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Miglietta F, Fabi A, Generali D, Dieci MV, Arpino G, Bianchini G, Cinieri S, Conte PF, Curigliano G, De Laurentiis M, Del Mastro L, De Placido S, Gennari A, Puglisi F, Zambelli A, Perrone F, Guarneri V. Corrigendum to "Optimizing choices and sequences in the diagnostic-therapeutic landscape of advanced triple-negative breast cancer: An Italian consensus paper and critical review" [Cancer Treat. Rev. 114 (2023) 102511]. Cancer Treat Rev 2023; 119:102594. [PMID: 37400291 DOI: 10.1016/j.ctrv.2023.102594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
- F Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy; Oncology Unit 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - A Fabi
- Precision Medicine in Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Italy
| | - D Generali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy; Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Italy
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy; Oncology Unit 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - G Bianchini
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - S Cinieri
- Oncologia Medica, Ospedale Senatore Antonio Perrino, Brindisi, Italy
| | - P F Conte
- Rete Oncologica Veneta (ROV), Istituto Oncologico Veneto, Italy
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Italy; Division of Early Drug Development, European Institute of Oncology, Milano, Italy
| | - M De Laurentiis
- Department of Breast and Thoracic Oncology, National Cancer Institute, IRCCS "Fondazione G. Pascale", Naples, Italy
| | - L Del Mastro
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Italy
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - A Gennari
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - F Puglisi
- Department of Medicine, University of Udine, Udine, Italy; Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - A Zambelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Perrone
- Clinical Trials Unit, National Cancer Institute, IRCCS "Fondazione G. Pascale", Naples, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy; Oncology Unit 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy.
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Miglietta F, Fabi A, Generali D, Dieci MV, Arpino G, Bianchini G, Cinieri S, Conte PF, Curigliano G, De Laurentiis M, Del Mastro L, De Placido S, Gennari A, Puglisi F, Zambelli A, Perrone F, Guarneri V. Corrigendum to "Optimizing choices and sequences in the diagnostic-therapeutic landscape of advanced triple-negative breast cancer: An Italian consensus paper and critical review" [Cancer Treatm. Rev. 114 (2023) 102511]. Cancer Treat Rev 2023; 117:102570. [PMID: 37150120 DOI: 10.1016/j.ctrv.2023.102570] [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: 05/09/2023]
Affiliation(s)
- F Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy; Oncology 2 Unit, Istituto Oncologico Veneto, Padova, Italy
| | - A Fabi
- Precision Medicine in Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Italy
| | - D Generali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy; Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Italy
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy; Oncology 2 Unit, Istituto Oncologico Veneto, Padova, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - G Bianchini
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - S Cinieri
- Oncologia Medica, Ospedale Senatore Antonio Perrino, Brindisi, Italy
| | - P F Conte
- Rete Oncologica Veneta (ROV), Istituto Oncologico Veneto, Italy
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Italy; Division of Early Drug Development, European Institute of Oncology, Milano, Italy
| | - Michelino De Laurentiis
- Department of Breast and Thoracic Oncology, IRCCS Istituto Nazionale Tumori "Fondazione G. Pascale", Naples, Italy
| | - L Del Mastro
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Italy
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - A Gennari
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - F Puglisi
- Department of Medicine, University of Udine, Udine, Italy; Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - A Zambelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Perrone
- Clinical Trials Unit, National Cancer Institute, IRCCS "Fondazione G. Pascale", Naples, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy; Oncology 2 Unit, Istituto Oncologico Veneto, Padova, Italy.
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Miglietta F, Fabi A, Generali D, Dieci MV, Arpino G, Bianchini G, Cinieri S, Conte PF, Curigliano G, De Laurentis M, Del Mastro L, De Placido S, Gennari A, Puglisi F, Zambelli A, Perrone F, Guarneri V. Optimizing choices and sequences in the diagnostic-therapeutic landscape of advanced triple-negative breast cancer: An Italian consensus paper and critical review. Cancer Treat Rev 2023; 114:102511. [PMID: 36638600 DOI: 10.1016/j.ctrv.2023.102511] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/05/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
Triple-negative (TN) metastatic breast cancer (mBC) represents the most challenging scenario withing mBC framework, and it has been only slightly affected by the tremendous advancements in terms of drug availability and survival prolongation we have witnessed in the last years for advanced disease. However, although chemotherapy still represents the mainstay of TN mBC management, in the past years, several novel effective agents have been developed and made available in the clinical practice setting. Within this framework, a panel composed of a scientific board of 17 internationally recognized breast oncologists and 42 oncologists working within local spoke centers, addressed 26 high-priority statements, including grey areas, regarding the management of TN mBC. A structured methodology based on a modified Delphi approach to administer the survey and the Nominal Group Technique to capture perceptions and preferences on the management of TN mBC within the Italian Oncology community were adopted. The Panel produced a set of prioritized considerations/consensus statements reflecting the Panel position on diagnostic and staging approach, first-line and second-line treatments of PD-L1-positive/germline BRCA (gBRCA) wild-type, PD-L1-positive/gBRCA mutated, PD-L1-negative/gBRCA wild-type and PD-L1-negative/gBRCA mutated TN mBC. The Panel critically and comprehensively discussed the most relevant and/or unexpected results and put forward possible interpretations for statements not reaching the consensus threshold.
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Affiliation(s)
- F Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy; Oncology 2 Unit, Istituto Oncologico Veneto, Padova, Italy
| | - A Fabi
- Precision Medicine in Breast Cancer, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Italy
| | - D Generali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy; Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Italy
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy; Oncology 2 Unit, Istituto Oncologico Veneto, Padova, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - G Bianchini
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - S Cinieri
- Oncologia Medica, Ospedale Senatore Antonio Perrino, Brindisi, Italy
| | - P F Conte
- Rete Oncologica Veneta (ROV), Istituto Oncologico Veneto, Italy
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Italy; Division of Early Drug Development, European Institute of Oncology, Milano, Italy
| | - M De Laurentis
- Breast Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", Naples, Italy
| | - L Del Mastro
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Italy
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - A Gennari
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - F Puglisi
- Department of Medicine, University of Udine, Udine, Italy; Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - A Zambelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Perrone
- Clinical Trials Unit, National Cancer Institute IRCCS Fondazione G.Pascale, Naples, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy; Oncology 2 Unit, Istituto Oncologico Veneto, Padova, Italy.
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Miglietta F, Bottosso M, Griguolo G, Dieci MV, Guarneri V. Major advancements in metastatic breast cancer treatment: when expanding options means prolonging survival. ESMO Open 2022; 7:100409. [PMID: 35227965 PMCID: PMC8886005 DOI: 10.1016/j.esmoop.2022.100409] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 12/13/2022] Open
Abstract
In the last years we have witnessed tremendous advancements in the treatment landscape of metastatic breast cancer (MBC), leading to a progressive prolongation of progression-free survival and, in some cases, also of overall survival. This led to a substantial increase of advanced disease treatability. In the present review we comprehensively and critically describe the most significant progresses in the therapeutic scenario of MBC according to BC subtype. In particular, we reviewed studies reporting practice-changing data in hormone receptor-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive and triple-negative BC, with also a hint to BRCA-related tumors and the emerging HER2-low-positive category.
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Affiliation(s)
- F Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - M Bottosso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - G Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.
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Guarneri V, Griguolo G, Miglietta F, Conte PF, Dieci MV, Girardi F. Survival after neoadjuvant therapy with trastuzumab-lapatinib and chemotherapy in patients with HER2-positive early breast cancer: a meta-analysis of randomized trials. ESMO Open 2022; 7:100433. [PMID: 35276440 PMCID: PMC8917305 DOI: 10.1016/j.esmoop.2022.100433] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/10/2022] [Accepted: 02/05/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Studies testing the addition of lapatinib to neoadjuvant trastuzumab + chemotherapy reported an increase in pathologic complete response (pCR), with, nevertheless, discordant results in terms of survival, mainly due to suboptimal power. We here leverage the meta-analytic approach to resolve these inconsistencies. METHODS We conducted a meta-analysis of randomized phase II/III studies testing lapatinib + trastuzumab in combination with neoadjuvant chemotherapy for human epidermal growth factor receptor (HER2)-positive early breast cancer (BC). Recurrence-free survival (RFS) and overall survival (OS) were adopted as survival endpoints. Pooled hazard ratios (HR) were obtained for the effect of lapatinib + trastuzumab versus trastuzumab, pCR versus no-pCR in the whole study populations and pCR versus no-pCR according to hormone receptor status. RESULTS Four phase II/III randomized trials were included in the meta-analysis (CALGB 40601, Cher-LOB, NSABP-B41, NeoALTTO) for an overall population of 1410 patients receiving neoadjuvant chemotherapy in association with either trastuzumab, lapatinib or their combination. RFS was significantly improved with dual HER2 blockade as compared to trastuzumab [HR 0.62, 95% confidence interval (CI) 0.46-0.85]. Dual blockade also led to significantly improved OS (HR 0.65, 95% CI 0.43-0.98). For all treatments combined, patients achieving pCR had better RFS and OS than those with residual disease (HR 0.45, 95% CI 0.34-0.60, and HR 0.32, 95% CI 0.22-0.48, for RFS and OS, respectively). In patients with hormone receptor-negative tumors, pCR was associated with 65% and 73% relative reduction of risk of relapse and death, respectively. Patients with hormone receptor-positive tumors also experienced improved RFS if they achieved pCR; however, the benefit was smaller than that in hormone receptor-negative disease. CONCLUSION Findings from this meta-analysis further validate the role of pCR as a strong predictor of outcome in patients with HER2-positive BC, especially in hormone receptor-negative disease. Moreover, we provide robust evidence that dual blockade with lapatinib + trastuzumab in combination with neoadjuvant chemotherapy prolongs OS, suggesting that the role of lapatinib could be reconsidered in the early setting.
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Affiliation(s)
- V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Oncology 2, Veneto Institute of Oncology - IOV - IRCCS, Padova, Italy.
| | - G Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Oncology 2, Veneto Institute of Oncology - IOV - IRCCS, Padova, Italy
| | - F Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| | - P F Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Oncology 2, Veneto Institute of Oncology - IOV - IRCCS, Padova, Italy
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Oncology 2, Veneto Institute of Oncology - IOV - IRCCS, Padova, Italy
| | - F Girardi
- Oncology 2, Veneto Institute of Oncology - IOV - IRCCS, Padova, Italy
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6
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Zanelli S, Fiorio E, Zampiva I, Zacchi F, Borghesani G, Giontella E, Parolin V, Biondani P, Zuliani S, Dieci MV, Mioranza E, Zorzi M, Conti M, Gibellini D, Verlato G, Milella M. Risk and severity of SARS-CoV-2 infection in breast cancer patients undergoing a structured infection screening program at the University and Hospital Trust of Verona. Ann Oncol 2022; 33:661-663. [PMID: 35276335 PMCID: PMC8904004 DOI: 10.1016/j.annonc.2022.02.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- S Zanelli
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - E Fiorio
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - I Zampiva
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy; Centro Ricerche Cliniche di Verona (CRC), Verona, Italy
| | - F Zacchi
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - G Borghesani
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - E Giontella
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - V Parolin
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - P Biondani
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - S Zuliani
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - M V Dieci
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy; Department of Oncology, Surgery and Gastroenterology, University of Padova, Padua, Italy
| | - E Mioranza
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - M Zorzi
- Veneto Tumor Registry, Azienda Zero, Padua, Italy
| | - M Conti
- Section of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - D Gibellini
- Department of Diagnostic and Public Health, Microbiology Section, University of Verona, Verona, Italy
| | - G Verlato
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - M Milella
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy.
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Condorelli M, Bruzzone M, Ceppi M, Ferrari A, Grinshpun A, Hamy AS, de Azambuja E, Carrasco E, Peccatori FA, Di Meglio A, Paluch-Shimon S, Poorvu PD, Venturelli M, Rousset-Jablonski C, Senechal C, Livraghi L, Ponzone R, De Marchis L, Pogoda K, Sonnenblick A, Villarreal-Garza C, Córdoba O, Teixeira L, Clatot F, Punie K, Graffeo R, Dieci MV, Pérez-Fidalgo JA, Duhoux FP, Puglisi F, Ferreira AR, Blondeaux E, Peretz-Yablonski T, Caron O, Saule C, Ameye L, Balmaña J, Partridge AH, Azim HA, Demeestere I, Lambertini M. Safety of assisted reproductive techniques in young women harboring germline pathogenic variants in BRCA1/2 with a pregnancy after prior history of breast cancer. ESMO Open 2021; 6:100300. [PMID: 34775302 PMCID: PMC8593447 DOI: 10.1016/j.esmoop.2021.100300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Knowledge is growing on the safety of assisted reproductive techniques (ART) in cancer survivors. No data exist, however, for the specific population of breast cancer patients harboring germline BRCA1/2 pathogenic variants. PATIENTS AND METHODS This is a multicenter retrospective cohort study across 30 centers worldwide including women diagnosed at ≤40 years with stage I-III breast cancer, between January 2000 and December 2012, harboring known germline BRCA1/2 pathogenic variants. Patients included in this analysis had a post-treatment pregnancy either achieved through use of ART (ART group) or naturally (non-ART group). ART procedures included ovulation induction, ovarian stimulation for in vitro fertilization or intracytoplasmic sperm injection, and embryo transfer under hormonal replacement therapy. RESULTS Among the 1424 patients registered in the study, 168 were eligible for inclusion in the present analysis, of whom 22 were in the ART group and 146 in the non-ART group. Survivors in the ART group conceived at an older age compared with those in the non-ART group (median age: 39.7 versus 35.4 years, respectively). Women in the ART group experienced more delivery complications compared with those in the non-ART group (22.1% versus 4.1%, respectively). No other apparent differences in obstetrical outcomes were observed between cohorts. The median follow-up from pregnancy was 3.4 years (range: 0.8-8.6 years) in the ART group and 5.0 years (range: 0.8-17.6 years) in the non-ART group. Two patients (9.1%) in the ART group experienced a disease-free survival event (specifically, a locoregional recurrence) compared with 40 patients (27.4%) in the non-ART group. In the ART group, no patients deceased compared with 10 patients (6.9%) in the non-ART group. CONCLUSION This study provides encouraging safety data on the use of ART in breast cancer survivors harboring germline pathogenic variants in BRCA1/2, when natural conception fails or when they opt for ART in order to carry out preimplantation genetic testing.
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Affiliation(s)
- M Condorelli
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Fertility Clinic, Brussels, Belgium; Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - A Ferrari
- Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy
| | - A Grinshpun
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A S Hamy
- Department of Medical Oncology, Institut Curie, Paris, France
| | - E de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - E Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - F A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - A Di Meglio
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - S Paluch-Shimon
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - P D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Venturelli
- Department of Oncology and Haematology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - C Rousset-Jablonski
- Department of Surgery, Centre Léon Bérard and INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | - C Senechal
- Cancer Genetics Unit, Bergonie Institute, Bordeaux, France
| | - L Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; University of Siena, Siena, Italy
| | - R Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
| | - L De Marchis
- Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - K Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - C Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - O Córdoba
- Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain
| | - L Teixeira
- Breast Disease Unit, Saint-Louis Hospital, APHP, Université de Paris, INSERM U976, Paris, France
| | - F Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - K Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - R Graffeo
- Breast Unit of Southern Switzerland (CSSI), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - J A Pérez-Fidalgo
- Department of Medical Oncology, INCLIVA University Hospital of Valencia, CIBERONC, Valencia, Spain
| | - F P Duhoux
- Department of Medical Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - F Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - A R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - E Blondeaux
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - T Peretz-Yablonski
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - O Caron
- Department of Medical Oncology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - C Saule
- Department of Genetics, Institut Curie, Paris, France
| | - L Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - J Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - A H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - H A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - I Demeestere
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Fertility Clinic, Brussels, Belgium; Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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8
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Guarneri V, Dieci MV, Bisagni G, Frassoldati A, Bianchi GV, De Salvo GL, Orvieto E, Urso L, Pascual T, Paré L, Galván P, Ambroggi M, Giorgi CA, Moretti G, Griguolo G, Vicini R, Prat A, Conte PF. De-escalated therapy for HR+/HER2+ breast cancer patients with Ki67 response after 2-week letrozole: results of the PerELISA neoadjuvant study. Ann Oncol 2020; 30:921-926. [PMID: 30778520 PMCID: PMC6594455 DOI: 10.1093/annonc/mdz055] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [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] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In human epidermal growth factor receptor 2 (HER2+) breast cancers, neoadjuvant trials of chemotherapy plus anti-HER2 treatment consistently showed lower pathologic complete response (pCR) rates in hormone receptor (HR) positive versus negative tumors. The PerELISA study was aimed to evaluate the efficacy of a de-escalated, chemotherapy-free neoadjuvant regimen in HR+/HER2+ breast cancer patients selected on the basis of Ki67 inhibition after 2-week letrozole. PATIENTS AND METHODS PerELISA is a phase II, multicentric study for postmenopausal patients with HR+/HER2+ operable breast cancer. Patients received 2-week letrozole, and then underwent re-biopsy for Ki67 evaluation. Patients classified as molecular responders (Ki67 relative reduction >20% from baseline) continued letrozole and started trastuzumab-pertuzumab for five cycles. Patients classified as molecular non-responders started weekly paclitaxel for 13 weeks combined with trastuzumab-pertuzumab. Primary aim was breast and axillary pCR. According to a two-stage Simon's design, to reject the null hypothesis, at least 8/43 pCR had to be documented. RESULTS Sixty-four patients were enrolled, 44 were classified as molecular responders. All these patients completed the assigned treatment with letrozole-trastuzumab-pertuzumab and underwent surgery. A pCR was observed in 9/44 cases (20.5%, 95% confidence interval 11.1% to 34.5%). Among molecular non-responders, 16/17 completed treatment and underwent surgery, with pCR observed in 81.3% of the cases. PAM50 intrinsic subtype was significantly associated with Ki67 response and pCR. Among molecular responders, the pCR rate was significantly higher in HER2-enriched than in other subtypes (45.5% versus 13.8%, P = 0.042). CONCLUSIONS The primary end point of the study was met, by reaching the pre-specified pCRs. In patients selected using Ki67 reduction after short-term letrozole exposure, a meaningful pCR rate can be achieved without chemotherapy. PAM50 intrinsic subtyping further refines our ability to identify a subset of patients for whom chemotherapy might be spared. EUDRACT NUMBER 2013-002662-40. CLINICALTRIALS.GOV IDENTIFIER NCT02411344.
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Affiliation(s)
- V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova.
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova
| | - G Bisagni
- Department of Oncology and Advanced Technologies, Oncology Unit, Azienda USL-IRCCS di Reggio Emilia
| | - A Frassoldati
- Clinical Oncology, Department of Morphology, Surgery and Experimental Medicine, S Anna University Hospital, Ferrara
| | - G V Bianchi
- Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - G L De Salvo
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova
| | - E Orvieto
- Pathology Unit, Azienda ULSS 5 Polesana, Rovigo, Italy
| | - L Urso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova
| | - T Pascual
- Department of Medical Oncology, Hospital Clinic, Barcelona; Translational Genomics and Targeted Therapeutics in Solid Tumours Lab, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - L Paré
- Department of Medical Oncology, Hospital Clinic, Barcelona; Translational Genomics and Targeted Therapeutics in Solid Tumours Lab, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - P Galván
- Department of Medical Oncology, Hospital Clinic, Barcelona; Translational Genomics and Targeted Therapeutics in Solid Tumours Lab, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Ambroggi
- Department of Oncology-Hematology, Ospedale "G. da Saliceto", Piacenza
| | - C A Giorgi
- Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova
| | - G Moretti
- Department of Oncology and Advanced Technologies, Oncology Unit, Azienda USL-IRCCS di Reggio Emilia
| | - G Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova; Translational Genomics and Targeted Therapeutics in Solid Tumours Lab, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - R Vicini
- Department of Diagnostic and Clinical Medicine and Public Health, Statistics Unit, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - A Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona; Translational Genomics and Targeted Therapeutics in Solid Tumours Lab, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - P F Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova
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9
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Kos Z, Roblin E, Kim RS, Michiels S, Gallas BD, Chen W, van de Vijver KK, Goel S, Adams S, Demaria S, Viale G, Nielsen TO, Badve SS, Symmans WF, Sotiriou C, Rimm DL, Hewitt S, Denkert C, Loibl S, Luen SJ, Bartlett JMS, Savas P, Pruneri G, Dillon DA, Cheang MCU, Tutt A, Hall JA, Kok M, Horlings HM, Madabhushi A, van der Laak J, Ciompi F, Laenkholm AV, Bellolio E, Gruosso T, Fox SB, Araya JC, Floris G, Hudeček J, Voorwerk L, Beck AH, Kerner J, Larsimont D, Declercq S, Van den Eynden G, Pusztai L, Ehinger A, Yang W, AbdulJabbar K, Yuan Y, Singh R, Hiley C, Bakir MA, Lazar AJ, Naber S, Wienert S, Castillo M, Curigliano G, Dieci MV, André F, Swanton C, Reis-Filho J, Sparano J, Balslev E, Chen IC, Stovgaard EIS, Pogue-Geile K, Blenman KRM, Penault-Llorca F, Schnitt S, Lakhani SR, Vincent-Salomon A, Rojo F, Braybrooke JP, Hanna MG, Soler-Monsó MT, Bethmann D, Castaneda CA, Willard-Gallo K, Sharma A, Lien HC, Fineberg S, Thagaard J, Comerma L, Gonzalez-Ericsson P, Brogi E, Loi S, Saltz J, Klaushen F, Cooper L, Amgad M, Moore DA, Salgado R. Pitfalls in assessing stromal tumor infiltrating lymphocytes (sTILs) in breast cancer. NPJ Breast Cancer 2020; 6:17. [PMID: 32411819 PMCID: PMC7217863 DOI: 10.1038/s41523-020-0156-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/02/2020] [Indexed: 02/08/2023] Open
Abstract
Stromal tumor-infiltrating lymphocytes (sTILs) are important prognostic and predictive biomarkers in triple-negative (TNBC) and HER2-positive breast cancer. Incorporating sTILs into clinical practice necessitates reproducible assessment. Previously developed standardized scoring guidelines have been widely embraced by the clinical and research communities. We evaluated sources of variability in sTIL assessment by pathologists in three previous sTIL ring studies. We identify common challenges and evaluate impact of discrepancies on outcome estimates in early TNBC using a newly-developed prognostic tool. Discordant sTIL assessment is driven by heterogeneity in lymphocyte distribution. Additional factors include: technical slide-related issues; scoring outside the tumor boundary; tumors with minimal assessable stroma; including lymphocytes associated with other structures; and including other inflammatory cells. Small variations in sTIL assessment modestly alter risk estimation in early TNBC but have the potential to affect treatment selection if cutpoints are employed. Scoring and averaging multiple areas, as well as use of reference images, improve consistency of sTIL evaluation. Moreover, to assist in avoiding the pitfalls identified in this analysis, we developed an educational resource available at www.tilsinbreastcancer.org/pitfalls.
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Affiliation(s)
- Zuzana Kos
- Department of Pathology, BC Cancer - Vancouver, Vancouver, BC Canada
| | - Elvire Roblin
- 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
| | - Rim S. Kim
- National Surgical Adjuvant Breast and Bowel Project (NSABP)/NRG Oncology, Pittsburgh, PA USA
| | - Stefan Michiels
- 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
| | - Brandon D. Gallas
- Division of Imaging, Diagnostics, and Software Reliability (DIDSR); Office of Science and Engineering Laboratories (OSEL); Center for Devices and Radiological Health (CDRH), US Food and Drug Administration (US FDA), Silver Spring, MD USA
| | - Weijie Chen
- Division of Imaging, Diagnostics, and Software Reliability (DIDSR); Office of Science and Engineering Laboratories (OSEL); Center for Devices and Radiological Health (CDRH), US Food and Drug Administration (US FDA), Silver Spring, MD USA
| | - Koen K. van de Vijver
- Department of Pathology, University Hospital Antwerp, Antwerp, Belgium
- Department of Pathology, Ghent University Hospital, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Shom Goel
- The Sir Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria Australia
| | - Sylvia Adams
- Perlmutter Cancer Center, New York University Medical School, New York, NY USA
| | - Sandra Demaria
- Departments of Radiation Oncology and Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY USA
| | - Giuseppe Viale
- Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - Torsten O. Nielsen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Sunil S. Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - W. Fraser Symmans
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Christos Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - David L. Rimm
- Department of Pathology, Yale School of Medicine, New Haven, CT USA
| | - Stephen Hewitt
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD USA
| | - Carsten Denkert
- Institute of Pathology, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg and Philipps-Universität Marburg, Marburg, Germany
| | | | - Stephen J. Luen
- Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria Australia
- Division of Research and Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC Australia
| | - John M. S. Bartlett
- Ontario Institute for Cancer Research, Toronto, ON Canada
- University of Edinburgh Cancer Research Centre, Edinburgh, UK
| | - Peter Savas
- Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria Australia
- Division of Research and Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC Australia
| | - Giancarlo Pruneri
- Department of Pathology, IRCCS Fondazione Instituto Nazionale Tumori and University of Milan, School of Medicine, Milan, Italy
| | - Deborah A. Dillon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA USA
- Department of Pathology, Dana Farber Cancer Institute, Boston, MA USA
| | - Maggie Chon U. Cheang
- Institute of Cancer Research Clinical Trials and Statistics Unit, The Institute of Cancer Research, Surrey, UK
| | - Andrew Tutt
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | | | - Marleen Kok
- Department of Medical Oncology and Division of Tumor Biology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hugo M. Horlings
- Department of Pathology, University Hospital Antwerp, Antwerp, Belgium
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH USA
| | - Jeroen van der Laak
- Computational Pathology Group, Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Francesco Ciompi
- Computational Pathology Group, Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Enrique Bellolio
- Departamento de Anatomía Patológica, Universidad de La Frontera, Temuco, Chile
| | | | - Stephen B. Fox
- The Sir Peter MacCallum Cancer Centre, Melbourne, VIC Australia
- Department of Pathology, Peter MacCallum Cancer Centre Department of Pathology, Melbourne, VIC Australia
| | | | - Giuseppe Floris
- KU Leuven- Univerisity of Leuven, Department of Imaging and Pathology, Laboratory of Translational Cell & Tissue Research and KU Leuven- University Hospitals Leuven, Department of Pathology, Leuven, Belgium
| | - Jan Hudeček
- Department of Research IT, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Leonie Voorwerk
- Division of Tumor Biology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Denis Larsimont
- Department of Pathology, Jules Bordet Institute, Brussels, Belgium
| | | | | | - Lajos Pusztai
- Department of Internal Medicine, Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT USA
| | - Anna Ehinger
- Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Centre, Shanghai, China
| | - Khalid AbdulJabbar
- Centre for Evolution and Cancer; Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Yinyin Yuan
- Centre for Evolution and Cancer; Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Rajendra Singh
- Icahn School of Medicine at Mt. Sinai, New York, NY 10029 USA
| | - Crispin Hiley
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, UK
| | - Maise al Bakir
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, UK
| | - Alexander J. Lazar
- Departments of Pathology, Genomic Medicine, Dermatology, and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Stephen Naber
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, USA
| | - Stephan Wienert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Miluska Castillo
- Department of Medical Oncology and Research, Instituto Nacional de Enfermedades Neoplasicas, Lima, 15038 Peru
| | | | - Maria-Vittoria Dieci
- Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Fabrice André
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Charles Swanton
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, UK
- Francis Crick Institute, Midland Road, London, UK
| | - Jorge Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Joseph Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Eva Balslev
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - I-Chun Chen
- Department of Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Katherine Pogue-Geile
- National Surgical Adjuvant Breast and Bowel Project (NSABP)/NRG Oncology, Pittsburgh, PA USA
| | - Kim R. M. Blenman
- Department of Internal Medicine, Section of Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT USA
| | | | - Stuart Schnitt
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA USA
| | - Sunil R. Lakhani
- The University of Queensland Centre for Clinical Research and Pathology Queensland, Brisbane, QLD Australia
| | - Anne Vincent-Salomon
- Institut Curie, Paris Sciences Lettres Université, Inserm U934, Department of Pathology, Paris, France
| | - Federico Rojo
- Pathology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD) - CIBERONC, Madrid, Spain
- GEICAM-Spanish Breast Cancer Research Group, Madrid, Spain
| | - Jeremy P. Braybrooke
- Nuffield Department of Population Health, University of Oxford, Oxford and Department of Medical Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Matthew G. Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - M. Teresa Soler-Monsó
- Department of Pathology, Bellvitge University Hospital, IDIBELL. Breast Unit. Catalan Institut of Oncology. L ‘Hospitalet del Llobregat’, Barcelona, 08908 Catalonia Spain
| | - Daniel Bethmann
- University Hospital Halle (Saale), Institute of Pathology, Halle (Saale), Germany
| | - Carlos A. Castaneda
- Department of Medical Oncology and Research, Instituto Nacional de Enfermedades Neoplasicas, Lima, 15038 Peru
| | - Karen Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Universitè Libre de Bruxelles, Brussels, Belgium
| | - Ashish Sharma
- Department of Biomedical Informatics, Emory University, Atlanta, GA USA
| | - Huang-Chun Lien
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Susan Fineberg
- Department of Pathology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY USA
| | - Jeppe Thagaard
- DTU Compute, Department of Applied Mathematics, Technical University of Denmark; Visiopharm A/S, Hørsholm, Denmark
| | - Laura Comerma
- GEICAM-Spanish Breast Cancer Research Group, Madrid, Spain
- Pathology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Paula Gonzalez-Ericsson
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Sherene Loi
- Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria Australia
- Division of Research and Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC Australia
| | - Joel Saltz
- Biomedical Informatics Department, Stony Brook University, Stony Brook, NY USA
| | - Frederick Klaushen
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lee Cooper
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Mohamed Amgad
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA USA
| | - David A. Moore
- Department of Pathology, UCL Cancer Institute, UCL, London, UK
- University College Hospitals NHS Trust, London, UK
| | - Roberto Salgado
- Division of Research and Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC Australia
- Department of Pathology, GZA-ZNA, Antwerp, Belgium
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10
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Dieci MV, Conte P, Bisagni G, Brandes AA, Frassoldati A, Cavanna L, Musolino A, Giotta F, Rimanti A, Garrone O, Bertone E, Cagossi K, Sarti S, Ferro A, Piacentini F, Maiorana A, Orvieto E, Sanders M, Miglietta F, Balduzzi S, D'Amico R, Guarneri V. Association of tumor-infiltrating lymphocytes with distant disease-free survival in the ShortHER randomized adjuvant trial for patients with early HER2+ breast cancer. Ann Oncol 2020; 30:418-423. [PMID: 30657852 PMCID: PMC6442655 DOI: 10.1093/annonc/mdz007] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is the need to identify new prognostic markers to refine risk stratification for HER2-positive early breast cancer patients. The aim of this study was to evaluate the association of tumor-infiltrating lymphocytes (TILs) with distant disease-free survival (DDFS) in patients with HER2-positive early breast cancer enrolled in the ShortHER adjuvant trial which compared 9 weeks versus 1-year trastuzumab in addition to chemotherapy, and to test the interaction between TILs and treatment arm. PATIENTS AND METHODS Stromal TILs were assessed for 866 cases on centralized hematoxylin and eosin-stained tumor slides. The association of TILs as 10% increments with DDFS was assessed with Cox models. Kaplan-Meier curves were estimated for patients with TILs ≥20% and TILs <20%. Median follow-up was 6.1 years. RESULTS Median TILs was 5% (Q1-Q3 1%-15%). Increased TILs were independently associated with better DDFS in multivariable model [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.59-0.89, P = 0.006, for each 10% TILs increment]. Five years DDFS rates were 91.1% for patients with TILs <20% and 95.7% for patients with TILs ≥20% (P = 0.025). The association between 10% TILs increments and DDFS was significant for patients randomized to 9 weeks of trastuzumab (HR 0.60, 95% CI 0.41-0.88) but not for patients treated with 1 year of trastuzumab (HR 0.89, 95% CI 0.71-1.12; test for interaction P = 0.088). For patients with TILs <20%, the HR for the comparison between the short versus the long arm was 1.75 (95% CI 1.09-2.80, P=0.021); whereas, for patients with TILs ≥20% the HR for the comparison of short versus long arm was 0.23 (95% CI 0.05-1.09, P = 0.064), resulting in a significant interaction (P = 0.015). CONCLUSIONS TILs are an independent prognostic factor for HER2-positive early breast cancer patients treated with adjuvant chemotherapy and trastuzumab and may refine the ability to identify patients at low risk of relapse eligible for de-escalated adjuvant therapy.
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Affiliation(s)
- M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova.
| | - G Bisagni
- Oncology Unit, Department of Oncology and Advanced Technologies, Azienda USL-IRCCS, Reggio Emilia
| | - A A Brandes
- Medical Oncology, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna
| | - A Frassoldati
- Clinical Oncology, Department of Morphology, Surgery and Experimental Medicine, S Anna University Hospital, Ferrara
| | - L Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza
| | - A Musolino
- Medical Oncology Unit, University Hospital of Parma, Piacenza
| | - F Giotta
- Division of Medical Oncology, IRCCS, Istituto Tumori "Giovanni Paolo II", Bari
| | - A Rimanti
- Medical Oncology, Azienda Ospedaliera di Mantova, Mantova
| | - O Garrone
- Medical Oncology, A.O. S. Croce and Carle Teaching Hospital, Cuneo
| | - E Bertone
- Medical Oncology, S. Anna Hospital, Torino
| | - K Cagossi
- Breast Unit Ausl Modena, Ramazzini Hospital, Carpi
| | - S Sarti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola
| | - A Ferro
- Rete Clinica Senologica - Oncologia Medica S. Chiara, Trento
| | - F Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena; Azienda Ospedaliero-Universitaria di Modena, Modena
| | - A Maiorana
- Department of Diagnostic, Clinical Medicine and Public Health, University Hospital of Modena, Modena
| | - E Orvieto
- Pathology Unit, Ulss 5 Polesana, Rovigo, Italy
| | - M Sanders
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - F Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova
| | - S Balduzzi
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Italy
| | - R D'Amico
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
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Park JH, Jonas SF, Bataillon G, Criscitiello C, Salgado R, Loi S, Viale G, Lee HJ, Dieci MV, Kim SB, Vincent-Salomon A, Curigliano G, André F, Michiels S. Prognostic value of tumor-infiltrating lymphocytes in patients with early-stage triple-negative breast cancers (TNBC) who did not receive adjuvant chemotherapy. Ann Oncol 2019; 30:1941-1949. [PMID: 31566659 DOI: 10.1093/annonc/mdz395] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [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] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although stromal tumor-infiltrating lymphocytes (sTILs) have been considered an important prognostic factor in early-stage triple-negative breast cancer (TNBC), there have been limited data on their prognostic value in the absence of adjuvant chemotherapy. PATIENTS AND METHODS A pooled analysis was carried out using four cohorts of TNBC patients not treated with chemotherapy. sTILs were evaluated in the most representative tumoral block of surgical specimens. Cox proportional hazards regression models were used for invasive disease-free survival (iDFS), distant disease-free survival (D-DFS), and overall survival (OS), fitting sTILs as a continuous variable adjusted for clinicopathologic factors. RESULTS We analyzed individual data of 476 patients from 4 centers diagnosed between 1989 and 2015. Their median age was 64 years. The median tumor size was 1.6 cm and 83% were node-negative. The median level of sTILs was 10% (Q1-Q3, 4%-30%). Higher grade was associated with higher sTILs (P < 10-3). During follow-up, 107 deaths, and 173 and 118 events for iDFS and D-DFS were observed, respectively. In the multivariable analysis, sTILs obtained an independent prognostic value for all end points (likelihood ratio χ2 = 7.14 for iDFS; P < 10-2; χ2 = 9.63 for D-DFS, P < 10-2; χ2 = 5.96 for OS, P = 0.015). Each 10% increment in sTILs corresponded to a hazard ratio of 0.90 [95% confidence interval (CI) 0.82 - 0.97] for iDFS, 0.86 (95% CI 0.77 - 0.95) for D-DFS, and 0.88 (95% CI 0.79 - 0.98) for OS, respectively. In patients with pathological stage I tumors with sTILs ≥30% (n = 74), 5-year iDFS was 91% (95% CI 84% to 96%), D-DFS was 97% (95% CI 93% to 100%), and OS was 98% (95% CI 95% to 100%). CONCLUSION sTILs add important prognostic information in systemically untreated early-stage TNBC patients. Notably, sTILs can identify a subset of stage I TNBC patients with an excellent prognosis without adjuvant chemotherapy.
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Affiliation(s)
- J H Park
- Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul; Department of Hemato-Oncology, Konkuk Medical Center, University of Konkuk College of Medicine, Seoul, Korea
| | - S F Jonas
- Department of Biostatistics and Epidemiology, Gustave Roussy; INSERM, Unit 1018, University Paris-Sud, University Paris-Saclay, Villejuif
| | - G Bataillon
- Department of Pathology, Institut Curie, Université Paris Sciences Lettres, Paris, France
| | - C Criscitiello
- IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - R Salgado
- GZA, Antwerp, Belgium; Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - S Loi
- Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - G Viale
- Department of Pathology, European Institute of Oncology, IRCCS, Milano, Italy
| | - H J Lee
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - S-B Kim
- Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - A Vincent-Salomon
- Department of Pathology, Institut Curie, Université Paris Sciences Lettres, Paris, France; Inserm Unit 934, Paris, France
| | - G Curigliano
- IEO, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
| | - F André
- Department of Oncology, Gustave Roussy; INSERM, Unit 981, University Paris-Sud, University Paris-Saclay, Villejuif, France
| | - S Michiels
- Department of Biostatistics and Epidemiology, Gustave Roussy; INSERM, Unit 1018, University Paris-Sud, University Paris-Saclay, Villejuif.
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Dieci MV, Orvieto E, Tsvetkova V, Griguolo G, Miglietta F, Bonaguro S, Tasca G, Giorgi CA, Cumerlato E, Guarneri V, Conte P. Abstract P4-08-04: PD-L1 expression and prognosis in triple negative breast cancer (TNBC): An analysis of 265 patients (pts) treated with standard therapy for stage I-III disease. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-08-04] [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: Targeting the PD-L1/PD-1 axis has proved to be effective in various cancers, including promising data for metastatic TNBC pts. The evaluation of PD-L1 expression is limited by the lack of standardized methods. Here we sought to evaluate the prognostic role of PD-L1 expression in a large cohort of patients with non-metastatic TNBC treated with standard therapy.
Methods:
Consecutive patients diagnosed with stage I-III TNBC (ER and PgR <10%, HER2 0/1+ or ISH non amplified) between May 2012 and December 2015 and treated at the Istituto Oncologico Veneto of Padova were included. All patients received treatment with surgery, chemotherapy (neoadjuvant or adjuvant) and radiotherapy (when indicated).
For each case, one FFPE tumor slide was stained for PD-L1 with the PD-L1 IHC 73-10 Research Use Only assay developed by Agilent Technologies and one slide was stained for cytokeratins with MNF116 (to distinguish MNF116+ tumor cells from MNF116- stromal cells). Digital slides were evaluated by a specifically-developed Visiopharm® software application. Following alignment of the PD-L1 and MNF116 digital slides, the software analyzed PD-L1 expression on tumor cells (% of positively stained tumor cells/total tumor cells) and stromal cells (% of positively stained stromal cells/total stromal cells). Disease-free survival (DFS) was calculated from diagnosis to relapse or death. In survival analyses, PD-L1 was evaluated as continuous and categorical variable.
Results:
265 TNBC pts were evaluated. Median PD-L1 was 2.6% (Q1-Q3 0%-18.6%) on tumor cells and 5.2% (Q1-Q3 0.2%-25.4%) on stromal cells. PD-L1 levels on tumor and stromal cells were positively correlated (spearman's 0.938, p<0.001). For further analyses, PD-L1 on stromal cells was considered. Higher PD-L1 was associated with age <50 yrs (p=0.011), Grade 3 (p=0.003) and Ki67 >30% (p=0.005). Lower PD-L1 was observed in lobular and apocrine tumors (p=0.001).Cox model for DFS showed HR=0.99 (95%CI 0.97-1.00, p=0.059) for every 1% PD-L1 increment.
3-yrs DFS was 86% for pts with PD-L1>20% (n=88, 29%) vs 75% for pts with PD-L1<20% (n=177, 71%): HR 0.52, 95%CI 0.28-0.97, p=0.039. PD-L1 at 20% cut-off maintained prognostic value in multivariate model including stage (HR 0.48, 95%CI 0.25-0.89, p=0.021).
Of the 265 pts included, 108 received neoadjuvant chemotherapy (NACT). Of the 78 pts with residual disease after NACT, 61 had pre- and post-NACT samples evaluable for PD-L1. PD-L1 increased from pre- to post-NACT: median 2.7% (Q1-Q3 0%-26.9%) vs 20.1% (Q1-Q3 5.9%-41.4%), p<0.001. Pts with PD-L1>20% post-NACT showed improved DFS: 3-yrs DFS 68% vs 43% (HR 0.44, 95%CI 0.20-0.96, p=0.039), whereas PD-L1 pre-NACT did not show significant association with DFS in this subgroup (HR 0.47, 95%CI 0.23-1.40, p=0.218).
Conclusions:
PD-L1 expression evaluated with a software-assisted method was prognostic for stage I-III TNBC pts treated with standard therapy. The significant increase of PD-L1 on residual disease post-NACT supports the rationale to evaluate the efficacy of anti-PD-L1 drugs in this high-risk population.
Citation Format: Dieci MV, Orvieto E, Tsvetkova V, Griguolo G, Miglietta F, Bonaguro S, Tasca G, Giorgi CA, Cumerlato E, Guarneri V, Conte P. PD-L1 expression and prognosis in triple negative breast cancer (TNBC): An analysis of 265 patients (pts) treated with standard therapy for stage I-III disease [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-04.
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Affiliation(s)
- MV Dieci
- University of Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy; aulss 5 Polesana, Rovigo, Italy
| | - E Orvieto
- University of Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy; aulss 5 Polesana, Rovigo, Italy
| | - V Tsvetkova
- University of Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy; aulss 5 Polesana, Rovigo, Italy
| | - G Griguolo
- University of Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy; aulss 5 Polesana, Rovigo, Italy
| | - F Miglietta
- University of Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy; aulss 5 Polesana, Rovigo, Italy
| | - S Bonaguro
- University of Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy; aulss 5 Polesana, Rovigo, Italy
| | - G Tasca
- University of Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy; aulss 5 Polesana, Rovigo, Italy
| | - CA Giorgi
- University of Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy; aulss 5 Polesana, Rovigo, Italy
| | - E Cumerlato
- University of Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy; aulss 5 Polesana, Rovigo, Italy
| | - V Guarneri
- University of Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy; aulss 5 Polesana, Rovigo, Italy
| | - P Conte
- University of Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy; aulss 5 Polesana, Rovigo, Italy
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Prat A, Griguolo G, Dieci MV, Bisagni G, Frassoldati A, Bianchi GV, Pascual T, Pare L, Galvan P, Urso L, Conte P, Guarneri V. Abstract P6-17-05: Independent validation of a combined biomarker based on the PAM50 HER2-enriched subtype and ERBB2 mRNA levels following HER2 blockade without chemotherapy in the PerELISA phase II trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-05] [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: A combined biomarker based on HER2-enriched subtype (HER2-E) and ERBB2 mRNA predicts response and survival in HER2+ breast cancer following trastuzumab +/- lapatinib in the absence of chemotherapy (Prat et al. ASCO 2018). Here, we tested the ability of the combined biomarker to predict pathological complete response (pCR) following neoadjuvant trastuzumab, pertuzumab and endocrine therapy.
Methods: RNA from 40 baseline tumor samples from the phase II PerELISA trial were evaluated. PerELISA evaluated the efficacy of a de-escalated, chemotherapy-free neoadjuvant regimen based on dual HER2 blockade with trastuzumab and pertuzumab in combination with letrozole in HER2+/hormone receptor-positive breast cancer selected on the basis of Ki67 response after short course letrozole-alone (Guarneri ASCO 2018). Ki67 response was defined by protocol as relative Ki67 reduction ≥20% from baseline at day 14. Gene-expression was measured using the nCounter platform. Intrinsic subtypes and ERBB2 levels were determined by the PAM50 gene expression predictor. A pre-specified ERBB2 cutoff was determined to define ERBB2-high. Univariate and multivariable logistic regression analyses were performed.
Results: The proportion of HER2-E disease within the ERBB2-high and ERBB2-low groups was 46.2% (6/13) and 18.5% (5/27), respectively. The discordance rate at the individual level was 30% (12/40). A total of 6 (15%) and 34 (85%) samples were HER2-E/ERBB2-high and others, respectively. The magnitude of Ki67 reduction of the HER2-E/ERBB2-high and others groups was 64.8% and 63.2%, respectively (p=0.88). The pCR rate of HER2-E/ERBB2-high was 66.7%. The pCR rate of the others group was 14.7%. The univariate odds ratio between HER2-E/ERBB2-high tumors and the others groups was 11.60 (95% CI 1.66-81.10; p=0.014). No other clinical-pathological variable was significantly associated with pCR.
Conclusion: The combined HER2-E/ERBB2-high biomarker can identify patients who might be good candidates to receive dual HER2 blockade alone without chemotherapy.
Citation Format: Prat A, Griguolo G, Dieci MV, Bisagni G, Frassoldati A, Bianchi GV, Pascual T, Pare L, Galvan P, Urso L, Conte P, Guarneri V. Independent validation of a combined biomarker based on the PAM50 HER2-enriched subtype and ERBB2 mRNA levels following HER2 blockade without chemotherapy in the PerELISA phase II trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-05.
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Affiliation(s)
- A Prat
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - G Griguolo
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - MV Dieci
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - G Bisagni
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - A Frassoldati
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - GV Bianchi
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - T Pascual
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - L Pare
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - P Galvan
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - L Urso
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - P Conte
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - V Guarneri
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Hospital Clinic de Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumours Lab (IDIBAPS), Barcelona, Spain; Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; S Anna University Hospital, Ferrara, Italy; Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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Frezzini S, Giarratano T, Dieci MV, Giorgi CA, Griguolo G, Vernaci G, Menichetti A, Mantiero M, Tasca G, Faggioni G, Falci C, Miglietta F, Mioranza E, Angelini S, Ghiotto C, Conte P, Guarneri V. Abstract P6-18-24: Lapatinib-based therapies after pertuzumab and/or T-DM1 for HER2+ metastatic breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-24] [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:
Trastuzumab + pertuzumab + taxane and ado-trastuzumab emtansine (T-DM1) are standard first and second-line therapies for HER2+ metastatic breast cancer. Lapatinib is approved in combination with capecitabine in trastuzumab-resistant patients and in combination with letrozole in hormone receptor positive HER2+ pts for whom endocrine treatment is indicated. In Italy, L is also approved in combination with trastuzumab for hormone receptor-negative HER2+ pts. There are only few data on the activity of lapatinib in pts who received prior pertuzumab and /or T-DM1.
Methods: We retrospectively analysed HER2+ metastatic breast cancer pts who received lapatinib after prior pertuzumab and/or T-DM1 from July 2013 to June 2018. Objective response rate (ORR) was assessed according to RECIST 1.1. Progression-free survival (PFS) was calculated from lapatinib-based therapy starting to disease progression (PD) or last follow-up. Overall Survival (OS) was calculated from lapatinib-based therapy starting to death or last follow up.
Results: Data from 32 HER2+ mBC treated with lapatinib-based therapy were recorded: 30 pts (94%) received lapatinib combined with capecitabine, 1 pt received lapatinib combined with letrozole and 1 pt received lapatinib combined with trastuzumab. All patients had been treated with prior T-DM1 and 9 (28%) with prior pertuzumab for metastatic breast cancer. Setting of treatment with lapatinib-based therapy was: 2° line (n=2, 6%), 3° line (n=17, 53%) and >4° line (n=13, 41%).
Patients characteristics were as follows: median age 55 years (range 35-71), hormone receptor positive 66% (n=21), stage IV at diagnosis 34% (n=11), visceral involvement at lapatinib-based therapy starting 91% (n=29).
As of June 2018, lapatinib-based therapy was ongoing for 4 pts and 28 pts discontinued treatment due to disease progression (median number of courses for these pts was 8.5, range 2-27).
ORR in evaluable pts was: complete response (n=1, 3%), partial response (n=13, 41%), stable disease (n=9, 28%), disease progression (n=9, 28%). Median PFS was 6.4 months (95% CI 3.0-9.8). As of June 2018, 14 pts (44%) were alive, median OS was 11.8 months (95% CI 9.9-13.6).
Conclusion: These results confirm that lapatinib-based therapy retains clinical efficacy in HER2+ metastatic breast cancer pts treated with prior pertuzumab and/or T-DM1 and represents a valid therapeutic option in this setting.
Citation Format: Frezzini S, Giarratano T, Dieci MV, Giorgi CA, Griguolo G, Vernaci G, Menichetti A, Mantiero M, Tasca G, Faggioni G, Falci C, Miglietta F, Mioranza E, Angelini S, Ghiotto C, Conte P, Guarneri V. Lapatinib-based therapies after pertuzumab and/or T-DM1 for HER2+ metastatic breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-24.
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Affiliation(s)
- S Frezzini
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - T Giarratano
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - MV Dieci
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - CA Giorgi
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - G Griguolo
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - G Vernaci
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - A Menichetti
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - M Mantiero
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - G Tasca
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - G Faggioni
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - C Falci
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - F Miglietta
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - E Mioranza
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - S Angelini
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - C Ghiotto
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - P Conte
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - V Guarneri
- Università di Padova, Padova, Italy; Istituto Oncologico Veneto - IRCCS, Padova, Italy
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Luen SJ, Salgado R, Dieci MV, Vingiani A, Curigliano G, Gould RE, Castaneda C, D'Alfonso T, Sanchez J, Cheng E, Andreopoulou E, Castillo M, Adams S, Demaria S, Symmans WF, Michiels S, Loi S. Prognostic implications of residual disease tumor-infiltrating lymphocytes and residual cancer burden in triple-negative breast cancer patients after neoadjuvant chemotherapy. Ann Oncol 2019; 30:236-242. [PMID: 30590484 DOI: 10.1093/annonc/mdy547] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [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] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND For primary triple-negative breast cancer (TNBC) treated with neoadjuvant chemotherapy (NAC), higher pretreatment tumor-infiltrating lymphocytes (TILs) correlates with increased pathologic complete response (pCR) rates, and improved survival. We evaluated the added prognostic value of residual disease (RD) TILs to residual cancer burden (RCB) in predicting survival post-NAC. PATIENTS AND METHODS We combined four TNBC NAC patient cohorts who did not achieve pCR. RD TILs were investigated for associations with recurrence-free survival (RFS), and overall survival (OS) using Cox models with stromal TILs as a continuous variable (per 10% increment). The likelihood ratio test was used to evaluate added prognostic value of RD TILs. RESULTS A total of 375 RD TNBC samples were evaluable for TILs and RCB. The median age was 50 years, with 62% receiving anthracycline/taxane chemotherapy. The RCB class after NAC was 11%, 50%, and 39% for I, II, and III, respectively. The median RD TIL level was 20% (IQR 10-40). There was a positive correlation between RD TIL levels and CD8+ T-cell density (ρ = 0.41). TIL levels were significantly lower with increasing post-NAC tumor (P = 0.005), nodal stage (P = 0.032), but did not differ by RCB class (P = 0.84). Higher RD TILs were significantly associated with improved RFS (HR: 0.86; 95% CI 0.79-0.92; P < 0.001), and improved OS (HR: 0.87; 95% CI 0.80-0.94; P < 0.001), and remained significant predictors in multivariate analysis (RFS P = 0.032; OS P = 0.038 for OS). RD TILs added significant prognostic value to multivariate models including RCB class (P < 0.001 for RFS; P = 0.021 for OS). The positive prognostic effect of RD TILs significantly differed by RCB class for RFS (PInt=0.003) and OS (PInt=0.008) with a greater magnitude of positive effect observed for RCB class II than class III. CONCLUSIONS TIL levels in TNBC RD are significantly associated with improved RFS and OS and add further prognostic information to RCB class, particularly in RCB class II.
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Affiliation(s)
- S J Luen
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - R Salgado
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia; Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - M V Dieci
- University of Padova, Padova, Italy; Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - A Vingiani
- European Institute of Oncology IRCCS, Milan, Italy
| | - G Curigliano
- European Institute of Oncology IRCCS, Milan, Italy; University of Milano, Milan, Italy
| | - R E Gould
- MD Anderson Cancer Centre, Houston, USA
| | - C Castaneda
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - T D'Alfonso
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Sanchez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - E Cheng
- Department of Radiation Oncology and Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, USA
| | - E Andreopoulou
- Department of Radiation Oncology and Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, USA
| | - M Castillo
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - S Adams
- New York University School of Medicine, New York, USA
| | - S Demaria
- Department of Radiation Oncology and Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, USA
| | | | - S Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, University Paris-Sud, University Paris-Saclay, Villejuif, France
| | - S Loi
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
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Bonanno L, Pavan A, Dieci MV, Di Liso E, Schiavon M, Comacchio G, Attili I, Pasello G, Calabrese F, Rea F, Favaretto A, Rugge M, Guarneri V, Fassan M, Conte PF. The role of immune microenvironment in small-cell lung cancer: Distribution of PD-L1 expression and prognostic role of FOXP3-positive tumour infiltrating lymphocytes. Eur J Cancer 2018; 101:191-200. [PMID: 30077124 DOI: 10.1016/j.ejca.2018.06.023] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [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: 02/08/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The prognosis of small-cell lung cancer (SCLC) is dismal and new effective therapies are needed. Immunotherapy looks promising, but no molecular predictive markers are currently available, and data on immune microenvironment are very limited. METHODS We retrospectively analysed 104 SCLC cases. Immunohistochemistry evaluation of PD-L1 was performed both on tumour cells (TCs) and on tumour-infiltrating immune cells (TIICs) by using anti-PD-L1 22C3 antibody (DAKO) and categorised by using 1% as cut-off point. Tumour-infiltrating lymphocytes (TILs) were characterised by using anti-CD8 and anti-FOXP3 antibodies. Semi-quantitative score was used and categorised as positive versus negative/low. The relation of molecular markers with prognosis and with clinical variables was evaluated. RESULTS The analysis included 66 stage I-III patients (48 surgically resected, 18 treated with radical-intent chemoradiotherapy) and 38 metastatic cases. In the overall study population, PD-L1 was expressed on TCs and TIICs in 25% and 40% of cases, respectively. The proportion of PD-L1-positive cases was significantly higher in stage I-III versus metastatic patients (32% versus 13%, p: 0.034 for TCs; 51.5% versus 21% for TIICs, p: 0.002). CD8- and FOXP3-positive TILs were present in 59% and 72% of samples, respectively. The presence of FOXP3-TILs was associated with improved prognosis among non-metastatic patients, with a hazard ratio for survival of 0.32 (95% confidence interval [CI]: 0.16-0.7, p: 0.006) for univariate analysis, and 0.37 (95% CI: 0.17-0.81, p: 0.013) for multivariate analysis. CONCLUSIONS Immune contexture of SCLC may differ according to stage. The presence of FOXP3-positive TILs is a potential prognostic marker for stage I-III SCLCs and warrants further investigation.
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Affiliation(s)
- L Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.
| | - A Pavan
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, Università Degli Studi di Padova, Padova, Italy
| | - M V Dieci
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, Università Degli Studi di Padova, Padova, Italy
| | - E Di Liso
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - M Schiavon
- Thoracic Surgery, Department of Cardiothoracic and Vascular Sciences, Università Degli Studi di Padova, Padova, Italy
| | - G Comacchio
- Thoracic Surgery, Department of Cardiothoracic and Vascular Sciences, Università Degli Studi di Padova, Padova, Italy
| | - I Attili
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, Università Degli Studi di Padova, Padova, Italy
| | - G Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - F Calabrese
- Pathology, Department of Cardiothoracic and Vascular Sciences, Università Degli Studi di Padova, Padova, Italy
| | - F Rea
- Thoracic Surgery, Department of Cardiothoracic and Vascular Sciences, Università Degli Studi di Padova, Padova, Italy
| | | | - M Rugge
- Department of Medicine (DIMED), Surgical Pathology Unit, Università Degli Studi di Padova, Padova, Italy
| | - V Guarneri
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, Università Degli Studi di Padova, Padova, Italy
| | - M Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, Università Degli Studi di Padova, Padova, Italy
| | - P F Conte
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, Università Degli Studi di Padova, Padova, Italy
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17
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Pascual T, Tanioka M, Dieci MV, Pernas S, Gavila J, Guarnieri V, Cortes J, Llombart A, Conte P, Oliveira M, Paré L, Galván P, Perou CM, Prat A, Carey L. Abstract P2-09-05: Independent validation of the PAM50-based chemo-endocrine score (CES) in hormonal receptor positive (HR+)/HER2+ breast cancer (BC) treated with neoadjuvant (NA) anti-HER2-based therapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-09-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. HER2+/HR+ BC is heterogeneous and subgroups with different treatment sensitivities need to be identified. We previously reported a PAM50-based CES in HR+/HER2-negative BC (Prat et al. CCR 2016). Here, we evaluated the association of CES with pathologic complete response (pCR) following anti-HER2-based therapy in HR+/HER2+ BC across 6 NA studies.
Methods. Intrinsic subtype and clinico-pathological data were obtained from 6 NA clinical studies (CHERLOB, OptiHERHEART[OHH], PAMELA, LPT109096, ICO and CALGB 40601 [CALGB is part of the Alliance for Clinical Trials in Oncology]). All patients (pts) received chemotherapy (CT) and trastuzumab, except for pts in the PAMELA study who did not receive CT. A second anti-HER2 agent (lapatinib or pertuzumab) was included in the NA of all pts in OHH and PAMELA and in one of the treatment arms in CHERLOB, LPT and C40601. CES was evaluated as a continuous variable, and categorically (CES-E[endocrine-sensitive], CES-U[uncertain] and CES-C[chemo-sensitive]) using the previously reported cut-offs. In all studies, except CHERLOB and C40601, ERBB2 mRNA levels were measured using the nCounter platform. pCR in the breast was the endpoint. We first performed statistical analyses in each dataset individually, and then in a dataset with combined patient-level data. Univariate and multivariable logistic regressions analyses were used.
Results. A total of 345 pts were included in the analysis. In the combined cohort, CES-E, CES-U and CES-C were identified in 27.5%, 23.7% and 48.6% of the pts, respectively. Table 1 summarizes the distribution and pCR rates by CES groups. In the combined cohort, CES-C was associated with higher pCR rates compared to CES-U and CES-E independent of tumor size, nodal status, anti-HER2 treatment (single vs. dual HER2 blockade), intrinsic subtype (HER2-enriched [HER2E] versus not) and study (Table 2). In the PAMELA trial (no CT), CES-C was also found associated with higher pCR rates compared to CES-E (31.6% vs. 0%). Concordant with this finding, CES-C tumors showed higher ERBB2 mRNA levels than non-CES-C (P<0.01).
Conclusion. CES shows clinical validity for predicting CT/HER2-targeting sensitivity in HER2+/HR+ BC beyond intrinsic subtype and clinicopathologic characteristics. HER2+/HR+/CES-E tumors, which represent ˜20% of all HER2+ tumors, show low sensitivity to anti-HER2 regimens (with and without CT); other treatment strategies might be needed for this group.
Support: U10CA180882;U10CA180821;U24CA196171;P50-CA58823;BCRF;Komen.
Table 1. Distribution and pCR rates of CES-E, CES-U and CES-C groups across studies.n(%pCR)LPTCHERLOBOHHICOPAMELAC40601TOTALCES-E00/9(0)1/5(20)0/7(0)0/14(0)16/60(27)17/95 (18)CES-U0/1(0)4/15(27)5/7(71)4/13(30)2/25(8)10/21(47)25/82 (30)CES-C20/29(69)12/32(37)22/28(78)15/29(52)12/38(32)3/6(50)84/162(52)P0.330.080.040.03<0.01<0.01<0.01
Table 2. Association of CES, intrinsic subtype, clinicopathologic variables and study with pCR in a multivariable model (including type of study). OR95% CIPCES CES-E1 CES-U2.91.2-7.0<0.01CES-C6.22.3-16.4<0.01T3-4 vs T1-20.40.2-0.90.02N+ vs N00.90.4-1.70.68HER2E vs not2.21.1-4.30.02AntiHER2: 2vs12.90.7-3.20.20
Citation Format: Pascual T, Tanioka M, Dieci MV, Pernas S, Gavila J, Guarnieri V, Cortes J, Llombart A, Conte P, Oliveira M, Paré L, Galván P, Perou CM, Prat A, Carey L. Independent validation of the PAM50-based chemo-endocrine score (CES) in hormonal receptor positive (HR+)/HER2+ breast cancer (BC) treated with neoadjuvant (NA) anti-HER2-based therapy [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 P2-09-05.
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Affiliation(s)
- T Pascual
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - M Tanioka
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - MV Dieci
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - S Pernas
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - J Gavila
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - V Guarnieri
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - J Cortes
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - A Llombart
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - P Conte
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - M Oliveira
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - L Paré
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - P Galván
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - CM Perou
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - A Prat
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
| | - L Carey
- IDIBAPs, Hospital Clínic, Barcelona, Spain; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Padua and Veneto Institute of Oncology IOV-IRCCS, Padua, Spain; Instituto Catalán de Oncología (ICO)-Hospitalet, Barcelona, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Ramon y Cajal University Hospital, Madrid, Spain; Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Arnau de Vilanova, Valencia, Spain; Hospital Universitari Vall d' Hebro, Barcelona, Spain
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Guarneri V, Dieci MV, Bisagni G, Brandes AA, Frassoldati A, Cavanna L, Musolino A, Giotta F, Cavazzini G, Garrone O, Bertone E, Cagossi K, Nanni O, Ferro A, Donadio M, Aieta M, Zamagni C, Piacentini F, Maiorana A, Ragazzi M, Cucchi MC, Querzoli P, Orsi N, Curtarello M, Urso L, Amadori A, Orvieto E, Vicini R, Balduzzi S, D'Amico R, Conte P. Abstract P1-13-02: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- V Guarneri
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - MV Dieci
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - G Bisagni
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - AA Brandes
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Frassoldati
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - L Cavanna
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Musolino
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - F Giotta
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - G Cavazzini
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - O Garrone
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - E Bertone
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - K Cagossi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - O Nanni
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Ferro
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Donadio
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Aieta
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - C Zamagni
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - F Piacentini
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Maiorana
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Ragazzi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - MC Cucchi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - P Querzoli
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - N Orsi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - M Curtarello
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - L Urso
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - A Amadori
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - E Orvieto
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - R Vicini
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - S Balduzzi
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - R D'Amico
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
| | - P Conte
- University of Padova; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy; IRCCS AO S.Maria Nuova, Reggio Emilia, Italy; UOC Medical Oncology, AUSL Bologna, Bologna, Italy; Ferrara University Hospital, Ferrara, Italy; Guglielmo da Saliceto Hospital, Piacenza, Italy; University Hospital of Parma, Parma, Italy; National Cancer Research Centre Giovanni Paolo II, Bari, Italy; Azienda Ospedaliera Carlo Poma, Mantova, Italy; S. Croce and Carle Teaching Hospital, Cuneo, Italy; S.Anna Hospital, Torino, Italy; Ramazzini Hospital, Carpi, Italy; Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy; Santa Chiara Hospital, Trento, Italy; AOU Città della Salute e della Scienza, Torino, Italy; IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; S. Orsola-Malpighi Hospital, Bologna, Italy; Modena University Hospital, Modena, Italy; University of Modena and Reggio Emilia, Modena, Italy; Anatomic Pa
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Griguolo G, Pouderoux S, Dieci MV, Jacot W, Bourgier C, Miglietta F, Firmin N, Conte P, Viala M, Guarneri V, Darlix A. Abstract P1-17-04: Clinical presentation and outcome of leptomeningeal metastasis in patients with breast cancer in relation to histology and tumor subtypes. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-17-04] [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: Among solid tumors, breast cancer (BC) is one of the most common cause of leptomeningeal metastases. Leptomeningeal disease (LMD) typically carries a devastating prognosis; however, disease presentation and prognostic factors are still uncertain. The aim of this study was to characterize clinical features of LMD in relation to BC histology and subtypes.
Patients and Methods:104 patients (pts) with LMD from BC diagnosed between 2002 and 2017 at two European institutions were included. LMD diagnosis was based on the presence of neoplastic cells on cerebrospinal fluid examination and/or radiological evidence of LMD. Patients' characteristics and their associations with time from LMD to death or last follow up were evaluated by the Kaplan-Meier method, log-rank tests, and Cox proportional hazard models.
Results: Median age at LMD diagnosis was 56 yrs (range 26-75). Tumor histology (n=102) was ductal in 72 pts (70.6%), lobular in 22 (21.6%) and other histology in 8 (7.8%, including mixed ductal and lobular tumors). Tumor phenotype distribution was as follows: hormone receptor (HR)+/HER2- 54.8%, triple-negative (TN) 14.4%, HR+/HER2+ 12.5%, HR-/HER2+ 6.7% and unknown 11.5%. LMD diagnosis was cytologically proven (n=64, 62.7%) and/or radiologically proven (n=88, 85.4%). At time of LMD diagnosis, 63 pts (58.9%) had an ECOG performance status (PS) ≤ 2. 91 pts (87.5%) had extra-CNS disease localizations and 20 (18.7%) had a history of known BC brain metastasis (BM) (predating LMD diagnosis of more than 30 days). In lobular BC, LMD diagnosis was more frequently made in the absence of a known history of BM compared with ductal BC (95.5% vs 73.3%, Fisher test p=0.036). A majority of pts was treated with intrathecal (n=59, 55.1%) or systemic treatment (n=73, 68.2%) after LMD diagnosis, while only a minority underwent radiotherapy (n=28, 26.2%) or surgical derivation procedures (n=14, 13%). Median overall survival (OS) from LMD diagnosis was 3.2 months (95% CI, 1.9-4.4 months). No significant difference was observed across tumor phenotypes, with HER2+ subgroups experiencing better outcomes (median OS: 2.9, 1.6, 6.6 and 12.9 months in HR+HER2-, TN, HR+HER2+ and HR-HER2+ subgroups; p=0.54). In univariate analysis, ECOG PS ≤ 2 at LMD diagnosis, intrathecal treatment and systemic treatment after LDM diagnosis were significantly associated with an improved OS (see table). Multivariate analysis showed that only ECOG PS ≤ 2 and systemic treatment after LMD diagnosis were independent factors associated with OS (see table). Updated results on an extended cohort of about 150 patients total will be presented at the meeting.
UnivariateMultivariatePrognostic factorsMedian OS in months (95%CI)HR (95%CI)pHR (95%CI)pECOG PS 0-25.9 (2.1-9.7)0.43 (0.27-0.66)0.0010.64 (0.4-1.0)0.06≥31.7 (1.2-2.3)ref ref Intrathecal treatment Yes5.3 (1.9-8.7)0.65 (0.43-0.98)0.0370.89 (0.57-1.38)0.6No1.9 (0.5-3.3)ref ref Systemic treatment Yes7.3 (4.7-9.8)0.13 (0.08-0.22)<0.0010.16 (0.09-0.29)<0.001No1.0 (0.6-1.3)ref ref
Conclusions: LMD carries a dismal prognosis. The results of this series highlight that patient-related features and treatments (in particular the use of systemic treatment) contribute to modulate the prognosis of BC pts with LMD.
Citation Format: Griguolo G, Pouderoux S, Dieci MV, Jacot W, Bourgier C, Miglietta F, Firmin N, Conte P, Viala M, Guarneri V, Darlix A. Clinical presentation and outcome of leptomeningeal metastasis in patients with breast cancer in relation to histology and tumor subtypes [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-17-04.
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Affiliation(s)
- G Griguolo
- Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Institut Régional du Cancer de Montpellier (ICM), Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - S Pouderoux
- Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Institut Régional du Cancer de Montpellier (ICM), Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - MV Dieci
- Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Institut Régional du Cancer de Montpellier (ICM), Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - W Jacot
- Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Institut Régional du Cancer de Montpellier (ICM), Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - C Bourgier
- Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Institut Régional du Cancer de Montpellier (ICM), Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - F Miglietta
- Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Institut Régional du Cancer de Montpellier (ICM), Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - N Firmin
- Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Institut Régional du Cancer de Montpellier (ICM), Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - P Conte
- Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Institut Régional du Cancer de Montpellier (ICM), Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - M Viala
- Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Institut Régional du Cancer de Montpellier (ICM), Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - V Guarneri
- Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Institut Régional du Cancer de Montpellier (ICM), Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - A Darlix
- Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Institut Régional du Cancer de Montpellier (ICM), Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
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Dieci MV, Frassoldati A, Generali D, Bisagni G, Piacentini F, Cavanna L, Cagossi K, Puglisi F, Michelotti A, Berardi R, Banna G, Goubar A, Ficarra G, Griguolo G, Conte P, Guarneri V. Erratum to: Tumor-infiltrating lymphocytes and molecular response after neoadjuvant therapy for HR+/HER2- breast cancer: results from two prospective trials. Breast Cancer Res Treat 2017; 163:637. [PMID: 28374322 DOI: 10.1007/s10549-017-4219-3] [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: 11/30/2022]
Affiliation(s)
- M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, via Giustiniani 2, 35128, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, via Gattamelata 64, 35128, Padua, Italy
| | - A Frassoldati
- Division of Clinical Oncology, S. Anna University Hospital, via Moro 8, 44100, Cona, Ferrara, Italy
| | - D Generali
- Breast UnitASST Cremona, viale Concordia 1, 26100, Cremona, Italy.,Department of Medical, Surgery & Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy
| | - G Bisagni
- Division of Medical Oncology, Azienda Ospedaliera ASMN, IRCSS, Viale Umberto I 50, 42123, Reggio Emilia, Italy
| | - F Piacentini
- Department of Medical and Surgical Sciences of Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy.,Division of Medical Oncology, Modena University Hospital, via del Pozzo 71, 41124, Modena, Italy
| | - L Cavanna
- Division of Oncology, "Guglielmo da Saliceto" Hospital, via Taverna 49, 29121, Piacenza, Italy
| | - K Cagossi
- Division of Medical Oncology, "B.Ramazzini" Hospital, Via Molinari 2, 41012, Carpi, Italy
| | - F Puglisi
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy.,Department of Oncology, University Hospital of Udine, Piazzale Santa Maria della Misericordia 15, 33010, Udine, Italy
| | - A Michelotti
- UO Oncologia Medica I, Azienda Ospedaliera Universitaria Pisana, Santa Chiara Hospital, via Roma 67, 56126, Pisa, Italy
| | - R Berardi
- Division of Medical Oncology, Università Politecnica delle Marche, Ospedali Riuniti Umberto I, via Conca 71, 60126, Ancona, Italy
| | - G Banna
- Division of Medical Oncology, Cannizzaro Hospital, via Messina 829, 95126, Catania, Italy
| | - A Goubar
- ICR Clinical Trials and Statistics Unit, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - G Ficarra
- Division of Pathology, Modena University Hospital, via del Pozzo 71, 41124, Modena, Italy
| | - G Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, via Giustiniani 2, 35128, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, via Gattamelata 64, 35128, Padua, Italy
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, via Giustiniani 2, 35128, Padua, Italy. .,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, via Gattamelata 64, 35128, Padua, Italy.
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, via Giustiniani 2, 35128, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, via Gattamelata 64, 35128, Padua, Italy
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21
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Dieci MV, Frassoldati A, Generali D, Bisagni G, Piacentini F, Cavanna L, Cagossi K, Puglisi F, Michelotti A, Berardi R, Banna G, Goubar A, Ficarra G, Griguolo G, Conte P, Guarneri V. Tumor-infiltrating lymphocytes and molecular response after neoadjuvant therapy for HR+/HER2- breast cancer: results from two prospective trials. Breast Cancer Res Treat 2017; 163:295-302. [PMID: 28289852 DOI: 10.1007/s10549-017-4191-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/31/2016] [Accepted: 03/07/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim was to evaluate the role of tumor-infiltrating lymphocytes (TIL) in predicting molecular response after preoperative endocrine or cytotoxic treatment for HR+/HER2- patients who do not achieve a pathological complete response. METHODS Stromal (Str) TIL were centrally evaluated on samples from diagnostic core-biopsies of HR+/HER2- patients included in two prospective randomized trials: the LETLOB trial (neoadjuvant endocrine-based treatment) and the GIOB trial (neoadjuvant chemotherapy-based treatment). Pre- and post-treatment Ki67 was centrally assessed. RESULTS StrTIL were evaluable in 111 cases (n = 73 from the LETLOB trial and n = 38 from the GIOB trial). Median StrTIL was 2%. Patients with high StrTIL (StrTIL ≥10%, n = 28) had more frequently breast cancer of ductal histology (p = 0.02), high grade (p = 0.049), and high Ki67 (p = 0.02). After neoadjuvant endocrine treatment (LETLOB cohort), a significant Ki67 suppression (p < 0.01) from pre- to post-treatment was observed in both the low and high StrTIL groups. High StrTIL patients achieve more frequently a relative Ki67 suppression ≥50% from baseline as compared to low StrTIL patients (55 vs. 35%, p non significant). After neoadjuvant chemotherapy (GIOB cohort), a significant Ki67 suppression was observed only for low StrTIL patients (Wilcoxon p = 0.001) and not in the high StrTIL group (p = 0.612). In this cohort, the rate of patients achieving a relative Ki67 suppression ≥50% from baseline was significantly higher in the low vs high StrTIL group (64% vs 10%, p = 0.003). Geometric mean Ki67 suppression was evaluated in each cohort according to StrTIL: the lowest value (-41%) was observed for high StrTIL cases treated with chemotherapy. CONCLUSIONS This hypothesis-generating study suggests that in HR+/HER2- breast cancer StrTIL at baseline may influence the achievement of a molecular response after neoadjuvant treatment. Further evaluation in large studies is needed, and interaction with the type of treatment warrants to be explored.
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Affiliation(s)
- M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, via Giustiniani 2, 35128, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, via Gattamelata 64, 35128, Padua, Italy
| | - A Frassoldati
- Division of Clinical Oncology, S. Anna University Hospital, via Moro 8, 44100, Cona, Ferrara, Italy
| | - D Generali
- Breast UnitASST Cremona, viale Concordia 1, 26100, Cremona, Italy.,Department of Medical, Surgery & Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy
| | - G Bisagni
- Division of Medical Oncology, Azienda Ospedaliera ASMN, IRCSS, Viale Umberto I 50, 42123, Reggio Emilia, Italy
| | - F Piacentini
- Department of Medical and Surgical Sciences of Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy.,Division of Medical Oncology, Modena University Hospital, via del Pozzo 71, 41124, Modena, Italy
| | - L Cavanna
- Division of Oncology, "Guglielmo da Saliceto" Hospital, via Taverna 49, 29121, Piacenza, Italy
| | - K Cagossi
- Division of Medical Oncology, "B.Ramazzini" Hospital, Via Molinari 2, 41012, Carpi, Italy
| | - F Puglisi
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy.,Department of Oncology, University Hospital of Udine, Piazzale Santa Maria della Misericordia 15, 33010, Udine, Italy.,UO Oncologia Medica I, Azienda Ospedaliera Universitaria Pisana, Santa Chiara Hospital, via Roma 67, 56126, Pisa, Italy
| | - A Michelotti
- Division of Medical Oncology, Università Politecnica delle Marche, Ospedali Riuniti Umberto I, via Conca 71, 60126, Ancona, Italy
| | - R Berardi
- Division of Medical Oncology, Università Politecnica delle Marche, Ospedali Riuniti Umberto I, via Conca 71, 60126, Ancona, Italy
| | - G Banna
- Division of Medical Oncology, Cannizzaro Hospital, via Messina 829, 95126, Catania, Italy
| | - A Goubar
- ICR Clinical Trials and Statistics Unit, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - G Ficarra
- Division of Pathology, Modena University Hospital, via del Pozzo 71, 41124, Modena, Italy
| | - G Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, via Giustiniani 2, 35128, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, via Gattamelata 64, 35128, Padua, Italy
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, via Giustiniani 2, 35128, Padua, Italy. .,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, via Gattamelata 64, 35128, Padua, Italy.
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, via Giustiniani 2, 35128, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, via Gattamelata 64, 35128, Padua, Italy
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Dieci MV, Giaratano T, Miglietta F, Griguolo G, Orvieto E, Falci C, Giorgi CA, Mioranza E, Tasca G, Cappellesso R, Ghiotto C, Conte P, Guarneri V. Abstract P2-05-20: Tumor infiltrating lymphocytes in recurrent HER2+ and triple negative breast cancer: Prognostic value according to tumor phenotype. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Tumor infiltrating lymphocytes (TILs) have emerged as a prognostic and potential predictive factor in early triple negative (TN) and HER2+ breast cancer (BC). The prognostic role of TILs in advanced disease is largely unknown.
Methods: 109 HER2+ and TNBC patients with available tumor tissue from regional/distant BC recurrence (collected between 2001 and 2015) were identified from a prospectively maintained database at the Istituto Oncologico Veneto of Padova (Italy). Ipsilateral in-breast relapse/second primaries and contralateral BC were excluded from the definition of recurrence. StrTILs were assessed according to consensus guidelines (Salgado, 2014) on hematoxylin and eosin stained slides from BC recurrence samples and, when available, matched primaries. Post-progression survival was calculated as the time from first BC recurrence to last follow up or death.
Results: StrTILs were evaluable on recurrent BC for 72 cases (HER2+ n=43, TN n=29), after exclusion of lymphnode metastases. Median time to recurrence from initial BC diagnosis was longer for HER2+ than TN cases: 37 months (95%CI 23-51) and 18 months (95%CI 13-23), respectively. Accordingly, median time to biopsy of recurrence from initial BC diagnosis was 43 months (95%CI 35-51) for HER2+ patients and 20 months (95%CI 9-31) for TN patients. Site of biopsy was visceral metastasis in 54% and soft tissue metastasis in 46% of cases (similar for HER2+ and TN).
Median StrTILs level on recurrence was 5% (Q1 2,5%, Q3 10%), without differences according to TN or HER2+ phenotype (Student's t-test p=0.5).
In the whole cohort, post-progression survival did not differ for patients with high (>10%) vs low (<10%) StrTILs on recurrence (HR 0.83 95% CI 0.38-1.80, p=0.64).
In the TN subgroup, high StrTILs on recurrence were associated to a better post-progression survival (median not reached vs 12.7 months for StrTILs >10% and <10%, respectively, HR 0.03 95%CI 0.00-3.64, log-rank p=0.019). To the opposite, in the HER2+ subgroup, high StrTILs were associated to worse post-progression survival compared to low StrTILs (median 27.7 vs 41.1 months for high vs low StrTILs, HR 2.93 95%CI 1.17-7.31, log-rank p=0.016). Test for interaction between tumor phenotype and StrTILs was p=0.15. Similar results were obtained when including only those patients maintaining a concordant TN or HER2+ phenotype on both primary tumor and recurrence (n=59).
StrTILs were assessed on matched primary tumors for 43 patients. Overall, no significant StrTILs variation between primary tumor and recurrence was observed (mean change -4.5%, Wilcoxon p=0.5). Mean change was -2.5% and -7% in HER2+ and TN cases (Wilcoxon p=0.63 and p=0.15, respectively). For TN patients with StrTILs <10% on recurrence, a significant reduction from the primary tumor was observed (mean StrTILs 16% and 4% on primary and recurrent BC, respectively, Wilcoxon p 0.008).
Conclusions: Levels of StrTILs on recurrent BC seem to have an opposite effect on prognosis of metastatic BC patients according to tumor phenotype. Immunohistochemical characterization of TILs is ongoing, data will be available for the meeting.
Citation Format: Dieci MV, Giaratano T, Miglietta F, Griguolo G, Orvieto E, Falci C, Giorgi CA, Mioranza E, Tasca G, Cappellesso R, Ghiotto C, Conte P, Guarneri V. Tumor infiltrating lymphocytes in recurrent HER2+ and triple negative breast cancer: Prognostic value according to tumor phenotype [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-20.
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Affiliation(s)
- MV Dieci
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - T Giaratano
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - F Miglietta
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - G Griguolo
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - E Orvieto
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - C Falci
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - CA Giorgi
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - E Mioranza
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - G Tasca
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - R Cappellesso
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - C Ghiotto
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - P Conte
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
| | - V Guarneri
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; University of Padova, Padova, Italy; Azienda Ospedaliera di Padova, Padova, Italy
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Griguolo G, Dieci MV, Giarratano T, Giorgi CA, Orvieto E, Ghiotto C, Falci C, Mioranza E, Tasca G, Milite N, Miglietta F, Conte P, Guarneri V. Abstract P1-12-06: Factors related to the prognosis of breast cancer patients after the development of brain metastases. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-12-06] [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
Background: Brain metastases (BM) are a serious relatively common complication of breast cancer (BC). We evaluated prognostic factors for survival after diagnosis of BM from BC in a contemporary cohort of pts.
Methods:Pts diagnosed with BM from BC between 1999 and march 2016 and treated at the Istituto Oncologico Veneto of Padua were evaluated. Overall survival (OS) was defined as time from BM diagnosis to death or last follow-up. Pts were classified in 4 categories according to the breast cancer-specific Graded Prognostic Assessment (GPA) index according to validated criteria (Sperduto et al, 2012), based on age, Karnofsky Performance Status (KPS) and BC phenotype. Cox proportional models were used to calculate HR and 95% CI.
Results: 199 pts were identified. Median age at BM diagnosis was 56 yrs (range 28-84). Tumor phenotype distribution was as follows: triple negative (TN, 20.1%), hormone receptor (HR)-HER2+ (16.8%), HR+HER2+ (24.0%) and HR+HER2- (39.1%). Median time to BM diagnosis was 48.9 months (range 0-327), with significant differences according to tumor phenotype (median 27.3, 31.8, 46.1 and 55.2 months in TN, HR-HER2+, HR+HER2+, HR+HER2-, respectively, p=0.009). With respect to OS, no significant difference was observed across tumor phenotypes, with TN patients experiencing the worse outcome (median: 4.7, 7.7, 11.0 and 6.2 months in TN, HR-HER2+, HR+HER2+, HR+HER2-, p=0.187). The breast-specific GPA index, which combines tumor phenotype with patient-related features, was significantly associated with OS (Table). The number of local treatment received (radiotherapy, either whole brain or stereotactic, or neurosurgery) and the administration of systemic treatment after BM diagnosis were significantly associated with better OS (Table). Patients in the less favorable GPA category (GPA index <1) were less likely to receive systemic treatment after BM diagnosis compared to other GPA categories (43% vs 71%, p=0.009); no association between GPA category and local treatment was observed. Patients undergoing increased lines of local treatments where more likely to receive systemic therapy (chi2 square test p<0.001). To avoid bias we performed two separate multivariate analyses including: i) GPA category and number of local treatments; ii) GPA category (patients with GPA index <1 excluded) and systemic treatment. GPA maintained a significant prognostic value in both models (p=0.002 and p=0.038, respectively). Both local and systemic treatments added independent prognostication beyond GPA (Table).
Prognostic factorsMedian OS, months (95%CI)HR (95%CI), univariatep, univariateHR (95%CI), corrected for GPAGPA category 3.5-418.8 (15.2-22.5)ref -2.5-38.8 (3.8-13.8)1.40 (0.80-2.43) -1.5-25.5 (3.5-7.5)1.76 (1.00-3.10) -0-1.02.7 (1.2-4.3)2.67 (1.35-5.28)0.019-Number of local tretaments received 03.0 (1.8-7.5)ref ref18.0 (5.8-10.3)0.53 (0.38-0.74) 0.54 (0.38-0.78)221.3 (15.2-27.3)0.36 (0.20-0.65) 0.49 (0.26-0.93)335.5 (33.5-37.6)0.12 (0.04-0.38)<0.0010.08 (0.02-0.33)Systemic treatment yes13.1 (8.7-17.4) no2.6 (1.3-3.8)0.42 (0.30-0.58)<0.0010.46 (0.31-0.68)
Conclusions: Patient-related features, tumor phenotype and multimodal treatments all independently contribute to modulate the prognosis of pts with BM from BC.
Citation Format: Griguolo G, Dieci MV, Giarratano T, Giorgi CA, Orvieto E, Ghiotto C, Falci C, Mioranza E, Tasca G, Milite N, Miglietta F, Conte P, Guarneri V. Factors related to the prognosis of breast cancer patients after the development of brain metastases [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-12-06.
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Affiliation(s)
- G Griguolo
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - MV Dieci
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - T Giarratano
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - CA Giorgi
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - E Orvieto
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - C Ghiotto
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - C Falci
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - E Mioranza
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - G Tasca
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - N Milite
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - F Miglietta
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - P Conte
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
| | - V Guarneri
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova; University of Padova, Padova; Azienda Ospedaliera di Padova, Padova
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Musolino A, Naldi N, Dieci MV, Zanoni D, Rimanti A, Boggiani D, Sgargi P, Generali DG, Piacentini F, Ambroggi M, Cagossi K, Gianni L, Sarti S, Bisagni G, Ardizzoni A, Conte PF, Guarneri V. Immunoglobulin G fragment C receptor polymorphisms and efficacy of preoperative chemotherapy plus trastuzumab and lapatinib in HER2-positive breast cancer. Pharmacogenomics J 2016; 16:472-7. [PMID: 27378608 DOI: 10.1038/tpj.2016.51] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 11/09/2022]
Abstract
Lapatinib enhances antibody-dependent cell-mediated cytotoxicity (ADCC) activity of trastuzumab. FcγR polymorphisms have been associated with both ADCC and clinical activity of trastuzumab in HER2+ breast cancer (BC) patients (pts). We analyzed FcγRIIa-H131R and FcγRIIIa-V158F polymorphisms in the CHER-LOB trial population of HER2+ BCs treated with preoperative chemotherapy plus trastuzumab (arm A), lapatinib (arm B) or both (arm C). Genotyping was successfully performed in 73/121 (60%) pts. A significant improvement in pathological complete response (pCR) rate was observed for the combination arm C, but only in FcγRIIIa V allele carriers (C vs A, 67 vs 27%, P=0.043; C vs B, 67 vs 22%, P=0.012). An independent interaction between arm C and FcγRIIIa V allele was found for pCR (odds ratio=9.4; 95% confidence interval, 2.3-39.6; P=0.003). No significant associations were observed between pCR and FcγRIIa polymorphism, and between pre-treatment tumor-infiltrating lymphocytes and FcγR polymorphisms. Our study provides evidence for a FcγRIIIa V allele-restricted pCR benefit from neoadjuvant trastuzumab plus lapatinib in HER2+ BC.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - N Naldi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - M V Dieci
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - D Zanoni
- Department of Oncology, Guastalla Hospital, Guastalla, Italy
| | - A Rimanti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - D Boggiani
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - P Sgargi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - D G Generali
- U.O. Multidisciplinare di Patologia Mammaria, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy
| | - F Piacentini
- Medical Oncology Unit, Modena University Hospital, Modena, Italy
| | - M Ambroggi
- Medical Oncology Unit, Hospital of Piacenza, Piacenza, Italy
| | - K Cagossi
- Medical Oncology Unit, Ramazzini Hospital, Carpi, Italy
| | - L Gianni
- Medical Oncology Unit, Ospedale Infermi, Rimini, Italy
| | - S Sarti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - G Bisagni
- Medical Oncology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - A Ardizzoni
- Division of Oncology, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - P F Conte
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - V Guarneri
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
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25
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Loi S, Drubay D, Adams S, Francis PA, Joensuu H, Dieci MV, Badve S, Demaria S, Gray R, Piccart MJ, Kellokumpa-Lehtinen PL, Andre F, Dufaure-Gare I, Denkert C, Salgado R, Michiels S. Abstract S1-03: Pooled individual patient data analysis of stromal tumor infiltrating lymphocytes in primary triple negative breast cancer treated with anthracycline-based chemotherapy. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s1-03] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Retrospective analyses from individual clinical trials have suggested that host anti-tumor immunity as measured by stromal tumor infiltrating lymphocytes (TILs) is important for the outcomes of the primary triple negative breast cancer (TNBC) subgroup, but the clinical utility of TILs in day-to-day management of primary TNBC is still limited. Our objective was to conduct a pooled analysis of the clinical trials that have investigated TILs in TNBC patients treated by anthracyclines-based (A) chemotherapy regimens in order to gain a robust understanding of the prognostic value of TILs in this setting.
Material and methods:
Methods were predefined in a protocol. Eligible studies were randomized clinical trials that have evaluated the prognostic associations of TILs (evaluated in the same manner) in patients diagnosed with early stage TNBC treated with A or A plus taxanes (A+T). Cox regression models stratified by trial for invasive disease-free survival (IDFS, primary endpoint) and overall survival (OS), fitting stromal TILs as a continuous variable.
Results:
We collected individual data from 991 TNBC patients included in 6 randomized clinical trials (ECOG2197, ECOG1199, BIG2-98, FinHER, 2 from Gustave Roussy): 62% of patients were treated by A+T and 38% by A alone; 32% of patients had no nodal involvement, 43% of patients had 1-3 nodes and 25% patients more than 3 nodes involved. The average age was 49 years (range 22.6-85 yrs) and the average tumor size 3.0 cm (sd 1.7).
Across the entire data set, the average value of stromal TILs was 20% (sd 17%); 90% of patients had at least 1% stromal TILs. After adjusting for trial, stromal TILs were significantly lower with increasing tumor size (linear model, p<0.0001) but not significantly associated with nodal status categories (p=0.52 and p=0.37) nor age (p=0.25). With a median follow-up of 6.6 years for IDFS and 7.3 years for OS, a total of 363 IDFS events and 273 deaths were observed. Each 10% increase in stromal TILs was associated with a 14% relative reduction in IDFS events (HR=0.86, 95% 0.80 to 0.93, p<0.0001) and a 17% relative reduction in deaths (HR=0.83, 95% CI 0.76 to 0.91, p=0.0001). There was no significant evidence for heterogeneity between trials for IDFS (chi2=4.55, p=0.34) nor for OS (chi2=4.45, p=0.34).
In a multivariable analysis adjusted for age, nodal status, tumor size and chemotherapy regimen, stromal TILs added significant independent prognostic information for both IDFS and OS (likelihood chi2=17.9 for IDFS, p<0.0001 and chi2=16.7 for OS, p<0.0001). The adjusted hazard ratio for each 10% increase in stromal TILs was HR=0.86 (0.76-0.92) for IDFS events and HR=0.84 (0.76-0.92) for death.
Conclusion:
This large pooled individual patient data analysis confirms the strong prognostic role of stromal TILS in primary TNBC treated with A or A+T. TILs should now be strongly considered for incorporation as a stratification factor in future clinical trials enrolling TNBC patients. Given the important prognostic role of pre-existing immunity, patients with TNBC are rational candidates for immunotherapy clinical trials.
Funding:Ligue Nationale Contre le Cancer.
Citation Format: Loi S, Drubay D, Adams S, Francis PA, Joensuu H, Dieci MV, Badve S, Demaria S, Gray R, Piccart MJ, Kellokumpa-Lehtinen P-L, Andre F, Dufaure-Gare I, Denkert C, Salgado R, Michiels S. Pooled individual patient data analysis of stromal tumor infiltrating lymphocytes in primary triple negative breast cancer treated with anthracycline-based chemotherapy. [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 S1-03.
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Affiliation(s)
- S Loi
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - D Drubay
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - S Adams
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - PA Francis
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - H Joensuu
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - MV Dieci
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - S Badve
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - S Demaria
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - R Gray
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - MJ Piccart
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - P-L Kellokumpa-Lehtinen
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - F Andre
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - I Dufaure-Gare
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - C Denkert
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - R Salgado
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
| | - S Michiels
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; Gustave Roussy, Villejuif, France; New York University School of Medicine, NY; Helsinki University Central Hospital, Helsinki, Finland; University of Padova, Padova, Italy; Indiana University, Indianapolis, IN; Dana-Farber Cancer Institute, Boston, MA; Institut Jules Bordet, Brussels, Belgium; Tampere University Hospital, Tampere, Finland; Charite Universite Hospital, Berlin, Germany
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Dieci MV, Criscitiello C, Goubar A, Viale G, Conte P, Guarneri V, Ficarra G, Mathieu MC, Delaloge S, Curigliano G, Andre F. Prognostic value of tumor-infiltrating lymphocytes on residual disease after primary chemotherapy for triple-negative breast cancer: a retrospective multicenter study. Ann Oncol 2015; 26:1518. [PMID: 26109735 DOI: 10.1093/annonc/mdv241] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M V Dieci
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France Department of Oncological and Surgical Sciences, University of Padua, Padua Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - C Criscitiello
- Early Drug Development for Innovative Therapies Division, Department of Medicine, Istituto Europeo di Oncologia, Milano
| | - A Goubar
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France
| | - G Viale
- Department of Pathology, Istituto Europeo di Oncologia, Milano Faculty of Medicine, University of Milan, Milano
| | - P Conte
- Department of Oncological and Surgical Sciences, University of Padua, Padua Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - V Guarneri
- Department of Oncological and Surgical Sciences, University of Padua, Padua Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - G Ficarra
- Division of Pathology, Modena University Hospital, Modena, Italy
| | - M C Mathieu
- Departments of Medical Biology and Pathology
| | - S Delaloge
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France Medical Oncology, Institut Gustave Roussy, Villejuif
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Department of Medicine, Istituto Europeo di Oncologia, Milano
| | - F Andre
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France Medical Oncology, Institut Gustave Roussy, Villejuif Faculty of Medicine, Paris Sud University, Kremlin-Bicêtre, France
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Dieci MV, Mathieu MC, Guarneri V, Conte P, Delaloge S, Andre F, Goubar A. Prognostic and predictive value of tumor-infiltrating lymphocytes in two phase III randomized adjuvant breast cancer trials. Ann Oncol 2015; 26:1698-704. [PMID: 25995301 DOI: 10.1093/annonc/mdv239] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [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: 01/19/2015] [Accepted: 05/12/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Tumor-infiltrating lymphocytes (TILs) are emerging as strong prognostic factor for early breast cancer patients, especially in the triple-negative subtype. Here, we aim to validate previous findings on the prognostic role of TIL in the context of two randomized adjuvant trials and to investigate whether lymphocyte infiltrates can predict benefit from adjuvant anthracyclines. PATIENTS AND METHODS A total of 816 patients enrolled and treated at the Gustave Roussy in the context of two multicentric randomized trials comparing adjuvant anthracyclines versus no chemotherapy were included in the present analysis. Primary end point was overall survival (OS). Hematoxilin and eosin slides of primary tumors were retrieved and evaluated for the percentage of intratumoral (It) and stromal (Str) TIL. Each case was also defined as high-TIL or low-TIL breast cancer adopting previously validated cutoffs. RESULTS TIL were assessable for 781 of 816 cases. High-TIL cases were more likely grade 3 and estrogen receptor (ER)-negative (P < 0.001). In multivariate analysis, both continuous It-TIL and Str-TIL were strong prognostic factors for OS [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77-0.95 P = 0.003; HR 0.89, 95% CI 0.81-0.96, P = 0.005 for It-TIL and Str-TIL, respectively]. The prognostic effect of continuous TIL was limited to triple-negative and HER2-positive patients. Ten-year OS rates were: 89% and 68% for triple-negative high-TIL and low-TIL, respectively (HR 0.44, 95% CI 0.18-1.10, P = 0.07) and 78% and 57% for HER2-positive high-TIL versus low-TIL, respectively (HR 0.46, 95% CI 0.20-1.11, P = 0.08). Either continuous or binary TIL variables did not predict for the efficacy of anthracyclines. Test for interaction P value was not significant in the whole study population and in subgroups (ER+/HER2-, HER2+, ER-/HER2-). CONCLUSIONS We confirmed the prognostic role of TIL in triple-negative early breast cancer and suggested a prognostic impact in HER2+ patients as well. Basing on our data, TIL should not be used as a parameter to select patients for anthracyclines chemotherapy.
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Affiliation(s)
- M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - M C Mathieu
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - S Delaloge
- INSERM, Unit U981, Gustave Roussy, Villejuif Department of Medical Oncology, Gustave Roussy, Villejuif
| | - F Andre
- INSERM, Unit U981, Gustave Roussy, Villejuif Department of Medical Oncology, Gustave Roussy, Villejuif Université Paris Sud, Villejuif, France
| | - A Goubar
- INSERM, Unit U981, Gustave Roussy, Villejuif
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Dieci MV, Criscitiello C, Goubar A, Viale G, Conte P, Guarneri V, Ficarra G, Mathieu MC, Delaloge S, Curigliano G, Andre F. Prognostic value of tumor-infiltrating lymphocytes on residual disease after primary chemotherapy for triple-negative breast cancer: a retrospective multicenter study. Ann Oncol 2014; 25:611-618. [PMID: 24401929 PMCID: PMC3933248 DOI: 10.1093/annonc/mdt556] [Citation(s) in RCA: 309] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/09/2013] [Accepted: 11/18/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is a need to develop surrogates for treatment efficacy in the neoadjuvant setting to speed-up drug development and stratify patients according to outcome. Preclinical studies showed that chemotherapy induces an antitumor immune response. In order to develop new surrogates for drug efficacy, we assessed the prognostic value of tumor-infiltrating lymphocytes (TIL) on residual disease after neoadjuvant chemotherapy (NACT) in patients with triple-negative breast cancer (TNBC). PATIENTS AND METHODS Three hundred four TNBC patients with residual disease after NACT were retrospectively identified in three different hospitals. Hematoxylin and eosin-stained slides from surgical postchemotherapy specimens were evaluated for intratumoral (It-TIL) and stromal (Str-TIL) TIL. Cases were classified as High-TIL if It-TIL and/or Str-TIL >60%. RESULTS TIL were assessable for 278 cases. Continuous It-TIL and Str-TIL variables were strong prognostic factors in the multivariate model, both for metastasis-free [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.77-0.96, P = 0.01 and HR 0.85, 95% CI 0.75-0.98, P = 0.02 for Str-TIL and It-TIL, respectively] and overall survival (HR 0.86, 95% CI 0.77-0.97, P = 0.01 and HR 0.86, 95% CI 0.75-0.99, P = 0.03 for Str-TIL and It-TIL, respectively). The 5-year overall survival rate was 91% (95% CI 68% to 97%) for High-TIL patients (n = 27) and 55% (95% CI 48% to 61%) for Low-TIL patients (HR 0.19, 95% CI 0.06-0.61, log-rank P = 0.0017). The major prognostic impact of TIL was seen for patients with large tumor burden following NACT (residual tumor >2 cm and/or node metastasis). In all but one High-TIL case, It-TIL and Str-TIL values were lower on the prechemotherapy sample. CONCLUSIONS The presence of TIL in residual disease after NACT is associated with better prognosis in TNBC patients. This parameter may represent a new surrogate of drug efficacy to test investigational agents in the neoadjuvant setting and a new prognostic marker to select patients at high risk of relapse.
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Affiliation(s)
- M V Dieci
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France; Department of Oncological and Surgical Sciences, University of Padua, Padua; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - C Criscitiello
- Early Drug Development for Innovative Therapies Division, Department of Medicine, Istituto Europeo di Oncologia, Milano
| | - A Goubar
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France
| | - G Viale
- Department of Pathology, Istituto Europeo di Oncologia, Milano; Faculty of Medicine, University of Milan, Milano
| | - P Conte
- Department of Oncological and Surgical Sciences, University of Padua, Padua; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - V Guarneri
- Department of Oncological and Surgical Sciences, University of Padua, Padua; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - G Ficarra
- Division of Pathology, Modena University Hospital, Modena, Italy
| | - M C Mathieu
- Departments of Medical Biology and Pathology
| | - S Delaloge
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France; Medical Oncology, Institut Gustave Roussy, Villejuif
| | - G Curigliano
- Department of Oncological and Surgical Sciences, University of Padua, Padua; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - F Andre
- INSERM Unit U981, Institut Gustave Roussy, Villejuif, France; Medical Oncology, Institut Gustave Roussy, Villejuif; Faculty of Medicine, Paris Sud University, Kremlin-Bicêtre, France.
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Guarneri V, Boni C, Puglisi F, Cagossi K, Piacentini F, Bisagni G, Dieci MV, Barbieri E, Vicini R, Conte P. Abstract P4-14-03: Preoperative carboplatin-paclitaxel-bevacizumab in triple negative breast cancer: Final results of the phase II CA.Pa.Be study. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-14-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Management of triple negative breast cancer (TNBC) is still a major challenge: a significant proportion patients relapse despite adjuvant chemotherapy, and the median survival from relapse rarely exceeds 1 year. Angiogenesis activation as well as impairment in mechanisms of DNA repair are frequently described in sporadic TNBCs, but the role of angiogenesis inhibitors and platinum salts is still controversial. This is a phase II trial of preoperative carboplatin-paclitaxel in combination with bevacizumab in TNBC patients with previously untreated, stage II-III disease. The primary aim of the study is the pathologic complete response (pCR) rate. Among the secondary aims: safety, breast conserving surgery rate, early response assessment with dynamic contrast-enhanced Magnetic Resonance Imaging (DCE-MRI), biomarker analyses.
Methods: Patients with hormone receptor negative (ER and PgR <1%), HER2 negative stage II-III breast cancer are eligible. At baseline, patients undergo breast DCE-MRI, followed by a single dose of bevacizumab 5 mg/kg (day -7). DCE-MRI is repeated prior to start chemotherapy (CT). On day 1, patients start CT with paclitaxel 80 mg/sqm+carboplatin AUC2 on days 1,8, 15 q 28, combined with bevacizumab 10 mg/kg on days 1 and 15. Patients received 5 preoperative cycles and undergo surgery within 6 weeks from the last CT course. Bevacizumab is omitted on cycle 5, to minimize the risk of surgical complications. Tissue samples are centralized to evaluate treatment effect on several tissue markers, as well as to identify potential predictors of treatment benefit. The sample size is estimated with the two-stage Simon's design, on the basis of a 40% expected pCR rate. A total of 43 patients are required, with the combination deemed worthwhile in case of at least 13 pCRs.
Results: the accrual of the 44 planned patients is completed. Patients characteristics were as follows:
median age 46 yrs (29-74); clinical stage IIA: 38.2%, IIB: 35.3%, III: 26.5%; ductal histology: 89%; histologic grade 3: 95%. Notably, 59% of the patients had clinically involved axillary nodes. At present, 33 patients are assessable for toxicity. Bevacizumab-associated adverse events (AEs) were mild: grade 1-2 hypertension occurred in 3 patients (9%) and grade 1 bleeding in 9 patients (27%). No grade 4 non-hematologic AEs were recorded; Grade 3 AEs were: liver function tests abnormalities in 3 patients, diarrhea in 3 patients, and neuropathy in 1 patient. Thirty-one patients underwent surgery, 16 patients (51%) received breast conserving surgery. A pCR in breast and axillary lymph-nodes was achieved in 16 patients (51%); 25 patients (81%) had negative axillary nodes (yN0).
Conclusions: No unexpected toxicity was observed by combining bevacizumab to neoadjuvant platinum-taxane based CT. This combination is active in TNBCs, and the rate of pCR is in the expected range. Moreover, 80% of the patients have nodal negativity at surgery, and these results are of particular interest taking into account the high proportion of patients with clinically involved nodes at the time of diagnosis. The final results along with biomarkers data and early response assessment with DCE-MRI will be available at the time of the meeting.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-14-03.
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Affiliation(s)
- V Guarneri
- University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy; Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy; University of Udine, Udine, Italy; Ramazzini Hospital, Carpi, Italy
| | - C Boni
- University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy; Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy; University of Udine, Udine, Italy; Ramazzini Hospital, Carpi, Italy
| | - F Puglisi
- University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy; Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy; University of Udine, Udine, Italy; Ramazzini Hospital, Carpi, Italy
| | - K Cagossi
- University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy; Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy; University of Udine, Udine, Italy; Ramazzini Hospital, Carpi, Italy
| | - F Piacentini
- University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy; Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy; University of Udine, Udine, Italy; Ramazzini Hospital, Carpi, Italy
| | - G Bisagni
- University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy; Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy; University of Udine, Udine, Italy; Ramazzini Hospital, Carpi, Italy
| | - MV Dieci
- University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy; Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy; University of Udine, Udine, Italy; Ramazzini Hospital, Carpi, Italy
| | - E Barbieri
- University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy; Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy; University of Udine, Udine, Italy; Ramazzini Hospital, Carpi, Italy
| | - R Vicini
- University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy; Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy; University of Udine, Udine, Italy; Ramazzini Hospital, Carpi, Italy
| | - P Conte
- University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy; Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy; University of Udine, Udine, Italy; Ramazzini Hospital, Carpi, Italy
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Dieci MV, Lefebvre C, Viehl P, Mathieu MC, Laporte M, Scott V, Marty V, Drusch F, Guarneri V, Conte P, Lacroix L, Delaloge S, André F. Abstract PD4-4: Whole exome sequencing of aggressive rare breast cancers histologic subtypes reveals novel pathway for breast cancer progression. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-pd4-4] [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: Rare cancers sometimes present clonal evolution. Genomic characterisation of these rare entities could lead to identify new genes involved in the progression of more frequent cancers. In the present study, we have performed whole exome sequencing of three rare and aggressive histological subtypes in order to identify new targets that could subsequently be validated in common breast cancers.
Methods: Whole exome sequencing was applied in ten pleiomorphic lobular carcinoma, seven micropapillary BC and eight metaplastic BC. Each cancer sample was matched with normal DNA from the same patient. Overall 50 samples were therefore sequenced. Tumor samples were selected to present >30% cancer cells. Histological diagnosis was confirmed by a BC pathologist. Whole exome sequencing (WES) was performed by BGI (Bejing Genomic Institute, Hong-Kong, China) using the Illumina Hiseq2000 platform (90bp paired-end reads, depth ≥80x). Genes recurrently mutated (with somatic mutations in >2 cases) were selected for validation. The validation by IonTorrent target sequencing was performed on additional formalin-fixed paraffin-embedded (FFPE) tumor samples (>30% of tumor cells).
Results: Complete results of both WES and targeted resequencing validation are available for pleiomorphic lobular carcinoma. Nine of the 10 DNA pairs were eligible for WES. Genes already implicated in BC were significantly mutated: PIK3CA (3/9), TP53 (3/9) and CDH1 (3/9). Novel significantly mutated genes were identified: PYGM (2/9), EMR1 (2/9), ALDH1A2 (2/9), and DCLK1 (2/9). The validation using target gene sequencing was performed on the same 9 cases and on 19 additional confirmed pleiomorphic lobular BC cases (n = 28). For 8 out of the 9 cases with WES data, the results were reproducible on FFPE samples. Validation set confirmed recurrent mutations on PYGM genes (25%). PYGM is involved in glycogen metabolism. Further analyses on gene expression array revealed that PYGM is downregulated in most of the common BC samples, as compared to normal tissue, suggesting a role for this gene in the metabolism of common BC.
WES data are available for micropapillary and metaplastic BC. HSPA8 (coding for a Heat shock protein) was found mutated in 3/7 of micropapillary samples. Validation on additional FFPE samples is ongoing and will be presented. WES of metaplastic BC revealed a high frequency of TP53 and PIK3CA mutations (50% in both cases).
Conclusions: A novel mutated gene was identified in PLBC. PYGM is a gene involved in glycogen metabolism and was found downregulated in most of the common breast cancer. WES of micropapillary cancers suggests mutations on HSPA8, a gene encoding for a chaperon protein. Validation is ongoing. Deeper sequencing is ongoing for metaplastic BC that may help identifying new mutated genes in this multiclonal disease. Results will be presented.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD4-4.
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Affiliation(s)
- MV Dieci
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - C Lefebvre
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - P Viehl
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - M-C Mathieu
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - M Laporte
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - V Scott
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - V Marty
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - F Drusch
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - V Guarneri
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - P Conte
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - L Lacroix
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - S Delaloge
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
| | - F André
- Institut Gustave Roussy, Villejuif, France; Istituto Oncologico Veneto, Padova, Italy
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Guarneri V, Dieci MV, Barbieri E, Piacentini F, Omarini C, Ficarra G, Bettelli S, Conte PF. Loss of HER2 positivity and prognosis after neoadjuvant therapy in HER2-positive breast cancer patients. Ann Oncol 2013; 24:2990-4. [PMID: 24013581 DOI: 10.1093/annonc/mdt364] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Emerging literature data are showing that a change in human epidermal growth factor receptor (HER2) status adversely affects breast cancer patient's prognosis. The aim of this study was to evaluate the prognostic impact of HER2 loss in patients with HER2-positive disease treated with neoadjuvant therapy with or without anti-HER2 agents. METHODS One hundred and seven consecutive HER2-positive patients were identified from a prospectively maintained database. The first cohort includes 40 patients treated with chemotherapy (CT) alone. The second cohort includes 67 patients treated with neoadjuvant CT plus anti-HER2 agents (trastuzumab and/or lapatinib). HER2 expression was evaluated by immunihistochemistry or fluorescence in situ hybridization on pretreatment core biopsy and on surgical specimen after therapy. RESULTS The rates of pathologic complete response (pCR) and breast-conserving surgery were higher in the CT + anti-HER2 cohort. A loss of HER2 expression was observed in 40% of the patients with residual disease after CT alone versus 14.7% of the patients after CT + anti-HER2 agents (P = 0.019). Patients not achieving a pCR have a significant increase in the risk of relapse when compared with those achieving a pCR (hazard ratio [HR] 9.55, P = 0.028). Patients with HER2 loss tended to have a higher risk of relapse as comparing to patients with maintained HER2 positivity (HR 2.41, P = 0.063). CONCLUSION The pCR is confirmed as a powerful predictor of long-term outcome. The rate of HER2 loss is higher in patients receiving neoadjuvant CT without anti-HER2 agents. HER2 status on residual disease after preoperative therapy can be helpful in selecting patients at different risk of relapse, to be included in prospective trial exploring further adjuvant therapy.
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Affiliation(s)
- V Guarneri
- Istituto Oncologico Veneto IRCCS, University of Padova, Italy
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Dieci MV, Barbieri E, Piacentini F, Ficarra G, Bettelli S, Dominici M, Conte PF, Guarneri V. Discordance in receptor status between primary and recurrent breast cancer has a prognostic impact: a single-institution analysis. Ann Oncol 2012; 24:101-8. [PMID: 23002281 DOI: 10.1093/annonc/mds248] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Tumor phenotype may change during breast cancer progression. This study evaluates the prognostic impact of receptor discordance between paired primaries and recurrences. PATIENTS AND METHODS One hundred and thirty-nine patients underwent histological sampling of suspected breast cancer recurrence. All the pathology assessments [ER, PgR and human epidermal growth factor receptor 2 (HER2)] on both primaries and confirmed recurrences were performed at the same laboratory. RESULTS A breast cancer recurrence was confirmed in 119 cases. Rates of discordance were 13.4%, 39% and 11.8% for ER, PgR and HER2, respectively. Ninety-two patients maintained the same tumor phenotype [i.e. the same hormone receptors (HR) and HER2 status], whereas 27 (22.7%) changed during progression. The loss of HR positivity and the loss of HER2 positivity resulted in a worse post-recurrence survival (P=0.01 and P=0.008, respectively) and overall survival (OS; P=0.06 and P=0.0002, respectively), compared with the corresponding concordant-positive cases. Tumor phenotype discordance was associated with worse post-recurrence and OS (P=0.006 and P=0.002, respectively); those cases who turned into triple-negative experienced the poorest outcome, respect to the concordant group (P=0.001, OS). CONCLUSIONS We demonstrated for the first time an impact on OS of phenotype discordance between primary breast cancer and relapse. Among discordant cases, receptor loss resulted in the main determinant of poorer outcome.
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Affiliation(s)
- M V Dieci
- Department of Oncology, Hematology and Respiratory Diseases, University Hospital, Modena, Italy
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Barbieri E, Piacentini F, Dieci MV, Ficarra G, Bettelli S, Conte P, Guarneri V. P1-12-18: Change in HER2 Status in HER2 Positive Operable Breast Cancer Patients Treated with Neoadjuvant Chemotherapy with or without Anti-HER2 Therapy: Analysis of Two Consecutive Cohorts. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-12-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: emerging literature data have shown a change of HER2 expression from primary tumors to metastatic deposits. Tumor heterogeneity, genetic drift as well as selective pressure of adjuvant therapy have been suggested to explain this phenomenon. Aim of the present analysis is to evaluate the change in HER2 expression after neoadjuvant chemotherapy with or without anti-HER2 agents.
Methods: two consecutive cohorts of HER2+ breast cancer patients treated with neoadjuvant therapy were identified from a prospectively maintained database including 310 patients. The first cohort (A) includes 38 patients enrolled before 2005, treated with chemotherapy alone. The second cohort (B) includes 48 patients treated with neoadjuvant chemotherapy in combination with antiHER2 agents (trastuzumab or lapatinib).
HER2 expression was evaluated by IHC on pre-treatment core biopsy (tru-cut with 14 gauge needle) and on surgical specimen after neoadjuvant therapy. FISH analysis was performed on IHC 2+ samples.
Results: The two cohorts were balanced in respect of tumor stage, patient age, and HR expression. In particular, a co-expression of HER2 and HR was observed in 60% of the patients in cohort A and in 70% of the patients in cohort B (p=0.2).
Patients in cohort B have a significantly higher rate of pathologic complete response (pCR) in comparison to cohort A (45% vs 11%, p=0.001). A change in HER2 expression from biopsy to post-therapy samples was observed in 39% of the patients in cohort A vs 12% of the patients in cohort B (p=0.02). No patients with pCR have recurred so far vs 25% of the patients with less than pCR (p=0.005). The rate of recurrence was significantly higher for patients experiencing a change in HER2 expression (50% vs 19%, p=0.018).
Conclusion: contrary to our expectations, patients not receiving anti-HER2 therapy as part of neoadjuvant therapy were more likely to have a change in HER2 status vs patients receiving anti-HER2 neoadjuvant therapy. The change in HER2 status has a negative prognostic impact.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-12-18.
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Affiliation(s)
- E Barbieri
- 1Modena University Hospital, Modena, Italy
| | | | - MV Dieci
- 1Modena University Hospital, Modena, Italy
| | - G Ficarra
- 1Modena University Hospital, Modena, Italy
| | - S Bettelli
- 1Modena University Hospital, Modena, Italy
| | - P Conte
- 1Modena University Hospital, Modena, Italy
| | - V Guarneri
- 1Modena University Hospital, Modena, Italy
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Abstract
Since the introduction of anti-Her2 agents, the prognosis of HER2 positive breast cancer patients significantly improved. In the adjuvant setting, the monoclonal antibody trastuzumab has been evaluated in six randomized trials including more than 10,000 patients. Different modes of administration (concurrent versus sequential), durations (one year, two years or 9 weeks) and different chemotherapy regimens have been evaluated. To date, one year of trastuzumab in combination or after chemotherapy is the standard adjuvant therapy for patients with HER2 overexpressing tumors. Cardiac safety is still a major clinical issue, in particular in the treatment of early breast cancer. Several large randomized trials exploring shorter, and potentially less toxic, regimens are ongoing across several European countries. In the neoadjuvant setting, the addition of trastuzumab to chemotherapy resulted in a significantly higher activity as compared to chemotherapy alone. Unfortunately, primary and secondary resistance to trastuzumab is observed both in early and advanced disease. Several mechanisms are described as possible determinants of trastuzumab failure, and several new antiHER2 strategies are in development. Lapatinib, the HER1-2 TK inhibitor is currently approved in advanced disease after trastuzumab failure. Lapatinib is under evaluation in a large adjuvant trial, and in several neoadjuvant studies. Other molecules such pertuzumab, which binds the HER2 dimerization domain, or the pan-erbB TK inhibitor neratinib are under evaluation in the (neo)-adjuvant setting.
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Affiliation(s)
- V Guarneri
- Department of Oncology, Hematology and Respiratory Diseases, University Hospital, via del Pozzo 71, Modena, Italy
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Barbieri E, Piacentini F, Dieci MV, Ficarra G, Conte PF, Guarneri V. Abstract P3-10-30: Ki67 as a Predictor of Response and Long Term Survival in Hormone Receptor Positive/HER2 Negative Breast Cancer Patients Treated with Preoperative Chemotherapy. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p3-10-30] [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: Breast cancer is a heterogeneous disease, and newer technologies have identified different molecular classes with distinct behaviour. In particular, hormone receptor positive tumors can be classified as luminal A or luminal B subtypes. Luminal A is a true endocrine dependent disease, generally characterized by high hormone receptor expression, low proliferation and HER2 negativity. Luminal B tumors show a more aggressive phenotype, expressed as a higher proliferation and/or HER2 positivity. It is known that hormone receptor positive tumors are less likely to achieve a pathologic complete response (pCR) after preoperative chemotherapy. Aim of the present analysis was to discriminate, on the basis of tumor proliferation as measured by Ki67, patients with hormone receptor positive/HER2 negative tumors with different probability of obtaining a pCR, and with different long term outcome.
Patients and Methods: 274 consecutive stage II-III breast cancer patients treated with preoperative chemotherapy were evaluated. Patients were classified as having hormone receptor positive tumors in case of ER and/or PgR >/= 10%. On the basis of immunohistochemical characteristic, patients were classified as follows: Luminal A, in case of hormone receptor positivity, HER2 negativity, and Ki67<15% (16%); Ki67-Luminal B, in case of hormone receptor positivity, HER2 negativity and Ki67 >/= 15% (37%); HER2-Luminal B in case of hormone receptor positivity and HER2positivity (19%); HER2, in case of hormone receptor negativity and HER2 positivity (8%); triple negative, in case of hormone receptor negativity and HER2 negativity (20%)
Results: Patients characteristics were as follows: median age 50 yrs (range: 27-76); clinical stage: IIA 35.7%, IIB 42.3%, III 22%. After a median of 4 courses of preoperative chemotherapy, 46% of the patients underwent conservative surgery. A pCR, as defined as absence of infiltrating tumor in both breast and axillary lymph-nodes, was observed in 28 patients (10.2%). All hormone receptor positive patients received adjuvant hormonal therapy for 5 years after surgery.
The probability of obtaining a pCR was significantly lower in patients with hormone receptor positive tumors: 6.8% vs 17.5% in hormone receptor negative, p=0.010. No pCR was observed in the 40 patients classified as having Luminal A tumor; two pCRs only were observed among the 89 patients classified as having Ki67-Luminal B tumors. Patients in the Ki67-Luminal B group had significantly shorter disease-free survival (DFS) as compared with Luminal A patients (5-yr DFS 63% vs 86%, p= 0.0061). The 5-yr overall survival in Ki67-Luminal B group was 88% versus 93% in the Luminal A group. However, with 14 events only, this difference was not statistically significant.
Conclusions: In this analysis, patients with Ki67-Luminal B have a worse DFS as compared to patients with Luminal A disease. Due to the limited number of events, no differences in the probability of obtaining a pCR were observed between Luminal A and Ki67-Luminal B tumors.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-10-30.
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Affiliation(s)
| | | | - MV Dieci
- Modena University Hospital, Italy
| | | | - PF Conte
- Modena University Hospital, Italy
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