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Frenel JS, Zeghondy J, Guérin-Charbonnel C, Mailliez A, Volant E, Poumeaud F, Patsouris A, Arnedos M, Bailleux C, Cabal J, Galland L, de Nonneville A, Guiu S, Dalenc F, Pistilli B, Bachelot T, Pierga JY, Le Du F, Bocquet F, Larrouquere L, Loirat D. Tucatinib Combination Treatment After Trastuzumab-Deruxtecan in Patients With ERBB2-Positive Metastatic Breast Cancer. JAMA Netw Open 2024; 7:e244435. [PMID: 38568692 PMCID: PMC10993071 DOI: 10.1001/jamanetworkopen.2024.4435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/01/2024] [Indexed: 04/05/2024] Open
Abstract
Importance Little is known regarding the outcomes associated with tucatinib combined with trastuzumab and capecitabine (TTC) after trastuzumab-deruxtecan exposure among patients with ERBB2 (previously HER2)-positive metastatic breast cancer (MBC). Objective To investigate outcomes following TTC treatment in patients with ERBB2-positive MBC who had previously received trastuzumab-deruxtecan. Design, Setting, and Participants This cohort study included all patients with MBC who were treated in 12 French comprehensive cancer centers between August 1, 2020, and December 31, 2022. Exposure Tucatinib combined with trastuzumab and capecitabine administered at the recommended dose. Main Outcomes and Measures Clinical end points included progression-free survival (PFS), time to next treatment (TTNT), overall survival (OS), and overall response rate (ORR). Results A total of 101 patients with MBC were included (median age, 56 [range, 31-85] years). The median number of prior treatment lines for metastatic disease at TTC treatment initiation was 4 (range, 2-15), including 82 patients (81.2%) with previous trastuzumab and/or pertuzumab and 94 (93.1%) with previous ado-trastuzumab-emtansine) exposure. The median duration of trastuzumab-deruxtecan treatment was 8.9 (range, 1.4-25.8) months, and 82 patients (81.2%) had disease progression during trastuzumab-deruxtecan treatment, whereas 18 (17.8%) had stopped trastuzumab-deruxtecan for toxic effects and 1 (1.0%) for other reasons. Tucatinib combined with trastuzumab and capecitabine was provided as a third- or fourth-line treatment in 37 patients (36.6%) and was the immediate treatment after trastuzumab-deruxtecan in 86 (85.1%). With a median follow-up of 11.6 (95% CI, 10.5-13.4) months, 76 of 101 patients (75.2%) stopped TTC treatment due to disease progression. The median PFS was 4.7 (95% CI, 3.9-5.6) months; median TTNT, 5.2 (95% CI, 4.5-7.0) months; and median OS, 13.4 (95% CI, 11.1 to not reached [NR]) months. Patients who received TTC immediately after trastuzumab-deruxtecan had a median PFS of 5.0 (95% CI, 4.2-6.0) months; median TTNT of 5.5 (95% CI, 4.8-7.2) months, and median OS of 13.4 (95% CI, 11.9-NR) months. Those who received TTC due to trastuzumab-deruxtecan toxicity-related discontinuation had a median PFS of 7.3 (95% CI, 3.0-NR) months. Best ORR was 29 of 89 patients (32.6%). Sixteen patients with active brain metastasis had a median PFS of 4.7 (95% CI, 3.0-7.3) months, median TTNT of 5.6 (95% CI, 4.4 to NR), and median OS of 12.4 (95% CI, 8.3-NR) months. Conclusions and Relevance In this study, TTC therapy was associated with clinically meaningful outcomes in patients with ERBB2-positive MBC after previous trastuzumab-deruxtecan treatment, including those with brain metastases. Prospective data on optimal drug sequencing in this rapidly changing therapeutic landscape are needed.
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Affiliation(s)
- Jean-Sebastien Frenel
- Department of Medical Oncology, Institut de Cancerologie de l’Ouest, Saint-Herblain, France
| | - Jean Zeghondy
- Department of Medical Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | | | - Audrey Mailliez
- Department of Medical Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Elsa Volant
- Department of Medical Oncology, Institut de Cancerologie de l’Ouest, Saint-Herblain, France
| | | | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancerologie de l’Ouest, Angers, France
| | - Monica Arnedos
- Department of Medical Oncology Bordeaux, Institut Bergonie, Bordeaux, France
| | - Caroline Bailleux
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Julie Cabal
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Loick Galland
- Department of Medical Oncology, Centre Georges Francois Leclerc, Dijon, France
| | | | - Séverine Guiu
- Department of Medical Oncology, Montpellier Cancer Institute, Montpellier, France
| | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Fanny Le Du
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - François Bocquet
- Data Factory, Institut de Cancerologie de l’Ouest, Saint-Herblain, France
| | | | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, Paris, France
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Corné J, Quillien V, Godey F, Cherel M, Cochet A, Le Du F, Robert L, Bourien H, Brunot A, Crouzet L, Perrin C, Lefeuvre-Plesse C, Diéras V, De la Motte Rouge T. Plasma-based analysis of ERBB2 mutational status by multiplex digital PCR in a large series of patients with metastatic breast cancer. Mol Oncol 2024. [PMID: 38287892 DOI: 10.1002/1878-0261.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/16/2023] [Accepted: 01/15/2024] [Indexed: 01/31/2024] Open
Abstract
Erb-b2 receptor tyrosine kinase 2 (ERBB2)-activating mutations are therapeutically actionable alterations found in various cancers, including metastatic breast cancer (MBC). We developed multiplex digital PCR assays to detect and quantify ERBB2 mutations in circulating tumor DNA from liquid biopsies. We studied the plasma from 272 patients with hormone-receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) MBC to detect 17 ERBB2 mutations using a screening assay. The assay was developed on the three-color Crystal dPCR™ naica® platform with a two-step strategy for precise mutation identification. We found that nine patients (3.3%) harbored at least one ERBB2 mutation. The mutation rate was higher in patients with lobular histology (5.9%) compared to invasive breast carcinoma of no special type (2.6%). A total of 12 mutations were found with the following frequencies: L755S (25.00%), V777L (25.00%), S310Y (16.67%), L869R (16.67%), S310F (8.33%), and D769H (8.33%). Matched tumor samples from six patients identified the same mutations with an 83% concordance rate. In summary, our highly sensitive multiplex digital PCR assays are well suited for plasma-based monitoring of ERBB2 mutational status in patients with MBC.
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Affiliation(s)
- Julien Corné
- Department of Biology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Véronique Quillien
- Department of Biology, Centre Eugène Marquis, Unicancer, Rennes, France
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
- INSERM U1242, University of Rennes, France
| | - Florence Godey
- Department of Biology, Centre Eugène Marquis, Unicancer, Rennes, France
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
- INSERM U1242, University of Rennes, France
| | - Mathilde Cherel
- Department of Biology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Agathe Cochet
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Lucie Robert
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Héloïse Bourien
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Angélique Brunot
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Laurence Crouzet
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Christophe Perrin
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | | | - Véronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
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Le Du F, Carton M, Bachelot T, Saghatchian M, Pistilli B, Brain E, Loirat D, Vanlemmens L, Vermeulin T, Emile G, Gonçalves A, Ung M, Robert M, Jaffre A, Desmoulins I, Jouannaud C, Uwer L, Marc Ferrero J, Mouret-Reynier MA, Jacot W, Chevrot M, Delaloge S, Diéras V. Real-World Impact of Adjuvant Anti-HER2 Treatment on Characteristics and Outcomes of Women With HER2-Positive Metastatic Breast Cancer in the ESME Program. Oncologist 2023; 28:e867-e876. [PMID: 37589218 PMCID: PMC10546827 DOI: 10.1093/oncolo/oyad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/14/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Although adjuvant cancer treatments increase cure rates, they may induce clonal selection and tumor resistance. Information still lacks as whether (neo)adjuvant anti-HER2 treatments impact the patterns of recurrence and outcomes of HER2-positive (HER2+) metastatic breast cancer (MBC). We aimed to assess this in the large multicenter ESME real-world database. PATIENTS AND METHODS We examined the characteristics and outcomes (overall survival (OS) and progression-free survival under first-line treatment (PFS1)) of HER2+ patients with MBC from the French ESME program with recurrent disease, as a function of the previous receipt of adjuvant trastuzumab. Multivariable analyses used Cox models adjusted for baseline demographic, prognostic factors, adjuvant treatment received, and disease-free interval. RESULTS Two thousand one hundred and forty-three patients who entered the ESME cohort between 2008 and 2017 had a recurrent HER2+ MBC. Among them, 56% had received (neo)adjuvant trastuzumab and 2.5% another anti-HER2 in this setting. Patients pre-exposed to trastuzumab were younger, had a lower disease-free interval, more HR-negative disease and more metastatic sites. While the crude median OS appeared inferior in patients exposed to adjuvant trastuzumab, as compared to those who did not (37.2 (95%CI 34.4-40.3) versus 53.5 months (95% CI: 47.6-60.1)), this difference disappeared in the multivariable model (HR = 1.05, 95%CI 0.91-1.22). The same figures were observed for PFS1. CONCLUSIONS Among patients with relapsed HER2+ MBC, the receipt of adjuvant trastuzumab did not independently predict for worse outcomes when adjusted to other prognostic factors.
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Affiliation(s)
- Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon-Bérard, Lyon, France
| | | | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint Cloud, Paris, France
| | - Delphine Loirat
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | | | | | - George Emile
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Mony Ung
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, CRCT, Inserm, Toulouse, France
| | - Marie Robert
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - René Gauducheau, Saint-Herblain, France
| | - Anne Jaffre
- Anne jaffré Department of Medical Information, Institut Bergonié, Bordeaux, France
| | | | | | - Lionel Uwer
- Institut de Cancérologie de Lorraine, Nancy, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | - William Jacot
- Department of Medical Oncology, Institut du cancer de Montpellier, Montpellier, France
| | - Michaël Chevrot
- Health Data and Partnership Department, Unicancer, Paris, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Véronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
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Deleuze A, Massard C, Le Du F, You B, Lefeuvre-Plesse C, Bolze PA, de la Motte Rouge T. Management of trophoblastic tumors : review of evidence, current practice, and future directions. Expert Rev Anticancer Ther 2023; 23:699-708. [PMID: 37198729 DOI: 10.1080/14737140.2023.2215438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Gestational trophoblastic neoplasia (GTN) is a group of rare tumors characterized by abnormal trophoblastic proliferation following pregnancy including invasive moles, choriocarcinomas, and intermediate trophoblastic tumors (ITT). Although the treatment and follow-up of GTN has been heterogeneous, globally the emergence of expert networks has helped to harmonize its management. AREAS COVERED We provide an overview of the current knowledge, diagnosis, and management strategies in GTN and discuss innovative therapeutic options under investigation. While chemotherapy has been the historical backbone of GTN treatment, promising drugs such as immune checkpoint inhibitors targeting the PD-1/PD-L1 pathway and anti-angiogenic tyrosine kinase inhibitors are currently being investigated remodeling the therapeutical landscape of trophoblastic tumors. EXPERT OPINION Chemotherapy regimens for GTN have potential long-term effects on fertility and quality of life, making innovative and less toxic therapeutic approaches necessary. Immune checkpoint inhibitors have shown promise in reversing immune tolerance in GTN and have been evaluated in several trials. However, immunotherapy is associated with rare but life-threatening adverse events and evidence of immune-related infertility in mice, highlighting the need for further research and careful consideration of its use. Innovative biomarkers could help personalize GTN treatments and reduce chemotherapy burden in some patients.
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Affiliation(s)
- Antoine Deleuze
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | | | - Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Benoit You
- Department of Gynecological Oncological, and Obstetrics Department, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
- French Reference Center for Trophoblastic Diseases, University Hospital Lyon Sud, Lyon, France
- Institute of Cancerology, Hospices Civils de Lyon, CITOHL, Lyon, UR, France
| | | | - Pierre-Adrien Bolze
- Department of Gynecological Oncological, and Obstetrics Department, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
- Institute of Cancerology, Hospices Civils de Lyon, CITOHL, Lyon, UR, France
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Corné J, Quillien V, Callens C, Portois P, Bidard FC, Jeannot E, Godey F, Le Du F, Robert L, Bourien H, Brunot A, Crouzet L, Perrin C, Lefeuvre-Plesse C, Diéras V, De la Motte Rouge T. Development of sensitive and robust multiplex digital PCR assays for the detection of ESR1 mutations in the plasma of metastatic breast cancer patients. Clin Chim Acta 2023; 545:117366. [PMID: 37105452 DOI: 10.1016/j.cca.2023.117366] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Early detection of ESR1 mutations is a key element for better personalization of the management of patients with HR+/HER2- Metastatic Breast Cancer (MBC). Analysis of circulating tumor DNA from liquid biopsies is a particularly well-suited strategy for longitudinal monitoring of such patients. MATERIALS AND METHODS Using the naica® three-color digital PCR platform, we developed a screening assay allowing the detection of 11 ESR1 mutations and designed a sequential strategy for precise mutation identification. We then applied this strategy in the analysis of plasma circulating cell-free DNA from 109 HR+/HER2- MBC patients and performed a double-blind comparison study on a subset of patients, with the multiplex assay used at the Institut Curie (IC) for the PADA-1 study. RESULTS Thirty-one patients (28.4%) harboured at least one ESR1 mutation, with the following frequencies: D538G (41.03%), Y537S (25.64%), E380Q (10.26%), Y537N (10.26%), "(536-540)" (7.69%), Y537C (2.56%), and L536R (2.56%). The presence of ESR1 mutation(s) was significantly associated with liver metastases (p = 0.0091). A very good agreement (91%) was observed with the IC assay. CONCLUSION Our assays have proven to be robust and highly sensitive and are very well-suited for monitoring ESR1 mutations in the plasma of MBC patients.
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Affiliation(s)
- Julien Corné
- Department of Biology, Centre Eugène Marquis, Unicancer, Rennes, France.
| | - Véronique Quillien
- Department of Biology, Centre Eugène Marquis, Unicancer, Rennes, France; Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France; INSERM U1242, University of Rennes, Rennes, France
| | - Céline Callens
- Department of Genetics, Institut Curie, Paris and Saint-Cloud, France
| | - Pascal Portois
- Department of Genetics, Institut Curie, Paris and Saint-Cloud, France
| | | | - Emmanuelle Jeannot
- Department of Genetics, Institut Curie, Paris and Saint-Cloud, France; Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France; Department of Pathology, Institut Curie, Paris and Saint-Cloud, France
| | - Florence Godey
- Department of Biology, Centre Eugène Marquis, Unicancer, Rennes, France; Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France; INSERM U1242, University of Rennes, Rennes, France
| | - Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Lucie Robert
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Héloïse Bourien
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Angélique Brunot
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Laurence Crouzet
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | - Christophe Perrin
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
| | | | - Véronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Unicancer, Rennes, France
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Quillien V, Corne J, Rouge TDLM, Du FL, Godey F. Abstract 2314: Development of a 6-color multiplex Crystal Digital PCR assay for the detection of ESR1 and PIK3CA mutations in the plasma of metastatic breast cancer patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-2314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Blood-based liquid biopsies have become a real asset for patient treatment management in the field of precision oncology over the past few years, as they allow quick and easy access to tumor genetic alterations of interest. The analysis of circulating tumor DNA (ctDNA) from these liquid biopsies is a particularly well-suited strategy for longitudinal monitoring of patients. In patients with HR+/HER2- metastatic breast cancer (MBC), early detection of ESR1 and PIK3CA mutations is a key element to better personalize disease management. Among the technologies currently used for liquid biopsies, digital PCR (dPCR) has the advantage of being among the fastest and least expensive, providing robust results along with unmatched sensitivity as compared to other methods. Until recently, however, dPCR has been previously limited by multiplex capability. The recent availability of the 6-color version of the naica® platform (Stilla Technologies) has allowed us to develop a single-well multiplexed assay that combines an 11 pathogenic mutation ESR1 assay with a 21 mutation PIK3CA assay, for a combined total of 32 ESR1 and PIK3CA mutations. Here we present data on this new high-plex dPCR panel. As ESR1 and PIK3CA analyses are often requested together, this new screening assay represents a significant saving of time and resources for the analysis of our MBC patients with a relative ease of implementation and analysis.
Citation Format: Veronique Quillien, Julien Corne, Thibault De la Motte Rouge, Fanny Le Du, Florence Godey. Development of a 6-color multiplex Crystal Digital PCR assay for the detection of ESR1 and PIK3CA mutations in the plasma of metastatic breast cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2314.
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Francis PA, Fleming GF, Láng I, Ciruelos EM, Bonnefoi HR, Bellet M, Bernardo A, Climent MA, Martino S, Bermejo B, Burstein HJ, Davidson NE, Geyer CE, Walley BA, Ingle JN, Coleman RE, Müller B, Le Du F, Loibl S, Winer EP, Ruepp B, Loi S, Colleoni M, Coates AS, Gelber RD, Goldhirsch A, Regan MM. Adjuvant Endocrine Therapy in Premenopausal Breast Cancer: 12-Year Results From SOFT. J Clin Oncol 2023; 41:1370-1375. [PMID: 36493334 PMCID: PMC10419521 DOI: 10.1200/jco.22.01065] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/08/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The Suppression of Ovarian Function Trial (SOFT; ClinicalTrials.gov identifier: NCT00066690) randomly assigned premenopausal women with hormone receptor-positive breast cancer to 5 years of adjuvant tamoxifen, tamoxifen plus ovarian function suppression (OFS), or exemestane plus OFS. The primary analysis compared disease-free survival (DFS) between tamoxifen plus OFS versus tamoxifen alone; exemestane plus OFS versus tamoxifen was a secondary objective. After 8 years, SOFT reported a significant reduction in recurrence and improved overall survival (OS) with adjuvant tamoxifen plus OFS versus tamoxifen alone. Here, we report outcomes after median follow-up of 12 years. DFS remained significantly improved with tamoxifen plus OFS versus tamoxifen (hazard ratio, 0.82; 95% CI, 0.69 to 0.98) with a 12-year DFS of 71.9% with tamoxifen, 76.1% with tamoxifen plus OFS, and 79.0% with exemestane plus OFS. OS was improved with tamoxifen plus OFS versus tamoxifen (hazard ratio, 0.78; 95% CI, 0.60 to 1.01) and was 86.8% with tamoxifen, 89.0% with tamoxifen plus OFS, and 89.4% with exemestane plus OFS at 12 years. Among those who received prior chemotherapy for human epidermal growth factor receptor-2-negative tumors, OS was 78.8% with tamoxifen, 81.1% with tamoxifen plus OFS, and 84.4% with exemestane plus OFS. In conclusion, after 12 years, there remains a benefit from including OFS in adjuvant endocrine therapy, with an absolute improvement in OS more apparent with higher baseline risk of recurrence.[Media: see text].
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Affiliation(s)
- Prudence A. Francis
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
- Breast Cancer Trials Australia & New Zealand, University of Newcastle, Callaghan, Newcastle, Australia
- International Breast Cancer Study Group, Bern, Switzerland
| | - Gini F. Fleming
- The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL
| | - István Láng
- Clinexpert-Research, Budapest, Hungary
- National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Eva M. Ciruelos
- Medical Oncology Department, University Hospital and SOLTI Breast Cancer Research Cooperative Group, Madrid, Spain
| | - Hervé R. Bonnefoi
- Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U1312, and European Organisation for Research and Treatment of Cancer (EORTC), Bordeaux, France
| | - Meritxell Bellet
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, and SOLTI Breast Cancer Research Cooperative Group, Barcelona, Spain
| | | | - Miguel A. Climent
- Instituto Valenciano de Oncologia, Valencia and SOLTI Breast Cancer Research Cooperative Group, Barcelona, Spain
| | - Silvana Martino
- The Angeles Clinic and Research Institute and SWOG, Santa Monica, CA
| | - Begoña Bermejo
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, Incliva, Barcelona, Spain
- Medicine Department Universidad de Valencia, Valencia and SOLTI Breast Cancer Cooperative Group, Barcelona, Spain
| | - Harold J. Burstein
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Harvard Medical School and Alliance for Clinical Trials in Oncology, Boston, MA
| | - Nancy E. Davidson
- Fred Hutchinson Cancer Center, University of Washington and ECOG-ACRIN, Seattle, WA
| | - Charles E. Geyer
- University of Pittsburgh Medical Center Hillman Cancer Center and NRG Oncology, Pittsburgh, PA
| | - Barbara A. Walley
- University of Calgary and Canadian Cancer Trials Group, Calgary, Alberta, Canada
| | - James N. Ingle
- Mayo Clinic and Alliance for Clinical Trials in Oncology, Rochester, MN
| | - Robert E. Coleman
- Weston Park Hospital, Sheffield, United Kingdom
- NCRI Breast Cancer Clinical Studies Group, London, United Kingdom
- ICR-CTSU, London, United Kingdom
| | - Bettina Müller
- Chilean Cooperative Group for Oncological Research (GOCCHI), Santiago, Chile
| | - Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany
- Goethe University of Frankfurt, Frankfurt, Germany
| | - Eric P. Winer
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Harvard Medical School and Alliance for Clinical Trials in Oncology, Boston, MA
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
- Smilow Cancer Hospital, New Haven, CT
| | - Barbara Ruepp
- International Breast Cancer Study Group Coordinating Center, Bern, Switzerland
| | - Sherene Loi
- International Breast Cancer Study Group and Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Victoria, Australia
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS and International Breast Cancer Study Group, Milan, Italy
| | - Alan S. Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - Richard D. Gelber
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, MA
| | - Aron Goldhirsch
- IEO, European Institute of Oncology, IRCCS and International Breast Cancer Study Group, Milan, Italy
| | - Meredith M. Regan
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Bellier C, Gladieff L, Le Du F, Berton D, Bonnard C, Suau D, Richard AC, Brenner O, Lahouegue A, Freyer G, Floquet A, Frank S, Kfoury M. Olaparib First-Line Maintenance Monotherapy in BRCA-Mutated Epithelial Ovarian Cancer: Descriptive Analysis of the First French Real-World Data Study. Drugs Real World Outcomes 2023:10.1007/s40801-022-00349-9. [PMID: 36630055 DOI: 10.1007/s40801-022-00349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Olaparib, a poly(ADP-ribose) polymerase inhibitor, was approved by the European Commission in June 2019, following the results of the SOLO-1/GOG 3004 trial as maintenance monotherapy in adult patients with BRCA-mutated epithelial ovarian cancer. OBJECTIVE This study aimed to provide a descriptive analysis of the first real-world data from patients with BRCA-mutated ovarian cancer who received olaparib as first-line maintenance monotherapy in the French cohort Temporary Authorisation for Use (Autorisation Temporaire d'Utilisation de cohorte, ATUc) programme from 11 March, 2019 to 16 January, 2020. METHODS Eligible patients were aged 18 years and over with confirmed epithelial ovarian, primary peritoneal or Fallopian tube cancer and a deleterious or suspected deleterious germline or somatic BRCA 1/2 mutation. Patients were in complete or partial clinical response at the end of first-line platinum-based chemotherapy. Olaparib maintenance therapy was initiated within 8 weeks of the patients' last dose of chemotherapy. Real-world data were collected through treatment access request forms completed by physicians. Clinical and safety data were collected monthly until the end of the ATUc programme. RESULTS A total of 107 centres in metropolitan France and the French Overseas Departments and Territories requested the inclusion for 238 patients, of whom 194 received maintenance olaparib. In total, 87.6% of the primary tumour locations were ovary, the most common histology was high-grade serous (93.0%) and the most common International Federation of Gynaecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique) stage was IIIC (56.8%). BRCA testing was performed in routine practice, prior to inclusion into the ATUc programme. All patients had a BRCA mutation: 52.5% had a somatic mutation, 38.4% had a germinal mutation and 9.1% had germinal and somatic mutations. Twenty-four (12%) patients experienced serious adverse drug reactions at the last safety follow-up (17 February, 2020). The most common were anaemia (12 [6%] patients), neutropenia (3 [2%] patients) and thrombocytopenia (3 [2%] patients). CONCLUSIONS The rapid enrolment into the ATUc programme highlighted the strong unmet need for patients with ovarian cancer and a BRCA mutation in first-line maintenance treatment. Olaparib was well tolerated and no new safety signals were observed in this real-world patient population.
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Batista MFFV, Eiriz I, Fitzpatrick A, Le Du F, Braga S, Alpuim Costa D. Refining Therapy in Patients with HER2-Positive Breast Cancer with Central Nervous System Metastasis. Breast Care (Basel) 2022; 17:524-532. [PMID: 36590149 PMCID: PMC9801402 DOI: 10.1159/000526431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/07/2022] [Indexed: 01/04/2023] Open
Abstract
Background Brain metastasis (BM) is a major clinical problem in metastatic breast cancer (MBC), occurring in 50% of patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Historically omitted from clinical trials, recent studies of novel HER2-targeted agents have focused on HER2+ BM patients, addressing stable but also progressing BM and leptomeningeal carcinomatosis (LMC). Summary This review aimed to summarize the most relevant data on treating patients with HER2+ BM and LMC. Key Messages The treatment paradigm for patients with HER2+ MBC has changed. Local therapies play an important role, but accumulating evidence on the intracranial activity and clinical benefit of anti-HER2 targeting therapies might lead to a shift in the paradigm on treating BM in the next few years towards more widespread use of systemic therapy.
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Affiliation(s)
| | - Inês Eiriz
- Oncology Department, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal
| | - Amanda Fitzpatrick
- Oncology Department, Guy's and St Thomas' Hospital, London, UK
- Oncology Department, The Institute of Cancer Research, London, UK
| | - Fanny Le Du
- Oncology Department, CRLCC Eugène Marquis, Rennes, France
| | - Sofia Braga
- Oncology Department, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal
- Haematology and Oncology Department, CUF Oncologia, Lisbon, Portugal
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10
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Véron M, Chevret S, Grob JJ, Beylot-Barry M, Saiag P, Fléchon A, You B, Maubec E, Jouary T, Toulemonde E, Jamme P, Gambotti L, Lamrani-Ghaouti A, Dupuy A, Lebbe C, Seguin NB, Houede N, Leccia MT, Le Du F, de Pontville M, Gaudy-Marquestre C, Guillot B, Simon C, Marabelle A, Mortier L. Safety and efficacy of nivolumab, an anti-PD1 immunotherapy, in patients with advanced basal cell carcinoma, after failure or intolerance to sonic Hedgehog inhibitors: UNICANCER AcSé NIVOLUMAB trial. Eur J Cancer 2022; 177:103-111. [PMID: 36335780 DOI: 10.1016/j.ejca.2022.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common human malignancy. In most cases, BCC has slow progression and can be definitively cured by surgery or radiotherapy. However, in rare cases, it can become locally advanced or, even more rarely, metastatic. The alternative recommended treatments are Sonic Hedgehog pathway inhibitors; however, the response is often short-lived. METHODS This was a phase 2 basket study (NCT03012581) evaluating the efficacy and safety of nivolumab in a cohort of 32 advanced BCC patients, enrolled after failure of Sonic Hedgehog inhibitors, including 29 laBCC (91%) and 3 mBCC (9%). RESULTS Compared to previously published studies, our population consisted of severe patients with a poor prognosis because they had already received multiple lines of treatment: all patients received previous Sonic Hedgehog inhibitors, 53% of patients already had chemotherapy and 75% radiotherapy. At 12 weeks, we reported 3.1% of complete responses, 18.8% of partial responses, and 43.8% of stable diseases. The best response rate to nivolumab reached 12.5% of complete responses (four patients), 18.8% of partial responses (three patients), and 43.8% of stable diseases (14 patients). Adverse events (AE) were mostly grade 2 or 3, slightly different to the adverse events observed in the treatment of metastatic melanoma (higher rate of diabetes, no thyroid dysfunction). CONCLUSION Nivolumab is a relevant therapeutic option for patients with advanced relapsing/refractory BCC.
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Affiliation(s)
- Marie Véron
- Department of Dermatology, Claude Huriez Hospital, University Hospital of Lille, France; University School of Medecine Henri Warembourg, Lille, France.
| | | | - Jean-Jacques Grob
- Department of Dermatology, University Hospital La Timone, Marseille, France; CARADERM Network
| | - Marie Beylot-Barry
- Department of Dermatology, University Hospital of Bordeaux & Translational Research on Oncodermatology and Rare Skin Diseases, Bordeaux Institute of Oncology, INSERM 1312, University of Bordeaux, France; CARADERM Network
| | - Philippe Saiag
- Department of Dermatology, Ambroise Paré Hospital, APHP, & EA4340, University of Versailles-SQY and University of Paris-Saclay, France; CARADERM Network
| | - Aude Fléchon
- Department of Oncology, Léon Bérard Center, Lyon, France
| | - Benoit You
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, EA3738 CICLY, Université Claude Bernard Lyon 1, Lyon, France; CARADERM Network
| | - Eve Maubec
- Department of Dermatology, Avicenne Hospital, University Hospital of Paris, France; CARADERM Network
| | - Thomas Jouary
- Department of Dermatology, University Hospital of Pau, France; CARADERM Network
| | - Elise Toulemonde
- Department of Dermatology, Claude Huriez Hospital, University Hospital of Lille, France; University School of Medecine Henri Warembourg, Lille, France
| | - Philippe Jamme
- Department of Dermatology, Claude Huriez Hospital, University Hospital of Lille, France; University School of Medecine Henri Warembourg, Lille, France
| | | | | | | | - Céleste Lebbe
- Université de Paris Cite, Dermato-Oncologie, AP-HP Hôpital Saint Louis, F-75010 Paris, INSERM U976, France; CARADERM Network
| | - Nicole Basset Seguin
- Université de Paris Cite, Dermato-Oncologie, AP-HP Hôpital Saint Louis, F-75010 Paris, INSERM U976, France; CARADERM Network
| | - Nadine Houede
- Department of Dermatology, University Hospital of Nimes, France
| | - Marie-Thérèse Leccia
- Department of Dermatology, University Hospital of Grenoble, France; CARADERM Network
| | - Fanny Le Du
- Department of Oncology, Eugène Maquis Center, Rennes, France
| | - Michel de Pontville
- Department of Dermatology, University Hospital of Caen, France; CARADERM Network
| | | | - Bernard Guillot
- Department of Dermatology, St Eloi Hospital, University Hospital of Montpellier, France; CARADERM Network
| | | | - Aurélien Marabelle
- Département D'Innovation Thérapeutique et D'Essais Précoces (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - Laurent Mortier
- Department of Dermatology, Claude Huriez Hospital, University Hospital of Lille, France; University School of Medecine Henri Warembourg, Lille, France; CARADERM Network; INSERM 41189 / ONCOTHAI
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Du FL, Carton M, Saghatchian M, Perol D, Pistilli B, Brain E, Loirat D, Vanlemmens L, Vermeulin T, Levy C, Goncalves A, Ung M, Robert M, Jaffre A, Robain M, Delaloge S, Dieras V. Abstract P1-18-09: Impact of prior adjuvant trastuzumab (aT) on clinical characteristics, patterns of recurrence and outcomes in 4145 patients with Her2 positive (HER2+) metastatic breast cancer (MBC)- Results from the French ESME UNICANCER program. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-18-09] [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 management of HER2+ BC has changed dramatically with the introduction and widespread use of HER2-targeted therapies, especially in the adjuvant setting. It is well-known that de novo metastatic HER2+ breast cancer patients have better outcomes that women with metastatic relapse. This could be related both to a lead time bias, as well as to an ATRESS (adjuvant therapy-related shortening of survival) phenomenon [1]. Indeed, cancer treatments induce increased both clonal selection, as well as globally tumor resistance and agressivity [2]. However, there is relatively limited real-world information on the impact of adjuvant and neoadjuvant anti-HER2 targeted treatments on patterns of recurrence and outcomes of HER2+ MBC. Thus, the purpose of this study was to determine how and how long anti-HER2 targeted treatment in early setting impact outcomes of patients with HER2+ recurring BC. Methods: Since 2014, the 18 French Cancer Centers launched the Epidemiological Strategy and Medical Economics (ESME) program to provide real-world data on MBC patients (pts). All pts who started a 1st-line treatment for MBC between 01-Jan-2008 and 31-Dec-2017 were included. We examined clinical characteristics and outcomes (overall survival [OS] and time to 1st metastasis [TTM]) in patients with HER2+ MBC pretreated with trastuzumab in the (neo)adjuvant setting (aT) compared with trastuzumab-naïve patients and patients with de novo HER2+ MBC. Multivariate analyses adjusted for baseline demographic, prognostic factors, adjuvant treatment received and time to MBC. Results: Among the 23698 pts of the ESME database, 4145 were women treated in 1st line of a HER2+ MBC: 1716 pts (41%) had de novo and 2429 pts (59%) recurrent and 65% had Hormone Receptor (HR) + MBC; 53%, 26% and 21% had respectively 1, 2, or > 2 metastatic sites (64% visceral and 11% brain). With a median follow-up of 60.7 m, median OS is 42.4 m (95% CI: 40.1-45.0) for patients who relapsed. OS is significantly longer in de novo MBC: 64.7 m (95% CI: 60.2-73) (HRadjusted=0.68, 95% CI: 0.62-0.76, p < 0.0001). Among pts with recurrent MBC, 56% (1343) had received adjuvant trastuzumab (aT). As 1st-line therapy for MBC, 86 % of pts received HER2-targeted agents (74% T-based, 24% T-pertuzumab-based). Median TTM was 46.9 months (m): 57.6 m in HR+ and 30.2 m in HR-. Among pts with HR- diseases, 38% relapsed during the first 2 years of follow-up and 30% after 4 years (14.8%% and 56.9% in HR+ respectively). Among pts with recurrent MBC, crude median OS is inferior in pts who received aT, as compared to those who did not: 37.2 m (95% CI: 34.4-40.3) vs. 53.5 m (95% CI: 47.6-60.1), but this difference does not persist after adjustment for age, performans status, disease-free interval and number and type of metastatic sites in the multivariate model (HR=1.05, 95% CI: 0.91-1.22). A short disease-free interval (6-24 months compared to >48) remains, however, a strong adverse prognostic factor (HR=2.1, 95% CI: 1.82-2.50). Conclusions: The receipt of adjuvant trastuzumab does not predict for worse outcomes when adjusted to the other prognostic factors, among patients who relapsed during the 2008-2017 period. An ATRESS phenomenon is not suggested, although we cannot rule it out for those who relapsed within the initial 2 years. The much better prognosis of de novo MBC may be largely linked to lead time biases.
Citation Format: Fanny Le Du, Matthieu Carton, Mahasti Saghatchian, David Perol, Barbara Pistilli, Etienne Brain, Delphine Loirat, Laurence Vanlemmens, Thomas Vermeulin, Christelle Levy, Anthony Goncalves, Mony Ung, Marie Robert, Anne Jaffre, Mathieu Robain, Suzette Delaloge, Véronique Dieras. Impact of prior adjuvant trastuzumab (aT) on clinical characteristics, patterns of recurrence and outcomes in 4145 patients with Her2 positive (HER2+) metastatic breast cancer (MBC)- Results from the French ESME UNICANCER program [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-09.
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Affiliation(s)
| | | | | | - David Perol
- Department of Biostatistics, DRCI, Centre Léon Bérard, Lyon, France
| | | | - Etienne Brain
- CLCC Rene Huguenin Institut Curie, Saint Cloud, France
| | - Delphine Loirat
- Département d’Oncologie Médicale, Institut Curie, Paris, France
| | | | | | | | | | - Mony Ung
- UNGInstitut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Marie Robert
- Institut de Cancérologie de l'Ouest - René Gauducheau, Saint Herblain, France
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12
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Diéras V, Deluche E, Lusque A, Pistilli B, Bachelot T, Pierga JY, Viret F, Levy C, Salabert L, Du FL, Dalenc F, Jouannaud C, Venat-Bouvet L, Jacquin JP, Durando X, Petit T, Mahier - Aït Oukhatar C, Filleron T, Mosele MF, Lacroix-Triki M, Ducoulombier A, André F. Abstract PD8-02: Trastuzumab deruxtecan (T-DXd) for advanced breast cancer patients (ABC), regardless HER2 status: A phase II study with biomarkers analysis (DAISY). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd8-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The HER2-targeted antibody-drug conjugate (ADC) trastuzumab deruxtecan (T-DXd) demonstrated efficacy in heavily pretreated HER2-over- and HER2-low expressing ABC (1, 2). We aimed to assess the activity of T-DXd in HER2-over-, HER2-low and HER2-nul expressing ABC, to describe the drug mechanisms of action in the 3 cohorts and to identify biomarkers associated to drug response or resistance. Study Description: DAISY is a multicenter, open-label phase II trial designed to assess the efficacy of single agent T-DXd at 5.4 mg/kg dose in ABC with extensive biomarkers analysis. Three cohorts of patients were included: Cohort 1 (HER2 over-expressing: HER2 3+ on immunohistochemistry (IHC) or HER2 IHC2+/in situ hybridization [ISH]+), Cohort 2 (HER2 low-expressing: IHC1+ or IHC2+/ISH-) and cohort 3 (HER2-nul: IHC0+). Biopsy of metastatic sites was performed: at baseline, on treatment (mandatory for cohort 1, optional for cohort 2/3) and at tumor progression; blood samples for ctDNA were collected at baseline. The primary endpoint was the Best Overall Response (BOR) in each cohort, according to the investigator assessment. Secondary endpoints were BOR by central assessment, clinical benefit rate, duration of response (DOR), progression-free (PFS), overall survival (OS) and safety. Results:185 women and 1 man were enrolled between November 2019 and March 2021. Among the patients enrolled in the safety population (see Table 1), median (range) age was 55 (24-82) years, all received at least one prior line of therapy and 12 patients were TN. Table 2 shows investigator-reported T-Dxd activity in the 3 cohorts at a median follow-up of 10.1 months [95%CI: 9.2-11.1]. A total of 170 patients (95%) had at least one treatment-related toxicity. Key grade ≥3 treatment-related toxicities included neutropenia (10.6% of patients), fatigue (5.6%), leucopenia (4.5%), vomiting (4.5%) and anemia (3.4%). A total of 4 patients had drug-related interstitial lung disease or pneumonitis (grade 1 in 3 patients and grade 2 in 1 patient), 11 patients discontinued treatment due to treatment-related adverse events. No drug-related deaths occurred. Conclusions: T-DXd showed clinically meaningful activity in patients with HER2-overexpressing ABC and interestingly also in those with HER2low and HER2-nul ABC. Safety profile was consistent with previous reports. 1.Modi S et al N Engl J Med 2020 2.Mosi S et al J Clin Oncol 2020
Table 1.Analysis populationsTotalCohort 1 (HER2 over-expressing)Cohort 2 (HER2 low-expressing)Cohort 3 (HER2 non-detected)Enrolled population186727440Safety population*179687338 (including 12 TN)Full analysis Set**176687236TN: Triple Negative. *: safety population = enrolled population except 7 patients who did not receive at least one dose of study drug. **: Full Analysis Set = safety population except 3 patients (2 who did not have a valid first post-baseline assessment of disease status or who did not have progressive disease and 1 who did not have at least one radiologically measurable lesion according to RECIST v1.1)
Table 2.T-DXd activity in the three cohorts according to investigator assessmentTotalCohort 1Cohort 2Cohort 3BOR confirmedn/N82/176 (46.6%)47/68 (69.1%)24/72 (33.3%)11/36 (30.6%)[95%CI][39.1; 54.2][56.7; 79.8][22.7; 45.4]16.3; 48.1]Median DORmonths7.69.97.66.8[95%CI][6.2; 9.7][5.4; NR][4.4; 8.7][2.8; 8.3]Median PFSmonths6.911.16.74.2[95%CI][6.7; 8.7][8.4; NR][4.6; 8.5][2.1; 6.9]NR: Not Reached
Citation Format: Véronique Diéras, Elise Deluche, Amélie Lusque, Barbara Pistilli, Thomas Bachelot, Jean-Yves Pierga, Frédéric Viret, Christelle Levy, Laura Salabert, Fanny Le Du, Florence Dalenc, Christelle Jouannaud, Laurence Venat-Bouvet, Jean-Philippe Jacquin, Xavier Durando, Thierry Petit, Céline Mahier - Aït Oukhatar, Thomas Filleron, Maria Fernanda Mosele, Magali Lacroix-Triki, Agnès Ducoulombier, Fabrice André. Trastuzumab deruxtecan (T-DXd) for advanced breast cancer patients (ABC), regardless HER2 status: A phase II study with biomarkers analysis (DAISY) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD8-02.
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Affiliation(s)
- Véronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Elise Deluche
- Department of Medical Oncology, CHU Dupuytren, Limoges, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Claudius Regaud – IUCT Oncopole, Toulouse, France
| | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie Paris & Saint Cloud, Université de Paris, Paris, France
| | - Frédéric Viret
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Laura Salabert
- Department of Medical Oncology, Bergonie Institute, Bordeaux, France
| | - Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | | | - Jean-Philippe Jacquin
- Department of Medical Oncology, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | - Xavier Durando
- Department of Clinical Research, Délégation Recherche Clinique et Innovation, Centre Jean Perrin, Clermont Ferrand, France
| | - Thierry Petit
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg - Europe, Strasbourg, France
| | | | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud – IUCT Oncopole, Toulouse, France
| | | | | | | | - Fabrice André
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
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Deleuze A, Farce J, d'Abrigeon C, Girard A, Le Du F. Paraneoplastic cerebellar degeneration associated with anti-Yo antibodies in uterine papillary serous carcinoma. Int J Gynecol Cancer 2022; 32:101-104. [PMID: 34980663 DOI: 10.1136/ijgc-2021-003077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Antoine Deleuze
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Julien Farce
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | | | - Antoine Girard
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | - Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
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Le Du F, Dièras V, Curigliano G. Corrigendum to 'The role of tyrosine kinase inhibitors in the treatment of HER2+ metastatic breast cancer' [European Journal of Cancer 154 (2021) 175-189]. Eur J Cancer 2021; 158:255. [PMID: 34666920 DOI: 10.1016/j.ejca.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France.
| | - Véronique Dièras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano and European Institute of Oncology, IRCCS, Milano, Italy
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Le Du F, Diéras V, Curigliano G. The role of tyrosine kinase inhibitors in the treatment of HER2+ metastatic breast cancer. Eur J Cancer 2021; 154:175-189. [PMID: 34280871 DOI: 10.1016/j.ejca.2021.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Abstract
The introduction of trastuzumab and other subsequent human epidermal growth factor receptor 2 (HER2)-targeted therapies dramatically shifted the treatment landscape of HER2+ breast cancer, changing the natural history of the disease. There is no standard-of-care for patients with HER2+ metastatic breast cancer (MBC) in third and later lines of treatment; however, continued use of anti-HER2 therapies is recommended. Small-molecule tyrosine kinase inhibitors (TKIs) that target HER2 and other HER family receptors play a central role in this setting. TKIs have demonstrated various degrees of efficacy against central nervous system (CNS) metastases, which are a major clinical challenge for patients with HER2+ MBC. The TKIs lapatinib, neratinib, and tucatinib have received regulatory approval for the treatment of HER2+ MBC, while pyrotinib and afatinib have been evaluated in this setting. These TKIs vary by molecular weight, HER protein specificity and reversibility of binding and in turn have unique safety profiles. Toxicities reported in clinical trials of TKIs in HER2+ MBC that may require specific management strategies include diarrhoea, palmar-plantar erythrodysesthesia syndrome and rash. Here, we review the efficacy data, including CNS activity, and the safety profiles of the TKIs, and we provide guidance on adverse event management. Finally, we discuss how to incorporate the TKIs into the HER2+ MBC treatment algorithm.
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Affiliation(s)
- Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France.
| | - Véronqiue Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano and European Institute of Oncology, IRCCS, Milano, Italy
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Bourien H, Quillien V, Godey F, Perrin C, Le Du F, Guillermet S, Blanchot J, Lavoué V, Campillo-Gimenez B, Brunot A, Crouzet L, De la Motte Rouge T, Diéras V, Lefeuvre-Plesse C. Impact of EPclin on adjuvant therapeutic decision making and comparison of EPclin to the PREDICT tool. Int J Biol Markers 2021; 36:57-63. [PMID: 34027694 DOI: 10.1177/17246008211012424] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Genomic signatures, such as EndoPredict®, may help clinicians to decide which adjuvant treatment is the most appropriate. METHODS We propose the EndoPredict® assay for unclear cases of adjuvant treatment in patients treated in our comprehensive cancer center. We prospectively and retrospectively report the decision of adjuvant treatment before and after the EndoPredict® assay, respectively, compared to the PREDICT's tool scores. RESULTS From November 2016 to March 2019, 159 breast cancer tumors were analyzed and presented before and after the EndoPredict® assay. Before the EndoPredict® results, clinicians recommended chemotherapy for 57 patients (57/159, 36%). A total of 108 patients (108/159, 68%) were classified as EPclin high-risk score. There was only a slight agreement between clinicians' decisions and EPclin risk score. The EPclin score led to 37% changes in treatment (59/159); chemotherapy was favored in 80% of cases (47/59). The PREDICT tool recommended chemotherapy for 16 high-risk patients (16/159, 10%). CONCLUSION Although genomic tests were developed in order to de-escalate adjuvant treatment, in our comprehensive cancer center the use of the EndoPredict® assay led to an increase in prescribed chemotherapy.
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Affiliation(s)
| | | | | | | | - Fanny Le Du
- Centre Eugène Marquis, Unicancer, Rennes, France
| | | | | | - Vincent Lavoué
- Centre Eugène Marquis, Unicancer, Rennes, France.,Department of Surgery, CHU Pontchaillou, Unicancer, Rennes, France
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Estrade F, Le Du F, Crouzet L, Bourien H, Muzellec L, Edeline J. Tivozanib for hepatocellular carcinoma: not likely a new option. Ann Transl Med 2020; 8:1337. [PMID: 33313082 PMCID: PMC7723626 DOI: 10.21037/atm-20-3389] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Fanny Le Du
- Medical Oncology, Centre Eugène Marquis, Rennes, France
| | | | | | - Léa Muzellec
- Medical Oncology, Centre Eugène Marquis, Rennes, France
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Coudert B, Pierga JY, Mouret-Reynier MA, Kerrou K, Ferrero JM, Petit T, Du FL, Dupré PF, Bachelot T, Gabelle P, Chauvet MP, Coeffic D, Barbe C, Prevost JB, Paintaud G, Thibault G, Ferhat A, Dupin J, Berriolo-Riedinger A, Arnould L. Long-term outcomes in patients with PET-predicted poor-responsive HER2-positive breast cancer treated with neoadjuvant bevacizumab added to trastuzumab and docetaxel: 5-year follow-up of the randomised Avataxher study. EClinicalMedicine 2020; 28:100566. [PMID: 33205032 PMCID: PMC7649610 DOI: 10.1016/j.eclinm.2020.100566] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The open-label, randomised Phase 2 AVATAXHER study (NCT01142778) demonstrated that early PET assessment identified HER2-positive breast cancer patients who responded poorly to neoadjuvant docetaxel plus trastuzumab. Adding neoadjuvant bevacizumab for PET-predicted poor-responders improved pathological complete response (pCR) rates (43.8% vs 24.0%). We investigated long-term study outcomes. METHODS Patients were treated in three groups. All patients initially received two cycles of standard neoadjuvant therapy with [¹⁸F]-FDG PET conducted before each cycle. Those with ≥70% change in the maximum standardised uptake value (∆SUVmax) received four further cycles of standard neoadjuvant therapy (PET responders). PET-predicted poor-responders (∆SUVmax <70%) were randomised (2:1) to neoadjuvant therapy with (Group A) or without (Group B) bevacizumab for cycles 3-6. All patients received one further cycle of trastuzumab before surgery plus adjuvant trastuzumab (11 cycles). FINDINGS 142 patients were randomized and treated (PET responders, n = 69; Group A, n = 48; Group B, n = 25). 5-year disease-free survival rates were 90.5% (95% CI: 80.0-95.6%) in PET responders, 90.2% (95% CI: 75.9-96.2%) in Group A, and 76.0% (95% CI: 54.2-88.4%) in Group B. However, no difference was observed between randomised arms in a sensitivity analysis. During adjuvant therapy, the incidence of Grade ≥3 (Group A: 25.6%; Group B 12.5%) and serious adverse events (Group A: 18.6%; Group B 12.5%) was higher in Group A vs Group B, but with no apparent effect on cardiac events. INTERPRETATION In patients with HER2-positive breast cancer, an intervention based on early PET assessment and improvement of pCR does not modify disease-free survival. FUNDING Roche France.
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Affiliation(s)
- Bruno Coudert
- Centre Georges-Francois Leclerc, Dijon, France
- Corresponding author.
| | | | | | | | | | | | | | | | | | | | | | - David Coeffic
- Polyclinique Courlancy, Institut du Cancer Courlancy Reims, France
| | | | | | | | | | | | - Julien Dupin
- Roche France S.A.S., Boulogne Billancourt, France
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Le Du F, Brunot A, de la Motte Rouge T, Diéras V. Implications of BRCA Germline Mutations on Breast Cancer Medical Treatment. Curr Breast Cancer Rep 2020. [DOI: 10.1007/s12609-020-00362-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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D'Hondt V, Canon JL, Roca L, Levy C, Pierga JY, Le Du F, Campone M, Desmoulins I, Goncalves A, Debled M, Rios M, Ferrero JM, Serin D, Hardy-Bessard AC, Piot G, Brain E, Dohollou N, Orfeuvre H, Lemonnier J, Roché H, Delaloge S, Dalenc F. UCBG 2-04: Long-term results of the PACS 04 trial evaluating adjuvant epirubicin plus docetaxel in node-positive breast cancer and trastuzumab in the human epidermal growth factor receptor 2-positive subgroup. Eur J Cancer 2019; 122:91-100. [PMID: 31634648 DOI: 10.1016/j.ejca.2019.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE We conducted a double-randomised phase III trial to evaluate a concomitant taxane-anthracycline regimen in node-positive breast cancer and the efficacy of trastuzumab in the human epidermal growth factor receptor 2 (HER2)-positive subpopulation. METHODS A total of 3010 patients with node-positive breast cancer were randomly assigned to receive 6 cycles of 500 mg/m2 of fluorouracil, 100 mg/m2 of epirubicin and 500 mg/m2 of cyclophosphamide (FEC) or 75 mg/m2 of epirubicin and 75 mg/m2 of docetaxel (ED). Patients with HER2-positive tumours were secondary randomly assigned to either trastuzumab or observation. The primary end-point was disease-free survival (DFS) in the two chemotherapy arms. RESULTS After a 115-month median follow-up, DFS was not significantly better in the ED arm (DFS: 70%, 95% confidence interval [CI]: 67-72) than in the FEC arm (DFS: 68%, 95% CI: 65-70; hazard ratio [HR] = 0.88, 95% CI: 0.77-1.01; p = 0.064). The OS was not different between FEC (OS: 80%, 95% CI: 78-83) and ED (OS: 81%, 95% CI: 79-83); HR = 0.97, 95% CI: 0.81-1.16; p = 0.729). ED appeared more toxic. In the 528 HER2-positive subset, there was trend for a higher DFS, in the intention-to-treat population, in the trastuzumab arm (DFS: 68%, 95% CI: 61-74) than in the observation arm (DFS: 60%, 95% CI: 54-66; HR = 0.77, 95% CI: 0.57-1.03; p = 0.079). In the per-protocol population, DFS was significantly higher in the trastuzumab arm (DFS: 70%, 95% CI: 63-76) than in the observation arm (DFS: 59%, 95% CI: 53-65; HR = 0.69, 95% CI: 0.51-0.94; p = 0.0156). The OS was not different between these 2 arms. CONCLUSION This study did not show superiority of the concomitant anthracycline-taxane arm which was more toxic in high-risk node-positive breast cancer patients. Long-term results of the HER2-positive subpopulation are in line with those of the other adjuvant trastuzumab trials but quantitatively less pronounced mostly because of lack of power.
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Affiliation(s)
- Véronique D'Hondt
- Medical Oncology Department, Institut du Cancer, IRCM, INSERM, Univ Montpellier, France.
| | - Jean-Luc Canon
- Medical Oncology Department, Clinique Notre Dame, Charleroi, Belgium
| | - Lise Roca
- Biometrics Unit, Institut du Cancer, Montpellier, France
| | - Christelle Levy
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie & St Cloud, Université Paris Descartes, Paris, France
| | - Fanny Le Du
- Medical Oncology Department, Centre Eugène Marquis, Rennes, France
| | - Mario Campone
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | - Anthony Goncalves
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France
| | - Marc Debled
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | - Maria Rios
- Medical Oncology Department, Institut de Cancérologie de Lorraine - Alexis Vautrin, Vandoeuvre-Les-Nancy, France
| | - Jean-Marc Ferrero
- Medical Oncology Department, Centre Antoine Lacassagne, Nice, France
| | - Daniel Serin
- Medical Oncology Department, Institut Sainte-Catherine, Avignon, France
| | - Anne-Claire Hardy-Bessard
- Medical Oncology Department, Centre Armoricain de Radiothérapie, d'Imagerie et d'Oncologie, Plérin, France
| | - Gilles Piot
- Medical Oncology Department, Centre-Médico Chirurgical Les Ormeaux, Le Havre, France
| | - Etienne Brain
- Medical Oncology Department, Institut Curie, Centre René Huguenin, Saint-Cloud, France
| | - Nadine Dohollou
- Medical Oncology Department, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Hubert Orfeuvre
- Medical Oncology Department, CH - Hôpital de Fleyriat, Bourg-en-Bresse, France
| | | | - Henri Roché
- Medical Oncology Department, IUCT Claudius Regaud, Toulouse, France
| | | | - Florence Dalenc
- Medical Oncology Department, IUCT Claudius Regaud, Toulouse, France
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Le Du F, Perrin C, Brunot A, Crouzet L, De La Motte Rouge T, Lefeuvre-Plesse C, Dieras V. Therapeutic innovations in breast cancer. Presse Med 2019; 48:1131-1137. [PMID: 31151842 DOI: 10.1016/j.lpm.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 11/28/2022] Open
Abstract
Managing endocrine resistance and resistance to endocrine therapy for ER+ HER2- breast cancer with the CDK 4/6 inhibitors in the metastatic setting. New antibodies drug conjugates for HER2+ and TNBC. Targeting DNA damage and synthetic lethality strategies with PARP inhibitors for breast cancer patients harboring BRCA mutation. Immunotherapies in 1st line metastatic setting of TNBC.
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Affiliation(s)
- Fanny Le Du
- Centre Eugène-Marquis, avenue Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Christophe Perrin
- Centre Eugène-Marquis, avenue Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Angélique Brunot
- Centre Eugène-Marquis, avenue Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Laurence Crouzet
- Centre Eugène-Marquis, avenue Bataille Flandres-Dunkerque, 35000 Rennes, France
| | | | | | - Véronique Dieras
- Centre Eugène-Marquis, avenue Bataille Flandres-Dunkerque, 35000 Rennes, France.
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Bourien H, Palard X, Rolland Y, Le Du F, Beuzit L, Uguen T, Le Sourd S, Pracht M, Manceau V, Lièvre A, Boudjema K, Garin E, Edeline J. Yttrium-90 glass microspheres radioembolization (RE) for biliary tract cancer: a large single-center experience. Eur J Nucl Med Mol Imaging 2018; 46:669-676. [DOI: 10.1007/s00259-018-4199-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/17/2018] [Indexed: 01/27/2023]
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Lefeuvre-Plesse C, Lusque A, Bieche I, Lacroix L, Arnedos M, Campone M, Dalenc F, Gonçalves A, Le Du F, Jacquet A, Bonnefoi H, Attignon V, Sablin MP, Soubeyran I, Jézéquel P, Ferrero JM, Isambert N, Levy C, Filleron T, Bachelot T, André F. Characteristics of the Metastatic Breast Cancer Population with PIK3CA Mutation in the Randomized Phase II Study SAFIR02 Breast (UCBG-0105/1304). Breast 2017. [DOI: 10.1016/s0960-9776(17)30686-0] [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: 10/18/2022] Open
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Lefebvre C, Bachelot T, Filleron T, Pedrero M, Campone M, Soria JC, Massard C, Lévy C, Arnedos M, Lacroix-Triki M, Garrabey J, Boursin Y, Deloger M, Fu Y, Commo F, Scott V, Lacroix L, Dieci MV, Kamal M, Diéras V, Gonçalves A, Ferrerro JM, Romieu G, Vanlemmens L, Mouret Reynier MA, Théry JC, Le Du F, Guiu S, Dalenc F, Clapisson G, Bonnefoi H, Jimenez M, Le Tourneau C, André F. Mutational Profile of Metastatic Breast Cancers: A Retrospective Analysis. PLoS Med 2016; 13:e1002201. [PMID: 28027327 PMCID: PMC5189935 DOI: 10.1371/journal.pmed.1002201] [Citation(s) in RCA: 270] [Impact Index Per Article: 33.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/11/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Major advances have been achieved in the characterization of early breast cancer (eBC) genomic profiles. Metastatic breast cancer (mBC) is associated with poor outcomes, yet limited information is available on the genomic profile of this disease. This study aims to decipher mutational profiles of mBC using next-generation sequencing. METHODS AND FINDINGS Whole-exome sequencing was performed on 216 tumor-blood pairs from mBC patients who underwent a biopsy in the context of the SAFIR01, SAFIR02, SHIVA, or Molecular Screening for Cancer Treatment Optimization (MOSCATO) prospective trials. Mutational profiles from 772 primary breast tumors from The Cancer Genome Atlas (TCGA) were used as a reference for comparing primary and mBC mutational profiles. Twelve genes (TP53, PIK3CA, GATA3, ESR1, MAP3K1, CDH1, AKT1, MAP2K4, RB1, PTEN, CBFB, and CDKN2A) were identified as significantly mutated in mBC (false discovery rate [FDR] < 0.1). Eight genes (ESR1, FSIP2, FRAS1, OSBPL3, EDC4, PALB2, IGFN1, and AGRN) were more frequently mutated in mBC as compared to eBC (FDR < 0.01). ESR1 was identified both as a driver and as a metastatic gene (n = 22, odds ratio = 29, 95% CI [9-155], p = 1.2e-12) and also presented with focal amplification (n = 9) for a total of 31 mBCs with either ESR1 mutation or amplification, including 27 hormone receptor positive (HR+) and HER2 negative (HER2-) mBCs (19%). HR+/HER2- mBC presented a high prevalence of mutations on genes located on the mechanistic target of rapamycin (mTOR) pathway (TSC1 and TSC2) as compared to HR+/HER2- eBC (respectively 6% and 0.7%, p = 0.0004). Other actionable genes were more frequently mutated in HR+ mBC, including ERBB4 (n = 8), NOTCH3 (n = 7), and ALK (n = 7). Analysis of mutational signatures revealed a significant increase in APOBEC-mediated mutagenesis in HR+/HER2- metastatic tumors as compared to primary TCGA samples (p < 2e-16). The main limitations of this study include the absence of bone metastases and the size of the cohort, which might not have allowed the identification of rare mutations and their effect on survival. CONCLUSIONS This work reports the results of the analysis of the first large-scale study on mutation profiles of mBC. This study revealed genomic alterations and mutational signatures involved in the resistance to therapies, including actionable mutations.
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Affiliation(s)
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Inserm U1052, Lyon, France
| | - Thomas Filleron
- Biostatistics Department, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | - Mario Campone
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Nantes, France
| | - Jean-Charles Soria
- INSERM Unit U981, Gustave Roussy, Villejuif, France
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université Paris Sud, Kremlin-Bicêtre, France
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | | | - Christelle Lévy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Monica Arnedos
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | | | - Yannick Boursin
- Bioinformatics core facility, Gustave Roussy, Villejuif, France
| | - Marc Deloger
- Bioinformatics core facility, Gustave Roussy, Villejuif, France
| | - Yu Fu
- INSERM Unit U981, Gustave Roussy, Villejuif, France
| | | | | | - Ludovic Lacroix
- INSERM Unit U981, Gustave Roussy, Villejuif, France
- Department of Medical Biology and Pathology, Translational research laboratory and biobank, Gustave Roussy, Villejuif, France
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
- Medical Oncology 2, Veneto Institute of Oncology IOV—IRCCS, Padua, Italy
| | - Maud Kamal
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France
| | - Véronique Diéras
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Jean-Marc Ferrerro
- Department of Clinical Research, Centre Antoine Lacassagne, Nice, France
| | - Gilles Romieu
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | | | | | | | - Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Séverine Guiu
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | - Hervé Bonnefoi
- Department of Medical Oncology, Institut Bergonié, Université de Bordeaux, INSERM U916, Bordeaux, France
| | | | - Christophe Le Tourneau
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France
- EA7285, Versailles-Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Fabrice André
- INSERM Unit U981, Gustave Roussy, Villejuif, France
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université Paris Sud, Kremlin-Bicêtre, France
- * E-mail:
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Le Du F, Fujii T, Park M, Liu D, Hsu L, Gonzalez-Angulo AM, Ueno NT. Impact of clinical trial on survival outcomes. Breast Cancer Res Treat 2016; 159:273-81. [PMID: 27530453 DOI: 10.1007/s10549-016-3942-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
The number of patients with breast cancer who participate in therapeutic clinical trials remains low. One reason is a lack of opportunity; another is health care providers who do not recommend trials because they fear poorer outcome from the use of new drugs. Thus, we compared survival outcome in patients with metastatic breast cancer (MBC) who participated in first-line therapeutic clinical trials with outcome in patients who had never enrolled in a clinical trial and received only standard care. We hypothesized that first-line therapeutic clinical trials does not have a negative survival outcome. We reviewed the records of patients with MBC who were treated at MD Anderson Cancer Center between January 2000, and December 2010. The medical records of 5501 patients with MBC were screened, and 652 patients-285 in the trial arm and 367 in the control arm-met our specific eligible criteria. The median follow-up of our cohort was 7.16 years (95 % confidence interval [CI] 6.53-7.64 years). Among the global population, no significant differences in progression-free survival (PFS) or overall survival (OS) were observed between the treatment arms: for the clinical trial cohort, median PFS was 7 months (95 % CI 5.72-8.71 months), and median OS was 28.48 months (95 % CI 22.70-34.60 months). For the control cohort, median PFS was 10.02 months (95 % CI 7.13-11.99 months), and median OS was 28.71 months (95 % CI 24.41-31.31 months) (P = .089 and .335, respectively). Enrollment in first-line MBC therapeutic clinical trials does not result in less favorable survival outcome than that in MBC patients who never enrolled in a clinical trial.
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Affiliation(s)
- Fanny Le Du
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.,Department of Medical Oncology, Eugène Marquis Cancer Center, Rennes, France
| | - Takeo Fujii
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.,Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Minjeong Park
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Limin Hsu
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA
| | - Ana M Gonzalez-Angulo
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.,Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.
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Fujii T, Le Du F, Xiao L, Kogawa T, Barcenas CH, Alvarez RH, Valero V, Shen Y, Ueno NT. Effectiveness of an Adjuvant Chemotherapy Regimen for Early-Stage Breast Cancer: A Systematic Review and Network Meta-analysis. JAMA Oncol 2016; 1:1311-8. [PMID: 26402167 DOI: 10.1001/jamaoncol.2015.3062] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPORTANCE Different adjuvant chemotherapy regimens are available for early-stage breast cancer. Because conventional meta-analysis does not allow comparing all regimens, we performed a network meta-analysis to identify the most effective adjuvant chemotherapy regimen. OBJECTIVE To find the most effective adjuvant therapy regimen for early-stage breast cancer. DATA SOURCES We searched MEDLINE, Embase, and the Cochrane Library for articles published before June 2015; the American Society of Clinical Oncology annual meeting abstracts from January 1983 through December 2014; and the American Association for Cancer Research annual meeting abstracts from January 1916 through December 2014. Additionally, we manually searched bibliographies for related references. STUDY SELECTION We included randomized clinical trials of adjuvant treatments for early-stage breast cancer that compared 2 or more of the following: no adjuvant chemotherapy; sequential anthracycline-cyclophosphamide and taxane (AC-T); concurrent anthracycline-cyclophosphamide and taxane (ACT); anthracycline-cyclophosphamide without taxane (AC); docetaxel and cyclophosphamide (TC); cyclophosphamide, methotrexate, and fluorouracil (CMF); and platinum-containing regimens. DATA EXTRACTION AND SYNTHESIS We followed the PRISMA guidelines. Two investigators independently selected the articles and extracted information. Disagreements were resolved by discussion with another author. Quality was assessed by Cochrane risk-of-bias method. Data were pooled using random-effects models. MAIN OUTCOMES AND MEASURES We used network meta-analysis to test the most effective adjuvant therapy regimen in terms of overall survival (OS) by comparing regimens listed in the National Comprehensive Cancer Network guidelines and platinum-containing regimens. RESULTS We identified 24 trials. The TC and platinum-containing regimens had OS benefit similar to that of sequential AC-T (TC hazard ratio [HR], 0.93; 95% CI, 0.62-1.40; and platinum HR, 0.93; 95% CI, 0.66-1.31). Patients treated with CMF or AC had significantly worse OS than those treated with sequential AC-T (CMF HR, 1.56; 95% CI, 1.32-1.85; and AC HR, 1.22; 95% CI, 1.10-1.37). Platinum-containing regimens tended to be more toxic than sequential AC-T. The toxicity of TC was similar to or less than that of sequential AC-T. Meta-regression analysis showed that hormone receptor status did not impact the HRs for OS for any regimen. CONCLUSIONS AND RELEVANCE Sequential AC-T is likely to be the most effective adjuvant therapy regimen for early-stage breast cancer regardless of hormone receptor status.
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Affiliation(s)
- Takeo Fujii
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston2The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Fanny Le Du
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Takahiro Kogawa
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Ricardo H Alvarez
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Vicente Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
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Le Du F, Gonzalez-Angulo AM, Park M, Liu DD, Hortobagyi GN, Ueno NT. Effect of 21-Gene RT-PCR Assay on Adjuvant Therapy and Outcomes in Patients With Stage I Breast Cancer. Clin Breast Cancer 2015; 15:458-66. [PMID: 26233757 DOI: 10.1016/j.clbc.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 03/22/2015] [Accepted: 06/11/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recurrence score (RS) derived from a 21-gene reverse transcriptase-polymerase chain reaction assay is used to stratify patients with early-stage estrogen receptor-positive, HER2-normal breast cancer into 3 groups on the basis of 10-year distant metastasis risk: low, intermediate, and high. Published data are limited regarding the effect of RS on choice of adjuvant therapy for T1 breast cancer. We investigated the relationship between RS and choice of adjuvant therapy, prognosis, and benefit of chemotherapy (CT) in stage I breast cancer. MATERIALS AND METHODS We reviewed the records of 1030 patients with estrogen receptor-positive, HER2-normal stage I breast cancer and RS available. RSs were correlated with clinicopathologic characteristics, treatment, and outcome. RESULTS Patients with pathologic (p)T1a, pT1b, and pT1c disease did not differ in distribution of low, intermediate, and high RS (P = .673). Overall, fewer than 10% of patients had a high RS. Histologic grade 1, nuclear grade 1, and low Ki-67 expression had only 1%, 0%, and 6% of high RSs, respectively. Among patients with intermediate RSs, 41% with pT1b and 46% with pT1c disease received CT. Among patients with intermediate RSs, for pT1b disease, distant disease-free survival (DDFS) did not differ between hormonal therapy (HT) alone and CT with HT (P = .752); for pT1c, DDFS was superior for CT with HT (P = .020). Histologic grade was the only independent prognostic factor of DDFS (P = .0007, 1 vs. 3; P = .035, 2 vs. 3); RS did not predict DDFS (P = .083, high vs. low; P = .066, intermediate vs. low). CONCLUSION The added value of RS to known prognostic factors appears limited to patients with pT1b breast cancer. However, this study lacked long-term follow-up.
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Affiliation(s)
- Fanny Le Du
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Medical Oncology, Eugène Marquis Cancer Center, Rennes, France
| | - Ana M Gonzalez-Angulo
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Minjeong Park
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Le Du F, Eckhardt BL, Lim B, Litton JK, Moulder S, Meric-Bernstam F, Gonzalez-Angulo AM, Ueno NT. Is the future of personalized therapy in triple-negative breast cancer based on molecular subtype? Oncotarget 2015; 6:12890-908. [PMID: 25973541 PMCID: PMC4536987 DOI: 10.18632/oncotarget.3849] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/24/2015] [Indexed: 12/17/2022] Open
Abstract
Significant research has been conducted to better understand the extensive, heterogeneous molecular features of triple-negative breast cancer (TNBC). We reviewed published TNBC molecular classifications to identify major groupings that have potential for clinical trial development. With the ultimate aim to streamline translational medicine, we linked these categories of TNBC according to their gene-expression signatures, biological function, and clinical outcome. To this end, we define five potential clinically actionable groupings of TNBC: 1) basal-like TNBC with DNA-repair deficiency or growth factor pathways; 2) mesenchymal-like TNBC with epithelial-to-mesenchymal transition and cancer stem cell features; 3) immune-associated TNBC; 4) luminal/apocrine TNBC with androgen-receptor overexpression; and 5) HER2-enriched TNBC. For each defined subtype, we highlight the major biological pathways and discuss potential targeted therapies in TNBC that might abrogate disease progression. However, many of these potential targets need clinical validation by clinical trials. We have yet to know how we can enrich the targets by molecular classifications.
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Affiliation(s)
- Fanny Le Du
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Medical Oncology, Eugène Marquis Cancer Center, Rennes, France
| | - Bedrich L. Eckhardt
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bora Lim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas MD Anderson Women's Cancer Moons Shot Program, Houston, TX, USA
| | - Jennifer K. Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Clinical Cancer Genetics Program, The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA
- The University of Texas MD Anderson Women's Cancer Moons Shot Program, Houston, TX, USA
| | - Stacy Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas MD Anderson Women's Cancer Moons Shot Program, Houston, TX, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas MD Anderson Women's Cancer Moons Shot Program, Houston, TX, USA
| | - Ana M. Gonzalez-Angulo
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas MD Anderson Women's Cancer Moons Shot Program, Houston, TX, USA
| | - Naoto T. Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas MD Anderson Women's Cancer Moons Shot Program, Houston, TX, USA
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Perrin C, Frenel JS, Edeline J, Robert M, Tas P, Lefeuvre-Plesse C, Gourmelon C, Le Du F, Campone M, Kerbrat P. Could any pT1a,bN0M0 hormone-responsive, invasive breast carcinomas be safely treated without endocrine therapy? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Julien Edeline
- Oncology Medical Eugène Marquis Comprehensive Cancer Center, Rennes, France
| | - Marie Robert
- Institut de Cancérologie de l'Ouest, Nantes, France
| | | | | | | | | | | | - Pierre Kerbrat
- Medical Oncology Eugene Marquis Comprehensive Cancer Center, Rennes, France
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Le Du F, Fujii T, Davis DW, Wu W, Jackson S, Chavez-Mac Gregor M, Barcenas CH, Murray JL, Valero V, Tripathy D, Reuben JM, Ueno NT. EpCAM-independent isolation of EMT- circulating tumor cells in patients with primary breast cancer who receive primary systemic therapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.11034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fanny Le Du
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Takeo Fujii
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Summer Jackson
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - James L. Murray
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vicente Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debu Tripathy
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James M. Reuben
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naoto T. Ueno
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Le Du F, Duose DY, Dettman EJ, Summer JA, Chavez-MacGregor M, Barcenas CH, Brewster AM, Ricardo AH, Valero V, Gonzalez-Angulo AM, Reuben JM, Ueno NT. Abstract P4-01-10: Predictive impact of circulating tumor cells with an epithelial-to-mesenchymal transition phenotype in patients with primary breast cancer treated with primary systemic therapy. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p4-01-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Tumor cells with a mesenchymal phenotype include cancer stem-like cells (CSCs), which are known to contribute to metastasis. Circulating tumor cells (CTCs) are epithelial cells in peripheral blood that are detected using an anti-EpCAM antibody; however, CTCs undergoing epithelial-mesenchymal transition (EMT) may not be detected using this method. We have developed an antibody-independent CTC enrichment platform, Apostream®, which does not rely on EpCAM-based capture. We used this instrument to determine the clinical relevancy and feasibility of measuring EMT-CTCs in breast cancer patients.
Methods: Blood samples from newly diagnosed breast cancer patients were prospectively collected at baseline (T0), after primary systemic therapy (T1), and after definitive surgery (T2) and processed using the Apostream® system. Isolated cells were stained with antibodies to cytokeratin (anti-CK), leukocytes (anti-CD45), and the nuclear stain, 4,6-diamidino-2-phenylindole (DAPI), to identify CTCs. These CTCs were also stained with additional markers and examined on a laser scanning cytometer to measure protein expression levels of epithelial (EpCAM, E-cadherin), mesenchymal (β-catenin, vimentin) and CSC-markers (CD44, CD24). Pathological complete response (pCR) and residual cancer burden (RCB) statuses after preoperative treatment were obtained to correlate baseline CTCs and marker expression with treatment response.
Results: The study enrolled 33 patients (10 with early-stage, 19 with locally advanced, and 4 with metastatic breast cancer); 32, 12, and 10 patients provided samples at T0, T1, and T2, respectively. Of the 20 patients who underwent surgery, 6 patients achieved pCR. CTCs were detected (≥ 1 cell in at least one of the three samples) in 47%, 75%, and 80% of the T0, T1, and T2 samples, respectively. EMT markers (either vimentin or β-catenin) were detected in 67%, 11%, and 38% of these CTCs, respectively. The mean number of CTCs per mL detected at T0 was 0.43 (range, 0-3.7). CTC detection was correlated with a high histological Nottingham index (P=0.039). Conversely, vimentin-positive CTC detection was inversely correlated with clinical stage at T0 (P=0.034). No significant correlation was observed between CTCs detected at baseline and breast cancer subtypes. However, there was a trend for CTCs detected at T0 to be predictive of chemotherapy response, as 62% of patients with CTCs at T0 achieved a pCR, whereas only 11% of patients without CTCs at T0 had a pCR (P=0.057). The other EMT and CSC markers we tested did not predict response.
Conclusions: Apostream® was successful in detecting EMT-CTCs in this prospective study. There was a trend for the presence of CTCs at baseline to predict pCR. We will present our final data analysis of 50 patients.
pCR (n=6)†RCB-I (n=2)RCB-II (n=5)RCB-III (n=4)P-valueCK+CD45- CTCsNegative (n=9)1(11)2(22)3(33)3(33)0.146 0.057*Positive (n=8)5(62)0(0)2(25)1(13)† All data are no. of patients (%) Two did not have an RCB status available, and 1 did not have a T0 sample. * Comparing pCR status (pCR vs no-pCR) between CTCs negative and positive.
Citation Format: Fanny Le Du, Dzifa Y Duose, Elisha J Dettman, Jackson A Summer, Mariana Chavez-MacGregor, Carlos H Barcenas, Abenaa M Brewster, Alvarez H Ricardo, Vincente Valero, Ana M Gonzalez-Angulo, James M Reuben, Naoto T Ueno. Predictive impact of circulating tumor cells with an epithelial-to-mesenchymal transition phenotype in patients with primary breast cancer treated with primary systemic therapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-01-10.
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Affiliation(s)
- Fanny Le Du
- 1MD Anderson Cancer Center, University of Texas
- 2Centre Eugène Marquis
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Fujii T, Du FL, Xiao L, Kogawa T, Valero V, Shen Y, Ueno NT. Abstract P3-09-05: Identification of optimal adjuvant chemotherapy regimen for early-stage breast cancer: A systematic review and bayesian network meta-analysis. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p3-09-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The National Comprehensive Cancer Network (NCCN) guidelines for treatment of breast cancer recommend several adjuvant chemotherapy regimens, including sequential or concurrent anthracycline-cyclophosphamide and taxane-based regimens (sequential AC-T or concurrent ACT, respectively); anthracycline alone; cyclophosphamide, methotrexate, and 5-fluorouracil (CMF); and docetaxel and cyclophosphamide (TC). Sequential AC-T is the most commonly prescribed standard regimen. Two types of regimens without anthracycline, TC and platinum-containing regimens, have been speculated to have similar efficacy to that of ACT-based regimens. Platinum-containing regimens have also demonstrated high efficacy in breast cancer with tolerable adverse effects in several previous studies. However, because of the limitations of conventional meta-analysis, we do not know how these regimens compare with one another in terms of survival or adverse events. Thus, the best adjuvant chemotherapy regimen for breast cancer is not known. Bayesian network meta-analysis allows comparison of treatments for which there has been no head-to-head comparison by using indirect comparisons. Methods: We searched the MEDLINE, EMBASE, and Cochrane Library databases for articles published before January 2014; the American Society of Clinical Oncology annual meeting abstracts for 1983-2013; and the American Association for Cancer Research annual meeting abstracts for 1916-2013. We included only randomized controlled trials of adjuvant treatments for breast cancer that compared 2 or more of the following: observation alone; sequential AC-T; concurrent ACT; anthracycline alone; CMF; TC; and platinum-containing regimens. We compared regimens by using a network meta-analysis approach and random-effects models. Network meta-analysis allows derivation of hazard ratios (HRs) for death for each regimen and comparison of these HRs with each other even when there are no direct comparisons between 2 regimens. Results: We identified 24 trials with a total of 28,853 patients. Network meta-analysis showed that OS with TC and platinum-containing regimens were similar to OS with sequential AC-T (TC: HR=0.94; 95% CI, 0.58-1.52; platinum: HR=0.90; 95% CI, 0.69-1.19). Patients receiving CMF or anthracycline alone had significantly worse OS than those with sequential AC-T (CMF: hazard ratio [HR]=1.62; 95% CI, 1.31-2.01; anthracycline: HR=1.23; 95% CI, 1.07-1.43). For overall adverse events, the mean number of adverse events per patient was higher for platinum-containing regimens (2.1) and concurrent ACT (1.22) than for sequential AC-T (1.17). The mean number of hematological adverse events was higher for concurrent ACT (0.67) and TC (0.63), than for sequential AC-T (0.48). The mean number of nonhematological adverse events was higher for platinum-containing regimens (1.76) than for sequential AT (0.7). Conclusion: Our findings suggest that sequential AC-T should continue to be considered the optimal treatment for early-stage breast cancer because of the equivalent survival benefit of concurrent ACT, TC and platinum-containing regiments but superior adverse-event outcomes.
Citation Format: Takeo Fujii, Fanny Le Du, Lianchun Xiao, Takahiro Kogawa, Vicente Valero, Yu Shen, Naoto T Ueno. Identification of optimal adjuvant chemotherapy regimen for early-stage breast cancer: A systematic review and bayesian network meta-analysis [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-09-05.
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Affiliation(s)
- Takeo Fujii
- 1University of Texas MD Anderson Cancer Center
- 2University of Texas Health Science Center School of Publich Health
| | - Fanny Le Du
- 1University of Texas MD Anderson Cancer Center
| | | | | | | | - Yu Shen
- 1University of Texas MD Anderson Cancer Center
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Affiliation(s)
- Fanny Le Du
- Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA and Department of Medical Oncology, Eugène Marquis Cancer Center, Rennes, France
| | - Naoto T Ueno
- Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA, Tel.: +1 713 792 2817, Fax: +1 713 794 4385,
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Le Du F, Theriault RL, Willey JS, Valero V, Hortobagyi GN, Gonzalez-Angulo AM, Ueno NT. Impact of 21-gene RT-PCR assay on adjuvant therapy for stage I breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fanny Le Du
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jie S. Willey
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vicente Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Naoto T. Ueno
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
Breast cancer is a heterogeneous disease. For the past decades, new technical tools have been developed for biomarkers at the DNA, RNA and protein levels to better understand the biology of breast cancer. This progress is essential to classify the disease into clinically relevant subtypes, which may lead to new therapeutic opportunities. Novel biomarker development is paramount to deliver personalized cancer therapies. Further, tumor evolution, being natural or under treatment pressure, should be monitored and "liquid biopsies" by detecting circulating tumor cells or circulating free tumor DNA in blood samples will become an important option. This paper reviews the new generation of biomarkers and the current evidence to demonstrate their analytical validity, clinical validity and clinical utility.
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Affiliation(s)
- Fanny Le Du
- Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA ; Department of Medical Oncology, Eugène Marquis Cancer Center, Rennes, France
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ana M Gonzalez-Angulo
- Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA ; Department of Systems Biology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Edeline J, Lenoir L, Boudjema K, Rolland Y, Boulic A, Le Du F, Pracht M, Raoul JL, Clément B, Garin E, Boucher E. Volumetric changes after (90)y radioembolization for hepatocellular carcinoma in cirrhosis: an option to portal vein embolization in a preoperative setting? Ann Surg Oncol 2013; 20:2518-25. [PMID: 23494107 DOI: 10.1245/s10434-013-2906-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Contralateral hypertrophy after (90)Y radioembolization has been described in case reports, but the incidence and quantitative extent of liver volume modifications after this therapy are unknown. METHODS This retrospective study examined patients with hepatocellular carcinoma and underlying cirrhosis treated by (90)Y radioembolization. The main inclusion criteria were unilateral treatment, no prior liver surgery, and computed tomographic scans allowing for volumetric assessments. Treated, tumor, and contralateral liver volumes were measured. Whole liver volume and the ratio of contralateral to total functional liver volume after a virtual hepatectomy were calculated. RESULTS Data of 34 patients were analyzed. Response rates were 26 % according to Response Evaluation Criteria in Solid Tumors (RECIST) and 63 % according to modified RECIST. Median overall survival was 13.5 months. Median treated volume decreased from 938 mL (interquartile range [IQR] = 719) to 702 mL (IQR = 656) (p < 0.001), while median contralateral volume increased from 724 mL (IQR = 541) to 920 mL (IQR = 530) (p < 0.001). The whole liver volume remained stable, with a median volume of 1,702 mL (IQR = 568) versus 1,577 mL (IQR 670), respectively (p = 0.55). The mean maximal increase in contralateral volume was 42 % (95 % confidence interval 16-67). Overall, 13 patients (38.2 %) exhibited increases greater than 30 %, while 13 patients (38.2 %) showed no increase or showed increases less than 10 %. The median ratio of contralateral to total functional liver volume increased from 48.5 to 64.9 % (p < 0.001), with the proportion of patients with a ratio of ≥50 % increasing from 47.1 to 67.6 % (p = 0.013). CONCLUSIONS (90)Y radioembolization induced frequent and similar increases in functional liver remnant volume compared with portal vein embolization. This technique should be tested in a prospective study phase 2 study before liver resection.
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Affiliation(s)
- Julien Edeline
- Medical Oncology Department, Comprehensive Cancer Institute Eugène Marquis, Rennes, France.
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Crouzet L, Edeline J, Le Du F, Boucher E, Audrain O, Raoul JL. Haemolytic uremic syndrome and gemcitabine: jaundice is not always progression in cholangiocarcinoma. Acta Oncol 2012; 51:687-8. [PMID: 22356625 DOI: 10.3109/0284186x.2012.661073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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