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Adamo B, Bellet M, Paré L, Pascual T, Vidal M, Pérez Fidalgo JA, Blanch S, Martinez N, Murillo L, Gómez-Pardo P, López-González A, Amillano K, Canes J, Galván P, González-Farré B, González X, Villagrasa P, Ciruelos E, Prat A. Oral metronomic vinorelbine combined with endocrine therapy in hormone receptor-positive HER2-negative breast cancer: SOLTI-1501 VENTANA window of opportunity trial. Breast Cancer Res 2019; 21:108. [PMID: 31533777 PMCID: PMC6751874 DOI: 10.1186/s13058-019-1195-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 09/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background The biological effect of oral metronomic vinorelbine (mVNB) alone or in combination with endocrine therapy in patients with hormone receptor-positive (HR+)/HER2-negative breast cancer has been scarcely addressed. Methods Postmenopausal women with untreated stage I–III HR+/HER2-negative breast cancer were randomized (1:1:1) to receive 3 weeks of letrozole (LTZ) 2.5 mg/day, oral mVNB 50 mg 3 days/week, or the combination. The primary objective was to evaluate, within PAM50 Luminal A/B disease, if the anti-proliferative effect of LTZ+mVNB was superior to monotherapy. An anti-proliferative effect was defined as the mean relative decrease of the PAM50 11-gene proliferation score in combination arm vs. both monotherapy arms. Secondary objectives included the evaluation of a comprehensive panel of breast cancer-related genes and safety. An unplanned analysis of stromal tumor-infiltrating lymphocytes (sTILs) was also performed. PAM50 analyses were performed using the nCounter®-based Breast Cancer 360™ gene panel, which includes 752 genes and 32 signatures. Results Sixty-one patients were randomized, and 54 paired samples (89%) were analyzed. The main patient characteristics were mean age of 67, mean tumor size of 1.7 cm, mean Ki67 of 14.3%, stage I (55.7%), and grades 1–2 (90%). Most baseline samples were PAM50 Luminal A (74.1%) or B (22.2%). The anti-proliferative effect of 3 weeks of LTZ+mVNB (− 73.2%) was superior to both monotherapy arms combined (− 49.9%; p = 0.001) and mVNB (− 19.1%; p < 0.001). The anti-proliferative effect of LTZ+mVNB (− 73.2%) was numerically higher compared to LTZ (− 65.7%) but did not reach statistical significance (p = 0.328). LTZ+mVNB induced high expression of immune-related genes and gene signatures, including CD8 T cell signature and PDL1 gene and low expression of ER-regulated genes (e.g., progesterone receptor) and cell cycle-related and DNA repair genes. In tumors with ≤ 10% sTILs at baseline, a statistically significant increase in sTILs was observed following LTZ (paired analysis p = 0.049) and LTZ+mVNB (p = 0.012). Grade 3 adverse events occurred in 3.4% of the cases. Conclusions Short-term mVNB is well-tolerated and presents anti-proliferative activity alone and in combination with LTZ. The high expression of immune-related biological processes and sTILs observed with the combination opens the possibility of studying this combination with immunotherapy. Further investigation comparing these biological results with other metronomic schedules or drug combinations is warranted. Trial registration NCT02802748, registered 16 June 2016. Supplementary information Supplementary information accompanies this paper at 10.1186/s13058-019-1195-z.
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Affiliation(s)
- Barbara Adamo
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel 170, 08035, Barcelona, Spain
| | - Meritxell Bellet
- Vall d'Hebrón University Hospital/Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Laia Paré
- Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel 170, 08035, Barcelona, Spain.,SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Tomás Pascual
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel 170, 08035, Barcelona, Spain.,SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Maria Vidal
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel 170, 08035, Barcelona, Spain
| | | | - Salvador Blanch
- Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Laura Murillo
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Patricia Gómez-Pardo
- Vall d'Hebrón University Hospital/Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Jordi Canes
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Patricia Galván
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | - Eva Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain. .,Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel 170, 08035, Barcelona, Spain. .,SOLTI Breast Cancer Research Group, Barcelona, Spain.
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Sánchez-Rovira P, Zamora P, Salvador-Bofill J, Morales S, Martínez-Jáñez N, Martínez-de-Dueñas E, Lluch A, Illarramendi JJ, Gómez-Pardo P, Gavilá Gregori J, García-Palomo A, García-Mata J, Fernández Y, Del Barco S, de Juan A, Ciruelos E, Chacón JI, Calvo L, Barnadas A, Albanell J. Broad consensus on the optimal sequence for the systemic treatment of metastatic breast cancer: results from a survey of Spanish medical oncologists. J Drug Assess 2019; 8:62-69. [PMID: 31069129 PMCID: PMC6493326 DOI: 10.1080/21556660.2019.1604375] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/26/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: The aim of this survey conducted by 20 leading Spanish oncologists was to analyze the concurrence between Spanish clinical practice and the recently published definition of the optimal sequence for the systemic treatment of metastatic breast cancer (MBC) according to patient profiles. Methods: A self-administered questionnaire was developed, divided into five sections comprising 34 specific questions related to sequential treatments, plus three additional general questions. Respondents were asked to justify negative answers. Participants were recruited randomly by invitation out of a total of 619 oncologists. The questionnaire was sent and collected via e-mail between October 2015 and May 2016. A total of 191 completed questionnaires were received. Results: Overall, 70% of oncologists would keep the three patient profiles exactly as proposed (hormone receptor-positive and HER2-negative, HER2-positive, and triple negative breast cancer). Affirmative answers to questions regarding treatment sequences for these patient profiles (1–34) ranged from 77.8–99.5%, with an average of 90.9% of oncologists being in agreement with the recommended sequential treatments. The lowest degree of consensus was observed for endocrine treatments in pre-menopausal women and for chemotherapy options in hormone-resistant patients, whilst the highest degree of consensus was reached for targeted therapies in HER2-positive patients and for endocrine therapy in post-menopausal women. In their comments, participants revealed a number of economic constraints that prevented them from implementing some of the best treatment options. Conclusions: In conclusion, despite the complexity of MBC treatment, there is general agreement on the optimal treatment sequences.
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Affiliation(s)
| | | | | | | | | | | | - Ana Lluch
- Hospital ClínicUniversitari de València, València, Spain
| | | | | | | | | | | | | | | | - Ana de Juan
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Eva Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Lourdes Calvo
- Complejo Hospitalario Universitario de A CoruñaA Coruña, Spain
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Cortés J, Rugo HS, Awada A, Twelves C, Perez EA, Im SA, Gómez-Pardo P, Schwartzberg LS, Diéras V, Yardley DA, Potter DA, Mailliez A, Moreno-Aspitia A, Ahn JS, Zhao C, Hoch U, Tagliaferri M, Hannah AL, O'Shaughnessy J. Erratum to: Prolonged survival in patients with breast cancer and a history of brain metastases: results of a preplanned subgroup analysis from the randomized phase III BEACON trial. Breast Cancer Res Treat 2017; 166:327-328. [PMID: 28884461 DOI: 10.1007/s10549-017-4482-3] [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: 11/25/2022]
Affiliation(s)
- Javier Cortés
- Ramon y Cajal University Hospital, Madrid, Spain and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Hope S Rugo
- University of California, San Francisco, CA, USA
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | - Chris Twelves
- Leeds Institute of Cancer and Pathology and St James's University Hospital, Leeds, UK
| | | | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | - David A Potter
- Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Alvaro Moreno-Aspitia
- Ramon y Cajal University Hospital, Madrid, Spain and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Jin-Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Carol Zhao
- Nektar Therapeutics, San Francisco, CA, USA
| | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA, USA
| | | | | | - Joyce O'Shaughnessy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center/U.S. Oncology, 3410 Worth Street, Suite 400, Dallas, TX, 75246, USA.
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Cortés J, Rugo HS, Awada A, Twelves C, Perez EA, Im SA, Gómez-Pardo P, Schwartzberg LS, Diéras V, Yardley DA, Potter DA, Mailliez A, Moreno-Aspitia A, Ahn JS, Zhao C, Hoch U, Tagliaferri M, Hannah AL, O'Shaughnessy J. Prolonged survival in patients with breast cancer and a history of brain metastases: results of a preplanned subgroup analysis from the randomized phase III BEACON trial. Breast Cancer Res Treat 2017; 165:329-341. [PMID: 28612225 PMCID: PMC5543189 DOI: 10.1007/s10549-017-4304-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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] [Received: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 02/07/2023]
Abstract
Purpose Conventional chemotherapy has limited activity in patients with breast cancer and brain metastases (BCBM). Etirinotecan pegol (EP), a novel long-acting topoisomerase-1 inhibitor, was designed using advanced polymer technology to preferentially accumulate in tumor tissue including brain metastases, providing sustained cytotoxic SN38 levels. Methods The phase 3 BEACON trial enrolled 852 women with heavily pretreated locally recurrent or metastatic breast cancer between 2011 and 2013. BEACON compared EP with treatment of physician’s choice (TPC; eribulin, vinorelbine, gemcitabine, nab-paclitaxel, paclitaxel, ixabepilone, or docetaxel) in patients previously treated with anthracycline, taxane, and capecitabine, including those with treated, stable brain metastases. The primary endpoint, overall survival (OS), was assessed in a pre-defined subgroup of BCBM patients; an exploratory post hoc analysis adjusting for the diagnosis-specific graded prognostic assessment (GPA) index was also conducted. Results In the trial, 67 BCBM patients were randomized (EP, n = 36; TPC, n = 31). Treatment subgroups were balanced for baseline characteristics and GPA indices. EP was associated with a significant reduction in the risk of death (HR 0.51; P < 0.01) versus TPC; median OS was 10.0 and 4.8 months, respectively. Improvement in OS was observed in both poorer and better GPA prognostic groups. Survival rates at 12 months were 44.4% for EP versus 19.4% for TPC. Consistent with the overall BEACON population, fewer patients on EP experienced grade ≥3 toxicity (50 vs. 70%). Conclusions The significant improvement in survival in BCBM patients provides encouraging data for EP in this difficult-to-treat subgroup of patients. A phase three trial of EP in BCBM patients is underway (ClinicalTrials.gov NCT02915744). Electronic supplementary material The online version of this article (doi:10.1007/s10549-017-4304-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Javier Cortés
- Ramon y Cajal University Hospital, Madrid, Spain, and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Hope S Rugo
- University of California, San Francisco, CA, USA
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | - Chris Twelves
- Leeds Institute of Cancer and Pathology and St James's University Hospital, Leeds, UK
| | | | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | - David A Potter
- Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | | | - Alvaro Moreno-Aspitia
- Ramon y Cajal University Hospital, Madrid, Spain, and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jin-Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Carol Zhao
- Nektar Therapeutics, San Francisco, CA, USA
| | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA, USA
| | | | | | - Joyce O'Shaughnessy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center/U.S. Oncology, 3410 Worth Street, Suite 400, Dallas, TX, 75246, USA.
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Twelves C, Cortés J, O'Shaughnessy J, Awada A, Perez EA, Im S, Gómez-Pardo P, Schwartzberg LS, Diéras V, Yardley DA, Potter DA, Mailliez A, Moreno-Aspitia A, Ahn JS, Zhao C, Hoch U, Tagliaferri M, Hannah AL, Rugo HS. Health-related quality of life in patients with locally recurrent or metastatic breast cancer treated with etirinotecan pegol versus treatment of physician's choice: Results from the randomised phase III BEACON trial. Eur J Cancer 2017; 76:205-215. [DOI: 10.1016/j.ejca.2017.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 01/10/2017] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
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Oliveira M, Dienstmann R, Bellet M, Perez-Garcia JM, Gómez-Pardo P, Muñoz-Couselo E, Vidal M, Ortega V, Soberino J, Zamora E, Hierro C, Ruiz F, Nuciforo P, Vivancos A, Cortes J, Saura C. Clonality of PIK3CA mutations (mut) and efficacy of PI3K/AKT/mTOR inhibitors (PAMi) in patients (pts) with metastatic breast cancer (MBC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mafalda Oliveira
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Rodrigo Dienstmann
- Oncology Data Science (ODysSey) Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Meritxell Bellet
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jose Manuel Perez-Garcia
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Patricia Gómez-Pardo
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Eva Muñoz-Couselo
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Maria Vidal
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Vanessa Ortega
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jesus Soberino
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Esther Zamora
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Cinta Hierro
- Medical Oncology Department, Early Clinical Drug Development Group. Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Fiorella Ruiz
- Oncology Data Science (ODysSey) Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Paolo Nuciforo
- Molecular Pathology Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Javier Cortes
- Medical Oncology Department, Hospital Ramon y Cajal, Madrid, Spain
| | - Cristina Saura
- Medical Oncology Department, Breast Cancer Group, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Perez EA, Awada A, O'Shaughnessy J, Rugo HS, Twelves C, Im SA, Gómez-Pardo P, Schwartzberg LS, Diéras V, Yardley DA, Potter DA, Mailliez A, Moreno-Aspitia A, Ahn JS, Zhao C, Hoch U, Tagliaferri M, Hannah AL, Cortes J. Etirinotecan pegol (NKTR-102) versus treatment of physician's choice in women with advanced breast cancer previously treated with an anthracycline, a taxane, and capecitabine (BEACON): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol 2015; 16:1556-1568. [PMID: 26482278 DOI: 10.1016/s1470-2045(15)00332-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND New options are needed for patients with heavily pretreated breast cancer. Etirinotecan pegol is a long-acting topoisomerase-I inhibitor that prolongs exposure to, but reduces the toxicity of, SN38 (the active metabolite of irinotecan). We assessed whether etirinotecan pegol is superior to currently available treatments for patients with previously treated, locally recurrent or metastatic breast cancer. METHODS In this open-label, multicentre, randomised phase 3 study (BEACON; BrEAst Cancer Outcomes with NKTR-102), conducted at 135 sites in 11 countries, patients with locally recurrent or metastatic breast cancer previously treated with an anthracycline, a taxane, and capecitabine (and two to five previous regimens for advanced disease) were randomly assigned (1:1) centrally via an interactive response system to etirinotecan pegol (145 mg/m(2) as a 90-min intravenous infusion every 3 weeks) or single-drug treatment of physician's choice. Patients with stable brain metastases and an Eastern Cooperative Oncology Group performance status of 0-1 were eligible. Randomisation was stratified with a permuted block scheme by region, previous eribulin, and receptor status. After randomisation, patients and investigators were aware of treatment assignments. The primary endpoint was overall survival in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01492101. FINDINGS Between Dec 19, 2011, and Aug 20, 2013, 852 patients were randomly assigned; 429 to etirinotecan pegol and 423 to treatment of physician's choice. There was no significant difference in overall survival between groups (median 12·4 months [95% CI 11·0-13·6] for the etirinotecan pegol group vs 10·3 months [9·0-11·3] for the treatment of physician's choice group; hazard ratio 0·87 [95% CI 0·75-1·02]; p=0·084). The safety population includes the 831 patients who received at least one dose of assigned treatment (425 assigned to etirinotecan pegol and 406 to treatment of physician's choice). Serious adverse events were recorded for 128 (30%) patients treated with etirinotecan pegol and 129 (32%) treated with treatment of physician's choice. Fewer patients in the etirinotecan pegol group had grade 3 or worse toxicity than those in the treatment of physician's choice group (204 [48%] vs 256 [63%]; p<0·0001). The most common grade 3 or worse adverse events were diarrhoea (41 [10%] in the experimental group vs five [1%] in the control group), neutropenia (41 [10%] vs 125 [31%]), and peripheral neuropathy (two [<1%] vs 15 [4%]). Three patients in the etirinotecan pegol group died of treatment-related adverse events (pneumonia, myelodysplastic syndrome, and acute renal failure) and two in the treatment of physician's choice group (neutropenic sepsis and septic shock). INTERPRETATION This trial did not demonstrate an improvement in overall survival for etirinotecan pegol compared to treatment of physician's choice in patients with heavily pre-treated advanced breast cancer. The toxicity profile noted in the etirinotecan pegol group differed from that in the control group. In view of the frequency of cross-resistance and overlapping toxicities noted with many available drugs and the need for effective drugs in highly refractory disease, etirinotecan pegol may warrant further research in some subgroups of patients. FUNDING Nektar Therapeutics.
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Affiliation(s)
| | - Ahmad Awada
- Medical Oncology Clinic, Jules Bordet Institute, Brussels, Belgium
| | | | - Hope S Rugo
- University of California, San Francisco, CA, USA
| | - Chris Twelves
- University of Leeds and St James's University Hospital, Leeds, UK
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | | | - David A Potter
- University of Minnesota Department of Medicine and Masonic Cancer Center, Minneapolis, MN, USA
| | | | | | - Jin-Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Carol Zhao
- Nektar Therapeutics, San Francisco, CA, USA
| | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA, USA
| | | | | | - Javier Cortes
- Vall d'Hebron Institute of Oncology, Barcelona, Spain; Ramon y Cajal University Hospital, Madrid, Spain
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Rivas MA, Ibrahim YH, Rodríguez O, Antón P, Cozar P, Gómez-Pardo P, Aura C, Haines BB, Sathyanarayanan S, Zhang T, Serra V, Baselga J. Abstract 924: Predictive biomarker identification for combined anti-mTOR and anti-IGF-1R treatment in luminal B breast cancer. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-924] [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
Luminal B breast cancer is one of the most aggressive subtypes of breast cancer for which effective treatments are needed. Recently, a phase I clinical study revealed that blockade of mTOR and IGF-1R has potential clinical activity in this cancer subtype. However, biomarkers to predict patient's response to the combination are still needed. Previous exploratory studies in ovarian cancer have associated low RAS-pathway activity, as determined by a RAS gene expression signature score, and high levels of IGF-1R axis genes with response to this combination therapy. In the present study we evaluated low RAS signature/high IGF-1/high IGF-1R as potential predictive biomarkers for anti-mTOR and anti-IGF-1R combination therapy in luminal B breast cancer patient-derived xenografts (PDX) treated with the allosteric mTOR inhibitor ridaforolimus and the monoclonal antibody against IGF-1R, dalotuzumab. Expression array analysis revealed that our 6 luminal B PDXs exhibited a low RAS signature score, compared to 6 HER2 and triple negative PDXs. Overall, luminal B PDXs expressed higher IGF-1R as compared to the other breast cancer subtypes with some variability among the different luminal models. Low expression of human IGF-pathway ligands IGF-1 and IGF-2 among the luminal PDXs, compared to luminal B breast cancers, suggested to us the need of exogenous IGF-1 ligand supplementation to derive IGF-1R feedback activation and combinatorial antitumor response. Accordingly, three high IGF-1R-PDXs treated with the anti-mTOR and anti-IGF-1R combination therapy supplemented with recombinant human IGF-1 exhibited statistically significant anti-tumor response as compared to single agents, whereas two low IGF-1R-expressing PDXs did not. As anticipated, ridaforolimus induced the IGF-1R-axis by increasing the levels of the adapter protein IRS-1, which potentiated Akt signaling. Hence, in vitro knockdown of IRS-1 promoted the antiproliferative activity of ridaforolimus in patient-derived tumor cells. In conclusion, our results demonstrate that baseline IGF-pathway expression, namely IGF-1, IGF-1R and IRS-1, predict benefit to combined anti-mTOR and anti-IGF-1R treatment in breast cancer and supports further exploration in luminal B breast cancers that derived benefit from this combination.
Citation Format: Martin A. Rivas, Yasir H. Ibrahim, Olga Rodríguez, Pilar Antón, Patricia Cozar, Patricia Gómez-Pardo, Claudia Aura, Brian B. Haines, Sriram Sathyanarayanan, Theresa Zhang, Violeta Serra, José Baselga. Predictive biomarker identification for combined anti-mTOR and anti-IGF-1R treatment in luminal B breast cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 924. doi:10.1158/1538-7445.AM2014-924
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Affiliation(s)
| | | | | | - Pilar Antón
- 1Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | - Claudia Aura
- 1Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | | | - Violeta Serra
- 1Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - José Baselga
- 4Memorial Sloan-Kettering Cancer Center, New York, NY
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9
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Oliveira M, Navarro A, De Mattos-Arruda L, Sánchez-Ollé G, Bellet M, Balmaña J, Gómez-Pardo P, Perez-Garcia JM, Muñoz-Couselo E, Vidal M, Ortega V, Dienstmann R, Aura C, Prudkin L, Vivancos A, Rodon Ahnert J, Baselga J, Tabernero J, Cortes J, Saura C. PI3K pathway (PI3Kp) dysregulation and response to pan-PI3K/AKT/mTOR/dual PI3K-mTOR inhibitors (PI3Kpi) in metastatic breast cancer (MBC) patients (pts). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.509] [Citation(s) in RCA: 3] [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
509 Background: The role of PI3Kp dysregulation as a predictor of sensitivity to PI3Kpi is unclear. We aimed to evaluate the efficacy of PI3Kpi in two cohorts of MBC pts with assessable PI3Kp status. Methods: MBC pts treated in ≥3rd line with PI3Kpi were reviewed. PI3Kp status: (a) No dysregulation: PIK3CA wt and PTEN normal; (b) PI3Kp dysregulation: PIK3CA mutation (PIK3CAmut) or PTEN low (HScore≤50). Cohort A: pts treated with single agent PI3Kpi. Cohort B: pts treated with PI3Kpi in combination with hormonal therapy (HT), chemotherapy (CT) and/or trastuzumab (T). Results: Out of 232 MBC pts screened for PI3Kp alterations from Sep09 to Sep11, 32 were treated with PI3Kpi. Cohort A (n=17): HR+/HER2- 88%, HER2+ 6%, triple negative 6%; median age 43, median MBC lines 4 (2-9); PIK3CAmut in 10/17 (58.8%; 6 exon9, 4 exon20), PTEN low 3/17 (17.6%), 1 pt both; PI3Kp dysregulation 12/17 pts. Cohort B (n=15): HR+/HER2- 40%, HER2+ 60%; median age 49, median MBC lines 4 (2-13); PIK3CAmut 3/13 assessable (23.1%; all exon20), PTEN low 6/15 (40%), 1 pt both; PI3Kp dysregulation 8/15 pts. Time to progression to PI3Kpi (TTP), overall survival from MBC diagnosis (OSMBC) and OS from PI3Kpi beginning (OSPI3Kpi), according to PIK3CA status and PI3Kp dysregulation, are shown. No differences were found according to PTEN status. Conclusions: These results suggest that the best outcomes with PI3Kpi in PIK3CAmut MBC pts occur when they are used in combination with HT/CT/T. Activity of non selective PI3Kpi used as single agents seems to be limited, making results from prospective trials with selective PI3Kα inhibitors and PI3Kpi in combinations eagerly awaited. [Table: see text]
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Affiliation(s)
- Mafalda Oliveira
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Navarro
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Meritxell Bellet
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Judith Balmaña
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Eva Muñoz-Couselo
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maria Vidal
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Vanessa Ortega
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Rodrigo Dienstmann
- Molecular Therapeutics Research Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Claudia Aura
- Molecular Pathology Laboratory, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ludmilla Prudkin
- Molecular Pathology Laboratory, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Jordi Rodon Ahnert
- Experimental Therapeutics Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - José Baselga
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Josep Tabernero
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Javier Cortes
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Cristina Saura
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
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Navarro A, Oliveira M, De Mattos-Arruda L, Sánchez-Ollé G, Bellet M, Balmaña J, Gómez-Pardo P, Perez-Garcia JM, Muñoz-Couselo E, Vidal M, Ortega V, Dienstmann R, Aura C, Hernandez-Losa J, Rodon J, Ramon y Cajal S, Baselga J, Tabernero J, Cortes J, Saura C. Prognostic significance of PI3K pathway (PI3Kp) dysregulation in metastatic breast cancer (MBC) patients (pts). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.566] [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
566 Background: PI3Kp dysregulation represents a potential target for therapies that are currently being tested in clinical trials. This observational retrospective study aims to evaluate the prognostic implications of PI3Kp dysregulation in MBC. Methods: MBC pts with PI3Kp status assessment from Sep09 to Sep11 were reviewed. PIK3CA mutation status analyzed in paraffin-embedded tissue by DxS PI3K Mutation Test Kit or Sequenom MassARRAY. PTEN status determined by IHC. PI3Kp status: (a) No dysregulation: PIK3CA wt and PTEN normal; (b) PI3Kp dysregulation: PIK3CA mutation (PIK3CAmut) or PTEN low (HScore≤50). Results: 232 MBC pts screened, median age 49.8 (22.9-83.1) and median MBC lines 4 (1-15). Distribution: HR+/HER2- 99 (43%), HER2+ 52 (22%), triple negative 35 (15%), unclassified 46 (20%). Sites of metastasis: visceral 173 (75%), only skin 10 (4%), only bone 49 (21%). PIK3CA status assessed in 174 pts, 53 (22.8%) bearing a mutation (21 exon9, 32 exon20). PTEN status assessed in 229 pts, PTEN low 61 (26.6%). PI3Kp dysregulation in 103/185 pts (55.6%). Time to progression to first line MBC treatment (TTP) and overall survival after MBC diagnosis (OS) are shown. Disease free survival (DFS) and distant-disease free survival (DDFS) in pts initially diagnosed with early breast cancer (n=193) has also been calculated. Conclusions: These results suggest that PI3Kp dysregulation, either by PIK3CA mutation or PTEN low, does not seem to have impact on disease recurrence, response to first line MBC treatment or overall MBC survival.[Table: see text]
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Affiliation(s)
- Alejandro Navarro
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mafalda Oliveira
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Meritxell Bellet
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Judith Balmaña
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Eva Muñoz-Couselo
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maria Vidal
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Vanesa Ortega
- Breast Cancer Group, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Rodrigo Dienstmann
- Molecular Therapeutics Research Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Claudia Aura
- Molecular Pathology Laboratory, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Jordi Rodon
- Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Santiago Ramon y Cajal
- Molecular Therapeutics Research Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - José Baselga
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Josep Tabernero
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Javier Cortes
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Cristina Saura
- Breast Cancer Group, Vall d'Hebron University Hospital, Barcelona, Spain
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