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Mathelin C, Lodi M, Alghamdi K, Arboleda-Osorio B, Avisar E, Anyanwu S, Boubnider M, Costa MM, Elder E, Elonge T, Gebrim L, Hao X, Imoto S, Meka E, Mouelle M, Mundinger A, Ostapenko V, Özbaş S, Özmen T, Özmen V, Pienkowski T, Sarria G, Selim A, Semiglazov V, Schneebaum S. The Senologic International Society Survey on Ductal Carcinoma <i>In Situ</i>: Present and Future. Eur J Breast Health 2022; 18:205-221. [DOI: 10.4274/ejbh.galenos.2022.2022-4-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/08/2022] [Indexed: 12/01/2022]
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Peddi PF, Fasching PA, Liu D, Quinaux E, Robert NJ, Valero V, Crown J, Falkson C, Brufsky A, Cunningham JM, Weinshilboum RM, Pienkowski T, Eiermann W, Martín M, Bee V, Wang X, Wang L, Yang E, Slamon DJ, Hurvitz SA. Genetic polymorphisms and correlation with treatment induced cardiotoxicity and prognosis in breast cancer patients. Clin Cancer Res 2022; 28:1854-1862. [PMID: 35110416 DOI: 10.1158/1078-0432.ccr-21-1762] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/28/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac toxicity is a serious complication of HER2-directed therapies and anthracyclines. HER2 codon 655 and SLC28A3 gene polymorphisms have been reported to be associated with cardiac toxicity from anti-HER2 and anthracycline therapy, respectively. Association of the polymorphism at HER2 codon 655 with prognosis has also been reported. METHODS Whole blood samples from patients treated on a randomized adjuvant breast cancer trial (BCIRG-006) that compared anthracycline-based chemotherapy to trastuzumab plus either anthracycline or non-anthracycline chemotherapy were tested for genetic polymorphisms in HER2 codon 655 and SLC28A3 Genotypes were correlated with cardiac function and disease-free survival (DFS) outcomes. RESULTS Of 3,222 patients enrolled in BCIRG-006, 662 patient samples were successfully genotyped for the rs1136201 allele in HER2 (codon 655): 424 (64%) were AA, 30 (4.5%) were GG, and 208 (31%) were AG genotype. Additionally, 665 patient samples were successfully genotyped for the rs7853758 allele in the SLC28A3 gene: 19 (3%) were AA, 475 (71%) were GG, and 171 (26%) were AG genotype. Follow up time was 10 years. No correlation between DFS, cardiac event rate or mean left ventricular ejection fraction (LVEF) and rs1136201 genotype was seen in the trastuzumab treated or non-trastuzumab treated patients. Moreover, mean LVEF and cardiac event rates were similar in all rs7853758 genotype groups treated with anthracycline-based therapy. CONCLUSIONS In the largest study to date to evaluate whether two polymorphisms are associated with DFS and/or cardiac toxicity in HER2 positive breast cancer treated with trastuzumab and/or anthracyclines, we observed no correlation.
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Affiliation(s)
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg
| | - Duan Liu
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic
| | - Emmanuel Quinaux
- Biostatistics, International Drug Development Institute (Belgium)
| | | | - Vicente Valero
- Department of Breast Medical Oncology--424, The University of Texas MD Anderson Cancer Center
| | - John Crown
- Medical Oncology, St. Vincent's University Hospital
| | - Carla Falkson
- Wilmot Cancer Institute, University of Rochester Medical Center
| | - Adam Brufsky
- Hematology and Oncology, University of Pittsburgh
| | | | - Richard M Weinshilboum
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic
| | | | | | - Miguel Martín
- Medical Oncology, Department of Medical Oncology, Hospital General Universitario Gregorio Marañón Instituto de Investigacion Sanitaria Gregorio Marañon, CIBERONC, Universidad Complutense, Madrid
| | - Valerie Bee
- Project Management, Translational Oncology Research International (TRIO/CIRG)
| | - Xiaoyan Wang
- Department of General Internal Medicine and Healthy Services Research, University of California, Los Angeles
| | - Liewei Wang
- Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic
| | | | - Dennis J Slamon
- Division of Hematology-Oncology, Geffen School of Medicine at UCLA
| | - Sara A Hurvitz
- David Geffen School of Medicine Division of Hematology-Oncology, University of California, Los Angeles
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Triulzi T, Bianchini G, Di Cosimo S, Pienkowski T, Im YH, Bianchi GV, Galbardi B, Dugo M, De Cecco L, Tseng LM, Liu MC, Bermejo B, Semiglazov V, Viale G, de la Haba-Rodriguez J, Oh DY, Poirier B, Valagussa P, Gianni L, Tagliabue E. The TRAR gene classifier to predict response to neoadjuvant therapy in HER2-positive and ER-positive breast cancer patients: an explorative analysis from the NeoSphere trial. Mol Oncol 2021; 16:2355-2366. [PMID: 34816585 PMCID: PMC9208076 DOI: 10.1002/1878-0261.13141] [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: 06/25/2021] [Revised: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 11/07/2022] Open
Abstract
As most erb-b2 receptor tyrosine kinase 2 (HER2)-positive breast cancer (BC) patients currently receive dual HER2-targeting added to neoadjuvant chemotherapy, improved methods for identifying individual response, and assisting postsurgical salvage therapy, are needed. Herein, we evaluated the 41-gene classifier trastuzumab advantage risk model (TRAR) as a predictive marker for patients enrolled in the NeoSphere trial. TRAR scores were computed from RNA of 350 pre- and 166 post-treatment tumor specimens. Overall, TRAR score was significantly associated with pathological complete response (pCR) rate independently of other predictive clinico-pathological variables. Separate analyses according to estrogen receptor (ER) status showed a significant association between TRAR score and pCR in ER-positive specimens but not in ER-negative counterparts. Among ER-positive BC patients not achieving a pCR, those with TRAR-low scores in surgical specimens showed a trend for lower distant event-free survival. In conclusion, in HER2-positive/ER-positive BC, TRAR is an independent predictor of pCR and represents a promising tool to select patients responsive to anti-HER2-based neoadjuvant therapy and to assist treatment escalation and de-escalation strategies in this setting.
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Affiliation(s)
- Tiziana Triulzi
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Serena Di Cosimo
- DRAST, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tadeusz Pienkowski
- Oncology and Breast Diseases Department, Postgraduate Medical Education Center, Warsaw, Poland
| | - Young-Hyuck Im
- Department of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | | | - Barbara Galbardi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Matteo Dugo
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Loris De Cecco
- DRAST, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ling-Ming Tseng
- Taipei-Veterans General Hospital, National Yang-Ming University, Taiwan
| | - Mei-Ching Liu
- Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Begoña Bermejo
- Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain
| | | | - Giulia Viale
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Do-Youn Oh
- Division of Medical Oncology, Seoul National University Hospital Cancer Research Institute, Seoul National University College of Medicine, Republic of Korea
| | - Brigitte Poirier
- Centre des Maladies du sein, Hôpital du Saint-Sacrement, CHU de Québec, Canada
| | | | - Luca Gianni
- Fondazione Michelangelo, Milan, Italy.,Fondazione Gianni Bonadonna, Milan, Italy
| | - Elda Tagliabue
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Franzoi M, Martel S, Agbor-Tarh D, Piccart M, Bines J, Loibl S, Di Cosimo S, Vaz-Luis I, Di Meglio A, Del Mastro L, Gombos A, Desmedt C, Jerusalem G, Reaby L, Pienkowski T, Lambertini M, de Azambuja E. 131P Impact of body mass (BMI) and weight change after adjuvant treatment in patients (pts) with HER2-positive early breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Jagiello-Gruszfeld AI, Jodkiewicz M, Kowalska M, Michalski W, Olszewski WP, Niwinska A, Gorniak A, Pogoda K, Dubianski R, Gorska K, Glinka E, Pienkowski T, Nowecki Z. Prognostic and predictive value of neutrophil/lymphocyte ratio in patients with triple-negative and HER2-positive breast cancer undergoing neoadjuvant systemic therapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e12620] [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
e12620 Background: Preoperative neutrophil-lymphocyte ratio (NLR) have been suggested to be correlated with the prognosis of patients with breast cancer (BC). However, the results still remain controversial. The goal of our study was to evaluate the predictive and prognostic value of NLR in early stage triple negative and HER2-pos breast cancer patients undergoing NAC. Methods: 96 female patients (pts) with histologically proven breast cancer (51 TNBC, and 45 HER2 pos) were analysed in this retrospective analysis. The NLR before the initiation of NAC was documented. Histopathological response in surgically removed specimens was evaluated using the Residual Cancer Burden (RCB) Calculator (by MD Anderson Cancer Center). The pCR was defined as no invasive tumor in primary tumor bed and lymph nodes. The NLR variable was analyzed as both continuous and categorical. The impact on pCR and RCB was tested using Mann-Whitney, Kruskal-Willis or the Chi-2 test, respectively. Results: Only 4 categories of NAC were used: in TNBC 4 x ACdd followed by 12 x PCL (38 pts) or 4 x ACdd followed by 12 x PCL+ carboplatin AUC 1.0-2 (13 pts), in HER2-pos 39 pts received 6 x TCH (docetaxel + tratuzumab + carboplatin AUC 6) and 6 pts 4 x ACdd followed by 12 x PCL iv + 4 x trastuzumab. In 27 pts (53%) with TNBC and 24 pts (53%) with HER2-pos breast cancer pCR was obtained after NAC. RCB distribution was: 0-53.1%, 1-22%, 2-17.6%, 3-7.3%. No association with NLR and pCR could be observed (p > 0.26). No association with NLR and RCB could be observed (p > 0.18). Conclusions: In our retrospective analysis we could not demonstrate predictive or prognostic value of NLR in the cohort of early stage triple negative and HER2-positive breast cancer patients treated with NAC. Further studies are planned in a group of patients with Luminal B, HER2 – negative breast cancer, who received NAC.
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Affiliation(s)
- Agnieszka I. Jagiello-Gruszfeld
- Breast Cancer and Reconstructive Surgery Dept., Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Maria Kowalska
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Wojciech Michalski
- The Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology in Warsaw, Warszaw, Poland
| | - Wojciech P Olszewski
- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Niwinska
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Gorniak
- Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Katarzyna Pogoda
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Roman Dubianski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Katarzyna Gorska
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Ewa Glinka
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Zbigniew Nowecki
- Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
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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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Press MF, Seoane JA, Curtis C, Quinaux E, Guzman R, Sauter G, Eiermann W, Mackey JR, Robert N, Pienkowski T, Crown J, Martin M, Valero V, Bee V, Ma Y, Villalobos I, Slamon DJ. Assessment of ERBB2/HER2 Status in HER2-Equivocal Breast Cancers by FISH and 2013/2014 ASCO-CAP Guidelines. JAMA Oncol 2019; 5:366-375. [PMID: 30520947 PMCID: PMC6439848 DOI: 10.1001/jamaoncol.2018.6012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance The 2013/2014 American Society of Clinical Oncology and College of American Pathologists (ASCO-CAP) guidelines for HER2 testing by fluorescence in situ hybridization (FISH) designated an "equivocal" category (average HER2 copies per tumor cell ≥4-6 with HER2/CEP17 ratio <2.0) to be resolved as negative or positive by assessments with alternative control probes. Approximately 4% to 12% of all invasive breast cancers are characterized as HER2-equivocal based on FISH. Objective To evaluate the following hypotheses: (1) genetic loci used as alternative controls are heterozygously deleted in a substantial proportion of breast cancers; (2) use of these loci for assessment of HER2 by FISH leads to false-positive assessments; and (3) these HER2 false-positive breast cancer patients have outcomes that do not differ from clinical outcomes for patients with HER2-negative breast cancer. Design, Setting, and Participants We retrospectively assessed the use of chromosome 17 p-arm and q-arm alternative control genomic sites (TP53, D17S122, SMS, RARA, TOP2A), as recommended by the 2013/2014 ASCO-CAP guidelines for HER2 testing, in patients whose data were available through Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) and whose tissues were available through the Breast Cancer International Research Group clinical trials. We used data from an international cohort database of invasive breast cancers (1980 participants) and international clinical trial of adjuvant chemotherapy in invasive, node-positive breast cancer patients. Main Outcomes and Measures The primary objectives were to (1) assess frequency of heterozygous deletions in chromosome 17 genomic sites used as FISH internal controls for evaluation of HER2 status among HER2-equivocal cancers; (2) characterize impact of using deleted sites for determination of HER2-to-internal-control-gene ratios; (3) assess HER2 protein expression in each subgroup; and (4) compare clinical outcomes for each subgroup. Results Of the 1980 patients in METABRIC,1915 patients were fully evaluated. In addition, 100 HER2-equivocal breast cancers by FISH and 100 comparator FISH-negative breast cancers from the BCIRG-005 trial were analyzed. Heterozygous deletions, particularly in specific p-arm sites, were common in both HER2-amplified and HER2-not-amplified breast cancers. Use of alternative control probes from these regions to assess HER2 by FISH in HER2-equivocal as well as HER2-not-amplified breast cancers resulted in high rates of false-positive ratios (HER2-to-alternative control ratio ≥2.0) owing to heterozygous deletions of control p-arm genomic sites used in ratio denominators. Misclassification of HER2 status was observed not only in breast cancers with ASCO-CAP equivocal status but also in breast cancers with an average of fewer than 4.0 HER2 copies per tumor cell when using alternative control probes. Conclusions and Relevance The indiscriminate use of alternative control probes to calculate HER2 FISH ratios in HER2-equivocal breast cancers may lead to false-positive interpretations of HER2 status resulting from unrecognized heterozygous deletions in 1 or more of these alternative control genomic sites and incorrect HER2 ratio determinations.
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Affiliation(s)
- Michael F Press
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
| | - Jose A Seoane
- Departments of Medicine & Genetics, Stanford University, Stanford, California
| | - Christina Curtis
- Departments of Medicine & Genetics, Stanford University, Stanford, California
| | - Emmanuel Quinaux
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - Roberta Guzman
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
| | | | | | - John R Mackey
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - Nicholas Robert
- Virginia Cancer Specialists/US Oncology Research Network, Fairfax, Virginia
| | | | - John Crown
- Irish Cooperative Oncology Research Group, St Vincent's University Hospital, Dublin, Ireland
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain
| | - Vicente Valero
- The University of Texas, M.D. Anderson Cancer Center, Houston, Texas
| | - Valerie Bee
- Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Yanling Ma
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
| | - Ivonne Villalobos
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
| | - Dennis J Slamon
- Department of Medicine, Geffen School of Medicine at University of California Los Angeles, Los Angeles
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Perez EA, Barrios C, Eiermann W, Toi M, Im Y, Conte P, Martin M, Pienkowski T, Pivot XB, Burris HA, Petersen JA, De Haas S, Hoersch S, Patre M, Ellis PA. Trastuzumab emtansine with or without pertuzumab versus trastuzumab with taxane for human epidermal growth factor receptor 2–positive advanced breast cancer: Final results from MARIANNE. Cancer 2019; 125:3974-3984. [DOI: 10.1002/cncr.32392] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 11/11/2022]
Affiliation(s)
| | - Carlos Barrios
- School of Medicine Pontifical Catholic University of Rio Grande do Sul Porto Alegre Brazil
| | | | - Masakazu Toi
- Graduate School of Medicine Kyoto University Kyoto Japan
| | | | - Pierfranco Conte
- University of Padua Padua Italy
- Veneto Oncology Institute Padua Italy
| | - Miguel Martin
- Hospital General Universitario Gregorio Marañon, Complutense University, CIBERONC, GEICAM Madrid Spain
| | | | | | - Howard A. Burris
- Sarah Cannon Research Institute and Tennessee Oncology Nashville Tennessee
| | | | | | | | | | - Paul Anthony Ellis
- Guy's 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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Press MF, Seoane JA, Curtis C, Quinaux E, Guzman R, Sauter G, Eiermann W, Mackey JR, Robert N, Pienkowski T, Crown J, Martin M, Valero V, Bee V, Ma Y, Villalobos I, Slamon DJ. Abstract PD3-11: HER2/ ERBB2 status in “ HER2 equivocal” breast cancers by FISH and ASCO-CAP guidelines: False-positives due to heterozygous deletions of alternative control loci. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd3-11] [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
Background. The ASCO-CAP guidelines for HER2 testing by fluorescence in situ hybridization (FISH) have a category, referred to as “equivocal” (average HER2 copies per tumor cell >4-6 with HER2/CEP17 ratio <2·0), which is neither “HER2-positive” nor “HER2-negative”. Approximately 4% - 12% of invasive breast cancers are “HER2-equivocal” based on FISH. Cancers in this category may be resolved as “negative” or “positive” by FISH alternative control probes (2013/2014 guidelines) or HER2 immunohistochemistry (IHC) (2018 update). Our objectives were to evaluate the following hypotheses: 1.) Genetic loci used as alternative controls show heterozygous deletion in a substantial proportion of breast cancers; 2.) Use of these loci for assessment of HER2 by FISH leads to false-positives; 3.) HER2 FISH false-positive breast cancer patients have outcomes that do not differ from clinical outcomes for HER2-negative breast cancer patients; and 4.) HER2-equivocal breast cancers seldom show HER2 protein overexpression (IHC 3+).
Methods. We retrospectively assessed the use of chromosome 17 p-arm and q-arm alternative control genomic sites (TP53, D17S122, SMS, RARA, TOP2A), as recommended by the 2013/2014 ASCO-CAP guidelines, in patients whose data were available through the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC)(N=1980) or whose tissues were available from the BCIRG-005 clinical trial (N=3298). We used either FDA-approved HER2 IHC (HercepTest) or laboratory-developed HER2 (10H8) IHC assays to assess HER2 protein expression.
Results. Using METABRIC we found heterozygous deletions, particularly in specific p-arm sites, were common in both HER2-amplified and HER2-not-amplified breast cancers. Use of alternative control probes from these regions to assess HER2 by FISH in “HER2 equivocal” as well as HER2-not-amplified breast cancers resulted in high rates of false-positive ratios (HER2-to-alternative control ratio >2·0) due to heterozygous deletions of control p-arm genomic sites used as ratio denominators. Misclassifications of HER2 status was observed not only in breast cancers with ASCO-CAP “equivocal” status but also in breast cancers with an average of <4·0 HER2 copies per tumor cell. These deletions were also identified by FISH. IHC demonstrated <1% of FISH “HER2-equivocal” breast cancers in BCIRG-005 had IHC3+ immunostaining, consistent with HER2-not-amplified status. Clinical outcomes of “HER2-equivocal” breast cancer patients with HER2-to-alternative control ratio >2·0 did not differ significantly from clinical outcomes of those with HER2-to-alternative control ratio<2·0.
Conclusion. Using chromosome 17 p-arm alternative controls, as recommended by 2013/2014 ASCO-CAP guidelines, instead of CEP17 for resolution of “HER2 equivocal” cases, is problematic due to frequent heterozygous deletions of these loci in breast cancers. The indiscriminate use of alternative control probes to calculate a HER2 FISH ratio in “HER2-equivocal” breast cancers leads to false-positive interpretations of HER2 status resulting from unrecognized heterozygous deletions in one or more of these alternative control genomic sites and incorrect HER2 ratio determinations.
Citation Format: Press MF, Seoane JA, Curtis C, Quinaux E, Guzman R, Sauter G, Eiermann W, Mackey JR, Robert N, Pienkowski T, Crown J, Martin M, Valero V, Bee V, Ma Y, Villalobos I, Slamon DJ. HER2/ERBB2 status in “HER2 equivocal” breast cancers by FISH and ASCO-CAP guidelines: False-positives due to heterozygous deletions of alternative control loci [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 PD3-11.
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Affiliation(s)
- MF Press
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - JA Seoane
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - C Curtis
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - E Quinaux
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - R Guzman
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - G Sauter
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - W Eiermann
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - JR Mackey
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - N Robert
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - T Pienkowski
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - J Crown
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - M Martin
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - V Valero
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - V Bee
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Y Ma
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - I Villalobos
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
| | - DJ Slamon
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Stanford University, Stanford, CA; International Drug Development Institute, Louvain-la-Neuve, Belgium; University of Hamburg, Hamburg, Germany; Frauenklinik vom Roten Kreuz, Munich, Germany; University of Alberta, Edmonton, Canada; Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Postgraduate Medical Education Center, Warsaw, Poland; St Vincent's University Hospital, Dublin, Ireland; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; M.D. Anderson Cancer Center, Houston, TX; Cancer International Research Group/Translational Research in Oncology, Paris, France; Geffen School of Medicine at UCLA, Los Angeles, CA
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Teoh SHS, Symes WS, Sun H, Pienkowski T, Carrasco LR. A global meta-analysis of the economic values of provisioning and cultural ecosystem services. Sci Total Environ 2019; 649:1293-1298. [PMID: 30308899 DOI: 10.1016/j.scitotenv.2018.08.422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 06/08/2023]
Abstract
Despite a growing demand to integrate ecosystem services into sustainability decision-making, our understanding of the global distribution of the economic value of ES is scarce. We extracted information from provisioning and cultural ecosystem services (PCES) from The Economics of Ecosystems and Biodiversity (TEEB) database using a meta-analytical approach. We then employed geostatistical methods to analyze the relationship between economic values and environmental and socio-economic predictors. Here we show that anthropogenic related factors such as accessibility, spatially explicit gross domestic product and ecosystem services scarcity explain global trends of PCES economic values. We observe higher PCES values in agricultural areas of strong human presence such as the British Isles, Southwest of Brazil and India and lower values in less disturbed natural areas. These findings highlight the decisive role that human systems play in the economic realization of PCES and caution that single-criterion sustainability and conservation policies aimed at maximizing the economic returns of PCES may not overlap with wild nature.
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Affiliation(s)
- S H S Teoh
- Department of Biological Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117543, Republic of Singapore
| | - W S Symes
- Department of Biological Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117543, Republic of Singapore
| | - H Sun
- Department of Biological Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117543, Republic of Singapore
| | - T Pienkowski
- Department of Biological Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117543, Republic of Singapore
| | - L R Carrasco
- Department of Biological Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117543, Republic of Singapore.
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Triulzi T, Di Cosimo S, Bianchini G, Pienkowski T, Im Y, Bianchi G, De Cecco L, Tseng L, Liu M, Lluch A, Semiglazov V, De la Haba-Rodriguez J, Oh D, Poirier B, Pedrini J, Valagussa P, Tagliabue E, Gianni L. The 41-gene classifier TRAR predicts response of HER2 positive breast cancer patients in the NeoSphere study. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30266-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Press MF, Sauter G, Buyse M, Fourmanoir H, Quinaux E, Tsao-Wei DD, Eiermann W, Robert N, Pienkowski T, Crown J, Martin M, Valero V, Mackey JR, Bee V, Ma Y, Villalobos I, Campeau A, Mirlacher M, Lindsay MA, Slamon DJ. HER2 Gene Amplification Testing by Fluorescent In Situ Hybridization (FISH): Comparison of the ASCO-College of American Pathologists Guidelines With FISH Scores Used for Enrollment in Breast Cancer International Research Group Clinical Trials. J Clin Oncol 2017; 34:3518-3528. [PMID: 27573653 PMCID: PMC5074347 DOI: 10.1200/jco.2016.66.6693] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose ASCO and the College of American Pathologists (ASCO-CAP) recently recommended
further changes to the evaluation of human epidermal growth factor receptor 2 gene
(HER2) amplification by fluorescent in situ hybridization
(FISH). We retrospectively assessed the impact of these new guidelines by using
annotated Breast Cancer International Research Group (BCIRG) -005, BCIRG-006, and
BCIRG-007 clinical trials data for which we have detailed outcomes. Patients and Methods The HER2 FISH status of BCIRG-005/006/007 patients with breast
cancers was re-evaluated according to current ASCO-CAP guidelines, which
designates five different groups according to HER2 FISH ratio and
average HER2 gene copy number per tumor cell: group 1 (in situ
hybridization [ISH]–positive): HER2-to-chromosome 17
centromere ratio ≥ 2.0, average HER2 copies ≥ 4.0;
group 2 (ISH-positive): ratio ≥ 2.0, copies < 4.0; group 3
(ISH-positive): ratio < 2.0, copies ≥ 6.0; group 4 (ISH-equivocal):
ratio < 2.0, copies ≥ 4.0 and < 6.0; and group 5
(ISH-negative): ratio < 2.0, copies < 4.0. We assessed correlations
with HER2 protein, clinical outcomes by disease-free survival (DFS) and overall
survival (OS) and benefit from trastuzumab therapy (hazard ratio [HR]). Results Among 10,468 patients with breast cancers who were successfully screened for trial
entry, 40.8% were in ASCO-CAP ISH group 1, 0.7% in group 2; 0.5% in group 3, 4.1%
in group 4, and 53.9% in group 5. Distributions were similar in screened compared
with accrued subpopulations. Among accrued patients, FISH group 1 breast cancers
were strongly correlated with immunohistochemistry 3+ status (P
< .0001), whereas groups 2, 3, 4, and 5 were not; however, groups 2, 4 and,
5 were strongly correlated with immunohistochemistry 0/1+ status (all
P < .0001), whereas group 3 was not. Among patients
accrued to BCIRG-005, group 4 was not associated with significantly worse DFS or
OS compared with group 5. Among patients accrued to BCIRG-006, only group 1 showed
a significant benefit from trastuzumab therapy (DFS HR, 0.71; 95% CI, 0.60 to
0.83; P < .0001; OS HR, 0.69; 95% CI, 0.55 to 0.85;
P = .0006), whereas group 2 did not. Conclusion Our findings support the original categorizations of HER2 by FISH
status in BCIRG/Translational Research in Oncology trials.
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Affiliation(s)
- Michael F Press
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Guido Sauter
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Marc Buyse
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Hélène Fourmanoir
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Emmanuel Quinaux
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Denice D Tsao-Wei
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Wolfgang Eiermann
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Nicholas Robert
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Tadeusz Pienkowski
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - John Crown
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Miguel Martin
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Vicente Valero
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - John R Mackey
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Valerie Bee
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Yanling Ma
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Ivonne Villalobos
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Anaamika Campeau
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Martina Mirlacher
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Mary-Ann Lindsay
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - Dennis J Slamon
- Michael F. Press, Denice D. Tsao-Wei, Yanling Ma, Ivonne Villalobos, and Anaamika Campeau, University of Southern California Norris Comprehensive Cancer Center; Dennis J. Slamon, Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; Nicholas Robert, Virginia Cancer Specialists/US Oncology Research Network, Fairfax, VA; Vicente Valero, The University of Texas MD Anderson Cancer Center, Houston, TX; Guido Sauter and Martina Mirlacher, University of Hamburg, Hamburg; Wolfgang Eiermann, Frauenklinik vom Roten Kreuz, Munich, Germany; Marc Buyse, Hélène Fourmanoir, and Emmanuel Quinaux, International Drug Development Institute, Louvain-la-Neuve, Belgium; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; John Crown, Irish Cooperative Onoclogy Research Group, St Vincent's University Hospital, Dublin, Ireland; Miguel Martin, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain; John R. Mackey, University of Alberta; Mary-Ann Lindsay, Cancer International Research Group/Translational Research in Oncology, Edmonton, Alberta, Canada; and Valerie Bee, Cancer International Research Group/Translational Research in Oncology, Paris, France
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Gligorov J, Ataseven B, Verrill M, De Laurentiis M, Jung K, Azim H, Al-Sakaff N, Lauer S, Shing M, Pivot X, Koroveshi D, Bouzid K, Casalnuovo M, Cascallar D, Korbenfeld EP, Bastick P, Beith J, Colosimo M, Friedlander M, Ganju V, Green M, Patterson K, Redfern A, Richardson G, Ceric T, Gordana K, Beato CA, Ferrari M, Hegg R, Helena V, Ismael GF, Lessa AE, Mano M, Morelle A, Nogueira JA, Timcheva K, Tomova A, Tsakova M, Zlatareva-Petrova A, Asselah J, Assi H, Brezden-Masley C, Chia S, Freedman O, Harb M, Joy AA, Kulkarni S, Prady C, Gaete AAA, Matamala L, Torres R, Yanez E, Franco S, Urrego M, Gugić D, Vrbanec D, Melichar B, Prausová J, Vyzula R, Pilarte RG, León MI, Muñoz R, Ramos G, Azeem HA, Aziz AA, El Zawahry H, Osegueda FR, Alexandre J, Artignan X, Barletta H, Beguier E, Berdah JF, Marty CB, Bollet M, Bourgeois H, Bressac C, Burki F, Campone M, Coeffic D, Cojocarasu OZ, Dagada C, Dalenc F, Del Piano F, Desauw C, Desmoulins I, Dohollou N, Egreteau J, Ferrero JM, Foa C, Garidi R, Gasnault L, Gligorov J, Guardiola E, Hamizi S, Jarcau R, Jacquin JP, Jaubert D, Jolimoy G, Mineur HL, Largillier R, Leduc B, Martin P, Melis A, Monge J, Moullet I, Mousseau M, Nguyen S, Orfeuvre H, Petit T, Pivot X, Priou F, Bach IS, Simon H, Stefani L, Uwer L, Youssef A, Aktas B, von der Assen A, Augustin D, Balser C, Bauer LE, Bechtner C, Beyer G, Brucker C, Bückner U, Busch S, Christensen B, Deryal M, Farrokh A, Faust E, Friedrichs K, Graf H, Griesshammer M, Grischke EM, Hänle C, Heider A, Henschen S, Hesse T, Jackisch C, Kisro J, Köhler A, Kuemmel S, Lampe D, Lantzsch T, Latos K, Lex B, Liedtke C, Luedders D, Maintz C, Müller V, Overkamp F, Park-Simon TW, Paul M, Prechtl A, Ringsdorf U, Runnebaum I, Ruth S, Salat C, Scheffen I, Schilling J, Schmatloch S, Schmidt M, Schneeweiss A, Schrader I, Seipelt G, Simon E, Stefek A, Stickeler E, Thill M, Tio J, Tuczek A, Warm M, Weigel M, Wischnik A, Wojcinski S, Ziegler-Löhr K, Aravantinos G, Ardavanis A, Fountzilas G, Gogas H, Kakolyris S, Mavroudis D, Papadimitriou C, Papandreou C, Papazisis K, Castro H, Hernandez-Monroy CE, Ngan R, Yeo W, Bittner N, Boer K, Csejtei A, Horvath Z, Kocsis J, Mangel LC, Mezei K, Nagy Z, Szanto J, Atmakusuma D, Fadjari H, Kurnianda D, Prayogo N, Tanggo EH, Coate L, Hennessy B, Kelly C, Martin M, Nasim S, O'Connor M, Aieta M, Allegrini G, Amadori D, Bidoli P, Biti G, Bordonaro R, Bottini A, Carterni G, Cavanna L, Cazzaniga M, Cognetti F, Contu A, Cruciani G, Donadio M, Falcone A, Farci D, Forcignanò RC, Frassoldati A, Gaion F, Gamucci T, Giotta F, de Laurentiis M, Livi L, Lorusso V, Maiello E, Marchetti P, Mariani G, Mion M, Moscetti L, Musolino A, Pazzola A, Pedrazzoli P, Pigi A, de Placido S, Caremoli ER, Santoro A, Tienghi A, Ahn JS, Jung KH, Lee KS, Lee SH, Seo JH, Sohn JH, Cesas A, Juozaityte E, Cheah NLC, Chong FLT, Devi BC, Phua V, Teoh D, Ching LW, Yusof M, Corona J, Dominguez A, Mendoza RLG, Hernandez CA, Ramiro AJ, Santos JM, Espinosa PM, Villarreal Garza CM, Errihani H, Bakker S, van den Berkmortel F, Blaisse R, Huinink DTB, van den Bosch J, Braun J, Dercksen M, Droogendijk H, Erdkamp F, Haringhuizen A, de Jongh F, Kok T, Los M, Madretsma S, Terwogt JMM, van der Padt A, van Rossum-Schornagel QC, Smilde T, de Valk B, van der Velden A, van Warmerdam L, van de Wouw A, North R, Kersten C, Mjaaland I, Wist E, Aziz Z, Masood N, Rashid K, Shah M, Alcedo JC, Aleman D, Neciosup S, Reategui R, Valdiviezo N, Vera L, Fernando G, Roque F, Strebel HM, Krzemieniecki K, Litwiniuk M, Mruk A, Pienkowski T, Sawrycki P, Slomian G, Tomczak P, Afonso N, Cardoso F, Damasceno M, Nave M, Badulescu F, Ciule L, Curescu S, Eniu A, Filip D, Grecea D, Jinga DC, Lungulescu D, Oprean CM, Stanculeanu DL, Turdean M, Dvornichenko V, Emelyanov S, Lichinitser M, Manikhas A, Sakaeva D, Shirinkin V, Stroyakovskiy D, Abulkhair O, Zekri J, Filipovic S, Kovcin V, Nedovic J, Pesic J, Vasovic S, Ng R, Bystricky B, Leskova J, Mardiak J, Mišurová E, Wagnerova M, Takač I, Demetriou GS, Dreosti L, Govender P, Jordaan JP, Veersamy P, Romero JLA, Lopez NB, Arias CC, Chacon J, Aramburo AF, Morales LAF, Garcia M, Estevez LG, Garcia-Palomo Perez A, Garcia Saenz JA, Garcia Sanchis L, Cubells LG, Cortijo LG, Santiago SG, De Aranguiz BHF, Mañas JJI, Gallego PJ, Cussac AL, Ferrandiz CL, Garrido ML, Alvarez PL, Vega JML, Del Prado PM, Jañez NM, Murillo SM, Rosales AM, Jaso LM, Fernandez IP, Martorell AP, Carrion RP, Simon SP, Alcibar AP, Lorenzo JP, Garcia VQ, Asensio TRYC, Maicas MDT, Villanueva Silva MJ, Killander F, Svensson JH, Fehr M, Hauser N, Müller A, Pagani O, Passmann-Kegel H, Popescu R, Rabaglio M, Rauch D, Schlatter C, Zaman K, Chang TW, Huang CS, Wang HC, Yu JC, Bandidwattanawong C, Maneechavakajorn J, Seetalarom K, Dejthevaporn T(S, Somwangprasert A, Vongsaisuwon M, Akbulut H, Altundag K, Arican A, Bozcuk H, Eralp Y, Idris M, Isikdogan A, Senol CH, Sevinc A, Uygun K, Yucel E, Yucel I, Yumuk F, Shparyk Y, Voitko N, Jaloudi M, Adams J, Agrawal R, Ahmed S, Alhasso A, Allerton R, Anwar S, Archer C, Ashford R, Barraclough L, Bertelli G, Bishop J, Branson T, Butt M, Chakrabarti A, Chakraborti P, Churn M, Crowley C, Davis R, Dhadda A, Eldeeb H, Fraser J, Hall J, Hickish T, Hogg M, Howe T, Joffe J, Kelleher M, Kelly S, Kendall A, Kristeleit H, Lumsden G, Macmillan C, MacPherson I, Malik Z, Mithal N, Neal A, Panwar U, Proctor A, Proctor SJ, Raj S, Rehman S, Sandri I, Scatchard K, Sherwin E, Sims E, Singer J, Smith S, Tahir S, Taylor W, Tsalic M, Verrill M, Wardley A, Waters S, Wheatley D, Wright K, Yuille F, Alonso I, Artagaveytia N, Rodriguez R, Arbona E, Garcia Y, Lion L, Marcano D, Van Thuan T. Safety and tolerability of subcutaneous trastuzumab for the adjuvant treatment of human epidermal growth factor receptor 2-positive early breast cancer: SafeHer phase III study's primary analysis of 2573 patients. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perez EA, Barrios CH, Eiermann W, Toi M, Im YH, Conte PF, Martin M, Pienkowski T, Pivot XB, Burris HA, Hoersch S, Patre M, Ellis PA. Phase III, randomized study of first-line trastuzumab emtansine (T-DM1) ± pertuzumab (P) vs. trastuzumab + taxane (HT) treatment of HER2-positive MBC: Final overall survival (OS) and safety from MARIANNE. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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
1003 Background: In MARIANNE (NCT01120184), patients with HER2-positive advanced breast cancer were randomized to trastuzumab + docetaxel or paclitaxel (HT; n=365), T-DM1 + placebo (T-DM1; n=367), or T-DM1 + P (T-DM1 + P; n=363) as first-line therapy. In the primary analysis, T-DM1–based treatment exhibited noninferior, but not superior, progression-free survival relative to HT (Perez EA, et al. J Clin Oncol 2016). OS was similar between treatments in the first interim analysis. Here we report OS from the final descriptive analysis. Methods: Enrolled patients had centrally assessed HER2-positive (IHC3+ or ISH+) progressive/recurrent locally advanced breast cancer or previously untreated MBC with a ≥6-month interval since (neo)adjuvant treatment with taxanes or vinca alkaloids. Results: At the clinical cutoff date of May 15, 2016, median follow-up was 54 months and 512 patients had died. Median OS was 50.9, 53.7, and 51.8 months with HT, T-DM1, and T-DM1 + P, respectively (Table). A sensitivity analysis in which HT-treated patients who received T-DM1 and/or P after disease progression (n=85) were censored prior to treatment switch found similar results. There were numerically fewer grade ≥3 adverse events (AEs) with T-DM1. Conclusions: With this longer follow-up, the T-DM1 safety profile was consistent with the primary analysis and prior experience. While OS was similar across treatment arms, a median OS of 53.7 months and fewer grade ≥3 AEs (vs other arms) supports T-DM1 as an effective and tolerable alternative first-line treatment for HER2-positive MBC patients. Clinical trial information: NCT01120184. [Table: see text]
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Affiliation(s)
| | | | | | - Masakazu Toi
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Pier Franco Conte
- University of Padova and Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | - Howard A. Burris
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | | | | | - Paul Anthony Ellis
- Guy's Hospital and Sarah Cannon Research Institute, London, United Kingdom
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Bianchini G, Pienkowski T, Im YH, Bianchi GV, Tseng LM, Liu MC, Lluch A, de la Haba-Rodríguez J, Semiglazov V, Oh DY, Poirier B, Pedrini JL, Valagussa P, Gianni L. Abstract P1-09-04: Proliferation and p21 refine risk of relapse in residual disease after HER2-directed therapies. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-09-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients (pts) with residual disease (RD) after neoadjuvant therapy are at higher risk of relapse. We investigated whether biomarkers assessed at surgery in patients pts with RD in the NeoSphere study were informative for risk of distant event free survival (DEFS)
Methods: In NeoSphere 417 HER2+ pts were randomized to neoadjuvant TD, TPD, TP or PD (T=trastuzumab, P=pertuzumab, D=docetaxel), and received FAC/FEC and trastuzumab after surgery. 296 pts had RD. Affymetrix derived gene expression profiles (GEPs) were available at surgery for 201 pts (67.9%). 176 pts (60.1%) had paired samples before and after treatment with available GEPs. We investigated the prognostic value of proliferation evaluated by Mitosis Kinase Score (MKS) (Bianchini G Cancer Res 2010), and performed a gene discovery for association between gene expression at surgery and DEFS.
Results: MKS as continuous marker was associated with significantly higher risk of relapse when assessed at surgery (HR 1.80 [1.23-2.65]; p=0.002), but not before treatment (HR 1.50 [0.80-2.78]; p=0.20). In paired samples, there was an average decrease (p=9.2E-11) of MKS after treatment, which was prominent in ER+ and chemotherapy-containing arms. In ER- and TP arm there were cases of increase and of decrease of MKS. In ER+ the 5 years DEFS was 94.3% in the Low/Int MKS tertiles group (pooled) vs 70.5% in the High MKS tertile group (HR 5.41 [1.87-15.6]; p=0.002). In ER-, the 5 years DEFS was 85.0% in the Low/Int vs 64.1% in the High group (HR 2.89 [1.08-7.76]; p=0.035). Notably, MKS at surgery after the two monoclonal alone was also prognostic.
In the gene discovery approach only the expression of CDKN1A (p21)at surgery was associated with DEFS after correction for false discovery rate (FDR=0.01). Pre-treatment p21 was not associated with DEFS. Paired comparison showed significant upregulation of p21 in all patients, treatment arms and ER groups. The Int/High p21 tertiles group (pooled) had lower risk of recurrence than the low tertile in ER+ (HR 4.31 [1.60-11.6]; p=0.004) and in ER- (HR 5.81 [1.87-18.1]; p=0.002) groups. p21 in TP arm was also prognostic. MKS and p21 expression provided independent prognostic information and remained significant after correction for clinico-pathological variables (nodes and T stage) and tumor-infiltrating lymphocytes. Combining the two markers, there was a group at very low risk (Low/Int MKS and Int/High p21) and one at high risk (High MKS and Low p21). The other tertiles combinations had intermediate risk. In ER+, the 5 yrs DEFS was 94.9% in the low risk group and 52.9% in the high risk (p=1.9E-05). In ER-, the 5 yrs DEFS was 96.5% in the low and 45.5% in the high risk group (p=0.001).The markers' combination was also prognostic in the two monoclonal only arm.
Conclusions: Proliferation (MKS) and p21 expression are modulated by trastuzumab and/or pertuzumab regimens. Tumors with high MKS and low p21 in RD after neoadjuvant therapy defined a group at very high risk of relapse. Tumors with low/int proliferation and int/high p21 had low risk of recurrence similar to that of patients achieving pCR. Whether the pharmacodynamic modulation of p21 could be used as surrogate marker of long term benefit in patients with RD deserves additional investigation.
Citation Format: Bianchini G, Pienkowski T, Im Y-H, Bianchi GV, Tseng L-M, Liu M-C, Lluch A, de la Haba-Rodríguez J, Semiglazov V, Oh D-Y, Poirier B, Pedrini JL, Valagussa P, Gianni L. Proliferation and p21 refine risk of relapse in residual disease after HER2-directed therapies [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-09-04.
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Affiliation(s)
- G Bianchini
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - T Pienkowski
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - Y-H Im
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - GV Bianchi
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - L-M Tseng
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - M-C Liu
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - A Lluch
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - J de la Haba-Rodríguez
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - V Semiglazov
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - D-Y Oh
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - B Poirier
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - JL Pedrini
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - P Valagussa
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
| | - L Gianni
- IRCCS Ospedale San Raffaele, Milan, Italy; Centrum Onkologii, Warsaw, Poland; Samsung Medical Center, Seoul, Republic of Korea; IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy; Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain; Hospital Reina Sofia, Córdoba, Spain; NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation; Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea; Hôpital du Saint-Sacrement, CHU de Québec, Québec, Canada; Hospital Ernesto Dornelles, Porto Alegre, Brazil; Fondazione Michelangelo, Milan, Italy
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Perez EA, Barrios C, Eiermann W, Toi M, Im YH, Conte P, Martin M, Pienkowski T, Pivot X, Burris HA, Petersen JA, Stanzel S, Strasak A, Patre M, Ellis P. Trastuzumab Emtansine With or Without Pertuzumab Versus Trastuzumab Plus Taxane for Human Epidermal Growth Factor Receptor 2-Positive, Advanced Breast Cancer: Primary Results From the Phase III MARIANNE Study. J Clin Oncol 2017; 35:141-148. [PMID: 28056202 PMCID: PMC5455677 DOI: 10.1200/jco.2016.67.4887] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose Trastuzumab and pertuzumab are human epidermal growth factor receptor 2 (HER2) -targeted monoclonal antibodies, and trastuzumab emtansine (T-DM1) is an antibody-drug conjugate that combines the properties of trastuzumab with the cytotoxic activity of DM1. T-DM1 demonstrated encouraging efficacy and safety in a phase II study of patients with previously untreated HER2-positive metastatic breast cancer. Combination T-DM1 and pertuzumab showed synergistic activity in cell culture models and had an acceptable safety profile in a phase Ib and II study. Methods In the MARIANNE study, 1,095 patients with centrally assessed, HER2-positive, advanced breast cancer and no prior therapy for advanced disease were randomly assigned 1:1:1 to control (trastuzumab plus taxane), T-DM1 plus placebo, hereafter T-DM1, or T-DM1 plus pertuzumab at standard doses. Primary end point was progression-free survival (PFS), as assessed by independent review. Results T-DM1 and T-DM1 plus pertuzumab showed noninferior PFS compared with trastuzumab plus taxane (median PFS: 13.7 months with trastuzumab plus taxane, 14.1 months with T-DM1, and 15.2 months with T-DM1 plus pertuzumab). Neither experimental arm showed PFS superiority to trastuzumab plus taxane. Response rate was 67.9% in patients who were treated with trastuzumab plus taxane, 59.7% with T-DM1, and 64.2% with T-DM1 plus pertuzumab; median response duration was 12.5 months, 20.7 months, and 21.2 months, respectively. The incidence of grade ≥ 3 adverse events was numerically higher in the control arm (54.1%) versus the T-DM1 arm (45.4%) and T-DM1 plus pertuzumab arm (46.2%). Numerically fewer patients discontinued treatment because of adverse events in the T-DM1 arms, and health-related quality of life was maintained for longer in the T-DM1 arms. Conclusion T-DM1 showed noninferior, but not superior, efficacy and better tolerability than did taxane plus trastuzumab for first-line treatment of HER2-positive, advanced breast cancer.
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Affiliation(s)
- Edith A. Perez
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Carlos Barrios
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Wolfgang Eiermann
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Masakazu Toi
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Young-Hyuck Im
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Pierfranco Conte
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Miguel Martin
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Tadeusz Pienkowski
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Xavier Pivot
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Howard A. Burris
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Jennifer A. Petersen
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Sven Stanzel
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Alexander Strasak
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Monika Patre
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Paul Ellis
- Edith A. Perez, Mayo Clinic, Jacksonville, FL; Howard A. Burris, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Jennifer A. Petersen, Genentech, South San Francisco, CA; Carlos Barrios, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil; Wolfgang Eiermann, Interdisciplinary Oncology Center, Munich, Germany; Masakazu Toi, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Young-Hyuck Im, Samsung Medical Centre, Seoul, Korea; Pierfranco Conte, University of Padova and Istituto Oncologico Veneto, Padova, Italy; Miguel Martin, Instituto de Investigacion Sanitaria Gregorio Marañón; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Tadeusz Pienkowski, Postgraduate Medical Education Center, Warsaw, Poland; Xavier Pivot, University Hospital Jean Minjoz, Besançon, France; Sven Stanzel, Alexander Strasak, Monika Patre, F. Hoffmann-La Roche, Basel, Switzerland; and Paul Ellis, Guys Hospital and Sarah Cannon Research Institute, London, United Kingdom
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Bianchini G, Pienkowski T, Im YH, Bianchi GV, Tseng LM, Liu MC, Lluch A, Semiglazov V, de la Haba-Rodríguez J, Oh DY, Poirier B, Pedrini JL, Valagussa P, Gianni L. Abstract 3940: Baseline molecular markers and risk of distant relapse in the NeoSphere study. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-3940] [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 We investigated the association between gene-expression (GEP) based markers and distant event free survival (DEFS) in HER2+ breast cancer patients (pts) in the NeoSphere study.
Methods In NeoSphere HER2+ pts were randomized to neoadjuvant HD, PHD, PH or PD (H = trastuzumab, P = pertuzumab, D = docetaxel). Affymetrix-based GEPs were generated in 367/417 pts (88%). We evaluated the association with DEFS of 10 biomarkers in all patients with arms pooled and by each arm, and separately by ER status: six immune-related metagenes (CD8, IGG and MHC2, related to T cells, plasma cells and antigen presenting cells, respectively; MHC1, STAT1 and IF.I related to HLA cass I genes, and to genes modulated by interferons), ESR1 and an ER-related score (ERS), a proliferation marker (MKS) and ERBB2 expression. We re-assessed findings in GEPs derived from ER-/HER2+ pts of the NOAH trial treated with neoadjuvant chemotherapy (CT) or CT and trastuzumab (CTH).
Results Median follow-up was 5 years. Overall none of the markers was significant, but an interaction test for biomarkers and ER status was significant for MHC1, MHC2, STAT1, and marginally for MKS.
In ER+/HER2+ tumors, immune markers were not significant, but higher proliferation (MKS; HR 2.12 [1.07-4.19], p = 0.03) was linked to higher risk, with a similar trend for low ERS (p = 0.097). In ER-/HER2+ tumors higher MHC2 (HR 0.53 [0.36-0.79]; p = 0.002), MHC1 (HR 0.41 [0.22-0.77], p = 0.005) and STAT1 (HR 0.69 [0.49-0.97], p = 0.036) were linked to better DEFS. Outcome for high MHC1 tertile was excellent and similar in all treatment arms. Low/int MHC1 pts treated with PHD had a trend for better DEFS compared to other treatments (HR 0.41 (0.14-1.21), p = 0.11). In cases reaching pCR higher MHC1 (p = 0.009), MHC2 (p = 0.006), IGG (p = 0.027) and STAT1 (p = 0.008) were linked to better DEFS. For instance, the 5 yrs DEFS for high and low MHC1 tertiles was 100% and 74.6%, respectively.
Similarly, in ER-/HER2+ pts from NOAH, the 5-yrs DEFS in high, int and low MHC1 tertiles was 88.1%, 68.4% and 48.1%, respectively (p = 0.015). Prognosis was similar and good in patients with high MHC1 receiving CT or CTH (p = 0.674). Instead, in low/int MHC1 groups, CTH compared to CT significantly improved DEFS (HR 0.39 [0.16-0.93], p = 0.035). Also in NOAH, the 5 yrs DEFS of pCR cases was influenced by baseline MCH1 (100% and 76.2% with high and low/int MHC1, respectively).
Conclusions In this exploratory analysis of NeoSphere, different biological functions were linked to DEFS in ER+ (proliferation and ER-related genes) and ER- (immune related) cases. In particular outcome of ER-/HER2+ with high MHC1 was good. However, in this group the benefit from adding trastuzumab to CT or pertuzumab in the PHD regimen was relatively small. Instead, the benefit seemed significant and large in cases of low/int MHC1, who had higher relapse risk. Of note, baseline immune markers of ER-/HER2+ tumors were linked to different DEFS also for cases achieving pCR.
Citation Format: Giampaolo Bianchini, Tadeusz Pienkowski, Young-Hyuck Im, Giulia Valeria Bianchi, Ling-Ming Tseng, Mei-Ching Liu, Ana Lluch, Vladimir Semiglazov, Juan de la Haba-Rodríguez, Do-Youn Oh, Brigitte Poirier, Jose Luiz Pedrini, Pinuccia Valagussa, Luca Gianni. Baseline molecular markers and risk of distant relapse in the NeoSphere study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3940.
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Affiliation(s)
| | | | - Young-Hyuck Im
- 3Department of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | | | - Ling-Ming Tseng
- 5Taipei-Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Ching Liu
- 6Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Ana Lluch
- 7Hospital Clínico Universitario, INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Vladimir Semiglazov
- 8NN Petrov Research Institute of Oncology, St Petersburg, Russian Federation
| | | | - Do-Youn Oh
- 10Seoul National University Hospital Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Brigitte Poirier
- 11Hôpital du Saint-Sacrement, CHU de Québec, Québec, Quebec, Canada
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Barrios CH, Cella D, Martin M, Eiermann W, Burris HA, Im YH, Conte PF, Toi M, Pienkowski T, Pivot XB, Beckermann B, Stanzel SF, Petersen J, Ellis PA. Patient-reported outcomes (PROs) from MARIANNE: A phase III study of trastuzumab emtansine (T-DM1) +/- pertuzumab (P) vs trastuzumab + taxane (HT) for HER2-positive advanced breast cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - David Cella
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | | | - Pier Franco Conte
- University of Padova and Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Masakazu Toi
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | - Paul Anthony Ellis
- Guy’s Hospital and Sarah Cannon Research Institute, London, United Kingdom
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20
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Bianchini G, Pienkowski T, Im YH, Bianchi GV, Tseng LM, Liu MC, Lluch A, Semiglazov V, de la Haba-Rodriguez J, Oh DY, Poirier B, Pedrini JL, Valagussa P, Gianni L. Residual disease after HER2-directed therapies in the neosphere study: Modulation of tumor lymphocyte infiltration (TIL) and prognosis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.517] [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)
| | | | | | | | - Ling-Ming Tseng
- Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Ching Liu
- Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Ana Lluch
- Hospital Clinico Universitario de Valencia, Valencia, Spain
| | | | | | - Do-Youn Oh
- Seoul National University Hospital, Seoul, Korea, The Republic of
| | | | | | | | - Luca Gianni
- Department of Medical Oncology, San Raffaele Scientific Institute, Milano, Italy
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Press MF, Sauter G, Buyse ME, Fourmanoir H, Quinaux E, Tsao-Wei DD, Eiermann W, Robert NJ, Pienkowski T, Crown J, Martin M, Valero V, Mackey JR, Bee-Munteanu V, Ma Y, Villalobos I, Campeau A, Mirlacher M, Lindsay MA, Slamon DJ. HER2 gene amplification testing by fluorescence in situ hybridization (FISH): Comparison of the ASCO-CAP guidelines with FISH scores used for enrollment in breast cancer international research group (BCIRG) clinical trials. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.515] [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)
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc E. Buyse
- International Drug Development Institute, Cambridge, MA
| | | | - Emmanuel Quinaux
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | | | | | | | | | - John Crown
- Irish Cooperative Oncology Research Group, Dublin, Ireland
| | - Miguel Martin
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Vicente Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Yanling Ma
- Department of Pathology, University of Southern California, Los Angeles, CA
| | | | | | | | - Mary-Ann Lindsay
- Cancer International Research Group/Translational Research in Oncology, Edmonton, AB, Canada
| | - Dennis J. Slamon
- School of Medicine/Translational Oncology Research Laboratory, University of California, Los Angeles, Los Angeles, CA
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22
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Niwinska A, Pienkowski T, Pogoda K, Jagiello-Gruszfeld AI, Lemanska I, Sienkiewicz-Kozlowska R, Glinka - Malasnicka E, Szombara E, Brewczynska E, Gorniak A, Dubianski R, Nowecki Z. The role of systemic therapy after local treatment in breast cancer patients with first presentation of brain metastases recurrence. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e13527] [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)
- Anna Niwinska
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | | | | | - Izabela Lemanska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | | | - Ewa Szombara
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | - Anna Gorniak
- Maria Sklodowska-Curie Memorial Cancer Centre and Institute, Warszawa, Poland
| | - Roman Dubianski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Zbigniew Nowecki
- The Maria Sklodowska-Curie Memorial Cancer Centre and Institute, Warsaw, Poland
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Peddi PF, Hurvitz SA, Fasching PA, Wang L, Cunningham J, Weinshilboum RM, Liu D, Quinaux E, Fourmanoir H, Robert NJ, Valero V, Crown J, Falkson C, Brufsky A, Pienkowski T, Eiermann W, Martin M, Bee V, Slamon DJ. Abstract P6-03-09: Genetic polymorphism and correlation with treatment induced cardiotoxicity and prognosis in HER2 amplified early breast cancer patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-03-09] [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: Small studies have indicated a possible correlation between a HER2 gene polymorphism at codon 655 and trastuzumab-associated cardiotoxicity. Association between a synonymous coding variant rs7853758 within the SLC28A3 gene and anthracycline induced cardiotoxicity has also been reported. This study aimed to validate these correlations and assess for any relationship with prognosis.
Methods: Genomic DNA was isolated from 666 patients enrolled in a large trial of adjuvant chemotherapy in HER2 amplified early breast cancer (BCIRG 006). Genotyping was conducted using Sequenom MassARRAY System for HER2 G->A polymorphism at amino acid codon 655 (rs1136201) and variant rs7853758 (L461L) within the SLC28A3 gene.
Results: Of the 666 patients analyzed, 216 patients were treated with anthracycline based therapy, 226 with trastuzumab based therapy, and 224 with regimens containing both an anthracycline and trastuzumab. Compared with the overall results of the BCIRG006 study (N=3,222), in the subset of patients genotyped in this analysis, a less robust improvement in disease free survival (DFS) was observed for the trastuzumab arms than control arm (HR, 0.821). When stratified for prognostic features, the hazard ratio in favor of trastuzumab was consistent with that of the overall study (HR, 0.674). Samples from 662 patients were successfully genotyped for rs1136201. Of these, 424 (64%) were AA, 30 (4.5%) were GG, 208 (31%) were AG genotype. Samples from 665 patients were successfully genotyped for rs7853758. Of these, 19 (3%) were AA, 475 (71%) were GG, and 171 (26%) were AG genotype. There was no correlation seen between mean left ventricular ejection fraction (LVEF) and HER2 genotype at codon 655 in patients treated with trastuzumab. Of patients tested for the HER2 polymorphism, cardiac dysfunction [defined as > 10% decline in LVEF or clinical congestive heart failure (CHF)] developed in 16% of patients with AA, 17% of patients with GG and 20% of patients with AG. There was also no correlation between mean LVEF and variant rs7853758 in patients treated with anthracyclines. The percentage of patients who developed cardiac dysfunction was 13%, 17% and 21% in AA, GG, and AG genotypes respectively. No correlation between disease free survival and any of the genotypes was seen.
Conclusion: In the largest analysis to date to evaluate for relationship between cardiac toxicity and HER2 polymorphism, we did not find a correlation with rs1136201 HER2 polymorphism and trastuzumab induced cardiac toxicity. Our study also did not show a correlation between variant rs7853758 (L461L) and anthracycline induced cardiotoxicity. Neither polymorphism correlated with prognosis.
Citation Format: Peddi PF, Hurvitz SA, Fasching PA, Wang L, Cunningham J, Weinshilboum RM, Liu D, Quinaux E, Fourmanoir H, Robert NJ, Valero V, Crown J, Falkson C, Brufsky A, Pienkowski T, Eiermann W, Martin M, Bee V, Slamon DJ. Genetic polymorphism and correlation with treatment induced cardiotoxicity and prognosis in HER2 amplified early breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-03-09.
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Affiliation(s)
- PF Peddi
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - SA Hurvitz
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - PA Fasching
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - L Wang
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - J Cunningham
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - RM Weinshilboum
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - D Liu
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - E Quinaux
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - H Fourmanoir
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - NJ Robert
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - V Valero
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - J Crown
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - C Falkson
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - A Brufsky
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - T Pienkowski
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - W Eiermann
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - M Martin
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - V Bee
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - DJ Slamon
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
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Bianchini G, Pusztai L, Pienkowski T, Im YH, Bianchi G, Tseng LM, Liu MC, Lluch A, Galeota E, Magazzù D, de la Haba-Rodríguez J, Oh DY, Poirier B, Pedrini J, Semiglazov V, Valagussa P, Gianni L. Immune modulation of pathologic complete response after neoadjuvant HER2-directed therapies in the NeoSphere trial. Ann Oncol 2015; 26:2429-36. [DOI: 10.1093/annonc/mdv395] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/12/2015] [Indexed: 01/09/2023] Open
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Ellis PA, Barrios CH, Eiermann W, Toi M, Im YH, Conte PF, Martin M, Pienkowski T, Pivot XB, Burris HA, Strasak A, Patre M, Perez EA. Phase III, randomized study of trastuzumab emtansine (T-DM1) ± pertuzumab (P) vs trastuzumab + taxane (HT) for first-line treatment of HER2-positive MBC: Primary results from the MARIANNE study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.507] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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)
- Paul Anthony Ellis
- Guy’s Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | | | | | - Masakazu Toi
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Pier Franco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Istituto Oncologico Veneto, Padova, Italy
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Howard A. Burris
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN
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Gianni L, Pienkowski T, Im YH, Tseng LM, Liu MC, Lluch A, Staroslawska E, de la Haba-Rodriguez J, Im SA, Pedrini JL, Poirier B, Morandi P, Semiglazov V, Srimuninnimit V, Bianchi GV, McNally V, Douthwaite H, Ross G, Valagussa P. Five-year analysis of the phase II NeoSphere trial evaluating four cycles of neoadjuvant docetaxel (D) and/or trastuzumab (T) and/or pertuzumab (P). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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)
- Luca Gianni
- Oncologia Medical, Ospedale San Raffaele IRCCS, Milan, Italy
| | | | | | - Ling-Ming Tseng
- Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Ching Liu
- Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Ana Lluch
- Hospital Clínico Universitario, INCLIVA Health Research Institute, University of Valencia, Valencia, Spain
| | | | | | - Seock-Ah Im
- Division of Hematology/Medical Oncology, Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Brigitte Poirier
- Hôpital du Saint-Sacrément, Centre Hospitalier Affilié Universitaire de Québec, Québec, QC, Canada
| | - Paolo Morandi
- Reparto di Oncologia Medica, Ospedale S. Bortolo, Vincenza, Italy
| | | | | | | | | | | | - Graham Ross
- Roche Products Limited, Welwyn, United Kingdom
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Diéras V, Wildiers H, Jassem J, Dirix LY, Guastalla JP, Bono P, Hurvitz SA, Gonçalves A, Romieu G, Limentani SA, Jerusalem G, Lakshmaiah KC, Roché H, Sánchez-Rovira P, Pienkowski T, Seguí Palmer MÁ, Li A, Sun YN, Pickett CA, Slamon DJ. Trebananib (AMG 386) plus weekly paclitaxel with or without bevacizumab as first-line therapy for HER2-negative locally recurrent or metastatic breast cancer: A phase 2 randomized study. Breast 2015; 24:182-90. [PMID: 25747197 DOI: 10.1016/j.breast.2014.11.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/31/2014] [Accepted: 11/05/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This phase 2 randomized study evaluated trebananib (AMG 386), a peptide-Fc fusion protein that inhibits angiogenesis by neutralizing the interaction of angiopoietin-1 and -2 with Tie2, in combination with paclitaxel with or without bevacizumab in previously untreated patients with HER2-negative locally recurrent/metastatic breast cancer. METHODS Patients received paclitaxel 90 mg/m(2) once weekly (3-weeks-on/1-week-off) and were randomly assigned 1:1:1:1 to also receive blinded bevacizumab 10 mg/kg once every 2 weeks plus either trebananib 10 mg/kg once weekly (Arm A) or 3 mg/kg once weekly (Arm B), or placebo (Arm C); or open-label trebananib 10 mg/kg once a week (Arm D). Progression-free survival was the primary endpoint. RESULTS In total, 228 patients were randomized. Median estimated progression-free survival for Arms A, B, C, and D was 11.3, 9.2, 12.2, and 10 months, respectively. Hazard ratios (95% CI) for Arms A, B, and D versus Arm C were 0.98 (0.61-1.59), 1.12 (0.70-1.80), and 1.28 (0.79-2.09), respectively. The objective response rate was 71% in Arm A, 51% in Arm B, 60% in Arm C, and 46% in Arm D. The incidence of grade 3/4/5 adverse events was 71/9/4%, 61/14/5%, 62/16/3%, and 52/4/7% in Arms A/B/C/D. In Arm D, median progression-free survival was 12.8 and 7.4 months for those with high and low trebananib exposure (AUCss ≥ 8.4 versus < 8.4 mg·h/mL), respectively. CONCLUSIONS There was no apparent prolongation of estimated progression-free survival with the addition of trebananib to paclitaxel and bevacizumab at the doses tested. Toxicity was manageable. Exposure-response analyses support evaluation of combinations incorporating trebananib at doses > 10 mg/kg in this setting. TRIAL REGISTRATION ClinicalTrials.gov, NCT00511459.
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Affiliation(s)
| | | | | | - Luc Y Dirix
- General Hospital Sint-Augustinus, Antwerp, Belgium.
| | | | - Petri Bono
- Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | | | | | | - K C Lakshmaiah
- Kidwai Memorial Institute of Oncology, Bangalore, India.
| | | | | | | | | | - Ai Li
- Amgen Inc., Thousand Oaks, CA, USA.
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Stern HM, Gardner H, Burzykowski T, Elatre W, O'Brien C, Lackner MR, Pestano GA, Santiago A, Villalobos I, Eiermann W, Pienkowski T, Martin M, Robert N, Crown J, Nuciforo P, Bee V, Mackey J, Slamon DJ, Press MF. PTEN Loss Is Associated with Worse Outcome in HER2-Amplified Breast Cancer Patients but Is Not Associated with Trastuzumab Resistance. Clin Cancer Res 2015; 21:2065-74. [PMID: 25649019 DOI: 10.1158/1078-0432.ccr-14-2993] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/31/2014] [Indexed: 01/03/2023]
Abstract
PURPOSE To investigate the clinical relevance of PTEN in HER2-amplified and HER2-nonamplified disease. EXPERIMENTAL DESIGN We assessed PTEN status in two large adjuvant breast cancer trials (BCIRG-006 and BCIRG-005) using a PTEN immunohistochemical (IHC) assay that was previously validated in a panel of 33 breast cancer cell lines and prostate cancer tissues with known PTEN gene deletion. RESULTS In the HER2-positive patient population, absence of tumor cell PTEN staining occurred at a rate of 5.4% and was independent of ER/PR status. In contrast, 15.9% of HER2-negative patients exhibited absence of PTEN staining with the highest frequency seen in triple-negative breast cancer (TNBC) subgroup versus ER/PR-positive patients (35.1% vs. 10.9%). Complete absence of PTEN staining in tumor cells was associated with poor clinical outcome in HER2-positive disease. Those patients whose cancers demonstrated absent PTEN staining had a significant decrease in disease-free survival (DFS) and overall survival (OS) compared with patients with tumors exhibiting any PTEN staining patterns (low, moderate, or high). Trastuzumab appeared to provide clinical benefit even for patients lacking PTEN staining. In the HER2-negative population, there were no statistically significant differences in clinical outcome based on PTEN status. CONCLUSIONS This study is the largest to date examining PTEN status in breast cancer and the data suggest that the rate and significance of PTEN status differ between HER2-positive and HER2-negative disease. Furthermore, the data clearly suggest that HER2-positive patients with PTEN loss still benefit from trastuzumab.
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Affiliation(s)
- Howard M Stern
- Genentech Research and Early Development, South San Francisco, California
| | | | | | - Wafaa Elatre
- USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - Carol O'Brien
- Genentech Research and Early Development, South San Francisco, California
| | - Mark R Lackner
- Genentech Research and Early Development, South San Francisco, California
| | | | - Angela Santiago
- USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | | | | | | | | | - Nicholas Robert
- Virginia Cancer Specialists/U.S. Oncology Research Network, Fairfax, Virginia
| | - John Crown
- Irish Cooperative Oncology Research Group, St. Vincent's University Hospital, Dublin, Ireland
| | | | - Valerie Bee
- Cancer International Research Group/Translational Research in Oncology, Paris, France
| | - John Mackey
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - Dennis J Slamon
- Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Michael F Press
- USC/Norris Comprehensive Cancer Center, Los Angeles, California.
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Brodowicz T, Lang I, Kahan Z, Greil R, Beslija S, Stemmer SM, Kaufman B, Petruzelka L, Eniu A, Anghel R, Koynov K, Vrbanec D, Pienkowski T, Melichar B, Spanik S, Ahlers S, Messinger D, Inbar MJ, Zielinski C. Selecting first-line bevacizumab-containing therapy for advanced breast cancer: TURANDOT risk factor analyses. Br J Cancer 2014; 111:2051-7. [PMID: 25268370 PMCID: PMC4260030 DOI: 10.1038/bjc.2014.504] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/04/2014] [Accepted: 08/18/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The randomised phase III TURANDOT trial compared first-line bevacizumab-paclitaxel (BEV-PAC) vs bevacizumab-capecitabine (BEV-CAP) in HER2-negative locally recurrent/metastatic breast cancer (LR/mBC). The interim analysis revealed no difference in overall survival (OS; primary end point) between treatment arms; however, progression-free survival (PFS) and objective response rate were significantly superior with BEV-PAC. We sought to identify patient populations that may be most appropriately treated with one or other regimen. METHODS Patients with HER2-negative LR/mBC who had received no prior chemotherapy for advanced disease were randomised to either BEV-PAC (bevacizumab 10 mg kg(-1) days 1 and 15 plus paclitaxel 90 mg m(-2) days 1, 8 and 15 q4w) or BEV-CAP (bevacizumab 15 mg kg(-1) day 1 plus capecitabine 1000 mg m(-2) bid days 1-14 q3w). The study population was categorised into three cohorts: triple-negative breast cancer (TNBC), high-risk hormone receptor-positive (HR+) and low-risk HR+. High- and low-risk HR+ were defined, respectively, as having ⩾2 vs ⩽1 of the following four risk factors: disease-free interval ⩽24 months; visceral metastases; prior (neo)adjuvant anthracycline and/or taxane; and metastases in ⩾3 organs. RESULTS The treatment effect on OS differed between cohorts. Non-significant OS trends favoured BEV-PAC in the TNBC cohort and BEV-CAP in the low-risk HR+ cohort. In all three cohorts, there was a non-significant PFS trend favouring BEV-PAC. Grade ⩾3 adverse events were consistently less common with BEV-CAP. CONCLUSIONS A simple risk factor index may help in selecting bevacizumab-containing regimens, balancing outcome, safety profile and patient preference. Final OS results are expected in 2015 (ClinicalTrials.gov NCT00600340).
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Affiliation(s)
- T Brodowicz
- Clinical Division of Oncology and Department of Medicine I, Medical University of Vienna and CECOG, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - I Lang
- Ráth György u. 7-9, National Institute of Oncology, H-1122 Budapest, Hungary
| | - Z Kahan
- Department of Oncotherapy, University of Szeged, H-6720 Szeged, Korányi fasor 12, H-6720 Szeged, Hungary
| | - R Greil
- IIIrd Medical Department, Paracelsus Medical University Hospital Salzburg and AGMT, Salzburg, Austria
| | - S Beslija
- Institute of Oncology, Clinical Center, University of Sarajevo, Bolnicka 27, 71000 Sarajevo, Bosnia and Herzegovina
| | - S M Stemmer
- Davidoff Center, Rabin Medical Center, Kaplan Street, Petah Tiqwa 49100, Israel
| | - B Kaufman
- Breast Oncology Institute, Sheba Medical Center, 52621 Tel Hashomer, Ramat-Gan, Israel
| | - L Petruzelka
- Department of Oncology, First Faculty of Medicine and General Teaching Hospital, Charles University Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - A Eniu
- Department of Breast Tumors, Cancer Institute Ion Chiricuţă, Republicii 34–36, 400015 Cluj-Napoca, Romania
| | - R Anghel
- University of Medicine and Pharmacy Bucharest, Soseaua Fundeni, Nr 252, Sector 2, Bucharest 022328, Romania
| | - K Koynov
- Department of Medical Oncology, Hospital Serdika, 6 Damyan Gruev street, 1303 Sofia, Bulgaria
| | - D Vrbanec
- Department of Medical Oncology, University Hospital Zagreb-Rebro, Medical University of Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - T Pienkowski
- Oncology Department, European Health Centre Otwock, ul. Borowa 14/18, 04-500 Otwock, Poland
| | - B Melichar
- Department of Oncology, Palacký University Medical School, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic
| | - S Spanik
- St Elisabeth Cancer Institute, Heydukova 10, 812 50 Bratislava, Slovak Republic
| | - S Ahlers
- Biometrics, IST GmbH, Soldnerstrasse 1, 68219 Mannheim, Germany
| | - D Messinger
- Biometrics, IST GmbH, Soldnerstrasse 1, 68219 Mannheim, Germany
| | - M J Inbar
- Oncology Division, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel
| | - C Zielinski
- Clinical Division of Oncology and Department of Medicine I, Medical University of Vienna and CECOG, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Jagiello Gruszfeld AI, Nowecki Z, Lemanska I, Sienkiewicz RI, Rudnicka H, Giermek J, Pienkowski T. Retrospective study comparing tolerability of weekly paclitaxel in two group of metastatic breast cancer patients: Age 65 and older compared with younger than age 65. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Zbigniew Nowecki
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Izabela Lemanska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | - Halina Rudnicka
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Jerzy Giermek
- Maria Sklodowska-Curie - Memorial Cancer Center and Institute, Warszawa, Poland
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Mundinger A, Pienkowski T, Costa MM, Müller-Schimpfle M, Lebovic G, Schneebaum S. E08. Highlights in benign and pre-invasive breast disease. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70060-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brodowicz T, Pienkowski T, Beslija S, Melichar B, Lang I, Inbar MJ, Anghel R, Spanik S, Ahlers S, Zielinski C. Abstract P6-06-40: Analysis of outcome according to risk factors in the randomized phase III TURANDOT trial evaluating first-line bevacizumab-containing therapy for HER2-negative locally recurrent/metastatic breast cancer (LR/mBC). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-06-40] [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: The randomized phase III TURANDOT trial compared first-line bevacizumab (BEV) + paclitaxel (PAC) vs BEV + capecitabine (CAP) in HER2-negative LR/mBC [Lang, Lancet Oncol 2013]. At the prespecified interim analysis there was no detectable difference in overall survival (OS; primary endpoint) between treatment groups, but the secondary endpoints of progression-free survival (PFS) and objective response rate (ORR) favored BEV-PAC. We sought to identify patient populations defined by risk factors that may be most appropriately treated with one or other of the regimens.
Methods: Patients with HER2-negative LR/mBC who had received no prior chemotherapy for LR/mBC were randomized to either BEV-PAC (BEV 10 mg/kg d1 & 15 + PAC 90 mg/m2 d1, 8, & 15 q4w) or BEV-CAP (BEV 15 mg/kg d1 + CAP 1000 mg/m2 bid d1-14 q3w). The study population was categorized into three cohorts: triple-negative (TNBC), high-risk hormone receptor-positive (HR+) and low-risk HR+. High-risk and low-risk HR+ were defined, respectively, as having ≥2 vs ≤1 of the following four risk factors: disease-free interval ≤24 months; visceral metastases; prior (neo)adjuvant anthracycline and/or taxane; ≥3 metastatic sites.
Results: Baseline characteristics, efficacy, and safety by treatment arm are summarized below for the three cohorts. Although PFS results in all cohorts favored BEV-PAC, interim OS results showed a trend in favor of BEV-PAC in TNBC patients and in favor of BEV-CAP in low-risk HR+ patients. Grade ≥3 adverse events were less common with BEV-CAP than BEV-PAC in all three cohorts.
TNBCHigh-risk HR+Low-risk HR+ BEV-PAC (n = 63)BEV-CAP (n = 67)BEV-PAC (n = 146)BEV-CAP (n = 162)BEV-PAC (n = 75)BEV-CAP (n = 50)Median age, years545658576161ECOG PS 0,%756068666366PFS Events, n (%)50 (79)54 (81)93 (64)125 (77)33 (44)35 (70)Median, months (95% CI)9.0 (7.8-10.7)5.6 (4.9-8.0)11.1 (10.4-13.4)8.3 (7.1-10.7)14.4 (10.4-20.5)11.5 (8.1-16.3)HR (95% CI)a1.37 (0.93-2.02)1.29 (0.98-1.69)1.39 (0.86-2.25)OS Events, n (%)28 (44)34 (51)50 (34)52 (32)18 (24)11 (22)1-year OS rate,%786380828590HR (95% CI)a1.33 (0.80-2.19)0.97 (0.66-1.43)0.80 (0.38-1.69)Grade ≥3 AEs,%634261516148aBEV-CAP vs BEV-PAC
Conclusion: The simple risk factor index is prognostic for both PFS and OS and may be used to guide treatment choice when selecting BEV-containing therapy, balancing outcome with safety profile and patient preference. Final analysis of OS is expected in 2014.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-40.
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Affiliation(s)
- T Brodowicz
- Medical University of Vienna and Central European Cooperative Oncology Group (CECOG), Vienna, Austria; Postgraduate Medical Center, Warsaw, Poland; Institute of Oncology, Sarajevo, Bosnia and Herzegowina; Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic; National Institute of Oncology, Budapest, Hungary; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Medicine and Pharmacy, Bucharest, Romania; Onkol. Ustav Sv. Alzbety, Bratislava, Slovakia (Slovak Republic); IST GmbH, Mannheim, Germany
| | - T Pienkowski
- Medical University of Vienna and Central European Cooperative Oncology Group (CECOG), Vienna, Austria; Postgraduate Medical Center, Warsaw, Poland; Institute of Oncology, Sarajevo, Bosnia and Herzegowina; Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic; National Institute of Oncology, Budapest, Hungary; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Medicine and Pharmacy, Bucharest, Romania; Onkol. Ustav Sv. Alzbety, Bratislava, Slovakia (Slovak Republic); IST GmbH, Mannheim, Germany
| | - S Beslija
- Medical University of Vienna and Central European Cooperative Oncology Group (CECOG), Vienna, Austria; Postgraduate Medical Center, Warsaw, Poland; Institute of Oncology, Sarajevo, Bosnia and Herzegowina; Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic; National Institute of Oncology, Budapest, Hungary; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Medicine and Pharmacy, Bucharest, Romania; Onkol. Ustav Sv. Alzbety, Bratislava, Slovakia (Slovak Republic); IST GmbH, Mannheim, Germany
| | - B Melichar
- Medical University of Vienna and Central European Cooperative Oncology Group (CECOG), Vienna, Austria; Postgraduate Medical Center, Warsaw, Poland; Institute of Oncology, Sarajevo, Bosnia and Herzegowina; Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic; National Institute of Oncology, Budapest, Hungary; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Medicine and Pharmacy, Bucharest, Romania; Onkol. Ustav Sv. Alzbety, Bratislava, Slovakia (Slovak Republic); IST GmbH, Mannheim, Germany
| | - I Lang
- Medical University of Vienna and Central European Cooperative Oncology Group (CECOG), Vienna, Austria; Postgraduate Medical Center, Warsaw, Poland; Institute of Oncology, Sarajevo, Bosnia and Herzegowina; Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic; National Institute of Oncology, Budapest, Hungary; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Medicine and Pharmacy, Bucharest, Romania; Onkol. Ustav Sv. Alzbety, Bratislava, Slovakia (Slovak Republic); IST GmbH, Mannheim, Germany
| | - MJ Inbar
- Medical University of Vienna and Central European Cooperative Oncology Group (CECOG), Vienna, Austria; Postgraduate Medical Center, Warsaw, Poland; Institute of Oncology, Sarajevo, Bosnia and Herzegowina; Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic; National Institute of Oncology, Budapest, Hungary; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Medicine and Pharmacy, Bucharest, Romania; Onkol. Ustav Sv. Alzbety, Bratislava, Slovakia (Slovak Republic); IST GmbH, Mannheim, Germany
| | - R Anghel
- Medical University of Vienna and Central European Cooperative Oncology Group (CECOG), Vienna, Austria; Postgraduate Medical Center, Warsaw, Poland; Institute of Oncology, Sarajevo, Bosnia and Herzegowina; Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic; National Institute of Oncology, Budapest, Hungary; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Medicine and Pharmacy, Bucharest, Romania; Onkol. Ustav Sv. Alzbety, Bratislava, Slovakia (Slovak Republic); IST GmbH, Mannheim, Germany
| | - S Spanik
- Medical University of Vienna and Central European Cooperative Oncology Group (CECOG), Vienna, Austria; Postgraduate Medical Center, Warsaw, Poland; Institute of Oncology, Sarajevo, Bosnia and Herzegowina; Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic; National Institute of Oncology, Budapest, Hungary; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Medicine and Pharmacy, Bucharest, Romania; Onkol. Ustav Sv. Alzbety, Bratislava, Slovakia (Slovak Republic); IST GmbH, Mannheim, Germany
| | - S Ahlers
- Medical University of Vienna and Central European Cooperative Oncology Group (CECOG), Vienna, Austria; Postgraduate Medical Center, Warsaw, Poland; Institute of Oncology, Sarajevo, Bosnia and Herzegowina; Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic; National Institute of Oncology, Budapest, Hungary; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Medicine and Pharmacy, Bucharest, Romania; Onkol. Ustav Sv. Alzbety, Bratislava, Slovakia (Slovak Republic); IST GmbH, Mannheim, Germany
| | - C Zielinski
- Medical University of Vienna and Central European Cooperative Oncology Group (CECOG), Vienna, Austria; Postgraduate Medical Center, Warsaw, Poland; Institute of Oncology, Sarajevo, Bosnia and Herzegowina; Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic; National Institute of Oncology, Budapest, Hungary; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Medicine and Pharmacy, Bucharest, Romania; Onkol. Ustav Sv. Alzbety, Bratislava, Slovakia (Slovak Republic); IST GmbH, Mannheim, Germany
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Pajares B, Pollán M, Martín M, Mackey JR, Lluch A, Gavila J, Vogel C, Ruiz-Borrego M, Calvo L, Pienkowski T, Rodríguez-Lescure Á, Seguí MA, Tredan O, Antón A, Ramos M, Cámara MDC, Rodríguez-Martín C, Carrasco E, Alba E. Obesity and survival in operable breast cancer patients treated with adjuvant anthracyclines and taxanes according to pathological subtypes: a pooled analysis. Breast Cancer Res 2013; 15:R105. [PMID: 24192331 PMCID: PMC3978725 DOI: 10.1186/bcr3572] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 10/16/2013] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Obesity is an unfavorable prognostic factor in breast cancer (BC) patients regardless of menopausal status and treatment received. However, the association between obesity and survival outcome by pathological subtype requires further clarification. METHODS We performed a retrospective analysis including 5,683 operable BC patients enrolled in four randomized clinical trials (GEICAM/9906, GEICAM/9805, GEICAM/2003-02, and BCIRG 001) evaluating anthracyclines and taxanes as adjuvant treatments. Our primary aim was to assess the prognostic effect of body mass index (BMI) on disease recurrence, breast cancer mortality (BCM), and overall mortality (OM). A secondary aim was to detect differences of such prognostic effects by subtype. RESULTS Multivariate survival analyses adjusting for age, tumor size, nodal status, menopausal status, surgery type, histological grade, hormone receptor status, human epidermal growth factor receptor 2 (HER2) status, chemotherapy regimen, and under-treatment showed that obese patients (BMI 30.0 to 34.9) had similar prognoses to that of patients with a BMI < 25 (reference group) in terms of recurrence (Hazard Ratio [HR] = 1.08, 95% Confidence Interval [CI] = 0.90 to 1.30), BCM (HR = 1.02, 0.81 to 1.29), and OM (HR = 0.97, 0.78 to 1.19). Patients with severe obesity (BMI ≥ 35) had a significantly increased risk of recurrence (HR = 1.26, 1.00 to 1.59, P = 0.048), BCM (HR = 1.32, 1.00 to 1.74, P = 0.050), and OM (HR = 1.35, 1.06 to 1.71, P = 0.016) compared to our reference group. The prognostic effect of severe obesity did not vary by subtype. CONCLUSIONS Severely obese patients treated with anthracyclines and taxanes present a worse prognosis regarding recurrence, BCM, and OM than patients with BMI < 25. The magnitude of the harmful effect of BMI on survival-related outcomes was similar across subtypes.
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Cameron D, Brown J, Dent R, Jackisch C, Mackey J, Pivot X, Steger GG, Suter TM, Toi M, Parmar M, Laeufle R, Im YH, Romieu G, Harvey V, Lipatov O, Pienkowski T, Cottu P, Chan A, Im SA, Hall PS, Bubuteishvili-Pacaud L, Henschel V, Deurloo RJ, Pallaud C, Bell R. Adjuvant bevacizumab-containing therapy in triple-negative breast cancer (BEATRICE): primary results of a randomised, phase 3 trial. Lancet Oncol 2013; 14:933-42. [PMID: 23932548 DOI: 10.1016/s1470-2045(13)70335-8] [Citation(s) in RCA: 299] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The addition of bevacizumab to chemotherapy improves progression-free survival in metastatic breast cancer and pathological complete response rates in the neoadjuvant setting. Micrometastases are dependent on angiogenesis, suggesting that patients might benefit from anti-angiogenic strategies in the adjuvant setting. We therefore assessed the addition of bevacizumab to chemotherapy in the adjuvant setting for women with triple-negative breast cancer. METHODS For this open-label, randomised phase 3 trial we recruited patients with centrally confirmed triple-negative operable primary invasive breast cancer from 360 sites in 37 countries. We randomly allocated patients aged 18 years or older (1:1 with block randomisation; stratified by nodal status, chemotherapy [with an anthracycline, taxane, or both], hormone receptor status [negative vs low], and type of surgery) to receive a minimum of four cycles of chemotherapy either alone or with bevacizumab (equivalent of 5 mg/kg every week for 1 year). The primary endpoint was invasive disease-free survival (IDFS). Efficacy analyses were based on the intention-to-treat population, safety analyses were done on all patients who received at least one dose of study drug, and plasma biomarker analyses were done on all treated patients consenting to biomarker analyses and providing a measurable baseline plasma sample. This trial is registered with ClinicalTrials.gov, number NCT00528567. FINDINGS Between Dec 3, 2007, and March 8, 2010, we randomly assigned 1290 patients to receive chemotherapy alone and 1301 to receive bevacizumab plus chemotherapy. Most patients received anthracycline-containing therapy; 1638 (63%) of the 2591 patients had node-negative disease. At the time of analysis of IDFS, median follow-up was 31·5 months (IQR 25·6-36·8) in the chemotherapy-alone group and 32·0 months (27·5-36·9) in the bevacizumab group. At the time of the primary analysis, IDFS events had been reported in 205 patients (16%) in the chemotherapy-alone group and in 188 patients (14%) in the bevacizumab group (hazard ratio [HR] in stratified log-rank analysis 0·87, 95% CI 0·72-1·07; p=0·18). 3-year IDFS was 82·7% (95% CI 80·5-85·0) with chemotherapy alone and 83·7% (81·4-86·0) with bevacizumab and chemotherapy. After 200 deaths, no difference in overall survival was noted between the groups (HR 0·84, 95% CI 0·64-1·12; p=0·23). Exploratory biomarker assessment suggests that patients with high pre-treatment plasma VEGFR-2 might benefit from the addition of bevacizumab (Cox interaction test p=0·029). Use of bevacizumab versus chemotherapy alone was associated with increased incidences of grade 3 or worse hypertension (154 patients [12%] vs eight patients [1%]), severe cardiac events occurring at any point during the 18-month safety reporting period (19 [1%] vs two [<0·5%]), and treatment discontinuation (bevacizumab, chemotherapy, or both; 256 [20%] vs 30 [2%]); we recorded no increase in fatal adverse events with bevacizumab (four [<0·5%] vs three [<0·5%]). INTERPRETATION Bevacizumab cannot be recommended as adjuvant treatment in unselected patients with triple-negative breast cancer. Further follow-up is needed to assess the potential effect of bevacizumab on overall survival.
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Affiliation(s)
- David Cameron
- University of Edinburgh and Cancer Services, NHS Lothian, Edinburgh, UK.
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Au HJ, Eiermann W, Robert NJ, Pienkowski T, Crown J, Martin M, Pawlicki M, Chan A, Mackey J, Glaspy J, Pintér T, Liu MC, Fornander T, Sehdev S, Ferrero JM, Bée V, Santana MJ, Miller DP, Lalla D, Slamon DJ. Health-related quality of life with adjuvant docetaxel- and trastuzumab-based regimens in patients with node-positive and high-risk node-negative, HER2-positive early breast cancer: results from the BCIRG 006 Study. Oncologist 2013; 18:812-8. [PMID: 23814044 DOI: 10.1634/theoncologist.2013-0091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This study aims to describe and compare health-related quality of life (HRQL) in patients with node-positive and high-risk node-negative HER2-positive early breast cancer receiving adjuvant docetaxel and trastuzumab-based or docetaxel-based regimens alone. METHODS Eligible patients (n = 3,222) were randomly assigned to either four cycles of adjuvant doxorubicin and cyclophosphamide followed by four cycles of docetaxel (AC→T) or one of two trastuzumab-containing regimens: adjuvant doxorubicin and cyclophosphamide followed by docetaxel plus trastuzumab administered for 1 year (AC→TH) or six cycles of docetaxel plus carboplatin combined with trastuzumab administered for 1 year (TCH). The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 and BR-23 were administered at baseline, the start of cycle 4 (mid), and the end of chemotherapy (EOC), as well as at 6, 12, and 24 months after chemotherapy. RESULTS Compliance rates for the EORTC questionnaires were acceptable at 72%-93% of eligible patients out to the 12-month assessment. Systemic side effect (SE) change scores were significantly improved for TCH-treated patients compared with AC→TH and AC→T at EOC, suggesting improved tolerability. Physical functioning (PF) was only slightly worse at midpoint for those receiving TCH, compared with patients who were just starting on taxane in an AC→TH regimen, but was otherwise similar between arms. All treatment arms recovered from the deterioration in SE, PF, and Global Health Scale scores by 1 year and median future perspective change scores continued to improve throughout treatment and follow-up. CONCLUSION HRQL outcomes for adjuvant docetaxel and trastuzumab-based regimens are favorable and support TCH as a more tolerable treatment option.
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Affiliation(s)
- Heather-Jane Au
- Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
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Pollán M, Pajares B, Martin M, Mackey JR, Lluch A, Gavila J, Vogel CL, Ruiz Borrego M, Calvo L, Pienkowski T, Rodriguez-Lescure A, Seguí MA, Tredan O, Anton A, Ramos Vazquez M, Camara MC, Rodriguez-Martin C, Carrasco EM, Alba E. The effect of obesity on prognosis in operable breast cancer patients treated with adjuvant anthracyclines and taxanes according to pathologic subtypes. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1031] [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
1031 Background: According to observational studies, obesity is an unfavourable prognostic factor in breast cancer (BC), regardless of menopausal status and treatment received. Information collected in clinical trials should confirm this effect and serves to test its homogeneity by pathologic subtype. Methods: We retrospectively analysed 5,683 operable BC patients enrolled in four randomized clinical trials (GEICAM/9906, 9805, 2003–02, and BCIRG 001) evaluating adjuvant anthracyclines and taxanes. Our primary aim was to assess the prognostic effect of body mass index (BMI) on disease recurrence, breast cancer mortality (BCM), and overall mortality (OM). A secondary aim was to detect differences by BC subtypes (ER/PR-positive/HER2-negative, HER2-positive, triple-negative). Cox models were fitted for each end-point, adjusted by potential confounders. Results: Analyses adjusting for age, tumor size, nodal status, menopausal status, surgery, grade, hormone receptor and HER2 status, chemotherapy regimen, and undertreatment showed that obese patients (BMI 30.0–34.9) had similar prognoses to that of patients with a BMI<25 (reference group) in terms of recurrence (HR 1.08 [95% CI 0.9–1.3]; p=0.41), BCM (HR 1.02 [0.81–1.29]; p=0.85), and OM (HR 0.97 [0.78–1.19]; p=0.747). Patients with severe obesity (BMI≥35) had a significantly increased risk of recurrence (HR 1.26 [1.00–1.59]; p=0.05), BCM (HR 1.32 [1.00–1.74]; p=0.05), and OM (HR 1.35 [1.06–1.71]; p=0.02) compared to our reference group (Table). The prognostic effect of severe obesity did not vary by subtype. Conclusions: Severely obese patients treated with anthracyclines and taxanes present a worse prognosis regarding recurrence, BCM, and OM than patients with a BMI<25. The magnitude of the harmful effect of BMI was similar across subtypes. [Table: see text]
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Affiliation(s)
- Marina Pollán
- National Center of Epidemiology, Instituto Salud Carlos III, Madrid, Spain
| | - Bella Pajares
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Miguel Martin
- Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain
| | | | - Ana Lluch
- Hospital Clínico de Valencia - INCLIVA Health Research Institute, University of Valencia., Valencia, Spain
| | | | - Charles L. Vogel
- University of Miami School of Medicine, Comprehensive Cancer Research Group, Inc., Miami, FL
| | | | - Lourdes Calvo
- Complexo Hospitalario Universitario de A Coruña, A Coruna, Spain
| | | | | | - Miquel Angel Seguí
- Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Oncològic del Vallès, Sabadell, Spain
| | | | - Antonio Anton
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | | | - Emilio Alba
- Hospital Clínico Universitario Virgen de la Victoria, Malaga, Spain
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Zambetti M, Baselga J, Eiermann W, Guillem V, Semiglazov V, Lluch A, Sabadell D, Bozhok A, Byakhov MJ, Ojeda B, Mansutti M, Mariani G, Moliterni A, Cortes-Funes H, Colozza M, Pienkowski T, Magazzu D, Valagussa P, Bonadonna G, Gianni L. Freedom from progression (FFP) by adding paclitaxel (T) to doxorubicin (A) followed by CMF as adjuvant or primary systemic therapy: 10-yr results of a randomized phase III European Cooperative Trial in Operable Breast Cancer (ECTO). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.537] [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
537 Background: At the time the ECTO was designed in 1996, taxanes were only indicated for patients with metastatic breast cancer. However, paclitaxel and docetaxel were still to be tested in the adjuvant setting. In addition there was relatively scarce information on the comparative efficacy of neoadjuvant and adjuvant regimens. The ECTO trial was designed to evaluate the addition of paclitaxel to an anthracycline-based adjuvant regimen and to compare this combination with the same regimen given as primary systemic (neoadjuvant) therapy. Methods: A total of 1,355 women with operable breast cancer were randomized to one of three treatments: 1) surgery followed by adjuvant single agent doxorubicin (A) followed by CMF (arm A); 2) surgery followed by adjuvant paclitaxel plus doxorubicin (AT) followed by CMF (arm B); 3) AT followed by CMF followed by surgery (arm C). The two co-primary objectives were to assess the effects on freedom from progression (FFP) of: 1) the addition of paclitaxel to post-operative chemotherapy (arm B versus arm A); and 2) primary versus adjuvant chemotherapy (arm B versus arm C). Results: At 10 years, in the adjuvant setting FFP remained statistically significant in favor of AT followed by CMF (arm B, HR 0.77, P=0.045). Distant FFP was similarly improved but overall survival was not (HR 0.82, P=0.24). There was no significant difference in FFP when chemotherapy was given after surgery compared with the same regimen given before surgery (arm B vs arm C, HR 0.79, P=0.07). In the primary chemotherapy arm, patients who achieved a pathological complete remission (pCR) had improved distant FFP (P < 0.001) compared to patients who did not achieve pCR. When given as primary systemic therapy, the paclitaxel-containing regimen allowed breast-sparing surgery in a significant percentage of patients, which did not translate in an increased risk of ipsilateral breast recurrence compared to the risk observed in patients in the adjuvant arms. Conclusions: Incorporating paclitaxel into anthracycline-based adjuvant therapy resulted in a significantly improved FFP and DFFP.
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Affiliation(s)
| | - José Baselga
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | - Ana Lluch
- Hospital Clínico Universitario de Valencia- INCLIVA Health Research Institute, University of Valencia, Valencia, Spain
| | | | - Alla Bozhok
- N.N. Petrov Research Institute of Oncology, St. Petersburg, Russia
| | | | - Belen Ojeda
- Hospital de la Santa Creu i Sant Pau, Departement of Medical Oncology, Barcelona, Spain
| | - Mauro Mansutti
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Angela Moliterni
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Hernan Cortes-Funes
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
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Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, Abraham M, Alencar VHM, Badran A, Bonfill X, Bradbury J, Clarke M, Collins R, Davis SR, Delmestri A, Forbes JF, Haddad P, Hou MF, Inbar M, Khaled H, Kielanowska J, Kwan WH, Mathew BS, Müller B, Nicolucci A, Peralta O, Pernas F, Petruzelka L, Pienkowski T, Rajan B, Rubach MT, Tort S, Urrútia G, Valentini M, Wang Y, Peto R. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet 2013; 381:805-16. [PMID: 23219286 PMCID: PMC3596060 DOI: 10.1016/s0140-6736(12)61963-1] [Citation(s) in RCA: 1293] [Impact Index Per Article: 117.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND For women with oestrogen receptor (ER)-positive early breast cancer, treatment with tamoxifen for 5 years substantially reduces the breast cancer mortality rate throughout the first 15 years after diagnosis. We aimed to assess the further effects of continuing tamoxifen to 10 years instead of stopping at 5 years. METHODS In the worldwide Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial, 12,894 women with early breast cancer who had completed 5 years of treatment with tamoxifen were randomly allocated to continue tamoxifen to 10 years or stop at 5 years (open control). Allocation (1:1) was by central computer, using minimisation. After entry (between 1996 and 2005), yearly follow-up forms recorded any recurrence, second cancer, hospital admission, or death. We report effects on breast cancer outcomes among the 6846 women with ER-positive disease, and side-effects among all women (with positive, negative, or unknown ER status). Long-term follow-up still continues. This study is registered, number ISRCTN19652633. FINDINGS Among women with ER-positive disease, allocation to continue tamoxifen reduced the risk of breast cancer recurrence (617 recurrences in 3428 women allocated to continue vs 711 in 3418 controls, p=0·002), reduced breast cancer mortality (331 deaths vs 397 deaths, p=0·01), and reduced overall mortality (639 deaths vs 722 deaths, p=0·01). The reductions in adverse breast cancer outcomes appeared to be less extreme before than after year 10 (recurrence rate ratio [RR] 0·90 [95% CI 0·79–1·02] during years 5–9 and 0·75 [0·62–0·90] in later years; breast cancer mortality RR 0·97 [0·79–1·18] during years 5–9 and 0·71 [0·58–0·88] in later years). The cumulative risk of recurrence during years 5–14 was 21·4% for women allocated to continue versus 25·1% for controls; breast cancer mortality during years 5–14 was 12·2% for women allocated to continue versus 15·0% for controls (absolute mortality reduction 2·8%). Treatment allocation seemed to have no effect on breast cancer outcome among 1248 women with ER-negative disease, and an intermediate effect among 4800 women with unknown ER status. Among all 12,894 women, mortality without recurrence from causes other than breast cancer was little affected (691 deaths without recurrence in 6454 women allocated to continue versus 679 deaths in 6440 controls; RR 0·99 [0·89–1·10]; p=0·84). For the incidence (hospitalisation or death) rates of specific diseases, RRs were as follows: pulmonary embolus 1·87 (95% CI 1·13–3·07, p=0·01 [including 0·2% mortality in both treatment groups]), stroke 1·06 (0·83–1·36), ischaemic heart disease 0·76 (0·60–0·95, p=0·02), and endometrial cancer 1·74 (1·30–2·34, p=0·0002). The cumulative risk of endometrial cancer during years 5–14 was 3·1% (mortality 0·4%) for women allocated to continue versus 1·6% (mortality 0·2%) for controls (absolute mortality increase 0·2%). INTERPRETATION For women with ER-positive disease, continuing tamoxifen to 10 years rather than stopping at 5 years produces a further reduction in recurrence and mortality, particularly after year 10. These results, taken together with results from previous trials of 5 years of tamoxifen treatment versus none, suggest that 10 years of tamoxifen treatment can approximately halve breast cancer mortality during the second decade after diagnosis. FUNDING Cancer Research UK, UK Medical Research Council, AstraZeneca UK, US Army, EU-Biomed.
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Affiliation(s)
- Christina Davies
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, UKClinical Trial Service Unit and Epidemiological Studies Unit (CTSU)University of OxfordUK
- Correspondence to: Dr Christina Davies, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Hongchao Pan
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, UKClinical Trial Service Unit and Epidemiological Studies Unit (CTSU)University of OxfordUK
| | - Jon Godwin
- Glasgow Caledonian University, Glasgow, UKGlasgow Caledonian UniversityGlasgowUK
| | - Richard Gray
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, UKClinical Trial Service Unit and Epidemiological Studies Unit (CTSU)University of OxfordUK
| | - Rodrigo Arriagada
- Institut Gustave-Roussy, Villejuif, FranceInstitut Gustave-RoussyVillejuifFrance
| | - Vinod Raina
- Institute Rotary Cancer Hospital, All-India Institute of Medical Sciences, New Delhi, IndiaInstitute Rotary Cancer HospitalAll-India Institute of Medical SciencesNew DelhiIndia
| | - Mirta Abraham
- Instituto Cardiovascular Rosario (ICR), Rosario, ArgentinaInstituto Cardiovascular Rosario (ICR)RosarioArgentina
| | | | - Atef Badran
- National Cancer Institute, Cairo University, Cairo, EgyptNational Cancer InstituteCairo UniversityCairoEgypt
| | - Xavier Bonfill
- Sant Pau Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, SpainSant Pau Biomedical Research Institute (IIB Sant Pau-CIBERESP)BarcelonaSpain
| | - Joan Bradbury
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, AustraliaSchool of Public Health and Preventive MedicineMonash University, MelbourneMelbourneVictoriaAustralia
| | - Michael Clarke
- Queens University, Belfast, UKQueens UniversityBelfastUK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, UKClinical Trial Service Unit and Epidemiological Studies Unit (CTSU)University of OxfordUK
| | - Susan R Davis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, AustraliaSchool of Public Health and Preventive MedicineMonash University, MelbourneMelbourneVictoriaAustralia
| | - Antonella Delmestri
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, UKClinical Trial Service Unit and Epidemiological Studies Unit (CTSU)University of OxfordUK
| | - John F Forbes
- Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle, NSW, AustraliaAustralia and New Zealand Breast Cancer Trials GroupUniversity of NewcastleNewcastleNSWAustralia
| | - Peiman Haddad
- Cancer Institute, Tehran University of Medical Sciences, Tehran, IranCancer InstituteTehran University of Medical SciencesTehranIran
| | - Ming-Feng Hou
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ChinaKaohsiung Medical University HospitalKaohsiungTaiwanChina
| | - Moshe Inbar
- Tel Aviv Sourasky Medical Center, Tel Aviv, IsraelTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Hussein Khaled
- National Cancer Institute, Cairo University, Cairo, EgyptNational Cancer InstituteCairo UniversityCairoEgypt
| | - Joanna Kielanowska
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, PolandThe Maria Sklodowska-Curie Memorial Cancer Center and Institute of OncologyWarsawPoland
| | - Wing-Hong Kwan
- Comprehensive Oncology Centre, Hong Kong, ChinaComprehensive Oncology CentreHong KongChina
| | - Beela S Mathew
- Regional Cancer Centre, Trivandrum, IndiaRegional Cancer CentreTrivandrumIndia
| | - Bettina Müller
- Chilean Cooperative Group for Oncologic Research (GOCCHI) Santiago, ChileChilean Cooperative Group for Oncologic Research (GOCCHI) SantiagoChile
| | - Antonio Nicolucci
- Consorzio Mario Negri Sud, S Maria Imbaro, ItalyConsorzio Mario Negri SudS Maria ImbaroItaly
| | - Octavio Peralta
- Chilean Cooperative Group for Oncologic Research (GOCCHI) Santiago, ChileChilean Cooperative Group for Oncologic Research (GOCCHI) SantiagoChile
| | - Fany Pernas
- Instituto de Investigaciones Clinicas de Rosario, Rosario, ArgentinaInstituto de Investigaciones Clinicas de RosarioRosarioArgentina
| | - Lubos Petruzelka
- Medical Faculty 1, Charles University, Prague, Czech RepublicMedical Faculty 1Charles UniversityPragueCzech Republic
| | - Tadeusz Pienkowski
- European Health Centre Otwock (ECZO), Warsaw, PolandEuropean Health Centre Otwock (ECZO)WarsawPoland
| | - Balakrishnan Rajan
- The National Oncology Centre, Royal Hospital, OmanThe National Oncology CentreRoyal HospitalOman
| | - Maryna T Rubach
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, PolandThe Maria Sklodowska-Curie Memorial Cancer Center and Institute of OncologyWarsawPoland
| | - Sera Tort
- Sant Pau Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, SpainSant Pau Biomedical Research Institute (IIB Sant Pau-CIBERESP)BarcelonaSpain
| | - Gerard Urrútia
- Sant Pau Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, SpainSant Pau Biomedical Research Institute (IIB Sant Pau-CIBERESP)BarcelonaSpain
| | - Miriam Valentini
- Consorzio Mario Negri Sud, S Maria Imbaro, ItalyConsorzio Mario Negri SudS Maria ImbaroItaly
| | - Yaochen Wang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, UKClinical Trial Service Unit and Epidemiological Studies Unit (CTSU)University of OxfordUK
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, UKClinical Trial Service Unit and Epidemiological Studies Unit (CTSU)University of OxfordUK
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Lang I, Brodowicz T, Ryvo L, Kahan Z, Greil R, Beslija S, Stemmer SM, Kaufman B, Zvirbule Z, Steger GG, Melichar B, Pienkowski T, Sirbu D, Messinger D, Zielinski C. Bevacizumab plus paclitaxel versus bevacizumab plus capecitabine as first-line treatment for HER2-negative metastatic breast cancer: interim efficacy results of the randomised, open-label, non-inferiority, phase 3 TURANDOT trial. Lancet Oncol 2013; 14:125-33. [DOI: 10.1016/s1470-2045(12)70566-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jassem J, Ozmen V, Bacanu F, Drobniene M, Eglitis J, Kahan Z, Lakshmaiah K, Mardiak J, Pienkowski T, Semiglazova T, Stamatovic L, Timcheva C, Vasovics S, Vrbanec D, Zaborek P. Abstract P5-02-02: Factors influencing time to seeking medical advice and start of treatment in breast cancer (BC) patients – an International survey. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p5-02-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. We earlier reported patient-related factors influencing the delay in first medical advice for signs of BC in selected countries (J Clin Oncol 2012;30[15S]:578s). The present analysis, which includes additional countries, addresses the factors influencing time from first symptoms of BC to initiation of treatment (Total Delay Time; TDT).
Methods. A total of 6,588 female BC patients from 11 countries were surveyed using a uniform questionnaire translated into local languages. TDT was determined using 8 individual scales, including one pertaining to patient delay and 7 related to subsequent steps in a typical diagnostic process. Regression models were constructed using 18 variables concerning diverse contextual and personal patient characteristics. Due to expected differences in the relevant sets of predictors, time between first symptoms and first medical visit (Patient Delay Time; PDT) and time between first medical visit and start of therapy (System Delay Time; SDT) were modeled separately, with multilevel regression.
Results. Mean TDT varied in individual countries from 11.5 to 29.4 weeks (grand mean of 14.3 weeks; see table), with 43% of cases with a delay of >12 weeks. Multilevel regression equation indicated that factors significantly correlated with longer PDT were distrust in the medical system and ignoring disease. Patients with fear of the disease, stronger self-examination habits, at least secondary education, being employed, reporting more support from friends and family, and living in cities of >100,000 inhabitants had shorter PDT. Predictors of shorter SDT included being diagnosed by an oncologist vs. other physician, having at least secondary education, being older than 60 years, having a history of cancer in female relatives and having breast lump vs. other BC symptoms. Indicators of longer SDT were PDT >4 weeks, more than one BC symptom detected by patient, distrust in the medical system, disregard of BC signs, less support from friends and family, and having first medical examination in a public vs. private medical center. Individual countries differed significantly with regard to intercept of the multilevel models and slopes of regression coefficients for selected psychological and behavioral attributes.
Conclusions. An extensive set of variables potentially impacting delay times, mainly related to psychological and behavioral patient attributes, was examined. Several of them strongly determined both PDT and SDT, but their strength differed between individual countries. Both models (for PDT and SDT), although statistically significant, accounted for approximately 20% of variance in time; therefore other variables, e.g. related to the differences in national healthcare systems (not addressed in this study) might have a stronger impact on delays in the initiation of BC therapy and warrant further analyses.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-02-02.
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Affiliation(s)
- J Jassem
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - V Ozmen
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - F Bacanu
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - M Drobniene
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - J Eglitis
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - Z Kahan
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - K Lakshmaiah
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - J Mardiak
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - T Pienkowski
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - T Semiglazova
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - L Stamatovic
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - C Timcheva
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - S Vasovics
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - D Vrbanec
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
| | - P Zaborek
- Medical University of Gdansk, Poland; University of Istanbul, Turkey; Sf Maria Hospital, Bucharest, Romania; Institute of Oncology, Vilnius University, Vilnus, Lithuania; Riga East University Hospital, Riga, Latvia; University of Szeged, Hungary; Kidwai Memorial Institute of Oncology, Bangaluru, India; National Cancer Institute and Medical School of Comenius University, Bratislava, Slovakia (Slovak Republic); Medical Center of Postgraduate Education, ECZ, Otwock, Poland; Petrov Research Institute of Oncology, St. Petersburg, Russian Federation; Institute of Oncology and Radiology, Belgrade, Serbia; Chemiotherapy Clinic, Sofia, Bulgaria; Zagreb University Hospital Center, Zagreb, Croatia; Warsaw School of Economics, Warsaw, Poland
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Mackey JR, Martin M, Pienkowski T, Rolski J, Guastalla JP, Sami A, Glaspy J, Juhos E, Wardley A, Fornander T, Hainsworth J, Coleman R, Modiano MR, Vinholes J, Pinter T, Rodríguez-Lescure A, Colwell B, Whitlock P, Provencher L, Laing K, Walde D, Price C, Hugh JC, Childs BH, Bassi K, Lindsay MA, Wilson V, Rupin M, Houé V, Vogel C. Adjuvant docetaxel, doxorubicin, and cyclophosphamide in node-positive breast cancer: 10-year follow-up of the phase 3 randomised BCIRG 001 trial. Lancet Oncol 2012; 14:72-80. [PMID: 23246022 DOI: 10.1016/s1470-2045(12)70525-9] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND We compared standard adjuvant anthracycline chemotherapy with anthracycline-taxane combination chemotherapy in women with operable node-positive breast cancer. Here we report the final, 10-year follow-up analysis of disease-free survival, overall survival, and long-term safety. METHODS BCIRG 001 was an open label, phase 3, multicentre trial in which 1491 patients aged 18-70 years with node-positive, early breast cancer and a Karnofsky score of 80% or more were randomly assigned to adjuvant treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC) or fluorouracil, doxorubicin, and cyclophosphamide (FAC) every 3 weeks for six cycles. Randomisation was stratified according to institution and number of involved axillary lymph nodes per patient (one to three vs four or more). Disease-free survival was the primary endpoint and was defined as the interval between randomisation and breast cancer relapse, second primary cancer, or death, whichever occurred first. Efficacy analyses were based on the intention-to-treat principle. BCIRG 001 is registered with ClinicalTrials.gov, number NCT00688740. FINDINGS Enrolement took place between June 11, 1997 and June 3, 1999; 745 patients were assigned to receive TAC and 746 patients were assigned to receive FAC. After a median follow-up of 124 months (IQR 90-126), disease-free survival was 62% (95% CI 58-65) for patients in the TAC group and 55% (51-59) for patients in the FAC group (hazard ratio [HR] 0·80, 95% CI 0·68-0·93; log-rank p=0·0043). 10-year overall survival was 76% (95% CI 72-79) for patients in the TAC group and 69% (65-72) for patients in the FAC group (HR 0·74, 0·61-0·90; log-rank p=0·0020). TAC improved disease-free survival relative to FAC irrespective of nodal, hormone receptor, and HER2 status, although not all differences were significant in these subgroup analyses. Grade 3-4 heart failure occurred in 26 (3%) patients in the TAC group and 17 (2%) patients in the FAC group, and caused death in two patients in the TAC group and four patients in the FAC group. A substantial decrease in left ventricular ejection fraction (defined as a relative decrease from baseline of 20% or more) was seen in 58 (17%) patients who received TAC and 41 (15%) patients who received FAC. Six patients who received TAC developed leukaemia or myelodysplasia, as did three patients who received FAC. INTERPRETATION Our results provide evidence that the initial therapeutic outcomes seen at the 5-year follow-up with a docetaxel-containing adjuvant regimen are maintained at 10 years. However, a substantial percentage of patients had a decrease in left ventricular ejection fraction, probably caused by anthracycline therapy, which warrants further investigation. FUNDING Sanofi.
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Zielinski C, Lang I, Inbar M, Kahan Z, Greil R, Beslija S, Stemmer S, Kaufman B, Zvirbule Z, Steger G, Melichar B, Pienkowski T, Sirbu D, Petruzelka L, Eniu A, Nisenbaum B, Dank M, Anghel R, Messinger D, Brodowicz T. First Efficacy Results From the Turandot Phase III Trial Comparing Two Bevacizumab (BEV)-Containing Regimens as First-Line Therapy for HER2-Negative Metastatic Breast Cancer (MBC). Ann Oncol 2012. [DOI: 10.1093/annonc/mds393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ismael G, Hegg R, Muehlbauer S, Heinzmann D, Lum B, Kim SB, Pienkowski T, Lichinitser M, Semiglazov V, Melichar B, Jackisch C. Subcutaneous versus intravenous administration of (neo)adjuvant trastuzumab in patients with HER2-positive, clinical stage I-III breast cancer (HannaH study): a phase 3, open-label, multicentre, randomised trial. Lancet Oncol 2012; 13:869-78. [PMID: 22884505 DOI: 10.1016/s1470-2045(12)70329-7] [Citation(s) in RCA: 235] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A subcutaneous formulation of trastuzumab has been developed, offering potential improvements in patient convenience and resource use compared with the standard intravenous infusion of the drug. We compared the pharmacokinetic profile, efficacy, and safety of the subcutaneous and intravenous formulations in patients with HER2-positive early breast cancer. METHODS The HannaH study was a phase 3, randomised, international, open-label, trial in the (neo)adjuvant setting. Patients with HER2-positive, operable, locally advanced or inflammatory breast cancer were randomly assigned to eight cycles of neoadjuvant chemotherapy administered concurrently with trastuzumab every 3 weeks either intravenously (8 mg/kg loading dose, 6 mg/kg maintenance dose) or subcutaneously (fixed dose of 600 mg); 1:1 ratio. Chemotherapy consisted of four cycles of docetaxel (75 mg/m(2)) followed by four cycles of fluorouracil (500 mg/m(2)), epirubicin (75 mg/m(2)), and cyclophosphamide (500 mg/m(2)), every 3 weeks. After surgery, patients continued trastuzumab to complete 1 year of treatment. Coprimary endpoints were serum trough concentration (C(trough)) at pre-dose cycle 8 before surgery (non-inferiority margin for the ratio between groups of 0·80) and pathological complete response (pCR; non-inferiority margin for the difference between groups of -12·5%), analysed in the per-protocol population. This study is registered with ClinicalTrials.gov, number NCT00950300. FINDINGS 299 patients were randomly assigned to receive intravenous trastuzumab and 297 to receive subcutaneous trastuzumab. The geometric mean presurgery C(trough) was 51·8 μg/mL (coefficient of variation 52·5%) in the intravenous group and 69·0 μg/mL (55·8%) in the subcutaneous group. The geometric mean ratio of C(trough) subcutaneous to C(trough) intravenous was 1·33 (90% CI 1·24-1·44). 107 (40·7%) of 263 patients in the intravenous group and 118 (45·4%) of 260 in the subcutaneous group achieved a pCR. The difference between groups in pCR was 4·7% (95% CI -4·0 to 13·4). Thus subcutaneous trastuzumab was non-inferior to intravenous trastuzumab for both coprimary endpoints. The incidence of grade 3-5 adverse events was similar between groups. The most common of these adverse events were neutropenia (99 [33·2%] of 298 patients in the intravenous group vs 86 [29·0%] of 297 in the subcutaneous group), leucopenia (17 [5·7%] vs 12 [4·0%]), and febrile neutropenia (10 [3·4%] vs 17 [5·7%]). However, more patients had serious adverse events in the subcutaneous group (62 [21%] of 297 patients) than in the intravenous group (37 [12%] of 298); the difference was mainly attributable to infections and infestations (24 [8·1%] in the subcutaneous group vs 13 [4·4%] in the intravenous group). Four adverse events led to death (one in the intravenous group and three in the subcutaneous group), all of which occurred during the neoadjuvant phase. Of these, two--both in the subcutaneous group--were deemed to be treatment related. INTERPRETATION Subcutaneous trastuzumab, administered over about 5 min, has a pharmacokinetic profile and efficacy non-inferior to standard intravenous administration, with a similar safety profile to intravenous trastuzumab, and therefore offers a valid treatment alternative. FUNDING F Hoffmann-La Roche.
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Zaczek AJ, Markiewicz A, Seroczynska B, Skokowski J, Jaskiewicz J, Pienkowski T, Olszewski WP, Szade J, Rhone P, Welnicka-Jaskiewicz M, Jassem J. Prognostic significance of TOP2A gene dosage in HER-2-negative breast cancer. Oncologist 2012; 17:1246-55. [PMID: 22871798 DOI: 10.1634/theoncologist.2012-0023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Previous studies showed the prognostic and predictive impact of human epidermal growth factor receptor 2 (HER-2) gene alterations analyzed separately and jointly with topoisomerase II α (TOP2A) gene alterations; however, the role of TOP2A gene abnormalities alone has not been thoroughly investigated. Additionally, TOP2A aberrations were typically studied in HER-2-positive (HER-2(+)) tumors because these genes are frequently coamplified. Therefore, the knowledge concerning the impact of TOP2A abnormalities in HER-2-negative (HER-2(-)) patients is scarce. This study aimed to investigate the clinical significance of TOP2A anomalies in breast cancer patients with HER-2(-) and HER-2(+) tumors. MATERIALS AND METHODS Snap-frozen tumor samples from 322 consecutive stage I-III breast cancer patients were analyzed for TOP2A gene dosage using quantitative real-time PCR (qPCR). RESULTS A high TOP2A gene dosage was found in 94 tumors (29%)-32% and 27% of HER-2(+) and HER-2(-) tumors, respectively. The mean TOP2A gene dosages in the HER-2(+) and HER-2(-) groups were 1.49 ± 1.03 and 1.09 ± 0.35, respectively. High TOP2A gene dosage had an inverse prognostic impact in terms of shorter disease-free survival (DFS) and overall survival (OS) times in the entire group and in both the HER-2(-) and HER-2(+) subgroups. The unfavorable prognostic impact of TOP2A gene dosage was maintained in the multivariate Cox regression analysis in the entire group and in HER-2(-) patients. CONCLUSIONS A high gene dosage of TOP2A determined using qPCR occurs frequently both in HER-2(+) and HER-2(-) tumors and has a strong adverse prognostic impact.
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Affiliation(s)
- Anna J Zaczek
- Laboratory of Cell Biology, Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Dêbinki 1, 80-211 Gdańsk, Poland.
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Jassem J, Bacanu F, Eglitis J, Mardiak J, Pienkowski T, Kahan Z, Ozmen V, Drobniene M, Vrbanec D, Semiglazova T, Stamatovic L, Timcheva C, Vasovic S, Zaborek P. Patient-related factors influencing time between first signs of breast cancer (BC) and appointment for medical visit (AMV): An international survey. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.9046] [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
9046 Background: Reducing diagnostic delays may improve treatment outcomes in BC. We investigated in various countries patient-related factors influencing time to seeking medical advice for signs of BC. Methods: A total of 4,816 female BC patients from 10 countries were surveyed using a uniform questionnaire translated into local languages. Time between first patient-detected signs of BC and AMV was measured using categorized time scales. Out of 14 original items on a multiple scale measuring BC-related attitudes and behaviors, 5 factors were extracted and used for further analysis: distrust in medical system and success of therapy, disregard of signs, fear of BC, practicing regular breast self-examination and support from friends and family. Results: In the subset of 2,870 patients with self-detected BC who provided complete answers to relevant variables, the mean time to AMV varied in particular countries from 3.4 to 6.2 weeks (grand mean of 4.7 weeks), with 39% of cases with a delay of >4 weeks. Overall, patient attributes that significantly influenced time to AMV were: distrust (p<1E-36), disregard (p=1.26E-30), fear (p=2.65E-16), self-examination (p=1.31E-21), place of living (p=3.5E-3) and education (p=2.73E-3). Multilevel analysis indicated that significant differences among particular countries were only due to slopes of distrust and disregard included in general regression model. The model enhanced with the two abovementioned random effects provided significant improvement in predicting time to AMV. Re-estimation of the model based solely on data from individual countries produced 10 significant equations with varied coefficients for distrust and disregard (see table). Conclusions: Patient-related factors contribute considerably to delay in the diagnosis of BC. Differences between particular countries call for country-specific approaches. [Table: see text]
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Affiliation(s)
- Jacek Jassem
- Klinika Onkologii i Radioterapii Gdanski Uniwersytet Medyczny, Gdansk, Poland
| | | | | | - Jozef Mardiak
- Department of Medical Oncology, School of Medicine, Comenius University; National Cancer Institute, Bratislava, Slovakia
| | | | | | | | | | | | | | | | | | - Suzana Vasovic
- Institute for Oncology and Radiology, Belgrade, Bulgaria
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Niwinska A, Pogoda K, Murawska M, Pienkowski T. Analysis of pattern, time, and risk factors influencing recurrence in triple-negative breast cancer patients. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e11553] [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
e11553 Background: The aim of the study was to assess the rate, pattern and time of recurrence in patients with triple-negative breast cancer (TNBC) treated in one institution. The second goal was to evaluate factors influencing recurrence and overall survival in this group of patients. Methods: 2534 consecutive breast cancer patients were diagnosed at the Cancer Center and Institute of Oncology in Warsaw, Poland, between January 2005 and December 2006. Out of 2534 patients, 228 (9%) were TNBC (ER/PR/HER2-negative). The clinicopathological characteristics were determined using descriptive statistics. The overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. The univariate and multivariate analyses were developed to identify factors influencing recurrence and survival in TNBC patients. Results: Most of the patients were diagnosed with stage II or III breast cancer (47% and 34%, respectively), the median age at diagnosis was 54.5 years. The most common histological type was ductal cancer (81%). 31% of patients were treated with neoadjuvant chemotherapy and 49% with adjuvant chemotherapy – almost all consisted of anthracyclines. 6 years of observation revealed that the metastatic disease occurred in 35% of all TNBC patients: 15% in the brain, 14% in the lungs, 11% in the bones, 8% in the liver and 14% had locoregional relapse. The highest risk of recurrence was during the first 3 years after primary treatment and then during the next two years of observation it did not change. Median DFS and OS were not reached at the time of analysis, 6-year DFS and OS were 68% and 62%, respectively.Factors influencing recurrence were: tumor size and systemic adjuvant chemotherapy while factors influencing overall survival were: tumor size, nodal status, adjuvant/neoadjuvant treatment and metastases in the brain, liver and bones. Conclusions: Characteristic pattern of recurrence in time was revealed. The tumor size was responsible for recurrence despite lack of involvement of lymph nodes. Aggressive adjuvant/neoadjuvant treatment ordered in all clinical stages of TNBC (including N0) was factor responsible for avoiding local and distant relapse and prolonging overall survival.
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Affiliation(s)
- Anna Niwinska
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Katarzyna Pogoda
- Department of Chemotherapy, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Magdalena Murawska
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands
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Hurvitz SA, Betting DJ, Stern HM, Quinaux E, Stinson J, Seshagiri S, Zhao Y, Buyse M, Mackey J, Driga A, Damaraju S, Sliwkowski MX, Robert NJ, Valero V, Crown J, Falkson C, Brufsky A, Pienkowski T, Eiermann W, Martin M, Bee V, Marathe O, Slamon DJ, Timmerman JM. Analysis of Fcγ receptor IIIa and IIa polymorphisms: lack of correlation with outcome in trastuzumab-treated breast cancer patients. Clin Cancer Res 2012; 18:3478-86. [PMID: 22504044 DOI: 10.1158/1078-0432.ccr-11-2294] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The mechanisms by which trastuzumab imparts clinical benefit remain incompletely understood. Antibody-dependent cellular cytotoxicity via interactions with Fcγ receptors (FcγR) on leukocytes may contribute to its antitumor effects. Single-nucleotide polymorphisms (SNP) in FCGR3A and FCGR2A genes lead to amino acid substitutions at positions 158 and 131, respectively, and affect binding of antibodies to FcγR such that 158V/V and 131H/H bind with highest affinity. This study aimed to determine whether high-affinity SNPs are associated with disease-free survival (DFS) among patients with HER2-positive nonmetastatic breast cancer. EXPERIMENTAL DESIGN Genomic DNA was isolated from 1,286 patients enrolled in a trial of adjuvant trastuzumab-based chemotherapy. Genotyping was conducted using Sanger sequencing and Sequenom mass spectrometry. RESULTS Patient samples (N = 1,189) were successfully genotyped for FCGR3A and 1,218 for FCGR2A. Compared with the overall results of the BCIRG006 study, in the subset of patients genotyped in this analysis, a less robust improvement in DFS was observed for the trastuzumab arms than control arm (HR, 0.842; P = 0.1925). When stratified for prognostic features, the HR in favor of trastuzumab was consistent with that of the overall study (HR, 0.74; P = 0.036). No correlation between DFS and FCGR3A/2A genotypes was seen for trastuzumab-treated patients (158V/V vs. V/F vs. F/F, P = 0.98; 131H/H vs. H/R vs. R/R, P = 0.76; 158V/V and/or 131H/H vs. others, P = 0.67). CONCLUSION This analysis evaluating the association between FCGR3A/2A genotypes and trastuzumab efficacy in HER2-positive breast cancer did not show a correlation between FCGR3A-V/F and FCGR2A-H/R SNPs and DFS in patients treated with trastuzumab.
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Affiliation(s)
- Sara A Hurvitz
- University of California at Los Angeles, Los Angeles, California, USA.
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Galecki J, Kolodziejczyk M, Michalski W, Pienkowski T, Mentrak Z, Towpik E. 50 Long Term Results and Prognostic Factors in Patients with Unicentric and Multicentric Breast Cancer. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vrdoljak E, Wojtukiewicz MZ, Pienkowski T, Bodoky G, Berzinec P, Finek J, Todorović V, Borojević N, Croitoru A. Cancer epidemiology in Central, South and Eastern European countries. Croat Med J 2012; 52:478-87. [PMID: 21853542 PMCID: PMC3160694 DOI: 10.3325/cmj.2011.52.478] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To collect cancer epidemiology data in South Eastern European countries as a basis for potential comparison of their performance in cancer care. METHODS The South Eastern European Research Oncology Group (SEEROG) collected and analyzed epidemiological data on incidence and mortality that reflect cancer management in 8 countries - Croatia, Czech Republic, Hungary, Romania, Poland, Slovakia, and Serbia and Montenegro in the last 20-40 years. RESULTS The most common cancer type in men in all countries was lung cancer, followed by colorectal and prostate cancer, with the exception of the Czech Republic, where prostate cancer and colorectal cancer were more common. The most frequent cancer in women was breast cancer followed by colorectal cancer, with the exceptions of Romania and Central Serbia where cervical cancer was the second most common. Cancer mortality data from the last 20-40 years revealed two different patterns in men. In Romania and in Serbia and Montenegro, there was a trend toward an increase, while in the other countries mortality was declining, after increasing for a number of years. In women, a steady decline was observed over many years in the Czech Republic, Hungary, and Slovakia, while in the other countries it remained unchanged. CONCLUSIONS There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors which provides a clear challenge to prevention. There are some differences in incidence and mortality that cannot be explained by exposure to known risk factors or treatment availabilities.
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Affiliation(s)
- Eduard Vrdoljak
- University Hospital Split, School of Medicine, Center of Oncology, Spincićeva 1, 21000 Split, Croatia.
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Baselga J, Cortés J, Kim SB, Im SA, Hegg R, Im YH, Roman L, Pedrini JL, Pienkowski T, Knott A, Clark E, Benyunes MC, Ross G, Swain SM. Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med 2012; 366:109-19. [PMID: 22149875 PMCID: PMC5705202 DOI: 10.1056/nejmoa1113216] [Citation(s) in RCA: 1737] [Impact Index Per Article: 144.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The anti-human epidermal growth factor receptor 2 (HER2) humanized monoclonal antibody trastuzumab improves the outcome in patients with HER2-positive metastatic breast cancer. However, most cases of advanced disease eventually progress. Pertuzumab, an anti-HER2 humanized monoclonal antibody that inhibits receptor dimerization, has a mechanism of action that is complementary to that of trastuzumab, and combination therapy with the two antibodies has shown promising activity and an acceptable safety profile in phase 2 studies involving patients with HER2-positive breast cancer. METHODS We randomly assigned 808 patients with HER2-positive metastatic breast cancer to receive placebo plus trastuzumab plus docetaxel (control group) or pertuzumab plus trastuzumab plus docetaxel (pertuzumab group) as first-line treatment until the time of disease progression or the development of toxic effects that could not be effectively managed. The primary end point was independently assessed progression-free survival. Secondary end points included overall survival, progression-free survival as assessed by the investigator, the objective response rate, and safety. RESULTS The median progression-free survival was 12.4 months in the control group, as compared with 18.5 months in the pertuzumab group (hazard ratio for progression or death, 0.62; 95% confidence interval, 0.51 to 0.75; P<0.001). The interim analysis of overall survival showed a strong trend in favor of pertuzumab plus trastuzumab plus docetaxel. The safety profile was generally similar in the two groups, with no increase in left ventricular systolic dysfunction; the rates of febrile neutropenia and diarrhea of grade 3 or above were higher in the pertuzumab group than in the control group. CONCLUSIONS The combination of pertuzumab plus trastuzumab plus docetaxel, as compared with placebo plus trastuzumab plus docetaxel, when used as first-line treatment for HER2-positive metastatic breast cancer, significantly prolonged progression-free survival, with no increase in cardiac toxic effects. (Funded by F. Hoffmann-La Roche/Genentech; ClinicalTrials.gov number, NCT00567190.).
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Affiliation(s)
- José Baselga
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114, USA.
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