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Loibl S, André F, Bachelot T, Barrios CH, Bergh J, Burstein HJ, Cardoso MJ, Carey LA, Dawood S, Del Mastro L, Denkert C, Fallenberg EM, Francis PA, Gamal-Eldin H, Gelmon K, Geyer CE, Gnant M, Guarneri V, Gupta S, Kim SB, Krug D, Martin M, Meattini I, Morrow M, Janni W, Paluch-Shimon S, Partridge A, Poortmans P, Pusztai L, Regan MM, Sparano J, Spanic T, Swain S, Tjulandin S, Toi M, Trapani D, Tutt A, Xu B, Curigliano G, Harbeck N. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024; 35:159-182. [PMID: 38101773 DOI: 10.1016/j.annonc.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Affiliation(s)
- S Loibl
- GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology, Bethanien, Frankfurt, Germany
| | - F André
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Cancer Campus, Villejuif
| | - T Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - C H Barrios
- Oncology Department, Latin American Cooperative Oncology Group and Oncoclínicas, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet and Breast Cancer Centre, Karolinska Comprehensive Cancer Centre and University Hospital, Stockholm, Sweden
| | - H J Burstein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M J Cardoso
- Breast Unit, Champalimaud Foundation, Champalimaud Cancer Centre, Lisbon; Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - L A Carey
- Division of Medical Oncology, The University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - S Dawood
- Department of Oncology, Mediclinic City Hospital, Dubai, UAE
| | - L Del Mastro
- Medical Oncology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Internal Medicine and Medical Specialities, School of Medicine, University of Genoa, Genoa, Italy
| | - C Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Giessen and Marburg, Marburg
| | - E M Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - P A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H Gamal-Eldin
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - K Gelmon
- Department of Medical Oncology, British Columbia Cancer, Vancouver, Canada
| | - C E Geyer
- Department of Internal Medicine, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA
| | - M Gnant
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Oncology 2 Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - S Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S B Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Martin
- Hospital General Universitario Gregorio Maranon, Universidad Complutense, GEICAM, Madrid, Spain
| | - I Meattini
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence; Department of Experimental and Clinical Biomedical Sciences 'M. Serio', University of Florence, Florence, Italy
| | - M Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - W Janni
- Department of Obstetrics and Gynaecology, University of Ulm, Ulm, Germany
| | - S Paluch-Shimon
- Sharett Institute of Oncology Department, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - A Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - P Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - L Pusztai
- Yale Cancer Center, Yale School of Medicine, New Haven
| | - M M Regan
- Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - J Sparano
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - S Swain
- Medicine Department, Georgetown University Medical Centre and MedStar Health, Washington, USA
| | - S Tjulandin
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - M Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Bunkyo-ku, Japan
| | - D Trapani
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - A Tutt
- Breast Cancer Research Division, The Institute of Cancer Research, London; Comprehensive Cancer Centre, Division of Cancer Studies, Kings College London, London, UK
| | - B Xu
- Department of Medical Oncology, National Cancer Centre/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - N Harbeck
- Breast Centre, Department of Obstetrics & Gynaecology and Comprehensive Cancer Centre Munich, LMU University Hospital, Munich, Germany
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Chadha M, White J, Swain SM, Rakovitch E, Jagsi R, Whelan T, Sparano JA. Optimal adjuvant therapy in older (≥70 years of age) women with low-risk early-stage breast cancer. NPJ Breast Cancer 2023; 9:99. [PMID: 38097623 PMCID: PMC10721824 DOI: 10.1038/s41523-023-00591-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/06/2023] [Indexed: 12/17/2023] Open
Abstract
Older women are under-represented in breast cancer (BC) clinical trials, and treatment guidelines are primarily based on BC studies in younger women. Studies uniformly report an increased incidence of local relapse with omission of breast radiation therapy. Review of the available literature suggests very low rates of distant relapse in women ≥70 years of age. The incremental benefit of endocrine therapy in decreasing rate of distant relapse and improving disease-free survival in older patients with low-risk BC remains unclear. Integration of molecular genomic assays in diagnosis and treatment of estrogen receptor positive BC presents an opportunity for optimizing risk-tailored adjuvant therapies in ways that may permit treatment de-escalation among older women with early-stage BC. The prevailing knowledge gap and lack of risk-specific adjuvant therapy guidelines suggests a compelling need for prospective trials to inform selection of optimal adjuvant therapy, including omission of adjuvant endocrine therapy in older women with low risk BC.
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Affiliation(s)
- M Chadha
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - J White
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - S M Swain
- Department of Medicine, Georgetown Lombardi Comprehensive Cancer Center, MedStar Health, Washington, DC, USA
| | - E Rakovitch
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - R Jagsi
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - T Whelan
- Division of Radiation Oncology, Department of Oncology, McMaster University and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada
| | - J A Sparano
- Division of Hematology and Medical Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Trapani D, Franzoi MA, Burstein HJ, Carey LA, Delaloge S, Harbeck N, Hayes DF, Kalinsky K, Pusztai L, Regan MM, Sestak I, Spanic T, Sparano J, Jezdic S, Cherny N, Curigliano G, Andre F. Risk-adapted modulation through de-intensification of cancer treatments: an ESMO classification. Ann Oncol 2022; 33:702-712. [PMID: 35550723 DOI: 10.1016/j.annonc.2022.03.273] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The landscape of clinical trials testing risk-adapted modulations of cancer treatments is complex. Multiple trial designs, endpoints, and thresholds for non-inferiority have been used; however, no consensus or convention has ever been agreed to categorise biomarkers useful to inform the treatment intensity modulation of cancer treatments. METHODS An expert subgroup under the European Society for Medical Oncology (ESMO) Precision Medicine Working Group shaped an international collaborative project to develop a classification system for biomarkers used in the cancer treatment de-intensification, based on a tiered approach. A group of disease-oriented clinical, translational, methodology and public health experts, and patients' representatives provided an analysis of the status quo, and scanned the horizon of ongoing clinical trials. The classification was developed through multiple rounds of expert revisions and inputs. RESULTS The working group agreed on a univocal definition of treatment de-intensification. Evidence of reduction in the dose-density, intensity, or cumulative dose, including intermittent schedules or shorter treatment duration or deletion of segment(s) of the standard regimens, compound(s), or treatment modality must be demonstrated, to define a treatment de-intensification. De-intensified regimens must also portend a positive impact on toxicity, quality of life, health system burden, or financial toxicity. ESMO classification categorises the biomarkers for treatment modulation in three tiers, based on the level of evidence. Tier A includes biomarkers validated in prospective, randomised, non-inferiority clinical trials. The working group agreed that in non-inferiority clinical trials, boundaries are highly dependent upon the disease scenario and endpoint being studied and that the absolute differences in the outcomes are the most relevant measures, rather than relative differences. Biomarkers tested in single-arm studies with a threshold of non-inferiority are classified as Tier B. Tier C is when the validation occurs in prospective-retrospective quality cohort investigations. CONCLUSIONS ESMO classification for the risk-guided intensity modulation of cancer treatments provides a set of evidence-based criteria to categorise biomarkers deemed to inform de-intensification of cancer treatments, in risk-defined patients. The classification aims at harmonising definitions on this matter, therefore offering a common language for all the relevant stakeholders, including clinicians, patients, decision-makers, and for clinical trials.
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Affiliation(s)
- D Trapani
- New Drugs Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Medical Oncology, Dana-Farber Cancer Center, Boston, USA
| | - M A Franzoi
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, PRISM Center for Precision Medicine, Gustave Roussy, Villejuif, France
| | - H J Burstein
- Department of Medical Oncology, Dana-Farber Cancer Center, Boston, USA
| | - L A Carey
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - S Delaloge
- Breast Cancer Unit, Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - N Harbeck
- Breast Center, Department of Obstetrics & Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
| | - D F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - K Kalinsky
- Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, USA
| | - L Pusztai
- Yale Cancer Center Genetics and Genomics Program, Yale Cancer Center, Yale School of Medicine, New Haven, USA
| | - M M Regan
- Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - I Sestak
- Wolfson Institute of Preventive Medicine - Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - T Spanic
- ESMO Patient Advocates Working Group, Ljubljana, Slovenia
| | - J Sparano
- Division of Hematology/Oncology, Icahn School of Medicine at Mt. Sinai, Tisch Cancer Institute, New York, USA
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology, Lugano, Switzerland
| | - N Cherny
- Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, European Institute of Oncology, IRCCS, Milan, Italy.
| | - F Andre
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, PRISM Center for Precision Medicine, Gustave Roussy, Villejuif, France.
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Piccart MJ, Kalinsky K, Gray R, Barlow WE, Poncet C, Cardoso F, Winer E, Sparano J. Erratum to "Gene expression signatures for tailoring adjuvant chemotherapy of luminal breast cancer: stronger evidence, greater trust": [Annals of Oncology 32 (2021) 1077-1082]. Ann Oncol 2022; 33:668. [PMID: 35487836 DOI: 10.1016/j.annonc.2022.04.001] [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: 11/17/2022] Open
Affiliation(s)
- M J Piccart
- Institut Jules Bordet Brussels, Université Libre de Bruxelles (ULB), Belgium; Breast International Group(BIG)-aisbl, Brussels, Belgium.
| | - K Kalinsky
- Winship Cancer Institute, Emory University, Atlanta
| | - R Gray
- Department of Data Science, Dana-Farber Cancer Institute, Boston
| | - W E Barlow
- SWOG Statistics and Data Management Centre, Seattle, USA
| | - C Poncet
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - E Winer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - J Sparano
- Albert Einstein Cancer Center, Montefiore Medical Center, Bronx, USA
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Piccart MJ, Kalinsky K, Gray R, Barlow WE, Poncet C, Cardoso F, Winer E, Sparano J. Gene expression signatures for tailoring adjuvant chemotherapy of luminal breast cancer: stronger evidence, greater trust. Ann Oncol 2021; 32:1077-1082. [PMID: 34082017 DOI: 10.1016/j.annonc.2021.05.804] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- M J Piccart
- Institut Jules Bordet Brussels, Université Libre de Bruxelles (ULB), Brussels, Belgium; Breast International Group(BIG)-aisbl, Brussels, Belgium.
| | - K Kalinsky
- Winship Cancer Institute, Emory University, Atlanta, USA
| | - R Gray
- Department of Data Science, Dana-Farber Cancer Institute, Boston, USA
| | - W E Barlow
- SWOG Statistics and Data Management Centre, Seattle, USA
| | - C Poncet
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - E Winer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - J Sparano
- Albert Einstein Cancer Center, Montefiore Medical Center, Bronx, USA
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Abstract
Abstract
Since the untimely passing of Bill McGuire in 1992, breast cancer mortality rates have declined by approximately 40% despite stable incidence rates, largely due to mammographic screening and broader application of systemic adjuvant therapy in early stage disease. Continued progress is likely given recently reported clinical trials demonstrating improved survival in metastatic disease, including immune checkpoint blockade in triple negative disease, CDK4/6 inhibitors in ER-positive disease, and second-generation immunconjugates in HER2-positive disease. This remarkable progress in reducing breast cancer mortality has come with a price - broader use of adjuvant chemotherapy in patients with early stage disease who might have been adequately treated and perhaps cured without chemotherapy, and the short and long term side effects that may accompany it - which raises the question - what would Bill think of our progress? How would he challenge us to do better?This lecture will focus on three distinct topics that address some potential challenges: (1) How can gene expression profiles and other diagnostic tests be used to guide the use of adjuvant systemic therapy? (2) is time for reappraisal of active surveillance to detect impending recurrence and prevent it? (3) Are there diagnostic and therapeutic strategies that can be used to identify tumors at highest risk of systemic dissemination, and novel therapeutic strategies that block dissemination?
Citation Format: JA Sparano. What would Bill think? [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 ML.
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Affiliation(s)
- JA Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Albert Einstein Cancer Center, Bronx, NY
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Sparano J, Gray R, Makower D, Albain K, Saphner T, Badve S, Wagner L, Mihalcioiu C, Desbiens C, Hayes D, Dees E, Geyer C, Olson J, Wood W, Lively T, Paik S, Ellis M, Abrams J, Sledge G. Clinical outcomes by chemotherapy regimen in patients with RS 26-100 in TAILORx. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.004] [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: 11/13/2022] Open
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Oktay MH, D'Alfonso T, Ginter P, Lanjewar S, Entenberg D, Pastoriza JM, Wang Y, Lin Y, Karagiannnis GS, Lin J, Ye X, Anampa J, Xue X, Rohan TE, Sparano JA, Condeelis JS. Abstract P2-08-18: Tumor microenvironment of metastasis (TMEM) score in residual breast carcinoma post-neoadjuvant chemotherapy as an independent prognosticator of distant recurrence. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Tumor microenvironment of metastasis (TMEM) is a microanatomical structure composed by 3 cells in direct contact, including a tumor cell expressing the actin-regulatory protein Mammalian-enabled (Mena), a perivascular Tie2hi/Vegfhi-expressing macrophage, and an endothelial cell. TMEM are intravasation sites that function as doorways for hematogenous tumor cell dissemination and metastases (Harney et al. Cancer Discovery 2015). TMEM may be identified and enumerated by triple immunohistochemistry in mouse and human mammary carcinomas. High TMEM score is associated with increased risk of distant metastasis in early stage breast cancer, and provides complementary prognostic information to IHC4 (Rohan et al. JNCI 2014) and Oncotype DX Recurrence Score in ER+, HER2-negative breast cancer (Sparano et al. NPJ Breast Cancer, 2017). Neoadjuvant chemotherapy (NAC) increases TMEM score in breast carcinoma in animal models and humans, indicating a previously unrecognized mechanism of resistance to cytotoxic therapy (Karagiannis et al. Science Trans Med 2017). Intravasation at TMEM sites may be inhibited using agents that block release of VEGF from TMEM-associated TIE2-hi, VEGF-hi macrophages (Harney et al. Mol Cancer Ther, 2017). Here we investigated whether TMEM score in post-NAC treated breast carcinoma is prognostic of distant recurrence in localized breast cancer after NAC, and thus provides a foundation for testing agents that block TMEM function in combination with NAC.
Methods: We determined TMEM score in 80 evaluable patients' post-NAC specimens with residual invasive ductal carcinomas of at least 0.5 cm. Approximately 60% of patients had ER+/HER2-negative, 28% had triple negative and 12% had HER2+ disease. Most of the patients received doxorubicin/cyclophosphamide + taxane and an anti-HER2 therapy if applicable. Tissue sections from residual tumors were stained for TMEM using triple immunohistochemistry for Mena-expressing cancer cells, CD31-expressing endothelial cells and CD68-expressing macrophages. The stained slides were scanned, and the images were analyzed by three pathologists, blinded to outcome, who independently determined the tissue areas appropriate for TMEM scoring. TMEM was scored within these areas using an automated algorithm.
Results: TMEM score was significantly higher in patients with distant recurrence (average TMEM=106), compared to patients without distant recurrence (average TMEM=71) (p<0.01, two-sided t-test). Moreover, in a Cox proportional hazards model that included TMEM score (upper tertile vs. lower 2 tertiles), age (>50 yrs. vs. <50), race (black vs non-black), tumor stage (T 1-3), estrogen receptor (ER) status (+ vs -), high TMEM score was associated with a increased risk of distant recurrence (HR=2.2, 95% CI=1.0 to 4.9, p=0.05)
Conclusion: TMEM score may provide independent prognostic information for distant recurrence in patients with residual invasive carcinoma after NAC. These results support the use of agents that block TMEM function in combination with NAC, as planned in the I-SPY2 trial.
Citation Format: Oktay MH, D'Alfonso T, Ginter P, Lanjewar S, Entenberg D, Pastoriza JM, Wang Y, Lin Y, Karagiannnis GS, Lin J, Ye X, Anampa J, Xue X, Rohan TE, Sparano JA, Condeelis JS. Tumor microenvironment of metastasis (TMEM) score in residual breast carcinoma post-neoadjuvant chemotherapy as an independent prognosticator of distant recurrence [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 P2-08-18.
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Affiliation(s)
- MH Oktay
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - T D'Alfonso
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - P Ginter
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - S Lanjewar
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - D Entenberg
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - JM Pastoriza
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - Y Wang
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - Y Lin
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - GS Karagiannnis
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - J Lin
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - X Ye
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - J Anampa
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - X Xue
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - TE Rohan
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - JA Sparano
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
| | - JS Condeelis
- Albert Einstein College of Medicine/Montefiore Medical Center, Bornx, NY; Memorial Sloan-Kettering Cancer Center, New York, NY; Weill Cornell Medicine, New Yoik, NY
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Anampa JD, Xue X, Oh SY, Kornblum N, Sadan S, Oktay MH, Condeelis J, Sparano JA. Abstract P6-18-22: Phase Ib study of rebastinib plus antitubulin therapy with paclitaxel (P) or eribulin (E) in patients with HER2-negative metastatic breast cancer (MBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-22] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: TMEM (Tumor Microenvironment of Metastasis) are the portal for tumor cell intravasation into the circulation and subsequent metastasis (Harney et al Cancer Discov 2015). The potent Tie2 kinase inhibitor rebastinib inhibits intravasation at TMEM sites, reduces circulating tumor cell (CTC) burden, increases angiopoietin (Ang) 1/2 levels, prevents distant metastases, and improves survival in breast cancer animal models when added to either P or E (Harney et al MCT 2017), and circumvent chemotherapy-induced pro-metastatic changes in the tumor microenvironment mediated by TMEM (Karagiannis et al STM 2017). We sought to determine the safety of rebastinib combined with antitubulin therapy (P or E) in patients with HER2- MBC. We also hypothesized that addition of rebastinib would reduce CTC burden and increase Ang levels by blocking Ang-mediated stimulation of VEGF release from TMEM-associated macrophages.
METHODS: We aimed to determine the safety and recommended phase 2 dose (RP2D) of rebastinib (2 dose levels: 50 mg or 100 mg PO BID) in combination with P (80 mg/m2 x 12 weeks) or E (1.4 mg/m2 on day 1 & 8 q 21 days) using a standard 3+3 design (1 cycle = 21 days). Secondary objectives included evaluating the effect of the P/E + rebastinib combination on CTCs (TelomeScan) and Ang levels. Dose limiting toxicity (DLT) was defined as grade 3-4 febrile neutropenia, thrombocytopenia, and non-hematologic toxicity during the first 6 weeks of therapy. Eligibility included HER2- MBC, ECOG PS 0-1, CDK4/6 inhibitor progression if ER+. Patients with ≤ 2 prior non-taxane chemotherapy regimens received P+ rebastinib, whereas those with ≥ 2 chemo regimens (including a taxane) received E+ rebastinib.
RESULTS: Of 11 treated patients, 6 received rebastinib + P and 5 received rebastinib + E (2 non-evaluable due to rapid disease progression and non-compliance). Among 11 patients who received 60 treatment cycles, only 1 patient (treated with eribulin) had grade 3 events (anemia and neuropathy after week 6) potentially related to treatment. When combined with P, the RP2D of rebastinib was 100 mg PO BID, with DLT occurring in 0/6 patients. When combined with E, 0/3 evaluable patients had a DLT at 50 mg BID of rebastinib (accrual ongoing for 100mg BID). Best response included partial response/stable disease in 4(2PR/2SD) of 6 treated with P+ rebastinib, and 1(1PR) of 5 treated with E+ rebastinib. CTCs decreased during therapy (median decrease 99.7 %) and 4/8 patients converted from CTC+ to CTC-. Ang1 levels increased during therapy in 8 patients (0.2-7.0 fold), while Ang2 levels were also increased in 8 patients (0.2-1.4 fold).
CONCLUSIONS: When combined with P x 12 weeks, the RP2D of rebastinib is 100 mg PO BID. When combined with E, the RP2D of rebastinib is at least 50mg PO BID; however, the 100 mg PO BID dose level is still accruing patients. The P/E + rebastinib combinations are associated with antitumor activity and exhibit pharmacodynamic evidence indicating blockade of Tie2 (increased Ang) and TMEM function (reduced CTCs) We plan to further evaluate the P+ rebastinib combination as neoadjuvant therapy in the I-SPY program, and continue further evaluation of P/E + rebastinib combinations in MBC.
Citation Format: Anampa JD, Xue X, Oh S-y, Kornblum N, Sadan S, Oktay MH, Condeelis J, Sparano JA. Phase Ib study of rebastinib plus antitubulin therapy with paclitaxel (P) or eribulin (E) in patients with HER2-negative metastatic breast cancer (MBC) [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 P6-18-22.
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Affiliation(s)
- JD Anampa
- Montefiore Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY; White Plains Hospital, White plains, NY
| | - X Xue
- Montefiore Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY; White Plains Hospital, White plains, NY
| | - S-y Oh
- Montefiore Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY; White Plains Hospital, White plains, NY
| | - N Kornblum
- Montefiore Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY; White Plains Hospital, White plains, NY
| | - S Sadan
- Montefiore Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY; White Plains Hospital, White plains, NY
| | - MH Oktay
- Montefiore Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY; White Plains Hospital, White plains, NY
| | - J Condeelis
- Montefiore Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY; White Plains Hospital, White plains, NY
| | - JA Sparano
- Montefiore Medical Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY; White Plains Hospital, White plains, NY
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Wagner LI, Gray RJ, Garcia S, Whelan TJ, Tevarweerk A, Yanez B, Carlos R, Gareen I, McCaskill-Stevens W, Cella D, Sparano JA, Sledge GW. Abstract GS6-03: Symptoms and health-related quality of life on endocrine therapy alone (E) versus chemoendocrine therapy (C+E): TAILORx patient-reported outcomes results. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs6-03] [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: TAILORx patient-reported outcomes (PRO) quantify symptoms and health-related quality of life (HRQL) from C+E beyond E alone from the patient's perspective, thus can inform decision-making for women in the intermediate risk group for whom chemotherapy may still be considered.
Methods: TAILORx participants with OncoType DX Recurrence Scores 11-25 were randomly assigned to E or C+E. All TAILORx participants enrolled 1/2010-10/2010 (N=612) completed PROs measuring fatigue, endocrine symptoms, cognitive impairments (PCI), and fear of recurrence at baseline, 3, 6, 12, 24 and 36 months. HRQL was assessed at baseline, 12, and 36 months. Linear regression (LR) examined PRO scores among the per-protocol sample.
Results: Overall, participants reported significantly more fatigue, endocrine symptoms and PCI at 3, 6, 12, 24 and 36 months compared to baseline and those randomized to C+E reported a greater magnitude of change baseline-3 months compared to those randomized to E alone (Table 1). Overall, by 12 months symptoms were comparable between groups. Pre-menopausal women had comparable symptoms at 24 and 36 months. Post-menopausal women randomized to C+E had greater endocrine symptoms at 24 and 36 months and greater fatigue at 6 and 24 months. Fear of recurrence was comparable between arms during treatment and follow-up. Multiple linear regression identified increased fatigue (LR slope β=0.67), endocrine symptoms (β =0.14), and PCI (β=0.11) as significant predictors of decreased HRQL across arms (p< 0.001). HRQL was comparable between E and C+E at 12- and 36-months.
Mean PRO change scores from baseline by treatment arm and menopausal status in per protocol population Months 36122436N=Overall454469458384343n=Pre-menopausal153151150118103n=Post-menopausal301318308266240FACIT-Fatigue Overall sample C+E-8.77-4.37-4.01-4.27-3.67E-2.48-1.97-2.14-1.49-1.83LMED-5.32***-1.55-1.01-1.76-0.90Pre-M C+E-8.01-3.26-2.99-2.45-1.60E-3.87-1.66-1.32-2.52-2.11LMED-3.11-0.82-1.121.021.46Post-M C+E-9.22-4.97-4.55-5.14-4.67E-1.87-2.10-2.52-1.09-1.71LMED-6.42***-1.99*-1.16-3.02*-2.01FACT-Endocrine Symptoms Overall sample C+E-5.56-5.63-6.96-6.81-7.14E-3.61-4.24-5.62-5.31-5.17LMED-1.62*-0.97-1.08-1.05-1.69Pre-M C+E-7.62-8.34-7.94-8.29-8.96E-5.96-6.19-8.95-10.39-10.84LMED-1.44-1.631.062.272.18Post-M C+E-4.39-4.19-6.45-6.10-6.28E-2.55-3.41-4.10-3.23-2.87LMED-1.49-0.45-2.04-2.39*-3.17**Significance between mean change scores *p<0.05;**p<0.01;***p<0.001. LMED=estimated tx difference using linear model regressing score on baseline value and tx
Conclusions: TAILORx is the first trial to examine patient-reported fatigue, endocrine symptoms, PCI and HRQL among breast cancer patients randomized to endocrine therapy alone vs chemoendocrine therapy, thus allowing us to quantify acute and long-term symptoms uniquely attributable to chemotherapy. As expected, chemotherapy is associated with greater fatigue, endocrine symptoms and PCI acutely during treatment, and for post-menopausal women with greater long-term endocrine symptoms. Increased symptoms were associated with poorer HRQL. Long-term HRQL was comparable between groups.
Citation Format: Wagner LI, Gray RJ, Garcia S, Whelan TJ, Tevarweerk A, Yanez B, Carlos R, Gareen I, McCaskill-Stevens W, Cella D, Sparano JA, Sledge, Jr. GW, On behalf of the TAILORx Study Team. Symptoms and health-related quality of life on endocrine therapy alone (E) versus chemoendocrine therapy (C+E): TAILORx patient-reported outcomes results [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 GS6-03.
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Affiliation(s)
- LI Wagner
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - RJ Gray
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - S Garcia
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - TJ Whelan
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - A Tevarweerk
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - B Yanez
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - R Carlos
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - I Gareen
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - W McCaskill-Stevens
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - D Cella
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - JA Sparano
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
| | - GW Sledge
- Wake Forest School of Medicine, Winston Salem, NC; Dana-Farber Cancer Institute, Boston, MA; Northwestern University School of Medicine, Chicago, IL; McMaster University, Hamilton, ON, Canada; University of Wisconsin, Madison, WI; University of Michigan, Ann Arbor, MI; Brown University, Providence, RI; National Institutes of Health, National Cancer Institute, Bethesda, MD; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Stanford University Medical Center, Stanford, CA
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Albain K, Gray RJ, Sparano JA, Makower DF, Pritchard KI, Hayes DF, Geyer CE, Dees EC, Goetz MP, Olson JA, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin PM, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge GW. Abstract GS4-07: Race, ethnicity and clinical outcomes in hormone receptor-positive, HER2-negative, node-negative breast cancer: results from the TAILORx trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs4-07] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: Black race is associated with worse outcomes in localized hormone receptor (HR)-positive breast cancer in population-based and in clinical trial cohorts, whether using self-identified race (Albain et al. JNCI 2009 [PMID: 19584328; Sparano et al. JNCI 2012 [PMID: 22250182) or genetically-identified race (Schneider et al. J Precision Oncol 2017 [PMID: 29333527]). This disparity persists after adjustment for treatment delivery parameters (Hershman et al. JCO 2009 [PMID:19307504]). We evaluated clinicopathologic characteristics, treatment delivered and clinical outcomes in the Trial Assigning Individualized Options for Treatment (TAILORx) by race and ethnicity (Sparano et al. NEJM 2018 [PMID: 29860917]).
Methods: The analysis included 9719 evaluable TAILORx participants. The association between clinical outcomes and race (white, black, Asian, other/unknown) and ethnicity (Hispanic vs. non-Hispanic) was examined, including invasive disease-free survival (iDFS), distant relapse-free interval (DRFI), relapse-free interval (RFI), and overall survival (OS). Proportional hazards models were fit including age (5 categories), tumor size (>2 cm vs. <=2 cm), histologic grade (high vs. medium vs. low vs. unknown), continuous recurrence score (RS), race, and ethnicity in the overall population and randomized treatment arms in the RS 11-25 cohort.
Results: The study population included 8189 (84%) whites, 693 (7%) blacks, 405 (4%) Asians, and 432 (4%) with other/unknown race. Regarding ethnicity, 7635 (79%) were non-Hispanic, 889 (9%) Hispanic, and 1195 (12%) unknown. There was no significant difference in RS distribution (p=0.22) in blacks compared with whites, or in median (17 vs. 17) or mean RS (19.1 vs. 18.2). There was likewise no difference in Hispanic vs. non-Hispanic ethnicity for RS distribution (p=0.72) or median (17 vs. 17) or mean RS (18.5 vs. 18.0). Black race (39% vs. 30%) and Hispanic ethnicity (39% vs. 30%) were both associated with younger age (</=50 years) at diagnosis. The use and type of adjuvant chemotherapy and endocrine therapy, and duration of endocrine therapy, were similar in black (vs. white) and Hispanic (vs. non-Hispanic) populations. In proportional hazards models, black race (compared with white race) was associated with worse clinical outcomes in the entire population and in those with a RS 11-25 (see table). Hispanic ethnicity was generally associated with better outcomes (compared with non-Hispanic ethnicity). For the cohort with a RS of 11-25, there was no evidence for chemotherapy benefit for any racial or ethnic group.
Race (black vs.white) and clinical outcomes in proportional hazards modelsClinical endpointEntire Population (N=693 black) Hazard ratio for eventRS 11-25 (N=471 black) Hazard ratio for eveniDFS1.33 (p=0.005)1.49 (p=0.001)DRFI1.21 (p=0.28)1.60 (p=0.02)RFI1.39 (p=0.02)1.80 (p<0.001)OS1.52 (p=0.005)1.67 (p=0.003
Conclusions: In patients eligible and selected for participation in TAILORx, black women had worse clinical outcomes despite similar 21-gene assay RS results and comparable systemic therapy. This adds to an emerging body of evidence suggesting a biologic basis or other factors contributing to racial disparities in HR-positive breast cancer that requires further evaluation.
Citation Format: Albain K, Gray RJ, Sparano JA, Makower DF, Pritchard KI, Hayes DF, Geyer, Jr. CE, Dees EC, Goetz MP, Olson, Jr. JA, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin PM, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge, Jr. GW. Race, ethnicity and clinical outcomes in hormone receptor-positive, HER2-negative, node-negative breast cancer: results from the TAILORx trial [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 GS4-07.
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Affiliation(s)
- K Albain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - RJ Gray
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - JA Sparano
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - DF Makower
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - KI Pritchard
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - DF Hayes
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - CE Geyer
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - EC Dees
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - MP Goetz
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - JA Olson
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - T Lively
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - SS Badve
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - TJ Saphner
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - LI Wagner
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - TJ Whelan
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - MJ Ellis
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - S Paik
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - WC Wood
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - PM Ravdin
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - MM Keane
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - HL Gomez
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - PS Reddy
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - TF Goggins
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - IA Mayer
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - AM Brufsky
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - DL Toppmeyer
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - VG Kaklamani
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - JL Berenberg
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - J Abrams
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - GW Sledge
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
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Rakovitch E, Gray R, Baehner FL, Sutradhar R, Crager M, Gu S, Nofech-Mozes S, Badve SS, Hanna W, Hughes LL, Wood WC, Davidson NE, Paszat L, Shak S, Sparano JA, Solin LJ. Refined estimates of local recurrence risks by DCIS score adjusting for clinicopathological features: a combined analysis of ECOG-ACRIN E5194 and Ontario DCIS cohort studies. Breast Cancer Res Treat 2018; 169:359-369. [PMID: 29388015 PMCID: PMC5945747 DOI: 10.1007/s10549-018-4693-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/23/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Better tools are needed to estimate local recurrence (LR) risk after breast-conserving surgery (BCS) for DCIS. The DCIS score (DS) was validated as a predictor of LR in E5194 and Ontario DCIS cohort (ODC) after BCS. We combined data from E5194 and ODC adjusting for clinicopathological factors to provide refined estimates of the 10-year risk of LR after treatment by BCS alone. METHODS Data from E5194 and ODC were combined. Patients with positive margins or multifocality were excluded. Identical Cox regression models were fit for each study. Patient-specific meta-analysis was used to calculate precision-weighted estimates of 10-year LR risk by DS, age, tumor size and year of diagnosis. RESULTS The combined cohort includes 773 patients. The DS and age at diagnosis, tumor size and year of diagnosis provided independent prognostic information on the 10-year LR risk (p ≤ 0.009). Hazard ratios from E5194 and ODC cohorts were similar for the DS (2.48, 1.95 per 50 units), tumor size ≤ 1 versus > 1-2.5 cm (1.45, 1.47), age ≥ 50 versus < 50 year (0.61, 0.84) and year ≥ 2000 (0.67, 0.49). Utilization of DS combined with tumor size and age at diagnosis predicted more women with very low (≤ 8%) or higher (> 15%) 10-year LR risk after BCS alone compared to utilization of DS alone or clinicopathological factors alone. CONCLUSIONS The combined analysis provides refined estimates of 10-year LR risk after BCS for DCIS. Adding information on tumor size and age at diagnosis to the DS adjusting for year of diagnosis provides improved LR risk estimates to guide treatment decision making.
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Affiliation(s)
- E Rakovitch
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| | - R Gray
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - F L Baehner
- Genomic Health Incorporated, Redwood City, CA, USA
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - R Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M Crager
- Genomic Health Incorporated, Redwood City, CA, USA
| | - S Gu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - S Nofech-Mozes
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S S Badve
- Departments of Pathology and Internal Medicine, Clarian Pathology Laboratory of Indiana University, Indianapolis, IN, USA
| | - W Hanna
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L L Hughes
- Harris Radiation Therapy Center at Gordon Hospital, Calhoun, GA, USA
| | - W C Wood
- Emory University, Atlanta, GA, USA
| | | | - L Paszat
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - S Shak
- Genomic Health Incorporated, Redwood City, CA, USA
| | | | - L J Solin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, PA, USA
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Kalinsky K, Sparano JA, Zhong X, Andreopoulou E, Taback B, Wiechmann L, Feldman SM, Ananthakrishnan P, Ahmad A, Cremers S, Sireci AN, Cross JR, Marks DK, Mundi P, Connolly E, Crew KD, Maurer MA, Hibshoosh H, Lee S, Hershman DL. Pre-surgical trial of the AKT inhibitor MK-2206 in patients with operable invasive breast cancer: a New York Cancer Consortium trial. Clin Transl Oncol 2018; 20:1474-1483. [PMID: 29736694 DOI: 10.1007/s12094-018-1888-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 02/13/2018] [Accepted: 04/26/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The PI3K/AKT/mTOR pathway is an oncogenic driver in breast cancer (BC). In this multi-center, pre-surgical study, we evaluated the tissue effects of the AKT inhibitor MK-2206 in women with stage I-III BC. MATERIALS AND METHODS Two doses of weekly oral MK2206 were administered at days - 9 and - 2 before surgery. The primary endpoint was reduction of pAktSer473 in breast tumor tissue from diagnostic biopsy to surgery. Secondary endpoints included changes in PI3K/AKT pathway tumor markers, tumor proliferation (ki-67), insulin growth factor pathway blood markers, pharmacokinetics (PK), genomics, and MK-2206 tolerability. Paired t tests were used to compare biomarker changes in pre- and post-MK-2206, and two-sample t tests to compare with prospectively accrued untreated controls. RESULTS Despite dose reductions, the trial was discontinued after 12 patients due to grade III rash, mucositis, and pruritus. While there was a trend to reduction in pAKT after MK-2206 (p = 0.06), there was no significant change compared to controls (n = 5, p = 0.65). After MK-2206, no significant changes in ki-67, pS6, PTEN, or stathmin were observed. There was no significant association between dose level and PK (p = 0.11). Compared to controls, MK-2206 significantly increased serum glucose (p = 0.02), insulin (p < 0.01), C-peptide (p < 0.01), and a trend in IGFBP-3 (p = 0.06). CONCLUSION While a trend to pAKT reduction after MK-2206 was observed, there was no significant change compared to controls. However, the accrued population was limited, due to toxicity being greater than expected. Pre-surgical trials can identify in vivo activity in the early drug development, but side effects must be considered in this healthy population.
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Affiliation(s)
- K Kalinsky
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.
| | - J A Sparano
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA
| | - X Zhong
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | | | - B Taback
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, USA
| | - L Wiechmann
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, USA
| | - S M Feldman
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA
| | | | - A Ahmad
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - S Cremers
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - A N Sireci
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - J R Cross
- Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - D K Marks
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
| | - P Mundi
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
| | - E Connolly
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - K D Crew
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - M A Maurer
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
| | - H Hibshoosh
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - S Lee
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - D L Hershman
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
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Anampa JD, Xue X, Oktay M, Condeelis J, Sparano JA. Abstract OT2-06-04: Phase Ib study of rebastinib plus antitubulin therapy with paclitaxel or eribulin in patients with metastatic breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-06-04] [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: Metastasis is the primary cause of death in breast cancer, yet no specific therapies are available that inhibit the metastatic process. TMEM (Tumor Microenvironment of Metastasis) are microanatomic structures formed by a Mena-expressing tumor cell, Tie2-expressing macrophage, and endothelial cell in direct content, which serve as the primary portal for tumor cell intravasation into the circulation and subsequent metastasis. High TMEM score in the primary tumor is associated with higher risk of recurrence in ER+, HER2- early breast cancer. Paclitaxel induces the formation of TMEM in the primary tumors of patients treated with neoadjuvant chemotherapy, and in the primary tumor and distant metastases in the PyMT/PDX models. Tumor cell intravasation is mediated by release of VEGF that promotes focal vascular leakiness specifically at TMEM sites, and is derived from TMEM-associated Tie2HI/VEGFHI macrophages that release VEGF upon binding of the Tie2 receptor to angiopoietin2 (ANG2), which is elaborated by TMEM-associated endothelial cells. Moreover, ANG2-stimulated release of IL-10 by tumor-associated macrophages suppresses T cell proliferation, increases the ratio of CD4+T cells to CD8+ T cells, and promotes the expansion of CD4+CD25highFOXP3+ cells. The Tie2 inhibitor rebastinib inhibits intravasation at TMEM sites, reduces circulating tumor cell (CTC) burden, prevents distant metastases, and improves survival in breast cancer animal models when added to either paclitaxel or eribulin. We therefore hypothesize that the addition of a potent Tie2 inhibitor (rebastinib) to antitubulin therapy in patients with HER2 negative metastatic breast cancer (MBC) will prevent hematogenous dissemination and distant metastasis by inhibition of TMEM function, reduction in CTC burden, and inhibition of immune-system suppression resulting in improvement in breast clinical outcomes
Methods: Primary objective of this phase Ib study (NCT02824575) is to evaluate safety and tolerability of rebastinib in two dose levels (DL) (50mg or 100mg po BID) combined with paclitaxel IV 80mg/m2 (day 1, 8 and 15) or eribulin IV 1.4mg/m2 (day1 and 8) for four 21-day cycles.
Key eligibility includes histologically confirmed HER2 negative MBC. ≤ 2 non-taxane chemotherapy regimens are allowed for rebastinib plus paclitaxel arm, while ≥ 2 chemotherapy regimens (including a taxane) are required for eribulin plus rebastinib arm. ≥ 2 endocrine regimens, including an approved CDK4/6 inhibitor, is required for ER+ disease. Patients require ECOG PS 0 or 1 and normal organ and marrow function. Exclusion criteria include significant ocular disease, significant history of cardiac disease or concomitant use drugs that prolong QTc interval.
Pharmacodynamic biomarkers to be measured during cycle 1-3 include CTCs, ANG 1/2 levels and Tie-2 expressing monocytes. Tissue biopsy after two treatment cycles in 6 patients who have accessible tumors will be performed to evaluate TMEM score and function. With two DL of rebastinib, and 3-6 patients at each DL, it is anticipated that 6-12 patients will be required.
This trial has enrolled three patients assigned paclitaxel arm (DL1) and one patient in eribulin arm(DL1).
Citation Format: Anampa JD, Xue X, Oktay M, Condeelis J, Sparano JA. Phase Ib study of rebastinib plus antitubulin therapy with paclitaxel or eribulin in patients with metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-06-04.
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Affiliation(s)
- JD Anampa
- Montefiore Einstein Cancer Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY
| | - X Xue
- Montefiore Einstein Cancer Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY
| | - M Oktay
- Montefiore Einstein Cancer Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY
| | - J Condeelis
- Montefiore Einstein Cancer Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY
| | - JA Sparano
- Montefiore Einstein Cancer Center, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY
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Badve S, Wang V, Willis S, Leyland-Jones B, Gokmen-Polar Y, Shulman L, Martino S, Sparano J, Davidson N, Goldstein L, Buechler S. Abstract P1-06-08: Independent validation of EarlyR gene signature in E2197: A randomized clinical trial comparing doxorubicin plus docetaxel to doxorubicin plus cyclophosphamide as adjuvant chemotherapy in breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-06-08] [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: EarlyR is a prognostic gene signature score in ER+ breast cancer (BC) computed from the expression values of ESPL1, SPAG5, MKI67, PLK1 and PGR using a nonlinear mathematical formula. EarlyR has been validated in multiple cohorts profiled on Affymetrix and Illumina microarrays and by RNA-seq. This study sought to assess the prognostic features of EarlyR in a cohort of E2197.
Patients and Methods: Illumina DASL assay was used to measure gene expression in FFPE tissue of primary BC from a case-cohort sampling subset of women in E2197 treated with doxorubicin plus docetaxel (AT) or doxorubicin plus cyclophosphamide (AC). ER+ patients received hormone therapy at physician's discretion. After 79.5 months median follow-up, disease-free survival was 85% in both treatment arms. Among patients centrally reviewed with sufficient RNA material for the DASL assay, 319 with ER+ status and assessed for EarlyR are included in the analytic cohort. EarlyR scores and pre-specified risk strata (≤25=low, 26-75=intermediate, >75=high) were computed, while blinded to clinical data. The analysis endpoint was disease-free survival (DFS), defined as the time from randomization to date of invasive BC recurrence or death from any cause within 8 years. Weighted Cox proportional hazards models were used to associate EarlyR score or risk strata with DFS. Variances of the estimated coefficients were adjusted to account for the case-cohort design.
Results: The distribution of the EarlyR risk groups was 59% low, 11% intermediate and 30% high risk in this ER+ cohort. The continuous EarlyR score was significantly prognostic of DFS up to 8 years after randomization (p = 0.02). Patients with low EarlyR score (≤ 25) had significantly lower risk of BC recurrence within 8 years (p = 0.031, univariate HR=0.562, 95%CI: 0.334-0.948) compared to those with high EarlyR score (> 75). Analysis within the AC arm showed that patients with low EarlyR score had significantly lower risk of 8-year BC recurrence (p = 0.023, univariate HR=0.392, 95%CI: 0.175-0.878) compared to those with high EarlyR score. Within the AT arm there was no significant difference in 8-year DFS prognosis between any of the EarlyR risk groups.
Conclusions: This study confirmed the prognostic significance of EarlyR using FFPE tissue in a cohort of patients treated with AC chemotherapy from E2197. Patients with high EarlyR score who were treated with AC had significantly higher risk of recurrence than low EarlyR score patients treated with AC. On the other hand, prognosis of high EarlyR score AT-treated patients was not significantly lower than the prognosis of low EarlyR score AT-treated patients. Further study in a larger cohort is needed to assess the relative benefits of AC versus AT within the EarlyR high risk group and the EarlyR low risk group.
Citation Format: Badve S, Wang V, Willis S, Leyland-Jones B, Gokmen-Polar Y, Shulman L, Martino S, Sparano J, Davidson N, Goldstein L, Buechler S. Independent validation of EarlyR gene signature in E2197: A randomized clinical trial comparing doxorubicin plus docetaxel to doxorubicin plus cyclophosphamide as adjuvant chemotherapy in breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-06-08.
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Affiliation(s)
- S Badve
- Indiana University, Indianapolis, IN; ECOG-ACRIN, Boston, MA; Avera Health, Sioux Falls; University of Pennslyvania, Philadelphia, PA; The Angles Clinic, Los Angeles, CA; Montefiore Medical Center, Bronx, NY; Fred Hutchinson Cancer Center, Seattle, WA; Fox Chase Cancer Center, Philadelphia, PA; Notre Dame University, South Bend, IN
| | - V Wang
- Indiana University, Indianapolis, IN; ECOG-ACRIN, Boston, MA; Avera Health, Sioux Falls; University of Pennslyvania, Philadelphia, PA; The Angles Clinic, Los Angeles, CA; Montefiore Medical Center, Bronx, NY; Fred Hutchinson Cancer Center, Seattle, WA; Fox Chase Cancer Center, Philadelphia, PA; Notre Dame University, South Bend, IN
| | - S Willis
- Indiana University, Indianapolis, IN; ECOG-ACRIN, Boston, MA; Avera Health, Sioux Falls; University of Pennslyvania, Philadelphia, PA; The Angles Clinic, Los Angeles, CA; Montefiore Medical Center, Bronx, NY; Fred Hutchinson Cancer Center, Seattle, WA; Fox Chase Cancer Center, Philadelphia, PA; Notre Dame University, South Bend, IN
| | - B Leyland-Jones
- Indiana University, Indianapolis, IN; ECOG-ACRIN, Boston, MA; Avera Health, Sioux Falls; University of Pennslyvania, Philadelphia, PA; The Angles Clinic, Los Angeles, CA; Montefiore Medical Center, Bronx, NY; Fred Hutchinson Cancer Center, Seattle, WA; Fox Chase Cancer Center, Philadelphia, PA; Notre Dame University, South Bend, IN
| | - Y Gokmen-Polar
- Indiana University, Indianapolis, IN; ECOG-ACRIN, Boston, MA; Avera Health, Sioux Falls; University of Pennslyvania, Philadelphia, PA; The Angles Clinic, Los Angeles, CA; Montefiore Medical Center, Bronx, NY; Fred Hutchinson Cancer Center, Seattle, WA; Fox Chase Cancer Center, Philadelphia, PA; Notre Dame University, South Bend, IN
| | - L Shulman
- Indiana University, Indianapolis, IN; ECOG-ACRIN, Boston, MA; Avera Health, Sioux Falls; University of Pennslyvania, Philadelphia, PA; The Angles Clinic, Los Angeles, CA; Montefiore Medical Center, Bronx, NY; Fred Hutchinson Cancer Center, Seattle, WA; Fox Chase Cancer Center, Philadelphia, PA; Notre Dame University, South Bend, IN
| | - S Martino
- Indiana University, Indianapolis, IN; ECOG-ACRIN, Boston, MA; Avera Health, Sioux Falls; University of Pennslyvania, Philadelphia, PA; The Angles Clinic, Los Angeles, CA; Montefiore Medical Center, Bronx, NY; Fred Hutchinson Cancer Center, Seattle, WA; Fox Chase Cancer Center, Philadelphia, PA; Notre Dame University, South Bend, IN
| | - J Sparano
- Indiana University, Indianapolis, IN; ECOG-ACRIN, Boston, MA; Avera Health, Sioux Falls; University of Pennslyvania, Philadelphia, PA; The Angles Clinic, Los Angeles, CA; Montefiore Medical Center, Bronx, NY; Fred Hutchinson Cancer Center, Seattle, WA; Fox Chase Cancer Center, Philadelphia, PA; Notre Dame University, South Bend, IN
| | - N Davidson
- Indiana University, Indianapolis, IN; ECOG-ACRIN, Boston, MA; Avera Health, Sioux Falls; University of Pennslyvania, Philadelphia, PA; The Angles Clinic, Los Angeles, CA; Montefiore Medical Center, Bronx, NY; Fred Hutchinson Cancer Center, Seattle, WA; Fox Chase Cancer Center, Philadelphia, PA; Notre Dame University, South Bend, IN
| | - L Goldstein
- Indiana University, Indianapolis, IN; ECOG-ACRIN, Boston, MA; Avera Health, Sioux Falls; University of Pennslyvania, Philadelphia, PA; The Angles Clinic, Los Angeles, CA; Montefiore Medical Center, Bronx, NY; Fred Hutchinson Cancer Center, Seattle, WA; Fox Chase Cancer Center, Philadelphia, PA; Notre Dame University, South Bend, IN
| | - S Buechler
- Indiana University, Indianapolis, IN; ECOG-ACRIN, Boston, MA; Avera Health, Sioux Falls; University of Pennslyvania, Philadelphia, PA; The Angles Clinic, Los Angeles, CA; Montefiore Medical Center, Bronx, NY; Fred Hutchinson Cancer Center, Seattle, WA; Fox Chase Cancer Center, Philadelphia, PA; Notre Dame University, South Bend, IN
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Pluard T, Oh SY, Oliveira M, Cescon D, Tan-Chiu E, Wu Y, Carpenter C, Cunningham E, Ballas M, Dhar A, Sparano J. Abstract OT3-06-07: A phase I/II dose escalation and expansion study to investigate the safety, pharmacokinetics, pharmacodynamics and clinical activity of GSK525762 in combination with fulvestrant in subjects with ER+ breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-06-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Advanced or metastatic ER+BC (estrogen receptor positive breast cancer) is an incurable illness that will prove fatal for most afflicted women. Current standards of care include endocrine, targeted, and chemotherapy. Preclinical data suggest that altering the expression of the estrogen receptor (ER) as well as other ER-responsive genes may provide therapeutic benefit for women for whom endocrine therapy alone has proven inadequate. The bromodomain (BRD) and extra-terminal (BET) family of proteins (BRD2, BRD3, BRD4 and BRDT) bind to acetyl-histone residues and epigenetically control transcription of genes driving cell survival and proliferation. BET proteins have been implicated in carcinogenesis and treatment resistance in multiple tumors including ER+BC, and are a novel target for therapy in breast cancer. GSK525762 is a pan-BET inhibitor that has shown strong synergistic activity with fulvestrant in killing ER+BC cells in vitro and in xenograft models. The combination of BET agents with endocrine therapy may provide therapeutic benefit and restore sensitivity to ER targeting agents like fulvestrant.
Trial Design & Specific Aims:
This study is a Phase I/II dose-escalation, expansion (Phase I) and randomized control (Phase II) study with oral administration of GSK525762 in combination with fulvestrant in advanced or metastatic ER+BC subjects, whose disease has progressed on prior treatment with at least one line of endocrine therapy.
Phase I of the study is designed as parallel single arms to determine a recommended Phase 2 dose (RP2D) based on safety, tolerability, pharmacokinetic, and efficacy profiles in two distinct populations of ER+ breast cancer:
Subjects with disease that relapsed during treatment or within 12 months of adjuvant therapy with an AI, OR disease that progressed during treatment with an AI for advanced/metastatic disease.
OR
Subjects with disease that progressed during treatment with the combination of a CDK4/6 inhibitor plus letrozole for advanced or metastatic disease.
Phase II of the study is a randomized, double-blind, placebo-controlled cohort, designed to evaluate the efficacy of the combination.
Key Eligibility Criteria: Patients must have received <3 lines of systemic anti-cancer therapy (≤1 line of chemo), measurable disease, and PS 0-1.
Statistical Methods: A modified toxicity probability interval (mTPI) design will be used to monitor safety. A Bayesian adaptive design will be used to evaluate efficacy in Phase 1.
Present and Target Accrual: Target enrolment will be ˜300 subjects across ˜50 sites worldwide. To date, 2 subjects have been enrolled.
Contact Information: Elizabeth Cunningham, Elizabeth.A.Cunningham@GSK.com.
NCT02964507
Funding: GSK
Citation Format: Pluard T, Oh SY, Oliveira M, Cescon D, Tan-Chiu E, Wu Y, Carpenter C, Cunningham E, Ballas M, Dhar A, Sparano J. A phase I/II dose escalation and expansion study to investigate the safety, pharmacokinetics, pharmacodynamics and clinical activity of GSK525762 in combination with fulvestrant in subjects with ER+ breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-06-07.
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Affiliation(s)
- T Pluard
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - SY Oh
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - M Oliveira
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - D Cescon
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - E Tan-Chiu
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - Y Wu
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - C Carpenter
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - E Cunningham
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - M Ballas
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - A Dhar
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - J Sparano
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
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Obeid E, Miller KD, Sparano JA, Blackwell K, Goldstein LJ. Abstract OT2-01-17: A Phase II randomized trial of pembrolizumab with carboplatin and gemcitabine for treatment of patients with metastatic triple-negative breast cancer (mTNBC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-01-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Treatment for mTNBC is limited, and significant challenges persist in treating this disease, as outcomes remain largely dependent on chemotherapy without any effective targeted treatment. Pembrolizumab (MK-3475) is a highly selective, humanized monoclonal antibody against PD-1, blocking the negative immune regulatory signaling of the PD-1 receptor that is usually expressed by T-cells. Recent data showed that some patients with mTNBC may benefit from immune-based therapies (PD-1 or PD-L1 antibodies). Cumulative evidence suggest that stromal tumor infiltrating lymphocytes (sTILs) have a prognostic and predictive role in response to treatment in subsets of TNBC, particularly in response to carboplatin use. Preclinical data revealed that blocking PD-1/PD-L1 pathway in combination with platinum containing cytotoxic therapy improved response rates and survival. High levels of sTILs and an increased PD-L1 expression make mTNBC a candidate for PD-1–targeted therapy. As studies showed that the subset of TNBC with better response rates to carboplatin are heavily infiltrated with sTILs, pembrolizumab, becomes a very attractive drug to be tested in combination with carboplatin, with the goal of improving outcomes in mTNBC. A Phase II multicenter, randomized, trial has been initiated to evaluate the efficacy and safety of combining pembrolizumab with carboplatin and gemcitabine in patients with mTNBC.
Methods: A safety run-in will assess the safety and tolerability of combining pembrolizumab with carboplatin and gemcitabine in patients with mTNBC. Following the completion of the safety run-in, patients will be randomized 2:1 to receive pembrolizumab (200 mg IV) on day 1 along with carboplatin (AUC 2, day 1 and day 8, IV) plus gemcitabine (800 mg/m2, day 1 and day 8, IV) of a 21-day cycle, or carboplatin plus gemcitabine (same aforementioned dose) alone. Patients will have histologically documented unresectable mTNBC. Prior systemic therapy for mTNBC, for up to 2 lines is allowed, and patients will have ECOG PS 0–2 and measurable disease (RECIST v1.1). Prior carboplatin/gemcitabine or cisplatin therapy is allowed in the adjuvant or neoadjuvant setting, as long as it occurred more than 12 months from the beginning of their enrollment. Subjects whose tumors progressed while on treatment with carboplatin or cisplatin are excluded. Known CNS disease (except asymptomatic treated metastases), autoimmune disease or prior immune checkpoint blockade therapy is an exclusion to enrollment on this trial. Primary endpoint is assessing the objective response rate according to RECIST v1.1 . Other endpoints include clinical benefit rate (CBR), progression-free survival (PFS), overall survival (OS), duration of response (DOR), and safety. Tumor biopsies will be obtained at baseline and just prior to initiation of cycle 3 to assess biomarkers of response and immune escape. PD-L1 expression will be evaluated in exploratory analysis with a planned assessment of response based on PD-L1 status. This trial will enroll 6-12 patients in the safety run-in portion, and 75 patients in the randomized part, at 7 sites in the United States. Clinical trial information: NCT02755272 www.clinicaltrials.gov.
Citation Format: Obeid E, Miller KD, Sparano JA, Blackwell K, Goldstein LJ. A Phase II randomized trial of pembrolizumab with carboplatin and gemcitabine for treatment of patients with metastatic triple-negative breast cancer (mTNBC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-01-17.
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Affiliation(s)
- E Obeid
- Fox Chase Cancer Center, Philadelphia, PA; Indiana University, Indianapolis, IN; Albert Einstein College of Medicine/Montefiore Medical Cente, Bronx, NY; Duke University, Durham, NC
| | - KD Miller
- Fox Chase Cancer Center, Philadelphia, PA; Indiana University, Indianapolis, IN; Albert Einstein College of Medicine/Montefiore Medical Cente, Bronx, NY; Duke University, Durham, NC
| | - JA Sparano
- Fox Chase Cancer Center, Philadelphia, PA; Indiana University, Indianapolis, IN; Albert Einstein College of Medicine/Montefiore Medical Cente, Bronx, NY; Duke University, Durham, NC
| | - K Blackwell
- Fox Chase Cancer Center, Philadelphia, PA; Indiana University, Indianapolis, IN; Albert Einstein College of Medicine/Montefiore Medical Cente, Bronx, NY; Duke University, Durham, NC
| | - LJ Goldstein
- Fox Chase Cancer Center, Philadelphia, PA; Indiana University, Indianapolis, IN; Albert Einstein College of Medicine/Montefiore Medical Cente, Bronx, NY; Duke University, Durham, NC
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Donovan MJ, Jones JG, Entenberg DR, Condeelis JS, D'alfonso TM, Gustavson M, Molinaro A, Oktay MH, Xue X, Sparano JA, Peterson MA, Podznyakova O, Rohan TE, Shuber AP, Gertler FB, Ly A, Divelbiss ME, Hamilton DA. Abstract P2-05-06: Analytical and clinical validation of a fully automated tissue-based quantitative assay (MetaSite Breast™) to detect the likelihood of distant metastasis in hormone receptor (HR)-positive, HER2-negative early stage breast cancer (ESBC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: MetaSite Breast™ is a validated assay to predict risk of distant breast cancer metastasis in patients with HR+/HER2- ESBC. The assay measures the number of MetaSites defined as tumor microanatomic structures composed of MENA protein expressing tumor cells in contact with CD31+ endothelial cells and CD68+ macrophages. Previous studies have demonstrated that an increased number of these microanatomic structures is associated with distant metastasis (DM) in HR+/HER2- ESBC independent of clinicopathologic features. Analytical validation of MetaSite Breast™ demonstrated precision of 97-99% (repeat image analysis of the same slide) and performance of 91-96% (staining and image analysis of serial tumor sections). We sought to further understand the importance of the MetaSite in predicting distant breast cancer metastasis utilizing a fully automated prognostic assay in an independent large patient cohort.
Methods: We conducted a nested case-control study within a cohort of 3,760 patients diagnosed between 1980 and 2000 with invasive breast cancer from the Kaiser Permanente Northwest health care system. Cases (n=259) were women who developed a subsequent distant metastasis; controls, selected using incidence density sampling, were matched closely to cases (1:1) on age at and calendar year of primary diagnosis. Of the 481 patient tumor samples evaluated in this study, 57% were HR+/HER2-, 19% were triple negative (TN), and 15% were HER2+ disease. Multivariate models were adjusted for clinical factors including: lymph node status, tumor size, tumor grade, and HRT; as well as matching variables: age and year of diagnosis. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression.
Results: In the HR+/HER2- group, MetaSite Score (MS) ranged from 0-357 and the mean was 44.6. MS was a significant predictor of DM (P=0.039) in patients with HR+/HER2- disease. Cut-points based on tertiles of MS in all 259 controls defined intermediate (13-41) and high (>41) risk groups that were significantly associated with risk of DM versus the low risk group (OR=2.24; 95%CI=1.23-4.13, P=0.009) and (OR=2.94; 95%CI=1.62-5.41, P=0.0005), respectively. Univariate estimates of absolute risk of DM with cutoffs based on 90% sensitivity and specificity were 9.4% for the low risk group (MS<7), 14.1% for the intermediate (MS=7-91), and 23.4% for the high (MS>91). When adjusted for clinical factors, estimates of absolute risk of DM were 6.6%, 14.1%, and 33.0% for the low, intermediate, and high risk groups, respectively. A binary cut-point for the high risk group was determined (MS>14) and was significant with a 2-fold higher risk of DM versus the low risk group and adjusted for clinical covariates (P=0.036). MS was not positively associated with DM in TN or HER2+ disease.
Conclusions: MetaSite Breast™ significantly predicted the risk of distant breast cancer metastasis in ESBC patients with HR+/HER2-disease, independent of classical clinicopathologic features.
Citation Format: Donovan MJ, Jones JG, Entenberg DR, Condeelis JS, D'alfonso TM, Gustavson M, Molinaro A, Oktay MH, Xue X, Sparano JA, Peterson MA, Podznyakova O, Rohan TE, Shuber AP, Gertler FB, Ly A, Divelbiss ME, Hamilton DA. Analytical and clinical validation of a fully automated tissue-based quantitative assay (MetaSite Breast™) to detect the likelihood of distant metastasis in hormone receptor (HR)-positive, HER2-negative early stage breast cancer (ESBC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-06.
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Affiliation(s)
- MJ Donovan
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - JG Jones
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - DR Entenberg
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - JS Condeelis
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - TM D'alfonso
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - M Gustavson
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - A Molinaro
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - MH Oktay
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - X Xue
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - JA Sparano
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - MA Peterson
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - O Podznyakova
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - TE Rohan
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - AP Shuber
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - FB Gertler
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - A Ly
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - ME Divelbiss
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
| | - DA Hamilton
- Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, New York, NY; Montefiore, New York, NY; MetaStat, Inc., Boston, MA; Massachusetts General Hospital/Harvard Medical School, Boston, MA; Brigham and Womens Hospital/Harvard Medical School, Boston, MA; University of California, San Francisco, San Francisco, CA; Weill Cornell Medicine, New York, NY; Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA; Alberta Health Services, Calgary, AB, Canada
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Sparano JA, Gray R, Oktay MH, Entenberg D, Rohan T, Xue X, Donovan M, Peterson M, Shuber A, Hamilton D, D'Alfonso T, Goldstein LJ, Gerlter F, Davidson N, Condeelis J, Jones J. Abstract S4-04: Tumor microenvironment of metastasis (TMEM) score is associated with early distant recurrence in hormone receptor (HR) positive, HER2-negative early stage breast cancer (ESBC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-s4-04] [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: Metastasis is the primary cause of death in ESBC. We have shown in mouse models that a subpopulation of tumor cells expressing invasive Mena isoforms stream, form microanatomic structures (“TMEM”) with endothelial cells and macrophages, intravasate into the circulation at TMEM sites, and metastasize (Harney et al. Cancer Discovery, 2015). Further, TMEM sites (“MetaSites”) are identifiable in human ESBC, and “MetaSite score” [MS] is positively associated with distant recurrence in HR+/HER2- ESBC independent of clinicopathologic features, including IHC4 (Rohan et al. JNCI 2014). Here we determined the association between MS and recurrence in an independent ESBC cohort (E2197; NCT00003519).
Methods: We evaluated primary tumors from 600 patients (median followup 14.8 years) with ESBC (weighted % = 50% T1, 54% N0, 46% N1) treated with surgery and 4 cycles of adjuvant chemotherapy (AC or AT) and endocrine therapy. Grade, ER, PR, and HER2, and Oncotype DX Recurrence Score (RS) were evaluated in central labs (Badve et al. JCO 2008), and MS was determined in a CLIA-certified lab using an analytically validated, fully automated digital pathology/image analysis method that identifies Mena expressing tumor cells in direct contact with CD68+ macrophages and CD31+ endothelial cells (ie, “TMEMs”, or “MetaSites”). The objectives were to determine the association between MS and distant relapse free interval (DRFI) and relapse free interval (RFI). Kaplan-Meier survival curves were used to estimate time-to-event distributions. Cox proportional hazards models were used to assess hazard ratio associated with MS while controlling for covariates, and allowing time-varying association with MS. Both Kaplan-Meier and Cox regression methods addressed stratified sampling by incorporating proper weights. All analyses were performed in R 3.2.3.
Results: MS ranged from 0-199; the weighted mean MS was lower in HR+/HER2- than TN (16.1 vs. 23.8, p=0.001) and HER2+ disease (26.2, p=0.003). MS was not associated with T or N status, and correlated poorly with RS (r=0.29). Proportional hazards models revealed a significant positive association between continuous MS and DRFI (p=0.001) and RFI (p=0.00006) in HR+/HER2- disease in years 0-5 (and by MS tertiles for DRFI [p=0.04] and RFI [p=0.01]), but not after year 5 or in TN or HER2+ disease. Proportional hazards models including clinical covariates (N0 vs. N1; T1 vs. T2; high vs. int. vs. low grade) also revealed significant positive associations for continuous MS with RFI (p=0.04), and borderline association with DRFI (p=0.08). Similar findings for MS (RFI p=0.05;DRFI p=0.10) were noted in a joint model including categorical RS (<18,18-30, >30).
Conclusions: MS, a novel metastasis biomarker reflecting interaction between streaming and metastasizing tumor cells and microenvironment, provides prognostic information complementary to classical clinicopathologic features and RS in HR+/HER2- ESBC. Further evaluation is warranted in order to identify patients at highest risk of recurrence within 5 years most likely to benefit from adjuvant chemotherapy or novel therapies. (Supported by BCRF and NCI CA21115, CA180794, CA23318, CA66636, CA180820).
Citation Format: Sparano JA, Gray R, Oktay MH, Entenberg D, Rohan T, Xue X, Donovan M, Peterson M, Shuber A, Hamilton D, D'Alfonso T, Goldstein LJ, Gerlter F, Davidson N, Condeelis J, Jones J. Tumor microenvironment of metastasis (TMEM) score is associated with early distant recurrence in hormone receptor (HR) positive, HER2-negative early stage breast cancer (ESBC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S4-04.
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Affiliation(s)
- JA Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - R Gray
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - MH Oktay
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - D Entenberg
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - T Rohan
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - X Xue
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - M Donovan
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - M Peterson
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - A Shuber
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - D Hamilton
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - T D'Alfonso
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - LJ Goldstein
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - F Gerlter
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - N Davidson
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - J Condeelis
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - J Jones
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ECOG-ACRIN Research Group, Boston, MA; Albert Einstein College of Medicine, Bronx, NY; Mt. Sinai School of Medicine, New York, NY; MetaStat, Inc, Boston, MA; Weill Cornell Medical College, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Massachusetts Institute of Technology, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
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Acuna A, Gligich O, Khan H, Xue X, Lin J, Sparano J, Anampa J. Abstract P5-10-05: Time differences in breast cancer diagnosis among minorities in a large referal academic center. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-10-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer (BC) is the most common malignancy and leading cause of cancer death in women. BC incidence is lower in Hispanic (H) (91.9/100,000) compared to non-Hispanic Whites (NHW -128.1/100.000) and Non-Hispanic Black (NHB - 124.3/100,000) population; however, mortality rate is higher in NHB (31/100,000) compared to NHW (21.9/100,000) and H (14.5/100,000). Diagnosis delay is a plausible factor that may explain differences in BC clinical outcomes among different race/ethnicity subgroups.
Objective: To compare time to diagnosis (TTD) by race/ethnicity in women with breast cancer diagnosed at Montefiore Medical Center from 2004 to 2012.
Methods: Patients with breast cancer and available race/ethnicity information diagnosed between 2004 and 2012 were categorized into 4 race/ethnicity groups: NHB, NHW, H or Asian. Dates of screening mammogram, diagnostic mammogram and biopsy were obtained. TTD was defined as the time difference between abnormal mammogram and biopsy dates.
Results: 919 patients had ethnicity information, 302 (32.8%) were H. TTD was longer in H compared to non-Hispanics (35 vs 31 days, z=2.2, p=0.02). Race and ethnicity information was available for 834 patients with a mean age of 62 years (SD:12.4). Of these, 252 (30.2%) were H and 387 (46.4%) were NHB. NHW had the shortest TTD (30 days), the highest frequency of Stage I (70%) and lowest frequency of high-nuclear grade (15.6%). NHB had a TTD of 31 days and higher frequency of triple negative disease (18.9%). TTD was significantly longer in H compared to NHW (35 vs 30 days, z=2.3, p=0.02), and there was a non-significant longer TTD when comparing H versus NHB (35 vs 31 days, z=1.9, p=0.0574). TTD between NHB and NHW was not different (31 vs 30 days, z=1.4, p=0.14).
Conclusions: The longer TTD in H vs Non-Hispanics was driven by the TTD in NHW. NHW had shorter TTD and more favorable pathological features which could lead to lower mortality rate. There was no difference in TTD between NHW and NHB but the latter had higher frequencies of triple negative disease. Correlation between TTD and mortality in our population will help to clarify the clinical effect of TTD differences among race/ethnicity subgroups.
Total (n= 834)Not Hispanic Black (n=387)Not Hispanic White (n=180)Hispanic (n=302)Asian (n=15)Age (SD)62 (12.4)62.965.261.6 (11.9)53.2Stage* I613 (65.7)239 (61.6)126 (70)202 (67.3)10 (66.7)II242 (25.9)121 (31.3)36 (20)71 (23.7)3 (20)III56 (6)19 (4.9)12 (6.7)20 (6.7)3 (15.3)IV21 (2.3)8 (2.1)6 (3.3)7 (2.3)1 (1)Histology* IDC697 (75.1)292 (75.5)121 (67.2)224 (74.7)13 (86.7)ILC81 (8.7)34 (8.8)23 (12.8)21 (7)2 (13.3)Mixed140 (15.1)57 (14.7)33 (18.3)49 (16.3)0 (0)Grade* High253 (28.4)138 (35.7)28 (15.6)73 (24.3)4 (26.7)Moderate426 (48)155 (40.1)86 (47.8)151 (50.3)9 (60)Low210 (23.6)83 (21.5)49 (27.2)62 (20.7)1 (6.7)Receptor status* ER positive762 (81.8)286 (73.9)162 (90)258 (86)12 (80)PR positive632 (67.8)229 (59.2)137 (76.1)219 (73)11 (73.3)HER-2 positive143 (15.4)70 (18.1)14 (7.8)49 (16.3)5 (33.3)Triple negative115 (12.3)73 (18.9)14 (7.8)21 (7)1 (6.7)Times Time to diagnosis33 (20-52)31 (19-52)30 (19-44.5)35 (21-58.5)42 (21-72)Screening to Diagnostic22 (14-36)22 (13-36)21 (13-32)23 (14-14)26 (17-37)Diagnostic to Biopsy7 (0-13)7 (0-13)6 (0-14)7 (1-13)5 (0-9)
Citation Format: Acuna A, Gligich O, Khan H, Xue X, Lin J, Sparano J, Anampa J. Time differences in breast cancer diagnosis among minorities in a large referal academic center [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-10-05.
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Affiliation(s)
- A Acuna
- Montefiore Medical Center/Albert Einstein College of Medicine
| | - O Gligich
- Montefiore Medical Center/Albert Einstein College of Medicine
| | - H Khan
- Montefiore Medical Center/Albert Einstein College of Medicine
| | - X Xue
- Montefiore Medical Center/Albert Einstein College of Medicine
| | - J Lin
- Montefiore Medical Center/Albert Einstein College of Medicine
| | - J Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine
| | - J Anampa
- Montefiore Medical Center/Albert Einstein College of Medicine
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21
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Mundi PS, Codruta C, Accordino MK, Sparano J, Andreopoulou E, Vadhat LT, Tiersten A, Esteva F, O'Regan R, Jain S, Mayer I, Forero A, Crew KD, Hershman DL, Kalinsky KM. Abstract OT2-01-19: A randomized phase II trial of fulvestrant with or without ribociclib after progression on aromatase inhibition plus cyclin-dependent kinase 4/6 inhibition in patients with unresectable or metastatic hormone receptor positive, HER2 negative breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-01-19] [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
Cyclin dependent kinase 4 and 6 inhibitors (CDK4/6i), including palbociclib and ribociclib (R), have demonstrated remarkable benefit in progression free survival (PFS) in patients (pts) with hormone receptor positive (HR+), HER2- metastatic breast cancer (MBC) when combined with anti-estrogen therapy. Switching between anti-estrogen therapies at disease progression is standard of care in the treatment of HR+ MBC. We evaluate the strategy of switching anti-estrogen therapy to fulvestrant (F) and maintaining CDK4/6 inhibition with R in pts with HR+, HER2- MBC who have progressed on an aromatase inhibitor (AI) + CDK4/6i.
Trial Design
Phase II, multi-center, randomized, double-blind, placebo-controlled trial to evaluate F +/- R in pts with HR+, HER2- MBC who have previously progressed on any AI + CDK4/6i. Pts can be screened and registered at two different time points:
Scenario 1: Before receiving any CDK4/6i
Scenario 2: At the time of progression of disease (POD) while being treated with an AI + CDK4/6i
In scenario 1, the study will provide pts with letrozole + R, but pts will not be randomized until they demonstrate POD. At randomization, pts will be assigned 1:1 to either a) F + R or b) F + placebo, with treatment given in 4-week cycles. F will be given as a 500 mg dose intramuscularly every 2 weeks for 3 times and then every 4 weeks, as per standard of care. R or placebo will be given orally at 600 mg daily, 3 weeks on/1 week off. CT scans and bone scan are to be performed prior to every third cycle. Serum and whole blood samples and optional tissue biopsies for biomarker assessment will be performed prior to study treatment (scenario 1), prior to randomization to R +/- F, and when the patient goes off study.
Main Eligibility Criteria:
1. Age ≥ 18 years with unresectable or metastatic BC
2. Estrogen and/or progesterone receptor positive, HER2 negative, as per ASCO-CAP
3. Postmenopausal status or receiving ovarian suppression
4. Measurable or unmeasurable disease; stable CNS disease allowed
5. No clinically significant cardiac disease
6. No concomitant CYP3A4/5 inducer or inhibitor
Specific Aims
Primary: Progression free survival (PFS), defined as the time from randomization to POD or death.
Secondary: Objective response rate (ORR), clinical benefit rate (CBR = ORR + stable disease rate), overall survival (OS), and duration of response. Pts in scenario 1 will also be assessed for PFS, OS, CBR, and safety while receiving AI + R (pre-randomization).
Biomarker assessment will include amplification of cyclin D1 and cyclin E, phosphoRb and TK1 expression, Rb1 and p16 loss, and ctDNA for ESR1 and PIK3CA mutations.
Target Accrual
132 pts accrued from 11 academic medical centers in the U.S, with a goal of completing accrual in two years (∼60 to 72 pts in each scenario).
Statistical Methods
Assuming a median PFS of 3.8 months with F alone, we predict that F + R will lead to a median PFS of at least 6.5 months. A one-sided log-rank test with a sample size of N=120 and alpha=0.025, achieves 80% power to detect a difference in PFS of 2.7 months. N=132 pts allows for a 10% drop-out rate.
Citation Format: Mundi PS, Codruta C, Accordino MK, Sparano J, Andreopoulou E, Vadhat LT, Tiersten A, Esteva F, O'Regan R, Jain S, Mayer I, Forero A, Crew KD, Hershman DL, Kalinsky KM. A randomized phase II trial of fulvestrant with or without ribociclib after progression on aromatase inhibition plus cyclin-dependent kinase 4/6 inhibition in patients with unresectable or metastatic hormone receptor positive, HER2 negative breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-01-19.
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Affiliation(s)
- PS Mundi
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - C Codruta
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - MK Accordino
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - J Sparano
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - E Andreopoulou
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - LT Vadhat
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - A Tiersten
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - F Esteva
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - R O'Regan
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - S Jain
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - I Mayer
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - A Forero
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - KD Crew
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - DL Hershman
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
| | - KM Kalinsky
- Columbia University Medical Center, New York, NY; Albert Einstein College of Medicine, New York, NY; Weill Cornell Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; NYU Medical Center, New York, NY; University of Wisconsin School of Medicine, Madison, WI; Northwestern, Chicago, IL; Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Alabama-Birmingham, Birmingham, AL
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Karagiannis GS, Pastoriza JM, Wang Y, Harney AS, Entenberg D, Pignatelli J, Jones JG, Anampa J, Sparano JA, Rohan TE, Condeelis JS, Oktay MH. Abstract PD5-02: Paclitaxel induced mena- and TMEM-mediated pro-metastatic changes in the breast cancer microenvironment. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-pd5-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer cell intravasation and dissemination occurs specifically at microanatomical structures that we call tumor-microenvironment of metastasis (TMEM), representing direct physical contact between a tumor cell expressing the actin-regulatory protein Mammalian-enabled (Mena), a perivascular Tie2hi/Vegfhi-expressing macrophage, and an endothelial cell (Harney et al. Cancer Discovery 2015). TMEM sites have been identified in mouse and human mammary carcinomas, and both TMEM density (Rohan et al. JNCI 2014) and invasive Mena isoform expression (Agarwal et al. Breast Cancer Res, 2012; Forse et al. BMC Cancer, 2015]) correlates with metastasis in early stage breast cancer. Since cytotoxic agents such as PTX induce influx of bone marrow-derived progenitors that differentiate into Tie2hi/VEGFhi macrophages in the primary tumor, we hypothesized that PTX may potentiate tumor cell invasion and metastasis by inducing the formation of TMEM sites and/or function.
Methods and Results in humans: We analyzed the effect of chemotherapy on TMEM and invasive Mena isoforms in 10 patients with localized breast cancer who had residual disease after neoadjuvant chemotherapy (NAC: weekly paclitaxel followed by dose-dense doxorubicin-cyclophosphamide [AC]), of whom 7 had more than 2-fold increase in TMEM density in residual disease compared with pretreatment. In a separate cohort of 5 patients, NAC produced an acute increase of up to 150-fold in invasive Mena isoforms after 1-2 doses of NAC.
Methods and Results in mice: After our preliminary data in humans, we evaluated effects of PTX in 4 different models, including 2 mouse models (PyMT-spontaneous & transplantation) and 2 patient-derived xenograft (PDX) triple negative models (HT17, HT33). Although PTX delayed primary tumor growth, tumors in PTX-treated mice had significantly more TMEM sites, circulating tumor cells (CTCs) and metastatic foci when compared to vehicle-treated animals. Using intravital imaging of MMTV-PyMT-Dendra2/Cfms-CFP mice, PTX induced influx of macrophages into primary tumors and intravasation of cancer cells at TMEM sites. Furthermore, PTX treatment significantly increased expression of Mena at the gene and protein levels, including invasive Mena isoforms. Deletion of the Mena gene completely abolished dissemination and metastasis in all cases, including those treated with PTX.
Conclusions: We show in mammary carcinoma mouse models and PDX models that although PTX delays tumor growth, it induces invasive Mena isoform expression and significantly increases the density of TMEM sites that are responsible for cancer cell intravasation, dissemination and metastasis. Thus, our data indicate that PTX paradoxically induces dissemination of breast cancer cells by promoting invasive Mena isoforms and TMEM-mediated cancer cell intravasation, suggesting that blockade of TMEM assembly and/or function could enhance the effectiveness of PTX and possibly other cytotoxic agents commonly used to treat early and advanced stage breast cancer.
Citation Format: Karagiannis GS, Pastoriza JM, Wang Y, Harney AS, Entenberg D, Pignatelli J, Jones JG, Anampa J, Sparano JA, Rohan TE, Condeelis JS, Oktay MH. Paclitaxel induced mena- and TMEM-mediated pro-metastatic changes in the breast cancer microenvironment [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD5-02.
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Affiliation(s)
- GS Karagiannis
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - JM Pastoriza
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - Y Wang
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - AS Harney
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - D Entenberg
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - J Pignatelli
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - JG Jones
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - J Anampa
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - JA Sparano
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - TE Rohan
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - JS Condeelis
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
| | - MH Oktay
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY
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Anampa JD, Patel M, Pellegrino C, Fehn K, Makower D, Oh SY, Noah K, Chen A, Sparano JA, Andreopoulou E. Abstract P6-12-08: Phase I study of low dose oral cyclophosphamide (C) plus the poly-ADP-ribose- polymerase (PARP) inhibitor veliparib (V) in women with HER2/neu-negative inoperable locally advanced/metastatic breast cancer (MBC): NCI P8853. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-12-08] [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: PARP, an essential nuclear enzyme, is involved in the recognition of DNA damage and facilitation of DNA base-excision repair (BER). PARP inhibition sensitizes tumor cells to cytotoxic agents which induce DNA damage, including C. Metronomic dosing of C may optimize potential for synergy with PARP inhibitors, and also inhibits angiogenesis (Kerbel et al, Nat Rev Cancer, 4:423-36, 2004) and may enhance anti-tumor immunity (Ghiringhelli et al. Cancer Immunol Immunother 56:641–648, 2007) V is an oral small molecule inhibitor of PARP which potentiates the antineoplastic activity of DNA damaging agents such as C in MX-1 breast xenograft model (Donawho et al Clin Cancer Res 13:2728-37, 2007). We performed a phase I trial of metronomic dose oral C plus V in patients with MBC.
METHODS: The primary objective was to determine the safety and identify the recommended phase II dose (RPTD) of the combination of low-dose oral C once daily in combination with V (100, 200, 300 mg) administered BID for 21 days using a standard 3+3 design. Eligibility included HER2/neu negative MBC, ECOG PS 0-1, and at least 1 prior chemotherapy regimen for MBC. Dose limiting toxicity (DLT) was defined as any Grade 3 non-hematological toxicity or Grade 4 thrombocytopenia/neutropenia occurring during cycle 1. After the RPTD of V was shown to be 200 mg BID with C 50 mg daily, the trial was amended to increase the C dose to 75, 100 and then 125 mg daily until hematologic toxicity was dose-limiting.
RESULTS: 31 patients were enrolled, 19 treated with 50 mg of C and 12 treated at higher doses (75-125 mg), with V doses ranging from 50 mg-300 mg BID (see table);5 patients with not evaluable due to rapid disease progression (N=2), non-compliance (N=2), or tumor pain that was not a DLT (N=1). Median age was 52 years (28-72 years), 14 (45 %) had triple negative disease, all had at least 1 prior chemotherapy regimen for metastasis (median 2, range 1-8), and, 7 had germline BRCA mutations, (3 BRCA1 and 4 BRCA2). When combined with 50 mg C daily, RPTD of V was 200 mg PO BID, with nausea being DLT at 300 mg BID. DLT was not observed in any of the 9 additional patients. The median number of cycles given was 3 (range 1-14). Clinical benefit (response or stable disease for at least 24 weeks) occurred in 3/7 (43%), 1/3 (33%) and 1/16(6%) for BRCA mutated, BRCA negative and BRCA unknown, respectively. Median progression-free survival was 4.3 months (1.2-10.9 months) for BRCA mutated patients and 2 months (0.7-10 months) for non-mutated.
CONCLUSIONS: The combination of oral continuous dosing of V (200 mg PO BID) with metronomic C (50, 75, 100 and 125 mg daily) is well tolerated and shows antitumor activity in patients with BRCA mutation associated MBC. The RPTD is C 125 mg daily plus V 200 mg BID, although further escalation of the C dose may be feasible since DLT was not seen at this dose level.
Dose LevelsDose Level# Patients/Evaluable# DLTType of DLTDL 1 :V 50mg , C 50mg3/30 DL 2 :V 100 mg, C 50mg4/30 DL 3 :V 200 mg, C 50mg6/61HeadacheDL 4 :V 300 mg, C 50mg6/52Nausea (N=2)DL 3A :V 200 mg; C 75mg3/30 DL 3B :V 200 mg, C 100mg6/30 DL 3C :V 200 mg, C 125mg3/30
Citation Format: Anampa JD, Patel M, Pellegrino C, Fehn K, Makower D, Oh S-y, Noah K, Chen A, Sparano JA, Andreopoulou E. Phase I study of low dose oral cyclophosphamide (C) plus the poly-ADP-ribose- polymerase (PARP) inhibitor veliparib (V) in women with HER2/neu-negative inoperable locally advanced/metastatic breast cancer (MBC): NCI P8853 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-12-08.
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Affiliation(s)
- JD Anampa
- Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY; CTEP/NIH, Bethesda, MD; Weill Cornell Breast Center/ New York Presbyterian Hospital- Weill Cornell Medicine, NYC, NY
| | - M Patel
- Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY; CTEP/NIH, Bethesda, MD; Weill Cornell Breast Center/ New York Presbyterian Hospital- Weill Cornell Medicine, NYC, NY
| | - C Pellegrino
- Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY; CTEP/NIH, Bethesda, MD; Weill Cornell Breast Center/ New York Presbyterian Hospital- Weill Cornell Medicine, NYC, NY
| | - K Fehn
- Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY; CTEP/NIH, Bethesda, MD; Weill Cornell Breast Center/ New York Presbyterian Hospital- Weill Cornell Medicine, NYC, NY
| | - D Makower
- Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY; CTEP/NIH, Bethesda, MD; Weill Cornell Breast Center/ New York Presbyterian Hospital- Weill Cornell Medicine, NYC, NY
| | - S-y Oh
- Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY; CTEP/NIH, Bethesda, MD; Weill Cornell Breast Center/ New York Presbyterian Hospital- Weill Cornell Medicine, NYC, NY
| | - K Noah
- Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY; CTEP/NIH, Bethesda, MD; Weill Cornell Breast Center/ New York Presbyterian Hospital- Weill Cornell Medicine, NYC, NY
| | - A Chen
- Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY; CTEP/NIH, Bethesda, MD; Weill Cornell Breast Center/ New York Presbyterian Hospital- Weill Cornell Medicine, NYC, NY
| | - JA Sparano
- Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY; CTEP/NIH, Bethesda, MD; Weill Cornell Breast Center/ New York Presbyterian Hospital- Weill Cornell Medicine, NYC, NY
| | - E Andreopoulou
- Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY; CTEP/NIH, Bethesda, MD; Weill Cornell Breast Center/ New York Presbyterian Hospital- Weill Cornell Medicine, NYC, NY
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Brufsky A, Kim SB, Velu T, García-Saenz JA, Tan-Chiu E, Sohn JH, Dirix L, Borms MV, Liu MC, Moezi MM, Kozloff MF, Sparano JA, Xu N, Wongchenko M, Simmons B, McNally V, Miles D. Abstract P4-22-22: Cobimetinib (C) combined with paclitaxel (P) as a first-line treatment in patients (pts) with advanced triple-negative breast cancer (COLET study): Updated clinical and biomarker results. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-22-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Resistance to standard taxane-based chemotherapy is common in triple-negative breast cancer (TNBC). Mutations and gene amplifications in the MAPK pathway that upregulate MAPK signaling are present in many TNBC tumors. Upregulation of the MAPK signaling pathway can result in degradation of the pro-apoptotic protein BIM and upregulation of anti-apoptotic proteins, including BCL-2, BCL-XL, and MCL-1, thus promoting cell survival and desensitizing tumor cells to the pro-apoptotic effects of taxane chemotherapy. Updated data on clinical safety and efficacy are presented along with biomarker data evaluating the effects of treatment on induction of apoptosis.The COLET study (ClinicalTrials.gov ID, NCT02322814; EudraCT number, 2014-002230-32) consisted of a safety run-in (n∼12) followed by a blinded 1:1 randomized expansion stage (n∼90) to C + P or placebo (PBO) + P. The safety stage is complete and the randomized stage is enrolling pts. Two additional cohorts investigating the effect of adding atezolizumab will be recruiting and are out of scope of this submission. Pts in cohort I were treated with P 80 mg/m2 on days 1, 8, and 15 and C/PBO 60 mg/day on days 3–23 of each 28-day cycle until disease progression or unacceptable toxicity. Gene expression and apoptotic index were measured by RNA-Seq and TUNEL staining, respectively, to assess the biologic activity of C + P.Sixteen women (median age, 55.5 years) were enrolled in the safety run-in stage. At data snapshot (April 22, 2016), all 16 pts had received ≥1 dose of study treatment. Median time on treatment was 116 days (range, 7-336) for C and 84 days (range, 0-351) for P. Fifteen (94%) pts had ≥1 adverse event (AE); 5 (31%) pts had grade 1/2 AEs and 10 (63%) pts had grade 3 AEs (Table). No pts experienced grade 4–5 AEs. Among the 16 safety run-in patients, responses to date include partial response (PR; n = 8 [50.0%]), stable disease (SD, n = 4 [25.0%]), and progressive disease (n = 2 [12.5%]), as well as 2 pts with no post-baseline tumor assessment. Six pts maintained a PR at ∼20 weeks and three maintained a PR at ≥40 weeks. To date, matched pre- and on-treatment biopsies were evaluable for 2 pts, 1 with a PR and 1 with SD. In the patient who attained a PR, increased expression of pro-apoptosis genes, including BIM, was observed; but this was not seen in the patient experiencing SD. The PR patient also had an increase in apoptotic index. Updated biomarker data will be reported.This is the first study to evaluate C + P in TNBC. The safety profile of C + P is consistent with that of known safety profiles. Efficacy and safety will be further evaluated in the ongoing randomized stage.
Most common (any grade ≥20%) AEsTreatment-emergent AEs, n (%)C + P (safety run-in stage), N = 16 All gradesGrade 3Diarrhea10 (63)1 (6)Rash8 (50)0Nausea7 (44)0Alopecia5 (31)0Blood CPK level increase5 (31)1 (6)Stomatitis4 (25)2 (13)Asthenia4 (25)1 (6)Constipation4 (25)0Dyspnea4 (25)0Edema peripheral4 (25)0Pyrexia4 (25)0Vomiting4 (25)0AEs, adverse events; C, cobimetinib; CPK, creatinine phosphokinase; P, paclitaxel.
Citation Format: Brufsky A, Kim S-B, Velu T, García-Saenz JA, Tan-Chiu E, Sohn JH, Dirix L, Borms MV, Liu M-C, Moezi MM, Kozloff MF, Sparano JA, Xu N, Wongchenko M, Simmons B, McNally V, Miles D. Cobimetinib (C) combined with paclitaxel (P) as a first-line treatment in patients (pts) with advanced triple-negative breast cancer (COLET study): Updated clinical and biomarker results [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-22.
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Affiliation(s)
- A Brufsky
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - S-B Kim
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - T Velu
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - JA García-Saenz
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - E Tan-Chiu
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - JH Sohn
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - L Dirix
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - MV Borms
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - M-C Liu
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - MM Moezi
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - MF Kozloff
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - JA Sparano
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - N Xu
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - M Wongchenko
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - B Simmons
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - V McNally
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - D Miles
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
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Mundi PS, Chen E, Sparano J, Andreopoulou E, Taback B, Wiechmann L, Feldman S, Ananthakrishnan P, Hibshoosh H, Connolly E, Crew K, Maurer M, Hershman DL, Kalinsky K. Abstract P3-07-52: Identification of serum biomarkers associated with Akt inhibitor MK-2206-induced toxicity in a pre-surgical breast cancer (BC) trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-07-52] [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 PI3K/Akt/mTOR pathway is an important oncogenic driver in BC. A major hurdle in clinical Akt inhibitor development has been dose-limiting toxicities, such as rash. To facilitate the risk assessment of Akt inhibitor associated toxicity, we hypothesize that circulating biomarkers can be identified in proteins secreted by the tumor or tumor microenvironment and systemic response after treatment. Exosomes are small membrane bound vesicles containing proteins, mRNA, miRNA, and lipids that are secreted from host cells and remain viable after long-term storage of blood. In this study, we focused on identifying biomarkers associated with drug rash from serum exosomes in BC patients treated with the Akt inhibitor MK-2206.
Methods: In an open-label pre-surgical trial, 2 doses of weekly MK2206 were administered to patients (pts) with stage I-III invasive BC: first at day -9 and second at day -2 from surgery. Sera were collected before and after MK2206. 200 μL of serum was used to isolate total exosomes by precipitation and centrifugation, followed by trypsin digestion and multiplexing labeling analysis. The Orbitrap mass spectrometer was used to acquire LC-MS/MS data. 1,053 unique proteins were identified from the uniProt database. Maximum false discovery rate level (FDR) for predictive biomarkers was controlled at 26% (q<0.26). Analysis was conducted on pre-MK-2206 and post-MK-2206 treated sera from pts to develop a protein signature associated with rash and identify candidate biomarkers of MK-2206-associated rash.
Results: The study was discontinued after 12 pts were enrolled due to toxicity. Notably, an acneiform/maculopapular rash was observed in 5 pts. Unsupervised principal component analysis on the pre-MK-2206 specimens and the entire set of 1,053 proteins demonstrated that 4 of the 5 pts with rash formed a distinct cluster. 30 proteins were differentially expressed in pre-MK-2206 samples from pts who developed rash vs. no rash (q<0.26), with ≥1.5 fold difference in expression level in those with rash after MK-2206. Ingenuity pathway analysis revealed statistically significant over-representation of pathways involved in lipid metabolism (including MALRD1, AWAT2), nucleic acid synthesis (PPAT, ADSLL1), and protein synthesis (PPIB). 45 proteins were significantly different in post-MK-2206 samples (q<0.285). Lipid metabolism was the most significantly over-represented pathway in post-MK-2206 samples.
Conclusions: We demonstrated that mass spectrometry-based proteomic analysis of patient-derived serum exosomes is a promising approach to study drug-induced toxicity. We found significant changes of circulating proteins before and after MK-2206. Increased expression of different proteins involved in lipid metabolism appears to predict skin toxicity, commonly seen with PI3K/Akt pathway inhibitors. Since the PI3K/Akt signaling pathway plays a role in physiological regulation of lipid metabolism, lipid metabolic profiles of BC patients might be important for predicting the risk and controlling toxicity induced by Akt inhibitors. These toxicity-associated biomarkers should be validated and then assessed prospectively in clinical trials.
Citation Format: Mundi PS, Chen E, Sparano J, Andreopoulou E, Taback B, Wiechmann L, Feldman S, Ananthakrishnan P, Hibshoosh H, Connolly E, Crew K, Maurer M, Hershman DL, Kalinsky K. Identification of serum biomarkers associated with Akt inhibitor MK-2206-induced toxicity in a pre-surgical breast cancer (BC) trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-52.
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Affiliation(s)
- PS Mundi
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - E Chen
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - J Sparano
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - E Andreopoulou
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - B Taback
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - L Wiechmann
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - S Feldman
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - P Ananthakrishnan
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - H Hibshoosh
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - E Connolly
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - K Crew
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - M Maurer
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - DL Hershman
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
| | - K Kalinsky
- Columbia University Medical Center, NY, NY; Albert Einstein College of Medicine, Bronx, NY
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Connolly R, Zhao F, Miller K, Tevaarwerk A, Wagner L, Lee M, Murray J, Gray R, Piekarz R, Zujewski JA, Sparano J. Abstract OT2-01-04: E2112: Randomized phase III trial of endocrine therapy plus entinostat/placebo in patients with hormone receptor-positive advanced breast cancer. A trial of the ECOG-ACRIN cancer research group. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot2-01-04] [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:
A potential mechanism of resistance to endocrine therapy in breast cancer involves changes in gene expression secondary to epigenetic modifications, which might be modulated with the use of histone deacetylase (HDAC) inhibitors such as entinostat. ENCORE 301, a phase II study evaluating the addition of entinostat to the steroidal aromatase inhibitor (AI) exemestane in patients with hormone receptor (HR)-positive advanced breast cancer who had experienced disease progression after a non-steroidal AI (NSAI), showed a significant improvement in progression-free survival (PFS), and overall survival (OS). Entinostat has been designated a Breakthrough Therapy by the FDA.
Methods:
E2112 is a multicenter randomized double-blind placebo-controlled phase III study (NCT02115282) enrolling patients with advanced HR-positive, HER2-negative breast cancer with prior disease progression on a NSAI (n=600). Patients receive exemestane 25mg po daily and entinostat/placebo 5mg po every week. Eligibility: Postmenopausal women and men, ECOG 0-1, locally advanced/metastatic invasive adenocarcinoma of the breast: ER/PR-positive, HER2-negative, measurable or non-measurable (20% cap) disease. Disease progression after NSAI use in the metastatic setting OR relapse while on or within ≤ 12 months of end of adjuvant NSAI therapy.
Statistics: Both PFS (central review) and OS are primary endpoints, and the study is designed to show an improvement in either PFS or OS. Secondary endpoints include: Safety and tolerability, objective response rate, changes in lysine acetylation status in peripheral blood mononuclear cells, patient-reported symptom burden and treatment toxicities, adherence. One-sided type 1 error 0.025 split between two hypotheses tests: 0.001 for PFS test and 0.024 for OS. PFS is tested in the first 360 pts, 88.5% power to detect 42% reduction in the hazard of PFS failure (median PFS 4.1 to 7.1 months); OS is tested in all 600 pts, 80% power to detect 25% reduction in the hazard of death (median OS 22 to 29.3 months).
E2112 was activated in March 2014 and accrual is anticipated to complete in 40 months.
Citation Format: Connolly R, Zhao F, Miller K, Tevaarwerk A, Wagner L, Lee M, Murray J, Gray R, Piekarz R, Zujewski JA, Sparano J. E2112: Randomized phase III trial of endocrine therapy plus entinostat/placebo in patients with hormone receptor-positive advanced breast cancer. A trial of the ECOG-ACRIN cancer research group. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT2-01-04.
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Affiliation(s)
- R Connolly
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Dana-Farber Cancer Institute, Boston, MA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI; Wake Forest University Health Services, Winston-Salem, NC; National Cancer Institute, Bethesda, MD; Cancer Therapy Evaluation Program (CTEP) National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, Montefiore Medical Center, NY, NY
| | - F Zhao
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Dana-Farber Cancer Institute, Boston, MA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI; Wake Forest University Health Services, Winston-Salem, NC; National Cancer Institute, Bethesda, MD; Cancer Therapy Evaluation Program (CTEP) National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, Montefiore Medical Center, NY, NY
| | - K Miller
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Dana-Farber Cancer Institute, Boston, MA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI; Wake Forest University Health Services, Winston-Salem, NC; National Cancer Institute, Bethesda, MD; Cancer Therapy Evaluation Program (CTEP) National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, Montefiore Medical Center, NY, NY
| | - A Tevaarwerk
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Dana-Farber Cancer Institute, Boston, MA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI; Wake Forest University Health Services, Winston-Salem, NC; National Cancer Institute, Bethesda, MD; Cancer Therapy Evaluation Program (CTEP) National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, Montefiore Medical Center, NY, NY
| | - L Wagner
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Dana-Farber Cancer Institute, Boston, MA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI; Wake Forest University Health Services, Winston-Salem, NC; National Cancer Institute, Bethesda, MD; Cancer Therapy Evaluation Program (CTEP) National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, Montefiore Medical Center, NY, NY
| | - M Lee
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Dana-Farber Cancer Institute, Boston, MA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI; Wake Forest University Health Services, Winston-Salem, NC; National Cancer Institute, Bethesda, MD; Cancer Therapy Evaluation Program (CTEP) National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, Montefiore Medical Center, NY, NY
| | - J Murray
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Dana-Farber Cancer Institute, Boston, MA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI; Wake Forest University Health Services, Winston-Salem, NC; National Cancer Institute, Bethesda, MD; Cancer Therapy Evaluation Program (CTEP) National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, Montefiore Medical Center, NY, NY
| | - R Gray
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Dana-Farber Cancer Institute, Boston, MA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI; Wake Forest University Health Services, Winston-Salem, NC; National Cancer Institute, Bethesda, MD; Cancer Therapy Evaluation Program (CTEP) National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, Montefiore Medical Center, NY, NY
| | - R Piekarz
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Dana-Farber Cancer Institute, Boston, MA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI; Wake Forest University Health Services, Winston-Salem, NC; National Cancer Institute, Bethesda, MD; Cancer Therapy Evaluation Program (CTEP) National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, Montefiore Medical Center, NY, NY
| | - JA Zujewski
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Dana-Farber Cancer Institute, Boston, MA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI; Wake Forest University Health Services, Winston-Salem, NC; National Cancer Institute, Bethesda, MD; Cancer Therapy Evaluation Program (CTEP) National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, Montefiore Medical Center, NY, NY
| | - J Sparano
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Dana-Farber Cancer Institute, Boston, MA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI; Wake Forest University Health Services, Winston-Salem, NC; National Cancer Institute, Bethesda, MD; Cancer Therapy Evaluation Program (CTEP) National Cancer Institute, Bethesda, MD; Albert Einstein College of Medicine, Montefiore Medical Center, NY, NY
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Sparano J, Gray R, Zujewski J, Makower D, Pritchard K, Albain K, Hayes D, Geyer C, Dees C, Perez E, Keane M, Vallejos C, Goggins T, Mayer I, Brufsky A, Toppmeyer D, Kaklamani V, Atkins J, Olson J, Sledge G. 5BA Prospective trial of endocrine therapy alone in patients with estrogen-receptor positive, HER2-negative, node-negative breast cancer: Results of the TAILORx low risk registry. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31935-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Salgado R, Denkert C, Demaria S, Sirtaine N, Klauschen F, Pruneri G, Wienert S, Van den Eynden G, Baehner FL, Penault-Llorca F, Perez EA, Thompson EA, Symmans WF, Richardson AL, Brock J, Criscitiello C, Bailey H, Ignatiadis M, Floris G, Sparano J, Kos Z, Nielsen T, Rimm DL, Allison KH, Reis-Filho JS, Loibl S, Sotiriou C, Viale G, Badve S, Adams S, Willard-Gallo K, Loi S. The evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer: recommendations by an International TILs Working Group 2014. Ann Oncol 2015; 26:259-271. [PMID: 25214542 PMCID: PMC6267863 DOI: 10.1093/annonc/mdu450 10.1097/pai.0000000000000594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The morphological evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer (BC) is gaining momentum as evidence strengthens for the clinical relevance of this immunological biomarker. Accumulating evidence suggests that the extent of lymphocytic infiltration in tumor tissue can be assessed as a major parameter by evaluation of hematoxylin and eosin (H&E)-stained tumor sections. TILs have been shown to provide prognostic and potentially predictive value, particularly in triple-negative and human epidermal growth factor receptor 2-overexpressing BC. DESIGN A standardized methodology for evaluating TILs is now needed as a prerequisite for integrating this parameter in standard histopathological practice, in a research setting as well as in clinical trials. This article reviews current data on the clinical validity and utility of TILs in BC in an effort to foster better knowledge and insight in this rapidly evolving field, and to develop a standardized methodology for visual assessment on H&E sections, acknowledging the future potential of molecular/multiplexed approaches. CONCLUSIONS The methodology provided is sufficiently detailed to offer a uniformly applied, pragmatic starting point and improve consistency and reproducibility in the measurement of TILs for future studies.
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Affiliation(s)
- R Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels Department of Pathology and TCRU, GZA, Antwerp, Belgium
| | - C Denkert
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - S Demaria
- Perlmutter Cancer Center, New York University Medical School, New York, USA
| | - N Sirtaine
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - F Klauschen
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - G Pruneri
- European Institute of Oncology (IEO) and University of Milan, Milan, Italy
| | - S Wienert
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - G Van den Eynden
- Department of Pathology GZA, TCRU Hospitals and CORE Antwerp University, Antwerp, Belgium
| | - F L Baehner
- Genomic Health, Inc., Redwood City, USA University of California San Francisco, San Francisco, USA
| | - F Penault-Llorca
- Clermont-Ferrand Biopathology, University of Auvergne, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
| | - E A Perez
- Division of Haematology/Medical Oncology and
| | - E A Thompson
- Department of Cancer Biology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville
| | - W F Symmans
- Department of Pathology, The UT M.D. Anderson Cancer Center, Boston
| | - A L Richardson
- Department of Pathology, Brigham and Women's Hospital, Boston Department of Cancer Biology, Dana Farber Cancer Institute, Boston
| | - J Brock
- Department of Cancer Biology, Dana Farber Cancer Institute, Boston Department of Cancer Biology, Harvard Medical School, Boston, USA
| | | | - H Bailey
- Genomic Health, Inc., Redwood City, USA
| | - M Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - G Floris
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - J Sparano
- Department of Medicine, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein Medical Center, Bronx, USA
| | - Z Kos
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto
| | - T Nielsen
- Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, Canada
| | - D L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven
| | - K H Allison
- Department of Pathology, Stanford University Medical Centre, Stanford
| | - J S Reis-Filho
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - C Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - G Viale
- Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - S Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - S Adams
- Perlmutter Cancer Center, New York University Medical School, New York, USA
| | - K Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Loi
- Division of Research and Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia
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Barta SK, Samuel MS, Xue X, Wang D, Lee JY, Mounier N, Ribera JM, Spina M, Tirelli U, Weiss R, Galicier L, Boue F, Little RF, Dunleavy K, Wilson WH, Wyen C, Remick SC, Kaplan LD, Ratner L, Noy A, Sparano JA. Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma. Ann Oncol 2015; 26:958-966. [PMID: 25632071 DOI: 10.1093/annonc/mdv036] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/12/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We undertook the present analysis to examine the shifting influence of prognostic factors in HIV-positive patients diagnosed with aggressive non-Hodgkin lymphoma (NHL) over the last two decades. PATIENTS AND METHODS We carried out a pooled analysis from an existing database of patients with AIDS-related lymphoma. Individual patient data had been obtained prior from prospective phase II or III clinical trials carried out between 1990 until 2010 in North America and Europe that studied chemo(immuno)therapy in HIV-positive patients diagnosed with AIDS-related lymphomas. Studies had been identified by a systematic review. We analyzed patient-level data for 1546 patients with AIDS-related lymphomas using logistic regression and Cox proportional hazard models to identify the association of patient-, lymphoma-, and HIV-specific variables with the outcomes complete response (CR), progression-free survival, and overall survival (OS) in different eras: pre-cART (1989-1995), early cART (1996-2000), recent cART (2001-2004), and contemporary cART era (2005-2010). RESULTS Outcomes for patients with AIDS-related diffuse large B-cell lymphoma and Burkitt lymphoma improved significantly over time, irrespective of baseline CD4 count or age-adjusted International Prognostic Index (IPI) risk category. Two-year OS was best in the contemporary era: 67% and 75% compared with 24% and 37% in the pre-cART era (P < 0.001). While the age-adjusted IPI was a significant predictor of outcome in all time periods, the influence of other factors waxed and waned. Individual HIV-related factors such as low CD4 counts (<50/mm(3)) and prior history of AIDS were no longer associated with poor outcomes in the contemporary era. CONCLUSIONS Our results demonstrate a significant improvement of CR rate and survival for all patients with AIDS-related lymphomas. Effective HIV-directed therapies reduce the impact of HIV-related prognostic factors on outcomes and allow curative antilymphoma therapy for the majority of patients with aggressive NHL.
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Affiliation(s)
- S K Barta
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia.
| | - M S Samuel
- Department of Medical Oncology, Montefiore Medical Center, Bronx
| | - X Xue
- Department of Epidemiology and Population Health, Albert Einstein Cancer Center, Bronx
| | - D Wang
- Department of Epidemiology and Population Health, Albert Einstein Cancer Center, Bronx
| | - J Y Lee
- Department of Biostatistics, University of Arkansas, Little Rock, USA
| | - N Mounier
- Groupe d'Etude des Lymphomes de l'Adulte (GELA), France
| | - J-M Ribera
- ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain
| | - M Spina
- Department of Medical Oncology, National Cancer Institute, Aviano, Italy
| | - U Tirelli
- Department of Medical Oncology, National Cancer Institute, Aviano, Italy
| | - R Weiss
- Private Practice for Hematology and Oncology, Bremen, Germany
| | - L Galicier
- Department of Immunology, Hopital St Louis, Assistance Publique-Hopitaux de Paris, Paris
| | - F Boue
- Department of Internal Medicine and Immunology, Hopital Antoine Beclere, Clamart, France
| | | | - K Dunleavy
- Department of Medical Oncology, National Cancer Institute, Bethesda, USA
| | - W H Wilson
- Department of Medical Oncology, National Cancer Institute, Bethesda, USA
| | - C Wyen
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - S C Remick
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown
| | - L D Kaplan
- Department of Hematology and Oncology, University of California San Francisco, San Francisco
| | - L Ratner
- Division of Oncology, Washington University School of Medicine, St Louis
| | - A Noy
- Memorial Sloan-Kettering Cancer Center and Weill Cornell, Lymphoma Service, New York, USA
| | - J A Sparano
- Department of Medical Oncology, Montefiore Medical Center, Bronx
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Salgado R, Denkert C, Demaria S, Sirtaine N, Klauschen F, Pruneri G, Wienert S, Van den Eynden G, Baehner FL, Penault-Llorca F, Perez EA, Thompson EA, Symmans WF, Richardson AL, Brock J, Criscitiello C, Bailey H, Ignatiadis M, Floris G, Sparano J, Kos Z, Nielsen T, Rimm DL, Allison KH, Reis-Filho JS, Loibl S, Sotiriou C, Viale G, Badve S, Adams S, Willard-Gallo K, Loi S. The evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer: recommendations by an International TILs Working Group 2014. Ann Oncol 2014; 26:259-71. [PMID: 25214542 DOI: 10.1093/annonc/mdu450] [Citation(s) in RCA: 1861] [Impact Index Per Article: 186.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The morphological evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer (BC) is gaining momentum as evidence strengthens for the clinical relevance of this immunological biomarker. Accumulating evidence suggests that the extent of lymphocytic infiltration in tumor tissue can be assessed as a major parameter by evaluation of hematoxylin and eosin (H&E)-stained tumor sections. TILs have been shown to provide prognostic and potentially predictive value, particularly in triple-negative and human epidermal growth factor receptor 2-overexpressing BC. DESIGN A standardized methodology for evaluating TILs is now needed as a prerequisite for integrating this parameter in standard histopathological practice, in a research setting as well as in clinical trials. This article reviews current data on the clinical validity and utility of TILs in BC in an effort to foster better knowledge and insight in this rapidly evolving field, and to develop a standardized methodology for visual assessment on H&E sections, acknowledging the future potential of molecular/multiplexed approaches. CONCLUSIONS The methodology provided is sufficiently detailed to offer a uniformly applied, pragmatic starting point and improve consistency and reproducibility in the measurement of TILs for future studies.
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Affiliation(s)
- R Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels Department of Pathology and TCRU, GZA, Antwerp, Belgium
| | - C Denkert
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - S Demaria
- Perlmutter Cancer Center, New York University Medical School, New York, USA
| | - N Sirtaine
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - F Klauschen
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - G Pruneri
- European Institute of Oncology (IEO) and University of Milan, Milan, Italy
| | - S Wienert
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - G Van den Eynden
- Department of Pathology GZA, TCRU Hospitals and CORE Antwerp University, Antwerp, Belgium
| | - F L Baehner
- Genomic Health, Inc., Redwood City, USA University of California San Francisco, San Francisco, USA
| | - F Penault-Llorca
- Clermont-Ferrand Biopathology, University of Auvergne, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
| | - E A Perez
- Division of Haematology/Medical Oncology and
| | - E A Thompson
- Department of Cancer Biology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville
| | - W F Symmans
- Department of Pathology, The UT M.D. Anderson Cancer Center, Boston
| | - A L Richardson
- Department of Pathology, Brigham and Women's Hospital, Boston Department of Cancer Biology, Dana Farber Cancer Institute, Boston
| | - J Brock
- Department of Cancer Biology, Dana Farber Cancer Institute, Boston Department of Cancer Biology, Harvard Medical School, Boston, USA
| | | | - H Bailey
- Genomic Health, Inc., Redwood City, USA
| | - M Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - G Floris
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - J Sparano
- Department of Medicine, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein Medical Center, Bronx, USA
| | - Z Kos
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto
| | - T Nielsen
- Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, Canada
| | - D L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven
| | - K H Allison
- Department of Pathology, Stanford University Medical Centre, Stanford
| | - J S Reis-Filho
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - C Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - G Viale
- Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - S Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - S Adams
- Perlmutter Cancer Center, New York University Medical School, New York, USA
| | - K Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Loi
- Division of Research and Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia
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Schneider BP, Li L, Shen F, Miller KD, Radovich M, O'Neill A, Gray RJ, Lane D, Flockhart DA, Jiang G, Wang Z, Lai D, Koller D, Pratt JH, Dang CT, Northfelt D, Perez EA, Shenkier T, Cobleigh M, Smith ML, Railey E, Partridge A, Gralow J, Sparano J, Davidson NE, Foroud T, Sledge GW. Genetic variant predicts bevacizumab-induced hypertension in ECOG-5103 and ECOG-2100. Br J Cancer 2014; 111:1241-8. [PMID: 25117820 PMCID: PMC4453857 DOI: 10.1038/bjc.2014.430] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/26/2014] [Accepted: 07/08/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Bevacizumab has broad anti-tumour activity, but substantial risk of hypertension. No reliable markers are available for predicting bevacizumab-induced hypertension. METHODS A genome-wide association study (GWAS) was performed in the phase III bevacizumab-based adjuvant breast cancer trial, ECOG-5103, to evaluate for an association between genotypes and hypertension. GWAS was conducted in those who had experienced systolic blood pressure (SBP) >160 mm Hg during therapy using binary analysis and a cumulative dose model for the total exposure of bevacizumab. Common toxicity criteria (CTC) grade 3-5 hypertension was also assessed. Candidate SNP validation was performed in the randomised phase III trial, ECOG-2100. RESULTS When using the phenotype of SBP>160 mm Hg, the most significant association in SV2C (rs6453204) approached and met genome-wide significance in the binary model (P=6.0 × 10(-8); OR=3.3) and in the cumulative dose model (P=4.7 × 10(-8); HR=2.2), respectively. Similar associations with rs6453204 were seen for CTC grade 3-5 hypertension but did not meet genome-wide significance. Validation study from ECOG-2100 demonstrated a statistically significant association between this SNP and grade 3/4 hypertension using the binary model (P-value=0.037; OR=2.4). CONCLUSIONS A genetic variant in SV2C predicted clinically relevant bevacizumab-induced hypertension in two independent, randomised phase III trials.
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Affiliation(s)
- B P Schneider
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - L Li
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - F Shen
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - K D Miller
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - M Radovich
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - A O'Neill
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - R J Gray
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - D Lane
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - D A Flockhart
- Indiana Institute for Personalized Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - G Jiang
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Z Wang
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - D Lai
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - D Koller
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - J H Pratt
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - C T Dang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - D Northfelt
- Department of Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - E A Perez
- Mayo Clinic, Jacksonville, FL 32224, USA
| | - T Shenkier
- BCCA – Vancouver Cancer Center, Vancouver, BC, V5Z 4E6, USA
| | - M Cobleigh
- Department of Internal Medicine , Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA
| | - M L Smith
- Research Advocacy Network, Plano, TX 75093, USA
| | - E Railey
- Research Advocacy Network, Plano, TX 75093, USA
| | - A Partridge
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - J Gralow
- University of Washington, Seattle, WA 98195, USA
| | - J Sparano
- Department of Oncology, Montefiore Hospital and Medical Center, Bronx, NY 10467, USA
| | - N E Davidson
- Cancer Institute and University of Pittsburgh Cancer Center, Pittsburgh, PA 15232, USA
| | - T Foroud
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - G W Sledge
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
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Somlo G, Frankel P, Luu T, Ma C, Arun B, Garcia A, Cigler T, Fleming G, Harvey H, Sparano J, Nanda R, Chew H, Moynihan T, Vahdat L, Goetz M, Hurria A, Mortimer J, Gandara D, Chen A, Weitzel J. Abstract P2-16-05: Efficacy of ABT-888 (veliparib) in patients with BRCA-associated breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-16-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The potential for exploiting BRCA deficiencies with DNA repair inhibitors has both pre-clinical and clinical support. ABT-888 (veliparib), a DNA repair inhibitor initially thought to target Poly(ADP-Ribose) Polymerases (PARP), has demonstrated in vitro inhibition of BRCA1 and BRCA2 deficient mouse embryonic stell cells, with a larger effect on BRCA1 cells. We report on the pre-planned interim analysis of the efficacy of single agent veliparib in patients with either BRCA1 or BRCA2-associated stage IV breast cancer. Methods: BRCA 1 or 2 carrier patients with stage IV breast cancer, with measurable disease, without prior exposure to a PARP inhibitor or a platinum compound in the metastatic setting, were eligible. Velapirib was administered orally, at doses of 400 mg twice daily. Dose adjustments based on toxicity were permitted. Patients progressing on velapirib alone received carboplatin at an AUC of 5, IV, given Q 21 days, and velapirib 150 mg twice daily (the maximum tolerated dose [MTD] of the combination from our completed Phase I study: J Clin Oncol 30, 2012 [suppl; abstr 1024]). Patients were to be accrued from 7 NCI NO1- supported consortia. Initially 10 patients were to be accrued to each stratum (BRCA1 and BRCA2) to provide evidence of single agent activity. If there was sufficient activity to warrant consideration of velapirib as single agent therapy (defined as 2 or more confirmed partial [PR] or better responses out of 10 per stratum), an additional 12 patients would be accrued per stratum. Results: 20 evaluable patients (11 BRCA1 and 9 BRCA2 [1 in screening]) have been accrued, the majority with lung or liver as visceral metastatic sites of disease. Median age (range) is 46 (29-68) years. Tumors from 9 patients were hormone receptor positive. BRCA1 cohort: 4 of 11 patients are off treatment at a median of 2 months (1-4); 1 patient stopped velapirib due to toxicity (grade 2 rash/pruritus, grade 2 vomiting), 3 stopped for progressive disease (one with an unconfirmed PR). Seven patients are still on single agent veliparib with 1 unconfirmed PR, and 1 patient with two evaluations showing stable disease. BRCA2 cohort: 2 patients are off treatment at 2 months for progressive disease, 7 are still on treatment with 1 confirmed PR, and 3 unconfirmed PRs. Data on patients receiving combination of velapirib and carboplatin after progression is too early. Treatment-related toxicity is being updated and has so far been reported from 14 patients: 1 patient had grade 3 fatigue, 1 patient with liver metastasis had both grade 3 alanine aminotransferase elevation and grade 3 abdominal pain. Grade 2 toxicities occurring in more than 1 patient included nausea/vomiting (6 patients), chills (2 patients), and fatigue (2 patients). Conclusion: Velapirib has single agent activity in both BRCA1 and BRCA2-associated stage IV breast cancer patients, and is well-tolerated. Mature response, treatment, and toxicity data will be presented.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-16-05.
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Affiliation(s)
- G Somlo
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - P Frankel
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - T Luu
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - C Ma
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - B Arun
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - A Garcia
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - T Cigler
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - G Fleming
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - H Harvey
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - J Sparano
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - R Nanda
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - H Chew
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - T Moynihan
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - L Vahdat
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - M Goetz
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - A Hurria
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - J Mortimer
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - D Gandara
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - A Chen
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - J Weitzel
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
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Janakiram M, Zhang L, White R, Ayyappan S, Sparano J. Abstract P1-08-08: Tumor infiltrating lymphocytes (TILs) in breast cancer: A meta-analysis of response to neoadjuvant chemotherapy based on TIL status. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-08-08] [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:
TILs involving tumor and/or its associated stroma may be indicative of an immune response that may either facilitate anti-tumor immunity and clearance or immune tolerance and evasion. In this study we performed a meta-analysis evaluating the relationship between TILs and pathologic response to neoadjuvant chemotherapy (NAC) since this is considered as a surrogate endpoint of disease outcomes in ER negative or Her2 positive tumors.
Methods:
We searched PubMed and Embase (1991-May 2013), and ASCO abstracts (2009-2012), using a combination of free text search and controlled vocabulary search. We identified 1147 reports which met our initial search criteria, and they were reviewed to identify those which met the following criteria: (1) evaluated the presence of TILs, defined as tumor and/or stromal lymphocytes (CD4, CD8 or FOXP3) identified by H&E, IHC or gene expression before NAC, (2) classified TIL's “high/low” or “positive/negative”, and (3) correlated TILs with pathological complete response (pCR) or near pCR after NAC. Standard anthracycline-containing regimens were used as NAC in most studies, and anti-HER2 therapy was not used in most studies with HER2-positive disease. Results are presented as pooled odds ratios (OR) with 95% confidence intervals (CI), based on random-effects (to account for between study variance and heterogeneity due to different cutoffs and subtypes of T lymphocytes). Sensitivity analysis was done and publication bias was investigated using a funnel plot. We employed the Chi(2) test and calculated the I(2) statistic to investigate study heterogeneity. Meta-analysis statistics were calculated using StatsDirect Version 2.7.9.
Results:
Seven studies including 1641 patients met our criteria for inclusion in this analysis. A TIL ratio classified as either high or positive was associated with a significantly higher likelihood of achieving a pCR/near pCR after NAC (OR 3.68; 95% CI 1.93–7.01. p<0.0001) [Table 1]. This effect was driven mainly by a difference in ER negative tumors (OR 4.04, 95% CI 2.16-7.57. p<0.0001) and Her2 positive tumors (OR 5.61, 95% CI 1.8–17.47, p = 0.0007); the association was present, but nonsignificant, in ER positive tumors (OR 2.17, 95% CI 0.95-4.98). Sensitivity analyses did not change the inference. Funnel plots suggested low likelihood of publication bias (Harbord Egger test, p = 0.604) for all studies, and the I(2) statistic was 67.5%.
Table 1. Characteristics and Odds ratio for individual subtypesSubtypeNNo of studiesTIL low pCR%TIL high pCR%OR95% CIAll1641712.5%28.6%3.681.93 -7.01ER-/PR- and HER2- [except one study defined by ER-/PR-]403423.6%41.3%4.042.16 - 7.57Her2+326316.9%23.4%5.611.80 - 17.47ER/PR+55825.6%11.5%2.170.95 - 4.98
Conclusions:
In this systematic review and meta-analysis, high or positive TIL status before NAC was associated with a significantly better pathologic response to NAC (surrogate for DFS and OS), particularly in patients with ER/PR-negative or HER2-overexpressing disease. Patients with tumors characterized by low or absent TILs require novel therapeutic approaches, and may be candidates for immunotherapeutic approaches to enhance innate immunity or reverse immune tolerance.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-08.
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Affiliation(s)
- M Janakiram
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY; Case Western Reserve University, Cleveland, OH
| | - L Zhang
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY; Case Western Reserve University, Cleveland, OH
| | - R White
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY; Case Western Reserve University, Cleveland, OH
| | - S Ayyappan
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY; Case Western Reserve University, Cleveland, OH
| | - J Sparano
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Bronx, NY; Case Western Reserve University, Cleveland, OH
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Sparano JA. Abstract YR02: Clinical – Early breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-yr02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The past year has brought several major changes in the management of early stage breast cancer. First was evidence from two randomized phase III trials, including ATLAS (Lancet. 2013: 9; 381) and aTTom (ASCO 2013; abstract 5), that extending the duration of adjuvant tamoxifen therapy from 5 to 10 years reduced the risk of breast cancer recurrence, breast cancer mortality, and overall mortality. A pooled analysis of the 17,477 patients enrolled both trials showed that for patients who took tamoxifen for 10 years, although there was no benefit in years 5-9 during tamoxifen therapy, there was a 25% reduction in breast cancer mortality beginning at year 10 (hazard ratio [HR] 0.75, 95% CI 0.65-0.86; p = 0.00004) and a 16% reduction overall mortality (HR 0.84, 95% CI 0.77-0.93; p = 0.0007). Although there was an increase in the risk of endometrial cancer in ATLAS (2.20, p<0.0001) and aTTom (1.83, p = 0.02), there were far fewer excess endometrial cancers and deaths than breast cancer recurrences and deaths that were prevented. In other news regarding adjuvant endocrine therapy, an analysis of the BIG1-98 trial comparing letrozole with tamoxifen demonstrated that letrozole improved was superior in lobular carcinoma and luminal B ductal carcinoma, indicating that the benefits of letrozole over tamoxifen overall were driven by the benefits seen in these groups (SABCS 2012, abstract S1-1). Regarding other forms of systemic therapy, the GeparSixto trial showed that the additional of carboplatin significantly improved the pathologic complete response rate in patients with triple negative breast cancer when added to an anthracyclines-taxane neoadjuvant regimen (ASCO 2013, abstract 1004), the S0221 trial showed that standard dose biweekly paclitaxel was associated with more neurotoxicity when compared with adjuvant weekly paclitaxel without a reduction in the risk of recurrence (ASCO 2013, CRA1008), and the BEATRICE trial showed no benefit from adding bevacizumab to adjuvant chemotherapy (Lancet Oncol 2013;14:933). Regarding surgical therapy, two studies evaluated the role of sentinel node biopsy after neoadjuvant chemotherapy, including the SENTINA trial (Lancet Oncol 2013; 14: 609) and the Z1071 trial (SABCS 2012, abstract S2-1), revealing lower sentinel node detection rates (80% and 92%, respectively) and higher false negative rates (14.2% and 12.6%, respectively) than typically observed in patients not previously treated with neoadjuvant chemotherapy. Another trial (AMAROS 2013, LBA 1001) showed similar locoregional control rates when axillary radiation was compared with axillary dissection following a positive positive sentinel node biopsy, with less lymphedema associated with axillary dissection. Finally, the U.S. Food and Drug Administration (FDA) granted accelerated approval for the use of pertuzumab in combination with trastuzumab and docetaxel for neoadjuvant therapy based upon the results of the NeoSPHERE trial (Lancet Oncol 2012;13:25), the first drug to receive approval under the FDA's new guidance accepting pathologic complete response rate as an endpoint supporting accelerated approval, with full approval conditional on improved event free survival being demonstrated with additional followup in the same trial, or in other trials (N Eng J Med 2012:366;2438).
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr YR02.
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Affiliation(s)
- JA Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine
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Pothuri B, Sparano J, Blank S, Curtin J, Chuang E, Hershman D, Tiersten A, Liebes L, Chen A, Muggia F. Phase I study of the PARP inhibitor ABT-888 (veliparib) and pegylated liposomal doxorubicin (PLD) in recurrent ovarian (ov) and breast (br) cancers. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Andreopoulou E, Chen AP, Zujewski JA, Kalinsky K, Vahdat L, Raptis G, Hershman D, Novic Y, Muggia F, Sparano J. OT3-01-17: Randomized, Double-Blind, Placebo-Controlled Phase II Trial of Low-Dose Metronomic Cyclophosphamide Alone or in Combination with Veliparib (ABT-888) in Chemotherapy-Resistant ER and/or PR-Positive, HER2/neu-Negative Metastatic Breast Cancer: New York Cancer Consortium Trial P8853. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot3-01-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Veliparib is an orally available, small molecule inhibitor of poly(ADP-ribose) polymerase (PARP). PARP is an essential nuclear enzyme that plays a role in recognition of DNA damage and facilitation of DNA repair. PARP inhibitors potentiate the cytotoxicity of DNA-damaging agents, including cyclophosphamide (C). The rationale for the proposed trial is as follows: (1) low-dose, continuous metronomic C (50 mp PO daily) has activity in refractory metastatic breast cancer (MBC), (2) PARP is induced by DNA damaging agents, (3) PARP expression is comparable in ER-positive and ER-negative disease, (4) some ER-positive breast cancers exhibit defective homologous recombination pathway repair genes (eg, RAD51 and XRCC3), (5) the PARP inhibitor iniparib appears to be more effective when used in chemotherapy resistant disease. Taken together, these findings suggest that veliparib-C combination may be more effective than metronomic C alone in chemotherapy resistant MBC. Trial design: A randomized Phase II trial design 1:1. S. Blocked randomization will be performed at all participating sites. Patients are randomized to oral C (50mg PO daily) plus either veliparib (60mg PO daily) or matching placebo.
Eligibility criteria:(1) ER- and or PR-positive, HER2−negative MBC, (2) ECOG PS 0–1, (3) at least 2 prior chemotherapy regimens for MBC, including a taxane and capecitabine. 4) at least 1 line of endocrine therapy for metastatic disease (includes relapse while receiving endocrine therapy).
Specific aims: Primary: To determine if the addition of veliparib to metronomic dose C improves median progression free survival (PFS) compared with C alone in patients with ER and/or PR-positive, Her2-negative MBC who progressed on at least two lines of prior chemotherapy and one line of prior endocrine therapy.
Secondary: 1)To determine if the addition veliparib to C chemotherapy improves a) response rate b) clinical benefit rate (defined as objective response plus stable disease for at least 24 weeks from day +1) 2) Survival in patients treated with C alone and C plus veliparib. 3) Adverse event profile in patients treated with C alone and C plus veliparib.
Translational: Exploratory analyses will evaluate whether the macroH2A1.1 and PARP1 expression status in archival paraffin, or veliparib-induced PAR downregulation in peripheral blood mononuclear cells, is predictive of benefit from veliparib.
Statistical methods: The primary endpoint is PFS, and the trial is powered to detect an increase in median PFS from 3 to 6 months (alpha=0.10, beta=0.10), which will require enrollment of 62 eligible patients over 12 months.
Enrollment: The study is active and open to enrollment.
Clinical trials.gov NCT01351909
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT3-01-17.
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Affiliation(s)
- E Andreopoulou
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - AP Chen
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - JA Zujewski
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - K Kalinsky
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - L Vahdat
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - G Raptis
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - D Hershman
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - Y Novic
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - F Muggia
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - J Sparano
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
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Adelson KB, Raptis G, Sparano J, Germain D. OT3-01-01: Randomized Phase II Study of Fulvestrant Versus Fulvestrant Plus Bortezomib in Postmenopausal Women with Estrogen Receptor (ER) Positive, Aromatase-Inhibitor (AI) Resistant Metastatic Breast Cancer (MBC): New York Cancer Consortium Trial P8457. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot3-01-01] [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: Bortezomib ia proteasome inhibitor that enhances fulvestrant-mediated aggregation of the ER in the cytoplasm without blocking ER degradation in the nucleus in ER+ human breast cancer cell lines, thereby promoting cytoplasmic ER aggresomes which activate a sustained unfolded protein response leading to apoptotic cell death; the combination also induces tumor regression in a tamoxifen resistant T47D-cyclin D1 xenograft model more effectively than either agent alone (Clin Cancer Res 2011; 17: 2292–2300).
Hypothesis: We hpothesize that the combination of fulvestrant and bortezomib will be more effective than fulvestrant alone in ER+, AI-resistant MBC.
Trial design: This is an open-label randomized phase II design in which patients with MBC are randomized to receive fulvestrant alone (500 mg IM day −14, day +1, and day +14 during cycle 1, then 500 mg every 4 weeks on day +1 during cycle 2 and thereafter) or in combination with bortezomib (1.6 mg/m2 IV days +1, +8, +15 every cycle). Stratification factors for randomization include performance status (ECOG 0 vs. 1–2), measurable disease (yes vs. no), and prior chemotherapy for MBC (yes vs. no). Patients who progress on fulvestrant alone may cross over to the combination.
Eligibility criteria: Postmenopausal women with ER+, Her2-negative, MBC who have progressive disease during AI therapy for metastatic disease, or relapse while receiving adjuvant AI therapy. Up to one prior chemotherapy regimen for metastatic disease is permitted.
Specific aims: Primary Objective: To determine if the addition of bortezomib to fulvestrant significantly improves median progression-free survival (PFS), defined as the time from cycle 1, day 1 of therapy until disease progression or death from any cause.
Secondary Objectives: To determine: (1) adverse event rates in both arms, (2) the clinical benefit rate (CBR — objective response [by RECIST 1.1] and/or progression free at 24 weeks), (3) the objective response and CBR after crossover from fulvestrant to fulvestrant plus bortezomib.
Translational Objectives: To perform an exploratory analysis of the effects of the combination on intratumoral nuclear/cytoplasmic ER ratio, unfolded protein response (BiP), apoptotis (cleaved caspase 3, Bc1-2 phospho JNK.)
Statistical methods: he median PFS for patients receiving fulvestrant alone is expected to be approximately 5.4 months based upon patients with AI-resistant disease enrolled on the CONFIRM trial ( J Clin Oncol 2010; 28: 4594–4600). The trial is designed to detect a 70% improved in median PFS to 9.0 months (alpha=0.10, beta =0.10), which will require 59 eligible patients in each arm.
Present accrual and target accrual: 24/118
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT3-01-01.
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Affiliation(s)
- KB Adelson
- 1Mount Sinai School of Medicine, New York, NY; Albert Einstein Cancer Center, Bronx, NY
| | - G Raptis
- 1Mount Sinai School of Medicine, New York, NY; Albert Einstein Cancer Center, Bronx, NY
| | - J Sparano
- 1Mount Sinai School of Medicine, New York, NY; Albert Einstein Cancer Center, Bronx, NY
| | - D Germain
- 1Mount Sinai School of Medicine, New York, NY; Albert Einstein Cancer Center, Bronx, NY
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Tevaarwerk AJ, Gray R, Schneider BP, Smith ML, Wagner LI, Miller KD, Sparano JA. P1-08-01: Survival in Metastatic Breast Cancer (MBC): No Evidence for Improved Survival Following Distant Recurrence after Adjuvant Chemotherapy. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-08-01] [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
Population-based studies have suggested improved survival for patients diagnosed with MBC in recent years, presumably due to the availability of new and more effective therapies (Chia et al. Cancer 2007; Dawood et al. JCO, 2008). The objective of this analysis was to determine if survival improved for patients who participated in Eastern Cooperative Oncology Group (ECOG) adjuvant trials and later developed MBC.
Methods: Adjuvant trials coordinated by the ECOG that accrued patients between 1978 and 2002 were reviewed (n=12), which included followup until 2010. Cytotoxic and biologic agents approved for MBC during this time included paclitaxel (1994), capecitabine and trastuzumab (1998), docetaxel and gemcitabine (2004), lapatinib and ixabepilone (2007), and bevacizumab (2008). Survival following distant recurrence was estimated for 4 time periods ranging from 6–10 years, and adjusted for baseline covariates in a Cox proportional hazards model. Because distant relapse free interval (DRFI) was the covariate most strongly associated with survival after recurrence, and the potential for “gap time” bias this could introduce, logrank tests for other covariates and estimates of effects were computed stratified on DRFI (0-3, >3-6, > 6 years). HER2 status was not routinely available and thus not included.
Results: The 12 trials included 14,752 patients (93% received adjuvant chemotherapy); 3711 (25.2%) developed distant recurrence. Median survival after distant recurrence was 20 months; the estimated 5 and 10-year survival rates were 16.3% and 6.1%, respectively. Median survival by time period is shown in the table, stratified by DRFI. Median survival did not significantly change over time by DRFI (≤3 years, p=0.15; >3 yr, p=0.57). In a Cox proportional hazards model, factors associated with inferior survival after adjusting for other covariates included shorter DRFI (<3 years vs. 3–6 years — hazard ratio [HR] 1.60, p<0.001, and > 6 vs. < 3 years — HR 2.23, p <0.001), ER-negative disease (HR 1.30, p<0.001), PR-negative disease (HR 1.36, P<0.0001), number of positive axillary nodes at diagnosis (1-3 vs. 0 nodes — HR 1.28, 4–9 vs. 0 nodes — HR 1.51, > 9 vs. 0 nodes — HR 1.51, p<0.0001), and black vs. white race (HR 1.29, p=0.0003), but not age at recurrence (p=0.07). When the year of recurrence was added to the Cox proportional hazards model using the intervals shown in the table below, it was not significantly associated with survival. Results were similar when 1978–2010 was assessed by 5–6 year intervals.
Conclusions: In contrast to reports from population-based studies, we do not observe any improvement in survival over time for patients who develop distant recurrence after adjuvant chemotherapy. There remains a critical unmet need for new therapies for MBC, especially for those who recur after adjuvant chemotherapy.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-01.
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Affiliation(s)
- AJ Tevaarwerk
- 1University of Wisconsin-Carbone Cancer Center; Indiana University-Simon Cancer Center; Northwestern University, Chicago, IL; Dana-Farber Cancer Institute; Research Advocacy Network; Albert Einstein University-Montefiore Medical Center
| | - R Gray
- 1University of Wisconsin-Carbone Cancer Center; Indiana University-Simon Cancer Center; Northwestern University, Chicago, IL; Dana-Farber Cancer Institute; Research Advocacy Network; Albert Einstein University-Montefiore Medical Center
| | - BP Schneider
- 1University of Wisconsin-Carbone Cancer Center; Indiana University-Simon Cancer Center; Northwestern University, Chicago, IL; Dana-Farber Cancer Institute; Research Advocacy Network; Albert Einstein University-Montefiore Medical Center
| | - ML Smith
- 1University of Wisconsin-Carbone Cancer Center; Indiana University-Simon Cancer Center; Northwestern University, Chicago, IL; Dana-Farber Cancer Institute; Research Advocacy Network; Albert Einstein University-Montefiore Medical Center
| | - LI Wagner
- 1University of Wisconsin-Carbone Cancer Center; Indiana University-Simon Cancer Center; Northwestern University, Chicago, IL; Dana-Farber Cancer Institute; Research Advocacy Network; Albert Einstein University-Montefiore Medical Center
| | - KD Miller
- 1University of Wisconsin-Carbone Cancer Center; Indiana University-Simon Cancer Center; Northwestern University, Chicago, IL; Dana-Farber Cancer Institute; Research Advocacy Network; Albert Einstein University-Montefiore Medical Center
| | - JA Sparano
- 1University of Wisconsin-Carbone Cancer Center; Indiana University-Simon Cancer Center; Northwestern University, Chicago, IL; Dana-Farber Cancer Institute; Research Advocacy Network; Albert Einstein University-Montefiore Medical Center
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Horak CE, Alexe G, Baselga J, Vahdat LT, Valero V, Xing G, Mukhopadhyay P, Opatt DM, Sparano J. Activity of ixabepilone and PARP inhibitors in triple-negative breast cancer (TNBC) based on gene expression. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.601] [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: 11/20/2022] Open
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Valero V, Bosserman LD, Yardley DA, Roche HH, Thomas E, Vahdat LT, Mukhopadhyay P, Opatt DM, Peck RA, Sparano J. Maintenance of clinical efficacy following dose reduction of ixabepilone plus capecitabine (Cape) in patients (pts) with anthracycline (A) and taxane (T) pretreated (pretx) metastatic breast cancer (MBC): A retrospective analysis of pooled data from two phase III clinical studies (046/048). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chuang E, Wiener N, Christos P, Kessler R, Cobham M, Donovan D, Goldberg GL, Caputo T, Doyle A, Vahdat L, Sparano JA. Phase I trial of ixabepilone plus pegylated liposomal doxorubicin in patients with adenocarcinoma of breast or ovary. Ann Oncol 2010; 21:2075-2080. [PMID: 20357034 DOI: 10.1093/annonc/mdq080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ixabepilone is a semisynthetic epothilone B analogue that is active in taxane-resistant cell lines and has shown activity in patients with refractory breast and ovarian cancer. We carried out a phase I trial of ixabepilone plus pegylated liposomal doxorubicin (PLD) in patients with advanced taxane-pretreated ovarian and breast cancer. METHODS Patients with recurrent ovarian or breast carcinoma received PLD every 3 or 4 weeks plus five different dose schemas of ixabepilone in cohorts of three to six patients. RESULTS Thirty patients received a total of 142 treatment cycles of the PLD-ixabepilone combination. The recommended phase II dose and schedule of ixabepilone was 16 mg/m(2) on days 1, 8, and 15 plus PLD 30 mg/m(2) given on day 1, repeated every 4 weeks. Hand-foot syndrome and mucositis were dose limiting when both ixabepilone and PLD were given every 3 or 4 weeks. Objective responses were observed in 3 of 13 patients (23%) with breast cancer and 5 of 17 patients (29%) with ovarian cancer. CONCLUSION Ixabepilone may be safely combined with PLD, but tolerability is highly dependent upon the scheduling of both agents. This combination demonstrated efficacy in patients with breast and ovarian cancer and merits further evaluation in these settings.
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Affiliation(s)
| | | | - P Christos
- Division of Biostatistics and Epidemiology, Department of Public Health, Weill Cornell Medical College, New York, NY
| | | | | | | | - G L Goldberg
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - T Caputo
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - A Doyle
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | | | - J A Sparano
- Department of Medicine and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Sparano J, Gray R, Goldstein L, Childs B, Brassard D, Bugarini R, Rowley S, Baker J, Shak S, Badve S, Baehner F, Kenny P, Perez E, Shulman L, Martino S, Sledge G, Davidson N. Gene Expression Profiling of Phenotypically-Defined Hormone-Receptor Positive Breast Cancer: Evidence for Increased Transcriptional Activity of the Insulin Growth Factor Receptor Pathway and Other Pathways. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-5165] [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: Approximately 70% of all breast cancers are hormone receptor (HR)-positive tumors that are sensitive to endocrine therapy, but some patients have recurrence despite adjuvant endocrine therapy. We performed an exploratory analysis of gene expression in HR-pos operable breast cancer in order to identify potential novel therapeutic targets and biomarkers associated with recurrence. Methods: RNA was extracted from primary tumor samples obtained from 776 patients with stage I-III breast cancer treated with adjuvant chemohormonal therapy in trial E2197 (JCO 2008; 26: 4092-4099), of whom 458 had HR-pos disease (defined in a central lab; JCO 2008; 26: 2473). We evaluated RNA expression patterns (by quantitative RT-PCR using a panel of 371 rationally selected genes) in HR-pos cases compared with the HR-neg cases using weighted T statistics, and determined which genes in the HR-pos, HER2-neg group were associated with recurrence (using Cox proportional hazards model score test, Korn's adjusted P value <5% with false discovery rate < 10%).Results: The top 10 genes exhibiting significantly higher expression in the HR-pos group (p≤ 6.17e-160) included ESR1 plus 5 estrogen regulated genes, confirming our approach of evaluating gene expression in phenotypically-defined subsets. Other pathways that exhibited higher expression in the HR-pos group (among the 40 top genes with higher expression, p<8.66e-53) included the insulin growth factor (IGF) (IRS1, IGFR1, IGFB2), Ras (RhoB, RhoC, RAB27B, GGPS1), and HER pathways (ERBB2, ERBB3, ERBB4), and other genes involved in apoptosis (BCL2, BCL2L1, BAG1, NME6, BBC3), signaling (MAPK3, SEMA3F, RXRA), mismatch repair (MSH3), cell cycle regulation (CCND1), stress response (HSPB1), and tumor suppressor genes (TP53BP1, APC). These patterns were similar in HER2-pos cases. Pathway analysis (Ingenuity) revealed substantial interconnectivity among these genes, especially between IGFR1, ERB2/3/4, MAPK3, BCL2, and CCND1, but not RhoB/RhoC. Genes for which increased expression was associated with increased recurrence included those associated with proliferation (TOP2A, AURKB, PLK1) and apoptosis (BIRC5 - survivin).Conclusions: This exploratory analysis reveals several pathways that exhibit higher transcriptional expression in HR-pos disease, some of which are also associated with a higher risk of recurrence, suggesting that they may be potential therapeutic targets. This provides rationale for testing agents currently available in the clinic that inhibit the IGF and other pathways.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5165.
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Affiliation(s)
- J. Sparano
- 1Eastern Cooperative Oncology Group, MA,
| | - R. Gray
- 1Eastern Cooperative Oncology Group, MA,
| | | | | | | | | | | | | | | | - S. Badve
- 1Eastern Cooperative Oncology Group, MA,
| | | | - P. Kenny
- 1Eastern Cooperative Oncology Group, MA,
| | - E. Perez
- 4North Central Cancer Treatment Group, MN,
| | | | | | - G. Sledge
- 1Eastern Cooperative Oncology Group, MA,
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Sparano J, Zhuang S, Londhe A, Lantz K, Lowery C. Relationship of Anthracycline-Free Interval to Outcomes in a Phase 3 Trial of Pegylated Liposomal Doxorubicin Plus Docetaxel Compared with Docetaxel Monotherapy in Patients with Advanced Breast Cancer Treated with Adjuvant Anthracycline. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-2095] [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: An earlier report showed that pegylated liposomal doxorubicin (PLD) + docetaxel (D) improved time to progression (TTP) vs D alone in patients (pts) with advanced breast cancer (ABC) who had relapsed at least 1 year after adjuvant or neoadjuvant anthracycline therapy. (Sparano et al., SABC 2008, #80) This analysis evaluated whether the time between completion of adjuvant anthracycline therapy until relapse impacts overall outcome. We retrospectively examined outcomes in pts with an anthracycline-free (A-F) interval of 1 to 2 years and pts with an A-F of >2 years.Methods: 751 pts were randomly assigned to receive either D 75 mg/m2 (N=373) or PLD 30 mg/m2 followed by D 60 mg/m2 (N=378) every 21 days. Treatment was continued until disease progression or the occurrence of unacceptable toxicity. The primary endpoint was TTP and secondary endpoints included overall survival (OS), progression free survival (PFS), objective response rate (ORR), and safety. Pts were categorized into groups by anthracycline-free interval of 1-2 years or >2 years. Relationship between the interval and outcomes was examined by proportional hazards model for TTP, OS (updated as of 1-Dec-2008), and PFS.Results: Approximately 60% of pts in both treatment groups had A-F intervals of >2 years. Median TTP, OS, and PFS (months) by A-F interval groups are listed in the Table. A-F interval 1-2 years A-F interval >2 years D, n=151PLD+D, n=155HR (CI)*; P**D, n=221PLD+D, n=221HR (CI)*; P**TTP5.77.80.67 (0.52, 0.87); .0027.710.60.63 (0.50, 0.79); <.001OS15.817.90.90 (0.69, 1.16); .40424.722.91.10 (0.86, 1.40); .448PFS5.57.70.67 (0.52, 0.87); .0027.710.00.65 (0.51, 0.81); <.001ORR25%34%P=.086†27%36%P=.042† A-F interval 1-2 years, N=306 A-F interval >2 years, N=442 HR (CI)***; P**TTP6.6 8.9 0.74 (0.63, 0.88); .001OS17.2 23.4 0.63 (0.52, 0.75); <.001PFS6.5 8.7 0.74 (0.62, 0.87); <.001ORR30% 31% P=.826†*Proportional hazard model for PLD+D vs D; **Log-rank test; ***Proportional hazard model for >2 years vs ≤2 years A-F; †Cochran-Mantel-Haenszel test.Overall, HFS and stomatitis occurred more often in pts treated with PLD+D. The overall incidence of CHF was 1%.Conclusions: An A-F interval of >2 years reduced the risk for TTP, OS, and PFS, regardless of treatment. However, similar to results of the overall study, treatment with the combination PLD+D resulted in statistically significant improvement of TTP and PFS, but not OS, compared with D among pts with ABC, regardless of A-F interval. The addition of PLD to a D-based regimen is an active option for pts with ABC previously treated with adjuvant anthracycline regimens.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2095.
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Affiliation(s)
- J. Sparano
- 1Albert Enstein College of Medicine, NY,
| | | | - A. Londhe
- 3Centocor Ortho Biotech Services, LLC, PA,
| | - K. Lantz
- 3Centocor Ortho Biotech Services, LLC, PA,
| | - C. Lowery
- 3Centocor Ortho Biotech Services, LLC, PA,
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Chadburn A, Chiu A, Lee Y, Chen X, Hyjek E, Banhmam A, Noy A, Kaplan A, Sparano J, Bhatia K, Cesarman E. Immunophenotypic analysis of AIDS-related diffuse large B-cell lymphoma and clinical implications in patients from AIDS malignancies consortium clinical trials 010 and 034. Infect Agent Cancer 2009. [PMCID: PMC4261764 DOI: 10.1186/1750-9378-4-s2-p14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mayer E, Baurain J, Sparano J, Strauss L, Campone M, Fumoleau P, Rugo H, Awada A, Sy O, Llombart A. Dasatinib in advanced HER2/neu amplified and ER/PR-positive breast cancer: Phase II study CA180088. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1011 Background: SRC family kinases (SFKs) are involved in numerous signaling pathways including from ER and HER-2 receptors, as well as osteoclast function. Dasatinib is a potent oral inhibitor of SFKs. A phase II trial was performed in patients (pts) with ER+ and/or PR+ and/or HER-2-amplified progressive advanced breast cancer. Subsequent to study initiation, dasatinib demonstrated similar efficacy with a lower incidence of key side-effects at 100 mg once daily in CML and prostate cancer. Methods: Pts with measurable disease and progression after chemotherapy and other targeted agents were treated with dasatinib on a continuous twice-daily (BID) schedule; RECIST-defined response rate was primary endpoint. Results: Sixty-eight pts, 24 with HER-2-amplified and 44 with HER-2-normal, ER+ and/or PR+ disease, were treated. Original starting dose of 100 mg BID (23 pts) was reduced to 70 mg BID (45 pts) due to fluid retention, fatigue, or GI toxicity. Median age was 55 years; nearly all pts (93%) had prior therapy in advanced setting. 59 were radiographically-evaluable (8 discontinued for toxicity and 1 inevaluable). We observed 3 partial responses lasting 9, 9 and 8+ mos plus 6 stable disease ≥16 weeks (range 24–33 wks). All 9 controlled tumors were ER/PR+, 2 were also HER-2-amplified; thus, disease control rate was 19% in the 47 radiographically-evaluable pts with ER/PR+ disease. Median dose intensity was 136 mg/day at 70 mg BID and 175 mg/day at 100 mg BID; median duration of therapy was 1.8 mos in both dose groups. Most pts (75%) discontinued for disease progression. The most common drug-related AEs were diarrhea (49%), headache (34%), nausea (34%), asthenia (32%), pleural effusion (31%), musculoskeletal pain (25%), and vomiting (24%). Drug-related grade 3–4 AEs were reported in 37% of pts and comparable between doses, but related serious AEs were less frequent at 70 mg BID than 100 mg BID (16% vs 26%). Grade 3–4 laboratory abnormalities were uncommon. PK and biomarker analyses will be presented. Conclusions: Encouraging single-agent activity was observed with dasatinib in pts with advanced ER+ breast cancers. Future studies will address the combination of dasatinib with hormonal therapies using a better-tolerated once daily schedule. [Table: see text]
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Affiliation(s)
- E. Mayer
- Dana-Farber Cancer Institute, Boston, MA; Oncologie Médicale Cliniques Universitaires St-Luc, Brussels, Belgium; Montefiore-Einstein Cancer Center, New York, NY; Bristol-Myers Squibb, Wallingford, CT; Centre de Lutte contre le Cancer Nantes-Atlantique, Saint Herblain, France; Centre George-François Leclerc, Dijon, France; University of California, San Francisco, San Francisco, CA; Jules Bordet Institute, Brussels, Belgium; Hospital Arnau Vilanova, Lleida, Spain
| | - J. Baurain
- Dana-Farber Cancer Institute, Boston, MA; Oncologie Médicale Cliniques Universitaires St-Luc, Brussels, Belgium; Montefiore-Einstein Cancer Center, New York, NY; Bristol-Myers Squibb, Wallingford, CT; Centre de Lutte contre le Cancer Nantes-Atlantique, Saint Herblain, France; Centre George-François Leclerc, Dijon, France; University of California, San Francisco, San Francisco, CA; Jules Bordet Institute, Brussels, Belgium; Hospital Arnau Vilanova, Lleida, Spain
| | - J. Sparano
- Dana-Farber Cancer Institute, Boston, MA; Oncologie Médicale Cliniques Universitaires St-Luc, Brussels, Belgium; Montefiore-Einstein Cancer Center, New York, NY; Bristol-Myers Squibb, Wallingford, CT; Centre de Lutte contre le Cancer Nantes-Atlantique, Saint Herblain, France; Centre George-François Leclerc, Dijon, France; University of California, San Francisco, San Francisco, CA; Jules Bordet Institute, Brussels, Belgium; Hospital Arnau Vilanova, Lleida, Spain
| | - L. Strauss
- Dana-Farber Cancer Institute, Boston, MA; Oncologie Médicale Cliniques Universitaires St-Luc, Brussels, Belgium; Montefiore-Einstein Cancer Center, New York, NY; Bristol-Myers Squibb, Wallingford, CT; Centre de Lutte contre le Cancer Nantes-Atlantique, Saint Herblain, France; Centre George-François Leclerc, Dijon, France; University of California, San Francisco, San Francisco, CA; Jules Bordet Institute, Brussels, Belgium; Hospital Arnau Vilanova, Lleida, Spain
| | - M. Campone
- Dana-Farber Cancer Institute, Boston, MA; Oncologie Médicale Cliniques Universitaires St-Luc, Brussels, Belgium; Montefiore-Einstein Cancer Center, New York, NY; Bristol-Myers Squibb, Wallingford, CT; Centre de Lutte contre le Cancer Nantes-Atlantique, Saint Herblain, France; Centre George-François Leclerc, Dijon, France; University of California, San Francisco, San Francisco, CA; Jules Bordet Institute, Brussels, Belgium; Hospital Arnau Vilanova, Lleida, Spain
| | - P. Fumoleau
- Dana-Farber Cancer Institute, Boston, MA; Oncologie Médicale Cliniques Universitaires St-Luc, Brussels, Belgium; Montefiore-Einstein Cancer Center, New York, NY; Bristol-Myers Squibb, Wallingford, CT; Centre de Lutte contre le Cancer Nantes-Atlantique, Saint Herblain, France; Centre George-François Leclerc, Dijon, France; University of California, San Francisco, San Francisco, CA; Jules Bordet Institute, Brussels, Belgium; Hospital Arnau Vilanova, Lleida, Spain
| | - H. Rugo
- Dana-Farber Cancer Institute, Boston, MA; Oncologie Médicale Cliniques Universitaires St-Luc, Brussels, Belgium; Montefiore-Einstein Cancer Center, New York, NY; Bristol-Myers Squibb, Wallingford, CT; Centre de Lutte contre le Cancer Nantes-Atlantique, Saint Herblain, France; Centre George-François Leclerc, Dijon, France; University of California, San Francisco, San Francisco, CA; Jules Bordet Institute, Brussels, Belgium; Hospital Arnau Vilanova, Lleida, Spain
| | - A. Awada
- Dana-Farber Cancer Institute, Boston, MA; Oncologie Médicale Cliniques Universitaires St-Luc, Brussels, Belgium; Montefiore-Einstein Cancer Center, New York, NY; Bristol-Myers Squibb, Wallingford, CT; Centre de Lutte contre le Cancer Nantes-Atlantique, Saint Herblain, France; Centre George-François Leclerc, Dijon, France; University of California, San Francisco, San Francisco, CA; Jules Bordet Institute, Brussels, Belgium; Hospital Arnau Vilanova, Lleida, Spain
| | - O. Sy
- Dana-Farber Cancer Institute, Boston, MA; Oncologie Médicale Cliniques Universitaires St-Luc, Brussels, Belgium; Montefiore-Einstein Cancer Center, New York, NY; Bristol-Myers Squibb, Wallingford, CT; Centre de Lutte contre le Cancer Nantes-Atlantique, Saint Herblain, France; Centre George-François Leclerc, Dijon, France; University of California, San Francisco, San Francisco, CA; Jules Bordet Institute, Brussels, Belgium; Hospital Arnau Vilanova, Lleida, Spain
| | - A. Llombart
- Dana-Farber Cancer Institute, Boston, MA; Oncologie Médicale Cliniques Universitaires St-Luc, Brussels, Belgium; Montefiore-Einstein Cancer Center, New York, NY; Bristol-Myers Squibb, Wallingford, CT; Centre de Lutte contre le Cancer Nantes-Atlantique, Saint Herblain, France; Centre George-François Leclerc, Dijon, France; University of California, San Francisco, San Francisco, CA; Jules Bordet Institute, Brussels, Belgium; Hospital Arnau Vilanova, Lleida, Spain
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Li T, Christos PJ, Sparano JA, Hershman DL, Hoschander S, O'Brien K, Wright JJ, Vahdat LT. Phase II trial of the farnesyltransferase inhibitor tipifarnib plus fulvestrant in hormone receptor-positive metastatic breast cancer: New York Cancer Consortium Trial P6205. Ann Oncol 2009; 20:642-7. [PMID: 19153124 DOI: 10.1093/annonc/mdn689] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fulvestrant produces a clinical benefit rate (CBR) of approximately 45% in tamoxifen-resistant, hormone receptor (HR)-positive metastatic breast cancer (MBC) and 32% in aromatase inhibitor (AI)-resistant disease. The farnesyltransferase inhibitor tipifarnib inhibits Ras signaling and has preclinical and clinical activity in endocrine therapy-resistant disease. The objective of this study was to determine the efficacy and safety of tipifarnib-fulvestrant combination in HR-positive MBC. PATIENTS AND METHODS Postmenopausal women with no prior chemotherapy for metastatic disease received i.m. fulvestrant 250 mg on day 1 plus oral tipifarnib 300 mg twice daily on days 1-21 every 28 days. The primary end point was CBR. RESULTS The CBR was 51.6% [95% confidence interval (CI) 34.0% to 69.2%] in 31 eligible patients and 47.6% (95% CI 26.3% to 69.0%) in 21 patients with AI-resistant disease. A futility analysis indicated that it was unlikely to achieve the prespecified 70% CBR. Tipifarnib dose modification was required in 8 of 33 treated patients (24%). CONCLUSIONS The target CBR of 70% for the tipifarnib-fulvestrant combination in HR-positive MBC was set too high and was not achieved. The 48% CBR in AI-resistant disease compares favorably with the 32% CBR observed with fulvestrant alone in prior studies and merit further clinical and translational evaluation.
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Affiliation(s)
- T Li
- New York Cancer Consortium, Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Finn RS, Bengala C, Ibrahim N, Strauss LC, Fairchild J, Sy O, Roche H, Sparano J, Goldstein LJ. Phase II trial of dasatinib in triple-negative breast cancer: results of study CA180059. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-3118] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Abstract
Abstract #3118
Background: Dasatinib (SprycelR; BMS-354825) is a potent orally-available inhibitor of Src-family kinases and other kinases with anti-proliferative, anti-osteoclastic and anti-metastatic activity demonstrated pre-clinically. Expression profiling suggested that basal-like cancers may be preferentially sensitive to dasatinib. Methods: A Phase II single-agent trial of dasatinib, using a continuous schedule, was performed in patients with advanced triple-negative (as proxy for basal-like) breast cancers. Subjects were required to have measurable locally-advanced or metastatic triple-negative (ER/PR-negative, Her2-normal) disease and prior anthracycline and/or taxane therapy. A 2-stage Gehan design was adopted, with RECIST-defined response as primary endpoint; subjects discontinued for toxicity were considered non-responders. The original dasatinib dose of 100 mg BID (n=21) was reduced to 70 mg BID (n=23) to improve tolerability. Biomarkers were analyzed in tumor and plasma samples obtained for PK analysis. Results: From 12/06 through 12/07, 44 subjects were treated at 14 institutions: median age 55 yrs, median time from diagnosis 30 mo, prior therapy for advanced disease in 29 (66%). Of 43 response-evaluable subjects, 7 discontinued for toxicity prior to on-study assessment. Of 36 subjects with radiographic assessment, there were 2 confirmed PR [1 continues >1 year + 1 discontinued for intolerance at week 16] plus 2 SD lasting >16 weeks. Four additional subjects had transient clinical benefit reflected by improvement in bone pain (anecdotal) or short-term tumor shrinkage (reductions of 11 - 29%). Tolerability was improved at a dose of 70 mg compared with 100 mg BID. In preliminary analysis, fewer subjects experienced any serious adverse event (13% at 70 mg BID vs 48% at 100 mg BID), fewer reported Grade 3 toxicity, including gastrointestinal (10% vs 26%), pleural effusion (4% vs 9%), generalized edema (0% vs 9%) or pericardial effusion (0% vs 9%), and fewer had dasatinib dose reduction (24% vs 61%). Fatigue, myalgia/arthralgia and headache were comparable at the two doses. No Grade 4 drug-related events occurred. Grade 3-4 abnormal laboratory values were uncommon. Biomarker and PK data will be presented. Conclusions: Modest but encouraging single-agent activity was observed with dasatinib in patients with advanced triple-negative breast cancers, with clinical benefit rate of 9.3% (4/43). Future studies are warranted to address optimal dose and schedule of dasatinib in combination with chemotherapy for this challenging tumor type.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3118.
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Affiliation(s)
- RS Finn
- 1 UCLA Medical Ctr, Los Angeles
| | - C Bengala
- 2 Policlinica Di Modena, Modena, Italy
| | - N Ibrahim
- 3 U Texas MD Anderson Cancer Ctr, Houston
| | | | | | - O Sy
- 4 Bristol-Myers Squibb Inc, Wallingford
| | - H Roche
- 5 Inst Claudius Regaud, Toulouse, France
| | - J Sparano
- 6 Montefiore-Einstein Cancer Ctr, Bronx
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Sparano JA, Gray R, Goldstein LJ, Childs BH, Bugarini R, Rowley S, Baker J, Shak S, Badve S, Baehner FL, Perez EA, Shulman LN, Martino S, Sledge Jr. GW, Davidson NE. GRB7-dependent pathways are potential therapeutic targets in triple-negative breast cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #25
Background: Breast cancer lacking expression of the estrogen and progesterone receptor and overexpression of HER2/neu (ie, "triple-negative” disease) accounts for about 10-15% of all breast cancer and is characterized by a higher risk of recurrence, early recurrence, resistance to cytotoxic therapy, and lack of any specific targeted therapy.
 Methods: We extracted RNA from primary tumor samples of 246 patients with stage I-III triple-negative breast cancer (confirmed in a central lab) treated with 4 cycles of adjuvant doxorubicin (60 mg/m2) plus cyclophosphamide (600 mg/m2) or docetaxel (60 mg/m2) who were enrolled on trial E2197, and correlated RNA expression (by quantitative RT-PCR using a panel of 371 rationally selected genes) with recurrence. There was no difference in recurrence between the two treatment arms in the entire study population, nor in the 246 patients in this analysis (of whom 59 recurred) after a median followup of 76 months.
 Results: Higher expression of GRB7 was the only gene significantly associated with an increased risk of recurrence (nominal p value 0.0000853, Korn's adjusted p value controlling false discovery at 10% (KP10) p=0.0359), but did not correlate with any clinicopathologic features except age (low expression associated with age > 65 years, p=0.03). In a Cox proportional hazards model adjusted for age, nodal status, tumor size, and grade, higher GRB7 expression was associated with an increased risk of recurrence when evaluated as a continuous variable (hazard ratio 3.41; p = 0.001) or as a dichotomous variable (hazard ratio 2.24 above vs. below median; p=0.006). The 5-year recurrence rates were 10.5% (95% C.I.7.8%, 14.1%) in the low and 20.4% (95% C.I. 16.5%, 25.0%) in the high GRB7 groups. There were only six genes whose expression correlated with GRB7 (r> 0.4), including ERBB2 (r=0.70), DDR1 (discoidin domain receptor tyrosine kinase 1; r=0.53), KRT19 (keratin 19; r=0.49), ERBB3 (r=0.48), GPR56 (G protein-coupled receptor 56; r=0.48) and PHB (prohibitin; r=0.42).
 Conclusions: GRB7 is a calmodulin-binding protein which has an SH2 (Src homology 2) domain that binds to phosphorylated tyrosine residues and other specific protein targets, and which plays a critical role in signaling (EGFR, HER2), motility (eprhins), migration (focal adhesion kinase), and cell-matrix/cell-cell interactions (integrins). Higher GRB7 RNA expression is associated with a significantly higher risk of recurrence in triple-negative breast cancer, indicating that GRB7 or GRB7-dependent pathways are potential therapeutic targets in triple-negative disease.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 25.
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Affiliation(s)
- JA Sparano
- 1 Eastern Cooperative Oncology Group, Brookline, MA
| | - R Gray
- 2 Genomic Health, Inc., Redwood City, CA
| | - LJ Goldstein
- 1 Eastern Cooperative Oncology Group, Brookline, MA
| | | | - R Bugarini
- 2 Genomic Health, Inc., Redwood City, CA
| | - S Rowley
- 2 Genomic Health, Inc., Redwood City, CA
| | - J Baker
- 2 Genomic Health, Inc., Redwood City, CA
| | - S Shak
- 2 Genomic Health, Inc., Redwood City, CA
| | - S Badve
- 1 Eastern Cooperative Oncology Group, Brookline, MA
| | - FL Baehner
- 2 Genomic Health, Inc., Redwood City, CA
| | - EA Perez
- 4 North Central Cancer Treatment Group, Rochester, MN
| | - LN Shulman
- 5 Cancer and Leukemia Group B, Chicago, IL
| | - S Martino
- 6 Southwest Oncology Group, Ann Arbor, MI
| | | | - NE Davidson
- 1 Eastern Cooperative Oncology Group, Brookline, MA
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Von Roenn JH, Lee S, Cianfrocca M, Tulpule A, Scadden D, Aboulafia D, Sparano J. Phase III study of paclitaxel (Pac) versus pegylated liposomal doxorubicin (PLD) for the treatment of advanced human immunodeficiency virus (HIV)-associated Kaposi's sarcoma (KS): An Eastern Cooperative Oncology Group (ECOG) and AIDS Malignancy Consortium. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.20503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
20503 Background: PLD (doxorubicin HCL liposome injection, Doxil®, Tibotec Therapeutics, Raritan, NJ) and paclitaxel (Taxol®, Bristol Myers, Inc, New York, NY) are active in the treatment of HIV-associated KS; however, optimal therapy is undefined. Methods: A randomized phase III, multicenter trial was initiated to compare the efficacy of Pac (100 mg/m2) every 2 weeks to PLD (20 mg/m2) every 3 weeks for chemotherapy-naïve AIDS-related KS. Treatment continued until disease progression or unacceptable toxicity; concurrent antiretrovirals were permitted. 216 pts were required to detect at least a 3-month improvement in median progression free survival (PFS) for Pac compared with PLD (80% power, 2-sided alpha 0.05). Response was assessed using KS response and clinical benefit criteria, and global assessment of quality of life (QOL) using the Functional Assessment of Health Index (FAHI; version 3) plus 3 supplemental questions concerning pain, swelling, and satisfaction with physical appearance (measured at baseline and during/after treatment). Results: The trial was terminated early due to poor accrual; 46 pts were randomized to PLD, 43 to Pac. 11 pts were ineligible, 4 never started therapy and 6 lacked disease assessment or progression data, resulting in 68 pts for the efficacy analysis (34 in each arm) and 82 in the toxicity analysis. After a median follow-up of 35.8 months (mo.), there was no significant difference in PFS, response rate, or overall survival. Due to early termination, the study was not adequately powered to detect the hypothesized difference in PFS. There was no significant difference in QOL between the two arms. Grade 3–4 toxicity was comparable, including grade 4 neutropenia (34% vs. 27%) and infection (13% vs. 11%). Conclusions: Paclitaxel and PLD have comparable efficacy and toxicity in patients with HIV-associated KS. [Table: see text] [Table: see text]
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Affiliation(s)
- J. H. Von Roenn
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Northwestern University, Chicago, IL; University of Southern California, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Virginia Mason Medical Center, Seattle, WA; Montefiore Medical Center, Bronx, NY
| | - S. Lee
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Northwestern University, Chicago, IL; University of Southern California, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Virginia Mason Medical Center, Seattle, WA; Montefiore Medical Center, Bronx, NY
| | - M. Cianfrocca
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Northwestern University, Chicago, IL; University of Southern California, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Virginia Mason Medical Center, Seattle, WA; Montefiore Medical Center, Bronx, NY
| | - A. Tulpule
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Northwestern University, Chicago, IL; University of Southern California, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Virginia Mason Medical Center, Seattle, WA; Montefiore Medical Center, Bronx, NY
| | - D. Scadden
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Northwestern University, Chicago, IL; University of Southern California, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Virginia Mason Medical Center, Seattle, WA; Montefiore Medical Center, Bronx, NY
| | - D. Aboulafia
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Northwestern University, Chicago, IL; University of Southern California, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Virginia Mason Medical Center, Seattle, WA; Montefiore Medical Center, Bronx, NY
| | - J. Sparano
- Northwestern Univ, Chicago, IL; Dana-Farber Cancer Institute, Boston, MA; Northwestern University, Chicago, IL; University of Southern California, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Virginia Mason Medical Center, Seattle, WA; Montefiore Medical Center, Bronx, NY
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Badve SS, Baehner FL, Gray R, Childs B, Maddala T, Rowley S, Shak S, Davidson N, Goldstein LJ, Sparano J. Concordance of local and central laboratory hormone and HER2 receptor status in ECOG 2197. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.21022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
21022 Background: Central and local laboratory concordance for hormone and HER2 receptor measurement is of national interest. This study compares ER/PR/HER2 by local laboratories using immunohistochemistry (IHC) and central laboratories (IHC & quantitative RT-PCR). Methods: Of 2952 patients in E2197, a case-cohort sample of 776 patients who either did (N=179) or did not recur was studied. Central IHC for ER/PR/HER2 was performed using single 0.6 mm microarrays; Allred score (AS) was used for ER/PR (AS>2 = positive). Positive HER2 was 3+ staining in >10% cells for Central IHC and 2+ or 3+ for Local IHC. RT-PCR analysis by Oncotype DX™ for ER/PR/HER2 was performed using pre-defined cutoffs of 6.5, 5.5 and 11.5 units, respectively. Hormone receptor (HR) pos was defined as ER &/or PR pos. Results: Results from Local IHC (ER/PR in 776 & HER2 in 517 pts) were compared with Central IHC (760 pts) and RT-PCR results (776 pts). The discordance between HR positivity by Local IHC and RT-PCR was very low. However, 12% of HR neg pts by Local IHC (38/321) & Central IHC (39/326) were HR pos by RT-PCR. The relationship between ER and recurrence as a function of AS was examined. Patients with AS of 3–4 were found to be closer to the AS=2 group than to the AS>4 group Patients with AS of 3–4 were found to be closer to the AS ÿ 2 group than to the AS > 4 group (Est.HR for ER 0.97 for AS 3–4 vs. 0–2 and 0.46 for AS 5–8 vs. 0–2, and for PR were 0.84 for AS 3–4 vs. 0–2 and 0.41 for AS 5–8 vs. 0–2). Conclusions: There is a high degree of overall concordance among Local IHC, Central IHC, and Central RT-PCR for ER and PR. The degree of concordance is even greater for HR compared to ER or PR alone. Although the concordance with local labs for HER2 testing was poor, the concordance between Central IHC and RT-PCR was very high. The relatively high incidence (12%) of IHC HR neg pts who are HR pos by RT- PCR is notable. [Table: see text] [Table: see text]
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Affiliation(s)
- S. S. Badve
- Indiana Univ, Indianapolis, IN; Genomic Health Institute, Redwood, CA; ECOG, Boston, MA; sanofi-aventis, Cambridge, MA
| | - F. L. Baehner
- Indiana Univ, Indianapolis, IN; Genomic Health Institute, Redwood, CA; ECOG, Boston, MA; sanofi-aventis, Cambridge, MA
| | - R. Gray
- Indiana Univ, Indianapolis, IN; Genomic Health Institute, Redwood, CA; ECOG, Boston, MA; sanofi-aventis, Cambridge, MA
| | - B. Childs
- Indiana Univ, Indianapolis, IN; Genomic Health Institute, Redwood, CA; ECOG, Boston, MA; sanofi-aventis, Cambridge, MA
| | - T. Maddala
- Indiana Univ, Indianapolis, IN; Genomic Health Institute, Redwood, CA; ECOG, Boston, MA; sanofi-aventis, Cambridge, MA
| | - S. Rowley
- Indiana Univ, Indianapolis, IN; Genomic Health Institute, Redwood, CA; ECOG, Boston, MA; sanofi-aventis, Cambridge, MA
| | - S. Shak
- Indiana Univ, Indianapolis, IN; Genomic Health Institute, Redwood, CA; ECOG, Boston, MA; sanofi-aventis, Cambridge, MA
| | - N. Davidson
- Indiana Univ, Indianapolis, IN; Genomic Health Institute, Redwood, CA; ECOG, Boston, MA; sanofi-aventis, Cambridge, MA
| | - L. J. Goldstein
- Indiana Univ, Indianapolis, IN; Genomic Health Institute, Redwood, CA; ECOG, Boston, MA; sanofi-aventis, Cambridge, MA
| | - J. Sparano
- Indiana Univ, Indianapolis, IN; Genomic Health Institute, Redwood, CA; ECOG, Boston, MA; sanofi-aventis, Cambridge, MA
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