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Pixberg C, Zapatka M, Hlevnjak M, Benedetto S, Suppelna JP, Heil J, Smetanay K, Michel L, Fremd C, Körber V, Rübsam M, Buschhorn L, Heublein S, Schäfgen B, Golatta M, Gomez C, von Au A, Wallwiener M, Wolf S, Dikow N, Schaaf C, Gutjahr E, Allgäuer M, Stenzinger A, Pfütze K, Kirsten R, Hübschmann D, Sinn HP, Jäger D, Trumpp A, Schlenk R, Höfer T, Thewes V, Schneeweiss A, Lichter P. COGNITION: a prospective precision oncology trial for patients with early breast cancer at high risk following neoadjuvant chemotherapy. ESMO Open 2022; 7:100637. [PMID: 36423362 PMCID: PMC9808485 DOI: 10.1016/j.esmoop.2022.100637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/09/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND COGNITION (Comprehensive assessment of clinical features, genomics and further molecular markers to identify patients with early breast cancer for enrolment on marker driven trials) is a diagnostic registry trial that employs genomic and transcriptomic profiling to identify biomarkers in patients with early breast cancer with a high risk for relapse after standard neoadjuvant chemotherapy (NACT) to guide genomics-driven targeted post-neoadjuvant therapy. PATIENTS AND METHODS At National Center for Tumor Diseases Heidelberg patients were biopsied before starting NACT, and for patients with residual tumors after NACT additional biopsy material was collected. Whole-genome/exome and transcriptome sequencing were applied on tumor and corresponding blood samples. RESULTS In the pilot phase 255 patients were enrolled, among which 213 were assessable: thereof 48.8% were identified to be at a high risk for relapse following NACT; 86.4% of 81 patients discussed in the molecular tumor board were eligible for a targeted therapy within the interventional multiarm phase II trial COGNITION-GUIDE (Genomics-guided targeted post neoadjuvant therapy in patients with early breast cancer) starting enrolment in Q4/2022. An in-depth longitudinal analysis at baseline and in residual tumor tissue of 16 patients revealed some cases with clonal evolution but largely stable genetic alterations, suggesting restricted selective pressure of broad-acting cytotoxic neoadjuvant chemotherapies. CONCLUSIONS While most precision oncology initiatives focus on metastatic disease, the presented concept offers the opportunity to empower novel therapy options for patients with high-risk early breast cancer in the post-neoadjuvant setting within a biomarker-driven trial and provides the basis to test the value of precision oncology in a curative setting with the overarching goal to increase cure rates.
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Affiliation(s)
- C Pixberg
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany
| | - M Zapatka
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - M Hlevnjak
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; Research Group Computational Oncology, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany
| | - S Benedetto
- Division of Theoretical Systems Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J P Suppelna
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany
| | - J Heil
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - K Smetanay
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - L Michel
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany
| | - C Fremd
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, University Hospital Heidelberg, Heidelberg, Germany
| | - V Körber
- Division of Theoretical Systems Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Rübsam
- Research Group Computational Oncology, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany
| | - L Buschhorn
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany
| | - S Heublein
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - B Schäfgen
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - M Golatta
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - C Gomez
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - A von Au
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - M Wallwiener
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Heidelberg, Germany
| | - S Wolf
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - N Dikow
- Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - C Schaaf
- Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - E Gutjahr
- Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Allgäuer
- Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - A Stenzinger
- Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - K Pfütze
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany
| | - R Kirsten
- Liquid Biobank, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany
| | - D Hübschmann
- German Cancer Consortium (DKTK), Heidelberg, Germany; Research Group Computational Oncology, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg, Germany
| | - H-P Sinn
- Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - D Jäger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, University Hospital Heidelberg, Heidelberg, Germany
| | - A Trumpp
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg, Germany; Division of Stem Cells and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R Schlenk
- Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, University Hospital Heidelberg, Heidelberg, Germany; Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany; NCT Trial Center, National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center and DKFZ, Heidelberg, Germany
| | - T Höfer
- Division of Theoretical Systems Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - V Thewes
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany; Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany
| | - A Schneeweiss
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; University Hospital Heidelberg, Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P Lichter
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany; Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany.
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Elgaafary S, Hlevnjak M, Schulze M, Thewes V, Seitz J, Fremd C, Michel L, Beck K, Pfütze K, Richter D, Wolf S, Pixberg C, Hutter B, Ishaque N, Hirsch S, Gieldon L, Stenzinger A, Springfeld C, Kreutzfeld S, Horak P, Smetanay K, Mavratzas A, Brors B, Kirsten R, Trumpp A, Schütz F, Fröhling S, Sinn HP, Jäger D, Zapatka M, Lichter P, Schneeweiss A. Dauerhaftes Ansprechen auf Olaparib und endokrine Therapie bei einer Patientin mit metastasiertem luminalem Mammakarzinom und gBRCA-Mutation. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714539] [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: 03/22/2023] Open
Affiliation(s)
- S Elgaafary
- Gynäkologische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
- Molekulardiagnostik-Programm, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
| | - M Hlevnjak
- Molekulardiagnostik-Programm, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
- Abteilung für Molekulargenetik, Deutsches Krebskonsortium (DKTK), Deutsches Krebsforschungszentrum (DKFZ)
| | - M Schulze
- Molekulardiagnostik-Programm, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
- Abteilung für Molekulargenetik, Deutsches Krebskonsortium (DKTK), Deutsches Krebsforschungszentrum (DKFZ)
| | - V Thewes
- Gynäkologische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
- Abteilung für Molekulargenetik, Deutsches Krebskonsortium (DKTK), Deutsches Krebsforschungszentrum (DKFZ)
| | - J Seitz
- Gynäkologische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
| | - C Fremd
- Gynäkologische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
| | - L Michel
- Gynäkologische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
| | - K Beck
- Molekulardiagnostik-Programm, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
- Abteilung Translationale Medizinische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT) Heidelberg/Dresden, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg/Dresden
| | - K Pfütze
- Molekulardiagnostik-Programm, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
| | - D Richter
- Abteilung Translationale Medizinische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT) Heidelberg/Dresden, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg/Dresden
| | - S Wolf
- Kernfazilität Genomik und Proteomik, Deutsches Krebsforschungszentrum (DKFZ)
| | - C Pixberg
- Gynäkologische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
- Molekulardiagnostik-Programm, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
| | - B Hutter
- Molekulardiagnostik-Programm, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
- Abteilung Angewandte Bioinformatik, Deutsches Krebsforschungszentrum (DKFZ)
| | - N Ishaque
- Molekulardiagnostik-Programm, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
- Abteilung Theoretische Bioinformatik, Deutsches Krebsforschungszentrum (DKFZ)
| | - S Hirsch
- Institut für Humangenetik, Universität Heidelberg
| | - L Gieldon
- Molekulardiagnostik-Programm, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
- Institut für Humangenetik, Universität Heidelberg
| | - A Stenzinger
- Institut für Pathologie, Universitätsklinikum Heidelberg
| | - C Springfeld
- Klinik für Medizinische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg
| | - S Kreutzfeld
- Molekulardiagnostik-Programm, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
- Abteilung Translationale Medizinische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT) Heidelberg/Dresden, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg/Dresden
| | - P Horak
- Abteilung Translationale Medizinische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT) Heidelberg/Dresden, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg/Dresden
| | - K Smetanay
- Gynäkologische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
| | - A Mavratzas
- Gynäkologische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
| | - B Brors
- Abteilung Angewandte Bioinformatik, Deutsches Krebsforschungszentrum (DKFZ)
| | - R Kirsten
- Liquid Biobank, Nationales Zentrum für Tumorerkrankungen (NCT)
| | - A Trumpp
- Abteilung Stammzellen und Krebs, Deutsches Krebsforschungszentrum (DKFZ) und DKFZ-ZMBH-Bündnis
| | - F Schütz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Heidelberg
| | - S Fröhling
- Abteilung Translationale Medizinische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT) Heidelberg/Dresden, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg/Dresden
| | - H-P Sinn
- Institut für Pathologie, Universitätsklinikum Heidelberg
| | - D Jäger
- Klinik für Medizinische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg
| | - M Zapatka
- Abteilung für Molekulargenetik, Deutsches Krebskonsortium (DKTK), Deutsches Krebsforschungszentrum (DKFZ)
| | - P Lichter
- Molekulardiagnostik-Programm, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
- Abteilung für Molekulargenetik, Deutsches Krebskonsortium (DKTK), Deutsches Krebsforschungszentrum (DKFZ)
| | - A Schneeweiss
- Gynäkologische Onkologie, Nationales Zentrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Deutsches Krebsforschungszentrum (DKFZ)
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