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Font A, Mellado B, Climent MA, Virizuela JA, Oudard S, Puente J, Castellano D, González-Del-Alba A, Pinto A, Morales-Barrera R, Rodriguez-Vida A, Fernandez PL, Teixido C, Jares P, Aldecoa I, Gibson N, Solca F, Mondal S, Lorence RM, Serra J, Real FX. Phase II trial of afatinib in patients with advanced urothelial carcinoma with genetic alterations in ERBB1-3 (LUX-Bladder 1). Br J Cancer 2024; 130:434-441. [PMID: 38102226 PMCID: PMC10844502 DOI: 10.1038/s41416-023-02513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 10/31/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Preclinical and early clinical data suggest that the irreversible ErbB family blocker afatinib may be effective in urothelial cancers harbouring ERBB mutations. METHODS This open-label, phase II, single-arm trial (LUX-Bladder 1, NCT02780687) assessed the efficacy and safety of second-line afatinib 40 mg/d in patients with metastatic urothelial carcinoma with ERBB1-3 alterations. The primary endpoint was 6-month progression-free survival rate (PFS6) (cohort A); other endpoints included ORR, PFS, OS, DCR and safety (cohorts A and B). Cohort A was planned to have two stages: stage 2 enrolment was based on observed antitumour activity. RESULTS Thirty-four patients were enroled into cohort A and eight into cohort B. In cohorts A/B, PFS6 was 11.8%/12.5%, ORR was 5.9%/12.5%, DCR was 50.0%/25.0%, median PFS was 9.8/7.8 weeks and median OS was 30.1/29.6 weeks. Three patients (two ERBB2-amplified [cohort A]; one EGFR-amplified [cohort B]) achieved partial responses. Stage 2 for cohort A did not proceed. All patients experienced adverse events (AEs), most commonly (any/grade 3) diarrhoea (76.2%/9.5%). Two patients (4.8%) discontinued due to AEs and one fatal AE was observed (acute coronary syndrome; not considered treatment-related). CONCLUSIONS An exploratory biomarker analysis suggested that basal-squamous tumours and ERBB2 amplification were associated with superior response to afatinib. CLINICAL TRIAL REGISTRATION NCT02780687.
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Grants
- The conduct of this research, study design, data collection and analysis were financially supported by Boehringer Ingelheim. The authors did not receive payment related to the development of this manuscript. Medical writing assistance, funded by Boehringer Ingelheim, was provided by Sharmin Bovill, PhD, and Jim Sinclair, PhD, of Ashfield MedComms, an Inizio Company, during the preparation of this manuscript.
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Affiliation(s)
- Albert Font
- Medical Oncology Department, Institut Català d'Oncologia, Badalona Applied Research Group in Oncology (BARGO), Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Begona Mellado
- Medical Oncology Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Miguel A Climent
- Medical Oncology Department, Instituto Valenciano de Oncología (IVO), València, Spain
| | | | - Stephane Oudard
- Medical Oncology Department, Hôpital Européen George Pompidou, University of Paris, Paris, France
| | - Javier Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Alvaro Pinto
- Medical Oncology Department, Hospital Universitario La Paz, Instituto de Investigacion Sanitaria Hospital La Paz (IdiPAZ), Madrid, Spain
| | - Rafael Morales-Barrera
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar, IMIM Research Institute, Barcelona, Spain
| | - Pedro L Fernandez
- Pathology Department, Hospital Germans Trias i Pujol, IGTP, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Teixido
- Pathology Department, Hospital Clínic Barcelona and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Translational Genomics and Targeted Therapeutics in Solid Tumors, Barcelona, Spain
| | - Pedro Jares
- Molecular Biology CORE and Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Iban Aldecoa
- Pathology Department, Hospital Clínic Barcelona - University of Barcelona and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Neil Gibson
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Flavio Solca
- Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Austria
| | - Shoubhik Mondal
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA
| | | | - Josep Serra
- Boehringer Ingelheim España, S.A., Barcelona, Spain
| | - Francisco X Real
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain.
- CIBERONC, Madrid, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
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2
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Albiges L, Gurney H, Atduev V, Suarez C, Climent MA, Pook D, Tomczak P, Barthelemy P, Lee JL, Stus V, Ferguson T, Wiechno P, Gokmen E, Lacombe L, Gedye C, Perini RF, Sharma M, Peng X, Lee CH. Pembrolizumab plus lenvatinib as first-line therapy for advanced non-clear-cell renal cell carcinoma (KEYNOTE-B61): a single-arm, multicentre, phase 2 trial. Lancet Oncol 2023; 24:881-891. [PMID: 37451291 DOI: 10.1016/s1470-2045(23)00276-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Immunotherapy-based combinations including pembrolizumab plus lenvatinib are the standard of care for patients with first-line clear-cell renal cell carcinoma, but these combinations are not well characterised in non-clear-cell renal cell carcinoma. We aimed to assess the activity and safety of pembrolizumab plus lenvatinib as a first-line treatment for patients with advanced non-clear-cell renal cell carcinoma. METHODS KEYNOTE-B61 is a single-arm, phase 2 trial being conducted at 48 sites (hospitals and cancer centres) in 14 countries (Australia, Canada, France, Hungary, Ireland, Italy, Poland, South Korea, Russia, Spain, Türkiye, Ukraine, the UK, and the USA). Adult patients (aged ≥18 years) with previously untreated stage IV non-clear-cell renal cell carcinoma and a Karnofsky performance status of 70% or higher were eligible for enrolment. All enrolled patients received pembrolizumab 400 mg intravenously every 6 weeks for up to 18 cycles (2 years) plus lenvatinib 20 mg orally once daily or until disease progression, unacceptable toxicity, or withdrawal; lenvatinib could be continued beyond 2 years. The primary endpoint was the proportion of patients with a confirmed objective response as per adjusted Response Evaluation Criteria in Solid Tumours (version 1.1) assessed by independent central review. Activity and safety were analysed in all patients who received at least one dose of study treatment (the as-treated population). This trial is registered with ClinicalTrials.gov (NCT04704219) and is no longer recruiting participants but is ongoing. FINDINGS Between Feb 23, 2021, and Jan 21, 2022, 215 patients were screened; 158 were enrolled and received treatment. Median age at baseline was 60 years (IQR 52-69), 112 (71%) of 158 patients were male, 46 (29%) were female, 128 (81%) were White, 12 (8%) were Asian, three (2%) were Black or African American, and 15 (9%) were missing data on race. As of data cutoff (Nov 7, 2022), median study follow-up was 14·9 months (IQR 11·1-17·4). 78 of 158 patients had a confirmed objective response (49%; 95% CI 41-57), including nine (6%) patients with a confirmed complete response and 69 (44%) with a confirmed partial response. Grade 3-4 treatment-related adverse events occurred in 81 (51%) of 158 patients, the most common of which were hypertension (37 [23%] of 158), proteinuria (seven [4%]), and stomatitis (six [4%]). Serious treatment-related adverse events occurred in 31 (20%) of 158 patients. Eight (5%) patients died due to adverse events, none of which was considered related to the treatment by the investigators (one each of cardiac failure, peritonitis, pneumonia, sepsis, cerebrovascular accident, suicide, pneumothorax, and pulmonary embolism). INTERPRETATION Pembrolizumab plus lenvatinib has durable antitumour activity in patients with previously untreated advanced non-clear-cell renal cell carcinoma, with a safety profile consistent with that of previous studies. Results from KEYNOTE-B61 support the use of pembrolizumab plus lenvatinib as a first-line treatment option for these patients. FUNDING Merck Sharp & Dohme (a subsidiary of Merck & Co, NJ, USA), and Eisai.
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Affiliation(s)
| | | | - Vagif Atduev
- Volga District Medical Center, Federal Medical-Biological Agency, Nizhny Novgorod, Russia
| | - Cristina Suarez
- Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - David Pook
- School of Clinical Sciences, Monash Health, Melbourne, VIC, Australia
| | - Piotr Tomczak
- Poznań University of Medical Sciences, Poznań, Poland
| | | | - Jae Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Viktor Stus
- Dnipro State Medical University, Dnipro, Ukraine
| | | | - Pawel Wiechno
- Maria Skłodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | | | - Louis Lacombe
- Centre de Recherche du CHU de Québec, Québec City, QC, Canada
| | - Craig Gedye
- Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia
| | | | | | | | - Chung-Han Lee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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3
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Fernandez-Perez MP, Perez-Navarro E, Alonso-Gordoa T, Conteduca V, Font A, Vázquez-Estévez S, González-Del-Alba A, Wetterskog D, Antonarakis ES, Mellado B, Fernandez-Calvo O, Méndez-Vidal MJ, Climent MA, Duran I, Gallardo E, Rodriguez Sanchez A, Santander C, Sáez MI, Puente J, Tudela J, Martínez A, López-Andreo MJ, Padilla J, Lozano R, Hervas D, Luo J, de Giorgi U, Castellano D, Attard G, Grande E, Gonzalez-Billalabeitia E. A correlative biomarker study and integrative prognostic model in chemotherapy-naïve metastatic castration-resistant prostate cancer treated with enzalutamide. Prostate 2023; 83:376-384. [PMID: 36564933 PMCID: PMC10107622 DOI: 10.1002/pros.24469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/06/2022] [Accepted: 11/20/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is a considerable need to incorporate biomarkers of resistance to new antiandrogen agents in the management of castration-resistant prostate cancer (CRPC). METHODS We conducted a phase II trial of enzalutamide in first-line chemo-naïve asymptomatic or minimally symptomatic mCRPC and analyzed the prognostic value of TMPRSS2-ERG and other biomarkers, including circulating tumor cells (CTCs), androgen receptor splice variant (AR-V7) in CTCs and plasma Androgen Receptor copy number gain (AR-gain). These biomarkers were correlated with treatment response and survival outcomes and developed a clinical-molecular prognostic model using penalized cox-proportional hazard model. This model was validated in an independent cohort. RESULTS Ninety-eight patients were included. TMPRSS2-ERG fusion gene was detected in 32 patients with no differences observed in efficacy outcomes. CTC detection was associated with worse outcome and AR-V7 in CTCs was associated with increased rate of progression as best response. Plasma AR gain was strongly associated with an adverse outcome, with worse median prostate specific antigen (PSA)-PFS (4.2 vs. 14.7 m; p < 0.0001), rad-PFS (4.5 vs. 27.6 m; p < 0.0001), and OS (12.7 vs. 38.1 m; p < 0.0001). The clinical prognostic model developed in PREVAIL was validated (C-Index 0.70) and the addition of plasma AR (C-Index 0.79; p < 0.001) increased its prognostic ability. We generated a parsimonious model including alkaline phosphatase (ALP); PSA and AR gain (C-index 0.78) that was validated in an independent cohort. CONCLUSIONS TMPRSS2-ERG detection did not correlate with differential activity of enzalutamide in first-line mCRPC. However, we observed that CTCs and plasma AR gain were the most relevant biomarkers.
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Affiliation(s)
- María P Fernandez-Perez
- Department of Haematology and Medical Oncology, Hospital Universitario Morales Meseguer, IMIB, Murcia, Spain
| | - Enrique Perez-Navarro
- Department of Medical Oncology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Vicenza Conteduca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) "Dino Amadori" IRCCS, Meldola, Italy
| | - Albert Font
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona Applied Research Group in Oncology (BARGO), Badalona, Spain
| | | | | | - Daniel Wetterskog
- University College London Cancer Institute, Paul O'Gorman Building, London, UK
| | - Emmanuel S Antonarakis
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Begona Mellado
- Department of Medical Oncology, IDIBAPS, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain
| | - Ovidio Fernandez-Calvo
- Department of Medical Oncology, Complejo Hospitalario Universitario Ourense, Orense, Spain
| | - María J Méndez-Vidal
- Department of Medical Oncology, Hospital Universitario Reina Sofía (HURS), Maimonides Institute for biomedical research of Córdoba (IMIBIC), Córdoba, Spain
| | - Miguel A Climent
- Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
| | - Ignacio Duran
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Enrique Gallardo
- Department of Medical Oncology, Servicio de Oncología Médica, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | - Carmen Santander
- Department of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Maria I Sáez
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Javier Puente
- Department of Medical Oncology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Julian Tudela
- Department of Pathology, Hospital Morales Meseguer, Murcia, Spain
| | | | | | - José Padilla
- Department of Haematology and Medical Oncology, Hospital Universitario Morales Meseguer, IMIB, Murcia, Spain
| | - Rebeca Lozano
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre, Madrid, Spain
- Genitourinary Translational Research Group, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - David Hervas
- Data Science Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Jun Luo
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ugo de Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) "Dino Amadori" IRCCS, Meldola, Italy
| | - Daniel Castellano
- Department of Medical Oncology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gerhardt Attard
- University College London Cancer Institute, Paul O'Gorman Building, London, UK
| | | | - Enrique Gonzalez-Billalabeitia
- Department of Haematology and Medical Oncology, Hospital Universitario Morales Meseguer, IMIB, Murcia, Spain
- Department of Medical Oncology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
- Universidad Católica San Antonio de Murcia-UCAM, Murcia, Spain
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4
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Francis PA, Fleming GF, Láng I, Ciruelos EM, Bonnefoi HR, Bellet M, Bernardo A, Climent MA, Martino S, Bermejo B, Burstein HJ, Davidson NE, Geyer CE, Walley BA, Ingle JN, Coleman RE, Müller B, Le Du F, Loibl S, Winer EP, Ruepp B, Loi S, Colleoni M, Coates AS, Gelber RD, Goldhirsch A, Regan MM. Adjuvant Endocrine Therapy in Premenopausal Breast Cancer: 12-Year Results From SOFT. J Clin Oncol 2023; 41:1370-1375. [PMID: 36493334 PMCID: PMC10419521 DOI: 10.1200/jco.22.01065] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/08/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The Suppression of Ovarian Function Trial (SOFT; ClinicalTrials.gov identifier: NCT00066690) randomly assigned premenopausal women with hormone receptor-positive breast cancer to 5 years of adjuvant tamoxifen, tamoxifen plus ovarian function suppression (OFS), or exemestane plus OFS. The primary analysis compared disease-free survival (DFS) between tamoxifen plus OFS versus tamoxifen alone; exemestane plus OFS versus tamoxifen was a secondary objective. After 8 years, SOFT reported a significant reduction in recurrence and improved overall survival (OS) with adjuvant tamoxifen plus OFS versus tamoxifen alone. Here, we report outcomes after median follow-up of 12 years. DFS remained significantly improved with tamoxifen plus OFS versus tamoxifen (hazard ratio, 0.82; 95% CI, 0.69 to 0.98) with a 12-year DFS of 71.9% with tamoxifen, 76.1% with tamoxifen plus OFS, and 79.0% with exemestane plus OFS. OS was improved with tamoxifen plus OFS versus tamoxifen (hazard ratio, 0.78; 95% CI, 0.60 to 1.01) and was 86.8% with tamoxifen, 89.0% with tamoxifen plus OFS, and 89.4% with exemestane plus OFS at 12 years. Among those who received prior chemotherapy for human epidermal growth factor receptor-2-negative tumors, OS was 78.8% with tamoxifen, 81.1% with tamoxifen plus OFS, and 84.4% with exemestane plus OFS. In conclusion, after 12 years, there remains a benefit from including OFS in adjuvant endocrine therapy, with an absolute improvement in OS more apparent with higher baseline risk of recurrence.[Media: see text].
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Affiliation(s)
- Prudence A. Francis
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Center, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
- Breast Cancer Trials Australia & New Zealand, University of Newcastle, Callaghan, Newcastle, Australia
- International Breast Cancer Study Group, Bern, Switzerland
| | - Gini F. Fleming
- The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL
| | - István Láng
- Clinexpert-Research, Budapest, Hungary
- National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Eva M. Ciruelos
- Medical Oncology Department, University Hospital and SOLTI Breast Cancer Research Cooperative Group, Madrid, Spain
| | - Hervé R. Bonnefoi
- Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U1312, and European Organisation for Research and Treatment of Cancer (EORTC), Bordeaux, France
| | - Meritxell Bellet
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, and SOLTI Breast Cancer Research Cooperative Group, Barcelona, Spain
| | | | - Miguel A. Climent
- Instituto Valenciano de Oncologia, Valencia and SOLTI Breast Cancer Research Cooperative Group, Barcelona, Spain
| | - Silvana Martino
- The Angeles Clinic and Research Institute and SWOG, Santa Monica, CA
| | - Begoña Bermejo
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, Incliva, Barcelona, Spain
- Medicine Department Universidad de Valencia, Valencia and SOLTI Breast Cancer Cooperative Group, Barcelona, Spain
| | - Harold J. Burstein
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Harvard Medical School and Alliance for Clinical Trials in Oncology, Boston, MA
| | - Nancy E. Davidson
- Fred Hutchinson Cancer Center, University of Washington and ECOG-ACRIN, Seattle, WA
| | - Charles E. Geyer
- University of Pittsburgh Medical Center Hillman Cancer Center and NRG Oncology, Pittsburgh, PA
| | - Barbara A. Walley
- University of Calgary and Canadian Cancer Trials Group, Calgary, Alberta, Canada
| | - James N. Ingle
- Mayo Clinic and Alliance for Clinical Trials in Oncology, Rochester, MN
| | - Robert E. Coleman
- Weston Park Hospital, Sheffield, United Kingdom
- NCRI Breast Cancer Clinical Studies Group, London, United Kingdom
- ICR-CTSU, London, United Kingdom
| | - Bettina Müller
- Chilean Cooperative Group for Oncological Research (GOCCHI), Santiago, Chile
| | - Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany
- Goethe University of Frankfurt, Frankfurt, Germany
| | - Eric P. Winer
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Harvard Medical School and Alliance for Clinical Trials in Oncology, Boston, MA
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
- Smilow Cancer Hospital, New Haven, CT
| | - Barbara Ruepp
- International Breast Cancer Study Group Coordinating Center, Bern, Switzerland
| | - Sherene Loi
- International Breast Cancer Study Group and Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Victoria, Australia
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS and International Breast Cancer Study Group, Milan, Italy
| | - Alan S. Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - Richard D. Gelber
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, MA
| | - Aron Goldhirsch
- IEO, European Institute of Oncology, IRCCS and International Breast Cancer Study Group, Milan, Italy
| | - Meredith M. Regan
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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5
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Balar AV, Castellano DE, Grivas P, Vaughn DJ, Powles T, Vuky J, Fradet Y, Lee JL, Fong L, Vogelzang NJ, Climent MA, Necchi A, Petrylak DP, Plimack ER, Xu JZ, Imai K, Moreno BH, Bellmunt J, de Wit R, O'Donnell PH. Efficacy and safety of pembrolizumab in metastatic urothelial carcinoma: results from KEYNOTE-045 and KEYNOTE-052 after up to 5 years of follow-up. Ann Oncol 2023; 34:289-299. [PMID: 36494006 DOI: 10.1016/j.annonc.2022.11.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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: 07/27/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors are a standard therapy in metastatic urothelial carcinoma (UC). Long-term follow-up is necessary to confirm durability of response and identify further safety concerns. PATIENTS AND METHODS In KEYNOTE-045, patients with metastatic UC that progressed on platinum-containing chemotherapy were randomly assigned 1:1 to receive pembrolizumab or investigator's choice of paclitaxel, docetaxel, or vinflunine. Primary endpoints were progression-free survival per RECIST version 1.1 by blinded independent central review (BICR) and overall survival. In KEYNOTE-052, cisplatin-ineligible patients with metastatic UC received first-line pembrolizumab. The primary endpoint was objective response rate per RECIST version 1.1 by BICR. RESULTS A total of 542 patients (pembrolizumab, n = 270; chemotherapy, n = 272) were randomly assigned in KEYNOTE-045. The median follow-up was 62.9 months (range 58.6-70.9 months; data cut-off 1 October 2020). At 48 months, overall survival rates were 16.7% for pembrolizumab and 10.1% for chemotherapy; progression-free survival rates were 9.5% and 2.7%, respectively. The median duration of response (DOR) was 29.7 months (range 1.6+ to 60.5+ months) for pembrolizumab and 4.4 months (range 1.4+ to 63.1+ months) for chemotherapy; 36-month DOR rates were 44.4% and 28.3%, respectively. A total of 370 patients were enrolled in KEYNOTE-052. The median follow-up was 56.3 months (range 51.2-65.3 months; data cut-off 26 September 2020). The confirmed objective response rate was 28.9% (95% confidence interval 24.3-33.8), and the median DOR was 33.4 months (range 1.4+ to 60.7+ months); the 36-month DOR rate was 44.8%. Most treatment-related adverse events for pembrolizumab in either study were grade 1 or 2 and manageable, which is consistent with prior reports. CONCLUSION With ∼5 years of follow-up, pembrolizumab monotherapy continued to demonstrate durable efficacy with no new safety signals in patients with platinum-resistant metastatic UC and as first-line therapy in cisplatin-ineligible patients. CLINICAL TRIAL REGISTRY AND ID With ClinicalTrials.gov NCT02256436 (KEYNOTE-045); https://clinicaltrials.gov/ct2/show/NCT02256436 and NCT02335424 (KEYNOTE-052); https://clinicaltrials.gov/ct2/show/NCT02335424.
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Affiliation(s)
- A V Balar
- Perlmutter Cancer Center, New York University Langone Health, New York, USA
| | - D E Castellano
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Grivas
- Department of Medicine, Division of Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle
| | - D J Vaughn
- Division of Hematology/Oncology, Abramson Cancer Center, Penn Medicine, Philadelphia, USA
| | - T Powles
- Department of Genitourinary Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Vuky
- Department of Medicine/Oncology, Oregon Health and Science University, Knight Cancer Institute, Portland, USA
| | - Y Fradet
- Department of Surgery/Urology, CHU de Québec-Université Laval, Québec City, Canada
| | - J-L Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - L Fong
- Department of Medicine, University of California San Francisco, San Francisco
| | - N J Vogelzang
- Department of Medical Oncology, Comprehensive Cancer Centers of Nevada, Las Vegas, USA
| | - M A Climent
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, València, Spain
| | - A Necchi
- Department of Medical Oncology, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - D P Petrylak
- Department of Internal Medicine/Medical Oncology, Smilow Cancer Hospital, Yale New Haven Health, New Haven, USA
| | - E R Plimack
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - J Z Xu
- Department of Medical Oncology, Merck & Co., Inc., Rahway, USA
| | - K Imai
- Department of Medical Oncology, Merck & Co., Inc., Rahway, USA
| | - B H Moreno
- Department of Medical Oncology, Merck & Co., Inc., Rahway, USA
| | - J Bellmunt
- Department of Hematology and Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - R de Wit
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
| | - P H O'Donnell
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, USA.
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de Velasco G, Alonso-Gordoa T, Rodríguez-Vida A, Anguera G, Campayo M, Pinto Á, Ortega EM, Gallardo E, Núñez NF, García-Carbonero I, Reig O, Méndez-Vidal MJ, Fernández-Calvo O, Cassinello NV, Torregrosa D, López-Martín A, Rosero A, Valiente PG, de España CG, Climent MA, Santasusana MD, Sánchez ÁR, González IC, Afonso R, García Del Muro X, Casinello J, Fernández-Parra EM, García Sánchez L, Afonso J, Polo SH, Asensio Ú. Long-term Clinical Outcomes of a Spanish Cohort of Metastatic Renal Cell Carcinoma Patients with a Complete Response to Sunitinib. Clin Genitourin Cancer 2022; 21:e166-e174. [PMID: 36610891 DOI: 10.1016/j.clgc.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The long-term clinical outcomes of patients with metastatic renal cell carcinoma (mRCC) and a complete response (CR) to the tyrosine kinase inhibitor (TKI) sunitinib are poorly known. The characteristics of these patients could reveal previously undetected associations with clinical variables. PATIENTS AND METHODS This observational, retrospective study (ATILA) used data from a registry of patients with mRCC who had received first-line sunitinib and had achieved CR from 2007 to 2018 in Spain. RESULTS Sixty-two patients with CR were included; 48 patients (77.4%) received sunitinib in monotherapy and 14 (22.6%) combined with or followed by local treatment. Median age was 58.5 years (range, 32-81). Most patients (79.0%) had clear cell histology and had undergone previous nephrectomy (90.3%). The majority (70.2%) had an intermediate IMDC prognosis, 23% favorable and 7.0% poor. The median time on treatment with sunitinib was 28.2 months (IQR, 16.7-41.0) and the median time to CR was 10.9 months (IQR, 7.2-19.3). After a median follow-up of 8 years (range, 3-13 years), the median PFS was not reached. The overall median duration of complete response was 64.1 months (IQR, 32.2-99.4). The tolerance and safety profile of sunitinib was consistent with previous reports. CONCLUSION Durable CR to sunitinib was observed in patients regardless the prognosis group, metastasis site or histology type, with 75% of patients remaining in CR after 10 years. CLINICALTRIALS gov: NCT03916458.
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Affiliation(s)
| | - Teresa Alonso-Gordoa
- Department of Medical Oncology and Department of Genitourinary, Germ cell and Endocrine Tumors, Ramón y Cajal University Hospital and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Alejo Rodríguez-Vida
- Department of Medical Oncology, Hospital del Mar-CIBERONC, IMIM Research Institute, Barcelona, Spain
| | - Georgia Anguera
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marc Campayo
- Department of Medical Oncology, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Álvaro Pinto
- Department of Medical Oncology, University Hospital La Paz, Madrid, Spain
| | | | - Enrique Gallardo
- Department of Medical Oncology, University Hospital Parc Taulí, Institut d'Investigació i Innovació Parc Taulí, Sabadell, Spain
| | | | | | - Oscar Reig
- Department of Medical Oncology, Hospital Clínic and Translational Genomics and Targeted Therapeutics in Solid Tumors Group (IDIBAPS), Barcelona, Spain
| | - María José Méndez-Vidal
- Department of Medical Oncology, University Hospital Reina Sofía, Maimónides Institute for Biomedical research of Córdoba (IMIBIC), Córdoba, Spain
| | | | - Natalia Vidal Cassinello
- Department of Medical Oncology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Dolores Torregrosa
- Department of Medical Oncology, University Hospital Dr. Peset, Valencia, Spain
| | - Ana López-Martín
- Medical Oncology Department, University Hospital Severo Ochoa, Madrid, Spain
| | - Adriana Rosero
- Department of Medical Oncology, University Hospital Infanta Cristina, Parla, Madrid, Spain
| | - Patricia G Valiente
- Department of Medical Oncology, University Hospital Marqués de Valdecilla, Santander, Spain
| | | | - Miguel A Climent
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | | | | | - Isabel Chirivella González
- Department of Medical Oncology, Hospital Clínico Universitario, INCLIVA, University of Valencia, Valencia, Spain
| | - Ruth Afonso
- Department of Medical Oncology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Xavier García Del Muro
- Genitourinary Cancer and Sarcoma Unit, Institut Català d'Oncologia, Hospitalet, Barcelona, Spain
| | - Javier Casinello
- Department of Medical Oncology, University Hospital of Guadalajara, Guadalajara, Spain
| | | | | | - Javier Afonso
- Department of Medical Oncology, University Hospital of Ferrol, A Coruña, Spain
| | - Susana Hernando Polo
- Department of Medical Oncology, University Hospital Fundación Alcorcón, Madrid, Spain
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Climent MA, Font A, Durán I, Puente J, José Méndez-Vidal M, Sáez MI, Santander Lobera C, Ángel Arranz Arija J, González-Del-Alba A, Sánchez-Hernandez A, Juan Fita MJ, Esteban E, Alonso-Gordoa T, Mellado Gonzalez B, Maroto P, Lázaro-Quintela M, Cassinello-Espinosa J, Pérez-Valderrama B, Garcias C, Castellano D. A phase II randomised trial of abiraterone acetate plus prednisone in combination with docetaxel or docetaxel plus prednisone after disease progression to abiraterone acetate plus prednisone in patients with metastatic castration-resistant prostate cancer: The ABIDO-SOGUG trial. Eur J Cancer 2022; 175:110-119. [PMID: 36099670 DOI: 10.1016/j.ejca.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/22/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to compare the efficacy and safety of maintaining or withdrawing abiraterone acetate plus prednisone (AAP) in patients with metastatic castration-resistant prostate cancer who had experienced cancer progression to this treatment and were beginning a docetaxel-based therapy. PATIENTS AND METHODS Phase II, randomised, open-label study conducted in patients with metastatic castration-resistant prostate cancer who were asymptomatic or mildly symptomatic. After open-label treatment with AAP, patients who had experienced cancer progression to AAP were randomised to 75 mg/m2 of docetaxel plus AAP or to receive 75 mg/m2 of docetaxel plus 10 mg of prednisone orally daily. The primary outcome was the radiographic progression-free survival rate at 12 months as evaluated by the investigators in all randomised patients. RESULTS A total of 148 patients were included in open-label treatment with AAP, and of them, 94 patients were randomised to receive either docetaxel plus AAP (intervention group; n = 47) or docetaxel plus prednisone (control group; n = 47). The 12-month radiographic progression-free survival rates did not differ between the intervention group (34.9%; 95% CI 20.7-49.2) and the control group (33.9%; 95% CI 19.5-48.3). There were no significant differences in the time to radiographic progression and the overall survival between the intervention and control groups. Grade 3-5 neutropenia with the combination of docetaxel plus prednisone and AA was more frequent than with docetaxel plus prednisone (59.6% versus 27.7%). CONCLUSION Our results indicate that the therapeutic strategy of maintaining AAP added to docetaxel in chemotherapy-naïve patients who have experienced cancer progression to AAP treatment should not be further evaluated and should be avoided in clinical practice. CLINICAL TRIALS NCT02036060 https://clinicaltrials.gov/ct2/show/NCT02036060.
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Affiliation(s)
- Miguel A Climent
- Medical Oncology, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain.
| | - Albert Font
- Medical Oncology, Instituto Catalá d'Oncologia (ICO), Badalona, Spain.
| | - Ignacio Durán
- Medical Oncology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
| | - Javier Puente
- Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain.
| | - María José Méndez-Vidal
- Medical Oncology, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC) Hospital Universitario Reina Sofia (HURS), Córdoba, Spain.
| | - María Isabel Sáez
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain.
| | | | | | | | | | - Maria Jose Juan Fita
- Medical Oncology, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain.
| | - Emilio Esteban
- Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | - Begoña Mellado Gonzalez
- Medical Oncology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Pablo Maroto
- Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | | | | | - Carmen Garcias
- Medical Oncology, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
| | - Daniel Castellano
- Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Bellmunt J, de Wit R, Fradet Y, Climent MA, Petrylak DP, Lee JL, Fong L, Necchi A, Sternberg CN, O'Donnell PH, Powles T, Plimack ER, Bajorin DF, Balar AV, Castellano D, Choueiri TK, Culine S, Gerritsen W, Gurney H, Quinn DI, Vuky J, Vogelzang NJ, Cristescu R, Lunceford J, Saadatpour A, Loboda A, Ma J, Rajasagi M, Godwin JL, Homet Moreno B, Grivas P. Putative Biomarkers of Clinical Benefit With Pembrolizumab in Advanced Urothelial Cancer: Results from the KEYNOTE-045 and KEYNOTE-052 Landmark Trials. Clin Cancer Res 2022; 28:2050-2060. [PMID: 35247908 DOI: 10.1158/1078-0432.ccr-21-3089] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE In an exploratory analysis, we investigated the association between programmed death ligand 1 (PD-L1), tumor mutational burden (TMB), T-cell-inflamed gene expression profile (TcellinfGEP), and stromal signature with outcomes of pembrolizumab in urothelial carcinoma (UC). PATIENTS AND METHODS Patients with advanced UC received first-line pembrolizumab 200 mg every 3 weeks in the single-arm phase II KEYNOTE-052 trial (NCT02335424) and salvage pembrolizumab 200 mg every 3 weeks or chemotherapy (paclitaxel/docetaxel/vinflunine) in the randomized phase III KEYNOTE-045 trial (NCT02256436). The association of each biomarker (continuous variable) with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) was evaluated using logistic regression (ORR) and Cox PH (PFS, OS), adjusted for ECOG PS; nominal P values were calculated without multiplicity adjustment (one-sided, pembrolizumab; two-sided, chemotherapy). Significance was prespecified at α = 0.05. RESULTS In KEYNOTE-052, PD-L1, TMB, and TcellinfGEP were significantly associated with improved outcomes; stromal signature was significantly associated with worse outcomes. In KEYNOTE-045, although findings for TMB and TcellinfGEP with pembrolizumab were consistent with those of KEYNOTE-052, PD-L1 was not significantly associated with improved outcomes, nor was stromal signature associated with worse outcomes with pembrolizumab; chemotherapy was not associated with outcomes in a consistent manner for any of the biomarkers. Hazard ratio (HR) estimates at prespecified cutoffs showed an advantage for pembrolizumab versus chemotherapy regardless of PD-L1 or TMB, with a trend toward lower HRs in the combined positive score ≥10 and the TMB ≥175 mutation/exome subgroup. For TcellinfGEP, PFS and OS HRs were lower in the TcellinfGEP-nonlow subgroup regardless of treatment. CONCLUSIONS Multiple biomarkers characterizing the tumor microenvironment may help predict response to pembrolizumab monotherapy in UC, and potential clinical utility of these biomarkers may be context-dependent.
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Affiliation(s)
- Joaquim Bellmunt
- Department of Hematology and Oncology, Beth Israel Deaconess Medical Center, and IMIM-PSMAR Lab Harvard Medical School, Boston, Massachusetts
| | - Ronald de Wit
- Department of MedOnc, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Yves Fradet
- Department of Surgery/Urology, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, QC, Canada
| | - Miguel A Climent
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Daniel P Petrylak
- Department of Internal Medicine/Medical Oncology, Yale New Haven Health, Smilow Cancer Hospital, New Haven, Connecticut
| | - Jae-Lyun Lee
- Department of Oncology, Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea
| | - Lawrence Fong
- Department of Medicine, UCLA, Los Angeles, California
| | - Andrea Necchi
- Department of Medical Oncology, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Department of Hematology and Oncology, Weill Cornell Medicine, Meyer Cancer Center, New York, New York
| | - Peter H O'Donnell
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Thomas Powles
- Department of Genitourinary Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Elizabeth R Plimack
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Dean F Bajorin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Arjun V Balar
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario 12 de Octubre (CiberOnc), Madrid, Spain
| | | | - Stephane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, Paris, France
| | - Winald Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Howard Gurney
- Department of Medical Oncology, Westmead Hospital and Macquarie University, Sydney, NSW, Australia
| | - David I Quinn
- Department of Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Jacqueline Vuky
- Department of Medicine/Oncology, Oregon Health & Science University, Portland, Oregon
| | - Nicholas J Vogelzang
- Department of Medical Oncology, Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada
| | - Razvan Cristescu
- Department of Translational Medicine, Merck & Co., Inc., Kenilworth, New Jersey
| | - Jared Lunceford
- Department of Translational Oncology Statistics, Merck & Co., Inc., Kenilworth, New Jersey
| | - Assieh Saadatpour
- Department of Genome and Biomarker Sciences, Merck & Co., Inc., Kenilworth, New Jersey
| | - Andrey Loboda
- Department of Translational Medicine, Merck & Co., Inc., Kenilworth, New Jersey
| | - Junshui Ma
- Department of Translational Oncology Statistics, Merck & Co., Inc., Kenilworth, New Jersey
| | - Mohini Rajasagi
- Department of Oncology Early Development, Merck & Co., Inc., Kenilworth, New Jersey
| | | | | | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington
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9
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Oldenburg J, Berney DM, Bokemeyer C, Climent MA, Daugaard G, Gietema JA, De Giorgi U, Haugnes HS, Huddart RA, Leão R, Sohaib A, Gillessen S, Powles T. Testicular seminoma and non-seminoma: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:362-375. [PMID: 35065204 DOI: 10.1016/j.annonc.2022.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - D M Berney
- Department of Cellular Pathology, Barts Cancer Institute, Queen Mary University of London, London; Barts Health NHS Trust, London, UK
| | - C Bokemeyer
- Department of Oncology, Hematology, Bone Marrow Transplantation with section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M A Climent
- Fundacion Instituto Valenciano de Oncología, València, Spain
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST),'Dino Amadori', Meldola, Italy
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway and UiT-The Arctic University, Tromsoe, Norway
| | - R A Huddart
- Institute of Cancer Research and Royal Marsden Foundation Trust, London, UK
| | - R Leão
- Department of Urology, Hospital de Braga, Hospital CUF Coimbra, Faculty of Medicine University of Coimbra, Coimbra, Portugal
| | - A Sohaib
- Department of Diagnostic Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - S Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona; Faculty of Biomedical Sciences, USI, Lugano, Switzerland; Division of Cancer Medicine, University of Manchester, Manchester
| | - T Powles
- Barts Health NHS Trust, London, UK
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10
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Pinto Á, Reig O, Iglesias C, Gallardo E, García-Del Muro X, Alonso T, Anguera G, Suárez C, Muñoz-Langa J, Villalobos-León L, Rodríguez-Sánchez Á, Lainez N, Martínez-Ortega E, Campayo M, Velastegui A, Rodriguez-Vida A, Villa-Guzmán JC, Méndez-Vidal MJ, Rubio G, García I, Capdevila L, Lambea J, Vázquez S, Fernández O, Hernando-Polo S, Cerezo S, Santander C, García-Marrero R, Zambrana F, González-Del Alba A, Lazaro-Quintela M, Castellano D, Chirivella I, Anido U, Viana A, García A, Sotelo M, Arévalo MG, García-Donas J, Hernández C, Bolós MV, Llinares J, Climent MA. Clinical Factors Associated With Long-Term Benefit in Patients With Metastatic Renal Cell Carcinoma Treated With Axitinib: Real-World AXILONG Study. Clin Genitourin Cancer 2021; 20:25-34. [PMID: 34789409 DOI: 10.1016/j.clgc.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Axitinib monotherapy obtained approval in pre-treated mRCC patients and recently in combination with pembrolizumab or avelumab in the first-line setting. However, patient profiles that may obtain increased benefit from this drug and its combinations still need to be identified. PATIENTS AND METHODS Retrospective multicentre analysis describing clinical characteristics associated with axitinib long-responder (LR) population by comparing two extreme-response sub-groups (progression-free survival [PFS] ≥9 months vs. disease progression/refractory patients [RP]). A multivariate logistic-regression model was used to analyse clinical factors. Efficacy and safety were also analysed. RESULTS In total, 157 patients who received axitinib in second or subsequent line were evaluated (91 LR and 66 RP). Older age at start of axitinib and haemoglobin levels > LLN were independent predictive factors for LR in multivariate analyses. In LR patients, median (m) PFS was 18.1 months, median overall survival was 36.0 months and objective response rate (ORR) was 45.5%. In 59 LR patients receiving axitinib in second-line, mPFS was 18.7 months, mOS was 44.8 months and ORR was 43.9%. mOS was significantly longer in second line compared to subsequent lines (44.8 vs. 26.5 months; P = .009). In LR vs. RP, mPFS with sunitinib in first-line was correlated with mPFS with axitinib in second-line (27.2 vs. 10.9 months P < .001). The safety profile was manageable and consistent with known data. CONCLUSIONS This study confirms the long-term benefits of axitinib in a selected population, helping clinicians to select the best sequential approach and patients who could obtain a greater benefit from axitinib.
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Affiliation(s)
- Álvaro Pinto
- Medical Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Oscar Reig
- Medical Oncology Department, Hospital Clinic i Provincial, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Clara Iglesias
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida Roma, s/n, 33011 Oviedo, Spain
| | - Enrique Gallardo
- Medical Oncology Department, Hospital Universitario Parc Taulí de Sabadell, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain
| | - Xavier García-Del Muro
- Medical Oncology Department, Institut Català d'Oncologia Hospitalet, IDIBELL Institute of Researh, University of Barcelona, 1, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Alonso
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, M-607, km. 9, 100, 28034 Madrid, Spain
| | - Georgia Anguera
- Medical Oncology Department, Nou Hospital De La Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - Cristina Suárez
- Medical Oncology Department, Hospital Universitario Vall de Hebrón, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - José Muñoz-Langa
- Medical Oncology Department, Hospital Universitario La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Laura Villalobos-León
- Medical Oncology Department, Hospital Universitario Príncipe de Asturias, Carretera de Alcalá, s/n, 28805 Meco, Madrid, Spain
| | - Ángel Rodríguez-Sánchez
- Medical Oncology Department, Hospital Universitario de León, Calle Altos de Nava, s/n, 24071 León, Spain
| | - Nuria Lainez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Calle de Irunlarrea, 3, 31008 Pamplona, Spain
| | - Esther Martínez-Ortega
- Medical Oncology Department , Complejo Hospitalario de Jaén, Avenida del Ejército Español, 10, 23007 Jaén, Spain
| | - Marc Campayo
- Medical Oncology Department, Hospital Universitario MútuaTerrassa, Plaza del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Alejandro Velastegui
- Medical Oncology Department, Hospital Universitario Rey Juan Carlos, Calle Gladiolo, s/n, 28933 Móstoles, Madrid, Spain
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar, Passeig Marítim 25-29, 08001, Barcelona, Spain
| | - José C Villa-Guzmán
- Medical Oncology Department, Hospital General Universitario de Ciudad Real General, Calle Obispo Rafael Torija, s/n, 13005 Ciudad Real, Spain
| | - Maria J Méndez-Vidal
- Medical Oncology Department, Hospital Universitario Reina Sofía, Avenida Menendez Pidal, 14004, Córdoba, Spain
| | - Gustavo Rubio
- Medical Oncology Department, Hospital Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos, 2, 28040, Madrid, Spain
| | - Iciar García
- Medical Oncology Department, Hospital Virgen de la Salud, Av. de Barber, 30, 45004 Toledo, Spain
| | - Laia Capdevila
- Medical Oncology Department, Hospital San Pablo y Santa Tecla, Rambla Vella, 14, 43003 Tarragona, Spain
| | - Julio Lambea
- Medical Oncology Department, Hospital Clínico Universitario Lozano Blesa, Avda, Calle de San Juan Bosco, 15, 50009 Zaragoza, Spain
| | - Sergio Vázquez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Rúa Dr. Ulises Romero, 1, 27003 Lugo, Spain
| | - Ovidio Fernández
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Calle Ramon Puga Noguerol, 54, 32005 Ourense, Spain
| | - Susana Hernando-Polo
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain
| | - Sara Cerezo
- Medical Oncology Department, Hospital General La Mancha Centro, Av. Constitución, 3, 13600 Alcázar de San Juan, Ciudad Real, Spain
| | - Carmen Santander
- Medical Oncology Department, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Rosa García-Marrero
- Medical Oncology Department, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Francisco Zambrana
- Medical Oncology Department, Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28703 San Sebastián de los Reyes, Madrid, Spain
| | - Aranzazu González-Del Alba
- Medical Oncology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - Martin Lazaro-Quintela
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, 36213 Vigo, Spain
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Isabel Chirivella
- Medical Oncology Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain
| | - Urbano Anido
- Medical Oncology Department, Hospital Clínico Universitario de Santiago de Compostela, Rúa da Choupana, s/n, 15706 Santiago de Compostela, A Coruña, Spain
| | - Antonio Viana
- Medical Oncology Department, Hospital Nuestra Señora del Prado, Carretera de Madrid Km. 114, 45600 Talavera de la Reina, Toledo, Spain
| | - Arancha García
- TFS Trial Form Support S.L., Passeig de Gràcia, 11, 08007 Barcelona, Spain
| | - Miguel Sotelo
- Medical Oncology Department, Hospital Universitario Infanta Cristina, Av. 9 de Junio, 2, 28981 Parla, Madrid, Spain
| | - María Garrido Arévalo
- Medical Oncology Department, Hospital Universitario Severo Ochoa, Av. de Orellana, s/n, 28911 Leganés, Madrid, Spain
| | - Jesús García-Donas
- Medical Oncology Department, Hospital Universitario Clara Campal, Calle de Oña, 10, 28050 Madrid, Spain
| | - Carolina Hernández
- Medical Oncology Department, Hospital Universitario Nuestra Señora de la Candelaria, Ctra. Gral. del Rosario, 145, 38010 Santa Cruz de Tenerife, Spain
| | | | - Julia Llinares
- Pfizer S.L.U. Avenida de Europa, 20, 28108, Madrid, Spain
| | - Miguel A Climent
- Medical Oncology Department, Instituto Valenciano De Oncología, Carrer del Professor Beltrán Báguena, 8, 46009 Valencia, Spain
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11
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González Del Alba A, Méndez-Vidal MJ, Vazquez S, Castro E, Climent MA, Gallardo E, Gonzalez-Billalabeitia E, Lorente D, Maroto JP, Arranz JA. SEOM clinical guidelines for the treatment of advanced prostate cancer (2020). Clin Transl Oncol 2021; 23:969-979. [PMID: 33625671 PMCID: PMC8057980 DOI: 10.1007/s12094-021-02561-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/24/2022]
Abstract
The treatment of advanced prostate cancer has evolved due to recent advances in molecular research and new drug development. Dynamic aberrations in the androgen receptor, DNA repair genes, PTEN-PI3K, and other pathways drive the behavior of advanced prostate cancer allowing a better selection of therapies in each patient. Tumor testing for BRCA1 and BRCA2 is recommended for patients with metastatic prostate cancer, also considering a broad panel to guide decisions and genetic counseling. In symptomatic metastatic patients, castration should be stared to palliate symptoms and prolong survival. In high-risk or high-volume metastatic hormone-naïve patients, castration should be combined with docetaxel, abiraterone, enzalutamide or apalutamide. Radiotherapy to the primary tumor combined with systemic therapy is recommended in low-volume mHNPC patients. In patients with non-metastatic castration-resistant tumors, risk stratification can define the frequency of imaging. Adding enzalutamide, darolutamide or apalutamide to these patients prolongs metastasis-free and overall survival, but potential adverse events need to be taken into consideration. The choice of docetaxel, abiraterone or enzalutamide for treating metastatic castration-resistant patients depends on previous therapies, with cabazitaxel being also recommended after docetaxel. Olaparib is recommended in BRCA1/BRCA2 mutated castration-resistant patients after progression on at least one new hormonal therapy. Aggressive variants of prostate cancer respond to platinum-based chemotherapy. To optimize treatment efficiency, oncologists should incorporate all of these advances into an overall therapeutic strategy.
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Affiliation(s)
- A González Del Alba
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Joaquin Rodrigo 2, Majadahonda, 28222, Madrid, Spain.
| | - M J Méndez-Vidal
- Medical Oncology Department, Hospital Universitario Reina Sofía, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain
| | - S Vazquez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - E Castro
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria y Regional de Mälaga, Málaga, Spain
| | - M A Climent
- Medical Oncology Department, Fundación Instituto Valenciano de Oncología, València, Spain
| | - E Gallardo
- Medical Oncology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - E Gonzalez-Billalabeitia
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Instituto Imas12, Madrid, Spain
- Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
| | - D Lorente
- Medical Oncology Department, Hospital Provincial de Castellón, Castellon, Spain
| | - J P Maroto
- Medical Oncology Department, Hospital Universitari Santa Creu i San Pau, Barcelona, Spain
| | - J A Arranz
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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12
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Fradet Y, Bellmunt J, Vaughn DJ, Lee JL, Fong L, Vogelzang NJ, Climent MA, Petrylak DP, Choueiri TK, Necchi A, Gerritsen W, Gurney H, Quinn DI, Culine S, Sternberg CN, Nam K, Frenkl TL, Perini RF, de Wit R, Bajorin DF. Randomized phase III KEYNOTE-045 trial of pembrolizumab versus paclitaxel, docetaxel, or vinflunine in recurrent advanced urothelial cancer: results of >2 years of follow-up. Ann Oncol 2020; 30:970-976. [PMID: 31050707 PMCID: PMC6594457 DOI: 10.1093/annonc/mdz127] [Citation(s) in RCA: 285] [Impact Index Per Article: 71.3] [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: 12/14/2022] Open
Abstract
Background Novel second-line treatments are needed for patients with advanced urothelial cancer (UC). Interim analysis of the phase III KEYNOTE-045 study showed a superior overall survival (OS) benefit of pembrolizumab, a programmed death 1 inhibitor, versus chemotherapy in patients with advanced UC that progressed on platinum-based chemotherapy. Here we report the long-term safety and efficacy outcomes of KEYNOTE-045. Patients and methods Adult patients with histologically/cytologically confirmed UC whose disease progressed after first-line, platinum-containing chemotherapy were enrolled. Patients were randomly assigned 1 : 1 to receive pembrolizumab [200 mg every 3 weeks (Q3W)] or investigator’s choice of paclitaxel (175 mg/m2 Q3W), docetaxel (75 mg/m2 Q3W), or vinflunine (320 mg/m2 Q3W). Primary end points were OS and progression-free survival (PFS) per Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1) by blinded independent central radiology review (BICR). A key secondary end point was objective response rate per RECIST v1.1 by BICR. Results A total of 542 patients were enrolled (pembrolizumab, n = 270; chemotherapy, n = 272). Median follow-up as of 26 October 2017 was 27.7 months. Median 1- and 2-year OS rates were higher with pembrolizumab (44.2% and 26.9%, respectively) than chemotherapy (29.8% and 14.3%, respectively). PFS rates did not differ between treatment arms; however, 1- and 2-year PFS rates were higher with pembrolizumab. The objective response rate was also higher with pembrolizumab (21.1% versus 11.0%). Median duration of response to pembrolizumab was not reached (range 1.6+ to 30.0+ months) versus chemotherapy (4.4 months; range 1.4+ to 29.9+ months). Pembrolizumab had lower rates of any grade (62.0% versus 90.6%) and grade ≥3 (16.5% versus 50.2%) treatment-related adverse events than chemotherapy. Conclusions Long-term results (>2 years’ follow-up) were consistent with those of previously reported analyses, demonstrating continued clinical benefit of pembrolizumab over chemotherapy for efficacy and safety for treatment of locally advanced/metastatic, platinum-refractory UC. Trial registration ClinicalTrials.gov: NCT02256436.
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Affiliation(s)
- Y Fradet
- Department of Surgery/Urology, CHU de Québec-Université Laval, Québec City, Canada.
| | - J Bellmunt
- Department of Medical Oncology, PSMAR-IMIM Research Institute, Barcelona, Spain and Harvard Medical School University, Boston, USA
| | - D J Vaughn
- Department of Medical Oncology, Abramson Cancer Center, Perelman Center for Advanced Medicine, Philadelphia, USA
| | - J L Lee
- Department of Oncology, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - L Fong
- Department of Medicine and Urology, University of California San Francisco, San Francisco
| | - N J Vogelzang
- Department of Medical Oncology, Comprehensive Cancer Centers of Nevada, Las Vegas, USA
| | - M A Climent
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - D P Petrylak
- Division of Medical Oncology, Smilow Cancer Hospital at Yale University, New Haven
| | - T K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - W Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Gurney
- Department of Medical Oncology, Westmead Hospital and Macquarie University, Sydney, NSW, Australia
| | - D I Quinn
- Department of Medical Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, USA
| | - S Culine
- Department of Medical Oncology, Hôpital Saint-Louis, Paris, France
| | - C N Sternberg
- Department of Medical Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York-Presbyterian, New York
| | - K Nam
- Department of Medical Oncology, Merck & Co., Inc., Kenilworth, USA
| | - T L Frenkl
- Department of Medical Oncology, Merck & Co., Inc., Kenilworth, USA
| | - R F Perini
- Department of Medical Oncology, Merck & Co., Inc., Kenilworth, USA
| | - R de Wit
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - D F Bajorin
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
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13
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Roldan-Romero JM, Beuselinck B, Santos M, Rodriguez-Moreno JF, Lanillos J, Calsina B, Gutierrez A, Tang K, Lainez N, Puente J, Castellano D, Esteban E, Climent MA, Arranz JA, Albersen M, Oudard S, Couchy G, Caleiras E, Montero-Conde C, Cascón A, Robledo M, Rodríguez-Antona C, García-Donas J. PTEN expression and mutations in TSC1, TSC2 and MTOR are associated with response to rapalogs in patients with renal cell carcinoma. Int J Cancer 2019; 146:1435-1444. [PMID: 31335987 DOI: 10.1002/ijc.32579] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/31/2019] [Accepted: 06/14/2019] [Indexed: 02/01/2023]
Abstract
The mammalian target of rapamycin (mTOR) pathway inhibitors are key drugs for the treatment of many tumor types, however, there are no predictive biomarkers in clinical use. Here, we performed a molecular and immunohistochemical characterization of key mTOR pathway components in a series of 105 renal cell carcinoma patients treated with rapalogs, aimed at identifying markers of treatment response. Mutational analysis in MTOR, TSC1 and TSC2 was performed through targeted next-generation sequencing (NGS), and immunohistochemistry (IHC) was performed for PTEN, pAKT, pS6K1, pS6 and p21. Among patients with NGS data, 11 of 87 (13%) had mTOR pathway mutations (8 in MTOR, 1 in TSC1 and 2 in TSC2). When comparing the molecular data to the response of the patients, we found that partial response was more frequent in cases with mTOR pathway mutations than in those without mutations (odds ratio [OR] = 0.08, 95% confidence interval [CI] = 0.008-0.79, p = 0.030 univariate; p = 0.038 multivariable). Regarding IHC, negative PTEN staining was detected in 58% of the tumors, and it was more frequent in rapalog responder patients (OR = 0.24, 95% CI = 0.065-0.86, p = 0.029 univariate; p = 0.029 multivariable). Mutations and PTEN IHC were not mutually exclusive events and its combination improved response prediction (OR = 0.16, 95% CI = 0.04-0.62, p = 0.008 univariate; p = 0.013 multivariable). The staining of other proteins did not show and association with response and no association with PFS was observed in unselected patients. In conclusion, our findings suggest that mTOR pathway mutations, negative PTEN IHC and their combination are potential markers of rapalog response.
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Affiliation(s)
- Juan M Roldan-Romero
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Benoit Beuselinck
- Laboratory of Experimental Oncology, Department of Oncology, University of Leuven, Leuven, Belgium
| | - María Santos
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Juan F Rodriguez-Moreno
- Genitourinary and Gynecological Cancer Unit, HM Hospitales - Centro Integral Oncológico HM Clara Campal, Madrid, Spain
| | - Javier Lanillos
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Bruna Calsina
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | - Karin Tang
- Hospital Universitario de Móstoles, Móstoles, Spain
| | - Nuria Lainez
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Javier Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | | | | | | | - Jose A Arranz
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Stephane Oudard
- Department of Medical Oncology, Hôpital Européen Georges-Pompidou, Paris, France
| | | | - Eduardo Caleiras
- Histopathology Core Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Cristina Montero-Conde
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Alberto Cascón
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Cristina Rodríguez-Antona
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Jesús García-Donas
- Genitourinary and Gynecological Cancer Unit, HM Hospitales - Centro Integral Oncológico HM Clara Campal, Madrid, Spain
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14
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Francis PA, Pagani O, Fleming GF, Walley BA, Colleoni M, Láng I, Gómez HL, Tondini C, Ciruelos E, Burstein HJ, Bonnefoi HR, Bellet M, Martino S, Geyer CE, Goetz MP, Stearns V, Pinotti G, Puglisi F, Spazzapan S, Climent MA, Pavesi L, Ruhstaller T, Davidson NE, Coleman R, Debled M, Buchholz S, Ingle JN, Winer EP, Maibach R, Rabaglio-Poretti M, Ruepp B, Di Leo A, Coates AS, Gelber RD, Goldhirsch A, Regan MM. Tailoring Adjuvant Endocrine Therapy for Premenopausal Breast Cancer. N Engl J Med 2018; 379:122-137. [PMID: 29863451 PMCID: PMC6193457 DOI: 10.1056/nejmoa1803164] [Citation(s) in RCA: 375] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In the Suppression of Ovarian Function Trial (SOFT) and the Tamoxifen and Exemestane Trial (TEXT), the 5-year rates of recurrence of breast cancer were significantly lower among premenopausal women who received the aromatase inhibitor exemestane plus ovarian suppression than among those who received tamoxifen plus ovarian suppression. The addition of ovarian suppression to tamoxifen did not result in significantly lower recurrence rates than those with tamoxifen alone. Here, we report the updated results from the two trials. METHODS Premenopausal women were randomly assigned to receive 5 years of tamoxifen, tamoxifen plus ovarian suppression, or exemestane plus ovarian suppression in SOFT and to receive tamoxifen plus ovarian suppression or exemestane plus ovarian suppression in TEXT. Randomization was stratified according to the receipt of chemotherapy. RESULTS In SOFT, the 8-year disease-free survival rate was 78.9% with tamoxifen alone, 83.2% with tamoxifen plus ovarian suppression, and 85.9% with exemestane plus ovarian suppression (P=0.009 for tamoxifen alone vs. tamoxifen plus ovarian suppression). The 8-year rate of overall survival was 91.5% with tamoxifen alone, 93.3% with tamoxifen plus ovarian suppression, and 92.1% with exemestane plus ovarian suppression (P=0.01 for tamoxifen alone vs. tamoxifen plus ovarian suppression); among the women who remained premenopausal after chemotherapy, the rates were 85.1%, 89.4%, and 87.2%, respectively. Among the women with cancers that were negative for HER2 who received chemotherapy, the 8-year rate of distant recurrence with exemestane plus ovarian suppression was lower than the rate with tamoxifen plus ovarian suppression (by 7.0 percentage points in SOFT and by 5.0 percentage points in TEXT). Grade 3 or higher adverse events were reported in 24.6% of the tamoxifen-alone group, 31.0% of the tamoxifen-ovarian suppression group, and 32.3% of the exemestane-ovarian suppression group. CONCLUSIONS Among premenopausal women with breast cancer, the addition of ovarian suppression to tamoxifen resulted in significantly higher 8-year rates of both disease-free and overall survival than tamoxifen alone. The use of exemestane plus ovarian suppression resulted in even higher rates of freedom from recurrence. The frequency of adverse events was higher in the two groups that received ovarian suppression than in the tamoxifen-alone group. (Funded by Pfizer and others; SOFT and TEXT ClinicalTrials.gov numbers, NCT00066690 and NCT00066703 , respectively.).
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Affiliation(s)
- Prudence A Francis
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Olivia Pagani
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Gini F Fleming
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Barbara A Walley
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Marco Colleoni
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - István Láng
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Henry L Gómez
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Carlo Tondini
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Eva Ciruelos
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Harold J Burstein
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Hervé R Bonnefoi
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Meritxell Bellet
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Silvana Martino
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Charles E Geyer
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Matthew P Goetz
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Vered Stearns
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Graziella Pinotti
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Fabio Puglisi
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Simon Spazzapan
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Miguel A Climent
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Lorenzo Pavesi
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Thomas Ruhstaller
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Nancy E Davidson
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Robert Coleman
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Marc Debled
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Stefan Buchholz
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - James N Ingle
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Eric P Winer
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Rudolf Maibach
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Manuela Rabaglio-Poretti
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Barbara Ruepp
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Angelo Di Leo
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Alan S Coates
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Richard D Gelber
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Aron Goldhirsch
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
| | - Meredith M Regan
- From the Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, and Breast Cancer Trials Australia and New Zealand, University of Newcastle, Newcastle, NSW (P.A.F.), and the University of Sydney, Sydney (A.S.C.) - all in Australia; the Institute of Oncology of Southern Switzerland, Ospedale San Giovanni, Bellinzona (O.P.), Breast Cancer St. Gallen, St. Gallen (T.R.), and the International Breast Cancer Study Group Coordinating Center (R.M., M.R.-P., B.R., A.S.C.), University Hospital Inselspital (M.R.-P.), Bern - all in Switzerland; the University of Chicago Medical Center, Chicago (G.F.F.); the University of Calgary, Calgary, AB, Canada (B.A.W.); the Division of Medical Senology, European Institute of Oncology (M.C.), and the European Institute of Oncology and International Breast Cancer Study Group (A.G.), Milan, Ospedale Papa Giovanni XXIII, Bergamo (C.T.), Azienda Socio Sanitaria Territoriale Sette Laghi-Ospedale di Circolo and Fondazione Macchi, Varese (G.P.), Medical Oncology and Cancer Prevention, IRCCS, National Cancer Institute, Aviano (F.P., S.S.), the Department of Medicine, School of Medical Oncology, University of Udine, Udine (F.P.), Salvatore Maugeri Foundation, Pavia (L.P.), and the Hospital of Prato-Azienda Unità Sanitaria Locale Toscana Centro, Prato (A.D.L.) - all in Italy; the National Institute of Oncology, Budapest, Hungary (I.L.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (H.L.G.); University Hospital 12 de Octubre, Madrid (E.C.), Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona (M.B.), and Instituto Valenciano de Oncologia, Valencia (M.A.C.) - all in Spain; the Susan F. Smith Center for Women's Cancers (H.J.B., E.P.W.) and the International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology (R.D.G., M.M.R.), Dana-Farber Cancer Institute, Harvard Medical School, the Harvard T.H. Chan School of Public Health, and Frontier Science and Technology Research Foundation (R.D.G.) - all in Boston; Institut Bergonié Comprehensive Cancer Center, Université de Bordeaux, Bordeaux, France (H.R.B., M.D.); the Angeles Clinic and Research Institute, Santa Monica, CA (S.M.); Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond (C.E.G.); Mayo Clinic, Rochester, MN (M.P.G., J.N.I.); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore (V.S.); Fred Hutchinson Cancer Research Center, University of Washington, Seattle (N.E.D.); Weston Park Hospital, Sheffield, United Kingdom (R.C.); and the Department of Obstetrics and Gynecology, University Medical Center, Regensburg, Germany (S.B.)
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15
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GarcÃa-Donas J, Roldan JM, Lainez N, Castellano DE, González EE, Climent MA, Puente J, Rodriguez-Moreno JF, Alonso Gordoa T, Gonzalez del Alba A, Arranz JA, Santos M, Hernando Polo S, Domenech M, Rodriguez L, Herrador A, Sáez MI, Gallardo Díaz E, Gutierrez AM, Rodríguez-Antona C. Comprehensive molecular and immunohistochemical analysis of advanced renal cell carcinoma patients treated with mTOR inhibitors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Nuria Lainez
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | | | - Javier Puente
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - Maria Santos
- Spanish National Cancer Research Center, Madrid, Spain
| | | | | | | | | | - M Isabel Sáez
- CRIS Cancer Foundation Prostate Cancer Research Group, Institute of Biomedical Research in Malaga/ CNIO-IBIMA Genitourinary Cancer Research Unit, H Universitarios Virgen de la Victoria y Regional de Málaga, Malaga, Spain
| | - Enrique Gallardo Díaz
- Department of Oncology, Parc Tauli Sabadell Hospital Universitari, Institut d’Investigatió i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
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16
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Castellano DE, Climent MA, Duran I, Mellado B, Paramio J, Real FX, Ramirez JL, Sanz JL, Font Pous A. A phase I-II study to evaluate safety and efficacy of the combination of niraparib plus cabozantinib in patients with advanced kidney/urothelial carcinoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps4593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Ignacio Duran
- Hospital Universitario Marques de Valdecilla, Seville, Spain
| | | | - Jesus Paramio
- Unidad de Oncologia Molecular CIEMAT (ed70A), Madrid, Spain
| | | | - Jose Luis Ramirez
- Catalan Institute of Oncology, Laboratory of Molecular Biology, Badalona, Barcelona, Spain
| | | | - Albert Font Pous
- Institut Català d’Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Rodriguez Vida A, Mellado B, Garcia del Muro X, Taus A, Morales Barrera R, Maroto P, Bonfill T, Domenech M, Pinto A, Perez Valderrama B, Climent MA, Puente J, Perez-Gracia JL, González-Billalabeitia E, Vazquez F, Galtes S, Pons B, Macia S, Castellano DE, Bellmunt J. Phase II randomized study of first line avelumab with carboplatin-gemcitabine versus carboplatin-gemcitabine alone in patients with metastatic urothelial carcinoma ineligible for cisplatin-based therapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps4591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Pablo Maroto
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Teresa Bonfill
- Parc Taulí University Hospital, Parc Taulí Institute of Research and Innovation I3PT, Barcelona Autonomous University, Sabadell, Spain
| | | | | | | | | | - Javier Puente
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | | | - Susana Galtes
- Department of Medical Oncology, University Hospital del Mar-IMIM, Barcelona, Spain
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Fradet Y, Bellmunt J, De Wit R, Vaughn DJ, Lee JL, Fong L, Vogelzang NJ, Climent MA, Petrylak DP, Choueiri TK, Necchi A, Gerritsen WR, Gurney H, Quinn DI, Culine S, Sternberg CN, Nam K, Frenkl TL, Perini RF, Bajorin DF. Pembrolizumab (pembro) versus investigator’s choice (paclitaxel, docetaxel, or vinflunine) in recurrent, advanced urothelial cancer (UC): 2-year follow-up from the phase 3 KEYNOTE-045 trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yves Fradet
- CHU de Québec - Université Laval, Québec City, QC, Canada
| | | | | | | | - Jae-Lyun Lee
- Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea, Republic of (South)
| | - Lawrence Fong
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Howard Gurney
- Westmead Hospital and Macquarie University, Sydney, Australia
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Vaughn DJ, Bellmunt J, Fradet Y, Lee JL, Fong L, Vogelzang NJ, Climent MA, Petrylak DP, Choueiri TK, Necchi A, Gerritsen W, Gurney H, Quinn DI, Culine S, Sternberg CN, Mai Y, Li H, Perini RF, Bajorin DF, de Wit R. Health-Related Quality-of-Life Analysis From KEYNOTE-045: A Phase III Study of Pembrolizumab Versus Chemotherapy for Previously Treated Advanced Urothelial Cancer. J Clin Oncol 2018; 36:1579-1587. [PMID: 29590008 DOI: 10.1200/jco.2017.76.9562] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In the phase III KEYNOTE-045 study ( ClinicalTrials.gov identifier: NCT02256436), pembrolizumab significantly prolonged overall survival compared with investigator's choice of chemotherapy in patients with previously treated advanced urothelial cancer. Here, we report the results of health-related quality-of-life (HRQoL) analyses from the KEYNOTE-045 trial. Patients and Methods Patients were randomly assigned 1:1 to pembrolizumab 200 mg or investigator's choice of docetaxel 75 mg/m2, paclitaxel 175 mg/m2, or vinflunine 320 mg/m2 administered intravenously every 3 weeks. Key prespecified HRQoL analyses were time to deterioration (TTD) and mean change from baseline to week 15 in European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 global health status/quality-of-life score. Results Of 542 patients who were randomly assigned, 519 were included in HRQoL analyses (pembrolizumab, n = 266; chemotherapy, n = 253). HRQoL compliance was > 95% at baseline and approximately 88% at week 15 for both groups. Pembrolizumab prolonged TTD in global health status/quality-of-life score compared with chemotherapy (median, 3.5 months v 2.3 months; hazard ratio, 0.72; nominal one-sided P = .004). Mean (95% CI) change from baseline to week 15 in global health status/quality-of-life score was 0.69 (-2.40 to 3.77) with pembrolizumab and -8.36 (-11.84 to -4.89) with chemotherapy (mean difference, 9.05 points; 95% CI, 4.61 to 13.50; nominal two-sided P < .001). Conclusion Pembrolizumab prolonged TTD in HRQoL compared with chemotherapy. Patients who were treated with pembrolizumab had stable or improved global health status/quality of life, whereas those who were treated with investigator's choice of chemotherapy experienced declines in global health status/quality of life. Combined with efficacy and safety outcomes, these data support pembrolizumab as standard of care for patients with platinum-refractory advanced urothelial cancer.
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Affiliation(s)
- David J Vaughn
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joaquim Bellmunt
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yves Fradet
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jae Lyun Lee
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lawrence Fong
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicholas J Vogelzang
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Miguel A Climent
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel P Petrylak
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Toni K Choueiri
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Necchi
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Winald Gerritsen
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Howard Gurney
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David I Quinn
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephane Culine
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cora N Sternberg
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yabing Mai
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Haojie Li
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rodolfo F Perini
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dean F Bajorin
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ronald de Wit
- David J. Vaughn, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Joaquim Bellmunt and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Yves Fradet, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Jae Lyun Lee, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea; Lawrence Fong, University of California, San Francisco, San Francisco; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Miguel A. Climent, Fundación Instituto Valenciano de Oncología, Valencia, Spain; Daniel P. Petrylak, Smilow Cancer Hospital, Yale University, New Haven, CT; Andrea Necchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan; Cora N. Sternberg, San Camillo and Forlanini Hospitals, Rome, Italy; Winald Gerritsen, Radboud University Medical Center, Nijmegen; Ronald de Wit, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; Howard Gurney, Westmead Hospital and Macquarie University, Sydney, New South Wales, Australia; Stephane Culine, Hôpital Saint-Louis, Paris, France; Yabing Mai, Haojie Li, and Rodolfo F. Perini, Merk & Co., Inc., Kenilworth, NJ; and Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY
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Font Pous A, Puente J, Castellano DE, Real FX, Climent MA, Gonzalez del Alba AA, Oudard S, Vazquez Mazon FJ, Morales Barrera R, Virizuela JV, Sala N, Pérez-Valderrama B, Garcia del Muro X, Fernandez PL, Jares P, Aldecoa I, Gibson N, Serra J, Rodrigo Imedio E, Mellado B. Phase II trial of afatinib in patients with advanced/metastatic urothelial carcinoma (UC) with genetic alterations in ERBB receptors 1-3 who failed on platinum-based chemotherapy (CT). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.tps540] [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: 11/20/2022] Open
Abstract
TPS540 Background: First-line treatment of patients (pts) with advanced/metastatic UC consists of platinum-based CT, with no well-established subsequent therapy for platinum-refractory disease. Although checkpoint inhibitors have shown promising results recently, targeted agents have generally not demonstrated significant clinical activity in this setting. Around 20% of UC harbor ERBB family genetic alterations, as such it may be a suitable therapeutic target (Knowles, Nat Rev Cancer 2015;15:25–41). The irreversible ERBB family blocker, afatinib, has shown activity in a Phase II trial in a subset of pts with UC who had ERBB2/ERBB3 aberrations (Choudhury, J Clin Oncol 2016;34:2165–71). This Phase II trial will evaluate afatinib in pts with UC molecularly selected for ERBB receptor alterations. Methods: This single-arm trial will assess the efficacy and safety of afatinib in pts with UC harboring ERBB2/ERBB3 mutations or ERBB2 amplification (Cohort A), or EGFR (ERBB1) amplification (Cohort B). Eligible pts are ≥18 years of age with ECOG PS 0–1, histologically confirmed advanced/metastatic UC of the bladder, upper tract or urethra, not amenable to surgery and progressing during or after platinum-based CT, with available archival tissue samples for pre-screening biomarker analysis. Pts will receive oral afatinib 40 mg/day until disease progression or discontinuation. Cohort A is enrolling in two stages, with Stage 2 enrollment based on anti-tumor activity observed. The primary endpoint is progression-free survival (PFS) rate at 6 months; secondary endpoints include objective response rate, PFS, overall survival, disease control rate, duration of response and tumor shrinkage. Trial objectives will be analyzed separately for the two cohorts. Safety and biomarker assessments will also be performed. The trial commenced in June 2016; as of October 4, 2017, 201 samples have been analyzed, with 24.3% and 8% of pts with genetic alterations potentially eligible for inclusion in Cohort A and B, respectively. To date, 12 pts have received study treatment in Cohort A and 6 in Cohort B; recruitment is ongoing. Clinical trial information: NCT02780687.
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Affiliation(s)
- Albert Font Pous
- Institut Català d’Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Javier Puente
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Francisco X. Real
- Centro Nacional de Investigaciones Oncológicas, Madrid, Spain and Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | | | | | - Rafael Morales Barrera
- Vall d’Hebron Institute of Oncology, Vall d’ Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Nuria Sala
- Institut Català d'Oncologia Girona, Hospital Josep Trueta, Girona, Spain
| | | | | | | | - Pedro Jares
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Neil Gibson
- Boehringer Ingelheim Ltd/ GmbH and Co. KG, Biberach, Germany
| | - Josep Serra
- Boehringer Ingelheim España, SA, Barcelona, Spain
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Bellmunt J, De Wit R, Vaughn DJ, Fradet Y, Lee JL, Fong L, Vogelzang NJ, Climent MA, Petrylak DP, Choueiri TK, Necchi A, Gerritsen W, Gurney H, Quinn DI, Culine S, Sternberg CN, Nam K, Frenkl TL, Perini RF, Bajorin DF. Two-year follow-up from the phase 3 KEYNOTE-045 trial of pembrolizumab (pembro) vs investigator’s choice (paclitaxel, docetaxel, or vinflunine) in recurrent, advanced urothelial cancer (UC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.410] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
410 Background: Based on interim results from the phase 3 KEYNOTE-045 (NCT02256436) study comparing pembro v investigator’s choice of chemotherapy (chemo), pembro was approved for the treatment of locally advanced or metastatic UC that has progressed during or after a platinum-containing regimen. Updated results after 2 years of follow-up are presented. Methods: Eligible patients (histologically or cytologically confirmed UC, progression after platinum, ECOG PS 0-2, measurable disease per RECIST v1.1, ≤2 lines of systemic therapy) were randomly assigned 1:1 to pembro 200 mg Q3W or investigator’s choice of paclitaxel 175 mg/m2 Q3W, docetaxel 75 mg/m2 Q3W, or vinflunine 320 mg/m2 Q3W. Primary efficacy end points were OS and PFS (RECIST v1.1, blinded central review). ORR (RECIST v1.1, blinded central review) was a secondary end point. Results: As of Oct 26, 2017, among the 542 enrolled patients (pembro, 270; chemo, 272), median follow-up was 27.7 mo. Median OS was significantly longer with pembro v chemo (10.3 v 7.3 mo; HR, 0.70; P < 0.0002). OS benefit with pembro v chemo was seen in all PD-L1 expression subgroups (HR: combined positive score [CPS] < 1, 0.82; CPS ≥1, 0.58; CPS < 10, 0.75; CPS ≥10, 0.56) and was maintained regardless of age, ECOG PS, prior therapy, liver metastases, baseline hemoglobin, time from last chemo, histology, risk factor group, and choice of chemo. PFS was not different between arms (2.1 v 3.3 mo; HR, 0.96; P = 0.32). ORR was higher with pembro v chemo (21.1% v 11.0%). Median duration of response was longer with pembro (not reached [1.6+–30.3+ mo] v 4.4 mo [1.4+–29.9+ mo]), and a greater proportion of responses lasted ≥12 mo (68% v 35%) as assessed by Kaplan-Meier method. Fewer patients with pembro v chemo experienced a treatment-related adverse event of any grade (62.0% v 90.6%) and a grade ≥3 adverse event (16.5% v 50.2%). Conclusions: Results observed over 2 years of follow-up, including OS benefit and superior safety with pembro v chemo, were consistent with the interim analyses that led to the approval of pembro in locally advanced or metastatic UC that progressed during or after platinum-based chemotherapy. Clinical trial information: NCT02256436.
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Affiliation(s)
| | - Ronald De Wit
- Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Yves Fradet
- CHU de Québec Université Laval, Québec City, QC, Canada
| | - Jae-Lyun Lee
- University of Ulsan College of Medicine/ Asan Medical Center, Seoul, Korea, Republic of (South)
| | - Lawrence Fong
- University of California San Francisco, San Francisco, CA
| | | | | | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Winald Gerritsen
- Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Howard Gurney
- Westmead Hospital and Macquarie University, Sydney, Australia
| | - David I. Quinn
- USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA
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22
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Maximiano C, Puertas Alvarez JL, Maroto Rey JP, Pinto A, Miranda Pallares MJ, Suarez C, Climent MA, Garcia Carbonero I, Guzman JCV, Borrega P, De Velasco G, Fernandez Parra E, Crespo G, García Domínguez R, Gallardo Diaz E, Meana Garcia A, Garcia Marrero R, Gonzalez Larriba JL, Perez Ramirez S, Arranz Arija JA. SPAZO2 (SOGUG): Outcomes of patients treated with pazopanib as first line in mRC according to gender in real world. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
623 Background: Treatment of mRC is not affected by gender, studying possible differences in a real-world study, could increase the knowledge of toxicity and possible prognostic factors. Methods: SPAZO2 (NCT03091465) was a retrospective real-world study to analyze the effectiveness of 1st-line pazopanib and subsequent therapies in mRC. Data from 530 pt treated outside CT were collected in 50 spanish centers, and externally monitored. Ineligibility criteria: ECOG > 1, pure nonclear-cell, Hgb < 9 g/dl, renal failure, severe cardiovascular disease, chronic liver disease, or recent neoplasia Results: 530 pt were included, 67.2% men (M), mean age was 66.2 years (26-92). There were no significant differences (M vs W) in the age > 75 (24.7 vs 24.1%), clear cell carcinoma (77.2 vs 79.9%), nephrectomy (72.5 vs 68.4%), IMDC (favourable: 15.2 vs 12.1%, intermediate: 59.3 vs 64.4%, poor: 25.6 vs 23.6%), metastases (lymph nodes: 46.1 vs 43.1%, lung: 69,7 vs 67,2 %, liver: 16 vs 20.1%, bone: 27 vs 24.1%, skin/soft tissues: 1.1 vs 3,4% and CNS: 4,8% vs 6.3%). Discontinuation due to toxicity or comorbidities was 12.4 vs 9.8%. There were no differences in the second lines received (57.9 vs 56.9%), neither response, PFS and OS (table). Median follow up was 39 mo. The gender has no prognostic value when adjusted for the prognostic groups of IMDC (HR of PFS 0.96, CI 95% 0.78-1.2, HR of OS: 0.92, CI 95% 0.72-1.14). Only diarrhea and elevation of uric acid were higher in the men group. Conclusions: Pazopanib was safe and effective in both groups with similar outcome. Women had less diarrhea and less increased uric acid. There were not differences in OS or PFS. In IMDC subgroup analysis, there is a trend towards a better evolution or PFS in the poor prognosis women subgroup. Clinical trial information: NCT03091465. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Cristina Suarez
- Vall d’Hebron Institute of Oncology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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23
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Gavila J, Gozalbo F, Climent MA, Guerrero AL, Sandiego S, Blanch S, Algarra MA, Soriano V, Guillem V, Ruiz A, Lopez Guerrero JA. Abstract P2-09-27: Integrated analysis of PTEN protein expression and PI3KCA mutations as predictors for pathological complete response in HER2-positive breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-09-27] [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: Anti-HER2 treatment has also influenced the response to neoadjuvant chemotherapy in HER2-positive breast cancer (BC) by increasing the pathologic complete response (pCR) rate. The activation of HER2 signaling causes the downstream activation of the PI3K/AKT/mTOR pathway that plays a crucial role in developing resistance to trastuzumab (T). Therefore, candidate biomarkers with a potential role in the prediction of a pCR and prognosis after anti-HER2 treatment could be selected from this pathway.
Material and Methods: We retrospectively evaluated PTEN protein expression and PI3KCA mutations in core biopsies from HER2-positive patients treated at our institution with neoadjuvant therapy based on anthracyclines, paclitaxel and T. Protein expression was assessed by immunohistochemistry and used as dichotomic variable, PTEN loss was considered if Hscore ≤ 40. The association of PTEN status, PI3KCA mutation and PI3K activation (defined as either PTEN loss and/or presence of PI3KCA) with pathological complete response (ypT0/isN0) and progression-free survival (PFS) was evaluated.
Results: In our database 86 patients with HER2-positive clinical stage II-III BC were identified. Median follow-up was 75.85 months. PTEN was available from 84 (97.7%) and PI3KCA genotype from 67 patients (77.9%). Median age was 47.34, stage III 58.8% and 50% were hormonal receptor (HR) positive. Low PTEN was described in 29.8% tumors and was statistically associated with Grade1-2 and HR positive tumors. PI3KCA mutations (exon 9 and 20) were observed in 23.9% tumors. PI3K activation was detected in 37.5% tumors. Overall, the pCR rate was 53.5%. In low PTEN tumors pCR was 12% and in PTEN-high tumors, it was 72.1% (p<.0001). pCR rate was statistically different between PIK3CA mutant and wild-type tumors (6.3% vs. 51.9%; p<.0001). PI3K activation was statistically associated with lower pCR rate (12.5 vs. 72.9%; p<.0001). In multivariable analysis adjusted for baseline parameters, HR expression (OR 4.170; 95% CI 0.975-17.829;p=0.054) and PI3K activation (OR 45.87; 95% CI8.059-261.101; p<.0001) independently predicted pCR. In univariable analysis clinical, stage III, non-pCR and PI3K activation were correlated with worse PFS. PI3K activation was statistically associated with lower PFS at 5 years (OR 3.813;CI 95%1.369-10.347; p=0.009) in the multivariable analysis.
Conclusions: The study showed the potential role of PIK3CA Genotype and PTEN expression in predicting pCR and prognosis after anthracycline–taxane-based chemotherapy and anti-HER2 treatment.
Citation Format: Gavila J, Gozalbo F, Climent MA, Guerrero AL, Sandiego S, Blanch S, Algarra MA, Soriano V, Guillem V, Ruiz A, Lopez Guerrero JA. Integrated analysis of PTEN protein expression and PI3KCA mutations as predictors for pathological complete response in HER2-positive breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-27.
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Affiliation(s)
- J Gavila
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - F Gozalbo
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - MA Climent
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - AL Guerrero
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - S Sandiego
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - S Blanch
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - MA Algarra
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - V Soriano
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - V Guillem
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - A Ruiz
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
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24
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Fleming G, Francis PA, Láng I, Ciruelos EM, Bellet M, Bonnefoi HR, Climent MA, Pavesi L, Burstein HJ, Martino S, Davidson NE, Geyer CE, Walley BA, Coleman RE, Kerbrat P, Buchholz S, Ingle JN, Rabaglio-Poretti M, Colleoni M, Regan MM. Abstract GS4-03: Randomized comparison of adjuvant tamoxifen (T) plus ovarian function suppression (OFS) versus tamoxifen in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): Update of the SOFT trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs4-03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The primary results of SOFT at 5.6 years median follow-up found adding OFS to T did not provide a significant benefit in the overall study population of premenopausal women with HR+ BC (Francis et al, NEJM 2015). For those women at sufficient risk for recurrence to warrant adjuvant chemotherapy (CT) and who remained premenopausal, the addition of OFS improved disease outcomes. Follow-up was immature for overall survival (OS). We report a planned update with visit cut-off of 31Dec16 after 8 yrs median follow-up.
Methods: SOFT randomized premenopausal women with HR+ BC from Nov 2003 to Jan 2011 to 5 yrs of T vs T+OFS vs Exemestane(E)+OFS. OFS was by choice of GnRH agonist triptorelin, oophorectomy or ovarian irradiation. SOFT was stratified by the use of prior CT; 47% received no CT and 53% remained premenopausal after prior CT, determined by premenopausal estradiol level within 8 months of CT completion. The primary endpoint was invasive disease-free survival (DFS; randomization until invasive local, regional, distant recurrence or contralateral breast; invasive second malignancy; death). Secondary endpoints included invasive breast cancer-free interval (BCFI), distant recurrence-free interval (DRFI) and OS. NCT00066690.
Results: DFS for patients assigned T+OFS (n=1015) was significantly improved over T (n=1018; HR=0.76 [95%CI 0.62-0.93]) and 8yr DFS was 83.2% vs 78.9%, respectively; BCFI and DRFI results were supportive (see Table). Hazard ratios for these 3 endpoints showed no heterogeneity by use of prior CT. For patients with prior CT, 8yr DFS was 76.7% with T+OFS vs 71.4% with T (Δ=5.3%); in those without CT, 8yr DFS was 90.6% vs 87.4% (Δ=3.2%). E+OFS (n=1014) improved outcomes relative to T (Table); 8yr DFS for E+OFS was 85.9% (80.4% with use of prior CT and 92.5% for those without CT). OS was improved with T+OFS vs T (8yr OS 93.3% vs 91.5%). 8yr OS was 92.1% with E+OFS. 201/225 deaths occurred in women with prior CT. For women without CT there have been 10, 5 and 9 deaths in the T+OFS, T and E+OFS groups (total n=1419), respectively, only half of these deaths after breast cancer event.
N. EventsHazard Ratio (95% CI)Endpoint(3 arms)T+OFS vs TE+OFS vs TDFS5180.76 (0.62-0.93) P=0.0090.65 (0.53-0.81)BCFI4370.76 (0.61-0.95)0.64 (0.51-0.81)DRFI3060.86 (0.66-1.13)0.73 (0.55-0.96)OS2250.67 (0.48-0.92)0.85 (0.62-1.15)
Overall toxicity was worse with T+ OFS than with T, including 32% vs 25% grade 3+ targeted AEs. Early cessation of tamoxifen occurred for 19% assigned T+OFS and 22% of women assigned T; the cumulative incidence of early cessation of triptorelin on the T+OFS arm was 23% by 4yrs. Early cessation of exemestane occurred for 28% and of triptorelin for 21% by 4yrs on the E+OFS arm.
Conclusions: With additional follow-up to a median of 8yrs, SOFT further supports the value of OFS for some premenopausal women. Follow-up continues, which will further clarify the safety and the benefit of OFS for late recurrence and overall survival. Oncologists appear to be able to select a low risk group (no chemotherapy) for whom treatment escalation is unlikely to improve survival.
Citation Format: Fleming G, Francis PA, Láng I, Ciruelos EM, Bellet M, Bonnefoi HR, Climent MA, Pavesi L, Burstein HJ, Martino S, Davidson NE, Geyer Jr CE, Walley BA, Coleman RE, Kerbrat P, Buchholz S, Ingle JN, Rabaglio-Poretti M, Colleoni M, Regan MM. Randomized comparison of adjuvant tamoxifen (T) plus ovarian function suppression (OFS) versus tamoxifen in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): Update of the SOFT trial [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 GS4-03.
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Affiliation(s)
- G Fleming
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - PA Francis
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - I Láng
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - EM Ciruelos
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - M Bellet
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - HR Bonnefoi
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - MA Climent
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - L Pavesi
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - HJ Burstein
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - S Martino
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - NE Davidson
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - CE Geyer
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - BA Walley
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - RE Coleman
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - P Kerbrat
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - S Buchholz
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - JN Ingle
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - M Rabaglio-Poretti
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - M Colleoni
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - MM Regan
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
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Climent MA, Muñoz-Langa J, Basterretxea-Badiola L, Santander-Lobera C. Systematic review and survival meta-analysis of real world evidence on first-line pazopanib for metastatic renal cell carcinoma. Crit Rev Oncol Hematol 2017; 121:45-50. [PMID: 29279098 DOI: 10.1016/j.critrevonc.2017.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 07/31/2017] [Revised: 10/30/2017] [Accepted: 11/14/2017] [Indexed: 12/21/2022] Open
Abstract
A systematic review was conducted to identify real world studies reporting outcomes after first-line pazopanib in patients with metastatic renal cell carcinoma. Studies had to be observational and report survival data in terms of progression-free survival and overall survival in order to conduct meta-analysis techniques. These real-world data were compared to those obtained in the phase II and III randomized controlled trials of pazopanib. Real world evidence showed that the clinical and safety outcomes were consistent with those observed in the clinical trials despite the inclusion of unselected patients with a wide spectrum of prognostic features and comorbidities. Similarly to the results of the pivotal studies, good prognosis patients had the most benefit from pazopanib. Further investigation is needed to complement evidence from clinical trials, in particular focused on patient-centered outcomes.
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Affiliation(s)
| | - José Muñoz-Langa
- Department of Medical Oncology, University Hospital La Fe, Valencia, Spain.
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26
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Fizazi K, Ulys A, Sengeløv L, Moe M, Ladoire S, Thiery-Vuillemin A, Flechon A, Guida A, Bellmunt J, Climent MA, Chowdhury S, Dumez H, Matouskova M, Penel N, Liutkauskiene S, Stachurski L, Sternberg CN, Baton F, Germann N, Daugaard G. A randomized, double-blind, placebo-controlled phase II study of maintenance therapy with tasquinimod in patients with metastatic castration-resistant prostate cancer responsive to or stabilized during first-line docetaxel chemotherapy. Ann Oncol 2017; 28:2741-2746. [PMID: 29059273 PMCID: PMC6246397 DOI: 10.1093/annonc/mdx487] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This phase II study was conducted to assess clinical efficacy of tasquinimod maintenance therapy in patients with metastatic castrate-resistant prostate cancer not progressing during first-line docetaxel-based therapy. PATIENTS AND METHODS Patients were randomly assigned (1 : 1) to receive tasquinimod (0.25-1.0 mg/day orally) or placebo. The primary end point was radiologic progression-free survival (rPFS); secondary efficacy end points included: overall survival (OS); PFS on next-line therapy (PFS 2) and symptomatic PFS, assessed using the Brief Pain Inventory (BPI) questionnaire and analgesic use. Quality of life was measured by the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire and by the EuroQol-5 Dimension Quality of Life Instrument (EQ-5D). Adverse events were recorded. RESULTS A total of 219 patients were screened and 144 patients randomized. The median duration of treatment was 18.7 weeks (range 0.6-102.7 weeks) for the tasquinimod arm and 19.2 weeks (range 0.4-80.0 weeks) for the placebo arm. Median (90% CI) rPFS was 31.7 (24.3-53.7) and 22.7 (16.1-25.9) weeks in the tasquinimod and placebo arms, respectively [HR (90% CI) 0.6 (0.4-0.9), P = 0.0162]. The median OS was not reached because only 14 deaths occurred by the cut-off date. No statistically significant differences between treatment arms were noted for symptomatic PFS, PFS 2, BPI score, FACT-P score, or EQ-5D. The incidence of any treatment emergent adverse event (TEAE) was similar in the tasquinimod and placebo arms (97.2% versus 94.3%, respectively), whereas severe TEAEs (NCI-CTC Grade 3-5) incidence was higher in the tasquinimod group (50.7% versus 27.1%). CONCLUSIONS Randomized trials testing new drugs as maintenance can be successfully conducted after chemotherapy in castrate-resistant prostate cancer. Maintenance tasquinimod therapy significantly reduced the risk of rPFS by 40%. CLINICALTRIALS gov identifier NCT01732549.
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Affiliation(s)
- K Fizazi
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
| | - A Ulys
- National Cancer Institute, Vilnius, Lithuania
| | - L Sengeløv
- Department of Oncology, Herlev Hospital, Herlev
| | - M Moe
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - S Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | | | - A Flechon
- Medicine, Centre Léon Bérard, Lyon, France
| | - A Guida
- Department of Oncology & Hematology, Azienda University Hospital, Modena, Italy
| | - J Bellmunt
- Dana-Farber/Brigham and Women's Cancer Center, Boston, USA
| | - M A Climent
- Department of Medical Oncology, Instituto Valenciano de Oncología, Valencia, Spain
| | - S Chowdhury
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - H Dumez
- Department of General Medical Oncology, University Hospitals Leuven, Leuven; KU Leuven, Leuven, Belgium
| | | | - N Penel
- General Oncology Department, Centre Oscar Lambret, Lille, France
| | - S Liutkauskiene
- Lithuanian University of Health Sciences Hospital, Kaunas, Lithuania
| | | | - C N Sternberg
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - F Baton
- Ipsen Innovation, Les Ulis, France
| | | | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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27
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Bellmunt J, de Wit R, Vaughn DJ, Fradet Y, Lee JL, Fong L, Vogelzang NJ, Climent MA, Petrylak DP, Choueiri TK, Necchi A, Gerritsen W, Gurney H, Quinn DI, Culine S, Sternberg CN, Mai Y, Poehlein CH, Perini RF, Bajorin DF. Pembrolizumab as Second-Line Therapy for Advanced Urothelial Carcinoma. N Engl J Med 2017; 376:1015-1026. [PMID: 28212060 PMCID: PMC5635424 DOI: 10.1056/nejmoa1613683] [Citation(s) in RCA: 2323] [Impact Index Per Article: 331.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with advanced urothelial carcinoma that progresses after platinum-based chemotherapy have a poor prognosis and limited treatment options. METHODS In this open-label, international, phase 3 trial, we randomly assigned 542 patients with advanced urothelial cancer that recurred or progressed after platinum-based chemotherapy to receive pembrolizumab (a highly selective, humanized monoclonal IgG4κ isotype antibody against programmed death 1 [PD-1]) at a dose of 200 mg every 3 weeks or the investigator's choice of chemotherapy with paclitaxel, docetaxel, or vinflunine. The coprimary end points were overall survival and progression-free survival, which were assessed among all patients and among patients who had a tumor PD-1 ligand (PD-L1) combined positive score (the percentage of PD-L1-expressing tumor and infiltrating immune cells relative to the total number of tumor cells) of 10% or more. RESULTS The median overall survival in the total population was 10.3 months (95% confidence interval [CI], 8.0 to 11.8) in the pembrolizumab group, as compared with 7.4 months (95% CI, 6.1 to 8.3) in the chemotherapy group (hazard ratio for death, 0.73; 95% CI, 0.59 to 0.91; P=0.002). The median overall survival among patients who had a tumor PD-L1 combined positive score of 10% or more was 8.0 months (95% CI, 5.0 to 12.3) in the pembrolizumab group, as compared with 5.2 months (95% CI, 4.0 to 7.4) in the chemotherapy group (hazard ratio, 0.57; 95% CI, 0.37 to 0.88; P=0.005). There was no significant between-group difference in the duration of progression-free survival in the total population (hazard ratio for death or disease progression, 0.98; 95% CI, 0.81 to 1.19; P=0.42) or among patients who had a tumor PD-L1 combined positive score of 10% or more (hazard ratio, 0.89; 95% CI, 0.61 to 1.28; P=0.24). Fewer treatment-related adverse events of any grade were reported in the pembrolizumab group than in the chemotherapy group (60.9% vs. 90.2%); there were also fewer events of grade 3, 4, or 5 severity reported in the pembrolizumab group than in the chemotherapy group (15.0% vs. 49.4%). CONCLUSIONS Pembrolizumab was associated with significantly longer overall survival (by approximately 3 months) and with a lower rate of treatment-related adverse events than chemotherapy as second-line therapy for platinum-refractory advanced urothelial carcinoma. (Funded by Merck; KEYNOTE-045 ClinicalTrials.gov number, NCT02256436 .).
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Affiliation(s)
- Joaquim Bellmunt
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Ronald de Wit
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - David J Vaughn
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Yves Fradet
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Jae-Lyun Lee
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Lawrence Fong
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Nicholas J Vogelzang
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Miguel A Climent
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Daniel P Petrylak
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Toni K Choueiri
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Andrea Necchi
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Winald Gerritsen
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Howard Gurney
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - David I Quinn
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Stéphane Culine
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Cora N Sternberg
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Yabing Mai
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Christian H Poehlein
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Rodolfo F Perini
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
| | - Dean F Bajorin
- From Dana-Farber Cancer Institute, Boston (J.B., T.K.C.); Parc de Salut Mar, Hospital del Mar Medical Research Institute, Barcelona (J.B.), and Fundación Instituto Valenciano de Oncología, Valencia (M.A.C.) - both in Spain; Erasmus MC Cancer Institute, Rotterdam (R.W.), and Radboud University Medical Center, Nijmegen (W.G.) - both in the Netherlands; Abramson Cancer Center, University of Pennsylvania, Philadelphia (D.J.V.); Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada (Y.F.); Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea (J.-L.L.); the University of California, San Francisco, San Francisco (L.F.); Comprehensive Cancer Centers of Nevada, Las Vegas (N.J.V.); Smilow Cancer Hospital, Yale University, New Haven, CT (D.P.P.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Westmead Hospital and Macquarie University, Sydney (H.G.); the University of Southern California Norris Comprehensive Cancer Center and Hospital, Los Angeles (D.I.Q.); Hôpital Saint-Louis, Paris (S.C.); San Camillo and Forlanini Hospitals, Rome (C.N.S.); Merck, Kenilworth, NJ (Y.M., C.H.P., R.F.P.); and Memorial Sloan Kettering Cancer Center, New York (D.F.B.)
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Althammer S, Steele K, Rebelatto M, Tan TH, Wiestler T, Schmidt G, Higgs B, Li X, Shi L, Jin X, Antal J, Gupta A, Ranade K, Binning G, Bellmunt J, de Wit R, Vaughn DJ, Fradet Y, Lee JL, Fong L, Vogelzang NJ, Climent MA, Petrylak DP, Choueiri TK, Necchi A, Gerritsen W, Gurney H, Quinn DI, Culine S, Sternberg CN, Mai Y, Puhlmann M, Perini RF, Bajorin DF, Sharma P, Callahan MK, Calvo E, Kim JW, de Braud F, Ott PA, Bono P, Pillai RN, Morse M, Le DT, Taylor M, Spilliopoulou P, Bendell J, Jaeger D, Chan E, Antonia SJ, Ascierto PA, Hennicken D, Tschaika M, Azrilevich A, Rosenberg J, Levy O, Chan C, Cojocaru G, Liang S, Ophir E, Ganguly S, Toporik A, Kotturi M, Kfir TF, Murter BM, Logronio K, Dassa L, Leung L, Greenwald S, Azulay M, Kumar S, Alteber Z, Pan X, Machlenkin A, Benita Y, Drake AW, Chajut A, Salomon R, Vankin I, Safyon E, Hunter J, Levine Z, White M, Leidner R, Kang H, Haddad R, Segal NH, Wirth LJ, Ferris RL, Hodi FS, Sanborn RE, Gajewski TF, Sharfman W, McDonald D, Srivastava S, Gu X, Phillips P, Passey C, Seiwert T, Habtetsion T, Zhou G, Sakellariou-Thompson D, Haymaker C, Creasy C, Hurd M, Uraoka N, Canales JR, Koptez S, Hwu P, Maitra A, Bernatchez C, Coyle SM, Roybel KT, Rupp LJ, Santoro SP, Secrest S, Spelman M, Ho H, Gomes T, Tse T, Yung-Wu C, Taunton J, Lim W, Emtage P, Moudgil T, Ballesteros-Merino C, Hilton T, Paustian C, Leidner R, Page D, Urba W, Fox B, Bell B, Patel A, Olafsen T, Satpayev D, Torgov M, Marchioni F, Romero J, Jiang ZK, Zamilpa C, Keppler JS, Mascioni A, Jia F, Lee CY, Gudas J, Sullivan RJ, Hoshida Y, Logan T, Khushalani N, Giobbie-Hurder A, Margolin K, Roder J, Bhatt R, Koon H, Olencki T, Hutson T, Curti B, Blackmon S, Mier JW, Puzanov I, Roder H, Stewart J, Amin A, Ernstoff MS, Clark JI, Atkins MB, Kaufman HL, Sosman J, Signoretti S, McDermott DF, Anderson AA, Puzanov I, Milhem MM, Andtbacka RHI, Minor D, Gorski KS, Baker DM, Hamid O, Kaufman HL, Akporiaye E, Curti B, Koguchi Y, Leidner R, Sutcliffe K, Conder K, Urba W, Marron T, Bhardwaj N, Hammerich L, George F, Kim-Schulze S, Keler T, Davis T, Crowley E, Salazar A, Brody J, Monjazeb A, Daly ME, Riess J, Li T, Murphy WJ, Kelly K, Hu Z, Shen R, Campbell A, McMichael E, Yu L, Ramaswam B, London CA, Xu T, Carson W, Kokolus KM, Repasky EA, Schell TD, Drabick JD, Messenheimer DJ, Jensen S, Fox B, Rubinstein M, Andrijauskaite K, Swiderska-syn M, Lind K, Choppin A, Roell MK, Wrangle J, Andrijauskaite K, Swiderska-syn M, Rhode P, Wong H, Rubinstein M, Ahmad S, Webb M, Abu-Eid R, Shrimali R, Verma V, Doroodchi A, Berrong Z, Yashar D, Samara R, Mkrtichyan M, Khleif S, Powell S, Gitau M, Sumey C, Terrell A, Lohr M, Nowak RK, McGraw S, Jensen A, Blanchard M, Gold KA, Cohen EEW, Ellison C, Black L, Lee J, Spanos WC, Wennerberg E, Schwitzer E, Lhuillier C, Koelwyn G, Hiner R, Jones L, Demaria S, Amanda V, Greiner JW, Schlom J, Bookstaver M, Jewell CM, Paustian C, Gunderson A, Boulmay B, Li R, Spieler B, Happel K, Moudgil T, Feng Z, Ballesteros-Merino C, Dubay C, Fisher B, Koguchi Y, Aung S, Mederos E, Bifulco CB, McNamara M, Bahjat K, Redmond W, Ochoa A, Hu HM, Mehta A, Lund-Johansen F, Fox B, Urba W, Sanborn RE, Hilton T, Bedu-Addo F, Conn G, King M, Dutta P, Shepard R, Einstein M, Adams S, Wang E, Jin P, Novik Y, Morrison D, Oratz R, Marincola FM, Stroncek D, Goldberg J, Demaria S, Formenti SC, Galon J, Mlecnik B, Marliot F, Ou FS, Bifulco CB, Lugli A, Zlobec I, Rau TT, Nagtegaal ID, Vink-Borger E, Hartmann A, Geppert C, Roehrl MH, Bavi P, Ohashi PS, Wang JY, Nguyen LT, Han S, MacGregor HL, Hafezi-Bakhtiari S, Wouters BG, Kawakami Y, Papivanova B, Xu M, Fujita T, Hazama S, Suzuki N, Nagano H, Okuno K, Itoh K, Zavadova E, Vocka M, Spacek J, Petruzelka L, Konopasek B, Dundr P, Skalova H, Torigoe T, Sato N, Furuhata T, Takemasa I, Van den Eynde M, Jouret-Mourin A, Machiels JP, Fredriksen T, Lafontaine L, Buttard B, Church S, Maby P, Angell H, Angelova M, Vasaturo A, Bindea G, Berger A, Lagorce C, Patel PS, Vora HH, Shah B, Patel JB, Rajvik KN, Pandya SJ, Shukla SN, Wang Y, Zhang G, Masucci GV, Andersson EK, Grizzi F, Laghi L, Botti G, Tatangelo F, Delrio P, Cilberto G, Ascierto PA, Marincola F, Sargent DJ, Fox BA, Algazi A, Tsai K, Rosenblum M, Nandoskar P, Andtbacka RHI, Li A, Nonomura J, Takamura K, Dwyer M, Browning E, Talia R, Twitty C, Gargosky S, Campbell J, Ballesteros-Merino C, Bifulco CB, Fox B, Le M, Pierce RH, Daud A, Gartrell R, Marks D, Stack E, Lu Y, Izaki D, Beck K, Jia DT, Armenta P, White-Stern A, Fu Y, Blake Z, Kaufman HL, Taback B, Horst B, Saenger YM, Leonardo S, Gorden K, Fulton RB, Fraser K, Kangas TO, Walsh R, Ertelt K, Graff J, Uhlik M, Sims JS, Lei L, Tsujiuchi T, Bruce JN, Canoll P, Tolcher AW, Alley EW, Chichili G, Canoll JE, Moore P, Bonvini E, Johnson S, Shankar S, Vasselli J, Wigginton J, Powderly J. 31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016): late breaking abstracts. J Immunother Cancer 2016. [PMCID: PMC5260784 DOI: 10.1186/s40425-016-0191-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Goldhirsch A, Gelber RD, Francis PA, Regan MM, Fleming GF, Lang I, Ciruelos EM, Bellet M, Bonnefoi H, Climent MA, Pavesi L, Burstein HJ, Martino S, Davidson NE, Geyer CE, Walley BA, Coleman RE, Kerbrat P, Rabaglio-Poretti M, Coates AS. Abstract S3-08: Randomized comparison of adjuvant tamoxifen (T) plus ovarian function suppression (OFS) versus tamoxifen in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): Analysis of the SOFT trial. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-s3-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background It is uncertain if the addition of OFS to adjuvant endocrine therapy with T improves outcomes in premenopausal HR+ BC. The SOFT trial was designed to determine the value of OFS in women who remain premenopausal and are treated with T (OFS question) and also to test whether an AI improves outcome in premenopausal women with HR+ BC treated with OFS (AI question). In the combined analysis of the TEXT and SOFT trials (AI question), the group treated with the AI exemestane+OFS had a significantly better disease-free survival (DFS) than those with T+OFS. This abstract presents the results of the OFS question (n=2,045).
Patients and Methods Between November 2003 and January 2011, the SOFT phase 3 trial randomized 3066 premenopausal women with HR+ BC to 5 years of adjuvant endocrine therapy with exemestane+OFS versus T+OFS versus T alone, with OFS initiated by choice of GnRH agonist triptorelin, oophorectomy or ovarian irradiation. Prior chemotherapy was allowed, provided women had confirmed premenopausal estradiol levels within 8 months of completing chemotherapy. The primary end point was DFS which included invasive local, regional, distant and contralateral breast events, second non-breast malignancies and deaths without prior cancer. Because of a lower-than expected overall event rate and to ensure results within a reasonable time-frame, a protocol amendment in 2011 changed the originally event-driven analysis plan. The amendment (1) designated the comparison of T+OFS versus T alone as the primary analysis for SOFT (n=2045), recognizing that the statistical power for the original three pairwise comparisons would be substantially reduced and (2) specified that the primary analysis of T+OFS versus T be undertaken when median follow-up was at least 5 years. The comparison would be tested at the 2-sided 0.05 level with no interim analysis. Based on the projected number of events at the lower rates, the estimated power to detect hazard ratios of 0.75, 0.70, and 0.66 for the comparison would be 52%, 69%, and 80%.
Results The SOFT trial completed planned patient enrollment with an international collaboration involving 426 centres from BIG and NABCG led by the International Breast Cancer Study Group (IBCSG). Numbers of patients randomized, randomization strata, and pt age are summarized in the Table. The database lock for the primary analysis of the OFS question will occur in September 2014 and the final analysis will be completed by October 15, 2014.
SOFT Patients (%)Tamoxifen alone1021 (33%)Tamoxifen+OFS1024 (33%)Exemestane+OFS1021 (33%)* Prior Chemotherapy54%Lymph node positive35%Median age (% < 40 years)43 years (30%)*Patients randomized to Exemestane+OFS are not part of the current analysis
Conclusions We will present the primary analysis of outcomes and toxicities by treatment for women randomized to receive T+OFS versus T and address the value of OFS in addition to T as adjuvant endocrine therapy for premenopausal women with HR+ BC.
Citation Format: Aron Goldhirsch, Richard D Gelber, Prudence A Francis, Meredith M Regan, Gini F Fleming, Istvan Lang, Eva M Ciruelos, Meritxell Bellet, Herve Bonnefoi, Miguel A Climent, Lorenzo Pavesi, Harold J Burstein, Silvana Martino, Nancy E Davidson, Charles E Geyer Jr, Barbara A Walley, Robert E Coleman, Pierre Kerbrat, Manuela Rabaglio-Poretti, Alan S Coates. Randomized comparison of adjuvant tamoxifen (T) plus ovarian function suppression (OFS) versus tamoxifen in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): Analysis of the SOFT trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr S3-08.
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Affiliation(s)
- Aron Goldhirsch
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Richard D Gelber
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Prudence A Francis
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Meredith M Regan
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Gini F Fleming
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Istvan Lang
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Eva M Ciruelos
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Meritxell Bellet
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Herve Bonnefoi
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Miguel A Climent
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Lorenzo Pavesi
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Harold J Burstein
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Silvana Martino
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Nancy E Davidson
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Charles E Geyer
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Barbara A Walley
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Robert E Coleman
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Pierre Kerbrat
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Manuela Rabaglio-Poretti
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - Alan S Coates
- 1SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
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Francis PA, Regan MM, Fleming GF, Láng I, Ciruelos E, Bellet M, Bonnefoi HR, Climent MA, Da Prada GA, Burstein HJ, Martino S, Davidson NE, Geyer CE, Walley BA, Coleman R, Kerbrat P, Buchholz S, Ingle JN, Winer EP, Rabaglio-Poretti M, Maibach R, Ruepp B, Giobbie-Hurder A, Price KN, Colleoni M, Viale G, Coates AS, Goldhirsch A, Gelber RD. Adjuvant ovarian suppression in premenopausal breast cancer. N Engl J Med 2015; 372:436-46. [PMID: 25495490 PMCID: PMC4341825 DOI: 10.1056/nejmoa1412379] [Citation(s) in RCA: 456] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Suppression of ovarian estrogen production reduces the recurrence of hormone-receptor-positive early breast cancer in premenopausal women, but its value when added to tamoxifen is uncertain. METHODS We randomly assigned 3066 premenopausal women, stratified according to prior receipt or nonreceipt of chemotherapy, to receive 5 years of tamoxifen, tamoxifen plus ovarian suppression, or exemestane plus ovarian suppression. The primary analysis tested the hypothesis that tamoxifen plus ovarian suppression would improve disease-free survival, as compared with tamoxifen alone. In the primary analysis, 46.7% of the patients had not received chemotherapy previously, and 53.3% had received chemotherapy and remained premenopausal. RESULTS After a median follow-up of 67 months, the estimated disease-free survival rate at 5 years was 86.6% in the tamoxifen-ovarian suppression group and 84.7% in the tamoxifen group (hazard ratio for disease recurrence, second invasive cancer, or death, 0.83; 95% confidence interval [CI], 0.66 to 1.04; P=0.10). Multivariable allowance for prognostic factors suggested a greater treatment effect with tamoxifen plus ovarian suppression than with tamoxifen alone (hazard ratio, 0.78; 95% CI, 0.62 to 0.98). Most recurrences occurred in patients who had received prior chemotherapy, among whom the rate of freedom from breast cancer at 5 years was 82.5% in the tamoxifen-ovarian suppression group and 78.0% in the tamoxifen group (hazard ratio for recurrence, 0.78; 95% CI, 0.60 to 1.02). At 5 years, the rate of freedom from breast cancer was 85.7% in the exemestane-ovarian suppression group (hazard ratio for recurrence vs. tamoxifen, 0.65; 95% CI, 0.49 to 0.87). CONCLUSIONS Adding ovarian suppression to tamoxifen did not provide a significant benefit in the overall study population. However, for women who were at sufficient risk for recurrence to warrant adjuvant chemotherapy and who remained premenopausal, the addition of ovarian suppression improved disease outcomes. Further improvement was seen with the use of exemestane plus ovarian suppression. (Funded by Pfizer and others; SOFT ClinicalTrials.gov number, NCT00066690.).
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Baselga J, Gómez P, Greil R, Braga S, Climent MA, Wardley AM, Kaufman B, Stemmer SM, Pêgo A, Chan A, Goeminne JC, Graas MP, Kennedy MJ, Ciruelos Gil EM, Schneeweiss A, Zubel A, Groos J, Melezínková H, Awada A. Randomized phase II study of the anti-epidermal growth factor receptor monoclonal antibody cetuximab with cisplatin versus cisplatin alone in patients with metastatic triple-negative breast cancer. J Clin Oncol 2013; 31:2586-92. [PMID: 23733761 DOI: 10.1200/jco.2012.46.2408] [Citation(s) in RCA: 273] [Impact Index Per Article: 24.8] [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
PURPOSE Epidermal growth factor receptor is overexpressed in metastatic triple-negative breast cancers (mTNBCs), an aggressive subtype of breast cancer. Our randomized phase II study investigated cisplatin with or without cetuximab in this setting. PATIENTS AND METHODS Patients who had received no more than one previous chemotherapy regimen were randomly assigned on a 2:1 schedule to receive no more than six cycles of cisplatin plus cetuximab or cisplatin alone. Patients receiving cisplatin alone could switch to cisplatin plus cetuximab or cetuximab alone on disease progression. The primary end point was overall response rate (ORR). Secondary end points studied included progression-free survival (PFS), overall survival (OS), and safety profiles. Analyses included a significance level of α = .10 with no adjustments for multiplicity. RESULTS The full analysis set comprised 115 patients receiving cisplatin plus cetuximab and 58 receiving cisplatin alone; 31 patients whose disease progressed on cisplatin alone switched to cetuximab-containing therapy. The ORR was 20% (95% CI, 13 to 29) with cisplatin plus cetuximab and 10% (95% CI, 4 to 21) with cisplatin alone (odds ratio, 2.13; 95% CI, 0.81 to 5.59; P = .11). Cisplatin plus cetuximab resulted in longer PFS compared with cisplatin alone (median, 3.7 v 1.5 months; hazard ratio [HR], 0.67; 95% CI, 0.47 to 0.97; P = .032). Corresponding median OS was 12.9 versus 9.4 months (HR, 0.82; 95% CI, 0.56 to 1.20; P = .31). Common grade 3/4 adverse events included acne-like rash, neutropenia, and fatigue. CONCLUSION While the primary study end point was not met, adding cetuximab to cisplatin doubled the ORR and appeared to prolong PFS and OS, warranting further investigation in mTNBC.
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Affiliation(s)
- José Baselga
- Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Climent MA, Anido U, Méndez-Vidal MJ, Puente J. Zoledronic acid in genitourinary cancer. Clin Transl Oncol 2013; 15:871-8. [PMID: 23615978 DOI: 10.1007/s12094-013-1033-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 03/21/2013] [Indexed: 11/30/2022]
Abstract
Bone metastases are a common complication of advanced prostate cancer and while they are less common in non-prostate genitourinary (GU) malignances, they have been reported in up to 35 % of patients with advanced renal cell carcinoma and bladder cancer. Furthermore, they may occur in more than two-thirds of those patients with bladder cancer who develop distant metastases. In the absence of bone-targeted therapies, approximately 50 % of all patients with metastatic bone disease from GU cancers experience at least one skeletal-related event within their lifetime. Zoledronic acid is a bisphosphonate that has been shown to delay or prevent the development of skeletal complications in patients with bone metastases and reduce bone pain in these patients. Furthermore, zoledronic acid has also demonstrated the ability to prevent osteopenia, which may occur with the prolonged use of some pharmacological interventions in patients with cancer.
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Affiliation(s)
- M A Climent
- Servicio de Oncología Médica, Instituto Valenciano de Oncología (IVO), C/Beltrán Báguena, 8, 46009, Valencia, Spain,
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Cózar JM, Solsona E, Morote J, Miñana B, Maroto JP, González Del Alba A, Climent MA, Carles J, Alcaraz A, Castellano D. [Recomendations on the management of controversies in advanced castrate-resistant prostate cancer]. Actas Urol Esp 2012; 36:569-77. [PMID: 22999347 DOI: 10.1016/j.acuro.2012.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 06/30/2012] [Indexed: 11/17/2022]
Abstract
CONTEXT Controversies and uncertainties among integral management of advanced castration resistant prostate cancer continue to exist despite the number of evidence based clinical practice guidelines published with high international consensus. OBJECTIVE To develop a document that reviews the management of controversies in advanced castration resistant prostate cancer, with recommendations from the definition, to the management in hormonal maneuvers, first-line treatment and second-line with new treatments as cabazitaxel or abirarerone and the multidisciplinary approach of the pathology with the goal of finding the most efficient, best time to act and safety. EVIDENCE ACQUISITION Two meetings of a multidisciplinary group of experts involved in the management of this disease (Oncologist and Urologist) where pooled analysis of original literature and reached consensus document of recommendations on castration resistant prostate cancer, reviewing and attempting to address the current controversies of the disease. EVIDENCE SYNTHESIS This document is endorsed by the corresponding Scientific Associations and Working Groups involved in the current management of Genitourinary Tumours: the Spanish Association of Urology (AEU) with the Uro-Oncoloy Group (GUO) and the Spanish Oncology of Genitourinary Group (SOGUG). CONCLUSIONS With the adaptation and implementation of this Document of Recommendations for clinical practice are available for the first time, a real road map for quality, efficiency and safety in the management of patients with CRPC.
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Affiliation(s)
- J M Cózar
- Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada, España.
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Guerrero A, Gavilá J, Folkerd E, Ortiz B, Martínez F, García A, Climent MA, Guillem V, Ruíz A. Incidence and predictors of ovarian function recovery (OFR) in breast cancer (BC) patients with chemotherapy-induced amenorrhea (CIA) who switched from tamoxifen to exemestane. Ann Oncol 2012; 24:674-9. [PMID: 23108951 DOI: 10.1093/annonc/mds464] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aromatase inhibitors (AIs) may promote ovarian function recovery (OFR). True incidence, predictors and impact on the outcome of OFR are unknown. PATIENTS AND METHODS We carried out a prospective study to assess ovarian function in estrogen receptor (ER)-positive BC patients on tamoxifen who had at least 2 years of chemotherapy-induced amenorrhea (CIA) and postmenopausal E2 levels. Patients switched to exemestane and underwent a series of investigations including vaginal ultrasound, antimullerian hormone, follicle stimulating hormone (FSH), and E2. E2 measurements were made using a clinical assay (direct) and a highly sensitive (indirect) immunoassay for comparison. RESULTS Both E2 assays (indirect versus direct) showed a similar incidence of OFR 32% (95% CI 19.5-44.5) versus 30% (95% CI 17.7-42.3) and median time to OFR 5.4 months (95% CI 1.2-9.6) versus 6.0 months (95% CI 4.8-7.1).On multivariate analysis, the mean age at the start of exemestane treatment was the only marker associated with probability of OFR (OR: 0.44, 0.24-0.78; P = 0.006). According to a receiver operating characteristic (ROC) analysis, age <48 years predicted for OFR (sensitivity: 59%; 1-specificity: 17%; AUC: 0.796; P = 0.001). Patients with OFR had higher mean E2 levels (43.6 versus 5.76 pmol/l; P = 0.001) and a reduced disease-free survival [DFS; HR 9.3 (95% CI 3.3-48.0; P = 0.04)] than those without it. CONCLUSION Even with a clinical and biochemical profile compatible with menopause, switching from tamoxifen to an AI should be avoided in patients <48 with CIA.
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Affiliation(s)
- A Guerrero
- Department of Medical Oncology, Royal Marsden Hospital, London, UK.
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Climent MA, Piulats JM, Sánchez-Hernández A, Arranz JÁ, Cassinello J, García-Donas J, González del Alba A, León-Mateos L, Mellado B, Méndez-Vidal MJ, Pérez-Valderrama B. Recommendations from the Spanish Oncology Genitourinary Group for the treatment of patients with metastatic castration-resistant prostate cancer. Crit Rev Oncol Hematol 2012; 83:341-52. [PMID: 22285697 DOI: 10.1016/j.critrevonc.2012.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/05/2011] [Accepted: 01/06/2012] [Indexed: 10/14/2022] Open
Abstract
Prostate cancer is the most prevalent urogenital malignancy. However, despite initial disease control using androgen deprivation, most of patients eventually develop progressive disease that is resistant to further hormone manipulation. For these patients with castration-resistant prostate cancer (CRPC), and particularly patients with metastatic disease, options have been limited, and prognosis is grim. However, as newer regimens and agents become available, higher rates of objective and biochemical response are being achieved, providing renewed hope for the management of these patients. With the aim of facilitating the treatment of these patients, the Spanish Oncology Genitourinary Group (SOGUG) has issued a series of the recommendations which have been collected in this review. Each recommendation is accompanied by the appropriate level of evidence and grade of recommendation on the basis of the characteristics of the data available.
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Porta C, Calvo E, Climent MA, Vaishampayan U, Osanto S, Ravaud A, Bracarda S, Hutson TE, Escudier B, Grünwald V, Kim D, Panneerselvam A, Anak O, Motzer RJ. Efficacy and safety of everolimus in elderly patients with metastatic renal cell carcinoma: an exploratory analysis of the outcomes of elderly patients in the RECORD-1 Trial. Eur Urol 2012; 61:826-33. [PMID: 22297244 DOI: 10.1016/j.eururo.2011.12.057] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Elderly patients with metastatic renal cell carcinoma (mRCC) may require special treatment considerations, particularly when comorbidities are present. An understanding of the efficacy and safety of targeted agents in elderly patients with mRCC is essential to provide individualized therapy. OBJECTIVE To evaluate the efficacy and safety of everolimus in elderly patients (those ≥ 65 and ≥ 70 yr of age) enrolled in RECORD-1. DESIGN, SETTING, AND PARTICIPANTS The multicenter randomized RECORD-1 phase 3 trial (Clinicaltrials.gov identifier, NCT00410124; http://www.clinicaltrials.gov) enrolled patients with mRCC who progressed during or within 6 mo of stopping sunitinib and/or sorafenib treatment (n=416). INTERVENTION Everolimus 10mg once daily (n=277) or placebo (n=139) plus best supportive care. Treatment was continued until disease progression or unacceptable toxicity. MEASUREMENTS Median progression-free survival (PFS), median overall survival (OS), and time to deterioration in Karnofsky performance status (TTD-KPS) were assessed using the Kaplan-Meier method; the log-rank test was used to compare treatment arms. Other outcomes evaluated included reduction in tumor burden, overall response rate (ORR), and safety. RESULTS AND LIMITATIONS In RECORD-1, 36.8% of patients were ≥ 65 yr and 17.5% were ≥ 70 yr of age. PFS, OS, TTD-KPS, reduction in tumor burden, and ORR were similar in the elderly and the overall RECORD-1 population. Everolimus was generally well tolerated in elderly patients, and most adverse events were grade 1 or 2 in severity. The toxicity profile of everolimus was generally similar in older patients and the overall population; however, peripheral edema, cough, rash, and diarrhea were reported more frequently in the elderly regardless of treatment. The retrospective nature of the analyses was the major limitation. CONCLUSIONS Everolimus is effective and tolerable in elderly patients with mRCC. When selecting targeted therapies in these patients, the specific toxicity profile of each agent and any patient comorbidities should be considered.
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Affiliation(s)
- Camillo Porta
- IRCCS San Matteo University Hospital Foundation, Pavia, Italy.
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Garcia-Casado Z, Guerrero-Zotano A, Llombart-Cussac A, Calatrava A, Fernandez-Serra A, Ruiz-Simon A, Gavila J, Climent MA, Almenar S, Cervera-Deval J, Campos J, Albaladejo CV, Llombart-Bosch A, Guillem V, Lopez-Guerrero JA. A polymorphism at the 3'-UTR region of the aromatase gene defines a subgroup of postmenopausal breast cancer patients with poor response to neoadjuvant letrozole. BMC Cancer 2010; 10:36. [PMID: 20144226 PMCID: PMC2830181 DOI: 10.1186/1471-2407-10-36] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 02/09/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aromatase (CYP19A1) regulates estrogen biosynthesis. Polymorphisms in CYP19A1 have been related to the pathogenesis of breast cancer (BC). Inhibition of aromatase with letrozole constitutes the best option for treating estrogen-dependent BC in postmenopausal women. We evaluate a series of polymorphisms of CYP19A1 and their effect on response to neoadjuvant letrozole in early BC. METHODS We analyzed 95 consecutive postmenopausal women with stage II-III ER/PgR [+] BC treated with neoadjuvant letrozole. Response to treatment was measured by radiology at 4th month by World Health Organization (WHO) criteria. Three polymorphisms of CYP19A1, one in exon 7 (rs700519) and two in the 3'-UTR region (rs10046 and rs4646) were evaluated on DNA obtained from peripheral blood. RESULTS Thirty-five women (36.8%) achieved a radiological response to letrozole. The histopathological and immunohistochemical parameters, including hormonal receptor status, were not associated with the response to letrozole. Only the genetic variants (AC/AA) of the rs4646 polymorphism were associated with poor response to letrozole (p = 0.03). Eighteen patients (18.9%) reported a progression of the disease. Those patients carrying the genetic variants (AC/AA) of rs4646 presented a lower progression-free survival than the patients homozygous for the reference variant (p = 0.0686). This effect was especially significant in the group of elderly patients not operated after letrozole induction (p = 0.009). CONCLUSIONS Our study reveals that the rs4646 polymorphism identifies a subgroup of stage II-III ER/PgR [+] BC patients with poor response to neoadjuvant letrozole and poor prognosis. Testing for the rs4646 polymorphism could be a useful tool in order to orientate the treatment in elderly BC patients.
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Affiliation(s)
- Zaida Garcia-Casado
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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Cortes J, Di Cosimo S, Climent MA, Cortés-Funes H, Lluch A, Gascón P, Mayordomo JI, Gil M, Benavides M, Cirera L, Ojeda B, Rodríguez CA, Trigo JM, Vazquez J, Regueiro P, Dorado JF, Baselga J. Nonpegylated Liposomal Doxorubicin (TLC-D99), Paclitaxel, and Trastuzumab in HER-2-Overexpressing Breast Cancer: A Multicenter Phase I/II Study. Clin Cancer Res 2008; 15:307-14. [PMID: 19118059 DOI: 10.1158/1078-0432.ccr-08-1113] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Solsona E, Climent MA, Iborra I, Collado A, Rubio J, Ricós JV, Casanova J, Calatrava A, Monrós JL. Bladder preservation in selected patients with muscle-invasive bladder cancer by complete transurethral resection of the bladder plus systemic chemotherapy: long-term follow-up of a phase 2 nonrandomized comparative trial with radical cystectomy. Eur Urol 2008; 55:911-9. [PMID: 18722046 DOI: 10.1016/j.eururo.2008.08.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 08/06/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many phase 2 bladder-sparing programmes using transurethral resection of the bladder (TURB) plus chemotherapy or radio-chemotherapy have been undertaken, but some controversies remain. OBJECTIVE To determine the efficacy of complete TURB plus three cycles of cisplatin-based chemotherapy in selected patients with muscle-invasive bladder cancer (MIBC). DESIGN, SETTING, AND PARTICIPANTS A phase 2 nonrandomized trial was designed that included patients with MIBC who underwent complete TURB with positive biopsies of the tumour bed. Patients with negative biopsies of the tumour bed, with macroscopically residual tumour, with hydronephrosis, or with distant metastasis were excluded from this trial. Patients included in this trial were offered three cycles of systemic chemotherapy or radical cystectomy (RC). Clinical response (cR) was denoted by either no tumour or the presence of Ta1-Tis bladder tumour at 3-mo evaluation; clinical non-response (cNR) was denoted by cases of muscle-invasive tumour or distant metastasis. Of 146 patients who entered this trial, 75 choose the bladder-sparing programme and 71 chose RC. MEASUREMENTS At 5 yr and 10 yr, the cancer-specific survival (CSS) rate was 64.5% and 59.8%, respectively, with no significant difference compared to the RC arm (p=0.544). The progression-free survival with bladder preserved was 52.6% and 34.5%, respectively. In multivariate analysis, cR was the only predictive factor for survival (p=0.001) and bladder preservation (p=0.000). RESULTS AND LIMITATIONS This was not a randomized trial, and patients were included over 16 yr. However, no modifications were made to the therapy schedule except from chemotherapy schemes considered standard at the time. CONCLUSIONS Patients with microscopic residual cancer after complete TURB seem to be good candidates for the bladder-sparing programme using three cycles of systemic chemotherapy, with CSS comparable to RC.
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Affiliation(s)
- Eduardo Solsona
- Urology, Instituto Valenciano de Oncología, Valencia, Spain.
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40
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Tabernero J, Climent MA, Lluch A, Albanell J, Vermorken JB, Barnadas A, Antón A, Laurent C, Mayordomo JI, Estaun N, Losa I, Guillem V, Garcia-Conde J, Tisaire JL, Baselga J. A multicentre, randomised phase II study of weekly or 3-weekly docetaxel in patients with metastatic breast cancer. Ann Oncol 2005; 15:1358-65. [PMID: 15319242 DOI: 10.1093/annonc/mdh349] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A phase II randomised trial was conducted to evaluate the tolerability and activity of weekly or 3-weekly docetaxel in patients with metastatic breast cancer. PATIENTS AND METHODS Eighty-three patients with histologically proven metastatic breast cancer were randomised to receive either docetaxel 40 mg/m2 weekly for 6 consecutive weeks followed by 2 weeks without treatment (n = 41), or docetaxel 100 mg/m2 on day 1 every 3 weeks (n = 42). RESULTS The incidence of all grade 3-4 adverse events was higher in the 3-weekly group than in the weekly group (96 versus 44), and the number of patients with grade 3-4 adverse events was also greater in the 3-weekly group (31 versus 20). Analysis of individual adverse events tended to favour the weekly regimen. Intent-to-treat overall response rate was 34% and 33% in the weekly and 3-weekly groups, respectively. Median time to progression was 5.7 and 5.3 months after weekly and 3-weekly docetaxel, respectively, and median time to treatment failure was 4.1 and 4.9 months, respectively. CONCLUSION Weekly docetaxel is an active regimen in metastatic breast cancer with comparable efficacy to 3 weekly docetaxel. Although both schedules were well tolerated, weekly docetaxel appears to have a more favourable toxicity profile.
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Affiliation(s)
- J Tabernero
- Medical Oncology Service, Vall d'Hebron University Hospital, Barcelona, Spain
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Rubio Briones J, Iborra Juan I, Aznar E, Climent MA, López-Guerrero JA, Maíquez J, Monrós Lliso JL, Casanova Ramón-Borja J, Dumont Martínez R, Ricós Torrent JV, Solsona Narbón E. Utilidad de marcadores séricos del carcinoma renal. Actas Urol Esp 2004; 28:381-6. [PMID: 15264681 DOI: 10.1016/s0210-4806(04)73093-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To select a group of useful serum markers in renal cell carcinoma (RCC) with investigational purpose in future. MATERIAL AND METHODS Periodic determination in serum of 21 RCC patients of the following markers: EGR, RPC, hemogram and leucocyte differential count (LDC), standard biochemist parameters, beta-2 microglobuline, CEA, CA 12.5, CA 50, CA 15.3, ferritin, interleukin-6, serum interleukin-2 receptor, TNF-alpha and TPSA. RESULTS Different elements within the LDC had relations with the presence of symptoms/signs, tumour size, pathological stage and disease progression. There was a significant increase of beta-2 microglobuline and sIL-2 receptor when disease progressed, as well as a similar statistical trend with RPC and alkaline phosphatases. Beta-2 microglobuline and sIL-2 receptor also decreased after treatment of the disease progression. CONCLUSIONS We will keep analysing hemogram, LDC and standard byochemics, RPC, ferritin, beta-2 microglobuline and sIL-2 receptor only with investigational purposes, obviating the determination of the rest of the tested markers.
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Affiliation(s)
- J Rubio Briones
- Servicio Urología, Instituto Valenciano de Oncología, Valencia
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42
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Iborra I, Solsona E, Casanova J, Ricós JV, Rubio J, Climent MA. Conservative elective treatment of upper urinary tract tumors: a multivariate analysis of prognostic factors for recurrence and progression. J Urol 2003; 169:82-5. [PMID: 12478109 DOI: 10.1016/s0022-5347(05)64041-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE We evaluate the safety and efficacy of conservative elective treatment of upper urinary tract tumors, and determine predictive factors for recurrence and progression to optimize indications of this type of treatment. MATERIALS AND METHODS Since 1984 we have performed a prospective study of conservative treatment of single, low grade and stage, less than 3 cm. upper tract tumors. The study includes 54 patients with a normal contralateral kidney who had been followed for more than 36 months. Open conservative surgery was performed in 31 cases and endourological surgery in 23. Minimum followup was 36 months, maximum 210 and mean 84.8. Univariate and multivariate analyses of recurrence and progression were performed in relation to age, sex, association with a bladder tumor, bladder tumor stage and grade, sequence of bladder tumor in relation to upper urinary tract tumor, number of previous bladder tumor recurrences, association with bladder carcinoma in situ, upper urinary tract tumor grade, stage, location, size and therapy, and upper urinary tract cytology. RESULTS Of the 54 patients 19 (35%) had recurrence, which was bilateral recurrence in 4, and progression occurred in 9 (16%). At the end of analysis 44 (62.9%) patients were disease-free and alive at a mean time of 92.88 months, 13 (24%) died disease-free at a mean of 72.7 months and 7 (12.9%) died of disease at a mean of 97.85 months. Cause specific mortality occurred in 7 (12.9% cases). Among the 54 initially conservatively treated units 42 (77.7%) kidneys were ultimately preserved. On univariate and multivariate analysis tumor location in the renal pelvis and association with a previous multi-recurrent bladder tumor were variables significantly related to recurrence and progression, as well as bilateral recurrence. CONCLUSIONS Conservative treatment is an optional approach for select upper urinary tract tumors. The strongest risk factors for recurrence and progression were association with a previous multi-recurrent bladder tumor and tumor location in the renal pelvis but these conditions were also the strongest risk factors for bilateral recurrence. Conservative treatment can also be recommended in these cases but only with compliant patients and close followup.
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Affiliation(s)
- I Iborra
- Department of Urology and Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain
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43
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Iborra I, Solsona E, Casanova J, Ricós JV, Rubio J, Climent MA. Conservative elective treatment of upper urinary tract tumors: a multivariate analysis of prognostic factors for recurrence and progression. J Urol 2003; 169:82-5. [PMID: 12478109 DOI: 10.1097/01.ju.0000040589.56827.4a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluate the safety and efficacy of conservative elective treatment of upper urinary tract tumors, and determine predictive factors for recurrence and progression to optimize indications of this type of treatment. MATERIALS AND METHODS Since 1984 we have performed a prospective study of conservative treatment of single, low grade and stage, less than 3 cm. upper tract tumors. The study includes 54 patients with a normal contralateral kidney who had been followed for more than 36 months. Open conservative surgery was performed in 31 cases and endourological surgery in 23. Minimum followup was 36 months, maximum 210 and mean 84.8. Univariate and multivariate analyses of recurrence and progression were performed in relation to age, sex, association with a bladder tumor, bladder tumor stage and grade, sequence of bladder tumor in relation to upper urinary tract tumor, number of previous bladder tumor recurrences, association with bladder carcinoma in situ, upper urinary tract tumor grade, stage, location, size and therapy, and upper urinary tract cytology. RESULTS Of the 54 patients 19 (35%) had recurrence, which was bilateral recurrence in 4, and progression occurred in 9 (16%). At the end of analysis 44 (62.9%) patients were disease-free and alive at a mean time of 92.88 months, 13 (24%) died disease-free at a mean of 72.7 months and 7 (12.9%) died of disease at a mean of 97.85 months. Cause specific mortality occurred in 7 (12.9% cases). Among the 54 initially conservatively treated units 42 (77.7%) kidneys were ultimately preserved. On univariate and multivariate analysis tumor location in the renal pelvis and association with a previous multi-recurrent bladder tumor were variables significantly related to recurrence and progression, as well as bilateral recurrence. CONCLUSIONS Conservative treatment is an optional approach for select upper urinary tract tumors. The strongest risk factors for recurrence and progression were association with a previous multi-recurrent bladder tumor and tumor location in the renal pelvis but these conditions were also the strongest risk factors for bilateral recurrence. Conservative treatment can also be recommended in these cases but only with compliant patients and close followup.
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Affiliation(s)
- I Iborra
- Department of Urology and Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain
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Germà-Lluch JR, Garcia del Muro X, Maroto P, Paz-Ares L, Arranz JA, Gumà J, Alba E, Sastre J, Aparicio J, Fernández A, Barnadas A, Terrassa J, Sáenz A, Almenar D, López-Brea M, Climent MA, Sánchez MA, Lasso de la Vega R, Berenguer G, Pérez X. Clinical pattern and therapeutic results achieved in 1490 patients with germ-cell tumours of the testis: the experience of the Spanish Germ-Cell Cancer Group (GG). Eur Urol 2002; 42:553-62; discussion 562-3. [PMID: 12477650 DOI: 10.1016/s0302-2838(02)00439-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the clinical characteristics and treatment results obtained with the application of a homogeneous treatment protocol in 1490 patients with germ-cell tumours (GCT) registered in the 55 hospitals belonging to the Spanish Germ-Cell Cancer Group (GG) during the period between January 1994 and April 2001. METHODS In general, surveillance was the common policy for stage I patients without local poor prognosis factors, whereas they received adjuvant chemotherapy in case those factor were present. Chemotherapy schedules used in advanced cases were cisplatin and etoposide (EP) for seminoma and BEP or BOMP-EPI in non-seminoma, according to whether the patient was in the good or poor prognosis IGCCCG (International Germ-Cell Cancer Collaborative Group) group. Excision of residual masses was mandatory in non-seminomatous germ-cell tumour (NSGCT). RESULTS Initial local symptomatology was increased testis size in 90% of cases. Sonography was an excellent diagnostic tool to suggest tumour. Non-seminoma (64.2%) was more frequent than seminoma (35.8%). Approximately 10% had the antecedent of cryptorchidism. Non-seminoma patients were 7 years younger than seminoma. Right testis was involved predominantly. Pre-orchidectomy tumour markers were elevated in 21% of seminoma (betaHGC) and 79% in non-seminoma (alphaFP and/or betaHGC). Scrotum violation occurred in only 1.8%. There were significant differences among stage I and the IGCCCG prognosis groups related to a longer interval between the first symptom and orchiectomy. Eighteen percent of non-seminomatous germ-cell tumour belonged to the poor prognosis IGCCCG group. With a median follow-up to 33 months, this series has achieved a 3 year overall survival of 98% for seminoma and 94% for non-seminoma. Only 10% of excised residual masses present after chemotherapy contained malignant cells. CONCLUSION Spanish GCT have a similar clinical pattern to that described in the other occidental countries except for a slight increased proportion of non-seminoma upon seminoma. Co-operative groups as GG are unique structures to obtain quick and wide experience on the treatment of testis tumours, contributing to achieve a high cure rate.
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Affiliation(s)
- J R Germà-Lluch
- Department of Medical Oncology, Institut Català d'Oncologia, Hospital Duran y Reynals, Av. Gran via s/n, Km 2,7, 08907 Hospitalet, Barcelona, Spain.
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Bellmunt J, Albanell J, Paz-Ares L, Climent MA, González-Larriba JL, Carles J, de la Cruz JJ, Guillem V, Díaz-Rubio E, Cortés-Funes H, Baselga J. Pretreatment prognostic factors for survival in patients with advanced urothelial tumors treated in a phase I/II trial with paclitaxel, cisplatin, and gemcitabine. Cancer 2002; 95:751-7. [PMID: 12209718 DOI: 10.1002/cncr.10762] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND New chemotherapeutic agents, including paclitaxel and gemcitabine, are active in advanced bladder carcinoma, and combination regimens with these agents have shown promising results. Unlike conventional chemotherapy regimens, such as methotrexate, vinblastine, doxorubicin, and cisplatin, there are no data available on key predictive factors for response and survival with these novel agents. Since this information is needed for selection of patients for these new combinations and for stratification purposes in ongoing randomized trials, the authors aimed to study the predictive factors for response and survival to the current regimen containing cisplatin, paclitaxel, and gemcitabine. METHODS The authors studied 56 patients with advanced urothelial tumors treated on a Phase I/II trial of paclitaxel, cisplatin, and gemcitabine (TCG) to identify pretreatment characteristics that were prognostic for survival using this novel combination. The pretreatment characteristics analyzed were age, gender, Eastern Cooperative Oncology Group performance status, histopathology (pure transitional versus other), visceral (liver, lung, or bone) metastasis, number of sites of disease, lactate dehydrogenase, and hemoglobin. RESULTS The factors that were associated with a worse survival in univariate analysis were performance status > 0, presence of visceral metastasis, and more than one site of malignant disease. In a multivariate model, performance status (P = 0.044) and visceral disease (P = 0.008) showed independent statistical significance for decreased survival. Patients were then grouped based on these two independent prognostic factors. Median survival times in the groups of patients with zero, one, or two of these risk factors were 32.8 months, 17 months, and 9.6 months, respectively (P = 0.0005). CONCLUSIONS A pretreatment performance status > 0 and the presence of visceral metastasis have a profound impact on survival when using the TCG regimen. These two variables will be used to stratify patients in the upcoming Phase III randomized trial comparing this TGC regimen with a gemcitabine/cisplatin regimen in advanced urothelial tumors.
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Affiliation(s)
- Joaquim Bellmunt
- Medical Oncology Sevice, Vall d'Hebron University Hospital, Barcelona, Spain.
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Garcia del Muro X, Marcuello E, Gumá J, Paz-Ares L, Climent MA, Carles J, Parra MS, Tisaire JL, Maroto P, Germá JR. Phase II multicentre study of docetaxel plus cisplatin in patients with advanced urothelial cancer. Br J Cancer 2002; 86:326-30. [PMID: 11875692 PMCID: PMC2375206 DOI: 10.1038/sj.bjc.6600121] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2001] [Revised: 11/13/2001] [Accepted: 12/05/2001] [Indexed: 11/09/2022] Open
Abstract
A multicentre phase II trial was undertaken to evaluate the activity and toxicity of docetaxel plus cisplatin as first-line chemotherapy in patients with urothelial cancer. Thirty-eight patients with locally advanced or metastatic transitional-cell carcinoma of the bladder, renal pelvis or ureter received the combination of docetaxel 75 mg m(-2) and cisplatin 75 mg m(-2) on day 1 and repeated every 21 days, to a maximum of six cycles. The median delivered dose-intensity was 98% (range 79-102%) of the planned dose for both drugs. There were seven complete responses and 15 partial responses, for and overall response rate of 58% (95% CI, 41-74%). Responses were even seen in three patients with hepatic metastases. The median time to progression was 6.9 months, and the median overall survival was 10.4 months. Two patients who achieved CR status remain free of disease at 4 and 3 years respectively. Grade 3-4 granulocytopenia occurred in 27 patients, resulting in five episodes of febrile neutropenia. There was one toxic death in a patient with grade 4 granulocytopenia who developed acute abdomen. Grade 3-4 thrombocytopenia was rare (one patient). Other grade 3-4 toxicities observed were anaemia (three patients), vomiting (five patients), diarrhoea (four patients), peripheral neuropathy (two patients) and non-neutropenic infections (seven patients). Docetaxel plus cisplatin is an effective and well-tolerated regimen for the treatment of advanced urothelial cancer, and warrants further investigation.
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Affiliation(s)
- X Garcia del Muro
- Institut Català d'Oncologia, Department of Medical Oncology, Avda Gran Vía km 2.7, 08907 L'Hospitalet, Barcelona, Spain.
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Climent MA, Seguí MA, Peiró G, Molina R, Lerma E, Ojeda B, López-López JJ, Alonso C. Prognostic value of HER-2/neu and p53 expression in node-positive breast cancer. HER-2/neu effect on adjuvant tamoxifen treatment. Breast 2001; 10:67-77. [PMID: 14965564 DOI: 10.1054/brst.2000.0225] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
HER-2/neu and p53 expression, conventional clinical and pathologic prognostic factors, were evaluated in a retrospective series of 283 node-positive breast cancer patients. Overexpression was determined by immunohistochemistry in formalin-fixed paraffin-embedded tissue blocks. Twenty one percent were HER-2/neu positive and 40% p53 positive. HER-2/neu expression was related to axillary lymph node metastasis (P=0.014), inflammatory infiltrates (P=0.004), and the absence of oestrogen (ER) (P=0.0026) and progesterone (P=0.01) receptors (PR). p53 expression was related to lymph node involvement (P=0.03), necrosis (P=0.036), absence of ER (P=0.028) and PR (P=0.065). p53 was not associated with outcome. HER-2/neu was an unfavourable prognostic factor for disease-free (DFS) (P=0.05) and overall survival (OS) (P=0.02) in univariate analysis. Multivariate analysis showed that the number of involved axillary nodes (P<0.00001), age (P=0.004), grade (P=0.04), and PR (P=0.04) were independent predictors for OS. ER-positive patients treated with adjuvant tamoxifen had shorter DFS and OS when they were HER-2/neu positive.
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Affiliation(s)
- M A Climent
- Instituto Valenciano de Oncología, Barcelona, Spain
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48
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Gaspar C, Zapater E, Chust M, Climent MA, Ferrándis E, Muñoz MA, Mengual JL, Berrocal A, Vendrell BJ, Arribas L, Guillem V. [Experience in the treatment of 98 carcinomas of the nasopharynx. Long-term follow-up and analysis of prognostic factors]. Acta Otorrinolaringol Esp 2000; 51:691-6. [PMID: 11270103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
This was a retrospective study of 98 patients (pts.) with histologically confirmed nasopharyngeal carcinoma. The clinico-demographic characteristics were: median age of 53 years (11-83); 74 males and 24 females (ratio 3:1); histology subtype OMS 2-3 in 89 pts. (90.8%); cranial nerve deficits in 11 pts. (11.2%); 50 (51%) were stage T3T4; 68 pts. (69.4%) N2N3 and 77 pts. (78.6%) stage IV. The therapeutic modalities were: radical radiotherapy (RT) alone in 42 pts., chemotherapy (CT) alone in 4 pts., RT + adjuvant CT in 10 pts. and neoadjuvant CT + RT in 42 pts. RT was delivered in wide fields, doses between 50-75 Gy with conventional fractionation. CT consisted in cisplatinum-based schedules (PF in 34 pts., BEC in 9 and others in 13 pts.). Analyzed by treatment, more males and stages N2N3 and IV were accrued in neoCT + RT arm (p < or = 0.05). For the entire population, the overall complete response was achieved in 65 pts. (66.3%); in 27/35 pts. (77.1%) of the RT group and 30/51 pts. (58.8%) of CT + RT group (p 0.07) of pts. with III-IV stages. With a median follow-up of 74.5 months, 32 pts. (32.65%) are alive and free of disease. The projected OS for all pts. was 40 months (m), 51.4% at 3 years (y) and 45.5% at 5 y with a disease free survival of 37 m (0-236). No differences between treatment arms were found (p 0.4). In univariant analysis for OS in stage III-IV pts., age > 50 y, histology OMS1, cranial nerve deficits, stage T3T4 and N2N3, were considered adverse prognostic factors (p < or = 0.05). In multivariant analysis, only age > 50 y and stages T3-T4, N2-N3 were significant (p < or = 0.05). In conclusion, we demonstrated good long term survival without any differences among treatment modalities in pts. with advanced nasopharyngeal carcinomas. New therapeutic approaches are warranted in order to improve the outcome of this patients.
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Affiliation(s)
- C Gaspar
- Servicio de Oncología Médica, Instituto Valenciano de Oncología, C/Prof. Beltrán Báguena, 9 y 19, 46009 Valencia
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Bellmunt J, Guillem V, Paz-Ares L, González-Larriba JL, Carles J, Batiste-Alentorn E, Sáenz A, López-Brea M, Font A, Nogué M, Bastús R, Climent MA, de la Cruz JJ, Albanell J, Banús JM, Gallardo E, Diaz-Rubio E, Cortés-Funes H, Baselga J. Phase I-II study of paclitaxel, cisplatin, and gemcitabine in advanced transitional-cell carcinoma of the urothelium. Spanish Oncology Genitourinary Group. J Clin Oncol 2000; 18:3247-55. [PMID: 10986057 DOI: 10.1200/jco.2000.18.18.3247] [Citation(s) in RCA: 153] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the maximum-tolerated dose and the antitumor activity of a combination of paclitaxel, cisplatin, and gemcitabine in advanced transitional-cell carcinoma (TCC) of the urothelium. PATIENTS AND METHODS Patients with measurable, previously untreated, locally advanced or metastatic TCC and with Eastern Cooperative Oncology Group performance status < or = 2 and creatinine clearance > or = 55 mL/min were eligible. Cisplatin was given on day 1 at a fixed dose of 70 mg/m(2). Paclitaxel and gemcitabine were given on days 1 and 8 at increasing dose levels. Cycles were repeated every 21 days to a maximum of six cycles. RESULTS Sixty-one patients were registered. In phase I, 15 patients were entered at four different dose levels. Dose-limiting toxicity consisted of early onset (after the first cycle) grade 2 asthenia (two of six patients) and grade 3 asthenia (one of six patients) at dose level 4. A paclitaxel dose of 80 mg/m(2) and gemcitabine 1,000 mg/m(2) was recommended for phase II, and 46 additional patients were entered at this level for a total of 49 patients. Main nonhematologic toxicity was grade 2 asthenia in 18 patients, with early onset in five patients, and grade 3 in four patients. Grade 3/4 neutropenia and thrombocytopenia occurred in 27 (55%) and 11 (22%) patients, respectively. Overall, febrile neutropenia was seen in 11 patients, and one toxic death occurred because of neutropenic sepsis. The combination was active at all dose levels. In total, 58 of 61 eligible patients were assessable for response; 16 complete responses (27.6%) and 29 partial responses (50%) were observed for an overall response rate of 77.6% (95% confidence interval, 60% to 98%). The median survival time (MST) available for the phase I part of the study is 24.0 months. MST has not been reached for the whole group with the current follow-up. CONCLUSION This combination of paclitaxel, cisplatin, and gemcitabine is feasible and highly active in patients with advanced TCC of the urothelium. Further evaluation of this regimen in patients with TCC is warranted.
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Affiliation(s)
- J Bellmunt
- Hospital General Universitari Vall d'Hebron, Bacelona, Spain.
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Palau J, Picón I, Aznar E, Climent MA, Máiquez J. [Cost of antibiotic therapy in neutropenic patients undergoing peripheral blood stem cell transplantation for breast cancer]. Rev Esp Quimioter 2000; 13:193-8. [PMID: 10918094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The increase in pharmaceutical costs, especially for expensive procedures such as bone marrow transplants, has led to the study of the economic impact of febrile neutropenia in peripheral blood stem cell transplantation (PBSCT). We analyzed 89 consecutive patients with breast cancer who underwent PBSCT. All patients developed febrile neutropenia and were administered an empirical intravenous regimen based on the combination of piperacillin-tazobactam and amikacin. We analyzed the direct costs of this treatment and grouped them into drug acquisition cost, administration costs (cost of the additional material), and preparation costs (time employed for the preparation and administration of the drug). We found that the overall cost was $1,110, 65% of which corresponded to the initial therapy and the rest (35%) to the use of additional antibiotics. This higher cost was especially related to the use of vancomycin or teicoplanin (50%). The acquisition costs accounted for 90% of the overall treatment costs. Thirty-six patients (40%) did not need additional antibiotics and the cost in this group was less ($663). We concluded that knowledge of the costs of pharmacological therapy for infection in PBSCT is indispensable for the appropriate development of treatment units, especially in terms of optimizing resources and comparing different therapeutic or prophylactic approaches.
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Affiliation(s)
- J Palau
- Unidad de Trasplante de Médula Osea
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