel
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Paul Pharoah
- Department of Oncology, Cambridge, United Kingdom; Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Victoria Perry Skinner
- Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Dominique Stoppa-Lyonnet
- Department of Genetics, Institut Curie, Paris, France; University Paris Descartes, Paris, France
| | - Luzia Travado
- Psycho-Oncology, Champalimaud Clinical Center, Lisbon, Portugal
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom; Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, United Kingdom
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Visser L, Hoogstraat M, Elshof L, Leeuwen FV, Rutgers E, Schaapveld M, Schmidt M, Lips E, Wesseling J. PO-070 Identification of risk factors for subsequent invasive breast cancer after primary DCIS by transcriptomic profiling. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rutgers E, Aalders K, Poncet C, Cardoso F, Bogaerts J, Delaloge S, Thompson A, Tryfonidis K, Van’t Veer L, Piccart M, Rubio I. Very low risk of locoregional breast cancer recurrence in the EORTC 10041/BIG 03-04 MINDACT trial: Analysis of risk factors including the 70-gene signature. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30264-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wesseling J, Elshof LE, Tryfonidis K, Poncet C, Aalders K, van Leeuwen-Stok E, Skinner V, Loo C, Winter-Warnars G, Bleiker E, Retèl V, Pijnappel R, Bijker N, Rutgers E, van Duijnhoven F. Abstract OT3-07-01: Update of the randomized, non-inferiority LORD trial testing safety of active surveillance for women with screen-detected low risk ductal carcinoma in situ (EORTC-1401-BCG/BOOG 2014-04, DCIS). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-07-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The introduction of population-based breast cancer screening and implementation of digital mammography have led to an increased incidence of ductal carcinoma in situ (DCIS) without a decrease in the incidence of advanced breast cancer. This suggests DCIS overdiagnosis exists.
We hypothesize that asymptomatic, low-grade DCIS can safely be managed by active surveillance. If progression to invasive breast cancer would still occur, this will be low-grade and hormone receptor positive with excellent survival rates. Also, breast-conserving treatment will still be an option, if no prior radiotherapy has been applied. Management by active surveillance also may save many low-grade DCIS patients intensive treatment.
Therefore, we will compare active surveillance with conventional treatment, being either mastectomy, wide local excision (WLE) only, or WLE plus radiotherapy, possibly followed by hormonal therapy for primary low-grade DCIS. For this, we conduct a phase III, open-label, non-inferiority, multi-center, randomized clinical trial sponsored by the European Organization for Research and Treatment of Cancer (EORTC-1401-BCG). The Dutch Centers are coordinated by the Dutch Breast Cancer Research Group (BOOG) (BOOG 2014-04). This trial is developed and implemented in close collaboration with patient advocates.
Randomization will be in a 1:1 ratio among one of the following arms: (1) active surveillance or (2) standard treatment per local policy. In total, 1,240 women (≥ 45 years) will be included without prior breast cancer, but with asymptomatic, pure, low-grade DCIS, based on a minimum of tissue harvested by biopsy from calcifications detected by population-based or opportunistic screening. Assuming 25% of randomized women qualified to enroll in the study will drop out or will be excluded from per protocol evaluation, at least 1,240 women need to be randomized to obtain the 930 patients required for the evaluation of the primary endpoint. The same follow-up scheme will be applied in both study arms, i.e. annual mammography for a period of 10 years. The primary end-point is ipsilateral invasive breast tumor-free rate at 10 years. Secondary end-points are among others: overall survival, breast cancer-specific survival, mastectomy rate, patient reported outcomes and cost-effectiveness. Accrual has started in the Netherlands in February 2017 and will start internationally in over 30 centers shortly.
Acknowledgements: This trial is funded by Pink Ribbon Netherlands, the Dutch Cancer Society and Dutch Cancer Society/Alpe d'HuZes, and Cancer Research UK.
Citation Format: Wesseling J, Elshof LE, Tryfonidis K, Poncet C, Aalders K, van Leeuwen-Stok E, Skinner V, Loo C, Winter-Warnars G, Bleiker E, Retèl V, Pijnappel R, Bijker N, Rutgers E, van Duijnhoven F. Update of the randomized, non-inferiority LORD trial testing safety of active surveillance for women with screen-detected low risk ductal carcinoma in situ (EORTC-1401-BCG/BOOG 2014-04, DCIS) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-07-01.
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Affiliation(s)
- J Wesseling
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - LE Elshof
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - K Tryfonidis
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - C Poncet
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - K Aalders
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - E van Leeuwen-Stok
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - V Skinner
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - C Loo
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - G Winter-Warnars
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - E Bleiker
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - V Retèl
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - R Pijnappel
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - N Bijker
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - E Rutgers
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
| | - F van Duijnhoven
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Dutch Breast Cancer Research Group (BOOG), Amsterdam, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Dutch Reference Center for Screening, Nijmegen, Netherlands; Academic Medical Center, Amsterdam, Netherlands
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Rutgers E, Aalders K, Poncet C, Bogaerts J, Delaloge S, Rubio I, Thompson A, Tryfonidis K, van 't Veer L, Piccart M, Cardoso F. Abstract P1-07-02: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-07-02] [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
This abstract was withdrawn by the authors.
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Affiliation(s)
- E Rutgers
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; UCSF Helen Diller Family Comprehensive Cancer Center; Institut Jules Bordet, Université Libre de Bruxelles; Breast Cancer Unit, Champalimaud Cancer Center; Institut Gustave Roussy; Hospital Universitario Vall d´hebron; University of Texas M.D. Anderson Cancer Center
| | - K Aalders
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; UCSF Helen Diller Family Comprehensive Cancer Center; Institut Jules Bordet, Université Libre de Bruxelles; Breast Cancer Unit, Champalimaud Cancer Center; Institut Gustave Roussy; Hospital Universitario Vall d´hebron; University of Texas M.D. Anderson Cancer Center
| | - C Poncet
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; UCSF Helen Diller Family Comprehensive Cancer Center; Institut Jules Bordet, Université Libre de Bruxelles; Breast Cancer Unit, Champalimaud Cancer Center; Institut Gustave Roussy; Hospital Universitario Vall d´hebron; University of Texas M.D. Anderson Cancer Center
| | - J Bogaerts
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; UCSF Helen Diller Family Comprehensive Cancer Center; Institut Jules Bordet, Université Libre de Bruxelles; Breast Cancer Unit, Champalimaud Cancer Center; Institut Gustave Roussy; Hospital Universitario Vall d´hebron; University of Texas M.D. Anderson Cancer Center
| | - S Delaloge
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; UCSF Helen Diller Family Comprehensive Cancer Center; Institut Jules Bordet, Université Libre de Bruxelles; Breast Cancer Unit, Champalimaud Cancer Center; Institut Gustave Roussy; Hospital Universitario Vall d´hebron; University of Texas M.D. Anderson Cancer Center
| | - I Rubio
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; UCSF Helen Diller Family Comprehensive Cancer Center; Institut Jules Bordet, Université Libre de Bruxelles; Breast Cancer Unit, Champalimaud Cancer Center; Institut Gustave Roussy; Hospital Universitario Vall d´hebron; University of Texas M.D. Anderson Cancer Center
| | - A Thompson
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; UCSF Helen Diller Family Comprehensive Cancer Center; Institut Jules Bordet, Université Libre de Bruxelles; Breast Cancer Unit, Champalimaud Cancer Center; Institut Gustave Roussy; Hospital Universitario Vall d´hebron; University of Texas M.D. Anderson Cancer Center
| | - K Tryfonidis
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; UCSF Helen Diller Family Comprehensive Cancer Center; Institut Jules Bordet, Université Libre de Bruxelles; Breast Cancer Unit, Champalimaud Cancer Center; Institut Gustave Roussy; Hospital Universitario Vall d´hebron; University of Texas M.D. Anderson Cancer Center
| | - L van 't Veer
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; UCSF Helen Diller Family Comprehensive Cancer Center; Institut Jules Bordet, Université Libre de Bruxelles; Breast Cancer Unit, Champalimaud Cancer Center; Institut Gustave Roussy; Hospital Universitario Vall d´hebron; University of Texas M.D. Anderson Cancer Center
| | - M Piccart
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; UCSF Helen Diller Family Comprehensive Cancer Center; Institut Jules Bordet, Université Libre de Bruxelles; Breast Cancer Unit, Champalimaud Cancer Center; Institut Gustave Roussy; Hospital Universitario Vall d´hebron; University of Texas M.D. Anderson Cancer Center
| | - F Cardoso
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; UCSF Helen Diller Family Comprehensive Cancer Center; Institut Jules Bordet, Université Libre de Bruxelles; Breast Cancer Unit, Champalimaud Cancer Center; Institut Gustave Roussy; Hospital Universitario Vall d´hebron; University of Texas M.D. Anderson Cancer Center
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Aalders K, Genbrugge E, Poncet C, Kuijer A, Pistilli B, Piccart M, Tryfonidis K, van Dalen T, Cardoso F, van 't Veer L, Rutgers E. Abstract P1-07-08: Young age and the risk of disease recurrence as assessed by the 70-gene signature – an analysis from the EORTC 10041/BIG 03-04 MINDACT trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-07-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Purpose: Increased insight in tumor biology has revealed that not all young women are at high risk of disease recurrence. Therefore, in some patients extent of treatment could probably be safely scaled down. We aimed to evaluate the risk of breast cancer (BC) relapse according to the 70-gene signature (70-GS) result in relation to young age, in early-stage BC patients enrolled in the MINDACT trial.
Patients and Methods: The analyzed population consisted of enrolled BC patients in the MINDACT trial with available clinical (C), as per a modified version of Adjuvant!Online, and genomic (G), according to the 70-GS, risk assessments and known age (n=6693). Patients were categorized in three age groups; <45 (young), 45-55 (peri-menopausal) and >55 years (post-menopausal). Clinicopathological and treatment characteristics as well as gene expression were compared for the different age groups further split by corrected risk groups (C-low/G-low, C-low/G-high, C-high/G-low, C-high/G-high). Subsequently, the 5-year distant metastasis-free survival according to risk category was calculated.
Results: The study included 1100 patients <45 (16%), 2272 aged 45-55 (34%) and 3321 patients >55 years of age (50%). Median age of the young group was 41 (25.8-45.0) years. The young age group had a higher frequency of lymph node involvement (25% vs. 22% and 19%), poorly differentiated tumors (42% vs. 26% and 27%), ER-negative tumors (20% vs. 11% and 11%) and triple negative molecular IHC subtype (16% vs. 9% ad 8%). Median tumor size was the same across the 3 age groups (17mm). Of the 1100 young patients, 61% were C-high while the 70-GS assessed 48% as G-high. Overall, 31% were CL/GL (vs. 43% in other age groups), 9% CL/GH, 21% CH/GL and 40% CH/GH (vs. 24% and 25%).
In the discordant risk groups, chemotherapy (CT) allocation when randomized to no chemo occurred in 5% of young women as compared to 3% and 1% in the older age groups. Reason for non-compliance was 50/50 between patient refusal and PI decision.
Overall, the 5-year DMFS was 94.1% (95% CI 92.4-95.4) in <45 age group, 95.3% (95% CI 94.2-96.1) in 45-55 and 94.9% (95% CI 94.0-95.6) in >55. For the young patients, 5-year DMFS was 98.3% for the CL/GL (96.0-99.3), 97.4% in CL/GH (90.0-99.4), 95.5% in CH/GL (91.6-97.7) and 89.2% in CH/GH (85.6-92.0). In the older two age groups (45-55 and >55), the 5-year DMFS rates were 97.8% (96.5.98.6) and 97.2% (96.2-98.0) for CL/GL, 93.9% (88.8-96.7) and 94.5% (91.0-96.7) for CL/GH, 94.5% (92.0-96.3) and 95.4% (93.5-96.8) for CH/GL and 92.0% (89.2-94.1) and 90.4% (88.0-92.4) for CH/GH, respectively. With 9 events in the <45 group at a CH/GL risk, numbers were too small to evaluate chemotherapy effect in this population.
Conclusion: The use of the 70-GS reduces the proportion of patients characterized as high risk as compared to traditional clinical risk assessment (48% vs. 61%). Outcome was comparable for the 3 age categories with a very good 5-year DMFS of 95-98% in all GL groups. Performing the 70-GS provides clinically relevant information concerning the prognosis for young early-stage BC patients categorized as CH. These results add important new data to the limited available evidence on genomic expression in young BC patients.
Citation Format: Aalders K, Genbrugge E, Poncet C, Kuijer A, Pistilli B, Piccart M, Tryfonidis K, van Dalen T, Cardoso F, van 't Veer L, Rutgers E. Young age and the risk of disease recurrence as assessed by the 70-gene signature – an analysis from the EORTC 10041/BIG 03-04 MINDACT trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-08.
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Affiliation(s)
- K Aalders
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Diakonessenhuis Utrecht; Institut Gustave Roussy; Institut Jules Bordet, Universite Libre de Bruxelles; Champalimaud Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Netherlands Cancer Institute/Antoni van Leeuwenhoek
| | - E Genbrugge
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Diakonessenhuis Utrecht; Institut Gustave Roussy; Institut Jules Bordet, Universite Libre de Bruxelles; Champalimaud Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Netherlands Cancer Institute/Antoni van Leeuwenhoek
| | - C Poncet
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Diakonessenhuis Utrecht; Institut Gustave Roussy; Institut Jules Bordet, Universite Libre de Bruxelles; Champalimaud Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Netherlands Cancer Institute/Antoni van Leeuwenhoek
| | - A Kuijer
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Diakonessenhuis Utrecht; Institut Gustave Roussy; Institut Jules Bordet, Universite Libre de Bruxelles; Champalimaud Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Netherlands Cancer Institute/Antoni van Leeuwenhoek
| | - B Pistilli
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Diakonessenhuis Utrecht; Institut Gustave Roussy; Institut Jules Bordet, Universite Libre de Bruxelles; Champalimaud Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Netherlands Cancer Institute/Antoni van Leeuwenhoek
| | - M Piccart
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Diakonessenhuis Utrecht; Institut Gustave Roussy; Institut Jules Bordet, Universite Libre de Bruxelles; Champalimaud Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Netherlands Cancer Institute/Antoni van Leeuwenhoek
| | - K Tryfonidis
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Diakonessenhuis Utrecht; Institut Gustave Roussy; Institut Jules Bordet, Universite Libre de Bruxelles; Champalimaud Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Netherlands Cancer Institute/Antoni van Leeuwenhoek
| | - T van Dalen
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Diakonessenhuis Utrecht; Institut Gustave Roussy; Institut Jules Bordet, Universite Libre de Bruxelles; Champalimaud Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Netherlands Cancer Institute/Antoni van Leeuwenhoek
| | - F Cardoso
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Diakonessenhuis Utrecht; Institut Gustave Roussy; Institut Jules Bordet, Universite Libre de Bruxelles; Champalimaud Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Netherlands Cancer Institute/Antoni van Leeuwenhoek
| | - L van 't Veer
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Diakonessenhuis Utrecht; Institut Gustave Roussy; Institut Jules Bordet, Universite Libre de Bruxelles; Champalimaud Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Netherlands Cancer Institute/Antoni van Leeuwenhoek
| | - E Rutgers
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Diakonessenhuis Utrecht; Institut Gustave Roussy; Institut Jules Bordet, Universite Libre de Bruxelles; Champalimaud Cancer Center; UCSF Helen Diller Family Comprehensive Cancer Center; Netherlands Cancer Institute/Antoni van Leeuwenhoek
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Asselain B, Barlow W, Bartlett J, Bergh J, Bergsten-Nordström E, Bliss J, Boccardo F, Boddington C, Bogaerts J, Bonadonna G, Bradley R, Brain E, Braybrooke J, Broet P, Bryant J, Burrett J, Cameron D, Clarke M, Coates A, Coleman R, Coombes RC, Correa C, Costantino J, Cuzick J, Danforth D, Davidson N, Davies C, Davies L, Di Leo A, Dodwell D, Dowsett M, Duane F, Evans V, Ewertz M, Fisher B, Forbes J, Ford L, Gazet JC, Gelber R, Gettins L, Gianni L, Gnant M, Godwin J, Goldhirsch A, Goodwin P, Gray R, Hayes D, Hill C, Ingle J, Jagsi R, Jakesz R, James S, Janni W, Liu H, Liu Z, Lohrisch C, Loibl S, MacKinnon L, Makris A, Mamounas E, Mannu G, Martín M, Mathoulin S, Mauriac L, McGale P, McHugh T, Morris P, Mukai H, Norton L, Ohashi Y, Olivotto I, Paik S, Pan H, Peto R, Piccart M, Pierce L, Poortmans P, Powles T, Pritchard K, Ragaz J, Raina V, Ravdin P, Read S, Regan M, Robertson J, Rutgers E, Scholl S, Slamon D, Sölkner L, Sparano J, Steinberg S, Sutcliffe R, Swain S, Taylor C, Tutt A, Valagussa P, van de Velde C, van der Hage J, Viale G, von Minckwitz G, Wang Y, Wang Z, Wang X, Whelan T, Wilcken N, Winer E, Wolmark N, Wood W, Zambetti M, Zujewski JA. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol 2018; 19:27-39. [PMID: 29242041 PMCID: PMC5757427 DOI: 10.1016/s1470-2045(17)30777-5] [Citation(s) in RCA: 597] [Impact Index Per Article: 99.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. METHODS We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). FINDINGS Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5-14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21·4% for NACT versus 15·9% for adjuvant chemotherapy (5·5% increase [95% CI 2·4-8·6]; rate ratio 1·37 [95% CI 1·17-1·61]; p=0·0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38·2% for NACT vs 38·0% for adjuvant chemotherapy; rate ratio 1·02 [95% CI 0·92-1·14]; p=0·66), breast cancer mortality (34·4% vs 33·7%; 1·06 [0·95-1·18]; p=0·31), or death from any cause (40·9% vs 41·2%; 1·04 [0·94-1·15]; p=0·45). INTERPRETATION Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered-eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy. FUNDING Cancer Research UK, British Heart Foundation, UK Medical Research Council, and UK Department of Health.
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Janssen N, Eppenga R, Peeters MJV, van Duijnhoven F, Oldenburg H, van der Hage J, Rutgers E, Sonke JJ, Kuhlmann K, Ruers T, Nijkamp J. Real-time wireless tumor tracking during breast conserving surgery. Int J Comput Assist Radiol Surg 2017; 13:531-539. [PMID: 29134472 DOI: 10.1007/s11548-017-1684-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/30/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate a novel surgical navigation system for breast conserving surgery (BCS), based on real-time tumor tracking using the Calypso[Formula: see text] 4D Localization System (Varian Medical Systems Inc., USA). Navigation-guided breast conserving surgery (Nav-BCS) was compared to conventional iodine seed-guided BCS ([Formula: see text]I-BCS). METHODS Two breast phantom types were produced, containing spherical and complex tumors in which wireless transponders (Nav-BCS) or a iodine seed ([Formula: see text]I-BCS) were implanted. For navigation, orthogonal views and 3D volume renders of a CT of the phantom were shown, including a tumor segmentation and a predetermined resection margin. In the same views, a surgical pointer was tracked and visualized. [Formula: see text]I-BCS was performed according to standard protocol. Five surgical breast oncologists first performed a practice session with Nav-BCS, followed by two Nav-BCS and [Formula: see text]I-BCS sessions on spherical and complex tumors. Postoperative CT images of all resection specimens were registered to the preoperative CT. Main outcome measures were the minimum resection margin (in mm) and the excision times. RESULTS The rate of incomplete tumor resections was 6.7% for Nav-BCS and 20% for [Formula: see text]I-BCS. The minimum resection margins on the spherical tumors were 3.0 ± 1.4 mm for Nav-BCS and 2.5 ± 1.6 mm for [Formula: see text]I-BCS (p = 0.63). For the complex tumors, these were 2.2 ± 1.1 mm (Nav-BCS) and 0.9 ± 2.4 mm ([Formula: see text]I-BCS) (p = 0.32). Mean excision times on spherical and complex tumors were 9.5 ± 2.7 min and 9.4 ± 2.6 min (Nav-BCS), compared to 5.8 ± 2.2 min and 4.7 ± 3.4 min ([Formula: see text]I-BCS, both (p < 0.05). CONCLUSIONS The presented surgical navigation system improved the intra-operative awareness about tumor position and orientation, with the potential to improve surgical outcomes for non-palpable breast tumors. Results are positive, and participating surgeons were enthusiastic, but extended surgical experience on real breast tissue is required.
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Affiliation(s)
- Natasja Janssen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Roeland Eppenga
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Hester Oldenburg
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos van der Hage
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Emiel Rutgers
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Koert Kuhlmann
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Theo Ruers
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Nanobiophysics Group, MIRA Institute, University of Twente, Enschede, The Netherlands
| | - Jasper Nijkamp
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Cataliotti L, Marotti L, Beishon M, Costa A, Knox S, Rutgers E, Cardoso F. Reply to letter from Suguatti et al. Eur J Cancer 2017; 87:201-202. [PMID: 28943205 DOI: 10.1016/j.ejca.2017.06.044] [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] [Received: 06/09/2017] [Accepted: 06/11/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Luigi Cataliotti
- Breast Centres Certification and Senonetwork Italia Onlus, Italy
| | - Lorenza Marotti
- EUSOMA - European Society of Breast Cancer Specialists, Italy
| | - Marc Beishon
- Health Writer and Editor, London, United Kingdom
| | | | - Susan Knox
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Emiel Rutgers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal.
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Tryfonidis K, Poncet C, Slaets L, Viale G, de Snoo F, Aalders K, Van 't Veer L, Rutgers E, Piccart M, Bogaerts J, Cardoso F. Not all small node negative (pT1abN0) breast cancers are similar: Outcome results from an EORTC 10041/BIG 3-04 (MINDACT) trial substudy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Vliek S, Retel V, Drukker C, Bueno-De-Mesquita J, Rutgers E, van Tinteren H, van de Vijver M, Wesseling J, van Harten W, Linn S. The 70-gene signature in node positive breast cancer: 10-year follow-up of the observational RASTER study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vliek S, Retel V, Drukker C, Rutgers E, van Tinteren H, van de Vijver M, Bueno-De-Mesquita J, Wesseling J, van Harten W, Linn S. 10 years follow up of the RASTER study; implementing a genomic signature in daily practice. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wesseling J, Duijnhoven FV, Tryfonidis K, Peric A, Leeuwen-Stok EV, Bijker N, Elshof L, Rutgers E. Abstract CT137: Standard therapy versus active surveillance for low grade DCIS: the LORD trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-ct137] [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
The introduction of population-based breast cancer screening and implementation of digital mammography have led to an increased incidence of ductal carcinoma in situ (DCIS) without a decrease in the incidence of advanced breast cancer. This suggests DCIS overdiagnosis exists.
We hypothesize that asymptomatic, low-grade DCIS can safely be managed by active surveillance. If progression to invasive breast cancer would still occur, this will be low-grade and hormone receptor positive with excellent survival rates. Also, breast-conserving treatment will still be an option, if no prior radiotherapy has been applied. It also may save many low-grade DCIS patients from intensive treatment.
We will compare active surveillance with conventional treatment, being either wide local excision (WLE) only, WLE plus radiotherapy or mastectomy, possibly followed by hormonal therapy for primary low-grade DCIS, detected by calcifications only, in a phase III, open-label, non-inferiority, multi-center, randomized clinical trial legally supported by the Breast Cancer Group of the European Organisation for the Research and Treatment of Cancer (EORTC-1401-BCG). The Dutch Centers are coordinated by the BOOG Study Center (BOOG 2014-04).
Randomization will be 1:1 in to one of the following arms: active surveillance or standard treatment per local policy. In total, 1240 women (≥ 45 years) with asymptomatic, pure, low-grade DCIS, based on vacuum-assisted biopsies of calcifications as detected by population-based or opportunistic screening, without prior breast cancer, will be included. Assuming 25% of randomized women qualified to enroll in the study will drop out or will be excluded from per protocol population, at least 1,240 women need to be randomized to obtain the 930 patients required for the evaluation of the primary endpoint. The same follow-up scheme will be applied in both study arms, i.e. annual mammography for a period of 10 years. The primary end-point is ipsilateral invasive breast tumor-free rate at 10 years. Secondary end-points are among others: overall survival, breast cancer-specific survival, mastectomy rate and patient reported outcomes. Accrual has started in January 2017.
Acknowledgements: This trial is funded by Pink Ribbon Netherlands, the Dutch Cancer Society and Dutch Cancer Society/Alpe d’HuZes.
Citation Format: Jelle Wesseling, Frederieke van Duijnhoven, Konstantinos Tryfonidis, Aleksandra Peric, Elise van Leeuwen-Stok, Nina Bijker, Lotte Elshof, Emiel Rutgers. Standard therapy versus active surveillance for low grade DCIS: the LORD trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT137. doi:10.1158/1538-7445.AM2017-CT137
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Affiliation(s)
| | | | | | - Aleksandra Peric
- 2European Organization for the Research and Treatment of Cancer, Brussels, Belgium
| | | | - Nina Bijker
- 4Academic Medical Center, Amsterdam, Netherlands
| | - Lotte Elshof
- 1Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Emiel Rutgers
- 1Netherlands Cancer Institute, Amsterdam, Netherlands
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Cardoso F, Piccart M, Rutgers E, Slaets L, van 't Veer L, Viale G, Pierga JY, Brain E, Causeret S, Golfinopoulos V, Goulioti T, Knox S, Matos E, Neijenhuis P, Nitz U, Passalacqua R, Rubio IT, Saghatchian M, Smilde TJ, Sotiriou C, Stork L, Straehle C, Thomas G, Thompson A, Vrijaldenhoven S, Vuylsteke P, Tryfonidis K, Bogaerts J, Delaloge S. Abstract P5-14-01: Chemotherapy randomization of the EORTC 10041/ BIG 3-04 MINDACT (microarray in node-negative and 1 to 3 positive lymph node disease may avoid chemotherapy) trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-14-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- F Cardoso
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - M Piccart
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - E Rutgers
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - L Slaets
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - L van 't Veer
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - G Viale
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - J-Y Pierga
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - E Brain
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Causeret
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - V Golfinopoulos
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - T Goulioti
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Knox
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - E Matos
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - P Neijenhuis
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - U Nitz
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - R Passalacqua
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - IT Rubio
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - M Saghatchian
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - TJ Smilde
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - C Sotiriou
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - L Stork
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - C Straehle
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - G Thomas
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - A Thompson
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Vrijaldenhoven
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - P Vuylsteke
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - K Tryfonidis
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - J Bogaerts
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Delaloge
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
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Kuijer A, Straver M, Elias S, Smorenburg C, Wesseling J, Linn S, Rutgers E, Siesling S, van Dalen T. Abstract P1-03-04: Concordance of local immunohistochemistry with TargetPrint microarray based assessment of ER, PR and Her2 and BluePrint molecular subtyping in the Symphony Triple A study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-03-04] [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: 11/16/2022]
Abstract
Abstract
PURPOSE: A decade ago intrinsic biological breast cancer subtypes have been identified which have proven to be of clinical importance in terms of outcome and response to systemic treatment. The aim of the current study is to assess concordance between breast cancer subtypes determined by local immunohistochemistry (IHC) assessment of estrogen receptor (ER), progesterone receptor (PR) and Her2-receptor status and microarray based molecular subtyping in a subset of ER+ early stage breast cancer patients.
PATIENTS AND METHODS: In this prospective observational multicenter study information on local pathology assessment and BluePrint/TargetPrint results were obtained in ER+ Dutch early stage breast cancer patients in whom a 70-gene profile (MammaPrint) was used as they were enrolled in clinical trial based on the existence of controversy regarding the additional value of adjuvant CT. Local IHC assessment of ER, PR and Her2 status were compared with microarray based assessment (TargetPrint/BluePrint) of these characteristics. Reclassification of ER and PR overexpression was assessed by a McNemars test and by Spearman correlation. Furthermore, concordance between the clinical subtypes based on local pathology (Luminal-type: ER+/PR+/Her2-; Her2-type: Her2+ disease) and molecular subtyping was assessed.
RESULTS: Between January 2013 And December 2015 660 patients, treated in 31 hospitals, were enrolled. In 564 (85%) BluePrint and/or TargetPrint was performed in addition to the 70-GS. The majority of patients had ER+/Her2- disease and TargetPrint reclassified 1% (n = 7) of patients as ER-negative (r = 0,250, p <0,001). TargetPrint reclassified 7% (n = 40) and 2% (n = 11) of patients for PR and Her2 status respectively (table 1, r = 0,580, p <0,001 for PR
Table 1. Concordance between immunohistochemistry and TargetPrint. TargetPrint result (ER, PR and Her2 resp.) ImmunohistochemistryPositiveNegativeOverall discordance (%)p-value*Estrogenreceptor status Positive557 (99%)6 (1%) Negativen.a.n.a.1%n.a.Progesterone receptor status Positive474 (96%)18 (4%) Negative22 (31%)49 (69%)7%0,636Her2 receptor status Positive3 (30%)7 (70%) Negative4 (3%)546 (97%)2%0,549Equivocal0 (0%)3 (1%) * P-value represents results of the McNemar test.). Based on IHC 545 (98%) patients were regarded as luminal-type and the remaining 2% as Her2-type. BluePrint reclassified 2% of the clinical luminal-type patients: 4 (1%) patients were reclassified as basal-type and 3 (0%) patients as Her2-type. Of the clinical Her2-type patients 80% (n=8) was reclassified by BluePrint as molecular luminal-type.
Table 2. Concordance between clinical subtyping and molecular subtyping according to BluePrint. BluePrint resultClinical SubtypeNo. ptsLuminalBasalHer2Luminal545539 (99%)4 (1%)3 (0%)Her2108 (80%)02 (20%)Note. Overall discordance 3%.
Conclusion: In the current study we observe a high concordance between microarray-based assessment of ER, PR and Her2 and local pathology in Dutch ER+ early stage breast cancer patients. In the small subset of ER+ patients who are considered candidates for 70 GS use and who have HER2+ tumors by IHC molecular typing of HER2 status is of additional value.
Citation Format: Kuijer A, Straver M, Elias S, Smorenburg C, Wesseling J, Linn S, Rutgers E, Siesling S, van Dalen T. Concordance of local immunohistochemistry with TargetPrint microarray based assessment of ER, PR and Her2 and BluePrint molecular subtyping in the Symphony Triple A study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-03-04.
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Affiliation(s)
- A Kuijer
- Diakonessenhuis, Utrecht, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Center, Utrecht, Netherlands
| | - M Straver
- Diakonessenhuis, Utrecht, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Center, Utrecht, Netherlands
| | - S Elias
- Diakonessenhuis, Utrecht, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Center, Utrecht, Netherlands
| | - C Smorenburg
- Diakonessenhuis, Utrecht, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Center, Utrecht, Netherlands
| | - J Wesseling
- Diakonessenhuis, Utrecht, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Center, Utrecht, Netherlands
| | - S Linn
- Diakonessenhuis, Utrecht, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Center, Utrecht, Netherlands
| | - E Rutgers
- Diakonessenhuis, Utrecht, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Center, Utrecht, Netherlands
| | - S Siesling
- Diakonessenhuis, Utrecht, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Center, Utrecht, Netherlands
| | - T van Dalen
- Diakonessenhuis, Utrecht, Netherlands; University Medical Center Utrecht, Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Center, Utrecht, Netherlands
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Van de Velde C, Blok E, Meershoek-Klein Kranenbarg E, Putter H, Van den Bosch J, Maartense E, Duijm-de Carpentier M, Van Leeuwen-Stok E, Liefers G, Nortier J, Rutgers E, Kroep J. Optimal duration of extended letrozole treatment after 5 years of adjuvant endocrine therapy; results of the randomized phase III IDEAL trial (BOOG 2006–05). Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cardoso F, Cataliotti L, Costa A, Knox S, Marotti L, Rutgers E, Beishon M. European Breast Cancer Conference manifesto on breast centres/units. Eur J Cancer 2017; 72:244-250. [PMID: 28064097 DOI: 10.1016/j.ejca.2016.10.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
Abstract
MANIFESTO-CALL TO ACTION.
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Affiliation(s)
- Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal.
| | - Luigi Cataliotti
- Breast Centres Certification and Senonetwork Italia Onlus, Italy
| | | | - Susan Knox
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Lorenza Marotti
- EUSOMA - European Society of Breast Cancer Specialists, Italy
| | - Emiel Rutgers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands
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Cardoso F, van't Veer LJ, Bogaerts J, Slaets L, Viale G, Delaloge S, Pierga JY, Brain E, Causeret S, DeLorenzi M, Glas AM, Golfinopoulos V, Goulioti T, Knox S, Matos E, Meulemans B, Neijenhuis PA, Nitz U, Passalacqua R, Ravdin P, Rubio IT, Saghatchian M, Smilde TJ, Sotiriou C, Stork L, Straehle C, Thomas G, Thompson AM, van der Hoeven JM, Vuylsteke P, Bernards R, Tryfonidis K, Rutgers E, Piccart M. 70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. N Engl J Med 2016; 375:717-29. [PMID: 27557300 DOI: 10.1056/nejmoa1602253] [Citation(s) in RCA: 1143] [Impact Index Per Article: 142.9] [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: 12/19/2022]
Abstract
BACKGROUND The 70-gene signature test (MammaPrint) has been shown to improve prediction of clinical outcome in women with early-stage breast cancer. We sought to provide prospective evidence of the clinical utility of the addition of the 70-gene signature to standard clinical-pathological criteria in selecting patients for adjuvant chemotherapy. METHODS In this randomized, phase 3 study, we enrolled 6693 women with early-stage breast cancer and determined their genomic risk (using the 70-gene signature) and their clinical risk (using a modified version of Adjuvant! Online). Women at low clinical and genomic risk did not receive chemotherapy, whereas those at high clinical and genomic risk did receive such therapy. In patients with discordant risk results, either the genomic risk or the clinical risk was used to determine the use of chemotherapy. The primary goal was to assess whether, among patients with high-risk clinical features and a low-risk gene-expression profile who did not receive chemotherapy, the lower boundary of the 95% confidence interval for the rate of 5-year survival without distant metastasis would be 92% (i.e., the noninferiority boundary) or higher. RESULTS A total of 1550 patients (23.2%) were deemed to be at high clinical risk and low genomic risk. At 5 years, the rate of survival without distant metastasis in this group was 94.7% (95% confidence interval, 92.5 to 96.2) among those not receiving chemotherapy. The absolute difference in this survival rate between these patients and those who received chemotherapy was 1.5 percentage points, with the rate being lower without chemotherapy. Similar rates of survival without distant metastasis were reported in the subgroup of patients who had estrogen-receptor-positive, human epidermal growth factor receptor 2-negative, and either node-negative or node-positive disease. CONCLUSIONS Among women with early-stage breast cancer who were at high clinical risk and low genomic risk for recurrence, the receipt of no chemotherapy on the basis of the 70-gene signature led to a 5-year rate of survival without distant metastasis that was 1.5 percentage points lower than the rate with chemotherapy. Given these findings, approximately 46% of women with breast cancer who are at high clinical risk might not require chemotherapy. (Funded by the European Commission Sixth Framework Program and others; ClinicalTrials.gov number, NCT00433589; EudraCT number, 2005-002625-31.).
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Affiliation(s)
- Fatima Cardoso
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Laura J van't Veer
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Jan Bogaerts
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Leen Slaets
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Giuseppe Viale
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Suzette Delaloge
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Jean-Yves Pierga
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Etienne Brain
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Sylvain Causeret
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Mauro DeLorenzi
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Annuska M Glas
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Vassilis Golfinopoulos
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Theodora Goulioti
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Susan Knox
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Erika Matos
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Bart Meulemans
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Peter A Neijenhuis
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Ulrike Nitz
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Rodolfo Passalacqua
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Peter Ravdin
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Isabel T Rubio
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Mahasti Saghatchian
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Tineke J Smilde
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Christos Sotiriou
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Lisette Stork
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Carolyn Straehle
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Geraldine Thomas
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Alastair M Thompson
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Jacobus M van der Hoeven
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Peter Vuylsteke
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - René Bernards
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Konstantinos Tryfonidis
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Emiel Rutgers
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Martine Piccart
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
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Piccart M, Rutgers E, van’ t Veer L, Slaets L, Delaloge S, Viale G, Pierga JY, Vuylsteke P, Brain E, Vrijaldenhoven S, Neijenhuis P, Coudert B, Smilde T, Gil M, Thompson A, Rubio I, Passalaqua R, Matos E, Nitz U, Delorenzi M, Thomas G, Goulioti T, Straehle C, Tryfonidis K, Bogaerts J, Cardoso F. Abstract CT039: Primary analysis of the EORTC 10041/ BIG 3-04 MINDACT study: a prospective, randomized study evaluating the clinical utility of the 70-gene signature (MammaPrint) combined with common clinical-pathological criteria for selection of patients for adjuvant chemotherapy in breast cancer with 0 to 3 positive nodes. Clin Trials 2016. [DOI: 10.1158/1538-7445.am2016-ct039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Visser L, Elshof L, Groen E, van de Vijver K, Lips E, de Maaker M, Nieboer F, Schaapveld M, Rutgers E, Wesseling J. Abstract P5-17-09: Biomarkers to distinguish hazardous from harmless ductal carcinoma in situ (DCIS) of the breast. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-17-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. The incidence of DCIS has increased since the introduction of population-based screening. This has not resulted in a decrease in invasive breast cancer incidence, implying overdiagnosis exists. All women with DCIS are still intensively treated, by surgery, radiotherapy, and/or hormonal treatment, although only a minority will develop a subsequent invasive breast cancer. As we cannot discriminate such hazardous from harmless DCIS lesions, accurate prognostic biomarkers are urgently needed. In the current study we aim to identify molecular markers for DCIS aggressiveness, using a large population-based cohort.
Patients and methods. We used a population-based, nation-wide cohort consisting of 10,090 women treated for primary DCIS between 1989 and 2004 with a median follow-up time of 10.7 years. Within this cohort, a case-control study was set up to analyse which markers are associated with progression to invasive breast cancer. Formalin-fixed paraffin embedded (FFPE) tissue blocks were retrieved from 1580 DCIS patients who were treated by breast conserving surgery without radiotherapy (316 DCIS patients with a subsequent ipsilateral invasive breast cancer (iiBC): i.e. the "cases"; and 1264 DCIS patients without subsequent invasive breast cancer: i.e. the "controls"). A first study using this population-based cohort will involve immunohistochemistry (IHC) on 200 "cases" and 500 "controls" for an 8-marker IHC panel (ER, PR, HER2, Ki67, p16, p53, COX-2, and Annexin A1). Molecular subtypes of the DCIS and invasive breast cancer lesions will be determined and intra-individual heterogeneity will be assessed. IHC marker expression will be both compared between "cases" and " controls" as well as between DCIS lesions and its subsequent invasive breast cancer. In a second study, DNA and RNA will be isolated from these specimens, using laser microdissection, and extensive molecular profiling will be performed.
Results. We have collected FFPE tissue blocks of 287 "cases" and 1149 "controls" (86% of requested material) from 56 participating hospitals. At present, the specimens of 223 "cases" (matched DCIS and iiBC specimen) and 103 "controls" have been centrally revised for extensive morphological characteristics. Only a small part (14%) of the specimens had to be excluded from the study population. IHC staining of the tissue specimens, using the 8-marker IHC panel is ongoing.
Conclusion. Within a nation-wide cohort of 10,090 patients diagnosed with primary DCIS, we were able to collect tissue material of a representative case-control series of 200 "cases" with subsequent invasive breast cancer and 500 invasive breast cancer-free "controls". This is the first time such a large unique, unbiased DCIS series, with long-term follow-up is analysed integrating clinical, histological, and immunohistochemical data. The results will be presented at SABCS 2015.
Citation Format: Visser L, Elshof L, Groen E, van de Vijver K, Lips E, de Maaker M, Nieboer F, Schaapveld M, Rutgers E, Wesseling J. Biomarkers to distinguish hazardous from harmless ductal carcinoma in situ (DCIS) of the breast. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-17-09.
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Affiliation(s)
- L Visser
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - L Elshof
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - E Groen
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - E Lips
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - M de Maaker
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - F Nieboer
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - M Schaapveld
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - E Rutgers
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - J Wesseling
- The Netherlands Cancer Institute, Amsterdam, Netherlands
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Tot T, Viale G, Rutgers E, Bergsten-Nordström E, Costa A. Optimal breast cancer pathology manifesto. Eur J Cancer 2015; 51:2285-8. [DOI: 10.1016/j.ejca.2015.06.127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/05/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
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Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E, Zackrisson S, Cardoso F. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5:v8-30. [PMID: 26314782 DOI: 10.1093/annonc/mdv298] [Citation(s) in RCA: 1015] [Impact Index Per Article: 112.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | | | - S Ohno
- Breast Oncology Center, Cancer Institute Hospital, Tokyo, Japan
| | - F Penault-Llorca
- Department of Pathology, Centre Jean Perrin, Clermont-Ferrand EA 4677 Université d'Auvergne, Clermont-Ferrand, France
| | - P Poortmans
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - E Rutgers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Zackrisson
- Department of Diagnostic Radiology, Lund University, Malmö, Sweden
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
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Affiliation(s)
- J Michael Dixon
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - Emiel Rutgers
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Kelly K Hunt
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Affiliation(s)
- J Michael Dixon
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - Emiel Rutgers
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Kelly K Hunt
- University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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46
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Li J, Lindström LS, Foo JN, Rafiq S, Schmidt MK, Pharoah PDP, Michailidou K, Dennis J, Bolla MK, Wang Q, Van ‘t Veer LJ, Cornelissen S, Rutgers E, Southey MC, Apicella C, Dite GS, Hopper JL, Fasching PA, Haeberle L, Ekici AB, Beckmann MW, Blomqvist C, Muranen TA, Aittomäki K, Lindblom A, Margolin S, Mannermaa A, Kosma VM, Hartikainen JM, Kataja V, Chenevix-Trench G, Investigators KC, Phillips KA, McLachlan SA, Lambrechts D, Thienpont B, Smeets A, Wildiers H, Chang-Claude J, Flesch-Janys D, Seibold P, Rudolph A, Giles GG, Baglietto L, Severi G, Haiman CA, Henderson BE, Schumacher F, Le Marchand L, Kristensen V, Alnæs GIG, Borresen-Dale AL, Nord S, Winqvist R, Pylkäs K, Jukkola-Vuorinen A, Grip M, Andrulis IL, Knight JA, Glendon G, Tchatchou S, Devilee P, Tollenaar R, Seynaeve C, Hooning M, Kriege M, Hollestelle A, van den Ouweland A, Li Y, Hamann U, Torres D, Ulmer HU, Rüdiger T, Shen CY, Hsiung CN, Wu PE, Chen ST, Teo SH, Taib NAM, Har Yip C, Fuang Ho G, Matsuo K, Ito H, Iwata H, Tajima K, Kang D, Choi JY, Park SK, Yoo KY, Maishman T, Tapper WJ, Dunning A, Shah M, Luben R, Brown J, Chuen Khor C, Eccles DM, Nevanlinna H, Easton D, Humphreys K, Liu J, Hall P, Czene K. 2q36.3 is associated with prognosis for oestrogen receptor-negative breast cancer patients treated with chemotherapy. Nat Commun 2014; 5:4051. [PMID: 24937182 PMCID: PMC4082638 DOI: 10.1038/ncomms5051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/06/2014] [Indexed: 12/12/2022] Open
Abstract
Large population-based registry studies have shown that breast cancer prognosis is inherited. Here we analyse single-nucleotide polymorphisms (SNPs) of genes implicated in human immunology and inflammation as candidates for prognostic markers of breast cancer survival involving 1,804 oestrogen receptor (ER)-negative patients treated with chemotherapy (279 events) from 14 European studies in a prior large-scale genotyping experiment, which is part of the Collaborative Oncological Gene-environment Study (COGS) initiative. We carry out replication using Asian COGS samples (n=522, 53 events) and the Prospective Study of Outcomes in Sporadic versus Hereditary breast cancer (POSH) study (n=315, 108 events). Rs4458204_A near CCL20 (2q36.3) is found to be associated with breast cancer-specific death at a genome-wide significant level (n=2,641, 440 events, combined allelic hazard ratio (HR)=1.81 (1.49-2.19); P for trend=1.90 × 10(-9)). Such survival-associated variants can represent ideal targets for tailored therapeutics, and may also enhance our current prognostic prediction capabilities.
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Affiliation(s)
- Jingmei Li
- Human Genetics, Genome Institute of Singapore,
60 Biopolis Street 02-01, Singapore
138672, Singapore
- Saw Swee Hock School of Public Health, National University
of Singapore, MD3, 16 Medical Drive, Singapore
117597, Singapore
- These authors contributed equally to this work
| | - Linda S. Lindström
- Department of Surgery, University of California at San
Francisco (UCSF), San Francisco, California
94143, USA
- Department of Biosciences and Nutrition, Karolinska
Institutet and University Hospital, SE-171 77
Stockholm, Sweden
- These authors contributed equally to this work
| | - Jia N. Foo
- Human Genetics, Genome Institute of Singapore,
60 Biopolis Street 02-01, Singapore
138672, Singapore
| | - Sajjad Rafiq
- Faculty of Medicine, University of Southampton, University
Hospital Southampton, Southampton
SO16 6YD, UK
| | - Marjanka K. Schmidt
- Division of Psychosocial Research and Epidemiology,
Netherlands Cancer Institute, Postbus 90203, 1006
BE
Amsterdam, The Netherlands
- Division of Molecular Pathology, Netherlands Cancer
Institute, Postbus 90203, 1006 BE
Amsterdam, The Netherlands
| | - Paul D. P. Pharoah
- Centre for Cancer Genetic Epidemiology, Department of
Public Health and Primary Care, University of Cambridge,
Cambridge
CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of
Oncology, University of Cambridge, Worts Causeway,
Cambridge
CB1 8RN, UK
| | - Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of
Public Health and Primary Care, University of Cambridge,
Cambridge
CB1 8RN, UK
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of
Public Health and Primary Care, University of Cambridge,
Cambridge
CB1 8RN, UK
| | - Manjeet K. Bolla
- Centre for Cancer Genetic Epidemiology, Department of
Public Health and Primary Care, University of Cambridge,
Cambridge
CB1 8RN, UK
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of
Public Health and Primary Care, University of Cambridge,
Cambridge
CB1 8RN, UK
| | - Laura J. Van ‘t Veer
- Division of Molecular Pathology, Netherlands Cancer
Institute, Postbus 90203, 1006 BE
Amsterdam, The Netherlands
| | - Sten Cornelissen
- Division of Molecular Pathology, Netherlands Cancer
Institute, Postbus 90203, 1006 BE
Amsterdam, The Netherlands
| | - Emiel Rutgers
- Department of Surgery, Netherlands Cancer Institute,
Plesmanlaan 121, 1066 CX
Amsterdam, The Netherlands
| | - Melissa C. Southey
- Genetic Epidemiology Laboratory, Department of Pathology,
The University of Melbourne, 5th floor, West Wing, Medical
Building 181, Melbourne, Victoria
3010, Australia
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne
School of Population and Global Health, University of Melbourne,
Level 1, 723 Swanston Street, Melbourne,
Victoria
3010, Australia
| | - Gillian S. Dite
- Centre for Epidemiology and Biostatistics, Melbourne
School of Population and Global Health, University of Melbourne,
Level 1, 723 Swanston Street, Melbourne,
Victoria
3010, Australia
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne
School of Population and Global Health, University of Melbourne,
Level 1, 723 Swanston Street, Melbourne,
Victoria
3010, Australia
- Department of Health Science and Services, Graduate School
of Public Health, Seoul National University, 1 Gwanak-ro,
Gwanak-gu, Seoul
151-742, Korea
| | - Peter A. Fasching
- University Breast Center Franconia, Department of
Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander
University Erlangen–Nuremberg,
Universitätsstrasse 21-23, 91054
Erlangen, Germany
- Division of Hematology and Oncology, Department of
Medicine, David Geffen School of Medicine, University of California at Los
Angeles, 10833 Le Conte Avenue, Los Angeles,
California
90095, USA
| | - Lothar Haeberle
- University Breast Center Franconia, Department of
Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander
University Erlangen–Nuremberg,
Universitätsstrasse 21-23, 91054
Erlangen, Germany
| | - Arif B. Ekici
- Institute of Human Genetics, Friedrich Alexander
University Erlangen-Nuremberg, Schlossplatz 4,
91054
Erlangen, Germany
| | - Matthias W. Beckmann
- University Breast Center Franconia, Department of
Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander
University Erlangen–Nuremberg,
Universitätsstrasse 21-23, 91054
Erlangen, Germany
| | - Carl Blomqvist
- Department of Oncology, University of Helsinki and
Helsinki University Central Hospital, FI-00029 HUS Helsinki,
Finland
| | - Taru A. Muranen
- Department of Obstetrics and Gynecology, University of
Helsinki and Helsinki University Central Hospital, Haartmaninkatu
8, FI-00029
Helsinki, Finland
| | - Kristiina Aittomäki
- Department of Clinical Genetics, University of Helsinki
and Helsinki University Central Hospital, Haartmaninkatu
8, FI-00029
Helsinki, Finland
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska
Institutet, Stockholm
SE-17177, Sweden
| | - Sara Margolin
- Department of Oncology-Pathology, Karolinska
Institutet, Stockholm
SE-17177, Sweden
| | - Arto Mannermaa
- School of Medicine, Institute of Clinical Medicine,
Oncology, University of Eastern Finland, Yliopistonranta
1C, FI-70211
Kuopio, Finland
- Biocenter Kuopio, Cancer Center of Eastern Finland,
University of Eastern Finland, FI-70211 Kuopio,
Finland
- Cancer Center, Kuopio University Hospital,
Puijonlaaksontie 2, 70210
Kuopio, Finland
| | - Veli-Matti Kosma
- School of Medicine, Institute of Clinical Medicine,
Oncology, University of Eastern Finland, Yliopistonranta
1C, FI-70211
Kuopio, Finland
- Biocenter Kuopio, Cancer Center of Eastern Finland,
University of Eastern Finland, FI-70211 Kuopio,
Finland
- Cancer Center, Kuopio University Hospital,
Puijonlaaksontie 2, 70210
Kuopio, Finland
| | - Jaana M. Hartikainen
- School of Medicine, Institute of Clinical Medicine,
Oncology, University of Eastern Finland, Yliopistonranta
1C, FI-70211
Kuopio, Finland
- Biocenter Kuopio, Cancer Center of Eastern Finland,
University of Eastern Finland, FI-70211 Kuopio,
Finland
- Cancer Center, Kuopio University Hospital,
Puijonlaaksontie 2, 70210
Kuopio, Finland
| | - Vesa Kataja
- School of Medicine, Institute of Clinical Medicine,
Oncology, University of Eastern Finland, Yliopistonranta
1C, FI-70211
Kuopio, Finland
- Cancer Center, Kuopio University Hospital,
Puijonlaaksontie 2, 70210
Kuopio, Finland
- Jyväskylä Central Hospital,
Keskussairaalantie 19, 40620
Jyväskylä, Finland
| | - Georgia Chenevix-Trench
- Department of Genetics, QIMR Berghofer Medical Research
Institute, 300 Herston Road, Brisbane,
Queensland
4006, Australia
| | - kConFab Investigators
- Research Department, Peter MacCallum Cancer Center,
East Melbourne, Victoria 3002, Australia
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, Melbourne
School of Population and Global Health, University of Melbourne,
Level 1, 723 Swanston Street, Melbourne,
Victoria
3010, Australia
- Sir Peter MacCallum Department of Oncology, University of
Melbourne, St Andrews Place East, East
Melbourne, Victoria
3002, Australia
| | - Sue-Anne McLachlan
- Department of Oncology, St Vincent’s Hospital
Melbourne, 9 Princes Street, Fitzroy,
Victoria
3065, Australia
| | - Diether Lambrechts
- Vesalius Research Center (VRC), VIB,
Herestraat 49, 3000
Leuven, Belgium
- Laboratory for Translational Genetics, Department of
Oncology, University of Leuven, Herestraat 49,
3000
Leuven, Belgium
| | - Bernard Thienpont
- Vesalius Research Center (VRC), VIB,
Herestraat 49, 3000
Leuven, Belgium
- Laboratory for Translational Genetics, Department of
Oncology, University of Leuven, Herestraat 49,
3000
Leuven, Belgium
| | - Ann Smeets
- Multidisciplinary Breast Center, University Hospitals
Leuven, Herestraat 49, 3000
Leuven, Belgium
| | - Hans Wildiers
- Multidisciplinary Breast Center, University Hospitals
Leuven, Herestraat 49, 3000
Leuven, Belgium
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research
Center (DKFZ), Im Neuenheimer Feld 280, 69120
Heidelberg, Germany
| | - Dieter Flesch-Janys
- Division of Cancer Epidemiology, German Cancer Research
Center (DKFZ), Im Neuenheimer Feld 280, 69120
Heidelberg, Germany
- Department of Cancer Epidemiology/Clinical Cancer
Registry, University Clinic Hamburg-Eppendorf, Martinistrasse
52, 20246
Hamburg, Germany
- Institute for Medical Biometrics and Epidemiology,
University Clinic Hamburg-Eppendorf, Martinistrasse 52,
20246
Hamburg, Germany
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research
Center (DKFZ), Im Neuenheimer Feld 280, 69120
Heidelberg, Germany
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research
Center (DKFZ), Im Neuenheimer Feld 280, 69120
Heidelberg, Germany
| | - Graham G. Giles
- Centre for Epidemiology and Biostatistics, Melbourne
School of Population and Global Health, University of Melbourne,
Level 1, 723 Swanston Street, Melbourne,
Victoria
3010, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria,
1 Rathdowne Street, Melbourne, Victoria
3053, Australia
| | - Laura Baglietto
- Centre for Epidemiology and Biostatistics, Melbourne
School of Population and Global Health, University of Melbourne,
Level 1, 723 Swanston Street, Melbourne,
Victoria
3010, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria,
1 Rathdowne Street, Melbourne, Victoria
3053, Australia
| | - Gianluca Severi
- Centre for Epidemiology and Biostatistics, Melbourne
School of Population and Global Health, University of Melbourne,
Level 1, 723 Swanston Street, Melbourne,
Victoria
3010, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria,
1 Rathdowne Street, Melbourne, Victoria
3053, Australia
| | - Christopher A. Haiman
- Department of Preventive Medicine, Keck School of
Medicine, University of Southern California, 1975 San Pablo
Street, Los Angeles, California
90033, USA
| | - Brian E. Henderson
- University of Hawaii Cancer Center, 701
Ilalo Street, Honolulu, Hawaii
96813, USA
| | - Fredrick Schumacher
- Department of Preventive Medicine, Keck School of
Medicine, University of Southern California, 1975 San Pablo
Street, Los Angeles, California
90033, USA
| | - Loic Le Marchand
- University of Hawaii Cancer Center, 701
Ilalo Street, Honolulu, Hawaii
96813, USA
| | - Vessela Kristensen
- Department of Genetics, Institute for Cancer Research,
Oslo University Hospital, Radiumhospitalet, Ullernchausseen
70, N-0310
Oslo, Norway
- K.G. Jebsen Center for Breast Cancer Research, Institute
for Clinical Medicine, Faculty of Medicine, University of Oslo,
Kirkeveien 166, 0450
Oslo, Norway
- Department of Clinical Molecular Biology (EpiGen), Medical
Division, Akershus University Hospital, Sykehusveien 25,
1478
Lørenskog, Norway
| | - Grethe I. Grenaker Alnæs
- Department of Genetics, Institute for Cancer Research,
Oslo University Hospital, Radiumhospitalet, Ullernchausseen
70, N-0310
Oslo, Norway
- K.G. Jebsen Center for Breast Cancer Research, Institute
for Clinical Medicine, Faculty of Medicine, University of Oslo,
Kirkeveien 166, 0450
Oslo, Norway
| | - Anne-Lise Borresen-Dale
- Department of Genetics, Institute for Cancer Research,
Oslo University Hospital, Radiumhospitalet, Ullernchausseen
70, N-0310
Oslo, Norway
- K.G. Jebsen Center for Breast Cancer Research, Institute
for Clinical Medicine, Faculty of Medicine, University of Oslo,
Kirkeveien 166, 0450
Oslo, Norway
| | - Silje Nord
- Department of Genetics, Institute for Cancer Research,
Oslo University Hospital, Radiumhospitalet, Ullernchausseen
70, N-0310
Oslo, Norway
- K.G. Jebsen Center for Breast Cancer Research, Institute
for Clinical Medicine, Faculty of Medicine, University of Oslo,
Kirkeveien 166, 0450
Oslo, Norway
| | - Robert Winqvist
- Laboratory of Cancer Genetics and Tumor Biology,
Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, Oulu
University Hospital, Aapistie 5A, FI-90220
Oulu, Finland
| | - Katri Pylkäs
- Laboratory of Cancer Genetics and Tumor Biology,
Department of Clinical Chemistry and Biocenter Oulu, University of Oulu, Oulu
University Hospital, Aapistie 5A, FI-90220
Oulu, Finland
| | - Arja Jukkola-Vuorinen
- Laboratory of Oncology, Oulu University Hospital,
University of Oulu, Kajaanintie 50, FI-90220
Oulu, Finland
| | - Mervi Grip
- Laboratory of Oncology, Oulu University Hospital,
University of Oulu, Kajaanintie 50, FI-90220
Oulu, Finland
| | - Irene L. Andrulis
- Ontario Cancer Genetics Network, Lunenfeld-Tanenbaum
Research Institute of Mount Sinai Hospital, 600 University
Avenue, Toronto, Ontario, Canada
M5G 1 × 5
- Department of Molecular Genetics, University of
Toronto, 1 King’s College Circle,
Toronto, Ontario, Canada
M5S 1A8
| | - Julia A. Knight
- Prosserman Centre for Health Research, Lunenfeld-Tanenbaum
Research Institute of Mount Sinai Hospital, 600 University
Avenue, Toronto, Ontario, Canada
M5G 1 × 5
- Division of Epidemiology, Dalla Lana School of Public
Health, University of Toronto, 155 College Street,
Toronto, Ontario, Canada
M5T 3M7
| | - Gord Glendon
- Ontario Cancer Genetics Network, Lunenfeld-Tanenbaum
Research Institute of Mount Sinai Hospital, 600 University
Avenue, Toronto, Ontario, Canada
M5G 1 × 5
| | - Sandrine Tchatchou
- Research, Lunenfeld-Tanenbaum Research Institute of Mount
Sinai Hospital, 600 University Avenue,
Toronto, Ontario, Canada
M5G 1 × 5
| | - Peter Devilee
- Department of Human Genetics, Leiden University Medical
Center, Einthovenweg 20, 2333 ZC
Leiden, The Netherlands
- Department of Pathology, Leiden University Medical
Center, Einthovenweg 20, 2333 ZC
Leiden, The Netherlands
| | - Robert Tollenaar
- Department of Surgical Oncology, Leiden University Medical
Center, Einthovenweg 20, 2333 ZC
Leiden, The Netherlands
| | - Caroline Seynaeve
- Department of Medical Oncology, Erasmus MC Cancer
Institute, Groene Hilledijk 301, 3075EA
Rotterdam, The Netherlands
| | - Maartje Hooning
- Department of Medical Oncology, Erasmus MC Cancer
Institute, Groene Hilledijk 301, 3075EA
Rotterdam, The Netherlands
| | - Mieke Kriege
- Department of Medical Oncology, Erasmus MC Cancer
Institute, Groene Hilledijk 301, 3075EA
Rotterdam, The Netherlands
| | - Antoinette Hollestelle
- Department of Medical Oncology, Erasmus MC Cancer
Institute, Groene Hilledijk 301, 3075EA
Rotterdam, The Netherlands
| | - Ans van den Ouweland
- Department of Clinical Genetics, Erasmus University
Medical Center, Groene Hilledijk 301, 3075EA
Rotterdam, The Netherlands
| | - Yi Li
- Human Genetics, Genome Institute of Singapore,
60 Biopolis Street 02-01, Singapore
138672, Singapore
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, DKFZ,
Im Neuenheimer Feld 280, 69120
Heidelberg, Germany
| | - Diana Torres
- Molecular Genetics of Breast Cancer, DKFZ,
Im Neuenheimer Feld 280, 69120
Heidelberg, Germany
- Institute of Human Genetics, Pontificia University
Javeriana, Carrera 7, Bogotá
11001000, Colombia
| | - Hans U. Ulmer
- Frauenklinik der Stadtklinik Baden-Baden,
D-7570 Baden-Baden, Germany
| | - Thomas Rüdiger
- Institute of Pathology, Städtisches Klinikum
Karlsruhe, Moltkestrasse 90, 76133
Karlsruhe, Germany
| | - Chen-Yang Shen
- Institute of Biomedical Sciences, Academia Sinica,
Academia Road Nankang, Taipei
115, Taiwan
- College of Public Health, China Medical University,
No. 91, Hsueh-Shih Road, Taichung
40402, Taiwan
| | - Chia-Ni Hsiung
- Institute of Biomedical Sciences, Academia Sinica,
Academia Road Nankang, Taipei
115, Taiwan
| | - Pei-Ei Wu
- Taiwan Biobank, Academia Sinica, Academia
Road Nankang, Taipei
115, Taiwan
| | - Shou-Tung Chen
- Department of Surgery, Changhua Christian Hospital,
No. 135, Nanhsiao Street, Changhua
500, Taiwan
| | - Soo Hwang Teo
- Cancer Research Initiatives Foundation, Sime Darby Medical
Centre, 1 Jalan SS 12/1A, Subang
Jaya47500, Selangor, Malaysia
- Breast Cancer Research Unit, Faculty of Medicine,
University Malaya Cancer Research Institute, University Malaya,
Lembah Pantai, 59100
Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Breast Cancer Research Unit, Faculty of Medicine,
University Malaya Cancer Research Institute, University Malaya,
Lembah Pantai, 59100
Kuala Lumpur, Malaysia
| | - Cheng Har Yip
- Breast Cancer Research Unit, Faculty of Medicine,
University Malaya Cancer Research Institute, University Malaya,
Lembah Pantai, 59100
Kuala Lumpur, Malaysia
| | - Gwo Fuang Ho
- Department of Oncology, Faculty of Medicine, University
Malaya, Lembah Pantai, 59100
Kuala Lumpur, Malaysia
| | - Keitaro Matsuo
- Department of Preventive Medicine, Faculty of Medical
Sciences, Kyushu University, Fukuoka
812-8582, Japan
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer
Center Research Institute, 1-1 Kanokoden Chikusa-ku,
Nagoya
464-8681, Aichi, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center
Hospital, 1-1 Kanokoden Chikusa-ku, Nagoya
464-8681, Aichi, Japan
| | - Kazuo Tajima
- Division of Epidemiology and Prevention, Aichi Cancer
Center Research Institute, 1-1 Kanokoden Chikusa-ku,
Nagoya
464-8681, Aichi, Japan
| | - Daehee Kang
- Department of Preventive Medicine, Seoul National
University College of Medicine, 103 Daehak-ro, Jongno-gu,
Seoul
110-799, Korea
- Department of Biomedical Sciences, Seoul National
University Graduate School, 1 Gwanak-ro, Gwanak-gu,
Seoul
151-742, Korea
| | - Ji-Yeob Choi
- Department of Biomedical Sciences, Seoul National
University Graduate School, 1 Gwanak-ro, Gwanak-gu,
Seoul
151-742, Korea
| | - Sue K. Park
- Department of Preventive Medicine, Seoul National
University College of Medicine, 103 Daehak-ro, Jongno-gu,
Seoul
110-799, Korea
- Department of Biomedical Sciences, Seoul National
University Graduate School, 1 Gwanak-ro, Gwanak-gu,
Seoul
151-742, Korea
| | - Keun-Young Yoo
- Seoul National University College of Medicine,
103 Daehak-ro, Jongno-gu, Seoul
110-799, Korea
| | - Tom Maishman
- Faculty of Medicine, University of Southampton, University
Hospital Southampton, Southampton
SO16 6YD, UK
| | - William J. Tapper
- Faculty of Medicine, University of Southampton, University
Hospital Southampton, Southampton
SO16 6YD, UK
| | - Alison Dunning
- Centre for Cancer Genetic Epidemiology, Department of
Oncology, University of Cambridge, Worts Causeway,
Cambridge
CB1 8RN, UK
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of
Oncology, University of Cambridge, Worts Causeway,
Cambridge
CB1 8RN, UK
| | - Robert Luben
- Centre for Cancer Genetic Epidemiology, Department of
Public Health and Primary Care, University of Cambridge,
Cambridge
CB1 8RN, UK
| | - Judith Brown
- Centre for Cancer Genetic Epidemiology, Department of
Public Health and Primary Care, University of Cambridge,
Cambridge
CB1 8RN, UK
| | - Chiea Chuen Khor
- Human Genetics, Genome Institute of Singapore,
60 Biopolis Street 02-01, Singapore
138672, Singapore
| | - Diana M. Eccles
- Faculty of Medicine, University of Southampton, University
Hospital Southampton, Southampton
SO16 6YD, UK
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of
Helsinki and Helsinki University Central Hospital, Haartmaninkatu
8, FI-00029
Helsinki, Finland
| | - Douglas Easton
- Centre for Cancer Genetic Epidemiology, Department of
Public Health and Primary Care, University of Cambridge,
Cambridge
CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of
Oncology, University of Cambridge, Worts Causeway,
Cambridge
CB1 8RN, UK
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics,
Karolinska Institutet, Box 281, 171 77
Stockholm, Sweden
| | - Jianjun Liu
- Human Genetics, Genome Institute of Singapore,
60 Biopolis Street 02-01, Singapore
138672, Singapore
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics,
Karolinska Institutet, Box 281, 171 77
Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics,
Karolinska Institutet, Box 281, 171 77
Stockholm, Sweden
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47
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Viale G, Slaets L, Bogaerts J, Rutgers E, Van't Veer L, Piccart-Gebhart MJ, de Snoo FA, Stork-Sloots L, Russo L, Dell'Orto P, van den Akker J, Glas A, Cardoso F. High concordance of protein (by IHC), gene (by FISH; HER2 only), and microarray readout (by TargetPrint) of ER, PgR, and HER2: results from the EORTC 10041/BIG 03-04 MINDACT trial. Ann Oncol 2014; 25:816-823. [PMID: 24667714 PMCID: PMC3969556 DOI: 10.1093/annonc/mdu026] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [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: 07/18/2013] [Revised: 11/04/2013] [Accepted: 01/17/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To investigate the correlation of TargetPrint with local and central immunohistochemistry/fluorescence in situ hybridization assessment of estrogen (ER), progesterone (PgR), and human epidermal growth factor receptor 2 (HER2) in the first 800 patients enrolled in the MINDACT trial. PATIENTS AND METHODS Data from local (N = 800) and central (N = 626) assessments of receptor status were collected and compared with TargetPrint results. RESULTS For ER, the positive agreement (the percentage of central pathology positive assessments that were also TargetPrint/local laboratory positive) for TargetPrint in comparison to centralized assessment was 98% with a negative agreement (the percentage of central pathology negative assessments that were also TargetPrint/local laboratory negative) of 96%. For PgR, the positive agreement was 83% with a negative agreement of 92%. For HER2, the positive agreement was 75% with a negative agreement of 99%. Even though the local assessment showed higher positive agreement for PgR (89%) and higher positive agreement for HER2 (85%), the range of discordant local versus central assessments were as high as 6.7% for ER, 12.9% for PgR, and 4.3% for HER2. CONCLUSION TargetPrint and local assessment of ER, PgR, and HER2 show high concordance with central assessment in the first 800 MINDACT patients. However, there are concerns about the higher discordance rates for some local sites. TargetPrint can improve the reliability of hormone receptor and HER2 testing for those centers with a lower rate of concordance with the reference laboratory, with the limitation of a positive agreement of 75% for HER2. TargetPrint consequently has important implications for treatment decisions in clinical practice and is a reliable alternative to local assessment for ER. CLINICAL TRIALS NUMBER NCT00433589.
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Affiliation(s)
- G Viale
- Department of Pathology, European Institute of Oncology and University of Milan, Milan, Italy.
| | - L Slaets
- Department of Statistics, European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - J Bogaerts
- Department of Statistics, European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - E Rutgers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam
| | - L Van't Veer
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA; Research and Development, Agendia, Amsterdam, The Netherlands
| | - M J Piccart-Gebhart
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - F A de Snoo
- Medical Affairs, Agendia, Amsterdam, The Netherlands
| | | | - L Russo
- Department of Pathology, European Institute of Oncology and University of Milan, Milan, Italy
| | - P Dell'Orto
- Department of Pathology, European Institute of Oncology and University of Milan, Milan, Italy
| | - J van den Akker
- Research and Development, Agendia, Amsterdam, The Netherlands
| | - A Glas
- Research and Development, Agendia, Amsterdam, The Netherlands
| | - F Cardoso
- Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal
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48
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Elkhuizen PHM, Bartelink H, van de Vijver M, Rutgers E, Loo C, Vogel W, Rivera S, Lekberg T, van den Bongard D. Abstract OT2-1-03: Preoperative accelerated partial breast irradiation trial (PAPBI); defining radiosensitivity. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot2-1-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background and aim of the study:
A.The ongoing Preoperative Accelerated Partial Breast Irradiation (PAPBI) trial (NCT01024582) is based on the rationale that three-dimensional conformal external-beam radiation (3D-CRT) leads to more dose homogeneity compared with brachy-or intraoperative radiotherapy (RT). By irradiating preoperatively this can lead to more accurate tumor delineation and smaller irradiated volumes. As the tumor remains in situ during irradiation, more precise delivery of the radiation dose is guaranteed with CT cone beam linear accelerators, avoiding the uncertainties of the original tumor position in the operation cavity as is the case in postoperative RT. Tumor excision 6 weeks after RT removes the high dose volume tissue and can lead to better cosmesis.
B. By assessing tumor response to radiotherapy, an additional goal of the study is to develop a gene expression profile that predicts breast cancer radiosensitivity. This gene signature of breast radiosensitivity would further design optimal treatment strategies for individual breast cancer patients treated with BCT.
Inclusion citeria:
Patients 60 years or older with a cT< = 3cm, ductal carcinoma (no in situ component), unifocal on mammogram and MRI, pN0(sn) (sentinel node procedure before RT), will be treated by preoperative RT (CTV = GTV + 2 cm, 10 × 4 Gy IMRT/VMAT over two weeks). Six weeks after pre-operative RT, a wide local excision will be performed. Skin toxicity and fibrosis is scored using EORTC/RTOG criteria. Patients are followed during RT and on a 3-monthly basis. Cosmesis is scored and photographs are taken for analysis (BCCT.core project score).
To study radiosensit ivity, gene expression profiling from RNA and DNA isolated from biopsies (mRNA gene expression profiles, the miRNA expression profiles and the DNA copy number changes) taken of the tumor before radiotherapy and at time of surgery will be correlated with response to radiotherapy, defined as pathologic response at the time of the lumpectomy. Response of the tumor will be evaluated by MRI scan and PET (before radiotherapy and before surgery) and classical pathology.
Endpoint :
The main objective is to investigate the impact of a short fractionated schedule given preoperatively on cosmesis and breast fibrosis. Therefore, it is anticipated that the percentage of moderate or severe fibrosis will decrease from 27% as found in the boost arm of the EORTC boost-no boost trial to 15% (Collette et al EJC 2008). The total sample size of 120 patients will provide in excess of 80% power to detect the difference between the null hypotheses (a rate of fibrosis of 27%) and the alternative hypothesis (a rate of fibrosis of 15%) with an exact binomial test at 0.05 2-sided significance level. In addition, the 2-sided 95% confidence interval for the proportion of patients without local recurrence will extend 0.035 from the observed proportion for an expected proportion of 96%. An additional objective is to build a classifier (genomic or proteomic or any kind of molecular signature) to identify responders and non-responders. A total of 120 patients will be included in the study. The main analysis will include 60 patients in the training set and 60 in the validation set.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT2-1-03.
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Affiliation(s)
- PHM Elkhuizen
- The Netherlands Cancer Institute, Amsterdam, Netherlands; Amsterdam Medical Center, Amsterdam, Netherlands; Institute Gustave Roussy, Villejuif, France; Karolinska Institutet, Stockholm, Sweden; Utrecht University Medical Center, Utrecht, Netherlands
| | - H Bartelink
- The Netherlands Cancer Institute, Amsterdam, Netherlands; Amsterdam Medical Center, Amsterdam, Netherlands; Institute Gustave Roussy, Villejuif, France; Karolinska Institutet, Stockholm, Sweden; Utrecht University Medical Center, Utrecht, Netherlands
| | - M van de Vijver
- The Netherlands Cancer Institute, Amsterdam, Netherlands; Amsterdam Medical Center, Amsterdam, Netherlands; Institute Gustave Roussy, Villejuif, France; Karolinska Institutet, Stockholm, Sweden; Utrecht University Medical Center, Utrecht, Netherlands
| | - E Rutgers
- The Netherlands Cancer Institute, Amsterdam, Netherlands; Amsterdam Medical Center, Amsterdam, Netherlands; Institute Gustave Roussy, Villejuif, France; Karolinska Institutet, Stockholm, Sweden; Utrecht University Medical Center, Utrecht, Netherlands
| | - C Loo
- The Netherlands Cancer Institute, Amsterdam, Netherlands; Amsterdam Medical Center, Amsterdam, Netherlands; Institute Gustave Roussy, Villejuif, France; Karolinska Institutet, Stockholm, Sweden; Utrecht University Medical Center, Utrecht, Netherlands
| | - W Vogel
- The Netherlands Cancer Institute, Amsterdam, Netherlands; Amsterdam Medical Center, Amsterdam, Netherlands; Institute Gustave Roussy, Villejuif, France; Karolinska Institutet, Stockholm, Sweden; Utrecht University Medical Center, Utrecht, Netherlands
| | - S Rivera
- The Netherlands Cancer Institute, Amsterdam, Netherlands; Amsterdam Medical Center, Amsterdam, Netherlands; Institute Gustave Roussy, Villejuif, France; Karolinska Institutet, Stockholm, Sweden; Utrecht University Medical Center, Utrecht, Netherlands
| | - T Lekberg
- The Netherlands Cancer Institute, Amsterdam, Netherlands; Amsterdam Medical Center, Amsterdam, Netherlands; Institute Gustave Roussy, Villejuif, France; Karolinska Institutet, Stockholm, Sweden; Utrecht University Medical Center, Utrecht, Netherlands
| | - D van den Bongard
- The Netherlands Cancer Institute, Amsterdam, Netherlands; Amsterdam Medical Center, Amsterdam, Netherlands; Institute Gustave Roussy, Villejuif, France; Karolinska Institutet, Stockholm, Sweden; Utrecht University Medical Center, Utrecht, Netherlands
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49
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Zwart W, Koornstra R, Wesseling J, Rutgers E, Linn S, Carroll JS. A carrier-assisted ChIP-seq method for estrogen receptor-chromatin interactions from breast cancer core needle biopsy samples. BMC Genomics 2013; 14:232. [PMID: 23565824 PMCID: PMC3637562 DOI: 10.1186/1471-2164-14-232] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 03/22/2013] [Indexed: 01/16/2023] Open
Abstract
Background The Estrogen Receptor alpha (ERα) is the key transcriptional regulator in luminal breast cancer and is therefore the main target for adjuvant treatment of this subtype. Luminal gene signatures are dictated by the transcriptional capacities of ERα, which are a direct consequence of the receptors binding preference at specific sites on the chromatin. The identification of ERα binding signatures on a genome-wide level has greatly enhanced our understanding of Estrogen Receptor biology in cell lines and tumours, but the technique has its limitations with respect to its applicability in limited amounts of tumour tissue. Results Here, we present a refinement of the ChIP-seq procedures to enable transcription factor mapping on limited amounts of tissue culture cells as well as from a limited amount of tumor tissue derived from core needle biopsies. Our approach uses a carrier that can be removed prior to DNA amplification and sequencing. Conclusion We illustrate the applicability of this refined technology by mapping the ERα genome-wide chromatin binding landscape in core needle biopsy material from primary breast tumours. With this, our refined technology permits for a high-resolution transcription factor mapping even from clinical samples.
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Affiliation(s)
- Wilbert Zwart
- Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Robinson Way, Cambridge, UK.
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50
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Viale G, Slaets L, de Snoo F, van't VL, Rutgers E, Piccart M, Bogaerts J, van den Akker J, Stork-Sloots L, Engelen K, Russo L, Dell'Orto P, Cardoso F. Abstract P3-05-02: Pathological assessment of discordant cases for molecular (BluePrint and MammaPrint) versus clinical subtypes for breast cancer among 621 patients from the EORTC 10041/BIG 3–04 (MINDACT) trial. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p3-05-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Biology has become the main driver of breast cancer therapy. Intrinsic biological subtypes by gene expression profiling have been identified. Pathology can be used to define surrogates of these subtypes but these are not always concordant, which may lead to different treatment plans. We investigated the concordance between BluePrint and MammaPrint (microarray-based) breast cancer subtypes and pathological surrogates (based on ER, PR, HER2 & Ki67).
Methods: Using available data (centrally assessed pathology and genomics) from the MINDACT pilot phase [Rutgers et al. EJC 2011] 621 tumors were analyzed. Patients were classified according to 4-category based pathology (ER, PR, HER2 and Ki67); additionally, classification was performed adhering to the recent St. Gallen recommendations [Goldhirsch et al. 2011], which recognizes an additional category (Luminal B HER2+). Based on BluePrint and MammaPrint 4 subtypes are formed: Luminal A (Luminal-type/MammaPrint Low Risk); Luminal B (Luminal-type/MammaPrint High Risk); HER2-type; and Basal-type. This study is an analysis of discordant patient groups (i.e. clinical HER2+/BluePrint Luminal-type; clinical Hormone Receptor (HR)-positive/BluePrint Basal-type) providing comparison of centrally assessed tumor heterogeneity as well as comparison of quantified ER, PR and HER2 results.
Results: Ki67 is often used as biomarker to distinguish Luminal A from Luminal B subgroups. The concordance between MammaPrint and centrally assessed Ki67 in Luminal-type patients is 71%, with a κ score of 0.35 (95% CI 0.26–0.45) indicating that Ki67 and MammaPrint cannot reliably substitute for each other. There is a relatively large group of clinical HER2+ cases that are BluePrint Luminal-type (29 out of 76; 38%) indicating that tumor expression of the Luminal profile is dominant compared with expression of the HER2 profile. These patients have high IHC ER results and fall into the group that St Gallen separately defines as Luminal B HER2-type. These patients may have lower response to trastuzumab [von Minckwitz et al. JCO 2012]. 12 out of 76 BluePrint Basal-type patients are clinical HR+. These patients have low centrally assessed IHC ER and PR expression (≥1% and <10%).
Conclusions: Marked differences are observed between BluePrint and MammaPrint (microarray based) breast cancer subtypes and centrally re-assessed pathological surrogates (based on ER, PR, HER2 & Ki67). The greatest discordance is seen in the sub-stratification of Luminal patients, and in the HR+/HER2+ patients. The observed subtype discrepancies may have an important impact on treatment decision making.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-05-02.
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Affiliation(s)
- G Viale
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - L Slaets
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - F de Snoo
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - Veer L van't
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - E Rutgers
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - M Piccart
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - J Bogaerts
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - J van den Akker
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - L Stork-Sloots
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - K Engelen
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - L Russo
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - P Dell'Orto
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
| | - F Cardoso
- European Institute of Oncology; European Organisation for Research and Treatment of Cancer; Agendia NV; Netherlands Cancer Institute; Jules Bordet Institute; Champalimaud Cancer Center
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