1
|
Lambertini M, Blondeaux E, Agostinetto E, Hamy AS, Kim HJ, Di Meglio A, Bernstein Molho R, Hilbers F, Pogoda K, Carrasco E, Punie K, Bajpai J, Ignatiadis M, Moore HCF, Phillips KA, Toss A, Rousset-Jablonski C, Peccatori FA, Renaud T, Ferrari A, Paluch-Shimon S, Fruscio R, Cui W, Wong SM, Vernieri C, Ruddy KJ, Dieci MV, Matikas A, Rozenblit M, Villarreal-Garza C, De Marchis L, Del Mastro L, Puglisi F, Del Pilar Estevez-Diz M, Rodriguez-Wallberg KA, Mrinakova B, Meister S, Livraghi L, Clatot F, Yerushalmi R, De Angelis C, Sánchez-Bayona R, Meattini I, Cichowska-Cwalińska N, Berlière M, Salama M, De Giorgi U, Sonnenblick A, Chiodi C, Lee YJ, Maria C, Azim HA, Boni L, Partridge AH. Pregnancy After Breast Cancer in Young BRCA Carriers: An International Hospital-Based Cohort Study. JAMA 2024; 331:49-59. [PMID: 38059899 PMCID: PMC10704340 DOI: 10.1001/jama.2023.25463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
Importance Young women with breast cancer who have germline pathogenic variants in BRCA1 or BRCA2 face unique challenges regarding fertility. Previous studies demonstrating the feasibility and safety of pregnancy in breast cancer survivors included limited data regarding BRCA carriers. Objective To investigate cumulative incidence of pregnancy and disease-free survival in young women who are BRCA carriers. Design, Setting, and Participants International, multicenter, hospital-based, retrospective cohort study conducted at 78 participating centers worldwide. The study included female participants diagnosed with invasive breast cancer at age 40 years or younger between January 2000 and December 2020 carrying germline pathogenic variants in BRCA1 and/or BRCA2. Last delivery was October 7, 2022; last follow-up was February 20, 2023. Exposure Pregnancy after breast cancer. Main Outcomes and Measures Primary end points were cumulative incidence of pregnancy after breast cancer and disease-free survival. Secondary end points were breast cancer-specific survival, overall survival, pregnancy, and fetal and obstetric outcomes. Results Of 4732 BRCA carriers included, 659 had at least 1 pregnancy after breast cancer and 4073 did not. Median age at diagnosis in the overall cohort was 35 years (IQR, 31-38 years). Cumulative incidence of pregnancy at 10 years was 22% (95% CI, 21%-24%), with a median time from breast cancer diagnosis to conception of 3.5 years (IQR, 2.2-5.3 years). Among the 659 patients who had a pregnancy, 45 (6.9%) and 63 (9.7%) had an induced abortion or a miscarriage, respectively. Of the 517 patients (79.7%) with a completed pregnancy, 406 (91.0%) delivered at term (≥37 weeks) and 54 (10.4%) had twins. Among the 470 infants born with known information on pregnancy complications, 4 (0.9%) had documented congenital anomalies. Median follow-up was 7.8 years (IQR, 4.5-12.6 years). No significant difference in disease-free survival was observed between patients with or without a pregnancy after breast cancer (adjusted hazard ratio, 0.99; 95% CI, 0.81-1.20). Patients who had a pregnancy had significantly better breast cancer-specific survival and overall survival. Conclusions and Relevance In this global study, 1 in 5 young BRCA carriers conceived within 10 years after breast cancer diagnosis. Pregnancy following breast cancer in BRCA carriers was not associated with decreased disease-free survival. Trial Registration ClinicalTrials.gov Identifier: NCT03673306.
Collapse
Affiliation(s)
- Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U. O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Eva Blondeaux
- U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Agostinetto
- Breast Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Universite Paris Cité, Institut Curie, Paris, France
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Antonio Di Meglio
- Cancer Survivorship Program–Molecular Predicitors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Rinat Bernstein Molho
- Susanne Levy Gertner Oncogenetics Unit, Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center Affiliated to Tel Aviv University, Tel Hashomer, Israel
| | - Florentine Hilbers
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Estela Carrasco
- Hereditary Cancer Genetics Unit, Medical Oncology Department, Vall d´Hebron University Hospital, Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Center, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Michail Ignatiadis
- Breast Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Halle C. F. Moore
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Toss
- Department of Oncology and Haematology, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Fedro A. Peccatori
- Gynecologic Oncology Department, European Institute of Oncology (IRCCS), Milan, Italy
| | | | - Alberta Ferrari
- Hereditary Breast and Ovarian Cancer Unit and General Surgery 3–Senology, Surgical Department, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
| | - Shani Paluch-Shimon
- Breast Oncology Unit, Sharett Institute of Oncology, Hadassah University Hospital, and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Robert Fruscio
- UO Gynecology, Department of Medicine and Surgery, University of Milan–Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephanie M. Wong
- Stroll Cancer Prevention Centre, Jewish General Hospital, and McGill University Medical School, Montreal, Quebec, Canada
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- IFOM ETS, AIRC Institute of Molecular Oncology, Milan, Italy
| | - Kathryn J. Ruddy
- Department of Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Maria Vittoria Dieci
- Dipartimento di Scienze Chirurgiche, Oncologiche, e Gastroenterologiche, Università di Padova, Padova, Italy
- Oncologia 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alexios Matikas
- Department of Oncology/Pathology, Karolinska Institute, and Breast Center, Karolinska University Hospital, Stockholm, Sweden
| | - Mariya Rozenblit
- Department of Medical Oncology, Smilow Cancer Hospital at Yale New Haven, New Haven, Connecticut
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion–TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Laura De Marchis
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy
- Division of Oncology, Department of Hematology, Oncology, and Dermatology, Umberto 1 University Hospital, Rome, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U. O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Avano (CRO) IRCCS, Aviano, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Maria Del Pilar Estevez-Diz
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Kenny A. Rodriguez-Wallberg
- Department of Oncology-Pathology, Laboratory of Translational Fertility Preservation, Karolinska Institute, Stockholm, Sweden
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Bela Mrinakova
- First Department of Oncology, Comenius University and St Elisabeth Cancer Institute, Bratislava, Slovakia
| | - Sarah Meister
- Department of Obstetrics and Gynecology, Ludwig Maximilian University (LMU) Hospital, LMU Munich, Germany
| | - Luca Livraghi
- Department of Medical Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
- Department of Medical Oncology, Hospital of Prato, Azienda USL Toscana Centro, Italy
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Rinat Yerushalmi
- Department of Medical Oncology, Davidoff Center, Rabin Medical Center, Petah Tikva, Tel Aviv University, Tel Aviv, Israel
| | - Carmine De Angelis
- Department of Medical Oncology, University of Naples Federico II, Napoli, Italy
| | | | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences M. Serio, University of Florence, and Radiation Oncology Unit, Oncology Department, Florence University Hospital, Florence, Italy
| | - Natalia Cichowska-Cwalińska
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
- Early Phase Clinical Trials Centre, Medical University of Gdańsk, Gdańsk, Poland
| | - Martine Berlière
- Department of Medical Oncology and Breast Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Mahmoud Salama
- Oncofertility Consortium and Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Camila Chiodi
- Cancer Survivorship Program–Molecular Predicitors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Young-Jin Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Camille Maria
- Department of Medical Oncology, Universite Paris Cité, Institut Curie, Paris, France
| | - Hatem A. Azim
- Breast Cancer Center, Hospital Zambrano Hellion–TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
- Cairo Oncology Center, Cairo, Egypt
| | - Luca Boni
- U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
2
|
Desmedt C, Nguyen HL, Richard F, Linn S, Metzger O, Poncet C, Wesseling J, Hilbers F, Aalders K, Delorenzi M, Delaloge S, Pierga JY, Brain E, Vrijaldenhoven S, Neijenhuis PA, Van Baelen K, Maetens M, Rutgers E, Piccart M, Van ’t Veer L, Viale G, Cardoso F. Abstract P5-14-01: Transcriptomic insights into lobular breast cancer biology: a retrospective analysis of the MINDACT clinical trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p5-14-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Invasive lobular carcinoma (ILC) represents the second most common subtype of breast cancer after invasive breast cancer of no special type (NST). In this retrospective analysis of the MINDACT trial, we aimed at identifying/refining the transcriptomic differences between: 1) estrogen receptor positive/HER2-negative (ER+/HER2-) ILC versus ER+/HER2- NST, 2) classic and non-classic ER+/HER2- ILC, and, 3) recurring and non-recurring ER+/HER2- ILC in the subgroup of patients with a low clinical and low genomic (cL/gL) risk (as defined by a modified version of Adjuvant Online! and the 70-gene signature). Patients and methods: Central pathology review was performed for histological subtype, grade and Ki67 (G.V.) for 5929/6693 (88.6%) of the patients included in the MINDACT trial (NCT00433589). Analysis of transcriptomic data adjusted for age and grade was performed using the R/Bioconductor package ‘limma’ to identify differentially expressed genes (DEGs). DEGs having absolute log-fold change (logFC)≥ 0.2 and FDR-adjusted p-value (q-value) < 0.05 were considered. Gene set enrichment analyses (GSEA) of MSigDB hallmark gene sets were performed. Adjusted Cox regression models were used to evaluate the association of these hallmarks with disease free survival (DFS) and distant recurrence free survival (DRFS). Results: After central pathological review, 464 patients with ER+/HER2- ILC and 3798 patients with ER+/HER2- NST were identified. Patients with ILC were significantly older at diagnosis, had larger tumors, less axillary nodal involvement, more grade 2 tumors than patients with NST. At the transcriptomic level, we observed a high number of DEGs between these 2 subgroups, confirming their distinct phenotype. CDH1, the gene coding for E-cadherin, was as expected the most highly overexpressed gene in NST versus ILC. We further observed an increased expression of leptin (LEP), leptin receptor (LEPR), lipoprotein lipase (LPL), and the fatty acid transporter CD36 in ILC. This could suggest that ILC relied on increased lipid uptake thanks to the increased contact of ILC tumor cells with the adipocytes. IGF1 was also overexpressed in ILC versus NST, as a potential consequence of high LEP and high LEPR expression. Differences were also evident with regard to the extracellular matrix (ECM), with many collagens, matrix metalloproteinases (MMPs) and other key enzymes (e.g. LOXL1) being differentially expressed. We confirmed a decreased ER-signaling and increased PI3K/Akt signaling in ILC versus NST. Out of the 464 ER+/HER2- ILC tumors, 253 (55%) were classic ILC and 211 (45%) non-classic ILC. There were more grade 3 tumors, more highly proliferative tumors and more nodal involvement in patients with non-classic versus classic ILC. At the transcriptomic level, differences were subtler than the differences seen above. Still, a significant enrichment of the hallmarks related to cell cycle in the non-classic ILC, and of the hallmarks related to epithelial-to-mesenchymal transition, hypoxia, adipogenesis and IL6/JAK/STAT3 signaling in classic ILC was observed. Finally, 216/464 patients with ER+/HER2- ILC (47%) were assigned to the cL/gL risk group and did not receive chemotherapy. 28/216 of these patients (13%) relapsed (DFS, median FU: 8.7 years). Enrichment of hallmarks related to apoptosis, inflammatory response, hypoxia and oncogenic signaling (PI3K/Akt, Ras, c-Myc) was associated with worse survival. Conclusion: This represents, to the best of our knowledge, the largest set of gene expression data for patients with ILC, issued from a clinical trial where histology was reviewed centrally. These results could be used to personalize treatment for patients with ILC. This project is funded by the Breast Cancer Research Foundation.
Citation Format: Christine Desmedt, Ha-Linh Nguyen, François Richard, Sabine Linn, Otto Metzger, Coralie Poncet, Jelle Wesseling, Florentine Hilbers, Kim Aalders, Mauro Delorenzi, Suzette Delaloge, Jean-Yves Pierga, Etienne Brain, Suzan Vrijaldenhoven, Peter A Neijenhuis, Karen Van Baelen, Marion Maetens, Emiel Rutgers, Martine Piccart, Laura Van ’t Veer, Giuseppe Viale, Fatima Cardoso. Transcriptomic insights into lobular breast cancer biology: a retrospective analysis of the MINDACT clinical trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-14-01.
Collapse
Affiliation(s)
- Christine Desmedt
- 1Laboratory for Translation Breast Cancer Research/KU Leuven, Belgium
| | - Ha-Linh Nguyen
- 2Laboratory for Translational Breast Cancer Research, Department of Oncology, Leuven, Vlaams-Brabant, Belgium
| | - François Richard
- 3Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Sabine Linn
- 4Netherlands Cancer Institute, Amsterdam, Netherlands, Netherlands
| | - Otto Metzger
- 5Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Coralie Poncet
- 6European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium, Brussels, Belgium
| | | | | | | | | | | | | | - Etienne Brain
- 13European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | | | | | - Karen Van Baelen
- 16Laboratory for Translational Breast Cancer Research, Department of Oncology, Leuven, Vlaams-Brabant, Belgium
| | - Marion Maetens
- 17Laboratory for Translational Breast Cancer Research, KU Leuven, Leuven, Belgium, Belgium
| | - Emiel Rutgers
- 18Department of Surgical Oncology, Netherlands Cancer Institute
| | - Martine Piccart
- 19Institut Jules Bordet – Université Libre de Bruxelles, Brussels, Belgium, Anderlecht, Brussels Hoofdstedelijk Gewest, Belgium
| | | | - Giuseppe Viale
- 21European Institute of Oncology IRCCS, and University of Milan, Milan, Italy, Milan, Italy
| | - Fatima Cardoso
- 22Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal, Lisbon, Portugal
| |
Collapse
|
3
|
Chumsri S, Li Z, Serie DJ, Norton N, Mashadi-Hossein A, Tenner K, Brauer HA, Warren S, Danaher P, Colon-Otero G, Partridge AH, Carey LA, Hilbers F, Van Dooren V, Holmes E, Di Cosimo S, Werner O, Huober JB, Dueck AC, Sotiriou C, Saura C, Moreno-Aspitia A, Knutson KL, Perez EA, Thompson EA. Adaptive immune signature in HER2-positive breast cancer in NCCTG (Alliance) N9831 and NeoALTTO trials. NPJ Breast Cancer 2022; 8:68. [PMID: 35610260 PMCID: PMC9130150 DOI: 10.1038/s41523-022-00430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/19/2022] [Indexed: 12/14/2022] Open
Abstract
Trastuzumab acts in part through the adaptive immune system. Previous studies showed that enrichment of immune-related gene expression was associated with improved outcomes in HER2-positive (HER2+) breast cancer. However, the role of the immune system in response to lapatinib is not fully understood. Gene expression analysis was performed in 1,268 samples from the North Central Cancer Treatment Group (NCCTG) N9831 and 244 samples from the NeoALTTO trial. In N9831, enrichment of CD45 and immune-subset signatures were significantly associated with improved outcomes. We identified a novel 17-gene adaptive immune signature (AIS), which was found to be significantly associated with improved RFS among patients who received adjuvant trastuzumab (HR 0.66, 95% CI 0.49-0.90, Cox regression model p = 0.01) but not in patients who received chemotherapy alone (HR 0.96, 95% CI 0.67-1.40, Cox regression model p = 0.97). This result was validated in NeoALTTO. Overall, AIS-low patients had a significantly lower pathologic complete response (pCR) rate compared with AIS-high patients (χ2 p < 0.0001). Among patients who received trastuzumab alone, pCR was observed in 41.7% of AIS-high patients compared with 9.8% in AIS-low patients (OR of 6.61, 95% CI 2.09-25.59, logistic regression model p = 0.003). More importantly, AIS-low patients had a higher pCR rate with an addition of lapatinib (51.1% vs. 9.8%, OR 9.65, 95% CI 3.24-36.09, logistic regression model p < 0.001). AIS-low patients had poor outcomes, despite receiving adjuvant trastuzumab. However, these patients appear to benefit from an addition of lapatinib. Further studies are needed to validate the significance of this signature to identify patients who are more likely to benefit from dual anti-HER2 therapy. ClinicalTrials.gov Identifiers: NCT00005970 (NCCTG N9831) and NCT00553358 (NeoALTTO).
Collapse
Affiliation(s)
- Saranya Chumsri
- Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, USA.
| | - Zhuo Li
- Department of Health and Human Services, Mayo Clinic, Jacksonville, FL, USA
| | - Daniel J Serie
- Department of Health and Human Services, Mayo Clinic, Jacksonville, FL, USA
| | - Nadine Norton
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Kathleen Tenner
- Department of Health and Human Services, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Lisa A Carey
- The University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Eileen Holmes
- The Frontier Science, Perth, UK
- Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Serena Di Cosimo
- Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Jens Bodo Huober
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - Cristina Saura
- Vall d'Hebrón University Hospital, Vall d'Hebron Institute of Oncology (VHIO), SOLTI Breast Cancer Research Group, Barcelona, Spain
| | | | - Keith L Knutson
- Department of Immunology, Mayo Clinic, Jacksonville, FL, USA
| | - Edith A Perez
- Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, USA
| | | |
Collapse
|
4
|
Pondé N, Agbor-Tarh D, Dal Lago L, Korde LA, Hilbers F, Jackisch C, Werner O, Gelber RD, Jatoi A, Dueck AC, Moreno-Aspitia A, Sotiriou C, de Azambuja E, Piccart M. Correction to: Tolerability and toxicity of trastuzumab or trastuzumab + lapatinib in older patients: a sub‑analysis of the ALTTO trial (BIG 2‑06; NCCTG (Alliance) N063D). Breast Cancer Res Treat 2021; 191:225. [PMID: 34625860 DOI: 10.1007/s10549-021-06409-y] [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: 11/27/2022]
Affiliation(s)
- Noam Pondé
- AC Camargo Cancer Center, Rua Pires da Mota, São Paulo, 1167, Brazil.
- Institut Jules Bordet, Brussels, Belgium.
| | | | | | | | | | | | | | - Richard D Gelber
- Dana-Farber Cancer Institute, Boston, USA
- Frontier Science and Technology Research Foundation, Boston, MA, USA
| | | | | | | | | | | | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| |
Collapse
|
5
|
Bayani J, Poncet C, Crozier C, Neven A, Piper T, Cunningham C, Sobol M, Aebi S, Benstead K, Bogler O, Dal Lago L, Fraser J, Hilbers F, Hedenfalk I, Korde L, Linderholm B, Martens J, Middleton L, Murray M, Kelly C, Nilsson C, Nowaczyk M, Peeters S, Peric A, Porter P, Schröder C, Rubio IT, Ruddy KJ, van Asperen C, Van Den Weyngaert D, van Deurzen C, van Leeuwen-Stok E, Vermeij J, Winer E, Giordano SH, Cardoso F, Bartlett JMS. Evaluation of multiple transcriptomic gene risk signatures in male breast cancer. NPJ Breast Cancer 2021; 7:98. [PMID: 34312396 PMCID: PMC8313692 DOI: 10.1038/s41523-021-00301-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/24/2021] [Indexed: 12/12/2022] Open
Abstract
Male breast cancer (BCa) is a rare disease accounting for less than 1% of all breast cancers and 1% of all cancers in males. The clinical management is largely extrapolated from female BCa. Several multigene assays are increasingly used to guide clinical treatment decisions in female BCa, however, there are limited data on the utility of these tests in male BCa. Here we present the gene expression results of 381 M0, ER+ve, HER2-ve male BCa patients enrolled in the Part 1 (retrospective analysis) of the International Male Breast Cancer Program. Using a custom NanoString™ panel comprised of the genes from the commercial risk tests Prosigna®, OncotypeDX®, and MammaPrint®, risk scores and intrinsic subtyping data were generated to recapitulate the commercial tests as described by us previously. We also examined the prognostic value of other risk scores such as the Genomic Grade Index (GGI), IHC4-mRNA and our prognostic 95-gene signature. In this sample set of male BCa, we demonstrated prognostic utility on univariate analysis. Across all signatures, patients whose samples were identified as low-risk experienced better outcomes than intermediate-risk, with those classed as high risk experiencing the poorest outcomes. As seen with female BCa, the concordance between tests was poor, with C-index values ranging from 40.3% to 78.2% and Kappa values ranging from 0.17 to 0.58. To our knowledge, this is the largest study of male breast cancers assayed to generate risk scores of the current commercial and academic risk tests demonstrating comparable clinical utility to female BCa.
Collapse
Affiliation(s)
- Jane Bayani
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Coralie Poncet
- Department of Statistics, European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Cheryl Crozier
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Anouk Neven
- Department of Statistics, European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | | | | | | | - Stefan Aebi
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Kim Benstead
- Department of Oncology, Cheltenham General Hospital, Cheltenham, UK
| | - Oliver Bogler
- Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lissandra Dal Lago
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium
| | - Judith Fraser
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | | | - Ingrid Hedenfalk
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Barbro Linderholm
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - John Martens
- Medical Oncology, Erasmus Medical Center Rotterdam; BOOG, Rotterdam, The Netherlands
| | - Lavinia Middleton
- Department Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melissa Murray
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Catherine Kelly
- All Ireland Cooperative Oncology Research Group (ICORG), Dublin, Ireland
| | - Cecilia Nilsson
- Department of Oncology, Västmanlands Hospital, Västerås, Sweden
| | | | - Stephanie Peeters
- Department of Radiation Oncology Maastro, Masstricht, The Netherlands
| | - Aleksandra Peric
- Department of Statistics, European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Peggy Porter
- Divisions of Human Biology and Public Health Sciences, Fred Hutchinson Cancer Research Center & Department of Pathology, University of Washington, Seattle, WA, USA
| | - Carolien Schröder
- Department Medical Oncology, University Medical Center Groningen; BOOG, Groningen, The Netherlands
| | - Isabel T Rubio
- Breast Surgical Unit. Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | | | - Christi van Asperen
- Department of Clinical Genetics, Leiden University Medical Center; BOOG, Leiden, The Netherlands
| | | | | | | | - Joanna Vermeij
- Department of Medical Oncology, ZNA Jan Palfijn, Merksem, Belgium
| | - Eric Winer
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation; EORTC, Lisbon, Portugal
| | - John M S Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
- University of Edinburgh, Scotland, UK.
| |
Collapse
|
6
|
Chic N, Luen SJ, Nuciforo P, Salgado R, Fumagalli D, Hilbers F, Wang Y, de Azambuja E, Làng I, Di Cosimo S, Saura C, Huober J, Prat A, Loi S. Tumor Cellularity and Infiltrating Lymphocytes (CelTIL) as a Survival Surrogate in HER2-Positive Breast Cancer. J Natl Cancer Inst 2021; 114:467-470. [PMID: 33787900 DOI: 10.1093/jnci/djab057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/01/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
In early-stage HER2-positive breast cancer, biomarkers that guide de-escalation and/or escalation of systemic therapy are needed. CelTIL score is a novel, combined biomarker based on stromal tumor-infiltrating lymphocytes and tumor cellularity and determined in tumor biopsies at week 2 of anti-HER2 therapy only. We evaluated the prognostic value of CelTIL in 196 patients with early-stage HER2-positive disease treated with standard trastuzumab-based chemotherapy in the NeoALTTO phase III trial. Using a pre-specified CelTIL cutoff, a better 5-year event-free survival and overall survival was observed between CelTIL-high and CelTIL-low score with a 76.4% (95% confidence interval [CI] = 68.0%-85.0%) versus 59.7% (95% CI = 50.0%-72.0%) (hazard ratio = 0.40; 95% CI = 0.17 to 0.94), and 86.4% (95% CI = 80.0%-94.0%) vs 73.5% (95% CI = 64.0%-84.0%) (hazard ratio = 0.43; 95% CI = 0.20 to 0.92), respectively. Statistical significance was maintained after adjusting for baseline TILs, hormone receptor status, pre-treatment tumor size and nodal status, type of surgery, treatment arm, and pathological complete response. Further studies to support CelTIL as an early read-out biomarker to help de-escalate/escalate systemic therapy in HER2-positive breast cancer seem warranted.
Collapse
Affiliation(s)
- Nuria Chic
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,SOLTI Breast Cancer Research group, Barcelona, Spain
| | - Stephen J Luen
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Roberto Salgado
- Division of Research, Peter Mac Callum Cancer Centre, Melbourne, Australia.,Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | | | | | | | - Evandro de Azambuja
- Universite Libre de Bruxelles (U.L.B), Brussels, Belgium.,Department of Medical Oncology, Institut Jules Bordet, Brussels, Belgium
| | - István Làng
- Istenhegyi Géndiagnosztika Private Health Center Oncology Clinic, Budapest, Hungary
| | - Serena Di Cosimo
- SOLTI Breast Cancer Research group, Barcelona, Spain.,Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Cristina Saura
- SOLTI Breast Cancer Research group, Barcelona, Spain.,Department of Medical Oncology, Vall d'Hebron University Hospital and Breast Cancer Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jens Huober
- Department of Obstetrics and Gynaecology of the University of Ulm, Ulm, Germany
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,SOLTI Breast Cancer Research group, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Institute of Oncology (IOB)-Quiron, Barcelona, Spain
| | - Sherene Loi
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| |
Collapse
|
7
|
Piccart M, van 't Veer LJ, Poncet C, Lopes Cardozo JMN, Delaloge S, Pierga JY, Vuylsteke P, Brain E, Vrijaldenhoven S, Neijenhuis PA, Causeret S, Smilde TJ, Viale G, Glas AM, Delorenzi M, Sotiriou C, Rubio IT, Kümmel S, Zoppoli G, Thompson AM, Matos E, Zaman K, Hilbers F, Fumagalli D, Ravdin P, Knox S, Tryfonidis K, Peric A, Meulemans B, Bogaerts J, Cardoso F, Rutgers EJT. 70-gene signature as an aid for treatment decisions in early breast cancer: updated results of the phase 3 randomised MINDACT trial with an exploratory analysis by age. Lancet Oncol 2021; 22:476-488. [PMID: 33721561 DOI: 10.1016/s1470-2045(21)00007-3] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The MINDACT trial showed excellent 5-year distant metastasis-free survival of 94·7% (95% CI 92·5-96·2) in patients with breast cancer of high clinical and low genomic risk who did not receive chemotherapy. We present long-term follow-up results together with an exploratory analysis by age. METHODS MINDACT was a multicentre, randomised, phase 3 trial done in 112 academic and community hospitals in nine European countries. Patients aged 18-70 years, with histologically confirmed primary invasive breast cancer (stage T1, T2, or operable T3) with up to three positive lymph nodes, no distant metastases, and a WHO performance status of 0-1 were enrolled and their genomic risk (using the MammaPrint 70-gene signature) and clinical risk (using a modified version of Adjuvant! Online) were determined. Patients with low clinical and low genomic risk results did not receive chemotherapy, and patients with high clinical and high genomic risk did receive chemotherapy (mostly anthracycline-based or taxane-based, or a combination thereof). Patients with discordant risk results (ie, patients with high clinical risk but low genomic risk, and those with low clinical risk but high genomic risk) were randomly assigned (1:1) to receive chemotherapy or not based on either the clinical risk or the genomic risk. Randomisation was done centrally and used a minimisation technique that was stratified by institution, risk group, and clinical-pathological characteristics. Treatment allocation was not masked. The primary endpoint was to test whether the distant metastasis-free survival rate at 5 years in patients with high clinical risk and low genomic risk not receiving chemotherapy had a lower boundary of the 95% CI above the predefined non-inferiority boundary of 92%. In the primary test population of patients with high clinical risk and low genomic risk who adhered to the treatment allocation of no chemotherapy and had no change in risk post-enrolment. Here, we present updated follow-up as well as an exploratory analysis of a potential age effect (≤50 years vs >50 years) and an analysis by nodal status for patients with hormone receptor-positive and HER2-negative disease. These analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT00433589, and the European Clinical Trials database, EudraCT2005-002625-31. Recruitment is complete and further long-term follow-up is ongoing. FINDINGS Between Feb 8, 2007, and July 11, 2011, 6693 patients were enrolled. On Feb 26, 2020, median follow-up was 8·7 years (IQR 7·8-9·7). The updated 5-year distant metastasis-free survival rate for patients with high clinical risk and low genomic risk receiving no chemotherapy (primary test population, n=644) was 95·1% (95% CI 93·1-96·6), which is above the predefined non-inferiority boundary of 92%, supporting the previous analysis and proving MINDACT as a positive de-escalation trial. Patients with high clinical risk and low genomic risk were randomly assigned to receive chemotherapy (n=749) or not (n=748); this was the intention-to-treat population. The 8-year estimates for distant metastasis-free survival in the intention-to-treat population were 92·0% (95% CI 89·6-93·8) for chemotherapy versus 89·4% (86·8-91·5) for no chemotherapy (hazard ratio 0·66; 95% CI 0·48-0·92). An exploratory analysis confined to the subset of patients with hormone receptor-positive, HER2-negative disease (1358 [90.7%] of 1497 randomly assigned patients, of whom 676 received chemotherapy and 682 did not) shows different effects of chemotherapy administration on 8-year distant metastasis-free survival according to age: 93·6% (95% CI 89·3-96·3) with chemotherapy versus 88·6% (83·5-92·3) without chemotherapy in 464 women aged 50 years or younger (absolute difference 5·0 percentage points [SE 2·8, 95% CI -0·5 to 10·4]) and 90·2% (86·8-92·7) versus 90·0% (86·6-92·6) in 894 women older than 50 years (absolute difference 0·2 percentage points [2·1, -4·0 to 4·4]). The 8-year distant metastasis-free survival in the exploratory analysis by nodal status in these patients was 91·7% (95% CI 88·1-94·3) with chemotherapy and 89·2% (85·2-92·2) without chemotherapy in 699 node-negative patients (absolute difference 2·5 percentage points [SE 2·3, 95% CI -2·1 to 7·2]) and 91·2% (87·2-94·0) versus 89·9% (85·8-92·8) for 658 patients with one to three positive nodes (absolute difference 1·3 percentage points [2·4, -3·5 to 6·1]). INTERPRETATION With a more mature follow-up approaching 9 years, the 70-gene signature shows an intact ability of identifying among women with high clinical risk, a subgroup, namely patients with a low genomic risk, with an excellent distant metastasis-free survival when treated with endocrine therapy alone. For these women the magnitude of the benefit from adding chemotherapy to endocrine therapy remains small (2·6 percentage points) and is not enhanced by nodal positivity. However, in an underpowered exploratory analysis this benefit appears to be age-dependent, as it is only seen in women younger than 50 years where it reaches a clinically relevant threshold of 5 percentage points. Although, possibly due to chemotherapy-induced ovarian function suppression, it should be part of informed, shared decision making. Further study is needed in younger women, who might need reinforced endocrine therapy to forego chemotherapy. FUNDING European Commission Sixth Framework Programme.
Collapse
Affiliation(s)
- Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - Laura J van 't Veer
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Coralie Poncet
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | | | | | - Jean-Yves Pierga
- Institut Curie, Paris & Saint-Cloud, Université de Paris, Paris, France
| | | | - Etienne Brain
- Institut Curie-Hôpital Rene Huguenin, Saint-Cloud, France
| | | | | | | | | | - Giuseppe Viale
- University of Milan, Milan, Italy; European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mauro Delorenzi
- Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland
| | - Christos Sotiriou
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Gabriele Zoppoli
- Gruppo Oncologico Italiano di Ricerca Clinica, Università degli Studi di Genova and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Khalil Zaman
- Lausanne University Hospital CHUV, Lausanne, Switzerland
| | | | | | - Peter Ravdin
- University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Susan Knox
- Europa Donna-European Breast Cancer Coalition, Milan, Italy
| | | | - Aleksandra Peric
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Bart Meulemans
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Jan Bogaerts
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Fatima Cardoso
- Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | | |
Collapse
|
8
|
Lambertini M, Agbor-Tarh D, Metzger-Filho O, Ponde N, Poggio F, Hilbers F, Korde LA, Chumsri S, Werner O, Del Mastro L, Caparica R, Moebus V, Moreno-Aspitia A, Piccart M, de Azambuja E. Abstract PD3-04: Prognostic role of distant disease-free interval from completion of adjuvant trastuzumab in HER2-positive early breast cancer: Analysis from the ALTTO (BIG 2-06) trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd3-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In HER2-positive breast cancer patients, timing from the end of (neo)adjuvant trastuzumab (T)-based therapy to diagnosis of metastatic breast cancer is the key factor in determining the optimal first-line treatment. There is currently lack of clear evidence to support the possible prognostic role of this interval and 12 months has been mostly empirically used. The present analysis aimed to investigate patterns of relapse, first-line choice and survival outcomes of patients with HER2-positive early breast cancer who relapsed after adjuvant T-based therapy depending on T-free interval (TFI, i.e. timing from end of adjuvant T to diagnosis of distant metastases).
Methods: In ALTTO, HER2-positive early breast cancer patients were randomized to 1 year of either T alone, lapatinib (L) alone, their sequence (T–>L) or their combination (T+L). This exploratory analysis included only pts in the T or T+L arms who experienced a distant disease-free survival (DDFS) event. Two cohorts of patients were defined depending on TFI: group A (TFI of <12 months) and group B (>12 months). Baseline characteristics, patterns of relapse, first-line choice and overall survival (OS) were compared. OS was defined as time between date of DDFS event to death; age at diagnosis, tumor size and hormone receptor status were the variables included in the final multivariate models.
Results: Out of 8,381 patients included in ALTTO, 404 patients in the T and T+L arms developed a DDFS event, of whom 201 occurred <12 months (group A) and 203 >12 months (group B) after the end of adjuvant T. Patients in group A were older (p=0.013), had larger tumors (p=0.004) and more frequently hormone receptor-negative disease (p<0.001). No significant difference in patterns of first DDFS event was observed (p=0.073); however, a numerically higher number of patients in group A compared to group B developed brain metastasis (26% vs. 15%). First-line anti-HER2 therapy was received by 57% of the patients. Choice of first-line anti-HER2 therapy was different between the two groups (p=0.022): the majority of patients received T in both groups (61% vs. 65% in groups A and B, respectively), while more patients in group A received L (25% vs. 11%) and less received pertuzumab (8% vs. 17%). OS survival was significantly shorter in group A compared to group B: median OS was 18.4 and 29.3 months in groups A and B, respectively (adjusted HR 0.69; 95% CI 0.54-0.89; p=0.004). Similar results were observed after the exclusion of patients treated with first-line pertuzumab-based therapy (n=29): median OS was 18.2 and 26.8 months in groups A and B, respectively (adjusted HR 0.66; 95% CI 0.51-0.86; p=0.002). Better outcomes in terms of OS for patients in group B was observed across all analyzed subgroups with no interaction according to hormone receptor status (p=0.814) nor type of adjuvant anti-HER2 treatment (p=0.233): hormone receptor-positive (adjusted HR 0.69; 95% CI 0.48-0.99), hormone receptor-negative (adjusted HR 0.68; 95% CI 0.48-0.98), T+L arm (adjusted HR 0.55; 95% CI 0.38-0.80) and T arm (adjusted HR 0.80; 95% CI 0.55-1.17).
Conclusions: In the ALTTO trial, HER2-positive early breast cancer patients who experienced shorter TFI (i.e. <12 months vs. >12 months) following adjuvant T-based therapy had inferior OS after the diagnosis of distant recurrence. Given its prognostic value, TFI can help to individualize clinical recommendations and to design future trials in the metastatic setting for patients relapsing after prior exposure to anti-HER2 therapy for early disease.
Citation Format: Matteo Lambertini, Dominique Agbor-Tarh, Otto Metzger-Filho, Noam Ponde, Francesca Poggio, Florentine Hilbers, Larissa A Korde, Saranya Chumsri, Olena Werner, Lucia Del Mastro, Rafael Caparica, Volker Moebus, Alvaro Moreno-Aspitia, Martine Piccart, Evandro de Azambuja. Prognostic role of distant disease-free interval from completion of adjuvant trastuzumab in HER2-positive early breast cancer: Analysis from the ALTTO (BIG 2-06) trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD3-04.
Collapse
Affiliation(s)
- Matteo Lambertini
- 1University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Otto Metzger-Filho
- 3Dana-Farber Cancer Institute, Harvard Medical School, Harvard Medical School, Boston, MA
| | - Noam Ponde
- 4A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | | | | | | | - Lucia Del Mastro
- 1University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rafael Caparica
- 10ut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Volker Moebus
- 11Medical Clinic II, Department of Hematology/Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Martine Piccart
- 12Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Evandro de Azambuja
- 12Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| |
Collapse
|
9
|
Chic N, Luen S, Nuciforo P, Salgado R, Fumagalli D, Hilbers F, Wang Y, de Azambuja E, Lang I, Di Cosimo S, Saura C, Huober J, Prat A, Loi S. Abstract PS5-03: Celtil score and long-term survival outcome in early stage HER2-positive (HER2+) breast cancer treated with anti-HER2-based chemotherapy: A correlative analysis of neoALTTO trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps5-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Biomarkers to help escalate or de-escalate systemic therapies are urgently needed in early-stage HER2+ breast cancer patients. The combination of high stromal tumor infiltrating lymphocytes (TILs) and low tumor cellularity at 2 weeks of anti-HER2 therapy (CelTIL score) has been associated with high rates of pathologic complete response (pCR) after completion of neoadjuvant therapy. However, the value of CelTIL as a prognostic biomarker is unknown. Here, we present an independent validation of CelTIL in the NeoALTTO phase III trial. Methods: NeoALTTO randomized 455 patients (pts) with HER2+ early breast cancer to receive lapatinib (arm A), trastuzumab (Arm B) or lapatinib and trastuzumab (Arm C) for 6 weeks, followed by the assigned anti-HER2 treatment combined with paclitaxel weekly for 12 weeks. After surgery, patients received 3 cycles of fluorouracil, epirubicin and cyclophosphamide, and then continued the assigned anti-HER2 treatment for 34 weeks. CelTIL was centrally evaluated in tumor biopsies performed at week 2 in arms B and C using the pre-established formula (CelTIL score = -0.8 × tumor cellularity [%] + 1.3 ×TILs [%]). The primary objective was to evaluate the association of CelTIL (as a continuous variable and using the pre-established 33.59% cut-off as defined by Nuciforo P, et al; Ann Oncol. 2018) with event-free survival (EFS). Secondary objectives were to evaluate the association of CelTIL with overall survival (OS) and pCR. Univariable and multivariable analyses were performed adjusting for hormone-receptor status, pre-treatment tumor size and nodal status, planned type of surgery, pCR status, and treatment arm. Results: The CelTIL score was evaluable in 196 samples (108 samples in arm B and 88 samples in arm C), of which 45.4% (89/196) had low CelTIL score and 54.6% (107/196) had a high CelTIL score. As a continuous score, higher CelTIL levels were independently associated with improved EFS (hazard ratio [HR]=0.84 per 10% increment; 95% CI 0.73-0.97; P=0.006), but not OS (HR=0.85; 95% CI 0.71-1.03; P=0.094). Using the pre-established cutoff, the 5-year EFS estimate was 76% (95% CI 68-85%) and 60% (95% CI 50-72%) in pts with high- and low-CelTIL, respectively (adjusted HR=0.53; 95% CI 0.30-0.94; p=0.030). Moreover, the 5-year OS rate was 86% (95% CI 80-94%) and 73% (95 CI 64-84%) in high- and low-CelTIL respectively (adjusted HR=0.43; 95% CI 0.20-0.92; p=0.029). CelTIL as a continuous score was also independently associated with higher rates of pCR (odds ratio [OR]=1.18; 95% CI 1.02-1.36; p=0.024). The pCR rate in the high-CelTIL group was 37% (40/107) versus 18% (16/89) in the low-CelTIL group (adjusted OR=2.60; 95% CI 1.31-5.14; p=0.006). Conclusions: CelTIL score measured at week 2 of anti-HER2 therapy is significantly associated with long-term survival outcomes in early-stage HER2+ breast cancer, independently of pCR status and other prognostic variables. Further validation of this biomarker could help select early-on pts candidates for escalation or de-escalation of systemic therapy.
Citation Format: Nuria Chic, Stephen Luen, Paolo Nuciforo, Roberto Salgado, Debora Fumagalli, Florentine Hilbers, Yingbo Wang, Evandro de Azambuja, Itsvan Lang, Serena Di Cosimo, Cristina Saura, Jens Huober, Aleix Prat, Sherene Loi. Celtil score and long-term survival outcome in early stage HER2-positive (HER2+) breast cancer treated with anti-HER2-based chemotherapy: A correlative analysis of neoALTTO trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS5-03.
Collapse
Affiliation(s)
- Nuria Chic
- 1Hospital Clinic of Barcelona, Barcelona, Spain
| | - Stephen Luen
- 2Peter MacCallum Cancer Center, Melbourne, Australia
| | - Paolo Nuciforo
- 3Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | | | - Evandro de Azambuja
- 7Institut Jules Bordet and l’Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Itsvan Lang
- 8National Institute for Oncology Ráth György., Budapest, Hungary
| | | | - Cristina Saura
- 10Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jens Huober
- 11Department of Obstetrics and Gynaecology of the University of Ulm, Ulm, Germany
| | - Aleix Prat
- 1Hospital Clinic of Barcelona, Barcelona, Spain
| | - Sherene Loi
- 2Peter MacCallum Cancer Center, Melbourne, Australia
| |
Collapse
|
10
|
van 't Veer LJ, Cardoso F, Poncet C, Cardozo JL, Delaloge S, Pierga JY, Vuylsteke P, Brain E, Viale G, Kümmel S, Rubio IT, Zoppoli G, Thompson A, Matos E, Zaman K, Knox S, Hilbers F, Peric A, Meulemans B, Picccart M, Rutgers EJT. Abstract GS4-11: How low is low risk: MINDACT updated outcome and treatment benefit in patients considered clinical low risk and stratified by genomic signature, age and nodal status. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-gs4-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background With 8.7 years follow-up, the prospective phase III randomized MINDACT trial (EORTC 10041/BIG3-04) continues to meet its primary objective, i.e. 95.1% (95%CI 93.1-96.6), 5-year distant metastasis-free survival (DMFS) in clinical high (C-High)/genomic low (G-Low) risk patients who did not receive adjuvant chemotherapy (ACT) (Cardoso et al., ASCO 2020). In addition, about half of the MINDACT patients had a low clinical risk (C-Low) defined by pre-specified clinical-pathological characteristics. Here, we evaluated the outcome of this C-Low population stratified by the 70-gene signature (MammaPrint®) (G-Low or G-High) for outcome considering age, and present data on the total G-low population (C-Low and C-High combined). Methods Of 6693 patients enrolled in the MINDACT trial between 2007 and 2011, 3337 were C-Low, characterized as mainly T1, grade 1 or 2, and node negative. We evaluated the pre-specified DMFS, distant metastasis free interval (DMFI), and overall survival (OS) rates at 5 and 8 years in the C-Low population: i) in patients with genomic low risk (C-Low/G-Low, n=2744) who were recommended to receive endocrine therapy only (for 99% HR+), and ii) in C-Low/G-High who received ACT or not following randomization (ITT, n=690, 81% HR+). Exploratory analyses by age, ≤50 and >50, were conducted for ACT vs no ACT received in C-Low/G-High. In parallel we estimated survival rates for all G-low patients if all would have followed the genomic low risk assignment and received no ACT (C-Low/G-Low, and C-High/G-Low randomized to no ACT double weighted, n=4130). We used Kaplan-Meier estimates for time to event endpoints and hazard ratios with 95%CI from Cox-regression models adjusted for stratification factors used for the randomization. Results C-low/G-low patients who were recommended endocrine therapy only (compliance > 79%, based on local guidelines) have excellent 5 and 8 year survival rates for all endpoints (Table 1). The estimated survival rates for all G-Low patients, if all would have followed the genomic low risk assignment and received no ACT, is excellent as well (Table 1), albeit this population includes both C-Low and C-High patients. The survival estimates for C-Low/G-High patients are for all endpoints a few percentage points lower than for the C-Low/G-Low group (Table 1). At 8 years of follow-up, in the relatively small subset of 690 patients with C-Low/G-High tumors assigned to ACT or not by randomization (ITT), a 1.5% (SE ±2.3%) higher DMFS is seen in the ACT group, and a 2.9% (SE ±2.0%) higher DMFI. This suggested benefit is mostly seen in patients under 50 years of age (absolute Δ in DMFS for ACT vs no ACT at 8 years: 5.4% for age ≤50 vs -0.3% for age >50). Conclusion Patients with a 70-gene G-Low risk tumor have an excellent 8 year outcome in the context of C-Low characteristics when recommended for endocrine therapy only, very close to the outcome in the larger group of all G-Low patients regardless of clinical risk. Stratification of C-Low patients in to G-Low and G-high provides meaningful information. The benefit of ACT in C-Low patients with a 70-gene G-High risk tumor needs further confirmation, especially relevant in younger women.
Table 1All Patients PopulationPatientsObserved events% at 5 years (95% CI)% at 8 years (95% CI)DMFSC-Low / G-Low274417097.3 (96.6-97.9)94.7 (93.8-95.6)C-Low / G-High5936194.2 (92.0-95.9)91.1 (88.4-93.3)DMFIC-Low / G-Low274410398.5 (97.9-98.9)96.7 (95.9-97.3)C-Low / G-High5934695.8 (93.8-97.2)93.5 (91.0-95.3)OSC-Low / G-Low274412298.2 (97.6-98.7)96.5 (95.7-97.2)C-Low / G-High5934496.8 (94.9-98.0)93.1 (90.5-95.0)Patients G-low (C-Low & C-High)PatientsEstimated events% at 5 years% at 8 yearsDMFSAll G-Low - no ACT413033996.492.8DMFIAll G-Low - no ACT413024497.494.6OSAll G-Low - no ACT413022397.995.7
Citation Format: Laura J van 't Veer, Fatima Cardoso, Coralie Poncet, Josephine Lopes Cardozo, Suzette Delaloge, Jean-Yves Pierga, Peter Vuylsteke, Etienne Brain, Giuseppe Viale, Sherko Kümmel, Isabel T Rubio, Gabriele Zoppoli, Alistair Thompson, Erika Matos, Khalil Zaman, Susan Knox, Florentine Hilbers, Aleksandra Peric, Bart Meulemans, Martine Picccart, Emiel J Th Rutgers. How low is low risk: MINDACT updated outcome and treatment benefit in patients considered clinical low risk and stratified by genomic signature, age and nodal status [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr GS4-11.
Collapse
Affiliation(s)
| | - Fatima Cardoso
- 2Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | | | | | | | | | | | - Etienne Brain
- 7Institut Curie - Hôpital Rene Huguenin, Saint-Cloud, France
| | - Giuseppe Viale
- 8University of Milan & IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | | | | | | | - Khalil Zaman
- 14University Hospital CHUV, Lausanne, Switzerland
| | - Susan Knox
- 15Europa Donna-European Breast Cancer Coalition, Milan, Italy
| | | | | | | | - Martine Picccart
- 17Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | |
Collapse
|
11
|
van 't Veer LJ, Cardoso F, Poncet C, Cardozo JL, Delaloge S, Pierga JY, Vuylsteke P, Brain E, Viale G, Kümmel S, Rubio IT, Zoppoli G, Thompson A, Matos E, Zaman K, Knox S, Hilbers F, Peric A, Meulemans B, Picccart M, Th Rutgers EJ. Abstract PS6-01: How low is low risk: MINDACT updated outcome and treatment benefit in patients considered clinical low risk and stratified by genomic signature, age and nodal status. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps6-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background With 8.7 years follow-up, the prospective phase III randomized MINDACT trial (EORTC 10041/BIG3-04) continues to meet its primary objective, i.e. 95.1% (95%CI 93.1-96.6), 5-year distant metastasis-free survival (DMFS) in clinical high (C-High)/genomic low (G-Low) risk patients who did not receive adjuvant chemotherapy (ACT) (Cardoso et al., ASCO 2020). In addition, about half of the MINDACT patients had a low clinical risk (C-Low) defined by pre-specified clinical-pathological characteristics. Here, we evaluated the outcome of this C-Low population stratified by the 70-gene signature (MammaPrint®) (G-Low or G-High) for outcome considering age, and present data on the total G-low population (C-Low and C-High combined). Methods Of 6693 patients enrolled in the MINDACT trial between 2007 and 2011, 3337 were C-Low, characterized as mainly T1, grade 1 or 2, and node negative. We evaluated the pre-specified DMFS, distant metastasis free interval (DMFI), and overall survival (OS) rates at 5 and 8 years in the C-Low population: i) in patients with genomic low risk (C-Low/G-Low, n=2744) who were recommended to receive endocrine therapy only (for 99% HR+), and ii) in C-Low/G-High who received ACT or not following randomization (ITT, n=690, 81% HR+). Exploratory analyses by age, ≤50 and >50, were conducted for ACT vs no ACT received in C-Low/G-High. In parallel we estimated survival rates for all G-low patients if all would have followed the genomic low risk assignment and received no ACT (C-Low/G-Low, and C-High/G-Low randomized to no ACT double weighted, n=4130). We used Kaplan-Meier estimates for time to event endpoints and hazard ratios with 95%CI from Cox-regression models adjusted for stratification factors used for the randomization. Results C-low/G-low patients who were recommended endocrine therapy only (compliance > 79%, based on local guidelines) have excellent 5 and 8 year survival rates for all endpoints (Table 1). The estimated survival rates for all G-Low patients, if all would have followed the genomic low risk assignment and received no ACT, is excellent as well (Table 1), albeit this population includes both C-Low and C-High patients. The survival estimates for C-Low/G-High patients are for all endpoints a few percentage points lower than for the C-Low/G-Low group (Table 1). At 8 years of follow-up, in the relatively small subset of 690 patients with C-Low/G-High tumors assigned to ACT or not by randomization (ITT), a 1.5% (SE ±2.3%) higher DMFS is seen in the ACT group, and a 2.9% (SE ±2.0%) higher DMFI. This suggested benefit is mostly seen in patients under 50 years of age (absolute Δ in DMFS for ACT vs no ACT at 8 years: 5.4% for age ≤50 vs -0.3% for age >50). Conclusion Patients with a 70-gene G-Low risk tumor have an excellent 8 year outcome in the context of C-Low characteristics when recommended for endocrine therapy only, very close to the outcome in the larger group of all G-Low patients regardless of clinical risk. Stratification of C-Low patients in to G-Low and G-high provides meaningful information. The benefit of ACT in C-Low patients with a 70-gene G-High risk tumor needs further confirmation, especially relevant in younger women.
Table 1All Patients PopulationPatientsObserved events% at 5 years (95% CI)% at 8 years (95% CI)DMFSC-Low / G-Low274417097.3 (96.6-97.9)94.7 (93.8-95.6)C-Low / G-High5936194.2 (92.0-95.9)91.1 (88.4-93.3)DMFIC-Low / G-Low274410398.5 (97.9-98.9)96.7 (95.9-97.3)C-Low / G-High5934695.8 (93.8-97.2)93.5 (91.0-95.3)OSC-Low / G-Low274412298.2 (97.6-98.7)96.5 (95.7-97.2)C-Low / G-High5934496.8 (94.9-98.0)93.1 (90.5-95.0)Patients G-low (C-Low & C-High)PatientsEstimated events% at 5 years% at 8 yearsDMFSAll G-Low - no ACT413033996.492.8DMFIAll G-Low - no ACT413024497.494.6OSAll G-Low - no ACT413022397.995.7
Citation Format: Laura J van 't Veer, Fatima Cardoso, Coralie Poncet, Josephine Lopes Cardozo, Suzette Delaloge, Jean-Yves Pierga, Peter Vuylsteke, Etienne Brain, Giuseppe Viale, Sherko Kümmel, Isabel T Rubio, Gabriele Zoppoli, Alistair Thompson, Erika Matos, Khalil Zaman, Susan Knox, Florentine Hilbers, Aleksandra Peric, Bart Meulemans, Martine Picccart, Emiel J Th Rutgers. How low is low risk: MINDACT updated outcome and treatment benefit in patients considered clinical low risk and stratified by genomic signature, age and nodal status [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-01.
Collapse
Affiliation(s)
| | - Fatima Cardoso
- 2Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | | | | | | | | | | | - Etienne Brain
- 7Institut Curie - Hôpital Rene Huguenin, Saint-Cloud, France
| | - Giuseppe Viale
- 8University of Milan & IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | | | | | | | - Khalil Zaman
- 14University Hospital CHUV, Lausanne, Switzerland
| | - Susan Knox
- 15Europa Donna-European Breast Cancer Coalition, Milan, Italy
| | | | | | | | - Martine Picccart
- 17Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | |
Collapse
|
12
|
Martel S, Lambertini M, Agbor-Tarh D, Ponde NF, Gombos A, Paterson V, Hilbers F, Korde L, Manukyants A, Dueck A, Maurer C, Piccart M, Moreno-Aspitia A, Desmedt C, Di Cosimo S, de Azambuja E. Body Mass Index and Weight Change in Patients With HER2-Positive Early Breast Cancer: Exploratory Analysis of the ALTTO BIG 2-06 Trial. J Natl Compr Canc Netw 2021; 19:181-189. [PMID: 33401235 DOI: 10.6004/jnccn.2020.7606] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The association between obesity and prognosis in HER2-positive early breast cancer remains unclear, with limited data available. This study aimed to determine the impact of body mass index (BMI) at baseline and weight change after 2 years on outcomes of patients with HER2-positive early breast cancer. METHODS ALTTO was a randomized phase III trial in patients with HER2-positive early breast cancer. BMI was collected at randomization and 2 years after. WHO BMI categories were used: underweight, <18.5 kg/m2; normal weight, 18.5 to <25 kg/m2; overweight, ≥25 to <30 kg/m2; and obese ≥30 kg/m2. A weight change from baseline of ≥5.0% and ≤5.0% was categorized as weight gain and weight loss. The impact of BMI at randomization and of weight change on disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) were investigated with multivariate analyses, adjusting for baseline patients and tumor characteristics. RESULTS A total of 8,381 patients were included: 187 (2.2%), 3,797 (45.3%), 2,690 (32.1%), and 1,707 (20.4%) were underweight, normal weight, overweight, and obese at baseline, respectively. Compared with normal weight, being obese at randomization was associated with a significantly worse DDFS (adjusted hazard ratio [aHR], 1.25; 95% CI, 1.04-1.50) and OS (aHR, 1.27; 95% CI, 1.01-1.60), but no significant difference in DFS (aHR, 1.14; 95% CI, 0.97-1.32). Weight loss ≥5.0% at 2 years after randomization was associated with significantly poorer DFS (aHR, 1.34; 95% CI, 1.05-1.71), DDFS (aHR, 1.46; 95% CI, 1.07-1.98), and OS (aHR, 1.83; 95% CI, 1.18-2.84). Hormone receptor and menopausal status but not anti-HER2 treatment type influenced outcomes. Toxicities were more frequent in obese patients. CONCLUSIONS In patients with HER2-positive early breast cancer, obesity at baseline is a poor prognostic factor. Weight loss during treatment and follow-up negatively impacts clinical outcomes. Dietary counseling should be part of survivorship care programs.
Collapse
Affiliation(s)
- Samuel Martel
- 1Department of Hemato-Oncology, CISSS Montérégie Centre/Hôpital Charles Le Moyne, Université de Sherbrooke, Greenfield Park, Quebec, Canada
| | - Matteo Lambertini
- 2Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Noam F Ponde
- 4Department of Medicine, Camargo Cancer Center, Sao Paulo, Brazil
| | - Andrea Gombos
- 5Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | | | | | | | | | | | - Christian Maurer
- 10University of Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Martine Piccart
- 5Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | | | - Christine Desmedt
- 11Laboratory for Translational Breast Cancer Research, Department of Oncology, Leuven, Belgium; and
| | | | - Evandro de Azambuja
- 5Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| |
Collapse
|
13
|
Metzger O, Cardoso F, Poncet C, Desmedt C, Linn S, Wesseling J, Hilbers F, Aalders K, Delorenzi M, Delaloge S, Pierga J, Brain E, Vrijaldenhoven S, Neijenhuis P, Rutgers E, Piccart M, van ’t Veer L, Viale G. Clinical utility of MammaPrint testing in Invasive Lobular Carcinoma: Results from the MINDACT phase III trial. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30542-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
14
|
Nuciforo P, Townend J, Saura C, de Azumbaja E, Hilbers F, Manukyants A, Werutsky G, Bliss J, Moebus V, Colleoni M, Aspitia A, Di Cosimo S, Van dooren V, Kroep J, Ferro A, Cameron D, Gelber R, Piccart-Gebhart M, Huober J. Nine-year survival outcome of neoadjuvant lapatinib with trastuzumab for HER2-positive breast cancer (NeoALTTO, BIG 1-06): final analysis of a multicentre, open-label, phase 3 randomised clinical trial. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30560-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
15
|
Pondé N, Agbor-Tarh D, Dal Lago L, Korde LA, Hilbers F, Jackisch C, Werner O, Gelber RD, Jatoi A, Dueck AC, Moreno-Aspitia A, Sotiriou C, de Azambuja E, Piccart M. Tolerability and toxicity of trastuzumab or trastuzumab + lapatinib in older patients: a sub-analysis of the ALTTO trial (BIG 2-06; NCCTG (Alliance) N063D). Breast Cancer Res Treat 2020; 185:107-116. [PMID: 32951084 DOI: 10.1007/s10549-020-05915-9] [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] [Received: 01/28/2020] [Accepted: 09/01/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Little is known about the use of trastuzumab or trastuzumab + lapatinib in older patients. We have performed a sub-analysis of the Adjuvant Lapatinib And/Or Trastuzumab Treatment Optimisation (ALTTO) trial focused on toxicity and treatment completion of both regimens in older patients (≥ 65 years old) METHODS: The ALTTO trial randomised 8381 patients with early HER2-positive BC in 4 arms. Eligible patients for this study were those having received at least one dose of assigned treatment in either the trastuzumab or trastuzumab + lapatinib arms. Treatment completion was evaluated through the rate of temporary treatment interruptions, permanent treatment discontinuations and lapatinib dose reductions. Toxicity was evaluated via a selected subset of adverse events of interest (AEI). Risk factors for both treatment completion outcomes and toxicity were investigated, including comorbidities and use of 5 or more co-medications at randomization. RESULTS A total of 430 patients ≥ 65 year were eligible. Median age was 68 (range 65-80). In comparison with the younger cohort, older patients had a significantly higher number of comorbidities at randomization (p < 0.001). Treatment completion outcomes were worse, particularly in the trastuzumab + lapatinib arm. Adverse events of interest were likewise more common in the trastuzumab + lapatinib arm with higher AEI rates (63.4% in younger vs 78.0% in older, p < 0.001). Concomitant chemotherapy was associated with worse treatment completion outcomes among older patients. CONCLUSION Trastuzumab plus lapatinib was significantly more toxic among older patients and had worse treatment completion. Trastuzumab was generally well tolerated.
Collapse
Affiliation(s)
- Noam Pondé
- AC Camargo Cancer Center, Rua Pires da Mota, 1167, São Paulo, 01529-001, Brazil. .,Institut Jules Bordet, Brussels, Belgium.
| | | | | | | | | | | | | | - Richard D Gelber
- Dana-Farber Cancer Institute, Boston, USA.,Frontier Science and Technology Research Foundation, Boston, MA, USA
| | | | | | | | | | | | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| |
Collapse
|
16
|
Rediti M, Venet D, Rothé F, Qing T, Maetens M, Bradbury I, Izquierdo MA, Cosimo SD, Hilbers F, Bajji M, Harbeck N, Untch M, Rimm DL, Chia S, Liu MC, Saura C, Huober J, Nuciforo P, Salgado R, Loi S, Pusztai L, Sotiriou C. Abstract 1998: Predictive and prognostic role of T- and B-cell receptor repertoire in HER2-positive breast cancer: An analysis of the NeoALTTO clinical trial. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1998] [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: Disease relapse is observed in a significant proportion of HER2-positive breast cancer (BC) patients with residual disease (RD) after neoadjuvant treatment, as well as in a subgroup of those achieving pathological complete response (pCR). As the host immune response plays a key role in modulating the activity of anti-HER2 agents, we investigated the association of T- and B-cell receptor (TCR and BCR) repertoires with pCR and event-free survival (EFS) in the NeoALTTO phase 3 trial.
Methods: RNA sequencing (RNAseq) data from baseline tumor biopsies were available for 254 patients out of the 455 enrolled in the study. Among those, 166 did not achieve a pCR defined as ypT0/is. Matched RNAseq data from RD samples were available for 43 cases. TCR/BCR repertoires were extracted from RNAseq data using the MiXCR software. TCR and BCR read counts, number of clones, evenness, Shannon entropy, Gini index, length of the complementarity determining region 3, top and second top clone proportion were evaluated. Survival analysis was performed using univariate and multivariate (adjusted for tumor size, nodal status, grade, estrogen receptor [ER] status, age and treatment arm) Cox proportional hazard models, while logistic regressions were used for pCR. False discovery rate (FDR) was obtained using Benjamini & Hochberg method.
Results: Baseline TCR top (odds ratio [OR]=0.63 [95% CI 0.46-0.87], FDR=0.021) and second top (OR=0.57 [0.41-0.79], FDR=0.004) clone proportion were significantly associated with a lower probability of achieving pCR in the multivariate analysis. BCR evenness (hazard ratio [HR]=1.5 [1.2-2], FDR=0.015) and Gini index (HR=0.66 [0.52-0.85], FDR=0.015) were significantly associated with EFS in the multivariate analysis. In residual disease, BCR evenness and Gini index showed a similar trend in the EFS univariate analysis, while TCR read counts, number of clones, and entropy were associated with lower HR (P<0.05), although FDR were borderline significant (0.05<FDR<0.1). A model to predict EFS including baseline BCR evenness, ER status, stromal tumor-infiltrating lymphocyte level, and pCR was able to identify 3 groups with good, intermediate and poor prognosis (Kaplan-Meier 5-year EFS rates of 95%, 80% and 58%, respectively). Of note, about 63%, 45% and 12% of the patients achieved a pCR in the three prognostic groups, respectively.
Conclusions: In the NeoALTTO trial, the presence of an evenly distributed BCR repertoire was associated with worse EFS. A model integrating baseline immune-related and clinical features was able to identify patients with excellent prognosis despite RD or, conversely, with poor prognosis after pCR. We envision that our model has the potential to allow the personalization of post-operative treatment strategies after both pCR and RD in HER2-positive BC. Further validation of our findings is warranted.
Citation Format: Mattia Rediti, David Venet, Françoise Rothé, Tao Qing, Marion Maetens, Ian Bradbury, Miguel A. Izquierdo, Serena Di Cosimo, Florentine Hilbers, Mohammed Bajji, Nadia Harbeck, Michael Untch, David L. Rimm, Stephen Chia, Minetta C. Liu, Cristina Saura, Jens Huober, Paolo Nuciforo, Roberto Salgado, Sherene Loi, Lajos Pusztai, Christos Sotiriou. Predictive and prognostic role of T- and B-cell receptor repertoire in HER2-positive breast cancer: An analysis of the NeoALTTO clinical trial [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1998.
Collapse
Affiliation(s)
| | | | | | - Tao Qing
- 2Yale Cancer Center, New Haven, CT
| | | | - Ian Bradbury
- 4Frontier Science Scotland, Kingussie, United Kingdom
| | | | | | | | | | - Nadia Harbeck
- 8Ludwig-Maximilians-Universitat Munich, Munich, Germany
| | | | | | - Stephen Chia
- 11BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Cristina Saura
- 13Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Paolo Nuciforo
- 13Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Sherene Loi
- 15Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | |
Collapse
|
17
|
Cardoso F, van 't Veer L, Poncet C, Lopes Cardozo J, Delaloge S, Pierga JY, Vuylsteke P, Brain E, Viale G, Kuemmel S, Rubio IT, Zoppoli G, Thompson AM, Matos E, Zaman K, Hilbers F, Dudek-Perić A, Meulemans B, Piccart-Gebhart MJ, Rutgers EJ. MINDACT: Long-term results of the large prospective trial testing the 70-gene signature MammaPrint as guidance for adjuvant chemotherapy in breast cancer patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.506] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
506 Background: The 70-gene signature MammaPrint has been shown to identify breast cancer patients for whom adjuvant chemotherapy (CT) could be safely omitted even in the presence of unfavorable standard clinical-pathological criteria. The MINDACT primary endpoint at 5 years median follow-up was met in 2016 (Cardoso et al, NEJM 2016) with a distant metastasis free survival (DMFS) rate at 5 years of 94.7% (95% CI: 92.5-96.2) in clinical high (C-High) / genomic low (G-Low) risk patients who received no CT. Longer follow-up is now available. Methods: 6693 patients were enrolled in the prospective phase III randomized MINDACT study (EORTC 10041/BIG3-04) between 2007-2011. We assessed the DMFS rate at 5 years in the primary test (PT) population of C-High / G-Low patients who were randomized to receive no CT (n = 644). As secondary analysis, we evaluated DMFS and overall survival (OS) in the intention to treat (ITT) population of the C-High / G-Low group randomized to CT vs no CT (n = 749 and 748 respectively). Comparisons between CT and no CT groups are low-powered. We used Kaplan-Meier estimates for time to event endpoints and hazard ratios (HR) with 95% CI from cox-regression models adjusted for stratification factors used for the randomization. Results: The median follow-up is 8.7 years, resulting in an updated 5-year DMFS rate for the PT population of C-High / G-Low patients with no CT of 95.1% (95% CI 93.1-96.6). The updated outcomes of the ITT population of C-High / G-Low patients are shown in the table. Further analyses will update the suggested age-dependent effect of CT omission for luminal breast cancer seen at 5 years in pre- versus post-menopausal women as in Tailor-X (Piccart et al, SABCS 2019). Conclusions: The primary DMFS endpoint at 5 years continues to be met in CT untreated C-High / G-Low risk women, confirming MINDACT as a positive de-escalation study. With longer follow-up and in line with the natural history of luminal breast cancer, more distant relapses do occur but the estimated gain of 2.6% for CT administration in C-High / G-Low patients remains small in light of CT harmful effects. The level IA evidence for the clinical utility of the 70-gene signature for adjuvant CT decision making is maintained. Clinical trial information: NCT00433589 . [Table: see text]
Collapse
Affiliation(s)
- Fatima Cardoso
- Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Laura van 't Veer
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | | | - Suzette Delaloge
- Breast Cancer Unit, Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | | | - Etienne Brain
- Institut Curie-Hôpital Rene Huguenin, Saint-Cloud, France
| | - Giuseppe Viale
- University of Milan & IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Gabriele Zoppoli
- Università degli Studi di Genova & Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Erika Matos
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | | | | | | | | | | |
Collapse
|
18
|
Rediti M, Venet D, Rothe F, Qing T, Maetens M, Bradbury I, Izquierdo MA, Di Cosimo S, Hilbers F, Bajji M, Harbeck N, Untch M, Liu MC, Saura C, Huober JB, Nuciforo P, Salgado R, Loi S, Pusztai L, Sotiriou C. Association of T- and B-cell receptor repertoires with molecular subtypes and outcome in HER2+ breast cancer: An analysis of the NeoALTTO clinical trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
511 Background: Clinicopathological and molecular features, including estrogen receptor (ER) status and PAM50 subtypes, have shown an association with immunogenicity and tumor-infiltrating lymphocyte (TIL) levels in breast cancer (BC). To investigate the complexity of the immune response in HER2+ BC, we explored the association of T- and B-cell receptor (TCR and BCR) repertoires with clinicopathological characteristics, PAM50 subtypes and outcome in the NeoALTTO phase III trial. Methods: RNA sequencing (RNAseq) data from baseline tumor biopsies were available for 254 out of the 455 patients enrolled. TCR and BCR repertoires were extracted from RNAseq data using the MiXCR software. Repertoire and diversity measures (read counts, number of clones, evenness, Gini index, Shannon entropy, length of the complementarity-determining region 3 [CDR3], top and second top clone proportions) were estimated. PAM50 subtypes were computed from RNAseq data. Univariate and multivariate (adjusted for clinicopathological characteristics, TIL levels dichotomized using the median value of 12.5% and treatment arm) Cox proportional hazard models were used for survival analysis, while logistic regressions were used for pathological complete response (pCR), defined as ypT0/is. All results reported had a false discovery rate (FDR) <0.05. Results: Higher BCR read counts, number of clones and Gini index were significantly associated with ER-negative as well as grade 3 tumors. Among the PAM50 subtypes, HER2-enriched (HER2-E) showed significantly higher BCR read counts, number of clones and Gini index along with lower evenness compared to luminal A and B, as well as higher length of CDR3 than luminal A. Of note, basal-like showed similar BCR diversity measures to HER2-E. No significant differences were noted for TCR diversity measures. In multivariate analyses, neither TCR nor BCR features were associated with pCR, while BCR evenness (HR 1.5; 95%CI 1.1-2.1) and Gini index (HR 0.66; 95%CI 0.5-0.88) were associated with event-free survival. Conclusions: BCR repertoire measures suggest a clonal expansion in HER2-E and basal-like PAM50 subtypes. Furthermore, the implementation of BCR-derived biomarkers can help to identify patients with an improved clinical outcome after neoadjuvant anti-HER2 treatment. Our findings highlight the heterogeneity of the immune response within HER2+ BC and provide support for biomarker-driven treatment strategies including immunotherapy in this BC subtype. Further validation is required. Clinical trial information: NCT00553358 .
Collapse
Affiliation(s)
- Mattia Rediti
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - David Venet
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Francoise Rothe
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Tao Qing
- Breast Medical Oncology, School of Medicine, Yale University, New Haven, CT
| | | | | | | | - Serena Di Cosimo
- Biomarker Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Mohammed Bajji
- Institut Jules Bordet (Breast European Adjuvant Study Team), Brussels, Belgium
| | - Nadia Harbeck
- Breast Center, Dept. Obstetrics & Gynecology, University of Munich (LMU) and CCCLMU, Munich, Germany
| | | | | | - Cristina Saura
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Paolo Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Roberto Salgado
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Sherene Loi
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Lajos Pusztai
- Yale School of Medicine, Yale Cancer Center, New Haven, CT
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
19
|
Bayani J, Poncet C, Crozier C, Trinh QM, Hopkins M, Uwimana AL, Piper T, Cunningham C, Sobol M, Aebi S, Benstead K, Bogler O, Lago LD, Hilbers F, Hedenfalk I, Korde L, Linderholm B, Martens J, Middleton L, Murray M, Kelly C, Nilsson C, Nowaczyk M, Peeters S, Peric A, Porter P, Schröder C, Rubio IT, Ruddy KJ, van Asperen C, Weyngaert DVD, van Deurzen CHM, van Leeuwen-Stok E, Vermeij J, Winer E, Stein LD, Giordano SH, Cardoso F, Bartlett JMS. Abstract P4-10-03: The genomic landscape of male breast cancers using the oncomine comprehensive assay for actionable mutations. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-10-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Male breast cancer (BCa) is a rare disease accounting for less than 1% of all breast cancers (BC) and 1% of all cancers in males. The clinical management is largely extrapolated from female BCa. Few studies have examined the genomic landscape of male BCas, with six male BCas included in The Cancer Genome Atlas (TCGA). Familial studies of male BCas have shown genomic changes similar to female BCa, while a larger targeted sequencing study of 59 male breast cancers identified recurrent mutations affecting PIK3CA and GATA3. To date, there is still limited information regarding the genomic landscape of male BCas; particularly in the context of identifying targeted treatments. To reveal genomic changes that characterize male BCas in the context of known cancer driver genes linked to prognosis and targeted agents, we performed a targeted sequencing study on 248 male BCas from the International Male Breast Cancer Program. Methods: 248 primary M0, ER+ve, HER2-ve male BCas enrolled in the Part 1 (retrospective joint analysis) International Male Breast Cancer Program of 1483 patients diagnosed between 1990-2010 (Cardoso et al. Annals of Oncology, 2018) were processed for nucleic acid extraction from formalin-fixed paraffin embedded (FFPE) tissues. Using the Thermo Fisher Scientific Oncomine Comprehensive Assay v3 (OCAv3), a validated targeted sequencing panel currently used in the NCI-MATCH trial (NCT02465060), we evaluated mutational and copy number variations (CNVs) of genes that are prognostic or predictive to targeted therapies currently in use in the clinic or late-stage clinical trials. The OCAv3 DNA pan-cancer panel assays 115 genes for determining mutational status (48 full coding and 67 hotspot) as well as copy-number assessment in 43 genes. The OCAv3 uses Ampliseq-based technology linked to the Oncomine NGS workflow to identify actionable mutations and CNVs Results: Of the 248 samples assayed, 216 passed strict quality control parameters (87.1%). Using the Oncomine NGS workflow, actionable mutations at ≥5% variant allele frequency (VAF) were most frequently identified in PIK3CA (29.2%), BRCA2 (11.1%), NF1 (11.6%), indels in TP53 (10.6%), ATR (5.6%), ATRX (5.1%), indel BRCA2 (5.1%), TP53 point mutations (4.6%), MET (4.6%), ATM (4.6%), NOTCH2 (4.6%), CHEK1 (4.2%), FANCI (4.2%), PTEN (3.2%) with a number of additional genes identified at lower frequencies. Gene amplifications were most frequently detected in MYC (24.5%), FGFR1 (14.8%), CCND1 (12%), FGF3 (9.7%), FGF19 (9.7%), MDM2 (6.5%), CDK4 (1.4%), FGFR3, MDM4, ERBB2 (0.9% each), and FLT3, AR, MYCL, CDK6, IGF1R, FGFR4, KRAS, AKT3 and ESR1 (0.5% each). Although the results here describe the mutations and copy-number changes deemed to be actionable, further analysis of all non-actionable somatic mutations and CNVs will be presented and compared to female BCas previously assayed using the same panel. Conclusion: In this targeted sequencing study of the largest series of male BCas to our knowledge, we have revealed that PIK3CA continues to be a frequently altered gene in both male and female BCas. However, there is an enrichment of mutations in genes related to DNA repair in male BCs. Interestingly, while MYC is commonly amplified in female BCa, a higher frequency of amplified cases were seen in male BCas, in contrast to female BCas. Together with our previously generated transcriptional profiling data in this data set, we believe that both common and unique biological processes comprising male and female BCas will ultimately improve their clinical management and move towards the goal of precision medicine.
This work has been funded by the Breast Cancer Research Foundation (BCRF).
Citation Format: Jane Bayani, Coralie Poncet, Cheryl Crozier, Quang M Trinh, Megan Hopkins, Aime Lambert Uwimana, Tammy Piper, Carrie Cunningham, Monika Sobol, Stefan Aebi, Kim Benstead, Oliver Bogler, Lissandra Dal Lago, Florentine Hilbers, Ingrid Hedenfalk, Larissa Korde, Barbro Linderholm, John Martens, Lavinia Middleton, Melissa Murray, Catherine Kelly, Cecilia Nilsson, Monika Nowaczyk, Stephanie Peeters, Aleksandra Peric, Peggy Porter, Carolien Schröder, Isabel T Rubio, Kathryn J Ruddy, Christi van Asperen, Danielle Van Den Weyngaert, Carolien HM van Deurzen, Elise van Leeuwen-Stok, Joanna Vermeij, Eric Winer, Lincoln D Stein, Sharon H Giordano, Fatima Cardoso, John MS Bartlett. The genomic landscape of male breast cancers using the oncomine comprehensive assay for actionable mutations [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-10-03.
Collapse
Affiliation(s)
- Jane Bayani
- 1Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Coralie Poncet
- 2European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Cheryl Crozier
- 1Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Quang M Trinh
- 1Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Megan Hopkins
- 1Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Aime Lambert Uwimana
- 2European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Tammy Piper
- 3University of Edinburgh, Edinburgh, United Kingdom
| | | | - Monika Sobol
- 3University of Edinburgh, Edinburgh, United Kingdom
| | - Stefan Aebi
- 4Swiss Group for Clinical Cancer Research (SAKK), Bern, Swaziland
| | - Kim Benstead
- 5Cheltenham General Hospital, Gloucestershire, United Kingdom
| | - Oliver Bogler
- 6University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | - John Martens
- 12Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | | | | | - Catherine Kelly
- 14All Ireland Cooperative Oncology Research Group (ICORG), Dublin, Ireland
| | | | | | | | - Aleksandra Peric
- 2European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Peggy Porter
- 18Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Isabel T Rubio
- 20Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | | | | | | | | | | | - Joanna Vermeij
- 25Department of Medical Oncology, ZNA, Jan Palfijn, Belgium
| | - Eric Winer
- 26Dana-Farber Cancer Institute,, Boston, MA
| | | | | | - Fatima Cardoso
- 27Champalimaud Clinical Center/Champalimaud Foundation, Lisbond, Portugal
| | | |
Collapse
|
20
|
Risi E, Biagioni C, Benelli M, Migliaccio I, McCartney A, Bonechi M, Guarducci C, Hilbers F, Di Cosimo S, Huober J, Romagnoli D, Boccalini G, Vitale S, Sotiriou C, Biganzoli L, Di Leo A, Malorni L. An RB-1 loss of function gene signature as a tool to predict response to neoadjuvant chemotherapy plus anti-HER2 agents: a substudy of the NeoALTTO trial (BIG 1-06). Ther Adv Med Oncol 2019; 11:1758835919891608. [PMID: 31853266 PMCID: PMC6906346 DOI: 10.1177/1758835919891608] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 11/05/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Chemotherapy added to anti-HER2 agents (H) is the treatment of choice in
patients with HER2+ early breast cancer. However, HER2+ tumours are
clinically and biologically heterogeneous, and treatment response varies
significantly by hormone receptor (HR) status and molecular subtype.
Predictive biomarkers are needed in this context. This study assessed
whether an RB-1 loss of function gene signature (RBsig) is predictive of
response to neoadjuvant chemotherapy in combination with trastuzumab,
lapatinib or both, within the NeoALTTO trial. Methods: We collected RNA-sequencing data from pretreatment biopsies derived from the
NeoALTTO trial. RBsig expression was computed retrospectively and correlated
with pathological complete response (pCR) using receiver-operating
characteristic (ROC) curves. The RBsig was dichotomised as High/Low in
correspondence to the 25th percentile. Reported p values
resulted from Fisher’s exact test. Results: Of 455 NeoALTTO patients, 244 were eligible for this substudy (HR+
n = 129; HR− n = 115). Overall, pCR
rate was significantly higher in patients with RBsig High tumours than those
with RBsig Low (35% versus 18% respectively;
p = 0.01). The area under the ROC curve (AUC) was 0.60
(95% CI 0.52–0.67). A remarkably low pCR rate of 11% was seen in HR+/RBsig
Low patients versus 28% in HR+/RBsig High. Conclusions: These results indicate RBsig may add valuable information to HER2 and HR
expression, which may in turn inform treatment choices. HR+/HER2+/RBsig Low
breast cancers exhibited the poorest pathological response following
chemotherapy plus H. Accordingly, in such patients, endocrine therapy in
combination with H and, possibly, a CDK4/6 inhibitor, may potentially prove
to be a more effective treatment.
Collapse
Affiliation(s)
- Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, via Suor Niccolina Infermiera 20, Prato, 59100, Italy
| | | | | | - Ilenia Migliaccio
- Sandro Pitigliani Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Amelia McCartney
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Martina Bonechi
- Sandro Pitigliani Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Cristina Guarducci
- Sandro Pitigliani Translational Research Unit, Hospital of Prato, Prato, Italy
| | | | - Serena Di Cosimo
- Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jens Huober
- Breast Center, University of Ulm, Ulm, Germany
| | | | - Giulia Boccalini
- Sandro Pitigliani Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Stefania Vitale
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Angelo Di Leo
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Luca Malorni
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| |
Collapse
|
21
|
Solinas C, Silva PD, Venet D, Garaud S, Gu-Trantien C, Hilbers F, Azambuja ED, Werner O, Peña LDL, Dueck A, Cosimo SD, Lang I, Huober J, Küemmel S, Denkert C, Salgado R, Sotiriou C, Piccart-Gebhart M, Fumagalli D, Willard-Gallo K. Abstract 3132: Immune regulatory gene expression and clinical outcome in the NeoALTTO trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3132] [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 level of immune suppression in an individual breast cancer (BC) patient is relevant for having a major benefit from treatments that act via or are directed to the immune response, such as anti-HER2 agents and immune checkpoint molecules, respectively. The link(s) between the tumor immune microenvironment and treatment responses has been investigated in HER2-positive BC. This study analyzed the association between baseline expression of genes regulating T cell activities (PD1, CTLA4, LAG3, TIM3, PDL1, PDL2, FOXP3, IL10, TGFβ (1-3), FOXP1 and other related genes) and pathologic complete response (pCR) rates in the NeoALTTO trial. Methods: NeoALTTO randomized early-stage HER2-positive BC patients to neoadjuvant trastuzumab (T), lapatinib (L) or T+L for 6 weeks followed by 12 weeks of concurrent paclitaxel. Anthracyclines were given after surgery (FEC). Patients with RNA sequencing data from their baseline tumor samples (N=254 patients out of 455 from the original cohort) were included in the current study. The primary endpoint, pCR, was defined as ypT0/is ypN0. Logistic regression was used for analysis of pCR. Cox regression univariate and multivariate (adjusted for clinicopathological parameters and treatment arms) analyses were performed. Results: In the total cohort analyzed, high PD1 (odds ratio, OR: 1.4, P=0.03), PDL2 (OR: 1.4, P=0.04), CTLA4 (OR: 1.4, P=0.03) and TGFβ3 (OR: 1.4, P=0.02) expression was associated with an increased probability of achieving pCR at the multivariate analysis. ERBB2 (HER2) expression was associated with pCR in the three arms (T: OR: 2.7, P=0.02; L: OR: 2.3, P=0.01; T+L: OR: 5, P<0.001). Additionally in the T+L arm, PAM50 HER2-enriched subtype (OR: 2.9, P=0.03), as well as immune genes PD1 (OR: 2.1, P=0.01), PDL1 (OR: 1.8, P=0.03) and CTLA4 (OR: 2; P=0.01), were also associated with pCR. Conclusions: In the NeoALTTO population examined, PD1, PDL2, CTLA-4 and TGFβ3 expression at diagnosis were all associated with improved pCR rates after anti-HER2 treatment. The effect of these treatments seemed to be dependent on HER2 expression levels, which was particularly relevant in the T+L arm. These observations confirm previous findings that link immune infiltrates to higher pCR rates, demonstrate the clinical significance of the PD-1 pathway and additionally show that CTLA-4 and TGFβ3 could also be important in early stage HER2-positive BC. The association of tumors linked with immune regulatory gene expression with positive responses to neoadjuvant anti-HER2 agents suggests that they act in a way that reinvigorates the antitumor immunity in the face of tumor-mediated suppression. Patients whose tumors highly express these genes may be good candidates for immunotherapy before the start or after the neoadjuvant treatment when residual disease is detected at surgery, although these hypotheses require further confirmation.
Citation Format: Cinzia Solinas, Pushpamali De Silva, David Venet, Soizic Garaud, Chunyan Gu-Trantien, Florentine Hilbers, Evandro de Azambuja, Olena Werner, Lorena De la Peña, Amylou Dueck, Serena Di Cosimo, Istvan Lang, Jens Huober, Sherko Küemmel, Carsten Denkert, Roberto Salgado, Christos Sotiriou, Martine Piccart-Gebhart, Debora Fumagalli, Karen Willard-Gallo. Immune regulatory gene expression and clinical outcome in the NeoALTTO trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3132.
Collapse
Affiliation(s)
- Cinzia Solinas
- 1Molecular Immunology Unit, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Pushpamali De Silva
- 1Molecular Immunology Unit, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - David Venet
- 2Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Soizic Garaud
- 1Molecular Immunology Unit, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Chunyan Gu-Trantien
- 3Institute for Medical Immunology, Université Libre de Bruxelles, Bruxelles, Charleroi, Belgium
| | | | - Evandro de Azambuja
- 5Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | | | | | | | | | - Istvan Lang
- 9National Institute of Oncology, Budapest, Hungary
| | - Jens Huober
- 10Universitätsfrauenklinik Ulm, Ulm, Germany
| | | | - Carsten Denkert
- 12Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christos Sotiriou
- 2Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Martine Piccart-Gebhart
- 5Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Karen Willard-Gallo
- 1Molecular Immunology Unit, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| |
Collapse
|
22
|
Nuciforo P, Hlauschek D, Saura C, de Azambuja E, Fasani R, Villagrasa P, Muehlbacher K, Sotiriou C, Prat A, Pfeiler G, Hilbers F, Wilson TR, Aimi J, Stout T, Valero V, Fesl C, Baselga J, Gnant M, Piccart M, Andre F. Exploratory analysis of the effect of taselisib on downstream pathway modulation and correlation with tumor response in ER-positive/HER2-negative early-stage breast cancer from the LORELEI trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1050 Background: Taselisib (T) is an oral, potent, selective inhibitor of Class I PI3-kinase with enhanced activity against PIK3CA mutant cancer cells. Results from the LORELEI trial have demonstrated a significant improvement in ORR (objective response rate) by centrally assessed magnetic resonance imaging in all randomized patients as well as in the PIK3CA mutant (MT) cohort treated with neoadjuvant T plus letrozole (L) compared to placebo (P) plus L. Here we present the results of exploratory analyses of selected pathway-related phosphoproteins. Methods: Baseline (BL) and week3 (W3) tumor biopsies were obtained from 334 patients enrolled in the trial. Phosphoproteins (pAKT, pPRAS40 and pS6) were analyzed by IHC. BL levels as well as changes from BL to W3 were correlated with response assessed either by ORR or cell cycle arrest (Ki67 at W3 < 2.7%). Results: In the overall population, BL phosphoproteins levels were similar between the T and P arms. Higher pAKT (p < 0.001) and pPRAS40 (p = 0.004) levels were observed in MT vs wild-type (WT), whereas the opposite result was found for pS6 (p = 0.03). Treatment-induced absolute changes of phosphoproteins adjusted for BL levels were not significantly different between the T and P arms in the overall population, except for pPRAS40 with higher decrease in the T arm (p = 0.014). After stratification for PIK3CA genotype, a significantly greater decrease in expression levels was observed for pPRAS40 (p < 0.001) and pS6 (p = 0.020) in MT tumors treated with T. The treatment effects were not significantly different in the WT population. A trend for an association between decrease in pS6 levels at W3 and improved ORR was observed in the MT (p = 0.08) and T (p = 0.09) subgroups. The magnitude of pS6 suppression at W3 was higher in tumors achieving a cell cycle arrest in the MT/T subgroup (biserial correlation = -0.473). Conclusions: Exploratory analyses of phosphoproteins showed bioactivity of taselisib as indicated by downstream pathway suppression. Translational research aiming to integrate these results with additional exploratory biomarkers data is currently ongoing. Clinical trial information: NCT02273973.
Collapse
Affiliation(s)
- Paolo Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | - Roberta Fasani
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Georg Pfeiler
- Department of Obstetrics and Gynecology and Center for Breast Health, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | - Vicente Valero
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | |
Collapse
|
23
|
Ponde NF, Agbor-Tarh D, Dal Lago L, Korde LA, Hilbers F, Jackisch C, Werner O, Gelber RD, Jatoi A, Dueck AC, Moreno-Aspitia A, Sotiriou C, de Azambuja E, Piccart M. Treatment completion and toxicity of trastuzumab or trastuzumab + lapatinib in older patients (pts): BIG 2-06; NCCTG N063D (Alliance). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11553 Background: Little is known about the toxicity of trastuzumab (T) or of trastuzumab + lapatinib (T + L), approved in the advanced setting, in older pts. We have performed a sub-analysis of the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation (ALTTO) trial focused on treatment completion and toxicity of T and T+L in older pts (aged ≥65 years (yr)). Methods: The ALTTO trial (NCT00490139, NCCTG N063D) randomised 8381 pts with early HER2+ BC into 4 arms and we included the T and T+L arms in our analysis. Eligible pts for our study were those having received at least one dose of assigned treatment. Treatment completion was evaluated through the rate of temporary treatment interruptions (TTI), permanent treatment discontinuations (PTD) and lapatinib dose reductions (LDR). Toxicity was evaluated via a selected set of adverse events of interest (AEIs). Risk factors for TTI, PTD, LDR and AEIs were assessed, including comorbidities and polypharmacy at baseline (defined as use 5 or more co-medications) and AEIs during treatment. Results: A total of 430 pts≥65-year-old were identified for this sub-analysis, out of a total of 4190 pts with a median age of 68 yrs (range 65-80). Older pts were more likely to have comorbidities (70% vs 38%). Treatment completion was worse among older pts in the T+L arm but not in the T arm (Table). AEIs were more common in the T+L arm in all patients, with older patients having higher AEI rates (78.04% in older vs 63.38% in younger), particularly diarrhea (60.75% vs 38.0%). Identified risk factors (multivariate) for worse treatment completion in the T and T+ L arms included concomitant use of chemotherapy and the occurrence of grade 3 adverse events, among others. Conclusions: T + L has worse treatment completion and is more toxic in older patients, while T was well tolerated. Identifiable risk factors at baseline and during the course of treatment could be used to aid in regimen selection and management for both T and T + L in their respective indications. Support: UG1CA189823, Novartis;https://acknowledgments.alliancefound.org. [Table: see text]
Collapse
Affiliation(s)
| | | | | | - Larissa A. Korde
- Head, Breast Cancer Therapeutics, Clinical Investigations Branch, National Cancer Institute, Bethesda, MD
| | | | | | | | - Richard D. Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston, MA
| | | | | | | | | | | | | |
Collapse
|
24
|
Aftimos P, Antunes De Melo e Oliveira A, Hilbers F, Venet D, Vingiani A, Nili Gal Yam E, Martinez J, Ndozeng J, Irrthum A, Piccart M. First report of AURORA, the breast international group (BIG) molecular screening initiative for metastatic breast cancer (MBC) patients (pts). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz100.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
25
|
Di Cosimo S, Appierto V, Pizzamiglio S, Tiberio P, Iorio MV, Hilbers F, de Azambuja E, de la Peña L, Izquierdo M, Huober J, Baselga J, Piccart M, de Braud FG, Apolone G, Verderio P, Daidone MG. Plasma miRNA Levels for Predicting Therapeutic Response to Neoadjuvant Treatment in HER2-positive Breast Cancer: Results from the NeoALTTO Trial. Clin Cancer Res 2019; 25:3887-3895. [PMID: 30814109 DOI: 10.1158/1078-0432.ccr-18-2507] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/20/2018] [Accepted: 02/21/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the potential of circulating-miRNAs (ct-miRNA) as noninvasive biomarkers to predict the efficacy of single/dual HER2-targeted therapy in the NeoALTTO study. EXPERIMENTAL DESIGN Patients with plasma samples at baseline (T0) and/or after 2 weeks (T1) of treatment were randomized into training (n = 183) and testing (n = 246) sets. RT-PCR-based high-throughput miRNA profiling was employed in the training set. After normalization, ct-miRNAs associated with pathologic complete response (pCR) were identified by univariate analysis. Multivariate logistic regression models were implemented to generate treatment-specific signatures at T0 and T1, which were evaluated by RT-PCR in the testing set. Event-free survival (EFS) according to ct-miRNA signatures was estimated by Kaplan-Meier method and Cox regression model. RESULTS In the training set, starting from 51 ct-miRNAs associated with pCR, six signatures with statistically significant predictive capability in terms of area under the ROC curve (AUC) were identified. Four signatures were confirmed in the testing set: lapatinib at T0 and T1 [AUC 0.86; 95% confidence interval (CI), 0.73-0.98 and 0.71 (0.55-0.86)], respectively; trastuzumab at T1 (0.81; 0.70-0.92); lapatinib + trastuzumab at T1 (0.67; 0.51-0.83). These signatures were confirmed predictive after adjusting for known variables, including estrogen receptor status. ct-miRNA signatures failed to correlate with EFS. However, the levels of ct-miR-140-5p, included in the trastuzumab signature, were associated with EFS (HR 0.43; 95% CI, 0.22-0.84). CONCLUSIONS ct-miRNAs discriminate patients with and without pCR after neoadjuvant lapatinib- and/or trastuzumab-based therapy. ct-miRNAs at week two could be valuable to identify patients responsive to trastuzumab, to avoid unnecessary combination with other anti-HER2 agents, and finally to assist deescalating treatment strategies.
Collapse
Affiliation(s)
- Serena Di Cosimo
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valentina Appierto
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Pizzamiglio
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Tiberio
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marilena V Iorio
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Evandro de Azambuja
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Jens Huober
- Department of Obstetrics and Gynecology, University of Ulm, Ulm, Germany
| | - José Baselga
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Martine Piccart
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Filippo G de Braud
- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Verderio
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Grazia Daidone
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| |
Collapse
|
26
|
Di Cosimo S, Appierto V, Pizzamiglio S, Baselga J, Piccart M, Huober J, Izquierdo M, de la Pena L, Hilbers F, de Azambuja E, Untch M, Pusztai L, Pritchard KI, Nuciforo P, Salomon AV, Symmans FW, Apolone G, de Braud F, Verderio P, Daidone MG. Abstract P4-01-03: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Di Cosimo S, Appierto V, Pizzamiglio S, Baselga J, Piccart M, Huober J, Izquierdo M, de la Pena L, Hilbers F, de Azambuja E, Untch M, Pusztai L, Pritchard KI, Nuciforo P, Salomon AV, Symmans FW, Apolone G, de Braud F, Verderio P, Daidone MG. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-03.
Collapse
Affiliation(s)
- S Di Cosimo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - V Appierto
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - S Pizzamiglio
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - J Baselga
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - M Piccart
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - J Huober
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - M Izquierdo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - L de la Pena
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - F Hilbers
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - E de Azambuja
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - M Untch
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - L Pusztai
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - KI Pritchard
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - P Nuciforo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - AV Salomon
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - FW Symmans
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - G Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - F de Braud
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - P Verderio
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| | - MG Daidone
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Memorial Sloan Kettering Cancer Center, New York; Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Ulm University, Ulm, Germany; Novartis Pharma AG, Basel, Switzerland; SOLTI Breast Cancer Research Group, Barcelona, Spain; Breast International Group (BIG), Brussels, Belgium; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Yale Cancer Center, Yale; Sunnybrook Health Sciences Centre, Toronto, Canada; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Institut Curie, Paris, France; MD Anderson Cancer Center, Houston
| |
Collapse
|
27
|
Chumsri S, Serie D, Mashadi-Hossein A, Kachergus JM, Warren S, Colon-Otero G, Partridge AH, Carey LA, Hilbers F, Van Dooren V, Holmes E, Di Cosimo S, Werner O, Huober JB, Baselga J, Sotiriou C, Perez EA, Dueck AC, Moreno-Aspitia A, Thompson EA. Association between adaptive immune signature and outcome in HER2-positive breast cancer treated with trastuzumab and lapatinib in the NCCTG-N9831 (Alliance) and NeoALTTO trials. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Serena Di Cosimo
- Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Jens Bodo Huober
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | |
Collapse
|
28
|
Lambertini M, Martel S, Campbell C, Guillaume S, Hilbers F, Schuehly U, Korde L, Azim HA, Di Cosimo S, Tenglin RC, Huober JB, Baselga J, Moreno-Aspitia A, Piccart-Gebhart MJ, Gelber RD, De Azambuja E, Ignatiadis M. Pregnancies during and following trastuzumab (T) and/or lapatinib (L) in patients (pts) with HER2-positive (HER2+) early breast cancer (EBC): Analysis from the NeoALTTO (BIG 1-06) and ALTTO (BIG 2-06) trials. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10065] [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)
| | - Samuel Martel
- Centre Hospitalier Universitaire Sherbrook - Hopital Fleurimont, Sherbrooke, QC, Canada
| | | | | | | | | | | | - Hatem A Azim
- American University of Beirut (AUB), Beirut, Lebanon
| | - Serena Di Cosimo
- Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Jens Bodo Huober
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Richard D. Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston, MA
| | | | | |
Collapse
|
29
|
Martel S, Lambertini M, Agbor-Tarh D, Falbel Ponde N, Gombos A, Paterson V, Hilbers F, Korde L, Manukyants A, Dueck AC, Maurer C, Piccart-Gebhart MJ, Moreno-Aspitia A, Desmedt C, Di Cosimo S, De Azambuja E. Impact of body mass index (BMI) and weight change after treatment in patients (pts) with HER2-positive (HER2+) early breast cancer (EBC): Secondary analysis of the ALTTO BIG 2-06 trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10067] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
Affiliation(s)
- Samuel Martel
- Centre Hospitalier Universitaire Sherbrook - Hopital Fleurimont, Sherbrooke, QC, Canada
| | | | | | | | - Andrea Gombos
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | | | - Christian Maurer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | | | | | | | - Serena Di Cosimo
- Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | |
Collapse
|
30
|
Risi E, Biagioni C, Benelli M, Migliaccio I, McCartney A, Bonechi M, Guarducci C, Hilbers F, Di Cosimo S, Baselga J, Romagnoli D, Boccalini G, Vitale S, Grilli A, Bicciato S, Sotiriou C, Biganzoli L, Di Leo A, Malorni L. A RB-1 loss of function gene-signature (RBsig) as a tool to predict response to neoadjuvant chemotherapy (CT) plus anti-HER2 agents (H): A substudy of the NeoALTTO trial (BIG 1-06). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.570] [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)
- Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | | | - Ilenia Migliaccio
- Sandro Pitigliani Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Amelia McCartney
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Martina Bonechi
- Sandro Pitigliani Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Cristina Guarducci
- Sandro Pitigliani Translational Research Unit, Hospital of Prato, Prato, Italy
| | | | - Serena Di Cosimo
- Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dario Romagnoli
- Bioinformatics Unit, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
| | - Giulia Boccalini
- Sandro Pitigliani Translational Research Unit, Hospital of Prato, Prato, Italy
| | - Stefania Vitale
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Andrea Grilli
- Center for Genome Research, Department of Life Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvio Bicciato
- Department of Biomedical Science, Centre from Genome Research, Univeristy of Modena and Reggio Emilia, Modena, Italy
| | | | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Angelo Di Leo
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Luca Malorni
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| |
Collapse
|
31
|
Zardavas D, Regan M, Maibach R, Ruepp B, Hiltbrunner A, Blacher L, Gelber R, Gebhart G, Di Leo A, Hilbers F, Colleoni M, Zoppoli G, Bertelli G, Bliss J, Duhoux F, Piccart M, Malorni L. PYTHIA: A phase II study of palbociclib plus fulvestrant for pretreated patients with ER+/HER2- metastatic breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
32
|
Southey MC, Park DJ, Nguyen-Dumont T, Campbell I, Thompson E, Trainer AH, Chenevix-Trench G, Simard J, Dumont M, Soucy P, Thomassen M, Jønson L, Pedersen IS, Hansen TV, Nevanlinna H, Khan S, Sinilnikova O, Mazoyer S, Lesueur F, Damiola F, Schmutzler R, Meindl A, Hahnen E, Dufault MR, Chris Chan T, Kwong A, Barkardóttir R, Radice P, Peterlongo P, Devilee P, Hilbers F, Benitez J, Kvist A, Törngren T, Easton D, Hunter D, Lindstrom S, Kraft P, Zheng W, Gao YT, Long J, Ramus S, Feng BJ, Weitzel JN, Nathanson K, Offit K, Joseph V, Robson M, Schrader K, Wang S, Kim YC, Lynch H, Snyder C, Tavtigian S, Neuhausen S, Couch FJ, Goldgar DE. COMPLEXO: identifying the missing heritability of breast cancer via next generation collaboration. Breast Cancer Res 2013; 15:402. [PMID: 23809231 PMCID: PMC3706918 DOI: 10.1186/bcr3434] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|