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Schmid P, Pinder S, Wheatley D, Zummit C, Macaskill EJ, Hu J, Price R, Bundred N, Hadad S, Shia A, Sarker SJ, Lim L, Mousa K, O'Brien C, Wilson TR, Lackner MR, Gendreau S, Gazinska P, Korbie D, Trau M, Mainwaring P, Thompson A, Purushotham A. Abstract P2-08-02: Interaction of PIK3CA mutation subclasses with response to preoperative treatment with the PI3K inhibitor pictilisib in patients with estrogen receptor-positive breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Although preclinical data suggest that combining PI3K inhibitors with endocrine therapy may overcome resistance, results from randomized clinical trials have failed to identify a subgroup of patients that derive a substantial benefit. This preoperative window study assessed whether adding the PI3K inhibitor pictilisib can increase the anti-tumor effects of anastrozole in primary breast cancer and aimed to identify the most appropriate patient population for combination therapy.
Methods: In this randomized, open-label, phase 2 study, 167 postmenopausal women with newly diagnosed, operable, ER-positive, HER2-negative breast cancers were recruited. Participants were randomly allocated (2:1, favoring the combination) to two-weeks of preoperative treatment with anastrozole 1 mg once daily or the combination of anastrozole 1mg with pictilisib 260 mg once daily. The primary endpoint was inhibition of tumor cell proliferation, as measured by change in Ki-67 protein expression between tumor samples taken before and at the end of treatment. Secondary endpoints include induction of apoptosis (Caspase3) and safety. Comprehensive biomarkers analyses included targeted NGS of a comprehensive cancer panel of >400 genes (Ampliseq Comprehensive Cancer panel), copy number variation analyses, and pre- and post-treatment reverse-phase protein arrays (RPPA) and RNA profiling (NanoString nCounter platform).
Results:There was significantly greater geometric mean Ki67 suppression of 82.5% (90% CI, 78.3%-85.8%) for the combination vs 70.7% (61.0%-78.0%) for anastrozole [geometric mean ratio (combination/ anastrozole) 0.60 (0.58-0.85);p=0.01]. Higher baseline Ki67, Luminal B status and/or negative PR status were associated with increased benefit from adding pictilisib. A significant interaction was observed between PIK3CA mutation subtypes [helical domain mutations (HD), kinase domain mutations (KD), wildtype (WT)] and mean Ki67 suppression; the combination/anastrozole geometric mean ratio of Ki67 suppression was 0.48 (0.27-0.84; p=0.02) for patients with HD mutations and 0.63 (0.39–1.0; p=0.05) for patients with PIK3Ca WT, compared to 1.17 (0.57–2.41; p=0.64) for patients with KD mutations. This was largely due to patients with HD mutations showing a particularly poor response to anastrozole alone [mean Ki67 suppression 53.9% (9.5%-76.5%)], that was reversed by the addition of pictilisib [mean Ki-67 suppression 78.1% (71.0%-83.4%)]. On the other hand, patients with KD mutations responded well to anastrozole alone [mean Ki-67 suppression 77.7% (57.0%-88.4%)] and showed no benefit from the addition of pictilisib [mean Ki-67 suppression 73.9% (59.8%-83.0%)]. There was no significant difference in induction of apoptosis between treatment groups. Comprehensive pre- and post-treatment biomarkers analyses will be presented.
Conclusions: Adding pictilisib to anastrozole significantly increases the anti-proliferative response to preoperative treatment with anastrozole. A significant interaction was observed between PIK3CA mutation subtypes, with patients with helical domain mutations showing a particularly poor response to anastrozole alone that was reversed by the addition of pictilisib.
Citation Format: Schmid P, Pinder S, Wheatley D, Zummit C, Macaskill EJ, Hu J, Price R, Bundred N, Hadad S, Shia A, Sarker S-J, Lim L, Mousa K, O'Brien C, Wilson TR, Lackner MR, Gendreau S, Gazinska P, Korbie D, Trau M, Mainwaring P, Thompson A, Purushotham A. Interaction of PIK3CA mutation subclasses with response to preoperative treatment with the PI3K inhibitor pictilisib in patients with estrogen receptor-positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-02.
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Affiliation(s)
- P Schmid
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S Pinder
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - D Wheatley
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - C Zummit
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - EJ Macaskill
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - J Hu
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - R Price
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - N Bundred
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S Hadad
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - A Shia
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S-J Sarker
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - L Lim
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - K Mousa
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - C O'Brien
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - TR Wilson
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - MR Lackner
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S Gendreau
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - P Gazinska
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - D Korbie
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - M Trau
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - P Mainwaring
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - A Thompson
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - A Purushotham
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
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Sipos O, Tovey H, Quist J, Haider S, Nowinski S, Gazinska P, Kernaghan S, Toms C, Timms KM, Lanchbury JS, Linn SC, Pinder SE, Bliss JM, Tutt A, Cheang MC, Grigoriadis A. Abstract P1-06-07: Characterization of chromosomal instability in the TNT trial: A randomized phase III trial of carboplatin compared with docetaxel for patients with metastatic or recurrent locally advanced triple negative or BRCA1/2 breast cancer (CRUK/07/012). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-06-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
A distinctive trait of triple negative breast cancer (TNBC) is the acquisition of genome wide highly aberrant copy number states, which is more evident in metastatic settings. The level of copy number alterations can be characterized by quantitative estimates of chromosomal instability, such as allelic imbalanced copy number aberrations, telomeric allelic imbalance (NtAI), homologous recombination deficiency (HRD) score, referred here as genomic scars. Several of these scars are reported as being indicative of BRCAness and potential predictive and/or prognostic biomarkers of chemotherapy response, currently mostly demonstrated in neoadjuvant settings in TNBC.
Aims
Using several genomic scar measures, we aim to capture chromosomal instability and test their predictive and prognostic value in metastatic or recurrent locally advanced triple negative or BRCA1/2 mutated breast cancer in the TNT trial.
Methods
Patients recruited to TNT (n=376) had ER-/PR-/Her2- breast cancer or were germline BRCA mutation carriers. Genome-wide copy numbers (CN) were derived from FFPE samples including primary tumours and positive lymph nodes (n=183, docetaxel=93, carboplatin=90; BRCA1 mut=25). Genomic scars were generated using ASCAT (Van loo et al., PNAS 2010) CN profiles. HRD scores were established by Myriad Genetics, Inc. assay (n=272). BRCA1-like classifier was applied as described in Schouten et al., Mol Onc 2015. Shannon diversity index was calculated using ASCAT raw CN profiles. Association of genomic scars with PAM50 subtypes and BRCA1 deficiency status were evaluated using Kruskal-Wallis test; p-values were adjusted for multiple comparisons (Dunn's test). Statistical significance was defined as p<0.05. Association of genomic scars with objective tumour response rate (ORR) and Progression Free Survival (PFS) was assessed using logistic regression and restricted mean survival analysis, respectively.
Results
HRD and NtAI scores were higher in basal like samples compared to non-basal like (median diff. HRD=11.5, p=0.005; NtAI=3, p=0.04). HRD (p=2e-14) and NtAI (p=0.003) scores were also higher in BRCA1 deficient (BRCA1 germline/somatic mutant or BRCA1 methylated) samples compared to non-deficient. Using the BRCA1-like classifier, 42 out of 50 BRCA1 deficient samples and 93 out of 133 BRCA1 non-deficient/undetermined samples were identified as BRCA1-like. The Shannon diversity index, measuring CN heterogeneity, clustered samples into 3 groups. Analysis of ORR showed non-significant trends to preferential response rates with docetaxel in cluster 1 and 3. Membership of cluster 2 predicted higher ORR to carboplatin over docetaxel (interaction p=0.017). PFS indicated a treatment effect in cluster 2, but not in cluster 1 or 3; there was no evidence of interaction between subgroups and treatment (p=0.15).
Conclusions
Our results suggest that the overall heterogeneity of the copy number landscape is a promising area for seeking predictive/prognostic biomarkers in metastatic TNBC, and combined with other modalities of high-dimensional omics data could provide essential treatment response information.
Citation Format: Sipos O, Tovey H, Quist J, Haider S, Nowinski S, Gazinska P, Kernaghan S, Toms C, Timms KM, Lanchbury JS, Linn SC, Pinder SE, Bliss JM, Tutt A, Cheang MC, Grigoriadis A, On behalf of the TNT Trial Management Group and Investigators. Characterization of chromosomal instability in the TNT trial: A randomized phase III trial of carboplatin compared with docetaxel for patients with metastatic or recurrent locally advanced triple negative or BRCA1/2 breast cancer (CRUK/07/012) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-06-07.
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Affiliation(s)
- O Sipos
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - H Tovey
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - J Quist
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - S Haider
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - S Nowinski
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - P Gazinska
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - S Kernaghan
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - C Toms
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - KM Timms
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - JS Lanchbury
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - SC Linn
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - SE Pinder
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - JM Bliss
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - A Tutt
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - MC Cheang
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - A Grigoriadis
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
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