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Le Du F, Carton M, Bachelot T, Saghatchian M, Pistilli B, Brain E, Loirat D, Vanlemmens L, Vermeulin T, Emile G, Gonçalves A, Ung M, Robert M, Jaffre A, Desmoulins I, Jouannaud C, Uwer L, Marc Ferrero J, Mouret-Reynier MA, Jacot W, Chevrot M, Delaloge S, Diéras V. Real-World Impact of Adjuvant Anti-HER2 Treatment on Characteristics and Outcomes of Women With HER2-Positive Metastatic Breast Cancer in the ESME Program. Oncologist 2023; 28:e867-e876. [PMID: 37589218 PMCID: PMC10546827 DOI: 10.1093/oncolo/oyad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/14/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Although adjuvant cancer treatments increase cure rates, they may induce clonal selection and tumor resistance. Information still lacks as whether (neo)adjuvant anti-HER2 treatments impact the patterns of recurrence and outcomes of HER2-positive (HER2+) metastatic breast cancer (MBC). We aimed to assess this in the large multicenter ESME real-world database. PATIENTS AND METHODS We examined the characteristics and outcomes (overall survival (OS) and progression-free survival under first-line treatment (PFS1)) of HER2+ patients with MBC from the French ESME program with recurrent disease, as a function of the previous receipt of adjuvant trastuzumab. Multivariable analyses used Cox models adjusted for baseline demographic, prognostic factors, adjuvant treatment received, and disease-free interval. RESULTS Two thousand one hundred and forty-three patients who entered the ESME cohort between 2008 and 2017 had a recurrent HER2+ MBC. Among them, 56% had received (neo)adjuvant trastuzumab and 2.5% another anti-HER2 in this setting. Patients pre-exposed to trastuzumab were younger, had a lower disease-free interval, more HR-negative disease and more metastatic sites. While the crude median OS appeared inferior in patients exposed to adjuvant trastuzumab, as compared to those who did not (37.2 (95%CI 34.4-40.3) versus 53.5 months (95% CI: 47.6-60.1)), this difference disappeared in the multivariable model (HR = 1.05, 95%CI 0.91-1.22). The same figures were observed for PFS1. CONCLUSIONS Among patients with relapsed HER2+ MBC, the receipt of adjuvant trastuzumab did not independently predict for worse outcomes when adjusted to other prognostic factors.
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Affiliation(s)
- Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon-Bérard, Lyon, France
| | | | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint Cloud, Paris, France
| | - Delphine Loirat
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | | | | | - George Emile
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Mony Ung
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, CRCT, Inserm, Toulouse, France
| | - Marie Robert
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - René Gauducheau, Saint-Herblain, France
| | - Anne Jaffre
- Anne jaffré Department of Medical Information, Institut Bergonié, Bordeaux, France
| | | | | | - Lionel Uwer
- Institut de Cancérologie de Lorraine, Nancy, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | - William Jacot
- Department of Medical Oncology, Institut du cancer de Montpellier, Montpellier, France
| | - Michaël Chevrot
- Health Data and Partnership Department, Unicancer, Paris, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Véronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
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Bello Roufai D, Gonçalves A, De La Motte Rouge T, Akla S, Blonz C, Grenier J, Gligorov J, Saghatchian M, Bailleux C, Simon H, Desmoulins I, Tharin Z, Renaud E, Bertho M, Benderra MA, Delaloge S, Robert L, Cottu P, Pierga JY, Loirat D, Bertucci A, Renouf B, Bidard FC, Lerebours F. Correction: Alpelisib and fulvestrant in PIK3CA-mutated hormone receptor-positive HER2-negative advanced breast cancer included in the French early access program. Oncogene 2023; 42:1417. [PMID: 36922682 DOI: 10.1038/s41388-023-02615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- D Bello Roufai
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France.
| | - A Gonçalves
- Aix-Marseille Univ, CNRS, INSERM, Department of Medical Oncology, Institut Paoli Calmettes, CRCM, Marseille, France
| | | | - S Akla
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - C Blonz
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Sait-Herblain and Angers, France
| | - J Grenier
- Department of Medical Oncology, Institut du Cancer d'Avignon, Avignon, France
| | - J Gligorov
- Department of Medical Oncology, Hôpital Tenon, AP-HP, Paris, France.,INSERM U938, Institut Universitaire de Cancérologie, AP-HP Sorbonne Université, Paris, France
| | - M Saghatchian
- Breast Cancer Unit, American Hospital of Paris, Neuilly-sur-Seine, France
| | - C Bailleux
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - H Simon
- Department of Medical Oncology, University Hospital of Brest, Brest, France
| | - I Desmoulins
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Z Tharin
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - E Renaud
- Department of Medical Oncology, University Hospital of Brest, Brest, France
| | - M Bertho
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Sait-Herblain and Angers, France
| | - M-A Benderra
- Department of Medical Oncology, Hôpital Tenon, AP-HP, Paris, France
| | - S Delaloge
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - L Robert
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - P Cottu
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France
| | - J Y Pierga
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France.,Paris Cité University, Paris, France
| | - D Loirat
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France
| | - A Bertucci
- Aix-Marseille Univ, CNRS, INSERM, Department of Medical Oncology, Institut Paoli Calmettes, CRCM, Marseille, France
| | - B Renouf
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France
| | - F C Bidard
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France.,UVSQ, Paris-Saclay University, Saint Cloud, France
| | - F Lerebours
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France
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Bello Roufai D, Gonçalves A, De La Motte Rouge T, Akla S, Blonz C, Grenier J, Gligorov J, Saghatchian M, Bailleux C, Simon H, Desmoulins I, Tharin Z, Renaud E, Bertho M, Benderra MA, Delaloge S, Robert L, Cottu P, Pierga JY, Loirat D, Bertucci A, Renouf B, Bidard FC, Lerebours F. Alpelisib and fulvestrant in PIK3CA-mutated hormone receptor-positive HER2-negative advanced breast cancer included in the French early access program. Oncogene 2023:10.1038/s41388-022-02585-3. [PMID: 36611120 DOI: 10.1038/s41388-022-02585-3] [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] [Received: 10/08/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 01/09/2023]
Abstract
SOLAR-1 and BYLieve trials documented the efficacy of the PI3K-inhibitor alpelisib in pre-treated PIK3CA-mutant, hormone receptor-positive, HER2-negative (HR+/HER2-) advanced breast cancer (ABC) patients. We report here real-life data of patients prospectively registered in the French alpelisib early access program (EAP) opened to PIK3CA-mutant HR+/HER2- ABC patients treated with alpelisib and fulvestrant. Primary endpoint was PFS by local investigators using RECIST1.1. Eleven centers provided individual data on 233 consecutive patients. Patients had received a median number of 4 (range: 1-16) prior systemic treatments for ABC, including CDK4/6 inhibitor, chemotherapy, fulvestrant and everolimus in 227 (97.4%), 180 (77.3%), 175 (75.1%) and 131 (56.2%) patients, respectively. After a median follow-up of 7.1 months and 168 events, median PFS was 5.3 months (95% CI: 4.7-6.0). Among 186 evaluable patients, CBR at 6 months was 45.3% (95% CI: 37.8-52.8). In multivariable analysis, characteristics significantly associated with a shorter PFS were age < 60 years (HR = 1.5, 95% CI = 1.1-2.1), >5 lines of prior treatments (HR = 1.4, 95% CI = 1.0-2.0) and the C420R PI3KCA mutation (HR = 4.1, 95% CI = 1.3-13.6). N = 91 (39.1%) patients discontinued alpelisib due to adverse events. To our knowledge, this is the largest real-life assessment of alpelisib efficacy. Despite heavy pre-treatments, patients derived a clinically relevant benefit from alpelisib and fulvestrant.
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Affiliation(s)
- D Bello Roufai
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France.
| | - A Gonçalves
- Aix-Marseille Univ, CNRS, INSERM, Department of Medical Oncology, Institut Paoli Calmettes, CRCM, Marseille, France
| | | | - S Akla
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - C Blonz
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Sait-Herblain and Angers, France
| | - J Grenier
- Department of Medical Oncology, Institut du Cancer d'Avignon, Avignon, France
| | - J Gligorov
- Department of Medical Oncology, Hôpital Tenon, AP-HP, Paris, France.,INSERM U938, Institut Universitaire de Cancérologie, AP-HP Sorbonne Université, Paris, France
| | - M Saghatchian
- Breast Cancer Unit, American Hospital of Paris, Neuilly-sur-Seine, France
| | - C Bailleux
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - H Simon
- Department of Medical Oncology, University Hospital of Brest, Brest, France
| | - I Desmoulins
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Z Tharin
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - E Renaud
- Department of Medical Oncology, University Hospital of Brest, Brest, France
| | - M Bertho
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Sait-Herblain and Angers, France
| | - M-A Benderra
- Department of Medical Oncology, Hôpital Tenon, AP-HP, Paris, France
| | - S Delaloge
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - L Robert
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - P Cottu
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France
| | - J Y Pierga
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France.,Paris Cité University, Paris, France
| | - D Loirat
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France
| | - A Bertucci
- Aix-Marseille Univ, CNRS, INSERM, Department of Medical Oncology, Institut Paoli Calmettes, CRCM, Marseille, France
| | - B Renouf
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France
| | - F C Bidard
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France.,UVSQ, Paris-Saclay University, Saint Cloud, France
| | - F Lerebours
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France
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Bouillet T, Joly F, Saghatchian M, Guéroult-Accolas L, Tahar JM, Descotes JM, Krakowski I. Activité Physique Adaptée et cancer métastatique : quels besoins et quelles attentes ? Bull Cancer 2022; 109:1287-1297. [DOI: 10.1016/j.bulcan.2022.07.011] [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] [Received: 03/07/2022] [Revised: 07/04/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022]
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Giacchero D, Buiret G, Bartolini-Grosjean C, Taieb C, Saghatchian M, Krakowski I. Creation of a tool to evaluate supportive care. Palliat Support Care 2022:1-8. [PMID: 35913037 DOI: 10.1017/s1478951522000918] [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] [Indexed: 11/06/2022]
Abstract
RATIONAL The absence of a specific tool to evaluate the impact of supportive care in general and socioesthetics (SE) in particular is undoubtedly at the origin of the lack of published research based on scientific standards. OBJECTIVE We developed a supportive-care, patient-reported outcome questionnaire using the multistep methods, following COSMIN recommendations. METHODS The Patient Centricity Questionnaire (PCQ) was developed using the standardized methodology for designing patient-reported outcome (PRO) questionnaires according to the following steps: elaboration of the questionnaire, measurement properties of the questionnaire, internal and external validation, test-retest validation and translation, cross-cultural adaptation, and cognitive debriefing. A multidisciplinary work group was designed including professionals, such as physicians, public health experts, sociologists, supportive-care experts, and socioestheticians. RESULTS Our questionnaire includes 11 items. It is scored by adding each Visual Analogue Scale [VAS], making it range from 0 to 110, with a higher benefit when the score is higher. The Cronbach's α coefficient is 0.88 for the entire questionnaire. As the questionnaire is a reflection of the patient's feelings, it is quite natural that the name "Patient Centricity Questionnaire" (PCQ) was retained and validated by the Scientific Committee. The PCQ correlated negatively and moderately with the Perceived Stress Scale [PSS], positively and moderately with the mental dimension of the Short Form-12, and poorly with the Well Beng 12 [WB12], the physical dimension of the SF-12, and the satisfaction VAS. CONCLUSION Constructed according to the recommendations, the PCQ meets the prerequisite for this type of questionnaire. Its short format and simplicity of use allow it to be used by a large number of people. The PCQ is a simple, reliable, easy-to-use, and validated tool for research teams, making it possible for randomized studies to prove the impact of supportive care in general and SE in particular, on the patient's quality of life.
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Affiliation(s)
- Damien Giacchero
- Department of Medical Oncology, University Côte d'Azur, Centre Antoine Lacassagne, Nice, France
| | - Guillaume Buiret
- Department of Otorhinolaryngology Surgery, Hospital of Valence, Valence, France
| | | | - Charles Taieb
- Patient Priority Department, European Market Maintenance Assessment, Fontenay-sous-Bois, France
| | - Mahasti Saghatchian
- Department of Oncology, American Hospital of Paris, Neuilly-sur-Seine, France
- Department of Medical Oncology, Gustave Roussy Institute, Villejuif, France
| | - Ivan Krakowski
- Association Francophone pour les Soins Oncologiques de Support, Bègles, France
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6
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Du FL, Carton M, Saghatchian M, Perol D, Pistilli B, Brain E, Loirat D, Vanlemmens L, Vermeulin T, Levy C, Goncalves A, Ung M, Robert M, Jaffre A, Robain M, Delaloge S, Dieras V. Abstract P1-18-09: Impact of prior adjuvant trastuzumab (aT) on clinical characteristics, patterns of recurrence and outcomes in 4145 patients with Her2 positive (HER2+) metastatic breast cancer (MBC)- Results from the French ESME UNICANCER program. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-18-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The management of HER2+ BC has changed dramatically with the introduction and widespread use of HER2-targeted therapies, especially in the adjuvant setting. It is well-known that de novo metastatic HER2+ breast cancer patients have better outcomes that women with metastatic relapse. This could be related both to a lead time bias, as well as to an ATRESS (adjuvant therapy-related shortening of survival) phenomenon [1]. Indeed, cancer treatments induce increased both clonal selection, as well as globally tumor resistance and agressivity [2]. However, there is relatively limited real-world information on the impact of adjuvant and neoadjuvant anti-HER2 targeted treatments on patterns of recurrence and outcomes of HER2+ MBC. Thus, the purpose of this study was to determine how and how long anti-HER2 targeted treatment in early setting impact outcomes of patients with HER2+ recurring BC. Methods: Since 2014, the 18 French Cancer Centers launched the Epidemiological Strategy and Medical Economics (ESME) program to provide real-world data on MBC patients (pts). All pts who started a 1st-line treatment for MBC between 01-Jan-2008 and 31-Dec-2017 were included. We examined clinical characteristics and outcomes (overall survival [OS] and time to 1st metastasis [TTM]) in patients with HER2+ MBC pretreated with trastuzumab in the (neo)adjuvant setting (aT) compared with trastuzumab-naïve patients and patients with de novo HER2+ MBC. Multivariate analyses adjusted for baseline demographic, prognostic factors, adjuvant treatment received and time to MBC. Results: Among the 23698 pts of the ESME database, 4145 were women treated in 1st line of a HER2+ MBC: 1716 pts (41%) had de novo and 2429 pts (59%) recurrent and 65% had Hormone Receptor (HR) + MBC; 53%, 26% and 21% had respectively 1, 2, or > 2 metastatic sites (64% visceral and 11% brain). With a median follow-up of 60.7 m, median OS is 42.4 m (95% CI: 40.1-45.0) for patients who relapsed. OS is significantly longer in de novo MBC: 64.7 m (95% CI: 60.2-73) (HRadjusted=0.68, 95% CI: 0.62-0.76, p < 0.0001). Among pts with recurrent MBC, 56% (1343) had received adjuvant trastuzumab (aT). As 1st-line therapy for MBC, 86 % of pts received HER2-targeted agents (74% T-based, 24% T-pertuzumab-based). Median TTM was 46.9 months (m): 57.6 m in HR+ and 30.2 m in HR-. Among pts with HR- diseases, 38% relapsed during the first 2 years of follow-up and 30% after 4 years (14.8%% and 56.9% in HR+ respectively). Among pts with recurrent MBC, crude median OS is inferior in pts who received aT, as compared to those who did not: 37.2 m (95% CI: 34.4-40.3) vs. 53.5 m (95% CI: 47.6-60.1), but this difference does not persist after adjustment for age, performans status, disease-free interval and number and type of metastatic sites in the multivariate model (HR=1.05, 95% CI: 0.91-1.22). A short disease-free interval (6-24 months compared to >48) remains, however, a strong adverse prognostic factor (HR=2.1, 95% CI: 1.82-2.50). Conclusions: The receipt of adjuvant trastuzumab does not predict for worse outcomes when adjusted to the other prognostic factors, among patients who relapsed during the 2008-2017 period. An ATRESS phenomenon is not suggested, although we cannot rule it out for those who relapsed within the initial 2 years. The much better prognosis of de novo MBC may be largely linked to lead time biases.
Citation Format: Fanny Le Du, Matthieu Carton, Mahasti Saghatchian, David Perol, Barbara Pistilli, Etienne Brain, Delphine Loirat, Laurence Vanlemmens, Thomas Vermeulin, Christelle Levy, Anthony Goncalves, Mony Ung, Marie Robert, Anne Jaffre, Mathieu Robain, Suzette Delaloge, Véronique Dieras. Impact of prior adjuvant trastuzumab (aT) on clinical characteristics, patterns of recurrence and outcomes in 4145 patients with Her2 positive (HER2+) metastatic breast cancer (MBC)- Results from the French ESME UNICANCER program [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-09.
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Affiliation(s)
| | | | | | - David Perol
- Department of Biostatistics, DRCI, Centre Léon Bérard, Lyon, France
| | | | - Etienne Brain
- CLCC Rene Huguenin Institut Curie, Saint Cloud, France
| | - Delphine Loirat
- Département d’Oncologie Médicale, Institut Curie, Paris, France
| | | | | | | | | | - Mony Ung
- UNGInstitut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Marie Robert
- Institut de Cancérologie de l'Ouest - René Gauducheau, Saint Herblain, France
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Petit T, Hajjaji N, Antoine EC, Benderra MA, Gozy M, Foa C, Mouysset JL, Grenier J, Mousseau M, Mailliez A, Saghatchian M, Lachaier E, Desmoulins I, Hennequin A, Maes P, Loirat D, Ricci F, Diéras V, Berton D, Tiong FL, Teixeira L, Dohollou N, Lévy C, Bachelot T, Pierga JY. Abstract P2-13-26: Trastuzumab deruxtecan in previously treated HER2-positive metastatic or unresectable breast cancer (BC): First real-life data from the cohort temporary authorization for use (cATU) program in France. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-13-26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate (ADC) composed of an HER2-directed antibody and a topoisomerase I inhibitor covalently linked via a tetrapeptide-based cleavable linker. In DESTINY-Breast01, tolerability and efficacy of T-DXd including overall response rate, progression-free survival, duration of response and overall survival have been demonstrated for HER2-positive metastatic and/or unresectable BC in patients (pts) relapsing after 2 or more anti-HER2-based regimens. In France, rapid and fair access to innovative drugs outside clinical trials, prior to their marketing authorization in a given indication, is granted by the French Health Agency, ANSM (Agence Nationale de Sécurité du Médicament et des Produits de Santé), through cATU program. Here we report first real world evidence data from cATU program in HER2+ BC pts treated with T-DXd. Methods T-DXd 5.4mg/kg was given intravenously in monotherapy every 3 weeks in HER2-positive metastatic and/or unresectable BC pts who had previously received at least 2 lines of anti-HER2 regimens in the metastatic setting. Eligible pts needed to have normal neutrophil count and no left ventricular dysfunction. Pts with active or history of interstitial lung disease (ILD), pneumonitis, severe pulmonary disease were excluded. Clinical, biological and safety data were collected until the end of cATU, as well as treatment response according to RECIST 1.1., dose modification, treatment interruption and discontinuation. Analysis was performed on March 31th, 2021 on the basis of available collected data. Results From September 30th, 2020 to March 31th, 2021, 155 centers requested at least one ATU for a total of 539 adult pts; 468 requests were accepted and 71 were refused as they did not meet eligibility criteria. T-DXd was received by 459 pts with the following characteristics: 99.1% were women, median age was 58 years, 90.4% had a ECOG score of 0-1, 98.9% had initial HER2-positive BC (IHC 3+ or IHC 2+/ISH+), 67% were hormone receptor positive. The main sites of metastases were bones (57.3%), lymph nodes (51.6%), lungs (36.2%), liver (33.1%), brain (28.1%) and cutaneous/subcutaneous (13.9%). Median time between initial diagnosis of primary BC and inclusion was 6.6 years (range: 6.6 months - 33.9 years). 81.7% of pts had previously received radiotherapy and 76.5% underwent surgery. The median number of prior cancer regimens in the metastatic setting was 4 (range: 2-22). 21.1% received 2 prior lines of metastatic treatments, 19.6% received 3 lines and 59.3% received 4 lines or more. 94.8% pts received prior trastuzumab emtansine, and 79.3% had prior pertuzumab. During follow-up, data on tumor assessment were available for 160 pts. Of these, 56.7% had complete or partial response and 12.1% had progression. Of the 459 treated pts, 97 pts (21.1%) experienced ≥ 1 Adverse Drug Reaction (ADR) including 41 pts (8.9%) with ≥ 1 serious ADR. Most frequent ADRs were related to gastrointestinal toxicity (35.4%). During cATU, 17 cases (3.7%) with ILD or considered as ILD were reported but no cases had a fatal outcome (only grade 1 or 2 when reported by physicians). 13 fatal cases were reported (no drug-related deaths, attributed by physician). ADRs leading to T-DXd discontinuation were reported in 4 pts (0.9%). Dose reductions were reported in 17 pts (3.7%) and 21 pts (4.6%) had temporary interruptions. Conclusions We report here the first real world data from the French cATU in HER2-positive BC pts treated by T-DXd. The enrolment of 468 pts in 6 months illustrated the unmet medical need for this population. T-DXd had antitumor activity with a similar response rate to that reported in previous clinical studies. T-DXd was well tolerated and no new safety signals were observed.
Citation Format: Thierry Petit, Nawale Hajjaji, Eric-Charles Antoine, Marc-Antoine Benderra, Michel Gozy, Cyril Foa, Jean-Loup Mouysset, Julien Grenier, Mireille Mousseau, Audrey Mailliez, Mahasti Saghatchian, Emma Lachaier, Isabelle Desmoulins, Audrey Hennequin, Patricia Maes, Delphine Loirat, Francesco Ricci, Véronique Diéras, Dominique Berton, Florence Lai Tiong, Luis Teixeira, Nadine Dohollou, Christelle Lévy, Thomas Bachelot, Jean-Yves Pierga. Trastuzumab deruxtecan in previously treated HER2-positive metastatic or unresectable breast cancer (BC): First real-life data from the cohort temporary authorization for use (cATU) program in France [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-13-26.
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Affiliation(s)
- Thierry Petit
- Département d’Oncologie Médicale, Centre Paul Strauss, Strasbourg, France
| | - Nawale Hajjaji
- Département de Cancérologie Sénologique, Centre Oscar Lambret, Lille, France
| | | | | | - Michel Gozy
- Département de Radiothérapie-Oncologie, Clinique de l’Europe, Amiens, France
| | - Cyril Foa
- Département d’Oncologie Médicale, Hôpital Saint-Joseph, Marseille, France
| | - Jean-Loup Mouysset
- Département de Cancérologie, Hôpital Privé de Provence, Aix-en-Provence, France
| | - Julien Grenier
- Unité Oncologie Sein-Gynécologie, Institut Sainte-Catherine, Avignon, France
| | | | - Audrey Mailliez
- Département de Cancérologie Sénologique, Centre Oscar Lambret, Lille, France
| | - Mahasti Saghatchian
- Département d’Oncologie Médicale, Hôpital Américain de Paris, Neuilly-sur-Seine, France
| | - Emma Lachaier
- Département d’Oncologie Médicale, CHU Amiens, Amiens, France
| | - Isabelle Desmoulins
- Département d’Oncologie Médicale, Centre Georges François Leclerc, Dijon, France
| | - Audrey Hennequin
- Département d’Oncologie Médicale, Centre Georges François Leclerc, Dijon, France
| | - Patricia Maes
- Département d’Oncologie, Hôpital Privé Le Bois, Lille, France
| | - Delphine Loirat
- Département d’Oncologie Médicale, Institut Curie, Paris, France
| | - Francesco Ricci
- Département d’Oncologie Médicale, Institut Curie, Paris, France
| | - Véronique Diéras
- Département d’Oncologie Médicale, Centre Eugène Marquis, Rennes, France
| | - Dominique Berton
- Département d’Oncologie Médicale, Institut de Cancérologie de l’Ouest, Saint-Herblain, France
| | | | - Luis Teixeira
- Breast Disease Unit, APHP, Hôpital Saint-Louis, Pathophysiology of Breast Cancer Team, Université de Paris, INSERM U976, HIPI, Paris, France
| | - Nadine Dohollou
- Service d’Oncologie Médicale, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Christelle Lévy
- Département d’Oncologie Médicale, Centre François Baclesse, Caen, France
| | - Thomas Bachelot
- Département d’Oncologie Médicale, Centre Léon Bérard, Lyon, France
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8
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Carey LA, Zelnak A, Rugo HS, Dalenc F, Nanda R, Danso M, Saghatchian M, Kalinsky K, Firmin N, Ruiz-Borrego M, Favret A, Sun J, Schwartzberg L, Hilton C, Omene C, Young R, Hurvitz SA, Harting E, Phan S, Bardia A. Abstract P5-16-07: Assessment of sacituzumab govitecan (SG) in Black patients (pts) from the phase 3 ASCENT study in metastatic triple-negative breast cancer (mTNBC). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-16-07] [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: Black women have higher incidence rates of TNBC and may experience worse clinical outcomes compared with White women with TNBC, due to disparities, comorbidities, or differences in TNBC biology (Dietze EG, et al. Nat Rev Cancer. 2015;15:248-254). As a result, Black pts with TNBC may benefit from novel therapies to improve outcomes. SG is an antibody-drug conjugate composed of an anti-Trop-2 antibody coupled to the cytotoxic SN-38 payload via a proprietary, hydrolyzable linker. SG received FDA approval for pts with mTNBC who received ≥2 prior chemotherapies (at least 1 in the metastatic setting). The confirmatory phase 3 ASCENT study (NCT02574455) in pts treated in second line or greater (2L+) mTNBC setting demonstrated a significant survival benefit of SG over single-agent chemotherapy treatment of physician’s choice (TPC; median progression-free survival, [PFS]: 4.8 vs 1.7 mo, HR 0.43, P<0.001; median overall survival [OS]: 11.8 vs 6.9 mo, HR 0.51) in the full trial population, with a manageable safety profile. To better understand the clinical outcomes of Black pts in the ASCENT study, a subgroup analysis was performed. Methods: In ASCENT, pts with mTNBC refractory to or relapsing after ≥2 prior chemotherapies (at least 1 in the metastatic setting) were randomized 1:1 to receive SG (10 mg/kg IV on days 1 and 8, every 21 days) or TPC (capecitabine, eribulin, vinorelbine, or gemcitabine). Primary endpoint was PFS per RECIST 1.1 by independent review in brain metastases-negative pts. Secondary endpoints included OS, objective response rate (ORR), clinical benefit rate (CBR), and safety. Race was self-reported and a prespecified subgroup for efficacy analyses. In this subgroup analysis, efficacy outcomes were assessed in the full trial population (including pts with and without known brain metastases) of pts reporting Black race; safety was analyzed in pts who received ≥1 dose of study drug in this subgroup. Results: Of the 529 pts in the full trial population, 62 (12%) pts who received SG (n=28) or TPC (n=34) were Black pts (median age, 54 y [range, 32-75] with a median of 4 prior anticancer regimens [range, 2-10]; 2 pts (3%) were positive for BRCA1/2 mutations). Characteristics were generally balanced across treatment arms. Median duration of treatment was 5.3 vs 1.6 mo in the SG vs TPC arms, respectively. In this subgroup, median PFS was improved with SG vs TPC (5.4 vs 2.2 mo; HR, 0.44; 95% CI, 0.24-0.80; P=0.008) as were ORR (32% vs 6%; odds ratio, 7.6; 95% CI, 1.5-38.8; P=0.008) and CBR (43% vs 15%; odds ratio, 4.4; 95% CI, 1.3-14.6; P=0.014). Median OS was numerically longer with SG vs TPC (13.8 vs 8.5 mo; HR, 0.64; 95% CI, 0.34-1.19; P=0.159). The safety profile of SG in Black pts was similar to that of the full trial population. Key treatment-related adverse events (TRAEs) of grade ≥3 in this subgroup (SG vs TPC) were neutropenia (48% vs 42%), anemia (12% vs 6%), leukopenia (8% vs 16%), and febrile neutropenia (8% vs 3%). No pts in the SG arm discontinued due to TRAEs; 1 pt in the TPC (3%) arm discontinued due to TRAEs. There were no treatment-related deaths. Conclusions: While only 12% of pts in the ASCENT trial self-identified as Black, Black pts with pretreated mTNBC derived a similar clinical benefit from SG over TPC as seen in the full trial population, with a manageable safety profile. SG should be considered as a treatment option for pts with mTNBC in the 2L+ setting.
Citation Format: Lisa A. Carey, Amelia Zelnak, Hope S. Rugo, Florence Dalenc, Rita Nanda, Michael Danso, Mahasti Saghatchian, Kevin Kalinsky, Nelly Firmin, Manuel Ruiz-Borrego, Anne Favret, Jun Sun, Lee Schwartzberg, Christie Hilton, Coral Omene, Robyn Young, Sara A. Hurvitz, Eliza Harting, See Phan, Aditya Bardia. Assessment of sacituzumab govitecan (SG) in Black patients (pts) from the phase 3 ASCENT study in metastatic triple-negative breast cancer (mTNBC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-16-07.
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Affiliation(s)
- Lisa A. Carey
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Hope S. Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | | | - Rita Nanda
- The University of Chicago Medical Center, Chicago, IL
| | | | | | | | - Nelly Firmin
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | - Anne Favret
- Virginia Cancer Specialists, PC, Fairfax, VA
| | - Jun Sun
- Maryland Oncology Hematology – Clinton Office, Clinton, MD
| | | | | | - Coral Omene
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robyn Young
- The Center for Cancer and Blood Disorders, Fort Worth, TX
| | - Sara A. Hurvitz
- University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | | | - See Phan
- Gilead Sciences Inc., Foster City, CA
| | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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9
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Saghatchian M, Abehsera M, Yamgnane A, Geyl C, Gauthier E, Hélin V, Bazire M, Villoing-Gaudé L, Reyes C, Gentien D, Golmard L, Stoppa-Lyonnet D. Feasibility of personalized screening and prevention recommendations in the general population through breast cancer risk assessment: results from a dedicated risk clinic. Breast Cancer Res Treat 2022; 192:375-383. [PMID: 34994879 PMCID: PMC8739506 DOI: 10.1007/s10549-021-06445-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/08/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE A personalized approach to prevention and early detection based on known risk factors should contribute to early diagnosis and treatment of breast cancer. We initiated a risk assessment clinic for all women wishing to undergo an individual breast cancer risk assessment. METHODS Women underwent a complete breast cancer assessment including a questionnaire, mammogram with evaluation of breast density, collection of saliva sample, consultation with a radiologist, and a breast cancer specialist. Women aged 40 or older, with 0 or 1 first-degree relative with breast cancer diagnosed after the age of 40 were eligible for risk assessment using MammoRisk, a machine learning-based tool that provides an individual 5-year estimated risk of developing breast cancer based on the patient's clinical data and breast density, with or without polygenic risk scores (PRSs). DNA was extracted from saliva samples for genotyping of 76 single-nucleotide polymorphisms. The individual risk was communicated to the patient, with individualized screening and prevention recommendations. RESULTS A total of 290 women underwent breast cancer assessment, among which 196 women (68%) were eligible for risk assessment using MammoRisk (median age 52, range 40-72). When PRS was added to MammoRisk, 40% (n = 78) of patients were assigned a different risk category, with 28% (n = 55) of patients changing from intermediate to moderate or high risk. CONCLUSION Individual risk assessment is feasible in the general population. Screening recommendations could be given based on individual risk. The use of PRS changed the risk score and screening recommendations in 40% of women.
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Affiliation(s)
- Mahasti Saghatchian
- American Hospital of Paris, Neuilly-sur-Seine, France. .,Paris-Descartes University, Paris, France.
| | - Marc Abehsera
- American Hospital of Paris, Neuilly-sur-Seine, France
| | | | - Caroline Geyl
- American Hospital of Paris, Neuilly-sur-Seine, France
| | | | | | | | | | | | | | - Lisa Golmard
- INSERM U830 D.R.U.M. Team, Institut Curie Hospital, Paris-University, Paris, France
| | - Dominique Stoppa-Lyonnet
- Institut Curie, Paris, France.,INSERM U830 D.R.U.M. Team, Institut Curie Hospital, Paris-University, Paris, France
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10
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Bizot A, Karimi M, Rassy E, Heudel PE, Levy C, Vanlemmens L, Uzan C, Deluche E, Genet D, Saghatchian M, Giacchetti S, Grenier J, Patsouris A, Dieras V, Pierga JY, Petit T, Ladoire S, Jacot W, Benderra MA, De Jesus A, Delaloge S, Lambertini M, Pistilli B. Multicenter evaluation of breast cancer patients' satisfaction and experience with oncology telemedicine visits during the COVID-19 pandemic. Br J Cancer 2021; 125:1486-1493. [PMID: 34588616 PMCID: PMC8480754 DOI: 10.1038/s41416-021-01555-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 05/29/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, teleconsultation was implemented in clinical practice to limit patient exposure to COVID-19 while monitoring their treatment and follow-up. We sought to examine the satisfaction of patients with breast cancer (BC) who underwent teleconsultations during this period. METHODS Eighteen centres in France and Italy invited patients with BC who had at least one teleconsultation during the first wave of the COVID-19 pandemic to participate in a web-based survey that evaluated their satisfaction (EORTC OUT-PATSAT 35 and Telemedicine Satisfaction Questionnaire [TSQ] scores) with teleconsultation. RESULTS Among the 1299 participants eligible for this analysis, 53% of participants were undergoing standard post-treatment follow-up while 22 and 17% were currently receiving active anticancer therapy for metastatic and localised cancers, respectively. The mean satisfaction scores were 77.4 and 73.3 for the EORTC OUT-PATSAT 35 and TSQ scores, respectively. In all, 52.6% of participants had low/no anxiety. Multivariable analysis showed that the EORTC OUT-PATSAT 35 score correlated to age, anxiety score and teleconsultation modality. The TSQ score correlated to disease status and anxiety score. CONCLUSION Patients with BC were satisfied with oncology teleconsultations during the COVID-19 pandemic. Teleconsultation may be an acceptable alternative follow-up modality in specific circumstances.
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Affiliation(s)
- Alexandra Bizot
- Medical Oncology Department, Gustave Roussy, Villejui, France
| | - Maryam Karimi
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, University Paris-Saclay, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Elie Rassy
- Medical Oncology Department, Gustave Roussy, Villejui, France
| | | | - Christelle Levy
- Institut Normand du Sein, Centre Francois Baclesse, Caen, France
| | | | - Catherine Uzan
- Breast and Gynecologic Surgery, Assistance Publique - Hopitaux De Paris, Paris, France
| | - Elise Deluche
- Medical Oncology Department, CHU Limoges - Hopital Dupuytren, Limoges, France
| | - Dominique Genet
- Medical Oncology Department, Clinique Chenieux, Limoges, France
| | | | | | - Juline Grenier
- Medical Oncology Department, Institut Ste Catherine, Avignon, France
| | - Anne Patsouris
- Medical Oncology Department, ICO - Institut de Cancérologie de l'Ouest Nantes-Angers, Angers, France
| | - Véronique Dieras
- Medical Oncology Department, Centre Eugene - Marquis, Rennes, France
| | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie & St Cloud, Université de Paris, Paris, France
| | - Thierry Petit
- Medical Oncology Department, Centre Paul Strauss Centre de Lutte contre le Cancer, Strasbourg, France
| | - Sylvain Ladoire
- Medical Oncology Department, Centre Georges-François Leclerc (Dijon), Dijon, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier University, INSERM, U1194, Montpellier, France
| | | | - Anne De Jesus
- Patient Relationship Coordination, Gustave Roussy, Villejuif, France
| | | | - Matteo Lambertini
- Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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11
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Saghatchian M, Lacas B, Charles C, Ghouadni A, Clain GT, Boinon D, Delaloge S, Vaz-Luis I, Dauchy S, Amiel P. BEAUTY and the breast: is adjuvant chemotherapy the right time for a beauty boost? Lessons learned from a large randomized controlled trial. Qual Life Res 2021; 31:723-732. [PMID: 34324138 DOI: 10.1007/s11136-021-02947-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Beauty care (BTC) is offered at many cancer hospitals having a great uptake among patients. Nevertheless, its benefits in the Quality of life (QoL) of cancer survivors have not been assessed so far. METHODS Our study aims to determine whether BTC improves patients' QoL related to their body image measured by the BRBI scale of the QLQ-BR23 questionnaire at the end of adjuvant chemotherapy, after breast cancer (BC) surgery. The BEAUTY study is a prospective, randomized, controlled intervention trial. The following patient-reported outcomes were filled before initiation of chemotherapy (T1) and after their last cycle (T2): EORTC QLQ-C30, QLQ-BR23, and Body Image Scale (BIS). Primary objective was improvement in the BIS of BR23 (BRBI). A qualitative assessment of patients' experience was performed at each cycle through a relevant questionnaire. RESULTS In total, 269 (67%) patients filled BRBI at T1 and T2. Mean BRBI scores substantially decreased between T1 and T2 and were not different with or without BTC (p = 0.88). Qualitative assessment suggests impact of BTC in physical well-being and avoids thoughts related to the disease. CONCLUSION A substantial proportion of patients have a poor body image and chemotherapy induced a substantial degradation of BRBI scores. Although BTC does not seem to impact BRBI scores, the qualitative assessment suggests some benefit of BTC in other domains. Our study highlights the need to assess patients-perceived body image and build tailored interventions at this critical phase of their disease and generates hypothesis for the impact of BTC among BC patients. Clinical trial registration The study is registered at ClinicalTrials.gov under the NCT01459003 number since October 25, 2011.
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Affiliation(s)
- Mahasti Saghatchian
- Medical Oncology Department, Gustave Roussy, Villejuif, France. .,Breast Cancer Unit, Institut de Cancérologie Gustave Roussy, 114, rue Edouard Vaillant, 94800, Villejuif, France.
| | - Benjamin Lacas
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France.,INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Cécile Charles
- Social Sciences Research Unit, Gustave Roussy, Villejuif, France
| | - Amal Ghouadni
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | | | - Diane Boinon
- Social Sciences Research Unit, Gustave Roussy, Villejuif, France
| | | | - Ines Vaz-Luis
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Sarah Dauchy
- Supportive Care Department, Gustave Roussy, Villejuif, France
| | - Philippe Amiel
- Social Sciences Research Unit, Gustave Roussy, Villejuif, France
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12
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Mamounas EP, Untch M, Mano MS, Huang CS, Geyer CE, von Minckwitz G, Wolmark N, Pivot X, Kuemmel S, DiGiovanna MP, Kaufman B, Kunz G, Conlin AK, Alcedo JC, Kuehn T, Wapnir I, Fontana A, Hackmann J, Polikoff J, Saghatchian M, Brufsky A, Yang Y, Zimovjanova M, Boulet T, Liu H, Tesarowski D, Lam LH, Song C, Smitt M, Loibl S. Adjuvant T-DM1 versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: subgroup analyses from KATHERINE. Ann Oncol 2021; 32:1005-1014. [PMID: 33932503 DOI: 10.1016/j.annonc.2021.04.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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: 11/02/2020] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In the KATHERINE study (NCT01772472), patients with residual invasive early breast cancer (EBC) after neoadjuvant chemotherapy (NACT) plus human epidermal growth factor receptor 2 (HER2)-targeted therapy had a 50% reduction in risk of recurrence or death with adjuvant trastuzumab emtansine (T-DM1) versus trastuzumab. Here, we present additional exploratory safety and efficacy analyses. PATIENTS AND METHODS KATHERINE enrolled HER2-positive EBC patients with residual invasive disease in the breast/axilla at surgery after NACT containing a taxane (± anthracycline, ± platinum) and trastuzumab (± pertuzumab). Patients were randomized to adjuvant T-DM1 (n = 743) or trastuzumab (n = 743) for 14 cycles. The primary endpoint was invasive disease-free survival (IDFS). RESULTS The incidence of peripheral neuropathy (PN) was similar regardless of neoadjuvant taxane type. Irrespective of treatment arm, baseline PN was associated with longer PN duration (median, 105-109 days longer) and lower resolution rate (∼65% versus ∼82%). Prior platinum therapy was associated with more grade 3-4 thrombocytopenia in the T-DM1 arm (13.5% versus 3.8%), but there was no grade ≥3 hemorrhage in these patients. Risk of recurrence or death was decreased with T-DM1 versus trastuzumab in patients who received anthracycline-based NACT [hazard ratio (HR) = 0.51; 95% confidence interval (CI): 0.38-0.67], non-anthracycline-based NACT (HR = 0.43; 95% CI: 0.22-0.82), presented with cT1, cN0 tumors (0 versus 6 IDFS events), or had particularly high-risk tumors (HRs ranged from 0.43 to 0.72). The central nervous system (CNS) was more often the site of first recurrence in the T-DM1 arm (5.9% versus 4.3%), but T-DM1 was not associated with a difference in overall risk of CNS recurrence. CONCLUSIONS T-DM1 provides clinical benefit across patient subgroups, including small tumors and particularly high-risk tumors and does not increase the overall risk of CNS recurrence. NACT type had a minimal impact on safety.
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Affiliation(s)
- E P Mamounas
- NSABP Foundation and; Department of Surgery, Orlando Health UF Health Cancer Center, Orlando, USA.
| | - M Untch
- AGO-B and Department of Gynecologic Oncology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - M S Mano
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - C-S Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C E Geyer
- NSABP Foundation and; NSABP Foundation and Department of Internal Medicine, Division of Hematology and Medical Oncology, Houston Methodist Cancer Center, Houston, USA
| | | | - N Wolmark
- NSABP Foundation and; NSABP Foundation and Department of Surgery, The University of Pittsburgh, Pittsburgh, USA
| | | | - S Kuemmel
- Breast Unit Kliniken Essen-Mitte, Essen, Germany; Klinik für Gynäkologie mit Brustzentrum Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M P DiGiovanna
- Yale University School of Medicine, Yale Cancer Center and Smilow Cancer Hospital, New Haven, USA
| | - B Kaufman
- Oncology Division, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - G Kunz
- GBG, Neu-Isenburg, Germany; St. Johannes Hospital Dortmund, Dortmund, Germany
| | - A K Conlin
- NSABP Foundation and; NSABP Foundation and Department of Medical Oncology, Providence Cancer Institute, Portland, USA
| | - J C Alcedo
- Department of Clinical Oncology, Centro Hemato Oncologico, Panama City, Panama
| | - T Kuehn
- AGO-B and Klinikum Esslingen, Esslingen, Germany
| | - I Wapnir
- NSABP Foundation and; NSABP Foundation and Stanford University School of Medicine, Stanford, USA
| | - A Fontana
- Division of Medical Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - J Hackmann
- GBG, Neu-Isenburg, Germany; Marien-Hospital Witten, SEG, Witten, Germany
| | - J Polikoff
- NSABP Foundation and; NSABP Foundation and Department of Hematology/Oncology, Kaiser Permanente, San Diego, USA
| | - M Saghatchian
- Breast Cancer Department, Institut Gustave Roussy, Villejuif, France
| | - A Brufsky
- NSABP Foundation and; NSABP Foundation and Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Y Yang
- Division of Hematology-Oncolog, Taichung Veterans General Hospital and School of Medicine, China Medical University, Taichung City, Taiwan
| | - M Zimovjanova
- Department of Oncology, Charles University and General University Hospital, Prague, Czech Republic
| | - T Boulet
- Department of Biostatistics, F. Hoffmann-La Roche, Basel, Switzerland
| | - H Liu
- Product Development Safety, Genentech, Inc., South San Francisco, USA
| | - D Tesarowski
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - L H Lam
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - C Song
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - M Smitt
- Product Development Oncology, Genentech, Inc., South San Francisco, USA; Seattle Genetics, South San Francisco, USA
| | - S Loibl
- GBG, Neu-Isenburg, Germany; Center for Haematology and Oncology Bethanien, Frankfurt, Germany
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13
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Kehrloesser S, Oberst S, Westerhuis W, Wendler A, Wind A, Blaauwgeers H, Burrion JB, Nagy P, Saeter G, Gustafsson E, De Paoli P, Lovey J, Lombardo C, Philip T, de Valeriola D, Docter M, Boomsma F, Saghatchian M, Svoboda M, Philip I, Monetti F, Hummel H, McVie G, Otter R, van Harten W. Analysing the attributes of Comprehensive Cancer Centres and Cancer Centres across Europe to identify key hallmarks. Mol Oncol 2021; 15:1277-1288. [PMID: 33734563 PMCID: PMC8096787 DOI: 10.1002/1878-0261.12950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/06/2021] [Accepted: 03/17/2021] [Indexed: 12/22/2022] Open
Abstract
There is a persistent variation in cancer outcomes among and within European countries suggesting (among other causes) inequalities in access to or delivery of high‐quality cancer care. European policy (EU Cancer Mission and Europe’s Beating Cancer Plan) is currently moving towards a mission‐oriented approach addressing these inequalities. In this study, we used the quantitative and qualitative data of the Organisation of European Cancer Institutes’ Accreditation and Designation Programme, relating to 40 large European cancer centres, to describe their current compliance with quality standards, to identify the hallmarks common to all centres and to show the distinctive features of Comprehensive Cancer Centres. All Comprehensive Cancer Centres and Cancer Centres accredited by the Organisation of European Cancer Institutes show good compliance with quality standards related to care, multidisciplinarity and patient centredness. However, Comprehensive Cancer Centres on average showed significantly better scores on indicators related to the volume, quality and integration of translational research, such as high‐impact publications, clinical trial activity (especially in phase I and phase IIa trials) and filing more patents as early indicators of innovation. However, irrespective of their size, centres show significant variability regarding effective governance when functioning as entities within larger hospitals.
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Affiliation(s)
- Sebastian Kehrloesser
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, UK
| | - Simon Oberst
- Organisation of European Cancer Institutes, Brussels, Belgium.,Cancer Research UK Cambridge Centre, University of Cambridge, UK
| | - Willien Westerhuis
- the Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Astrid Wendler
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, UK
| | - Anke Wind
- Rijnstate Hospital, Arnhem, The Netherlands
| | - Harriët Blaauwgeers
- the Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | | | - Péter Nagy
- National Institute of Oncology, Budapest, Hungary
| | - Gunnar Saeter
- Organisation of European Cancer Institutes, Brussels, Belgium.,Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Eva Gustafsson
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | | | - József Lovey
- Organisation of European Cancer Institutes, Brussels, Belgium.,National Institute of Oncology, Budapest, Hungary
| | | | - Thierry Philip
- Organisation of European Cancer Institutes, Brussels, Belgium.,Institut Curie, Paris Cedex 05, France
| | - Dominique de Valeriola
- Organisation of European Cancer Institutes, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Femke Boomsma
- Radiotherapeutisch Instituut Friesland, Leeuwarden, The Netherlands
| | - Mahasti Saghatchian
- Institut Gustave Roussy, Villejuif, France.,American Hospital of Paris, Neuilly-sur-Seine, France
| | - Marek Svoboda
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | | | | | - Henk Hummel
- the Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | | | | | - Wim van Harten
- Organisation of European Cancer Institutes, Brussels, Belgium.,Rijnstate Hospital, Arnhem, The Netherlands.,The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
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14
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Martin E, Di Meglio A, Charles C, Ferreira A, Gbenou A, Blond M, Fagnou B, Arvis J, Pistilli B, Saghatchian M, Vaz Luis I. Use of mHealth to Increase Physical Activity Among Breast Cancer Survivors With Fatigue: Qualitative Exploration. JMIR Cancer 2021; 7:e23927. [PMID: 33749606 PMCID: PMC8088868 DOI: 10.2196/23927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/29/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Physical activity has shown beneficial effects in the treatment of breast cancer fatigue; nevertheless, a significant portion of patients remain insufficiently physically active after breast cancer. Currently most patients have a smartphone, and therefore mobile health (mHealth) holds the promise of promoting health behavior uptake for many of them. OBJECTIVE In this study, we explored representations, levers, and barriers to physical activity and mHealth interventions among inactive breast cancer patients with fatigue. METHODS This was an exploratory, qualitative study including breast cancer patients from a French cancer center. A total of 4 focus groups were conducted with 9 patients; 2 independent groups of patients (groups A and B) were interviewed at 2 consecutive times (sessions 1 to 4), before and after their participation in a 2-week mHealth group experience consisting of (1) a competitive virtual exercise group activity (a fictitious world tour), (2) participation in a daily chat network, and (3) access to physical activity information and world tour classification feedback. We used a thematic content analysis. RESULTS Several physical activity levers emerged including (1) physical factors such as perception of physical benefit and previous practice, (2) psychological factors such as motivation increased by provider recommendations, (3) social factors such as group practice, and (4) organizational factors including preplanning physical activity sessions. The main barriers to physical activity identified included late effects of cancer treatment, lack of motivation, and lack of time. The lack of familiarity with connected devices was perceived as the main barrier to the use of mHealth as a means to promote physical activity. The tested mHealth group challenge was associated with several positive representations including well-being and good habit promotion and being a motivational catalyzer. Following feedback, modifications were implemented into the mHealth challenge. CONCLUSIONS mHealth-based, easily accessed group challenges were perceived as levers for the practice of physical activity in this population. mHealth-based group challenges should be explored as options to promote physical activity in a population with fatigue after breast cancer.
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15
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Callens C, Driouch K, Boulai A, Tariq Z, Comte A, Berger F, Belin L, Bièche I, Servois V, Legoix P, Bernard V, Baulande S, Chemlali W, Bidard FC, Fourchotte V, Salomon AV, Brain E, Lidereau R, Bachelot T, Saghatchian M, Campone M, Giacchetti S, Zafrani BS, Cottu P. Molecular features of untreated breast cancer and initial metastatic event inform clinical decision-making and predict outcome: long-term results of ESOPE, a single-arm prospective multicenter study. Genome Med 2021; 13:44. [PMID: 33722295 PMCID: PMC7962302 DOI: 10.1186/s13073-021-00862-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/25/2021] [Indexed: 12/04/2022] Open
Abstract
Background Prognosis evaluation of advanced breast cancer and therapeutic strategy are mostly based on clinical features of advanced disease and molecular profiling of the primary tumor. Very few studies have evaluated the impact of metastatic subtyping during the initial metastatic event in a prospective study. The genomic landscape of metastatic breast cancer has mostly been described in very advanced, pretreated disease, limiting the findings transferability to clinical use. Methods We developed a multicenter, single-arm, prospective clinical trial in order to address these issues. Between November 2010 and September 2013, 123 eligible patients were included. Patients at the first, untreated metastatic event were eligible. All matched primary tumors and metastatic samples were centrally reviewed for pathological typing. Targeted and whole-exome sequencing was applied to matched pairs of frozen tissue. A multivariate overall survival analysis was performed (median follow-up 64 months). Results Per central review in 84 patients (out of 130), we show that luminal A breast tumors are more prone to subtype switching. By combining targeted sequencing of a 91 gene panel (n = 67) and whole-exome sequencing (n = 30), a slight excess of mutations is observed in the metastases. Luminal A breast cancer has the most heterogeneous mutational profile and the highest number of mutational signatures, when comparing primary tumor and the matched metastatic tissue. Tumors with a subtype change have more mutations that are private. The metastasis-specific mutation load is significantly higher in late than in de novo metastases. The most frequently mutated genes were TP53 and PIK3CA. The most frequent metastasis-specific druggable genes were PIK3CA, PTEN, KDR, ALK, CDKN2A, NOTCH4, POLE, SETD2, SF3B1, and TSC2. Long-term outcome is driven by a combination of tumor load and metastasis biology. Conclusions Profiling of the first, untreated, metastatic event of breast cancer reveals a profound heterogeneity mostly in luminal A tumors and in late metastases. Based on this profiling, we can derive information relevant to prognosis and therapeutic intervention, which support current guidelines recommending a biopsy at the first metastatic relapse. Trial registration The trial was registered at ClinicalTrials.gov (NCT01956552). Supplementary Information The online version contains supplementary material available at 10.1186/s13073-021-00862-6.
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Affiliation(s)
- Céline Callens
- Genetics Department, Institut Curie, PSL Research University, Paris, France
| | - Keltouma Driouch
- Genetics Department, Institut Curie, PSL Research University, Paris, France
| | - Anaïs Boulai
- Genetics Department, Institut Curie, PSL Research University, Paris, France
| | - Zakia Tariq
- Genetics Department, Institut Curie, PSL Research University, Paris, France
| | - Aurélie Comte
- Department of Medical Oncology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75005, Paris, France
| | | | - Lisa Belin
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - Ivan Bièche
- Genetics Department, Institut Curie, PSL Research University, Paris, France
| | - Vincent Servois
- Imaging Department, Institut Curie, PSL Research University, Paris, France
| | - Patricia Legoix
- Institut Curie Genomics of Excellence (ICGex) Platform, Institut Curie Research Center, PSL Research University, Paris, France
| | - Virginie Bernard
- Institut Curie Genomics of Excellence (ICGex) Platform, Institut Curie Research Center, PSL Research University, Paris, France
| | - Sylvain Baulande
- Institut Curie Genomics of Excellence (ICGex) Platform, Institut Curie Research Center, PSL Research University, Paris, France
| | - Walid Chemlali
- Genetics Department, Institut Curie, PSL Research University, Paris, France
| | - François-Clément Bidard
- Department of Medical Oncology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75005, Paris, France
| | | | - Anne Vincent- Salomon
- Pathology and Tumor Biology Department, Institut Curie, PSL Research University, Paris, France
| | - Etienne Brain
- Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Rosette Lidereau
- Genetics Department, Institut Curie, PSL Research University, Paris, France
| | | | | | - Mario Campone
- Institut de Cancérologie de l'Ouest Nantes, Nantes, France
| | | | - Brigitte Sigal Zafrani
- Pathology and Tumor Biology Department, Institut Curie, PSL Research University, Paris, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75005, Paris, France.
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16
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Saghatchian M, Abehsera M, Sigal R, Gauthier E, Helin V, Villoing-Gaude L, Reyes C, Rapinat A, Gentien D, Golmard L, Stoppa-Lyonnet D. Abstract PS7-31: Breast cancer risk assessment combined with a polygenic risk score in the general population for personalized screening. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps7-31] [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: Polygenic risk scores (PRS) composed of single nucleotide polymorphisms (SNPs) known to increase breast cancer risk could improve the performance of existing breast cancer risk prediction tools. However, data is still limited on the feasibility of risk assessment including PRS in the general population of women undergoing routine screening mammography.Patients and Methods: Women, aged 40 or older and not previously identified as high risk, underwent a complete breast cancer assessment, including a questionnaire on personal and family history, mammogram with evaluation of breast density using DenSeeMammo®, and saliva-based testing of 76 SNPs. The PRS was calculated using published per-allele odds ratio corresponding to the SNP associations with breast cancer. We analyzed whether the addition of PRS in eligible women modified risk classification. PRS was not used for risk assessment in non-Caucasian women, but was calculated for comparison between ethnicities.Results: A total of 140 Caucasian women underwent a breast cancer assessment and 130 were eligible for MammoRisk® assessment, with a median age of 51 (38-71). With MammoRisk without PRS: 26 (20%) were found to have moderate risk (5-year risk <1%), 71 (55%) intermediate risk (between 1 and 1.67%), and 33 (25%) high risk (≥1.67%). When PRS was performed and integrated into MammoRisk score, 34 (26%) were found to have moderate risk, 45 (35%) intermediate risk, and 51 (39%) high risk. The use of PRS changed the risk classification in 57 women (44%), 32 (25%) to a higher category and 25 (19%) to a lower category. When PRS was assessed for women of sub-Saharan African origin (n=36) using allele frequencies and odd-ratio observed in Caucasian populations, mean PRS was much higher (mean=1.89, [0.65-5.33], median = 1.65; n=36) than in the group of Caucasian women (mean=0.97 [0.33-3.05], median = 1.02; n=130), which would overestimate the PRS and the risk of developing breast cancer in women of African origin. Conclusions: The use of PRS changed the risk classification in a large subset of women. Results of ongoing large-scale studies will inform on the benefits of personalized risk-based screening compared to annual screening (Wisdom [NCT02620852], MyPEBS [NCT03672331]). As current PRSs have been developed and validated in women of European ancestry, population-specific PRSs need to be developed with data from ongoing large-scale genome-wide association studies for improved risk assessment in women of other ethnicities (Confluence Project, Nigerian Breast Cancer Study).
Number of women by risk categoryW/O PRSWith PRSModerate2634Intermediate7145High3351
Number of women with change in risk category when using PRSIntermediate to Moderate16Moderate to Intermediate5High to Intremediate9Moderate to High3Intermediate to high24
Citation Format: Mahasti Saghatchian, Marc Abehsera, Robert Sigal, Emilien Gauthier, Valerie Helin, Laure Villoing-Gaude, Cecile Reyes, Audrey Rapinat, David Gentien, Lisa Golmard, Dominique Stoppa-Lyonnet. Breast cancer risk assessment combined with a polygenic risk score in the general population for personalized screening [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-31.
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Affiliation(s)
| | - Marc Abehsera
- 1American Hospital of Paris, Neuilly sur Seine, France
| | - Robert Sigal
- 1American Hospital of Paris, Neuilly sur Seine, France
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17
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Bonnefoi H, Lerebours F, Tredan O, Dalenc F, Levy C, Saghatchian M, Reynier MAM, Mollon D, Guiu S, Bouvet LV, Carola E, Martineau G, Pulido M, MacGrogan G, Goncalves A. Abstract PS12-05: First efficacy results of a 2-stage Simon’s design randomised phase 2 of darolutamide or capecitabine in patients with triple-negative, androgen receptor positive advanced breast cancer (UCBG06-3). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps12-05] [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: Triple negative breast cancer (TNBC) is an heterogeneous disease and encompasses at least 4 subtypes. One of these expresses the androgen receptor (AR). Several prospective trials demonstrated antitumour efficacy with anti-androgen treatment in patients with advanced breast cancer. Darolutamide is an androgen-receptor antagonist with a potent anti-tumour efficacy in metastatic prostate cancer with a favorable safety profile. We conducted a randomized non-comparative phase II trial to study the efficacy and tolerability of darolutamide and capecitabine in AR-positive TNBC (NCT03383679).
Material and methods: Patients (Pts) with a metastatic, centrally reviewed, AR-positive (≥ 10% by immunohistochemistry) and TNBC who have received a maximum of one line of chemotherapy for advanced disease were eligible. They were randomised in a 2:1 ratio to receive darolutamide (D arm) 600 mg twice daily or capecitabine (C arm) at 1000 mg/m² twice daily 2 weeks on and 1-week off, until progression or unacceptable toxicity. The primary endpoint was clinical benefit rate (CBR) defined as the proportion of pts presenting a complete response (CR), partial response (PR), or stable disease (SD) at 16 weeks. Main secondary endpoints included objective response rate, overall survival, progression-free survival and safety. An interim statistical analysis was planned when 19 assessable pts will be available in the D arm. According to an optimal 2-stage Simon’s design,if <5 patients experienced a CBR the trial should be stopped for futility; if 5 or more experienced a CBR the trial should continue up to a total of 54 patients in the D arm.
Results: Out of 133 pts screened and centrally analyzed, from 37 centres, 54% (72/133) were AR-positive. 45 pts were randomized (29 in D arm and 16 in C arm) from April 2018 to December 2019. In arm D, median age was 60 years (range 47-88). and 13.8 % received a first line of chemotherapy for metastatic disease. A total of 19 pts were eligible and assessable for the primary endpoint in D arm. 5 CBR were confirmed at 16 weeks (26.3%; 95% CI: 9.2%-51.2 %) including 1 confirmed PR and 4 SD. In arm D, fatigue (23.8%), ASAT increased (23.8%), and blood alkaline phosphatase increased (23.8%) were the most common drug-related adverse events; the majority of them being grade 1 or 2. 6 pts presented with drug-related serious adverse events: one in D arm and 5 in C arm.
Conclusions: According to the planned interim analysis, the efficacy objective is met (5 CBR) in D arm. Moreover, darolutamide is well tolerated. Thus, patients are now recruited in the second stage.
Keywords: Androgen receptor,triple-negative breast cancer, darolutamide, advanced breast cancer
Citation Format: Hervé Bonnefoi, Florence Lerebours, Olivier Tredan, Florence Dalenc, Christelle Levy, Mahasti Saghatchian, Marie Ange Mouret Reynier, Delphine Mollon, Severine Guiu, Laurence Venat Bouvet, Elisabeth Carola, Geraldine Martineau, Marina Pulido, Gaetan MacGrogan, Anthony Goncalves. First efficacy results of a 2-stage Simon’s design randomised phase 2 of darolutamide or capecitabine in patients with triple-negative, androgen receptor positive advanced breast cancer (UCBG06-3) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS12-05.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Severine Guiu
- 9Institut du Cancer de Montpellier, Montpellier, France
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Saghatchian M, Curtit E, Coeffic D, Flinois A, Levy C. [Real-life study of 7-year survival in patients treated with trastuzumab for HER2+ early breast cancer]. Bull Cancer 2020; 107:745-755. [PMID: 32532419 DOI: 10.1016/j.bulcan.2020.04.013] [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: 03/04/2020] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND RATIONALE Despite improved prognosis of HER2 since the introduction of trastuzumab in the adjuvant setting of early breast cancer, disease recurrences still occur, particularly in certain patient subgroups. The objective of this real-life study conducted in France is to evaluate after 7 years, disease-free survival (DFS) and distant metastatic-free survival (MFS). METHODS This was a multi-center, retrospective, observational study assessing early HER2+ breast cancer patients diagnosed between January 1st, 2009 and December 31st, 2010 treated with adjuvant trastuzumab. DFS and MFS were evaluated within subgroups according to hormonal and nodal status. RESULTS Based on 2311 patients documented, according to nodal status, the 7-year DFS rate was significantly higher for N- than for N+ patients [87.2% vs. 66.8%; P<0.001], and the 7-year MFS rate [94.7% for N- vs. 74.9% for N+; P<0.001]. According to hormonal status, the 7-year DFS rate was significantly higher for HR+ than for HR- patients [80.5% vs. 69.2%; P<0.001], and the 7-year MFS rate [88.0% for HR+ vs. 77.7% HR-]. CONCLUSIONS Despite the overall improvement in the prognosis of early HER2+ breast cancers, patients in the N+ and RH- subgroups have a high risk of metastatic recurrence at seven years, justifying the search for more effective treatment alternatives.
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Affiliation(s)
- Mahasti Saghatchian
- American hospital of Paris, department of medical oncology, Neuilly sur seine, France
| | - Elsa Curtit
- Jean-Minjoz university hospital, department of medical oncology, Besançon, France
| | - David Coeffic
- Courlancy polyclinic, department of medical oncology, Reims, France
| | - Alain Flinois
- Kantar health institute, department of oncology, Paris, France.
| | - Christelle Levy
- CRLCC François-Baclesse, department of medical oncology, Caen, France
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19
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Delaloge S, Piccart M, Rutgers E, Litière S, van 't Veer LJ, van den Berkmortel F, Brain E, Dudek-Peric A, Gil-Gil M, Gomez P, Hilbers FS, Khalil Z, Knox S, Kuemmel S, Kunz G, Lesur A, Pierga JY, Ravdin P, Rubio IT, Saghatchian M, Smilde TJ, Thompson AM, Viale G, Zoppoli G, Vuylsteke P, Tryfonidis K, Poncet C, Bogaerts J, Cardoso F. Standard Anthracycline Based Versus Docetaxel-Capecitabine in Early High Clinical and/or Genomic Risk Breast Cancer in the EORTC 10041/BIG 3-04 MINDACT Phase III Trial. J Clin Oncol 2020; 38:1186-1197. [PMID: 32083990 DOI: 10.1200/jco.19.01371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE MINDACT demonstrated that 46% of patients with early breast cancer at high clinical but low genomic risk on the basis of MammaPrint may safely avoid adjuvant chemotherapy. A second random assignment (R-C) compared docetaxel-capecitabine with an anthracycline-based regimen. PATIENTS AND METHODS R-C randomly assigned patients 1:1 between standard anthracycline-based regimens, with or without taxanes (control) and experimental docetaxel 75 mg/m2 intravenously plus oral capecitabine 825 mg/m2 two times per day for 14 days (DC) every 3 weeks for 6 cycles. The primary end point was disease-free survival (DFS). Secondary end points included overall survival and safety. RESULTS Of 2,832 patients, 1,301 (45%) were randomly assigned, and 97% complied with R-C assignment. In the control arm, 29.6% only received taxanes (0.5% of N0 patients). DFS events (n = 148) were much less than required (n = 422) as a result of a lower-than-expected accrual and event rate. At 5 years of median follow-up, DFS was not different between DC (n = 652) and control (n = 649; 90.7% [95% CI, 88% to 92.8%] v 88.8% [95% CI, 85.9% to 91.1%]; hazard ratio [HR], 0.83 [95% CI, 0.60 to 1.15]; P = .26). Overall survival (HR, 0.91 [95% CI, 0.54 to 1.53]) and DFS in the clinical high and genomic high-risk subgroup (86.1% v 88.1%; HR, 0.83 [95% CI, 0.58 to 1.21]) were similar in both arms. DC led to more grade 1 neuropathy (27.1% v 11.2%) and more grade 2 hand/foot syndrome (28.5% v 3.3%) and diarrhea (13.7% v 5.8%). Serious cardiac events occurred in 9 patients (control, n = 4; DC, n = 5). Fifty-three patients developed second cancers (control, n = 32; DC, n = 21; leukemia: 2 v 1). Five treatment-related deaths occurred (control, 2 [0.3%]; DC, 3 [0.5%]). CONCLUSION Although underpowered, this second randomization in MINDACT did not show any improvement in outcome or safety with the use of DC compared with anthracycline-based chemotherapy.
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Affiliation(s)
- Suzette Delaloge
- Gustave Roussy, Villejuif, France.,Unicancer Breast Group, Paris, France
| | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Emiel Rutgers
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Saskia Litière
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Laura J van 't Veer
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | | | - Etienne Brain
- Institut Curie-Hôpital Rene Huguenin, Saint-Cloud, France
| | | | - Miguel Gil-Gil
- Institut Catala D'Oncologia-Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet, Barcelona, Spain
| | | | | | - Zaman Khalil
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Susan Knox
- Europa Donna-The European Breast Cancer Coalition, Milan, Italy
| | - Sherko Kuemmel
- Breast Unit Kliniken Essen-Mitte, Westdeutsche Studiengruppe, Mönchengladbach, Germany
| | | | - Anne Lesur
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | - Jean-Yves Pierga
- Institut Curie-Hôpital Rene Huguenin, Saint-Cloud, France.,Institut Curie Paris Sciences et Lettres, Université de Paris, Paris, France
| | - Peter Ravdin
- The University of Texas Health Sciences Center, San Antonio, TX
| | - Isabel T Rubio
- Clinica Universidad de Navarra-Site Madrid, Madrid, Spain
| | | | | | | | - Giuseppe Viale
- University of Milan and European Institute of Oncology-Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gabriele Zoppoli
- University of Genoa and Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Peter Vuylsteke
- Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
| | | | - Coralie Poncet
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Jan Bogaerts
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Fatima Cardoso
- Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
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Mano MS, Loibl S, Mamounas EP, von Minckwitz G, Huang CS, Untch M, Wolmark N, Wapnir IL, Yang Y, Conlin AK, Kümmel S, Saghatchian M, DiGiovanna MP, Strunk C, Zimovjanova M, Song C, Liu H, Tesarowski D, Blotner S, Lam LH, Smitt M, Geyer CE. Abstract P3-14-01: Adjuvant trastuzumab emtansine (T-DM1) vs trastuzumab (H) in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: KATHERINE subgroup analysis. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-14-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients with HER2-positive early breast cancer with residual invasive disease after neoadjuvant chemotherapy (NACT) + HER2-targeted therapy have a higher risk of recurrence and death than those with pathologic complete response. In the phase III KATHERINE study, adjuvant T-DM1 reduced the risk of recurrence or death by 50% vs H in this population. Data from KATHERINE subgroups are reported here, including patients treated with non-anthracycline (AC) vs AC based NACT, patients with small tumors (cT1cN0) who typically do not receive neoadjuvant treatment, and patients with particularly higher-risk tumors defined by nodal involvement and hormone-receptor status. Methods: Eligible patients had HER2-positive early breast cancer, received taxane- and H-containing neoadjuvant therapy ± AC followed by surgery, and had residual invasive disease in the breast and/or axillary nodes. Patients received 14 cycles of adjuvant T-DM1 (3.6 mg/kg IV q3w) or H (6 mg/kg IV q3w) and endocrine and/or radiation therapy per local standards. The primary endpoint was invasive disease-free survival (IDFS), defined as time from randomization to the first occurrence of ipsilateral locoregional or contralateral invasive breast cancer recurrence, distant recurrence, or death from any cause. In this exploratory analysis, efficacy subpopulations were derived from the intent-to-treat population and safety data were reported for patients who received ≥1 dose of study treatment. Results: In the non-AC v AC based NACT analysis (N=1486), some patient characteristics were imbalanced. For non-AC/AC based NACT, respectively, these included: region (North America; 60.6% v 11.0%), race (Asian; 12.8% v 7.4%), ECOG PS 1 (28.0% v 15.7%); neoadjuvant HER2-based therapy (H + pertuzumab; 46.6% v 9.8%), and neoadjuvant carboplatin/cisplatin (78.7 v 2.3%). Benefit was observed with T-DM1 regardless of neoadjuvant AC use (Table). The all-grade incidence of selected AEs with T-DM1 including hepatotoxicity, peripheral neuropathy, hemorrhage, IRR/hypersensitivity, and cardiac dysfunction was similar between non-AC and AC NACT groups. There was a small increase in the non-AC group in all-grade thrombocytopenia (32.5% v 27.4%) and pulmonary toxicity (6.7% vs 1.7%). There was an increased incidence of grade ≥3 AEs (39.9% vs 21.7%) in the non-AC vs the AC group with T-DM1 which was likely driven by an increase in thrombocytopenia (10.4% v 4.3%) and peripheral sensory neuropathy (4.3% vs 0.5%). However, the percentage of patients with AEs leading to T-DM1 withdrawal in the non-AC vs AC groups (19.6% v 17.5%) was similar, as was the percentage with AEs leading to T-DM1 dose reduction (14.1% v 11.6%). In patients with cT1N0 tumors (n=77), baseline characteristics were well-balanced for H v T-DM1. There were only 6 IDFS events in this subgroup overall; none were observed with T-DM1 (Table). In the analysis of particularly higher-risk tumors, all subgroups showed a benefit with T-DM1; the number of patients was small in some subgroups (Table). Conclusions: T-DM1 provides clinical benefit regardless of prior non-AC vs AC based NACT, and in subgroups with small or particularly higher-risk tumors. There was an increased incidence of grade ≥3 AEs with T-DM1 in the non-AC vs the AC group but these did not result in increased treatment discontinuation and were likely driven by the imbalance in prior therapy.
Table 1. Risk of IDFS event in patients treated with non-AC versus AC based NACT, patients with small tumors, and patients with particularly higher-risk tumors.Unstratified hazard ratio of IDFS (95% confidence interval [CI])Patients treated with non-AC vs AC based NACT (N=1,486)Non-AC-based NACT: H (n=179) vs T-DM1 (n=164)0.43 (0.22–0.82)AC-based NACT: H (n=564) vs T-DM1 (n=579)0.51 (0.38–0.67)Patients with small (cT1cN0) tumors (N=77)H (n=32) vs T-DM1 (n=45)6 events with H; 0 events with T-DM1(hazard ratio not applicable due to zero events in T-DM1 arm)Tumor subgroups defined by nodal and HR status (N=957)Inoperable; any HR or ypN statusH (n=190)T-DM1 (n=185)3-year IDFS event-free rate, % (95% CI)60.2 (52.7–67.8)76.0 (70.0–82.4)Unstratified hazard ratio (95% CI)0.54 (0.37–0.80)Operable; ypN positive and HR negativeH (n=52)T-DM1 (n=58)3-year IDFS event-free rate, % (95% CI)69.5 (56.1–82.9)76.0 (64.5–87.5)Unstratified hazard ratio (95% CI)0.72 (0.35–1.50)Operable; ypN positive and HR positiveH (n=167)T-DM1 (n=168)3-year IDFS event-free rate, % (95% CI)77.2 (70.2–84.1)91.4 (86.6–96.2)Unstratified hazard ratio (95% CI)0.43 (0.25–0.75)Operable; ypN0 and HR negativeH (n=68)T-DM1 (n=69)3-year IDFS event-free rate, % (95% CI)77.2 (66.5–87.9)91.1 (84.3–97.9)Unstratified hazard ratio (95% CI)0.43 (0.17–1.06)
Citation Format: Max S Mano, Sibylle Loibl, Eleftherios P. Mamounas, Gunter von Minckwitz, Chiun-Sheng Huang, Michael Untch, Norman Wolmark, Irene L. Wapnir, Youngsen Yang, Alison K. Conlin, Sherko Kümmel, Mahasti Saghatchian, Michael P. DiGiovanna, Claudia Strunk, Martina Zimovjanova, Chunyan Song, Haying Liu, David Tesarowski, Steven Blotner, Lisa H. Lam, Melanie Smitt, Charles E. Geyer Jr. Adjuvant trastuzumab emtansine (T-DM1) vs trastuzumab (H) in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: KATHERINE subgroup analysis [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 P3-14-01.
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Affiliation(s)
- Max S Mano
- 1Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Sibylle Loibl
- 2GBG, Neu-Isenburg, Germany; Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
| | - Eleftherios P. Mamounas
- 3NSABP Foundation and Orlando Health University of Florida Health Cancer Center, Orlando, FL
| | | | - Chiun-Sheng Huang
- 5National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Michael Untch
- 6AGO-B and HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Norman Wolmark
- 7NSABP Foundation and Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | - Irene L. Wapnir
- 8NSABP Foundation and Stanford University School of Medicine, Stanford, CA
| | - Youngsen Yang
- 9Taichung Veterans General Hospital and School of Medicine, China Medical University, Taichung City, Taiwan
| | - Alison K. Conlin
- 10NSABP Foundation and Providence Cancer Institute, Portland, OR
| | | | | | - Michael P. DiGiovanna
- 13Yale University School of Medicine, Yale Cancer Center and Smilow Cancer Hospital, New Haven, CT
| | - Claudia Strunk
- 14St. Barbara-Klinik Hamm-Heessen GmbH; Frauenklinik, Hamm, Germany
| | - Martina Zimovjanova
- 15Charles University and General University Hospital, Prague, Czech Republic
| | | | - Haying Liu
- 16Genentech, Inc., South San Francisco, CA
| | | | | | | | | | - Charles E. Geyer
- 17NSABP Foundation and Virginia Commonwealth University Massey Cancer Center, Richmond, VA
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Saghatchian M, Abehsera M, Bara ML, Lallouet F, Razani T, Sigal R, Gauthier E, Helin V, Gentien D, Stoppa-Lyonnet D. Abstract P2-02-04: Feasibility of breast cancer risk assessment during check-up in the general population for personalized screening and prevention recommendations: Preliminary results from a dedicated risk clinic. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-02-04] [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: For women without specific high-risk, current breast cancer screening recommendations are based on age only, although the risk of developing cancer varies among women. While mammography screening reduces death from breast cancer, personalized screening strategies based on individual risk should improve the efficiency of screening programs and reduce overdiagnosis. However, data is limited on the feasibility of risk assessment in the general population of women undergoing routine screening mammography. Patients and Methods: Women, aged 35 or older and not previously identified as high risk, who scheduled an appointment at the Women's Risk Institute at the American Hospital of Paris underwent a complete breast cancer assessment including a questionnaire on personal and family history, mammogram with evaluation of breast density, collection of saliva sample, and consultation with a radiologist. DNA was extracted from saliva samples for genotyping of 76 single nucleotide polymorphisms (SNPs) using TaqMan® SNP Genotyping Assay. The polygenic risk score (PRS) was calculated using published per-allele odds ratio corresponding to the SNP associations with breast cancer. Breast density was estimated using a software tool, DenSeeMammo®. Women with 0 or 1 first-degree relative with breast cancer, diagnosed after the age of 40, were eligible for risk assessment using MammoRisk®, based on patient data, breast density, with or without PRS. For those with a strong family history of breast cancer, other risk assessment tools (Tyrer-Cuzick, Boadicea) were used. The visit concluded with a consultation with a breast cancer specialist to discuss the personalized screening and prevention plan based on the individual 5-year estimated risk. We compared the risk category assigned to each woman using MammoRisk® with and without PRS and analyzed whether the use of PRS modified clinical recommendations. Results: A total of 43 women underwent a breast cancer assessment between January and June 2019, with a median age of 52 (36-69). The entire assessment lasted approximately 2 hours including mammography exams. Thirty-two (74%) were eligible for MammoRisk® assessment: 13 (41%) were found to have moderate risk (5-year risk ≤1%), 13 (41%) intermediate risk (between 1 and 1.67%), and 6 (19%) high risk (≥1.67%). When using MammoRisk® with PRS, 14 (44%) were found to have moderate risk, 10 (31%) intermediate risk, and 8 (25%) high risk. The use of PRS changed the risk category for 14 women (44%): from moderate to intermediate (n=3), from intermediate to high (n=3), from moderate to high (n=1), from intermediate to moderate (n=5) and from high to intermediate (n=2). The use of PRS identified 3 (9%) women with a 5-year risk of ≥3%, who would be eligible for chemoprevention using Tamoxifen in the US. Results will be updated at presentation with data from over 100 patients. Conclusions: Breast cancer risk assessment is feasible in the general population. Risk assessment during check-up enabled the clinician to propose surveillance and shorter screening intervals to women at higher-than-average risk, and longer screening intervals to women at or below average risk. The use of PRS changed the risk score and the recommendations on monitoring and prevention in a subset of women. Results of ongoing large-scale studies will inform on the benefits of personalized screening strategies compared to the current age-based screening strategies for implementation by public health authorities in generalized breast cancer screening programs (Wisdom [NCT02620852], MyPEBS [NCT03672331]). <!–EndFragment→
Citation Format: Mahasti Saghatchian, Marc Abehsera, Marie-Laure Bara, Fabienne Lallouet, Tara Razani, Robert Sigal, Emilien Gauthier, Valerie Helin, David Gentien, Dominique Stoppa-Lyonnet. Feasibility of breast cancer risk assessment during check-up in the general population for personalized screening and prevention recommendations: Preliminary results from a dedicated risk clinic [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 P2-02-04.
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Affiliation(s)
| | - Marc Abehsera
- 1American Hospital of Paris, Neuilly sur Seine, France
| | | | | | - Tara Razani
- 1American Hospital of Paris, Neuilly sur Seine, France
| | - Robert Sigal
- 1American Hospital of Paris, Neuilly sur Seine, France
| | | | | | | | - Dominique Stoppa-Lyonnet
- 4Institut Curie Hospital / Paris Descartes Sorbonne-Paris-Cité University/ INSERM U830, D.R.U.M. Team, Paris, France
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Abstract
Despite proven survival benefits after breast cancer, long-trem compliance with adjuvant hormone therapy remains a major issue, partly due to the side effects of treatment. In young women treated for breast cancer, these treatments include tamoxifen, anti-aromatase and LH-RH analogues, with even more side effects when these treatments are combined, especially for younger patients with more aggressive disease. The management of the potential side effects requires first of all detailed and precise information at initiation of treatment, and preventive measures including patient education. Once the treatment has been initiated, clinicians should be able to propose to their patients appropriate measures to alleviate the potential of the side effects, which can be of various types: biological (dyslipidemia), physical (weight gain, hot flushes, vaginal dryness, sexual disorders with low libido, musculoskeletal symptoms…) or psychosocial (anxio-depressive disorders, poor body image, difficulties of professional reintegration). Management of these effects can combine various modalities: drugs (switching hormone therapy, anti-depressants, hormonal treatments of vaginal dryness in some cases, gabapentin), physical treatments (CO2 laser for vulvovaginal atrophy) or psycho-physical techniques (physical activity, mindfulness, acupuncture…). Eventually, the lenghth of these adjuvant hormonal treatments requires supportive measures to help young patients engage in new lifestyle measures, in particular in term of physical activity and diet. This will help them mitigate the symptoms related to these side-effects while reducing the long-term risks related to their disease and treatments.
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Affiliation(s)
- Mahasti Saghatchian
- Pôle oncologie, Hôpital américain de Paris, Neuilly-sur-Seine, France; Comité de pathologie mammaire, Département de médecine oncologique, Institut de cancérologie Gustave-Roussy, Villejuif, France.
| | - Anne Lesur
- Responsable PARCOURS SEIN, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
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Lesur A, Saghatchian M. Cancer du sein chez la femme jeune. Bull Cancer 2019. [DOI: 10.1016/s0007-4551(20)30040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gougis P, Carton M, Tchokothe C, Campone M, Dalenc F, Mailliez A, Levy C, Jacot W, Debled M, Leheurteur M, Bachelot T, Hennequin A, Perrin C, Gonçalves A, Uwer L, Eymard JC, Petit T, Mouret-Reynier MA, Chamorey E, Simon G, Saghatchian M, Cailliot C, Le Tourneau C. CinéBreast-factors influencing the time to first metastatic recurrence in breast cancer: Analysis of real-life data from the French ESME MBC database. Breast 2019; 49:17-24. [PMID: 31675683 PMCID: PMC7375625 DOI: 10.1016/j.breast.2019.10.004] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose The Time to First Metastatic Recurrence (TFMR) could be considered as an indirect reflection of the tumour growth kinetics which plays an important role in cancer. Molecular subtypes such as expression of estrogen receptor are known predictive factors of TFMR. The CinéBreast study aimed to identify predictive factors of the time to TFMR. Methods The French Epidemiological Strategy and Medical Economics (ESME) Metastatic Breast Cancer (MBC) Database (NCT03275311) was used, which contains data from a cohort of metastatic breast cancer patients from 2008 to 2016 using retrospective data collection. It is a national multi-centre database. The impact of TFMR on overall survival (OS) since first metastasis was also evaluated. Results Among 16 702 patients recorded in the ESME MBC database, 10 595 had an initially localised breast cancer with hormone receptor (HR) and HER2 status available, with a metastatic recurrence. Median follow up was 56 months. Median TFMR was 59 months (<24: 20%, 24–60: 31%, 60–120: 25%, >120: 24%). HER2+ and TNBC were respectively 4 times and 12 times (p < 0.0001) more likely to have a recurrence within 2 years when compared to the luminal subgroup. Short TFMR and HR-/HER2-subtype significantly correlated with a poor OS in multivariate analysis. Some patients with MBC (20% in HER2+, 10% in ER+/HER2-and <5% in the ER-/HER2-) were long-term survivors in all 3 subgroups. Conclusions In this large-scale real-life data study, patients with a TNBC metastatic recurrence had a shorter TFMR. Short TFMR significantly correlated with worse overall survival. ESME is a large-scale real-life database of 16 702 metastatic breast cancer patients. A short time to first metastatic recurrence is associated with poor overall survival. Triple-negative tumours were more likely to recur early than HR+ and HER2+ tumours.
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Affiliation(s)
- P Gougis
- Department of Drug Development and Innovation, Institut Curie, Paris, Saint-Cloud, France; Department of Clinical Pharmacology, Centre D'Investigation Clinique Paris-Est, AP-HP, Pitié-Salpêtrière Hospital, PSL University, CLIP² Galilée, Paris, France
| | - M Carton
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - C Tchokothe
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - M Campone
- Department of Medical Oncology, Institut de Cancérologie de L'Ouest, Nantes and Angers, France
| | - F Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - A Mailliez
- Department of Breast Cancer, Centre Oscar Lambret, Lille, France
| | - C Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - W Jacot
- Department of Medical Oncology, Institut Du Cancer de Montpellier, Montpellier, France
| | - M Debled
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - M Leheurteur
- Department of Medical Oncology, Henri Becquerel Centre, Rouen, France
| | - T Bachelot
- Department of Biostatistics, Centre Léon Bérard, Lyon, France
| | - A Hennequin
- Department of Medical Oncology, Center Georges François Leclerc, Dijon, France
| | - C Perrin
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - L Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - J C Eymard
- Department of Medical Oncology, Centre Jean Godinot, Reims, France
| | - T Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | - M A Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, Clermont Ferrand, France
| | - E Chamorey
- Department of Biostatistics, Centre Antoine Lacassagne, Nice, France
| | - G Simon
- Department of Research and Development, R&D Unicancer, Paris, France
| | - M Saghatchian
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - C Cailliot
- Department of Research and Development, R&D Unicancer, Paris, France
| | - C Le Tourneau
- Department of Drug Development and Innovation, Institut Curie, Paris, Saint-Cloud, France; U900 INSERM Research Unit, Saint-Cloud, France.
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Martin E, Di Meglio A, Charles C, Ferreira A, Gbenou A, Blond M, Fagnou B, Pistilli B, Saghatchian M, Vaz-Luis I. Feasibility study of using an app-based mHealth group challenge to improve physical activity (PA) and fatigue after breast cancer (BC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz101.019] [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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Saghatchian M, Bouleuc C, Naudet C, Arnaud S, Papazian P, Scotté F, Krakowski I. [Impact of beauty and well-being care assessed in a national survey including 1166 individuals]. Bull Cancer 2018; 105:671-678. [PMID: 30099993 DOI: 10.1016/j.bulcan.2018.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/15/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Research has suggested a high level of satisfaction following beauty and well-being care in oncology. We aimed to assess perception of beauty and well-being care in a large sample of patients affected by cancer. METHODS From June through August, 2017, a physical and online survey was conducted recruiting patients affected by cancer and their relatives. A questionnaire, established in a collaborative manner with healthcare providers and patients, collected general demographic and medical data, awareness and knowledge data, the experience of beauty and well-being care and perceived benefits. RESULTS At baseline, 1263 people were recruited (online, n=485; others, n=778) with 1254 usable replies. After excluding caregivers (n=88), the analysis was made on 1166 patients (mean age=51.7). This sample included 1080 women (92.6 %) and breast cancer was prominent (n=827; 70.9%). Among the 481 patients, who had received beauty and well-being care, 405 stated them as a relaxing time (84 %) and the average ranking was 8,1/10. Mean number of sessions was 2.8. A combined scheme of beauty and well-being care (individual and collective) and a greater number of sessions were statistically associated with a higher perceived benefit (P=0.02 and P<0.001) and a higher level of recommendation (P=0.039 and P=0.05). DISCUSSION This large national survey confirms the high level of satisfaction associated with beauty and well-being care. The type and number of sessions seem to be positively correlated with a greater benefit.
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Affiliation(s)
- Mahasti Saghatchian
- Institut Gustave-Roussy, comité de pathologie, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
| | - Carole Bouleuc
- Institut Curie, oncologie médicale, 26, rue d'Ulm, 75005 Paris 5, France
| | - Catherine Naudet
- Institut Curie, oncologie médicale, 26, rue d'Ulm, 75005 Paris 5, France
| | - Sylvie Arnaud
- Institut Curie, oncologie médicale, 26, rue d'Ulm, 75005 Paris 5, France
| | - Patrick Papazian
- Hôpital Bichat-Claude-Bernard, service de maladies infectieuses et tropicales, 46, rue Henri-Huchard, 75018 Paris 18, France
| | - Florian Scotté
- Hôpital Foch, soins de support, 40, rue Worth, 92150 Suresnes, France
| | - Ivan Krakowski
- Institut Bergonié, oncologie médicale, 229, cours de l'Argonne, 33076 Bordeaux, France
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Paradiso A, Andreopoulou E, Conte P, Eniu A, Saghatchian M. PARP Inhibitors in Breast Cancer: Why, How, and When? Breast Care (Basel) 2018; 13:216-219. [PMID: 30069183 DOI: 10.1159/000490746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Angelo Paradiso
- Experimental Medical Oncology, Istituto Tumori G. Paolo II, IRCCS, Bari, Italy
| | - Eleni Andreopoulou
- Weill Cornell Breast Center, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Alexandru Eniu
- Department of Breast Tumors, Cancer Institute 'Ion Chiricuta', Cluj-Napoca, Romania
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Pistilli B, Mazouni C, Zingarello A, Faron M, Saghatchian M, Grynberg M, Spielmann M, Kerbrat P, Roché H, Lorgis V, Bachelot T, Campone M, Levy C, Goncalves A, Lesur A, Veyrat C, Vanlemmens L, Lemonnier J, Delaloge S. Abstract PD7-06: MAAT: Menses after adjuvant treatment. Prediction of menses recovery after chemotherapy for early breast cancer (BC) by using a nomogram model in UNICANCER PACS04 and PACS05 trials. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd7-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose:The likelihood of menses recovery (MR) is largely variable in premenopausal patients (pts) receiving adjuvant chemotherapy for BC. Quantifying this probability for each single patient could impact discussion of chemotherapy side effects and better individualize fertility counseling.We performed a pooled analysis from PACS04 and PACS05 randomized trials aiming to develop a nomogram to estimate the probability of menses recovery at 6 and 18 months (mos) after the end of adjuvant chemotherapy (CT) for premenopausal pts with early BC.
Patients and Methods: The analyzed population consisted of 1683 pts who were premenopausal and ≤ 50 (out of 4524 enrolled in both trials). In PACS05 node-negative BC pts were randomized to 4 or 6 cycles of FE100C (standard arm); in PACS04 node-positive pts were randomized to 6 cycles of FE100C or 6 cycles of Epirubicin 75mg/m2 and Docetaxel 75 mg/m2 (ED75). Endocrine therapy (ET) (Tamoxifen) x 5 years was mandatory for ER+ BC. Variables significantly associated with MR in the univariate analysis (P<0.20) were included in the multivariate analysis. Using this data set, a logistic regression-based nomogram was developed to predict MR at 6 and 18 mos.
Results: Pts' characteristics were: median age 43 (22-50), median body mass index (BMI) at baseline 22.6 (15.6-54.7), at the end of chemotherapy 22.8 (15.8-58.6). ED75 was administrated to 517 (30.7%), while 802 (47.7%) received 6FE100C, 364 (21.6) 4FE100C. Trastuzumab was given to 122 (7.2%), ET to 1229 (73%) pts. CT-induced amenorrhea was observed in 1407 (83.6%) pts. Factors associated to MR were assessed on 1210 pts (excluding pts who recovered menses during CT or of whom date of recovery was not specified). At a median follow-up of 90 mos, 28.2% (342/1210) of pts had recovered menstrual cycles: 11% (133/1210) at 6 mos and 24.3% (294/1210) at 18 mos. Multivariate analysis showed that younger age, higher BMI at the end of CT, non-alkylating agents and absence of ET were independently associated to MR.
Table 1 Multivariate Cox regression analysis of menses recoveryVariablesHR (95%CI)P valueAge1.49 (1.16-1.93)< 0.002Age2*0.99 [0.98-0.99]<0.0001BMI after CT1.02 (0.99-1.04)0.07Alkylating agents0.72 (0.57-0.90)0.004Endocrine Therapy0.50 (0.40-0.62)<0.001* The quadratic term in the age variable accounts for the non-linearity of the relation between the age and the probability of recovering menses. Overall this probability tend to decrease when age increase with a greater decrease for the older patients.
Nomogram concordance-index was 0.749 and 0.750 for predicting MR at 6 and 18 mos respectively. A better calibration was observed at 18 mos, comparing nomogram predictions with the actual probability of MR in the 1210 women.
Conclusion:Our analysis confirmed the possibility of developing a user-friendly nomogram for predicting menses recovery after adjuvant chemotherapy. As next step, we will externally validate our nomogram on CANTO premenopausal population, one of the biggest national cohorts aiming to assess the long-term impact of cancer treatments toxicities (UNICANCER NCT01993498 - http://etudecanto.org/).
Citation Format: Pistilli B, Mazouni C, Zingarello A, Faron M, Saghatchian M, Grynberg M, Spielmann M, Kerbrat P, Roché H, Lorgis V, Bachelot T, Campone M, Levy C, Goncalves A, Lesur A, Veyrat C, Vanlemmens L, Lemonnier J, Delaloge S. MAAT: Menses after adjuvant treatment. Prediction of menses recovery after chemotherapy for early breast cancer (BC) by using a nomogram model in UNICANCER PACS04 and PACS05 trials [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 PD7-06.
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Affiliation(s)
- B Pistilli
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - C Mazouni
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - A Zingarello
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - M Faron
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - M Saghatchian
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - M Grynberg
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - M Spielmann
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - P Kerbrat
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - H Roché
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - V Lorgis
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - T Bachelot
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - M Campone
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - C Levy
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - A Goncalves
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - A Lesur
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - C Veyrat
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - L Vanlemmens
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - J Lemonnier
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
| | - S Delaloge
- Institut Gustave Roussy, Villejuif, France; Jean-Verdier Hospital, Bondy, France; IRCCS AOU San Martino - IST, Genova, Italy; Centre Eugene Marquis, Rennes, France; Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France; Centre Georges François Leclerc, Dijon, France; Centre Léon Bérard, Lyon, France; Centre, Institut de Cancérologie de l'Ouest, Angers, France; Centre F Baclesse, Caen, France; Institut Paoli-Calmettes, Marseille, France; Institut de Cancerologie de Lorraine, Nancy, France; Centre Henri Becquerel, Rouen, France; Centre O Lambret, Lille, France; UNICANCER, Paris, France
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Saghatchian M, Carton M, Piot I, Pérol D, Pistilli B, Brain E, Ghouadni A, Ricci F, Vanlemmens L, Loeb A, Levy C, Goncalves A, Dalenc F, Lefeuvre-Plesse C, Campone M, Jaffre A, Gourgou S, Cailliot C, Robain M, Dieras V. Abstract P5-20-03: Impact of prior adjuvant trastuzumab (aT) on clinical characteristics, patterns of recurrence and outcome in 2863 patients with Her2 positive (HER2+) metastatic breast cancer (MBC)- Results from the French ESME UNICANCER program. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-20-03] [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: The management of HER2+ BC has changed dramatically with the introduction and widespread use of HER2-targeted therapies, especially in the adjuvant setting. However, there is relatively limited real-world information on the impact of adjuvant Trastuzumab (aT) on patterns of recurrence and outcome of HER2+ MBC.
Methods: In 2014, the 18 French Cancer Centers launched the Epidemiological Strategy and Medical Economics (ESME) program to provide real-world data on MBC patients (pts). All pts who started a 1st-line treatment for MBC between 01-Jan-2008 and 31-Dec-2014 were included. We examined clinical characteristics and outcomes (overall survival [OS] and time to next treatment [TNT]) in patients with HER2+ MBC pretreated with trastuzumab in the adjuvant setting (aT) compared with trastuzumab-naïve patients (nT) and patients with de novo HER2+ MBC (dn). Multivariate analyses adjusted for baseline demographic, prognostic factors and year of diagnosis (prior or after 2005, when aT was approved and widely administered in France for early HER2+ breast cancer).
Results: Among the 15170 pts of the ESME database, 2863 (19%) were HER2+: 1093 pts (38%) had de novo and 1765 pts (62%) recurrent MBC; 63% were Hormone Receptor (HR) +; 54%, 25% and 21% had respectively 1, 2, or > 2 metastatic sites (68% visceral and 12% brain). Median time to 1st metastasis was 43.4 months (m) (95% CI: 24.6-84.4): 54 m in HR+ and 30 m in HR-. Among pts with recurrent MBC, 55% (995) had received aT. As 1st-line therapy for MBC, 90 % of pts received HER2-targeted agents (73% T-based). With a median follow-up of 46 m, median OS is 45 m (95% CI: 42.5-48). OS is significantly higher in de novo compared to recurrent MBC: 54 m (95% CI: 50.2-60.4) vs. 38.4 m (95% CI: 36.7-41.9), (p < 0.0001). Among pts with recurrent cancers, median OS is inferior in pts who had received aT, as compared to those who had not: 33.4 m (95% CI: 29.6-36.7) vs. 49.5 m (95% CI: 44.3-56.8), (p < 0.0001). Statistically significant differences persist after adjustment for age at MBC, disease-free interval, metastatic sites and RH status in the multivariate model (HR=1.45, 95% CI: 1.26-1.67) but not after adjustment for year of diagnosis (prior or after 2005) (HR=0.90, 95% CI: 0.70-1.15).
Conclusions: These large-scale real-world data in patients with HER2+ MBC provide evidence that the survival outcome remain similar in patients with failure of adjuvant trastuzumab compared with trastuzumab-naïve patients after adjustment for year of diagnosis. De novo HER2+ MBC pts have the best outcomes. Data on clinical characteristics of metastasis and time to next treatment for the three subgroups will be presented at the meeting.
Citation Format: Saghatchian M, Carton M, Piot I, Pérol D, Pistilli B, Brain E, Ghouadni A, Ricci F, Vanlemmens L, Loeb A, Levy C, Goncalves A, Dalenc F, Lefeuvre-Plesse C, Campone M, Jaffre A, Gourgou S, Cailliot C, Robain M, Dieras V. Impact of prior adjuvant trastuzumab (aT) on clinical characteristics, patterns of recurrence and outcome in 2863 patients with Her2 positive (HER2+) metastatic breast cancer (MBC)- Results from the French ESME UNICANCER program [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 P5-20-03.
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Affiliation(s)
- M Saghatchian
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - M Carton
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - I Piot
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - D Pérol
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - B Pistilli
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - E Brain
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - A Ghouadni
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - F Ricci
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - L Vanlemmens
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - A Loeb
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - C Levy
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - A Goncalves
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - F Dalenc
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - C Lefeuvre-Plesse
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - M Campone
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - A Jaffre
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - S Gourgou
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - C Cailliot
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - M Robain
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
| | - V Dieras
- Institut Gustave Roussy, Villejuif, France; Institut Curie; Unicancer; Centre Oscar Lambret; Centre François Baclesse; Institut Paoli-Calmettes; Institut Claudius Regaud; Centre Eugène Marquis; Institut de Cancérologie de l'Ouest - René Gauducheau; Institut Bergonié; ICM-Montpellier Cancer Institute
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Saghatchian M, Hummel H, Otter R, De Valeriola D, Van Harten W, Paradiso A, Koot B, Ringborg U, Tursz T. Towards Quality, Comprehensiveness and Excellence. The Accreditation Project of the Organisation of European Cancer Institutes (OECI). Tumori 2018; 94:164-71. [DOI: 10.1177/030089160809400206] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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
There are important gaps in the health status of citizens across Europe, as measured by life expectancy, mortality or morbidity data (Report for the European Commission on the health status of the European Union, 2003). Among the main determinants of the major causes of mortality and morbidity, stated in this report, stands recurrently access to quality healthcare. There is a fundamental need to define quality indicators and set minimal levels of performance quality criteria for healthcare. There is a need to integrate research into healthcare and to provide patients with equity of access to such high quality care. Oncology is a speciality particularly suited to experimenting a first application of accreditation at European level. The Organisation of European Cancer Institutes is a growing network of cancer Centres in Europe. The focus of the OECI is to work with professionals and organisations with regard to prevention, care, research, development, patient's role and education. In order to fulfil its mission, the OECI initiated in 2002 an accreditation project with three objectives: • to develop a comprehensive accreditation system for oncology care, taking into account prevention, care, research, education and networking. • to set an updated database of cancer centres in Europe, with exhaustive information on their resources and activities (in care, research, education and management) • to develop a global labelling tool dedicated to comprehensive cancer centres in Europe, designating the various types of cancer structures, and the comprehensive cancer centres of reference and Excellence. An accreditation tool has been established, defining standards and criteria for prevention, care, research, education and follow-up activities. A quantitative database of cancer centres is integrated in the tool, with a questionnaire, that provides an overall view of the oncological landscape in OECI cancer centres in Europe. Data on infrastructures, resources and activities have been collected. This OECI accreditation tool will be launched in autumn 2008 for all cancer centres in Europe. It serves as a basis for the development of the labelling tool for cancer structures in Europe, with a focus on Comprehensiveness and Excellence labels. Quality assessment and improvement is a critical need in Europe and is addressed by the OECI for cancer care in Europe. Accreditation is a well accepted process and is feasible. Standards and criteria as well as an accreditation tool have been developed. The OECI questionnaire gives an accurate vision of cancer institutions throughout Europe, helping assessing the needs and providing standards. The accreditation project is a long-term complete and voluntary process with external and internal added value, an active process of sharing information and experience that should help the whole cancer community reach comprehensiveness and excellence.
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Affiliation(s)
| | - Henk Hummel
- Integraal Kankercentrum Noord-Nederland, Gröninen, The Netherlands
| | - Renée Otter
- Integraal Kankercentrum Noord-Nederland, Gröninen, The Netherlands
| | | | - Wim Van Harten
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Ulrik Ringborg
- Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
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Ringborg U, De Valeriola D, van Harten W, Bosch AL, Lombardo C, Nilsson K, Philip T, Pierotti MA, Riegman P, Saghatchian M, Storme G, Tursz T, Verellen D. Improvement of European Translational Cancer Research. Collaboration between Comprehensive Cancer Centers. Tumori 2018; 94:143-6. [DOI: 10.1177/030089160809400202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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
Even though the increasing incidence of cancer is mainly a consequence of a population with a longer life span, part of this augmentation is related to the increasing prevalence of patients living with a chronic cancer disease. To fight the problem, improved preventive strategies are mandatory in combination with an innovative health care provision that is driven by research. To overcome the weakness of translational research the OECI is proposing a practical approach as part of a strategy foreseen by the EUROCAN+PLUS feasibility study, which was launched by the EC in order to identify mechanisms for the coordination of cancer research in Europe.
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Affiliation(s)
- Ulrik Ringborg
- Cancer Center Karolinska, Karolinska University Hospital, Sweden
| | | | | | | | | | | | | | | | | | | | - Guy Storme
- Universitair Ziekenhuis Brussel, Belgium
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Saghatchian M, Guepratte S, Hacene K, Neumann R, Floiras JL, Pichon MF. Serum HER-2 Extracellular Domain: Relationship with Clinicobiological Presentation and Prognostic Value before and after Primary Treatment in 701 Breast Cancer Patients. Int J Biol Markers 2018; 19:14-22. [PMID: 15077922 DOI: 10.1177/172460080401900102] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To determine the clinical correlations and prognostic value of serum HER-2 (sHER-2) before and after primary breast cancer treatment. Methods sHER-2 from 701 consecutive patients with stage I-III tumors (median follow-up 7.7 years) was assayed by an enzyme-linked immunosorbent assay (Immuno 1, Bayer Diagnostics). Results The median pretreatment sHER-2 concentration was 8.30 ng/mL (range 3.15–82.00 ng/mL). Forty-seven patients (6.7%) had sHER-2 concentrations >12 ng/mL (cutoff level). Pretreatment sHER-2 correlated positively with CA 15.3 (p=0.0169), pathological tumor size (p=0.0082), number of invaded lymph nodes (pN, p=0.0160) and histological grading (p=0.0086). Kaplan-Meier analyses indicated that pretreatment sHER-2 was of prognostic value for contralateral breast cancer (p=0.0018), metastasis-free survival (MFS) (p=0.0008) – particularly lung (p=0.0082) and liver metastases (p=0.0035) – and overall disease-specific survival (DSS) (p=0.0020). According to pN status, pretreatment sHER-2 was of prognostic value only for pN-positive patients (p=0.0017). When combined with estradiol or progesterone receptor status, patients with elevated sHER-2 and receptor-negative tumors had a significantly shorter DSS (p<0.0001 for both receptors). Post-treatment sHER-2 also had individual prognostic value for MFS (p=0.0144) and DSS (p=0.0212). In multivariate analysis, only sHER-2 after primary treatment was an independent prognostic variable for MFS and DSS (p=0.0078 and p=0.0058, respectively). Conclusion sHER-2 elevation in early breast cancer correlates with the principal criteria of tumor aggressiveness, thus permitting selection of patients with a high risk of visceral metastases and contralateral breast tumors. Post-treatment sHER-2 is an independent prognostic factor enabling to identify patients likely to benefit from aggressive adjuvant treatments.
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Affiliation(s)
- M Saghatchian
- Service d'Oncologie Médicale, Hôpital Européen Georges Pompidou, Paris, France
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Giacchetti S, Hamy AS, Delaloge S, Brain E, Berger F, Sigal-Zafrani B, Mathieu MC, Bertheau P, Guinebretière JM, Saghatchian M, Lerebours F, Mazouni C, Tembo O, Espié M, Reyal F, Marty M, Asselain B, Pierga JY. Long-term outcome of the REMAGUS 02 trial, a multicenter randomised phase II trial in locally advanced breast cancer patients treated with neoadjuvant chemotherapy with or without celecoxib or trastuzumab according to HER2 status. Eur J Cancer 2017; 75:323-332. [PMID: 28279941 DOI: 10.1016/j.ejca.2017.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The REMAGUS-02 multicenter randomised phase II trial showed that the addition to neoadjuvant chemotherapy (NAC) of trastuzumab in patients with localised HER2-positive breast cancer (BC) increased the pathological complete response (pCR) rate and that the addition of celecoxib in HER2-negative cases did not increase the pCR rate. We report here the long-term follow-up results for disease-free survival (DFS) and overall survival (OS). PATIENTS AND METHODS From 2004 to 2007, 340 stage II-III BC patients were randomly assigned to receive neoadjuvant EC-T (four cycles of epirubicin-cyclophosphamide followed by four cycles of docetaxel) +/- celecoxib in HER2-negative cases (n = 220) and ± trastuzumab in HER2-positive cases (n = 120). From September 2005, all patients with HER2-positive BC received adjuvant T (n = 106). RESULTS Median follow-up was nearly 8 years (94.4 months, 20-127 m). In the HER2-negative subgroup, addition of celecoxib was not associated with a DFS benefit. Favourable factors were smaller tumour size, expression of progesterone receptor status (PgR) and pCR. In the HER2-positive population, neoadjuvant trastuzumab was not associated with a DFS benefit. Axillary pCR was the only prognostic factor associated with DFS in this group [HR = 0.44, 95% CI = 0.2-0.97], p = 0.035]. To note, DFS and OS were significantly higher in the HER2-positive than in HER2-negative BC patients (HR = 0.58 [0.36-0.92], p = 0.021). CONCLUSION Celecoxib combined with NAC provided neither pCR nor survival benefit in patients with HER2-negative BC. Absence of PgR is a major prognostic factor. Neoadjuvant trastuzumab increased pCR rates without translation into a DFS or OS benefit compared with adjuvant trastuzumab only. Axillary pCR could be a more relevant surrogate of survival than in the breast in HER2-positive population. A retrospective comparison shows that patients with HER2-positive tumours have a better outcome than HER2-negative BC patients showing the impact of trastuzumab on the natural history of BC.
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Affiliation(s)
- Sylvie Giacchetti
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, 75475 Paris, France.
| | - Anne-Sophie Hamy
- Institut Curie, PSL Research University, Translational Research Department, INSERM, U932 Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory (RT2Lab), Paris, France
| | - Suzette Delaloge
- Medical Oncology Department, Gustave Roussy, Cancer Center Villejuif, France
| | - Etienne Brain
- Medical Oncology Department, Institut Curie, Saint Cloud, Paris, France
| | | | | | | | - Philippe Bertheau
- AP-HP, Hôpital Saint-Louis, Pathology Department, University Paris Diderot, Paris, France
| | | | - Mahasti Saghatchian
- Medical Oncology Department, Gustave Roussy, Cancer Center Villejuif, France
| | | | - Chafouny Mazouni
- Department of Surgery, Gustave Roussy, Cancer Center Villejuif, France
| | - Olivier Tembo
- Center for Therapeutic Innovations in Oncology and Haematology (CITOH), APHP, Hôpital Saint-Louis, Paris, France
| | - Marc Espié
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, 75475 Paris, France
| | - Fabien Reyal
- Institut Curie, PSL Research University, Translational Research Department, INSERM, U932 Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory (RT2Lab), Paris, France; Department of Surgery, Institut Curie, Paris, France
| | - Michel Marty
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, 75475 Paris, France; Center for Therapeutic Innovations in Oncology and Haematology (CITOH), APHP, Hôpital Saint-Louis, Paris, France
| | | | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie, Saint Cloud, Paris, France; Université Paris Descartes, Sorbonne Paris Cite, Paris, France
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Saghatchian M, Lacas B, Deneuve J, Bouvet N, Mokdad-Adi M, Ghouadni A, Amiel P, Charles C, Boinon D, Delaloge S, Dauchy S. Abstract P5-11-06: BEAUTY and the breast: Is adjuvant chemotherapy the right time for a beauty boost? Results of a randomised controlled trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-11-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the symposium.
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Affiliation(s)
| | - B Lacas
- Institut Gustave Roussy, Villejuif, France
| | - J Deneuve
- Institut Gustave Roussy, Villejuif, France
| | - N Bouvet
- Institut Gustave Roussy, Villejuif, France
| | | | - A Ghouadni
- Institut Gustave Roussy, Villejuif, France
| | - P Amiel
- Institut Gustave Roussy, Villejuif, France
| | - C Charles
- Institut Gustave Roussy, Villejuif, France
| | - D Boinon
- Institut Gustave Roussy, Villejuif, France
| | - S Delaloge
- Institut Gustave Roussy, Villejuif, France
| | - S Dauchy
- Institut Gustave Roussy, Villejuif, France
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35
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Cardoso F, Piccart M, Rutgers E, Slaets L, van 't Veer L, Viale G, Pierga JY, Brain E, Causeret S, Golfinopoulos V, Goulioti T, Knox S, Matos E, Neijenhuis P, Nitz U, Passalacqua R, Rubio IT, Saghatchian M, Smilde TJ, Sotiriou C, Stork L, Straehle C, Thomas G, Thompson A, Vrijaldenhoven S, Vuylsteke P, Tryfonidis K, Bogaerts J, Delaloge S. Abstract P5-14-01: Chemotherapy randomization of the EORTC 10041/ BIG 3-04 MINDACT (microarray in node-negative and 1 to 3 positive lymph node disease may avoid chemotherapy) trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-14-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- F Cardoso
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - M Piccart
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - E Rutgers
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - L Slaets
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - L van 't Veer
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - G Viale
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - J-Y Pierga
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - E Brain
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Causeret
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - V Golfinopoulos
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - T Goulioti
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Knox
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - E Matos
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - P Neijenhuis
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - U Nitz
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - R Passalacqua
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - IT Rubio
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - M Saghatchian
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - TJ Smilde
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - C Sotiriou
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - L Stork
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - C Straehle
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - G Thomas
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - A Thompson
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Vrijaldenhoven
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - P Vuylsteke
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - K Tryfonidis
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - J Bogaerts
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
| | - S Delaloge
- Champalimaud Clinical Center/ Champalimaud Foundation, Lisbon, Portugal; Institute Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; The Netherlands Cancer Institute, Amsterdam, Netherlands; EORTC Headquarters, Brussels, Belgium; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco; University of Milan&Istituto Europeao di Oncologia, Milan, Italy; Institute Curie PSL, Universite Paris Descartes, Sorbonne, Paris, France; Institute Curie- Hopital Rene Huguenin, Saint Cloud, Paris, France; Centre Georges- Francois- Leclerc, Dijon, France; Breast International Group Headquarters, Brussels, Belgium; Europpa Donna- The European Breast Cancer Coalition, Milan, Italy; Institute of Oncology, Ljubljana, Slovenia; Rijnland, Leiderdorp, Netherlands; Ev. Bethesda Kranjenhaus, Germany; Azienza Istituti Ospetalieri di Cremona, Cremona, Italy; Hospital Universitario Vall d' Hebron, Barcelona, Spain; Gustave Roussy, Villejuif, Paris, France; Jeroen Bosch Hospital, Hertogenbosch, Netherlands; Agen
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Delaloge S, Bonastre J, Borget I, Garbay JR, Fontenay R, Boinon D, Saghatchian M, Mathieu MC, Mazouni C, Rivera S, Uzan C, André F, Dromain C, Boyer B, Pistilli B, Azoulay S, Rimareix F, Bayou EH, Sarfati B, Caron H, Ghouadni A, Leymarie N, Canale S, Mons M, Arfi-Rouche J, Arnedos M, Suciu V, Vielh P, Balleyguier C. The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic. Eur J Cancer 2016; 66:131-7. [PMID: 27569041 DOI: 10.1016/j.ejca.2016.06.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/30/2016] [Accepted: 06/25/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE Rapid diagnosis is a key issue in modern oncology, for which one-stop breast clinics are a model. We aimed to assess the diagnosis accuracy and procedure costs of a large-scale one-stop breast clinic. PATIENTS AND METHODS A total of 10,602 individuals with suspect breast lesions attended the Gustave Roussy's regional one-stop breast clinic between 2004 and 2012. The multidisciplinary clinic uses multimodal imaging together with ultrasonography-guided fine needle aspiration for masses and ultrasonography-guided and stereotactic biopsies as needed. Diagnostic accuracy was assessed by comparing one-stop diagnosis to the consolidated diagnosis obtained after surgery or biopsy or long-term monitoring. The medical cost per patient of the care pathway was assessed from patient-level data collected prospectively. RESULTS Sixty-nine percent of the patients had masses, while 31% had micro-calcifications or other non-mass lesions. In 75% of the cases (87% of masses), an exact diagnosis could be given on the same day. In the base-case analysis (i.e. considering only benign and malignant lesions at one-stop and at consolidated diagnoses), the sensitivity of the one-stop clinic was 98.4%, specificity 99.8%, positive and negative predictive values 99.7% and 99.0%. In the sensitivity analysis (reclassification of suspect, atypical and undetermined lesions), diagnostic sensitivity varied from 90.3% to 98.5% and specificity varied from 94.3% to 99.8%. The mean medical cost per patient of one-stop diagnostic procedure was €420. CONCLUSIONS One-stop breast clinic can provide timely and cost-efficient delivery of highly accurate diagnoses and serve as models of care for multiple settings, including rapid screening-linked diagnosis.
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Affiliation(s)
- Suzette Delaloge
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
| | - Julia Bonastre
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Isabelle Borget
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Jean-Rémi Garbay
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Rachel Fontenay
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Diane Boinon
- Gustave Roussy, Université Paris-Saclay, Department of Supportive Care, Villejuif, F-94805, France
| | - Mahasti Saghatchian
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Marie-Christine Mathieu
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Chafika Mazouni
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Sofia Rivera
- Gustave Roussy, Université Paris-Saclay, Department of Radiation Therapy, Villejuif, F-94805, France
| | - Catherine Uzan
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Fabrice André
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Clarisse Dromain
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Bruno Boyer
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Barbara Pistilli
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Sandy Azoulay
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Françoise Rimareix
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - El-Hadi Bayou
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Benjamin Sarfati
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Hélène Caron
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Amal Ghouadni
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Nicolas Leymarie
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Sandra Canale
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Muriel Mons
- Gustave Roussy, Université Paris-Saclay, Department of Medical Information, Villejuif, F-94805, France
| | - Julia Arfi-Rouche
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Monica Arnedos
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Voichita Suciu
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Philippe Vielh
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Corinne Balleyguier
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
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Cardoso F, van't Veer LJ, Bogaerts J, Slaets L, Viale G, Delaloge S, Pierga JY, Brain E, Causeret S, DeLorenzi M, Glas AM, Golfinopoulos V, Goulioti T, Knox S, Matos E, Meulemans B, Neijenhuis PA, Nitz U, Passalacqua R, Ravdin P, Rubio IT, Saghatchian M, Smilde TJ, Sotiriou C, Stork L, Straehle C, Thomas G, Thompson AM, van der Hoeven JM, Vuylsteke P, Bernards R, Tryfonidis K, Rutgers E, Piccart M. 70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. N Engl J Med 2016; 375:717-29. [PMID: 27557300 DOI: 10.1056/nejmoa1602253] [Citation(s) in RCA: 1144] [Impact Index Per Article: 143.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The 70-gene signature test (MammaPrint) has been shown to improve prediction of clinical outcome in women with early-stage breast cancer. We sought to provide prospective evidence of the clinical utility of the addition of the 70-gene signature to standard clinical-pathological criteria in selecting patients for adjuvant chemotherapy. METHODS In this randomized, phase 3 study, we enrolled 6693 women with early-stage breast cancer and determined their genomic risk (using the 70-gene signature) and their clinical risk (using a modified version of Adjuvant! Online). Women at low clinical and genomic risk did not receive chemotherapy, whereas those at high clinical and genomic risk did receive such therapy. In patients with discordant risk results, either the genomic risk or the clinical risk was used to determine the use of chemotherapy. The primary goal was to assess whether, among patients with high-risk clinical features and a low-risk gene-expression profile who did not receive chemotherapy, the lower boundary of the 95% confidence interval for the rate of 5-year survival without distant metastasis would be 92% (i.e., the noninferiority boundary) or higher. RESULTS A total of 1550 patients (23.2%) were deemed to be at high clinical risk and low genomic risk. At 5 years, the rate of survival without distant metastasis in this group was 94.7% (95% confidence interval, 92.5 to 96.2) among those not receiving chemotherapy. The absolute difference in this survival rate between these patients and those who received chemotherapy was 1.5 percentage points, with the rate being lower without chemotherapy. Similar rates of survival without distant metastasis were reported in the subgroup of patients who had estrogen-receptor-positive, human epidermal growth factor receptor 2-negative, and either node-negative or node-positive disease. CONCLUSIONS Among women with early-stage breast cancer who were at high clinical risk and low genomic risk for recurrence, the receipt of no chemotherapy on the basis of the 70-gene signature led to a 5-year rate of survival without distant metastasis that was 1.5 percentage points lower than the rate with chemotherapy. Given these findings, approximately 46% of women with breast cancer who are at high clinical risk might not require chemotherapy. (Funded by the European Commission Sixth Framework Program and others; ClinicalTrials.gov number, NCT00433589; EudraCT number, 2005-002625-31.).
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Affiliation(s)
- Fatima Cardoso
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Laura J van't Veer
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Jan Bogaerts
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Leen Slaets
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Giuseppe Viale
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Suzette Delaloge
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Jean-Yves Pierga
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Etienne Brain
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Sylvain Causeret
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Mauro DeLorenzi
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Annuska M Glas
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Vassilis Golfinopoulos
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Theodora Goulioti
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Susan Knox
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Erika Matos
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Bart Meulemans
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Peter A Neijenhuis
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Ulrike Nitz
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Rodolfo Passalacqua
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Peter Ravdin
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Isabel T Rubio
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Mahasti Saghatchian
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Tineke J Smilde
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Christos Sotiriou
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Lisette Stork
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Carolyn Straehle
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Geraldine Thomas
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Alastair M Thompson
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Jacobus M van der Hoeven
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Peter Vuylsteke
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - René Bernards
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Konstantinos Tryfonidis
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Emiel Rutgers
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
| | - Martine Piccart
- From Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (L.J.V.); European Organization for Research and Treatment of Cancer Headquarters (J.B., L. Slaets, V.G., B.M., K.T.), Breast International Group Headquarters (T.G., C. Straehle), and Institut Jules Bordet, Université Libre de Bruxelles (C. Sotiriou, M.P.), Brussels, and Centre Hospitalier Universitaire Université Catholique de Louvain, Namur (P.V.) - both in Belgium; University of Milan and Istituto Europeo di Oncologia (G.V.) and Europa Donna-European Breast Cancer Coalition (S.K.), Milan, and Azienda Istituti Ospitalieri di Cremona, Cremona (R.P.) - both in Italy; Gustave Roussy, Villejuif (S.D., M.S.), Institut Curie Paris Sciences et Lettres, Université Paris Descartes, Sorbonne Paris Cité, Paris (J.-Y.P.). Institut Curie-Hôpital Rene Huguenin, Saint-Cloud (E.B.), and Centre Georges-Francois-Leclerc, Dijon (S.C.) - all in France; Swiss Institute of Bioinformatics and University of Lausanne, Lausanne, Switzerland (M.D.); Agendia (A.M.G., L. Stork) and the Netherlands Cancer Institute (R.B., E.R.), Amsterdam, Alrijne Ziekenhuis, Rijnland Leiderdorp (P.A.N.), Jeroen Bosch Hospital, 's-Hertogenbosch (T.J.S.), and Medisch Centrum Alkmaar, Alkmaar (J.M.H.) - all in the Netherlands; Institute of Oncology, Ljubljana, Slovenia (E.M.); Evangelisches Krankenhaus Bethesda, Duisburg, Germany (U.N.); University of Texas Health Sciences Center, San Antonio (P.R.); Hospital Universitario Vall d'Hebron, Barcelona (I.T.R.); Imperial College London, London (G.T.); and University of Texas M.D. Anderson Cancer Center, Houston (A.M.T.)
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Petracci F, Zarba J, Michelotti A, Livi L, Villanueva C, Bordonaro R, Sherstnev V, Kowalyszyn R, Marinsek N, Zhou Z, Macalalad A, Koo V, Trieschman E, Xie J, Signorovitch J, Ratto B, Higuchi K, Saghatchian M. Abstract 2269: Comparative effectiveness of everolimus + endocrine therapy vs endocrine monotherapy among postmenopausal women with HR+/HER2- advanced breast cancer: a multicountry retrospective chart review. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2269] [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: This study aims to compare patient characteristics and outcomes of everolimus (EVE) + endocrine therapy (ET) vs ET monotherapy among postmenopausal women with hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (aBC) across multiple countries.
Methods: This retrospective chart review included postmenopausal patients with HR+/HER2- aBC who were previously treated with a nonsteroidal aromatase inhibitor (NSAI) and later received EVE + ET, ET monotherapy, or chemotherapy (the index treatment) from 17 sites in 6 countries (Canada, the Netherlands, France, Italy, Russia, and Argentina). This is a subset analysis comparing patients who received EVE + ET vs ET monotherapy. Stratified sampling by index treatment and line of therapy was used to ensure the sample groups included different treatments and lines of therapy. Patient characteristics were compared using Wilcoxon rank-sum tests for continuous variables and Fisher exact tests for categorical variables. Progression-free survival (PFS) was estimated using Kaplan-Meier analysis and was compared between the 2 groups using Cox proportional hazards models adjusting for age, country, line of therapy, metastatic sites, symptoms, comorbidities, prior chemotherapy, recurrent vs de novo cancer, and time from the last adjuvant ET to aBC diagnosis.
Results: A total of 119 patients in the EVE + ET group (77 in 1st/2nd, and 42 in 3rd/4th lines) and 102 patients in the ET monotherapy group (76 in 1st /2nd, and 26 in 3rd/4th lines) were included in the study. All but 2 patients in the EVE + ET group received EVE + exemestane; ET monotherapy included fulvestrant (46.1%), exemestane (21.6%), NSAIs (16.7%), and tamoxifen (14.7%). Patients in the EVE + ET group were numerically younger (median 63.0 vs 66.0 years; P = .10); appeared to have fewer comorbidities, particularly hypertension (11.8% vs 35.3%; P < .01); had a higher proportion of visceral metastasis (43.7% vs 32.4%; P = .10) and a higher
number of metastatic sites (median 2.0 vs 1.0; P = .14); had a lower proportion of bone/joint symptoms (30.3% vs 42.2%; P = .07); and had a shorter time from initiation of the last adjuvant ET to aBC diagnosis (median 43.1 vs 55.6 months; P = .05). In the unadjusted analysis, patients in the EVE + ET group had similar PFS as those in the ET monotherapy group (median 9.1 vs 9.2 months; unadjusted HR = 0.98; P = .90), but after adjustment for baseline characteristics, the hazard of progression or death of any cause was lower (adjusted HR = 0.67; P = .05).
Conclusions: Patients who received EVE + ET tended to be younger with fewer comorbidities yet have disease with faster progression and a higher burden of metastases. After adjusting for these characteristics, EVE + ET was associated with longer PFS compared with ET monotherapy.
Citation Format: Fernando Petracci, Jose Zarba, Andrea Michelotti, Lorenzo Livi, Cristian Villanueva, Roberto Bordonaro, Viktor Sherstnev, Rubén Kowalyszyn, Nina Marinsek, Zhou Zhou, Alexander Macalalad, Valerie Koo, Erich Trieschman, Jipan Xie, James Signorovitch, Barbara Ratto, Keiko Higuchi, Mahasti Saghatchian. Comparative effectiveness of everolimus + endocrine therapy vs endocrine monotherapy among postmenopausal women with HR+/HER2- advanced breast cancer: a multicountry retrospective chart review. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2269.
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Affiliation(s)
| | - Jose Zarba
- 2Centro Médico San Roque Tucuman, San Miguel de Tucuman, Argentina
| | - Andrea Michelotti
- 3Oncologia Medica I, Ospedale S.Chiara, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Lorenzo Livi
- 4Azienda Ospedaliero Universitaria Careggi Firenze, Firenze, Italy
| | | | - Roberto Bordonaro
- 6UOC Oncologia Medica ARNAS Garibaldi Nesima-Catania, Nesima-Catania, Italy
| | - Viktor Sherstnev
- 7Oncology Clinical Oncology Dispensary #5, Moscow, Russian Federation
| | | | | | | | | | | | | | | | | | - Barbara Ratto
- 11Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Keiko Higuchi
- 11Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Comte A, Cottu PH, Belin L, Callens C, Servois V, Bidard FC, Brain E, Salomon AV, Bachelot TD, Saghatchian M, Campone M, Giacchetti S, Bonneterre J, Sigal-Zafrani B. Systematic biopsy of the first metastatic event in breast cancer: Results from ESOPE—A prospective multicenter trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Mario Campone
- Cancer Institute of the West (ICO), Centre René Gauducheau, Medical Oncology Department, Saint-Herblain, France
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Bonnefoi H, Grellety T, Tredan O, Saghatchian M, Dalenc F, Mailliez A, L'Haridon T, Cottu P, Abadie-Lacourtoisie S, You B, Mousseau M, Dauba J, Del Piano F, Desmoulins I, Coussy F, Madranges N, Grenier J, Bidard FC, Proudhon C, MacGrogan G, Orsini C, Pulido M, Gonçalves A. A phase II trial of abiraterone acetate plus prednisone in patients with triple-negative androgen receptor positive locally advanced or metastatic breast cancer (UCBG 12-1). Ann Oncol 2016; 27:812-8. [PMID: 27052658 DOI: 10.1093/annonc/mdw067] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/08/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several expression array studies identified molecular apocrine breast cancer (BC) as a subtype that expresses androgen receptor (AR) but not estrogen receptor α. We carried out a multicentre single-arm phase II trial in women with AR-positive, estrogen, progesterone receptor and HER2-negative (triple-negative) metastatic or inoperable locally advanced BC to assess the efficacy and safety of abiraterone acetate (AA) plus prednisone. PATIENTS AND METHODS Patients with a metastatic or locally advanced, centrally reviewed, triple-negative and AR-positive (≥10% by immunohistochemistry, IHC) BC were eligible. Any number of previous lines of chemotherapy was allowed. AA (1000 mg) was administered once a day with prednisone (5 mg) twice a day until disease progression or intolerance. The primary end point was clinical benefit rate (CBR) at 6 months defined as the proportion of patients presenting a complete response (CR), partial response (PR) or stable disease (SD) ≥6 months. Secondary end points were objective response rate (ORR), progression-free survival (PFS) and safety. RESULTS One hundred and forty-six patients from 27 centres consented for IHC central review. Of the 138 patients with sufficient tissue available, 53 (37.6%) were AR-positive and triple-negative, and 34 of them were included from July 2013 to December 2014. Thirty patients were eligible and evaluable for the primary end point. The 6-month CBR was 20.0% [95% confidence interval (CI) 7.7%-38.6%], including 1 CR and 5 SD ≥6 months, 5 of them still being under treatment at the time of analysis (6.4+, 9.2+, 14.5+, 17.6+, 23.4+ months). The ORR was 6.7% (95% CI 0.8%-22.1%). The median PFS was 2.8 months (95% CI 1.7%-5.4%). Fatigue, hypertension, hypokalaemia and nausea were the most common drug-related adverse events; the majority of them being grade 1 or 2. CONCLUSIONS AA plus prednisone treatment is beneficial for some patients with molecular apocrine tumours and five patients are still on treatment. CLINICALTRIALSGOV NCT01842321.
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Affiliation(s)
- H Bonnefoi
- Department of Medical Oncology, Institut Bergonié Unicancer, Univ. Bordeaux, INSERM U916, INSERM CIC1401, Bordeaux
| | - T Grellety
- Department of Medical Oncology, Institut Bergonié Unicancer, Univ. Bordeaux, INSERM U916, INSERM CIC1401, Bordeaux
| | - O Tredan
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | - M Saghatchian
- Department of Medical Oncology, Breast Cancer Unit, Gustave Roussy, Villejuif
| | - F Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse
| | - A Mailliez
- Department of Breast Cancer, Centre Oscar Lambret, Lille
| | - T L'Haridon
- Department of Medical Oncology, Centre Hospitalier Départemental Vendée, La Roche sur Yon
| | - P Cottu
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris
| | | | - B You
- Department of Medical Oncology, Teaching Hospital, Lyon-Sud University, Lyon
| | - M Mousseau
- Department of Medical Oncology, CHU Grenoble, Grenoble
| | - J Dauba
- Department of Medical Oncology, Centre Hospitalier Layné, Mont-de-Marsan
| | - F Del Piano
- Department of Gynecologic Surgery, Hôpital du Leman, Thonon-Les-Bains
| | - I Desmoulins
- Department of Medical Oncology, Centre GF Leclerc, Dijon
| | - F Coussy
- Department of Medical Oncology, Institut Curie, St Cloud
| | - N Madranges
- Department of Medical Oncology, Institut Bergonié Unicancer, Univ. Bordeaux, INSERM U916, INSERM CIC1401, Bordeaux
| | - J Grenier
- Department of Medical Oncology, Institut Sainte-Catherine, Avignon
| | - F C Bidard
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris
| | - C Proudhon
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris
| | - G MacGrogan
- Department of Pathology, Institut Bergonié, INSERM U916, Bordeaux
| | | | - M Pulido
- Clinical and Epidemiological Research Unit, Institut Bergonié, INSERM CIC1401, Bordeaux
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Cancer Research Center of Marseille, INSERM U7258, CNRS U1068, Aix-Marseille Université, Marseille, France
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Tlemsani C, Boinon D, Yung MF, Ragusa S, Mazouni C, Balleyguier C, Saghatchian M, Ghouadni A, Rivera S, Michiels S, Delaloge S. Abstract P3-10-03: Receipt of breast cancer risk assessment and personalized prevention information among women diagnosed with a benign breast lesion (BBL) in a one stop breast unit: A prospective assessment. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-10-03] [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: Women's awareness about their personal breast cancer (BC) risk in the general population is generally low. Mass screening and mass prevention interventions have as yet been moderately efficient in breast oncology. "Personalized prevention" including risk communication, personalized screening and primary prevention recommendations is a promising. A personal history of BBL slightly increases subsequent BC risk.
Objectives: the main objective was to evaluate the acceptability of a mathematical tool- based breast cancer risk assessment and subsequent proposal of a personalized BC prevention program in a BBL population. Secondary objectives were to evaluate information receipt, awareness, satisfaction, and anxiety.
Methods: Women were eligible for the study if aged 40-74, were recently diagnosed with a benign breast lesion at the one stop breast Unit of the center, had no personal history of cancer or atypical lesions and were not BRCA carriers. Women were proposed a personalized risk assessment using a mathematical tool (BCSC score adapted to the French population-Ragusa et al) together with personalized information on risk, BC screening and prevention, release of a personalized program and evaluation of their receipt. The main end point was the proportion of women willing to have a risk assessment and personalized counseling. A cut-off point of 70% was considered critical to consider acceptability. Secondary end points were perceived BC risk, satisfaction, anxiety and distress levels at day 2 using standardized questionnaires, as well as adherence with the proposed programs.
Results: Of 150 women proposed BC risk assessment and personalized prevention information between 02/2014 and 03/2015, 129 (86%) accepted. Median age: 53.6 years. 33% had a low BC risk (< 1.1% at 5 yrs [mean risk of 50 yrs-old women in France]), 53% a moderate risk (1.1-1.66% at 5 yrs), while 14% were high risk (> 1.66% at 5 yrs). 87% had never had any previous information on BC risk. 3 pts required a genetic assessment.
Participants were globally very satisfied with physicians' and nurses' interpersonal skills, availability and provision of information (mean score > 4; range 2-5). The mean scores of clarity of the BC risk information (4.14±1;range 2-5) and screening program information (4.21±0.93; range 2-5) were high.
The mean score of perceived risk level was estimated to 33.5% (SD=21.9).
Mean scores of state anxiety (36.7±12.2; range 20-71), trait anxiety (39.5±8.9; range 23-59), depressive symptoms (3.4±3.3; range 0-12) and psychological distress indicated low levels of all. Higher level of state-anxiety was associated with lower scores of satisfaction with doctors and nurses human qualities (r = 0.26, p<.05) and with lower scores of clarity of information about screening program (r = 0.25, p<.05).
Conclusion: The receipt of breast cancer risk assessment and personalized prevention information among women diagnosed with BBL was high (86%). Information need is high given the low level of real risk awareness. Such population may benefit from personalized prevention. Anxiety and distress scores were low and satisfaction rates high.
Citation Format: Tlemsani C, Boinon D, Yung MF, Ragusa S, Mazouni C, Balleyguier C, Saghatchian M, Ghouadni A, Rivera S, Michiels S, Delaloge S. Receipt of breast cancer risk assessment and personalized prevention information among women diagnosed with a benign breast lesion (BBL) in a one stop breast unit: A prospective assessment. [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 P3-10-03.
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Affiliation(s)
- C Tlemsani
- Gustave Roussy, Villejuif, France; Statlife, Villejuif, France
| | - D Boinon
- Gustave Roussy, Villejuif, France; Statlife, Villejuif, France
| | - MF Yung
- Gustave Roussy, Villejuif, France; Statlife, Villejuif, France
| | - S Ragusa
- Gustave Roussy, Villejuif, France; Statlife, Villejuif, France
| | - C Mazouni
- Gustave Roussy, Villejuif, France; Statlife, Villejuif, France
| | - C Balleyguier
- Gustave Roussy, Villejuif, France; Statlife, Villejuif, France
| | - M Saghatchian
- Gustave Roussy, Villejuif, France; Statlife, Villejuif, France
| | - A Ghouadni
- Gustave Roussy, Villejuif, France; Statlife, Villejuif, France
| | - S Rivera
- Gustave Roussy, Villejuif, France; Statlife, Villejuif, France
| | - S Michiels
- Gustave Roussy, Villejuif, France; Statlife, Villejuif, France
| | - S Delaloge
- Gustave Roussy, Villejuif, France; Statlife, Villejuif, France
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Giacchetti S, Hamy-Petit AS, Delaloge S, Brain E, Berger F, Mathieu MC, de Cremoux P, Bertheau P, Guinebretière JM, Saghatchian M, Tembo O, Marty M, Pierga JY. Abstract P1-14-09: Long term survival of locally advanced breast cancers (LABC) treated with neoadjuvant treatment, results of a multicenter randomised phase II study (Remagus 02 trial). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-14-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Backgound : The primary analysis of the REMAGUS-02 multicenter randomized phase II trial demonstrated that celecoxib did not improve pCR rates in pts with HER2-negative localized invasive breast cancer (BC), whereas trastuzumab increased pCR rates in HER2-positive ones [Pierga BCRT 2010]. We report here the long-term follow-up results of this trial for disease free survival (DFS) and overall survival (OS).
Patients and methods: From May 2004 to October 2007, 340 stage II-III BC patients were randomly assigned to receive 4 cycles (c) of epirubicin–cyclophosphamide q 3 w followed by 4 c of docetaxel q 3 w +/- trastuzumab in HER2 positive pts (120 pts) or +/- celecoxib in HER2 negative pts (n=220). From September 2005, all pts with HER2 positive BC received adjuvant T for a total of 18 c (n=106). Patients with hormone receptors (HR) positive tumor received adjuvant endocrine treatment according to menopausal status
Results: With a median follow up of nearly 8 years (94.4 months, 20-127m), 112 relapses and 75 deaths have been observed (median DFS and OS not reached). Eight years DFS and OS were respectively 63 % [57%-71%] and 75 % [70%-81%] in HER2 negative group; and 75% [67%-83%] and 82 % [74%-90%] in HER2 positive group. DFS was significantly higher in HER+ pts than in HER2-(HR: 0.64 [0.42-0.99], p=0.042), whereas OS did not differ significantly (HR: 0.67, [0.41-1.11], p=0.123).
In the overall population, progesterone receptor (PgR) positivity was associated with a better DFS (p=0.012) and OS (p<0.001) as compared to ER+/PgR- (DFS: HR=2.07 [1.27-3.39]; OS: HR=2.53 [1.3-4.92]) and ER-/PR-; DFS: HR=1.56 [0.98-2.46]; OS: HR: 3.34 [1.87 – 5.97]. In the ER-/PR- group, DFS reached a "plateau" after three years follow-up, while the annual risk of relapse remained constant in the ER+/PR- subgroup.
In the HER2- subgroup, no effect of neoadjuvant celocoxib was observed on survival, neither in intention to treat (ITT) nor in per protocol analyses. In the multivariate analysis clinical stage (T3/T4 versus T2, HR: 1.92 [1.209 - 3.05], p=0.006), PgR status (positive versus negative HR : 0.52, [0.32-0.84], p=0.007) and pCR (yes vs no, HR : 0.213 [0.066-0.687], p=0.01) were significant predictors of DFS.
In the HER2+ subgroup, neoadjuvant versus adjuvant trastuzumab was not significantly associated with DFS, neither in the ITT, nor in the per protocol analysis.
Conclusion: Celecoxib was not associated with pCR or survival benefit when added to conventional neoadjuvant CT in Her2-negative BC pts. Lack of PgR expression is a major prognostic factor for survival. Neoadjuvant versus adjuvant trastuzumab increased pCR rates but did not change significantly DFS and OS of HER2 positive BC pts.
Citation Format: Giacchetti S, Hamy-Petit A-S, Delaloge S, Brain E, Berger F, Mathieu M-C, de Cremoux P, Bertheau P, Guinebretière J-M, Saghatchian M, Tembo O, Marty M, Pierga J-Y. Long term survival of locally advanced breast cancers (LABC) treated with neoadjuvant treatment, results of a multicenter randomised phase II study (Remagus 02 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 P1-14-09.
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Affiliation(s)
- S Giacchetti
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - A-S Hamy-Petit
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - S Delaloge
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - E Brain
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - F Berger
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - M-C Mathieu
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - P de Cremoux
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - P Bertheau
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - J-M Guinebretière
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - M Saghatchian
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - O Tembo
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - M Marty
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
| | - J-Y Pierga
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Institut Curie, Paris, France; Gustave Roussy, Villejuif, France; Institut Curie, Saint-Cloud, France; Biostatistics Department, Paris, France; Hôpital Saint Louis, APHP, Paris, France; Molecular oncology, Hôpital Saint Louis, APHP, Paris, France; CITOH, Hôpital Saint Louis, Paris, France
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Thonon F, Boulkedid R, Teixeira M, Gottot S, Saghatchian M, Alberti C. Identifying potential indicators to measure the outcome of translational cancer research: a mixed methods approach. Health Res Policy Syst 2015; 13:72. [PMID: 26635108 PMCID: PMC4669638 DOI: 10.1186/s12961-015-0060-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/12/2015] [Indexed: 01/18/2023] Open
Abstract
Background In a context where there is an increasing demand to evaluate the outcome of bio-medical research, our work aims to develop a set of indicators to measure the impact of translational cancer research. The objective of our study was to explore the scope and issues of translational research relevant to evaluation, explore the views of researchers on the evaluation of oncological translational research, and select indicators measuring the outcomes and outputs of translational research in oncology by consensus. Methods Semi-structured interviews amongst 23 researchers involved in translational cancer research were conducted and analysed using thematic analysis. A two-round modified Delphi survey of 35 participants with similar characteristics was then performed followed by a physical meeting. Participants rated the feasibility and validity of 60 indicators. The physical meeting was held to discuss the methodology of the new indicators. Results The main themes emerging from the interviews included a common definition for translational research but disagreements about the exact scope and limits of this research, the importance of multidisciplinarity and collaboration for the success of translational research, the disadvantages that translational research faces in current evaluation systems, the relative lack of pertinence of existing indicators, and propositions to measure translational cancer research in terms of clinical applications and patient outcomes. A total of 35 participants took part in the first round survey and 12 in the second round. The two-round survey helped us select a set of 18 indicators, including four that seemed to be particularly adapted to measure translational cancer research impact on health service research (number of biomarkers identified, generation of clinical guidelines, citation of research in clinical guidelines, and citation of research in public health guidelines). The feedback from participants helped refine the methodology and definition of indicators not commonly used. Conclusion Indicators need to be accepted by stakeholders under evaluation. This study helped the selection and refinement of indicators considered as the most relevant by researchers in translational cancer research. The feasibility and validity of those indicators will be tested in a scientometric study. Electronic supplementary material The online version of this article (doi:10.1186/s12961-015-0060-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frédérique Thonon
- European and International Affairs Unit, Gustave Roussy, Villejuif, France. .,AP-HP, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1123 and CIC-EC 1426, ECEVE, Paris, France. .,INSERM, U 1123 and CIC-EC 1426, ECEVE, Paris, France.
| | - Rym Boulkedid
- AP-HP, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1123 and CIC-EC 1426, ECEVE, Paris, France. .,INSERM, U 1123 and CIC-EC 1426, ECEVE, Paris, France.
| | - Maria Teixeira
- AP-HP, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France.
| | - Serge Gottot
- AP-HP, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1123 and CIC-EC 1426, ECEVE, Paris, France. .,INSERM, U 1123 and CIC-EC 1426, ECEVE, Paris, France.
| | | | - Corinne Alberti
- AP-HP, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1123 and CIC-EC 1426, ECEVE, Paris, France. .,INSERM, U 1123 and CIC-EC 1426, ECEVE, Paris, France.
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Saghatchian M, Fadoukhair Z, Hofert K, Lanoy E, Mathieu MC, Mazouni C, Delaloge S. Uncovering Professional Attitudes Toward Treatment of Rare Carcinomas of the Breast: An International Practice e-Survey Involving 32 Countries. Breast J 2015; 22:96-100. [PMID: 26511594 DOI: 10.1111/tbj.12525] [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] [Indexed: 11/29/2022]
Abstract
World Health Organization classification has identified a dozen rare subtypes accounting for less than 10% of all breast cancers (BC), generally not taken into account in treatment guidelines. We evaluated professionals' attitudes toward decision-making regarding rare BC and consensus guidelines needs. In this international e-survey, 236 BC experts from all specialties were contacted through email to fill an online questionnaire about their practices. Eighty-six experts from 32 countries participated (36%); 50% medical oncologists, 21% surgeons, 17% pathologists, and 12% radiation oncologists. General BC care decisions were based on consensus guidelines in 77% of expert, whereas routine individual treatment decisions for BC were made by multi-disciplinary boards in 76%. Only 10% strongly considered rare BC should be treated following existing standard guidelines. Interestingly, 50-80% described individualizing treatment for rare BC according to pathologic subtype. More than 90% of experts would welcome international recommendations for rare BC. This large scale international multi-disciplinary survey revealed overarching concerns centered on several key themes: the lack of resources and data to address these less common BC; the heterogeneous management of rare BC depending on geographical location and specialist training; the demand for international consensus guidelines regarding their diagnosis and treatment.
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Affiliation(s)
- Mahasti Saghatchian
- Department of Medical Oncology, Breast Cancer Unit, Gustave Roussy, Villejuif, France
| | - Zouhour Fadoukhair
- Department of Medical Oncology, Breast Cancer Unit, Gustave Roussy, Villejuif, France
| | | | - Emilie Lanoy
- Biostatistics and Epidemiology Unit, Gustave Roussy, Villejuif, France
| | | | - Chafika Mazouni
- Department of Surgery, Unit of Breast and Plastic Surgery, Gustave Roussy, Villejuif, France
| | - Suzette Delaloge
- Department of Medical Oncology, Breast Cancer Unit, Gustave Roussy, Villejuif, France
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Thonon F, Watson J, Saghatchian M. Benchmarking facilities providing care: An international overview of initiatives. SAGE Open Med 2015; 3:2050312115601692. [PMID: 26770800 PMCID: PMC4712789 DOI: 10.1177/2050312115601692] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/28/2015] [Indexed: 11/18/2022] Open
Abstract
We performed a literature review of existing benchmarking projects of health facilities to explore (1) the rationales for those projects, (2) the motivation for health facilities to participate, (3) the indicators used and (4) the success and threat factors linked to those projects. We studied both peer-reviewed and grey literature. We examined 23 benchmarking projects of different medical specialities. The majority of projects used a mix of structure, process and outcome indicators. For some projects, participants had a direct or indirect financial incentive to participate (such as reimbursement by Medicaid/Medicare or litigation costs related to quality of care). A positive impact was reported for most projects, mainly in terms of improvement of practice and adoption of guidelines and, to a lesser extent, improvement in communication. Only 1 project reported positive impact in terms of clinical outcomes. Success factors and threats are linked to both the benchmarking process (such as organisation of meetings, link with existing projects) and indicators used (such as adjustment for diagnostic-related groups). The results of this review will help coordinators of a benchmarking project to set it up successfully.
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Affiliation(s)
- Frédérique Thonon
- European and International Affairs, Gustave Roussy, Villejuif, France
| | - Jonathan Watson
- HealthClusterNet, Unit 1, Carleton Business Park, Skipton, UK
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Valdagni R, Van Poppel H, Aitchison M, Albers P, Berthold D, Bossi A, Brausi M, Denis L, Drudge-Coates L, De Santis M, Feick G, Harrison C, Haustermans K, Hollywood D, Hoyer M, Hummel H, Mason M, Mirone V, Müller SC, Parker C, Saghatchian M, Sternberg CN, Tombal B, van Muilekom E, Watson M, Wesselmann S, Wiegel T, Magnani T, Costa A. Prostate Cancer Unit Initiative in Europe: A position paper by the European School of Oncology. Crit Rev Oncol Hematol 2015; 95:133-43. [PMID: 26092320 DOI: 10.1016/j.critrevonc.2015.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/04/2015] [Accepted: 05/26/2015] [Indexed: 02/06/2023] Open
Abstract
The Prostate Cancer Programme of the European School of Oncology developed the concept of specialised interdisciplinary and multiprofessional prostate cancer care to be formalized in Prostate Cancer Units (PCU). After the publication in 2011 of the collaborative article "The Requirements of a Specialist Prostate Cancer Unit: A Discussion Paper from the European School of Oncology", in 2012 the PCU Initiative in Europe was launched. A multiprofessional Task Force of internationally recognized opinion leaders, among whom representatives of scientific societies, and patient advocates gathered to set standards for quality comprehensive prostate cancer care and designate care pathways in PCUs. The result was a consensus on 40 mandatory and recommended standards and items, covering several macro-areas, from general requirements to personnel to organization and case management. This position paper describes the relevant, feasible and applicable core criteria for defining PCUs in most European countries delivered by PCU Initiative in Europe Task Force.
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Affiliation(s)
- Riccardo Valdagni
- European School of Oncology, Milan, Italy; Prostate Cancer Programme, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Hendrik Van Poppel
- Dept of Urology, University Hospital of the Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Peter Albers
- Dept of Urology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Dominik Berthold
- Centre Polidisciplinaire d'Oncologie, Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Alberto Bossi
- Dept of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Maurizio Brausi
- Dept of Urology, Ausl Modena, Nuovo Ospedale Civile-S. Agostino Estense, Modena, Italy
| | - Louis Denis
- Europa Uomo, Antwerp, Belgium; Oncological Centre, Antwerp, Belgium
| | | | - Maria De Santis
- University of Warwick, Cancer Research Unit, Coventry, UK; Queen Elizabeth Hospital-Cancer Centre, Birmingham, UK
| | - Günther Feick
- Europa Uomo, Antwerp, Belgium; Bundesverband Prostatakrebs Selbsthilfe, Bonn, Germany
| | - Chris Harrison
- Greater Manchester Strategic Health Authority, Manchester, UK
| | - Karin Haustermans
- Dept. of Radiation Oncology, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Donal Hollywood
- Urologic and Radiation Oncology, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Morton Hoyer
- Dept of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Henk Hummel
- Integraal Kankercentrum Nederland (IKNL), Comprehensive Cancer Centre Netherlands, Utrecht, The Netherlands
| | - Malcolm Mason
- Dept of Oncology and Palliative Medicine, Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - Vincenzo Mirone
- Dept of Urology, University of Naples Federico II, Naples, Italy
| | | | - Chris Parker
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Cora N Sternberg
- Dept of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - Bertrand Tombal
- Dept of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Erik van Muilekom
- Dept of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maggie Watson
- Research Department of Clinical, Educational and Health Psychology, University College, London, UK
| | | | - Thomas Wiegel
- Dept of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Tiziana Magnani
- Prostate Cancer Programme, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Rajan A, Wind A, Saghatchian M, Thonon F, Boomsma F, van Harten WH. Staff perceptions of change resulting from participation in a European cancer accreditation programme: a snapshot from eight cancer centres. Ecancermedicalscience 2015; 9:547. [PMID: 26180546 PMCID: PMC4494818 DOI: 10.3332/ecancer.2015.547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Indexed: 11/15/2022] Open
Abstract
Background Healthcare accreditation is considered to be an essential quality improvement tool. However, its effectiveness has been critiqued. Methods Twenty-four interviews were conducted with clinicians (five), nurses (six), managers (eight), and basic/translational researchers (five) from eight European cancer centres on changes observed from participating in a European cancer accreditation programme. Data were thematically analysed and verified with participants and checked against auditor’s feedback. Results Four change categories emerged: (i) the growing importance of the nursing and supportive care field (role change). Nurses gained more autonomy/clarity on their daily duties. Importance was given to the hiring and training of supportive care personnel (ii) critical thinking on data integration (strategic change). Managers gained insight on how to integrate institutional level data (iii) improved processes within multidisciplinary team (MDT) meetings (procedural change). Clinical staff experienced improved communication between MDTs (iv) building trust (organisational change). Accreditation improved the centre’s credibility with its own staff and externally with funders and patients. No motivational changes were perceived. Researchers perceived no changes. The auditor’s feedback included changes in 13 areas: translational research, biobanks, clinical trials, patient privacy and satisfaction, cancer registries, clinical practice guidelines, patient education, screening, primary prevention, role of nurses, MDT, supportive care, and data integration. However, our study revealed that staff perceived changes only in the last four areas. Conclusion Staff perceived changes in data integration, nursing and supportive care, and in certain clinical aspects. Accreditation programmes must pay attention to the needs of different stakeholder groups, track changes, and observe how/why change happens.
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Affiliation(s)
- Abinaya Rajan
- The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Anke Wind
- The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Mahasti Saghatchian
- Institut Gustave Roussy, 14 rue Edouard-Vaillant, Villejuif 94805, France ; Organisation of European Cancer Institutes (OECI-EEIG) c/o Fondation Universitaire, 11 Rue d'Egmont, Brussels B-1000, Belgium
| | - Frederique Thonon
- Institut Gustave Roussy, 14 rue Edouard-Vaillant, Villejuif 94805, France
| | - Femke Boomsma
- Organisation of European Cancer Institutes (OECI-EEIG) c/o Fondation Universitaire, 11 Rue d'Egmont, Brussels B-1000, Belgium ; Integraal Kankercentrum Nederland, Griffeweg 97, Groningen 9723 DV, The Netherlands
| | - Wim H van Harten
- The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
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Delaloge S, Saghatchian M, Ghouadni A, Fekih M, André F. Les signatures moléculaires commerciales : quelle utilité clinique ? Bull Cancer 2015; 102:S102-5. [DOI: 10.1016/s0007-4551(15)31227-3] [Citation(s) in RCA: 2] [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] [Received: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
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Bonastre J, Marguet S, Lueza B, Michiels S, Delaloge S, Saghatchian M. Reply to V.P. Retèl et al, D. Gauchan et al, and C. Rahilly-Tierney et al. J Clin Oncol 2015; 33:1629-30. [PMID: 25847933 DOI: 10.1200/jco.2014.60.5568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Julia Bonastre
- Institute Gustave Roussy; and Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale U1018, Paris-Sud University, Villejuif, France
| | - Sophie Marguet
- Institute Gustave Roussy; and Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale U1018, Paris-Sud University, Villejuif, France
| | - Beranger Lueza
- Institute Gustave Roussy; and Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale U1018, Paris-Sud University, Villejuif, France
| | - Stefan Michiels
- Institute Gustave Roussy; and Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale U1018, Paris-Sud University, Villejuif, France
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Thonon F, Saghatchian M, Nerfie A, Delaloge S. [Trends and evolutions of French breast cancer research: a bibliometric study]. Bull Cancer 2015; 102:417-27. [PMID: 25887175 DOI: 10.1016/j.bulcan.2015.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 10/08/2014] [Accepted: 02/26/2015] [Indexed: 01/18/2023]
Abstract
This article presents a bibliometric study carried out in order to describe the trends and evolutions of French breast cancer research from 2003 to 2013. The results show an increase in the number of publications, especially international publications coordinated by non-French institutions. The most visible topics, in terms of number of publications by keywords, are related to biology, clinical trials and genetics. Most publications are written by authors affiliated to comprehensive cancer centres, followed by universities, research centres, university hospitals and governmental agencies. The importance of publications by topic varies throughout the years: there has been an increase of the number of publications related to targeted therapies or genomics. The importance of institutions or country affiliation of authors varies with the topics. This study, especially the analysis by keywords, enables the coordinators of research programs to identify the predominant actors and themes.
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Affiliation(s)
- Frédérique Thonon
- Institut Gustave-Roussy, service des affaires européennes et internationales, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - Mahasti Saghatchian
- Institut Gustave-Roussy, service des affaires européennes et internationales, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Institut Gustave-Roussy, comité de pathologie mammaire, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Alexia Nerfie
- Institut Gustave-Roussy, bibliothèque médicale, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Suzette Delaloge
- Institut Gustave-Roussy, comité de pathologie mammaire, 114, rue Édouard-Vaillant, 94800 Villejuif, France
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