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Huang L, Pang D, Yang H, Li W, Wang S, Cui S, Liao N, Wang Y, Wang C, Chang YC, Wang HC, Kang SY, Seo JH, Shen K, Laohawiriyakamol S, Jiang Z, Wang H, Lamour F, Song G, Curran M, Duan C, Lysbet de Haas S, Restuccia E, Shao Z. Neoadjuvant-adjuvant pertuzumab in HER2-positive early breast cancer: final analysis of the randomized phase III PEONY trial. Nat Commun 2024; 15:2153. [PMID: 38461323 PMCID: PMC10925021 DOI: 10.1038/s41467-024-45591-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/29/2024] [Indexed: 03/11/2024] Open
Abstract
The randomized, multicenter, double-blind, placebo-controlled, phase III PEONY trial (NCT02586025) demonstrated significantly improved total pathologic complete response (primary endpoint) with dual HER2 blockade in HER2-positive early/locally advanced breast cancer, as previously reported. Here, we present the final, long-term efficacy (secondary endpoints: event-free survival, disease-free survival, overall survival) and safety analysis (62.9 months' median follow-up). Patients (female; n = 329; randomized 2:1) received neoadjuvant pertuzumab/placebo with trastuzumab and docetaxel, followed by adjuvant 5-fluorouracil, epirubicin, and cyclophosphamide, then pertuzumab/placebo with trastuzumab until disease recurrence or unacceptable toxicity, for up to 1 year. Five-year event-free survival estimates are 84.8% with pertuzumab and 73.7% with placebo (hazard ratio 0.53; 95% confidence interval 0.32-0.89); 5-year disease-free survival rates are 86.0% and 75.0%, respectively (hazard ratio 0.52; 95% confidence interval 0.30-0.88). Safety data are consistent with the known pertuzumab safety profile and generally comparable between arms, except for diarrhea. Limitations include the lack of ado-trastuzumab emtansine as an option for patients with residual disease and the descriptive nature of the secondary, long-term efficacy endpoints. PEONY confirms the positive benefit:risk ratio of neoadjuvant/adjuvant pertuzumab, trastuzumab, and docetaxel treatment in this patient population.
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Affiliation(s)
- Liang Huang
- Fudan University Shanghai Cancer Center, 200032, Shanghai, China
- Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Da Pang
- Harbin Medical University Cancer Hospital, 150040, Harbin, China
| | - Hongjian Yang
- Cancer Hospital of The University of Chinese Academy of Sciences, 310022, Hangzhou, China
| | - Wei Li
- The First Hospital of Jilin University, 130012, Changchun, China
| | - Shusen Wang
- Sun Yat-sen University Cancer Center, 510060, Guangzhou, China
| | - Shude Cui
- Henan Cancer Hospital, 450003, Zhengzhou, China
| | - Ning Liao
- Guangdong General Hospital, 510060, Guangzhou, China
| | | | - Chuan Wang
- Fujian Medical University Union Hospital, 350001, Fuzhou, China
| | - Yuan-Ching Chang
- Department of General Surgery, Mackay Memorial Hospital, 104, Taipei City, Taiwan
| | - Hwei-Chung Wang
- Department of Surgery, China Medical University Hospital, 404, Taichung City, Taiwan
| | - Seok Yun Kang
- Ajou University School of Medicine, 206, Suwon, Republic of Korea
| | - Jae Hong Seo
- Korea University Guro Hospital, 08308, Seoul, Republic of Korea
| | - Kunwei Shen
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | | | - Zefei Jiang
- The Affiliated Hospital of Military Medical Sciences (The 307th Hospital of Chinese. People's Liberation Army), 100071, Beijing, China
| | - Haiyan Wang
- Roche Product Development, 201203, Shanghai, China
| | - François Lamour
- F. Hoffmann-La Roche Ltd, 4070, Basel, Switzerland
- Alentis Therapeutics AG, Allschwil, Switzerland
| | - Grace Song
- Hangzhou Tigermed Consulting Co., Ltd, 310053, Shanghai, China
| | | | - Chunzhe Duan
- Department of Translational Medicine Oncology, Roche (China) Holding Ltd, 201203, Shanghai, China
| | | | | | - Zhimin Shao
- Fudan University Shanghai Cancer Center, 200032, Shanghai, China.
- Shanghai Medical College, Fudan University, 200032, Shanghai, China.
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Dang C, Ewer MS, Delaloge S, Ferrero JM, Colomer R, de la Cruz-Merino L, Werner TL, Dadswell K, Verrill M, Eiger D, Sarkar S, de Haas SL, Restuccia E, Swain SM. BERENICE Final Analysis: Cardiac Safety Study of Neoadjuvant Pertuzumab, Trastuzumab, and Chemotherapy Followed by Adjuvant Pertuzumab and Trastuzumab in HER2-Positive Early Breast Cancer. Cancers (Basel) 2022; 14:cancers14112596. [PMID: 35681574 PMCID: PMC9179451 DOI: 10.3390/cancers14112596] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 01/03/2023] Open
Abstract
BERENICE (NCT02132949) assessed the cardiac safety of the neoadjuvant−adjuvant pertuzumab−trastuzumab-based therapy for high-risk, HER2-positive early breast cancer (EBC). We describe key secondary objectives at final analysis. Eligible patients received dose-dense doxorubicin and cyclophosphamide q2w × 4 ➝ paclitaxel qw × 12 (Cohort A) or 5-fluorouracil, epirubicin, cyclophosphamide q3w × 4 ➝ docetaxel q3w × 4 (B) as per physician’s choice. Pertuzumab−trastuzumab (q3w) was initiated from the taxane start and continued post-surgery to complete 1 year. Median follow-up: 64.5 months. There were no new cardiac issues and a low incidence of Class III/IV heart failure (Cohort B only: one patient (0.5%) in the adjuvant and treatment-free follow-up (TFFU) periods). Fourteen patients (7.7%) had LVEF declines of ≥10% points from baseline to <50% in Cohort A, as did 20 (10.5%) in B during the adjuvant period (12 (6.2%) in A and 7 (3.6%) in B during TFFU). The five-year event-free survival rates in Cohorts A and B were 90.8% (95% CI: 86.5, 95.2) and 89.2% (84.8, 93.6), respectively. The five-year overall survival rates were 96.1% (95% CI: 93.3, 98.9) and 93.8% (90.3, 97.2), respectively. The final analysis of BERENICE further supports pertuzumab−trastuzumab-based therapies as standard of care for high-risk, HER2-positive EBC.
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Affiliation(s)
- Chau Dang
- Department of Medicine, Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Correspondence: ; Tel.: +1-646-888-5426
| | - Michael S. Ewer
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Suzette Delaloge
- Department of Medical Oncology, Institut Gustave Roussy, 94805 Paris, France;
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, University Côte d’Azur, 06110 Nice, France;
| | - Ramon Colomer
- Division of Medical Oncology, Hospital Universitario La Princesa, 28006 Madrid, Spain;
| | - Luis de la Cruz-Merino
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain;
| | - Theresa L. Werner
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA;
| | - Katherine Dadswell
- Global Product Development, Roche Products Limited, Welwyn Garden City AL7 1TW, UK;
| | - Mark Verrill
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, UK;
| | - Daniel Eiger
- Product Development Oncology, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (D.E.); (E.R.)
| | - Sriparna Sarkar
- External Business Partner, Roche Products Limited, Welwyn Garden City AL7 1TW, UK;
| | - Sanne Lysbet de Haas
- Oncology Biomarker Development, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland;
| | - Eleonora Restuccia
- Product Development Oncology, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (D.E.); (E.R.)
| | - Sandra M. Swain
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center and MedStar Health, Washington, DC 20007, USA;
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Perez EA, de Haas SL, Barrios CH, Eiermann W, Toi M, Im YH, Conte PF, Martin M, Pienkowski T, Pivot XB, Burris HA, Lambertini C, Hoersch S, Patre M, Ellis PA. Abstract PD5-11: Association of immune gene expression with outcome in the MARIANNE phase 3 clinical trial in HER2-positive metastatic breast cancer (MBC). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-pd5-11] [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: Although HER2+ breast cancer (BC) is considered a moderately immunogenic tumor, several studies have shown a role of pre-existing immunity associated with favorable long-term prognosis and better response to treatment. In this study, we performed exploratory analyses to assess whether the efficacy of HER2 targeted treatment in the MARIANNE trial correlated with immune gene expression. Methods: MARIANNE (NCT01120184) is a phase 3 study in patients (pts) with centrally confirmed HER2+ local advanced/metastatic BC naïve to prior treatments in the advanced disease. Pts were randomized (1:1:1) to trastuzumab+taxane (HT), T-DM1, or T-DM1+Petuzumab (P) and the trial showed noninferior PFS of T-DM1 and T-DM1+P vs HT. Gene expression (RNA) analysis was performed on tumor samples by a custom 800-gene codeset on the nCounter platform. PD-L1, CD8 expressions and immune gene signatures (sign) analyses were assessed by multivariate Cox regression models using median (cut-off) as categorical variable and adjusted by prior HT, presence of visceral disease, world region, baseline ECOG, measureable disease at baseline, therapy setting, HER2 mRNA expression, PIK3CA mutation status. Results: MARIANNE randomized 1095 pts (HT, n=365; T-DM1, n=367; T-DM1+P, n=363). Gene expression results were available for 671 pts (61.3% of the intent-to-treat [ITT] population) which was representative of ITT. In ITT, HR below 1 was observed when comparing pts with high (>median) vs low (≤median) immune gene expression by clinical outcome suggesting a potential association of high immune marker expression with improved PFS (Table 1) and to some extent with OS (data not shown). This association was primarily observed in the T-DM1 arm where the HR suggested a risk reduction of disease progression(PD)/death especially in the high Teff, high PD-L1 and high CD8 subgroups, and to some extent in the HT arm (Table 1). When assessing the predictive impact on PFS by comparing T-DM1 vs HT, HR below 1 was observed especially in pts with high Teff signature, high PD-L1 and high CD8 expressions (HR 0.67 (95% CI (0.47-0.95)), HR 0.68 (95% CI (0.48-0.97), and HR 0.64 (95%CI 0.44-0.93), respectively). When comparing T-DM1+P vs. HT, HR below 1 was observed especially in pts with low Teff signature and low PD-L1 expression (HR 0.70 (95% CI (0.50-0.99), and HR 0.68 (95% CI (0.48-0.96) respectively). No clear differences between immune gene expression subgroups was observed when comparing treatment arms in regards to OS (data not shown). Conclusions: In the exploratory analysis from the MARIANNE study, high immune gene expression, especially in the high PD-L1, CD8 and Teff subgroups, showed an association with improved clinical benefit with HRs reflecting for a risk reduction of PD/death for PFS and partially for OS. This association was less obvious in the T-DM1+P arm. When comparing the treatments effect, the data showed a potential impact of high Teff signature, and high CD8 and PD-L1 expressions on T-DM1 and less on HT. The potential opposite association of low Teff signature and low PD-L1 expression with improved benefit in the T-DM1+P arm was unexpected and needs further investigation.
Table 1: Prognostic biomarker effect on PFSBiomarker by categories (>Median vs ≤Median)HR (95% CI) ITT n=671HR (95% CI) HT n=220HR (95% CI) T-DM1 n=227HR (95% CI) T-DM1+P n=224Teff sign0.89 (0.73-1.09)0.97 (0.68-1.38)0.64 (0.45-0.91)1.09 (0.75-1.58)Th1 cytokine sign0.91 (0.74-1.11)0.92 (0.64-1.31)0.78 (0.55-1.11)0.96 (0.67-1.36)Checkpoint inhibitor sign0.95 (0.78-1.15)0.91 (0.64-1.29)0.90 (0.64-1.26)1.02 (0.71-1.47)PD-L10.80 (0.66-0.98)0.79 (0.55-1.13)0.62 (0.44-0.87)1.07 (0.74-1.55)CD80.91 (0.75-1.11)1.10 (0.77-1.57)0.66 (0.46-0.93)0.98 (0.68-1.41)
Citation Format: Edith A Perez, Sanne Lysbet de Haas, Carlos H Barrios, Wolfgang Eiermann, Masakazu Toi, Young-Hyuck Im, Pier Franco Conte, Miguel Martin, Tadeusz Pienkowski, Xavier B Pivot, Howard A Burris III, Chiara Lambertini, Silke Hoersch, Monika Patre, Paul Anthony Ellis. Association of immune gene expression with outcome in the MARIANNE phase 3 clinical trial in HER2-positive metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD5-11.
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Affiliation(s)
| | | | - Carlos H Barrios
- 3Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | | | - Masakazu Toi
- 5Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Young-Hyuck Im
- 6Samsung Medical Centre, Seoul, Korea, Democratic People's Republic of
| | - Pier Franco Conte
- 7Department of Surgery, Oncology and Gastroenterology, University of Padova and Istituto Oncologico Veneto, Padova, Italy
| | - Miguel Martin
- 8Instituto de Investigacion Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain
| | | | | | - Howard A Burris
- 11Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | | | | | | | - Paul Anthony Ellis
- 12Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
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Perez EA, de Haas SL, Eiermann W, Barrios CH, Toi M, Im YH, Conte PF, Martin M, Pienkowski T, Pivot XB, Burris HA, Stanzel S, Patre M, Ellis PA. Correction to: Relationship between tumor biomarkers and efficacy in MARIANNE, a phase III study of trastuzumab emtansine ± pertuzumab versus trastuzumab plus taxane in HER2-positive advanced breast cancer. BMC Cancer 2019; 19:620. [PMID: 31234810 PMCID: PMC6591955 DOI: 10.1186/s12885-019-5831-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Edith A Perez
- Mayo Clinic, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA.
| | | | - Wolfgang Eiermann
- Interdisciplinary Oncology Center, Nussbaumstrasse 12, 80336, Munich, Germany
| | - Carlos H Barrios
- PUCRS School of Medicine, Av. Ipiranga 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Masakazu Toi
- Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Young-Hyuck Im
- Samsung Medical Centre, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea
| | - Pier Franco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Istituto Oncologico Veneto, Via Gattamelata 64, 35128, Padova, Italy
| | - Miguel Martin
- Instituto de Investigacion Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Avda. de Séneca, 2, 28040, Madrid, Spain
| | - Tadeusz Pienkowski
- Postgraduate Medical Education Center, ul. Marymoncka 99, 02-813, Warsaw, Poland
| | - Xavier B Pivot
- Paul Strauss Cancer Center, 3 Rue de la Porte de l'Hôpital, BP 30042, 67065, Strasbourg, France
| | - Howard A Burris
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, 250 25th Ave N, Nashville, TN, 37203, USA
| | - Sven Stanzel
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Monika Patre
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Paul Anthony Ellis
- Guys Hospital and Sarah Cannon Research Institute, Great Maze Pond, London, SE1 9RT, UK
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Kim S, Wildiers H, Krop IE, Smitt M, Yu R, Lysbet de Haas S, Gonzalez‐Martin A. Relationship between tumor biomarkers and efficacy in TH3RESA, a phase III study of trastuzumab emtansine (T‐DM1) vs. treatment of physician's choice in previously treated HER2‐positive advanced breast cancer. Int J Cancer 2016; 139:2336-2342. [DOI: 10.1002/ijc.30276] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
In the phase III TH3RESA study (NCT01419197), 602 patients with HER2‐positive advanced breast cancer who received prior taxane therapy and ≥2 HER2‐directed regimens, including trastuzumab and lapatinib (advanced setting), were randomized to trastuzumab emtansine (T‐DM1) or treatment of physician's choice (TPC). A statistically significant progression‐free survival (PFS) benefit favoring T‐DM1 was demonstrated. Here, we examine the relationship between HER2‐related biomarkers and PFS in an exploratory analysis. Biomarkers assessed included HER2 (n = 505) and HER3 (n = 505) mRNA expression, PIK3CA mutation status (n = 410) and PTEN protein expression (n = 358). For biomarkers with continuous data (HER2, HER3, PTEN), subgroups were defined using median values (>median and ≤median). For all biomarker subgroups, median PFS was longer with T‐DM1 vs. TPC. The PFS benefit favoring T‐DM1 vs. TPC was numerically greater in the HER2 mRNA >median subgroup (7.2 vs. 3.4 months; unstratified hazard ratio [HR], 0.40; 95% CI, 0.28–0.59; p < 0.0001) vs. ≤median subgroup (5.5 vs. 3.9 months; HR, 0.68; 95% CI, 0.49–0.92; p = 0.0131). The PFS benefit with T‐DM1 was similar among HER3, PIK3CA and PTEN subgroups. Consistent with other reports, benefit was seen with T‐DM1 regardless of PIK3CA mutation status. In a multivariate analysis including an interaction term (treatment group by log2‐transformed HER2 mRNA), patients with higher HER2 mRNA levels benefited more from receiving T‐DM1 (HR, 0.84; 95% CI, 0.75–0.94; interaction p value = 0.0027). In summary, T‐DM1 prolonged median PFS in all biomarker subgroups analyzed, including activating PIK3CA mutations, with numerically greater benefit in patients with tumors expressing HER2 mRNA >median vs. ≤median.
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Affiliation(s)
- Sung‐Bae Kim
- Department of Oncology Asan Medical Center, University of Ulsan College of Medicine Seoul Korea
| | - Hans Wildiers
- Department of General Medical Oncology University Hospitals Leuven Leuven Belgium
| | - Ian E. Krop
- Department of Adult Oncology Harvard Medical School, Dana‐Farber Cancer Institute Boston MA
| | - Melanie Smitt
- Department of Product Development Oncology Genentech, Inc. South San Francisco CA
| | - Ron Yu
- Department of Biostatistics Genentech, Inc South San Francisco CA
| | - Sanne Lysbet de Haas
- Department of Oncology Biomarker Development F. Hoffmann‐La Roche, Ltd. Basel Switzerland
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