1
|
Stearns V, Jegede OA, Chang VTS, Skaar TC, Berenberg JL, Nand R, Shafqat A, Jacobs NL, Luginbuhl W, Gilman P, Benson AB, Goodman JR, Buchschacher GL, Henry NL, Loprinzi CL, Flynn PJ, Mitchell EP, Fisch MJ, Sparano JA, Wagner LI. A Cohort Study to Evaluate Genetic Predictors for Aromatase Inhibitor Musculoskeletal Symptoms (AIMSS): Results from ECOG-ACRIN E1Z11. Clin Cancer Res 2024:743149. [PMID: 38640040 DOI: 10.1158/1078-0432.ccr-23-2137] [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] [Received: 07/29/2023] [Revised: 10/13/2023] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE Aromatase Inhibitor-Associated Musculoskeletal Symptoms (AIMSS) are common and frequently lead to AI discontinuation. Single nucleotide polymorphisms (SNPs) in candidate genes have been associated with AIMSS and AI discontinuation. E1Z11 is a prospective cohort study designed to validate associations between 10 SNPs and AI discontinuation due to AIMSS. PATIENTS AND METHODS Postmenopausal women with stage I-III hormone receptor-positive breast cancer received anastrozole 1 mg daily and completed patient-reported outcomes (PRO) to assess AIMSS (Stanford Health Assessment Questionnaire; HAQ) at baseline, 3, 6, 9, and 12 months. We estimated that 40% of participants would develop AIMSS, and 25% would discontinue AI treatment within 12 months. Enrollment of 1,000 women with a fixed number per racial strata provided 80% power to detect an effect size of 1.5-4. SNPs were in ESR1 (rs2234693, rs2347868, rs9340835), CYP19A1 (rs1062033, rs4646), TCL1A (rs11849538, rs2369049, rs7158782, rs7159713), and HTR2A (rs2296972). RESULTS Of 970 evaluable women, 43% developed AIMSS and 12% discontinued AI therapy within 12 months. While more Black and Asian women developed AIMSS compared to White women (49% vs 39%, p=0.017; 50% vs 39%, p=0.004, respectively), AI discontinuation rates were similar across groups. None of the SNPs were significantly associated with AIMSS or AI discontinuation in the overall population, or in distinct cohorts. The odds ratio for rs2296972 (HTR2A) approached significance for developing AIMSS. CONCLUSION We were unable to prospectively validate candidate SNPs previously associated with AI discontinuation due to AIMSS. Future analyses will explore additional genetic markers, PRO predictors of AIMSS, and differences by race.
Collapse
Affiliation(s)
- Vered Stearns
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | | | - Todd C Skaar
- Indiana University Bloomington, Indianapolis, IN, United States
| | | | | | - Atif Shafqat
- Missouri Baptist Medical Center, St. Louis, MO, United States
| | | | - William Luginbuhl
- University of Pennsylvania Health System, West Chester, PA, United States
| | - Paul Gilman
- Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Al B Benson
- Northwestern Medicine, Chicago, Illinois, United States
| | | | | | - N Lynn Henry
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | | | - Patrick J Flynn
- Metro Minnesota Clinical Oncology Research Consortium, St. Louis Park, Minnesota, United States
| | | | | | - Joseph A Sparano
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Lynne I Wagner
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
2
|
Joyce E, Tao X, Stearns V, Hayes DF, Storniolo AM, Kidwell KM, Henry NL. Polypharmacy, over-the-counter medications, and aromatase inhibitor adherence in early-stage breast cancer. Breast Cancer Res Treat 2024; 204:539-546. [PMID: 38198070 DOI: 10.1007/s10549-023-07218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE Polypharmacy is associated with negative health outcomes and decreased medication adherence. Polypharmacy is common in cancer populations, but few studies have evaluated the relationship between polypharmacy and aromatase inhibitor (AI) adherence. No studies have evaluated the relationship between over-the-counter (OTC) supplements and AI adherence. Our primary hypothesis was that polypharmacy would be associated with increased risk of premature AI discontinuation. METHODS This exploratory analysis used data from the Exemestane and Letrozole Pharmacogenetics (ELPh) trial, a prospective, multicenter, randomized controlled trial that enrolled participants from 2005 to 2009. Included patients were female, postmenopausal, with stage 0-III breast cancer, who had completed indicated chemotherapy, surgery, and radiation. Participants were randomized to adjuvant exemestane or letrozole and completed serial clinical examinations and questionnaires for two years. Concomitant medication data were collected prospectively. Cox proportion models were used for statistical analysis of the relationship between polypharmacy, OTCs, medication class, and AI adherence. RESULTS In the 490 analyzed participants, use of any prescription medications at baseline was associated with decreased risk of premature AI discontinuation (HR 0.56, p = 0.02). Use of selective serotonin reuptake inhibitors (SSRIs) or selective serotonin and norepinephrine reuptake inhibitors (SNRIs) at baseline was associated with decreased risk of premature AI discontinuation (HR 0.67, p = 0.04). Use of any OTCs was not associated with AI discontinuation. CONCLUSION Baseline use of prescription medications but not OTCs was associated with increased AI persistence. Future research is needed to understand how this can be utilized to promote AI adherence.
Collapse
Affiliation(s)
- Elizabeth Joyce
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Xueting Tao
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, USA
| | - Vered Stearns
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Daniel F Hayes
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Anna Maria Storniolo
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, USA
| | - N Lynn Henry
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
3
|
Rattsev I, Stearns V, Blackford AL, Hertz DL, Smith KL, Rae JM, Taylor CO. Incorporation of emergent symptoms and genetic covariates improves prediction of aromatase inhibitor therapy discontinuation. JAMIA Open 2024; 7:ooae006. [PMID: 38250582 PMCID: PMC10799747 DOI: 10.1093/jamiaopen/ooae006] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/09/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
Objectives Early discontinuation is common among breast cancer patients taking aromatase inhibitors (AIs). Although several predictors have been identified, it is unclear how to simultaneously consider multiple risk factors for an individual. We sought to develop a tool for prediction of AI discontinuation and to explore how predictive value of risk factors changes with time. Materials and Methods Survival machine learning was used to predict time-to-discontinuation of AIs in 181 women who enrolled in a prospective cohort. Models were evaluated via time-dependent area under the curve (AUC), c-index, and integrated Brier score. Feature importance was analysis was conducted via Shapley Additive Explanations (SHAP) and time-dependence of their predictive value was analyzed by time-dependent AUC. Personalized survival curves were constructed for risk communication. Results The best-performing model incorporated genetic risk factors and changes in patient-reported outcomes, achieving mean time-dependent AUC of 0.66, and AUC of 0.72 and 0.67 at 6- and 12-month cutoffs, respectively. The most significant features included variants in ESR1 and emergent symptoms. Predictive value of genetic risk factors was highest in the first year of treatment. Decrease in physical function was the strongest independent predictor at follow-up. Discussion and Conclusion Incorporation of genomic and 3-month follow-up data improved the ability of the models to identify the individuals at risk of AI discontinuation. Genetic risk factors were particularly important for predicting early discontinuers. This study provides insight into the complex nature of AI discontinuation and highlights the importance of incorporating genetic risk factors and emergent symptoms into prediction models.
Collapse
Affiliation(s)
- Ilia Rattsev
- Institute for Computational Medicine, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21218, United States
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21218, United States
| | - Vered Stearns
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Amanda L Blackford
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, 48109, United States
| | - Karen L Smith
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - James M Rae
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, United States
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, 48109, United States
| | - Casey Overby Taylor
- Institute for Computational Medicine, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21218, United States
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21218, United States
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, United States
| |
Collapse
|
4
|
Roussos Torres ET, Ho WJ, Danilova L, Tandurella JA, Leatherman J, Rafie C, Wang C, Brufsky A, LoRusso P, Chung V, Yuan Y, Downs M, O'Connor A, Shin SM, Hernandez A, Engle EL, Piekarz R, Streicher H, Talebi Z, Rudek MA, Zhu Q, Anders RA, Cimino-Mathews A, Fertig EJ, Jaffee EM, Stearns V, Connolly RM. Entinostat, nivolumab and ipilimumab for women with advanced HER2-negative breast cancer: a phase Ib trial. Nat Cancer 2024:10.1038/s43018-024-00729-w. [PMID: 38355777 DOI: 10.1038/s43018-024-00729-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024]
Abstract
We report the results of 24 women, 50% (N = 12) with hormone receptor-positive breast cancer and 50% (N = 12) with advanced triple-negative breast cancer, treated with entinostat + nivolumab + ipilimumab from the dose escalation (N = 6) and expansion cohort (N = 18) of ETCTN-9844 ( NCT02453620 ). The primary endpoint was safety. Secondary endpoints were overall response rate, clinical benefit rate, progression-free survival and change in tumor CD8:FoxP3 ratio. There were no dose-limiting toxicities. Among evaluable participants (N = 20), the overall response rate was 25% (N = 5), with 40% (N = 4) in triple-negative breast cancer and 10% (N = 1) in hormone receptor-positive breast cancer. The clinical benefit rate was 40% (N = 8), and progression-free survival at 6 months was 50%. Exploratory analyses revealed that changes in myeloid cells may contribute to responses; however, no correlation was noted between changes in CD8:FoxP3 ratio, PD-L1 status and tumor mutational burden and response. These findings support further investigation of this treatment in a phase II trial.
Collapse
Affiliation(s)
- Evanthia T Roussos Torres
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Won J Ho
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ludmila Danilova
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Joseph A Tandurella
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - James Leatherman
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Christine Rafie
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chenguang Wang
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adam Brufsky
- University of Pittsburgh Cancer Institute and UPMC Cancer Center, Pittsburgh, PA, USA
| | | | | | - Yuan Yuan
- Cedars-Sinai Cancer, Los Angeles, CA, USA
| | - Melinda Downs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ashley O'Connor
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sarah M Shin
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alexei Hernandez
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth L Engle
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard Piekarz
- Cancer Therapy Evaluation Program (CTEP), National Cancer Institute, Bethesda, MD, USA
| | - Howard Streicher
- Cancer Therapy Evaluation Program (CTEP), National Cancer Institute, Bethesda, MD, USA
| | - Zahra Talebi
- Division of Pharmaceutics and Pharmacology, The Ohio State University, Columbus, OH, USA
| | - Michelle A Rudek
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Qingfeng Zhu
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert A Anders
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ashley Cimino-Mathews
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elana J Fertig
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth M Jaffee
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Roisin M Connolly
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland.
| |
Collapse
|
5
|
Liang Y, Gersch CL, Lehman J, Henry NL, Smith KL, Rae JM, Stearns V, Hertz DL. Attempted replication of pharmacogenetic association of variants in PPP1R14C and CCDC148 with aromatase inhibitor-induced musculoskeletal symptoms. Pharmacogenet Genomics 2024:01213011-990000000-00049. [PMID: 38359166 DOI: 10.1097/fpc.0000000000000522] [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: 02/17/2024]
Abstract
Third-generation aromatase inhibitors (AI) are the standard treatment for patients with hormone receptor positive (HR+) breast cancer. While effective, AI can lead to severe adverse events, including AI-induced musculoskeletal syndrome (AIMSS). Genetic predictors of AIMSS have the potential to personalize AI treatment and improve outcomes. We attempted to replicate results from a previous genome-wide association study that found a lower risk of AIMSS in patients carrying PPP1R14C rs912571 and a higher risk in patients carrying CCDC148 rs79048288. AIMSS data were collected prospectively from patients with HR+ breast cancer prior to starting and after 3 and 6 months of adjuvant AI via the Patient-Reported Outcome Measurement Information System and Functional Assessment of Cancer Therapy-Endocrine Symptom. Germline genotypes for PPP1R14C rs912571 and CCDC148 rs79048288 were tested for a similar association with AIMSS as previously reported via $2 tests. Of the 143 patients with AIMSS and genetics data were included in the analysis. There was no association identified between PPP1R14C rs912571 and AIMSS risk (P > 0.05). Patients carrying CCDC148 rs79048288 variant alleles had lower AIMSS incidence in a secondary analysis (P = 0.04); however, this was in the opposite direction of the previous finding. The study did not replicate previously reported associations with AIMSS risk for genetic variants in PPP1R14C and CCDC148 and AIMSS risk. Further research is needed to discover and validate genetic predictors of AIMSS that can be used to personalize treatment in patients with HR+ breast cancer.
Collapse
Affiliation(s)
- Yuqing Liang
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy
| | - Christina L Gersch
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer Lehman
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - N Lynn Henry
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Karen Lisa Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - James M Rae
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy
| |
Collapse
|
6
|
Gonsalves SG, Saligan LN, Bergeron CM, Lee PR, Fishbein KW, Spencer RG, Zampino M, Sun X, Sheng JYS, Stearns V, Carducci M, Ferrucci L, Lukkahatai N. Exploring the links of skeletal muscle mitochondrial oxidative capacity, physical functionality, and mental well-being of cancer survivors. Sci Rep 2024; 14:2669. [PMID: 38302539 PMCID: PMC10834492 DOI: 10.1038/s41598-024-52570-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024] Open
Abstract
Physical impairments following cancer treatment have been linked with the toxic effects of these treatments on muscle mass and strength, through their deleterious effects on skeletal muscle mitochondrial oxidative capacity. Accordingly, we designed the present study to explore relationships of skeletal muscle mitochondrial oxidative capacity with physical performance and perceived cancer-related psychosocial experiences of cancer survivors. We assessed skeletal muscle mitochondrial oxidative capacity using in vivo phosphorus-31 magnetic resonance spectroscopy (31P MRS), measuring the postexercise phosphocreatine resynthesis time constant, τPCr, in 11 post-chemotherapy participants aged 34-70 years. During the MRS procedure, participants performed rapid ballistic knee extension exercise to deplete phosphocreatine (PCr); hence, measuring the primary study outcome, which was the recovery rate of PCr (τPCr). Patient-reported outcomes of psychosocial symptoms and well-being were assessed using the Patient-Reported Outcomes Measurement Information System and the 36-Item Short Form health survey (SF-36). Rapid bioenergetic recovery, reflected through a smaller value of τPCr was associated with worse depression (rho ρ = - 0.69, p = 0.018, and Cohen's d = - 1.104), anxiety (ρ = - 0.61, p = .046, d = - 0.677), and overall mental health (ρ = 0.74, p = 0.010, d = 2.198) scores, but better resilience (ρ = 0.65, p = 0.029), and coping-self efficacy (ρ = 0.63, p = 0.04) scores. This is the first study to link skeletal muscle mitochondrial oxidative capacity with subjective reports of cancer-related behavioral toxicities. Further investigations are warranted to confirm these findings probing into the role of disease status and personal attributes in these preliminary results.
Collapse
Affiliation(s)
- Stephen G Gonsalves
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Christopher M Bergeron
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Philip R Lee
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Kenneth W Fishbein
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Richard G Spencer
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Marta Zampino
- Department of Internal Medicine, University of Maryland, Baltimore, MD, USA
| | - Xinyi Sun
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Vered Stearns
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Carducci
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Luigi Ferrucci
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Nada Lukkahatai
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
7
|
Lynce F, Stevens LE, Li Z, Brock JE, Gulvady A, Huang Y, Nakhlis F, Patel A, Force JM, Haddad TC, Ueno N, Stearns V, Wolff AC, Clark AS, Bellon JR, Richardson ET, Balko JM, Krop IE, Winer EP, Lange P, Hwang ES, King TA, Tolaney SM, Thompson A, Gupta GP, Mittendorf EA, Regan MM, Overmoyer B, Polyak K. TBCRC 039: a phase II study of preoperative ruxolitinib with or without paclitaxel for triple-negative inflammatory breast cancer. Breast Cancer Res 2024; 26:20. [PMID: 38297352 PMCID: PMC10829369 DOI: 10.1186/s13058-024-01774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Patients with inflammatory breast cancer (IBC) have overall poor clinical outcomes, with triple-negative IBC (TN-IBC) being associated with the worst survival, warranting the investigation of novel therapies. Preclinical studies implied that ruxolitinib (RUX), a JAK1/2 inhibitor, may be an effective therapy for TN-IBC. METHODS We conducted a randomized phase II study with nested window-of-opportunity in TN-IBC. Treatment-naïve patients received a 7-day run-in of RUX alone or RUX plus paclitaxel (PAC). After the run-in, those who received RUX alone proceeded to neoadjuvant therapy with either RUX + PAC or PAC alone for 12 weeks; those who had received RUX + PAC continued treatment for 12 weeks. All patients subsequently received 4 cycles of doxorubicin plus cyclophosphamide prior to surgery. Research tumor biopsies were performed at baseline (pre-run-in) and after run-in therapy. Tumors were evaluated for phosphorylated STAT3 (pSTAT3) by immunostaining, and a subset was also analyzed by RNA-seq. The primary endpoint was the percent of pSTAT3-positive pre-run-in tumors that became pSTAT3-negative. Secondary endpoints included pathologic complete response (pCR). RESULTS Overall, 23 patients were enrolled, of whom 21 completed preoperative therapy. Two patients achieved pCR (8.7%). pSTAT3 and IL-6/JAK/STAT3 signaling decreased in post-run-in biopsies of RUX-treated samples, while sustained treatment with RUX + PAC upregulated IL-6/JAK/STAT3 signaling compared to RUX alone. Both treatments decreased GZMB+ T cells implying immune suppression. RUX alone effectively inhibited JAK/STAT3 signaling but its combination with PAC led to incomplete inhibition. The immune suppressive effects of RUX alone and in combination may negate its growth inhibitory effects on cancer cells. CONCLUSION In summary, the use of RUX in TN-IBC was associated with a decrease in pSTAT3 levels despite lack of clinical benefit. Cancer cell-specific-targeting of JAK2/STAT3 or combinations with immunotherapy may be required for further evaluation of JAK2/STAT3 signaling as a cancer therapeutic target. TRIAL REGISTRATION www. CLINICALTRIALS gov , NCT02876302. Registered 23 August 2016.
Collapse
Affiliation(s)
- Filipa Lynce
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
- Brigham and Women's Hospital, Boston, MA, USA.
| | - Laura E Stevens
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Zheqi Li
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Jane E Brock
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Anushree Gulvady
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Ying Huang
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Faina Nakhlis
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Ashka Patel
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Naoto Ueno
- MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Amy S Clark
- University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer R Bellon
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Edward T Richardson
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Justin M Balko
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ian E Krop
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Eric P Winer
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Paulina Lange
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | | | - Tari A King
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Sara M Tolaney
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Elizabeth A Mittendorf
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Meredith M Regan
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Beth Overmoyer
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Kornelia Polyak
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
- Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
8
|
Lukkahatai N, Park J, Jia HM, Martin D, Li J, Sheng JYS, Gill J, Saligan LN, Stearns V, Carducci M. Feasibility of DNA Methylation Age as a Biomarker of Symptoms and Resilience among Cancer Survivors with Multiple Chronic Conditions. Biomedicines 2023; 11:3076. [PMID: 38002076 PMCID: PMC10669866 DOI: 10.3390/biomedicines11113076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
This study aims to examine the feasibility of DNA methylation age as a biomarker for symptoms and resilience in cancer survivors with multiple chronic conditions (MCCs). We included ten participants from our parent study, an ongoing randomized control trial study. Participants' symptoms and resilience were assessed, and peripheral blood was collected. DNA methylation age calculation was performed using DNAge® analysis. Data were analyzed using Spearman's correlation analysis and the Mann-Whitney U test. Participants in the intervention group tended to have a decrease in DNA methylation age and age acceleration after completing an exercise program (mean difference = -0.83 ± 1.26). The change in DNA methylation age was significantly correlated with the change in resilience score (r = -0.897, p = 0.015). The preliminary results suggest that DNA methylation age can be a potential biomarker for improving resilience in cancer survivors with multiple chronic conditions. This finding is limited by the small sample size, and a larger study is needed.
Collapse
Affiliation(s)
- Nada Lukkahatai
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jongmin Park
- College of Nursing, Research Institute of Nursing Science, Pusan National University, Yangsan-si 50612, Republic of Korea
| | - Hejingzi Monica Jia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Daniel Martin
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Junxin Li
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jennifer Yeong-Shin Sheng
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21205, USA
| | - Jessica Gill
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Vered Stearns
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Michael Carducci
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| |
Collapse
|
9
|
Smith KL, Tsai HL, Lim D, Wang C, Nunes R, Wilkinson MJ, Sheng JY, Couzi R, Fetting J, Riley C, Wolff AC, Santa-Maria CA, Papathakis K, Collins-Chase L, Hilton C, Thorner E, Montanari A, Ikejiani D, Snyder C, Stearns V. Feasibility of Symptom Monitoring During the First Year of Endocrine Therapy for Early Breast Cancer Using Patient-Reported Outcomes Collected via Smartphone App. JCO Oncol Pract 2023; 19:981-989. [PMID: 37733984 DOI: 10.1200/op.23.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/07/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE Treatment-associated symptoms drive early discontinuation of adjuvant endocrine therapy (ET) for breast cancer. We hypothesized that symptom monitoring with electronic patient-reported outcomes (ePROs) during adjuvant ET will enhance symptom detection, symptom management, and persistence. METHODS Eligible patients were initiating ET for stage 0-III breast cancer. Participants completed ePRO surveys via smartphone at baseline and 1, 3, 6, and 12 months. Measures included Patient-Reported Outcomes Measurement Information System Anxiety, Depression, Fatigue, and Vaginal Discomfort; plus Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events items assessing joint pain, hot flashes, vaginal dryness, concentration problems, and memory problems. Scores surpassing prespecified thresholds triggered alerts, and recommended symptom management pathways were provided to clinicians. The primary objective was to evaluate feasibility, assessed by survey completion rates, with targets of >65% for the baseline survey and ≥1 follow-up survey during the first 6 months. Secondary objectives included 12-month ET discontinuation rate (target: ≤15%), describing symptoms and evaluating pathway implementation. RESULTS Among 250 participants, 73.2% completed the baseline survey and 69.6% completed ≥1 follow-up survey during the first 6 months. Thirty-one percent of participants had ≥1 symptom alert at baseline and 74% had ≥1 symptom alert during follow-up. The proportions of participants for whom pathway-concordant symptom management was documented at each time point ranged from 12.8% to 36.6%. Twenty-eight participants (11.2%) discontinued ET by 12 months. CONCLUSION Symptom monitoring with ePROs during adjuvant ET is feasible. Despite infrequent documentation of pathway-concordant symptom management after symptom alerts, ePROs were associated with favorable short-term ET persistence.
Collapse
Affiliation(s)
- Karen Lisa Smith
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
- AstraZeneca, Gaithersburg, MD
| | - Hua-Ling Tsai
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - David Lim
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- Division of Statistics Collaborative Inc, WCG, Washington, DC
| | - Chenguang Wang
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- Regeneron Pharmaceuticals, Tarrytown, NY
| | - Raquel Nunes
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
- AstraZeneca, Gaithersburg, MD
| | - Mary J Wilkinson
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Y Sheng
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rima Couzi
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Fetting
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carol Riley
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cesar A Santa-Maria
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katie Papathakis
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Christie Hilton
- Division of Hematology and Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | - Elissa Thorner
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amanda Montanari
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Claire Snyder
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
10
|
Lenz L, Neff C, Solimeno C, Cogan ES, Abramson VG, Boughey JC, Falkson C, Goetz MP, Ford JM, Gradishar WJ, Jankowitz RC, Kaklamani VG, Marcom PK, Richardson AL, Storniolo AM, Tung NM, Vinayak S, Hodgson DR, Lai Z, Dearden S, Hennessy BT, Mayer EL, Mills GB, Slavin TP, Gutin A, Connolly RM, Telli ML, Stearns V, Lanchbury JS, Timms KM. Identifying homologous recombination deficiency in breast cancer: genomic instability score distributions differ among breast cancer subtypes. Breast Cancer Res Treat 2023; 202:191-201. [PMID: 37589839 PMCID: PMC10504389 DOI: 10.1007/s10549-023-07046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/07/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE A 3-biomarker homologous recombination deficiency (HRD) score is a key component of a currently FDA-approved companion diagnostic assay to identify HRD in patients with ovarian cancer using a threshold score of ≥ 42, though recent studies have explored the utility of a lower threshold (GIS ≥ 33). The present study evaluated whether the ovarian cancer thresholds may also be appropriate for major breast cancer subtypes by comparing the genomic instability score (GIS) distributions of BRCA1/2-deficient estrogen receptor-positive breast cancer (ER + BC) and triple-negative breast cancer (TNBC) to the GIS distribution of BRCA1/2-deficient ovarian cancer. METHODS Ovarian cancer and breast cancer (ER + BC and TNBC) tumors from ten study cohorts were sequenced to identify pathogenic BRCA1/2 mutations, and GIS was calculated using a previously described algorithm. Pathologic complete response (pCR) to platinum therapy was evaluated in a subset of TNBC samples. For TNBC, a threshold was set and threshold validity was assessed relative to clinical outcomes. RESULTS A total of 560 ovarian cancer, 805 ER + BC, and 443 TNBC tumors were included. Compared to ovarian cancer, the GIS distribution of BRCA1/2-deficient samples was shifted lower for ER + BC (p = 0.015), but not TNBC (p = 0.35). In the subset of TNBC samples, univariable logistic regression models revealed that GIS status using thresholds of ≥ 42 and ≥ 33 were significant predictors of response to platinum therapy. CONCLUSIONS This study demonstrated that the GIS thresholds used for ovarian cancer may also be appropriate for TNBC, but not ER + BC. GIS thresholds in TNBC were validated using clinical response data to platinum therapy.
Collapse
Affiliation(s)
- Lauren Lenz
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Chris Neff
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Cara Solimeno
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Elizabeth S Cogan
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | | | | | - Carla Falkson
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - James M Ford
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | - Andrea L Richardson
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anna Maria Storniolo
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nadine M Tung
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shaveta Vinayak
- University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, 15. AstraZeneca, Seattle, WA, USA
| | | | | | | | | | - Erica L Mayer
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Thomas P Slavin
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Alexander Gutin
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | | | | | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jerry S Lanchbury
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Kirsten M Timms
- Myriad Genetics, Inc, 320 Wakara Way, Salt Lake City, UT, 84108, USA.
| |
Collapse
|
11
|
Hennessy MA, Leal JP, Huang CY, Solnes LB, Denbow R, Abramson VG, Carey LA, Liu MC, Rimawi M, Specht J, Storniolo AM, Valero V, Vaklavas C, Winer EP, Krop IE, Wolff AC, Cimino-Mathews A, Wahl RL, Stearns V, Connolly RM. Correlation of SUV on Early Interim PET with Recurrence-Free Survival and Overall Survival in Primary Operable HER2-Positive Breast Cancer (the TBCRC026 Trial). J Nucl Med 2023; 64:1690-1696. [PMID: 37652539 DOI: 10.2967/jnumed.123.265853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/06/2023] [Indexed: 09/02/2023] Open
Abstract
Predictive biomarkers of response to human epidermal growth factor receptor 2 (HER2)-directed therapy are essential to inform treatment decisions. The TBCRC026 trial reported that early declines in tumor SUVs corrected for lean body mass (SULmax) on 18F-FDG PET/CT predicted a pathologic complete response (pCR) to HER2 therapy with neoadjuvant trastuzumab and pertuzumab (HP) without chemotherapy in estrogen receptor (ER)-negative, HER2-positive breast cancer. We hypothesized that 18F-FDG PET/CT SULmax parameters would predict recurrence-free survival (RFS) and overall survival (OS). Methods: Patients with stage II/III ER-negative, HER2-positive breast cancer received neoadjuvant HP (n = 88). pCR after HP alone was 22% (18/83), additional nonstudy neoadjuvant therapy was administered in 28% (25/88), and the majority received adjuvant therapy per physician discretion. 18F-FDG PET/CT was performed at baseline and at cycle 1, day 15 (C1D15). RFS and OS were summarized using the Kaplan-Meier method and compared between subgroups using logrank tests. Associations between 18F-FDG PET/CT (≥40% decline in SULmax between baseline and C1D15, or C1D15 SULmax ≤ 3) and pCR were evaluated using Cox regressions, where likelihood ratio CIs were reported because of the small numbers of events. Results: Median follow-up was 53.7 mo (83/88 evaluable), with 6 deaths and 14 RFS events. Estimated RFS and OS at 3 y was 84% (95% CI, 76%-92%) and 92% (95% CI, 87%-98%), respectively. A C1D15 SULmax of 3 or less was associated with improved RFS (hazard ratio [HR], 0.36; 95% CI, 0.11-1.05; P = 0.06) and OS (HR, 0.14; 95% CI, 0.01-0.85; P = 0.03), the latter statistically significant. The association of an SULmax decline of at least 40% (achieved in 59%) with RFS and OS did not reach statistical significance. pCR was associated with improved RFS (HR, 0.25; 95% CI, 0.01-1.24; P = 0.10) but did not reach statistical significance. Conclusion: For the first time, we report a potential association between a C1D15 SULmax of 3 or less on 18F-FDG PET/CT and RFS and OS outcomes in patients with ER-negative, HER2-positive breast cancer receiving neoadjuvant HP alone. If confirmed in future studies, this imaging-based biomarker may facilitate early individualization of therapy.
Collapse
Affiliation(s)
| | - Jeffrey P Leal
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland
| | - Chiung-Yu Huang
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland
- University of California, San Francisco, California
| | - Lilja B Solnes
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland
| | - Rita Denbow
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland
| | | | - Lisa A Carey
- University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - Anna Maria Storniolo
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, Indiana
| | | | | | | | - Ian E Krop
- Yale Cancer Center, New Haven, Connecticut; and
| | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland
| | | | | | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland
| | - Roisin M Connolly
- Cancer Research @UCC, Cork, Ireland;
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland
| |
Collapse
|
12
|
Parsons HA, Blewett T, Chu X, Sridhar S, Santos K, Xiong K, Abramson VG, Patel A, Cheng J, Brufsky A, Rhoades J, Force J, Liu R, Traina TA, Carey LA, Rimawi MF, Miller KD, Stearns V, Specht J, Falkson C, Burstein HJ, Wolff AC, Winer EP, Tayob N, Krop IE, Makrigiorgos GM, Golub TR, Mayer EL, Adalsteinsson VA. Circulating tumor DNA association with residual cancer burden after neoadjuvant chemotherapy in triple-negative breast cancer in TBCRC 030. Ann Oncol 2023; 34:899-906. [PMID: 37597579 PMCID: PMC10898256 DOI: 10.1016/j.annonc.2023.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND We aimed to examine circulating tumor DNA (ctDNA) and its association with residual cancer burden (RCB) using an ultrasensitive assay in patients with triple-negative breast cancer (TNBC) receiving neoadjuvant chemotherapy. PATIENTS AND METHODS We identified responders (RCB 0/1) and matched non-responders (RCB 2/3) from the phase II TBCRC 030 prospective study of neoadjuvant paclitaxel versus cisplatin in TNBC. We collected plasma samples at baseline, 3 weeks and 12 weeks (end of therapy). We created personalized ctDNA assays utilizing MAESTRO mutation enrichment sequencing. We explored associations between ctDNA and RCB status and disease recurrence. RESULTS Of 139 patients, 68 had complete samples and no additional neoadjuvant chemotherapy. Twenty-two were responders and 19 of those had sufficient tissue for whole-genome sequencing. We identified an additional 19 non-responders for a matched case-control analysis of 38 patients using a MAESTRO ctDNA assay tracking 319-1000 variants (median 1000 variants) to 114 plasma samples from 3 timepoints. Overall, ctDNA positivity was 100% at baseline, 79% at week 3 and 55% at week 12. Median tumor fraction (TFx) was 3.7 × 10-4 (range 7.9 × 10-7-4.9 × 10-1). TFx decreased 285-fold from baseline to week 3 in responders and 24-fold in non-responders. Week 12 ctDNA clearance correlated with RCB: clearance was observed in 10 of 11 patients with RCB 0, 3 of 8 with RCB 1, 4 of 15 with RCB 2 and 0 of 4 with RCB 3. Among six patients with known recurrence, five had persistent ctDNA at week 12. CONCLUSIONS Neoadjuvant chemotherapy for TNBC reduced ctDNA TFx by 285-fold in responders and 24-fold in non-responders. In 58% (22/38) of patients, ctDNA TFx dropped below the detection level of a commercially available test, emphasizing the need for sensitive tests. Additional studies will determine whether ctDNA-guided approaches can improve outcomes.
Collapse
Affiliation(s)
- H A Parsons
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston.
| | - T Blewett
- Broad Institute of MIT and Harvard, Cambridge
| | - X Chu
- Data Science, Dana-Farber Cancer Institute, Boston
| | - S Sridhar
- Broad Institute of MIT and Harvard, Cambridge
| | - K Santos
- Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - K Xiong
- Broad Institute of MIT and Harvard, Cambridge
| | | | - A Patel
- Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - J Cheng
- Broad Institute of MIT and Harvard, Cambridge
| | - A Brufsky
- University of Pittsburgh School of Medicine, Pittsburgh
| | - J Rhoades
- Broad Institute of MIT and Harvard, Cambridge
| | | | - R Liu
- Broad Institute of MIT and Harvard, Cambridge
| | - T A Traina
- Memorial Sloan Kettering Cancer Center, New York
| | - L A Carey
- The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
| | - M F Rimawi
- Baylor College of Medicine Dan L. Duncan Comprehensive Cancer Center, Houston
| | - K D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - V Stearns
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore
| | - J Specht
- Seattle Cancer Care Alliance, Seattle
| | - C Falkson
- The University of Alabama at Birmingham, Birmingham
| | - H J Burstein
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston
| | - A C Wolff
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore
| | - E P Winer
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston
| | - N Tayob
- Data Science, Dana-Farber Cancer Institute, Boston
| | - I E Krop
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston
| | | | - T R Golub
- Broad Institute of MIT and Harvard, Cambridge
| | - E L Mayer
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston.
| | | |
Collapse
|
13
|
Rhome R, Wright J, De Souza Lawrence L, Stearns V, Wolff A, Zellars R. Concurrent chemotherapy with partial breast irradiation in triple negative breast cancer patients may improve disease control compared with sequential therapy. Front Oncol 2023; 13:1146754. [PMID: 37503312 PMCID: PMC10370352 DOI: 10.3389/fonc.2023.1146754] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/06/2023] [Indexed: 07/29/2023] Open
Abstract
Purpose To report outcomes on a subset of patients with triple negative breast cancer (TNBC) treated on prospective trials with post-lumpectomy partial breast irradiation and concurrent chemotherapy (PBICC) and compare them to a retrospectively assessed similar cohort treated with whole breast irradiation after adjuvant chemotherapy (WBIaC). Methods and materials Women with T1-2, N0-1 invasive breast cancer with ≥ 2mm lumpectomy margins were offered therapy on one of two PBICC trials. PBI consisted of 40.5 Gy in 15 daily 2.7 Gy fractions delivered concurrently with the first 2 cycles of adjuvant chemotherapy. The comparison cohort received WBI to a median dose of 60.7 Gy, (including boost, range 42.5 - 66 Gy), after completion of non-concurrent, adjuvant chemotherapy. We evaluated disease-free survival (DFS), and local/loco-regional/distant recurrence-free survival (RFS). We compared survival rates using Kaplan-Meier curves and log-rank test of statistical significance. Results Nineteen patients with TNBC were treated with PBICC on prospective protocol, and 49 received WBIaC. At a median follow-up of 35.5 months (range 4.8-71.9), we observed no deaths in the PBICC cohort and 2 deaths in the WBIaC cohort (one from disease recurrence). With a median time of 23.4 (range 4.8 to 47) months, there were 7 recurrences (1 nodal, 4 local, 4 distant), all in the WBIaC group. At 5 years, there was a trend towards increased local RFS (100% vs. 85.4%, p=0.17) and loco-regional RFS (100% vs. 83.5, p=0.13) favoring the PBICC cohort. There was no significant difference in distant RFS between the two groups (100% vs. 94.4%, p=0.36). Five-year DFS was 100% with PBICC vs.78.9% (95% CI: 63.2 to 94.6%, p=0.08) with WBIaC. Conclusion This study suggests that PBICC may offer similar and possibly better outcomes in patients with TNBC compared to a retrospective cohort treated with WBIaC. This observation is hypothesis-generating for prospective trials.
Collapse
Affiliation(s)
- Ryan Rhome
- Department of Radiation Oncology, Indiana University Hospital, Indianapolis, IN, United States
| | - Jean Wright
- Department of Radiation Oncology, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | | | - Vered Stearns
- Department of Oncology, Division of Women’s Malignancies, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Antonio Wolff
- Department of Oncology, Division of Women’s Malignancies, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Richard Zellars
- Department of Radiation Oncology, Indiana University Hospital, Indianapolis, IN, United States
| |
Collapse
|
14
|
Uhelski ACR, Blackford AL, Sheng JY, Snyder C, Lehman J, Visvanathan K, Lim D, Stearns V, Smith KL. Factors associated with weight gain in pre- and post-menopausal women receiving adjuvant endocrine therapy for breast cancer. J Cancer Surviv 2023:10.1007/s11764-023-01408-y. [PMID: 37261654 DOI: 10.1007/s11764-023-01408-y] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Weight gain after breast cancer poses health risks. We aimed to identify factors associated with weight gain during adjuvant endocrine therapy (AET). METHODS Women initiating AET enrolled in a prospective cohort. Participants completed FACT-ES plus PROMIS pain interference, depression, anxiety, fatigue, sleep disturbance and physical function measures at baseline, 3, 6, 12, 24, 36, 48 and 60 months. Treatment-emergent symptoms were defined as changes in scores in the direction indicative of worsening symptoms that exceeded the minimal important difference at 3 and/or 6 months compared to baseline. We used logistic regression to evaluate associations of clinicodemographic features and treatment-emergent symptoms with clinically significant weight gain over 60 months (defined as ≥ 5% compared to baseline) in pre- and post-menopausal participants. RESULTS Of 309 participants, 99 (32%) were pre-menopausal. The 60 months cumulative incidence of clinically significant weight gain was greater in pre- than post-menopausal participants (67% vs 43%, p < 0.001). Among pre-menopausal participants, treatment-emergent pain interference (OR 2.49), aromatase inhibitor receipt (OR 2.8), mastectomy, (OR 2.06) and White race (OR 7.13) were associated with weight gain. Among post-menopausal participants, treatment-emergent endocrine symptoms (OR 2.86), higher stage (OR 2.25) and White race (OR 2.29) were associated with weight gain while treatment-emergent physical function decline (OR 0.30) was associated with lower likelihood of weight gain. CONCLUSIONS Weight gain during AET is common, especially for pre-menopausal women. Clinicodemographic features and early treatment-emergent symptoms may identify at risk individuals. IMPLICATIONS FOR CANCER SURVIVORS Patients at risk for weight gain can be identified early during AET. CLINICAL TRIALS GOV IDENTIFIER NCT01937052, registered September 3, 2013.
Collapse
Affiliation(s)
- Anna-Carson Rimer Uhelski
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Hematology/Oncology Fellowship Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Jennifer Y Sheng
- Johns Hopkins Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Lehman
- Johns Hopkins Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kala Visvanathan
- Johns Hopkins Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Cancer Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Lim
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Division of Statistics, Collaborative Inc., WCG, Washington, DC, USA
| | - Vered Stearns
- Johns Hopkins Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Under Armour Breast Health Innovation Center, The Skip Viragh Outpatient Cancer, Building 201 North Broadway Viragh 10th floor, Room 10291, Baltimore, MD, 21287, USA.
| | - Karen Lisa Smith
- Johns Hopkins Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- AstraZeneca, Gaithersburg, MD, USA
| |
Collapse
|
15
|
Parida S, Siddharth S, Muniraj N, Liu Z, Barman I, Smith M, Sheng J, Stearns V, Coughlin JW, Sharma D. Abstract 5916: Weight loss intervention triggered gut microbiota modulation can positively impact obesity associated endocrine therapy resistance. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5916] [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: 04/07/2023]
Abstract
Abstract
Background: 41.9% of adult US population is obese and every 5-unit BMI increase is associated with 12 percent increase in breast cancer risk; it is an independent predictor of poor outcomes in breast cancer. Microbiome has emerged as a central regulator of obesity and we recently discovered that microbes can not only potentiate breast cancer growth and metastasis but also affect therapeutic response. We showed weight-loss by Diet/Exercise/Behavioral intervention (POWER-remote trial) exerts favorable effects. Here, we examine molecular underpinnings of poor therapy response in obese state and explore the gut microbiome to mitigate the same.
Methods: We co-implanted lineage determined human White preAdipocytes (hWAT) with MCF7 breast cancer cells in the mammary glands of mice. Changes in tumor microenvironment and tumor cells were evaluated ex situ by RNA sequencing, flow cytometry, Raman spectroscopy, Quantitative phase microscopy, PCR, immunoblotting and functional assays. To inspect the gut microbiome, 16 obese breast cancer patients were subjected to weight loss intervention over 14 weeks. Gut microbiome was analyzed at baseline and post-intervention by microbial shotgun sequencing. Patients were divided into responders and non-responders based on % weight-loss.
Results: We found that human breast cancer cells co-implanted with hWAT formed more aggressive tumors compared to controls. RNA sequencing revealed significant upregulation of multiple oncogenic pathways along with robust innate immune response. Tumor dissociated cells from hWAT-MCF7 tumors showed extensive molecular reprogramming rendering them more proliferative, motile and stem-like along with dramatic physiological changes like increased intercellular lipid accumulation. hWAT-MCF7 cells attained resistance to multiple drugs including Tamoxifen, Fulvestrant, Letrozole and Palbociclib. Simultaneous targeting of multiple signaling pathways using pharmacological inhibitors is infeasible in clinical setting hence we explored the obesity-microbiome axis. Obese breast cancer patients underwent POWER-remote intervention and their gut microbiome analysis showed significant differential expression of many microbes. Based on abundance and metabolite profile, F. prausnitzii was selected as the candidate of interest. On treatment with F. prausnitzii growth media, acquired multi-drug resistance in hWAT-MCF7 cells could be reversed suggesting that increase in gut population of the bacterium could be helpful in sensitizing patients unresponsive to therapy.
Conclusion: Direct interaction between breast cancer cells and WAT rendered them resistant to multiple drugs. Metabolites produced by weight-loss-associated bacterium F. prausnitzii reversed adiposity-induced multi-drug resistance, hence, can potentially have therapeutic benefits in obese breast cancer patients.
Citation Format: Sheetal Parida, Sumit Siddharth, Nethaji Muniraj, Zhenhui Liu, Ishan Barman, Michael Smith, Jenni Sheng, Vered Stearns, Janelle W. Coughlin, Dipali Sharma. Weight loss intervention triggered gut microbiota modulation can positively impact obesity associated endocrine therapy resistance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5916.
Collapse
Affiliation(s)
- Sheetal Parida
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | - Michael Smith
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jenni Sheng
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vered Stearns
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Dipali Sharma
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
16
|
Parsons HA, Blewett T, Chu X, Sridhar S, Santos K, Xiong K, Abramson VG, Patel A, Cheng J, Brufsky A, Rhoades J, Force J, Liu R, Traina TA, Carey LA, Rimawi MF, Miller KD, Stearns V, Specht J, Falkson C, Burstein HJ, Wolff AC, Winer EP, Tayob N, Krop IE, Makrigiorgos GM, Golub TR, Mayer EL, Adalsteinsson VA. Circulating tumor DNA association with residual cancer burden after neoadjuvant chemotherapy in triple-negative breast cancer in TBCRC 030. medRxiv 2023:2023.03.06.23286772. [PMID: 36945501 PMCID: PMC10029037 DOI: 10.1101/2023.03.06.23286772] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Purpose To examine circulating tumor DNA (ctDNA) and its association with residual cancer burden (RCB) using an ultrasensitive assay in patients with triple-negative breast cancer (TNBC) receiving neoadjuvant chemotherapy (NAT). Patients and Methods We identified responders (RCB-0/1) and matched non-responders (RCB-2/3) from the phase II TBCRC 030 prospective study of neoadjuvant paclitaxel vs. cisplatin in TNBC. We collected plasma samples at baseline, three weeks, and twelve weeks (end of therapy). We created personalized ctDNA assays utilizing MAESTRO mutation enrichment sequencing. We explored associations between ctDNA and RCB status and disease recurrence. Results Of 139 patients, 68 had complete samples and no additional NAT. Twenty-two were responders and 19 of those had sufficient tissue for whole-genome sequencing. We identified an additional 19 non-responders for a matched case-control analysis of 38 patients using a MAESTRO ctDNA assay tracking 319-1000 variants (median 1000) to 114 plasma samples from 3 timepoints. Overall, ctDNA positivity was 100% at baseline, 79% at week 3, and 55% at week 12. Median tumor fraction (TFx) was 3.7 × 10 -4 (range: 7.9 × 10 -7 to 4.9 × 10 -1 ). TFx decreased 285-fold from baseline to week 3 in responders and 24-fold in non-responders. Week 12 ctDNA clearance correlated with RCB: clearance was observed in 10/11 patients with RCB-0, 3/8 with RCB-1, 4/15 with RCB-2, and 0/4 with RCB-3. Among 6 patients with known recurrence five had persistent ctDNA at week 12. Conclusion NAT for TNBC reduced ctDNA TFx by 285-fold in responders and 24-fold in non-responders. In 58% (22/38) of patients, ctDNA TFx dropped below the detection level of a commercially available test, emphasizing the need for sensitive tests. Additional studies will determine if ctDNA-guided approaches can improve outcomes.
Collapse
Affiliation(s)
- Heather A. Parsons
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Xiangying Chu
- Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Katheryn Santos
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kan Xiong
- Broad Institute of MIT and Harvard, Boston, MA, USA
| | | | - Ashka Patel
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ju Cheng
- Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Adam Brufsky
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Ruolin Liu
- Broad Institute of MIT and Harvard, Boston, MA, USA
| | | | - Lisa A. Carey
- The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Mothaffar F. Rimawi
- Baylor College of Medicine Dan L. Duncan Comprehensive Cancer Center, Houston, TX, USA
| | - Kathy D. Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA; Birmingham, AB, USA
| | - Vered Stearns
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - Carla Falkson
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harold J. Burstein
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Antonio C. Wolff
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Eric P. Winer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nabihah Tayob
- Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ian E. Krop
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Erica L. Mayer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
17
|
Tsou T, Blackford AL, Stearns V, Sheng JY. Abstract P3-03-22: Overweight and obesity trends over 5 years in early stage and metastatic breast cancer patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p3-03-22] [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: 03/06/2023]
Abstract
Abstract
Background: Obesity is associated with 25-33% of all breast cancer (BC) cases, and BC survivors with obesity have a 35% higher risk of BC-related death and 41% higher risk of all-cause mortality. We hypothesized that the prevalence of overweight (body mass index [BMI] 25-29.9 kg/m2) and obesity (BMI ≥30) after a diagnosis of early stage or metastatic BC increases, and baseline characteristics may increase risk of weight gain.
Methods: We conducted a retrospective chart review of 222 patients with Stage 0-IV BC who newly presented to Johns Hopkins from 2015-2018. Patients were part of the BC Program Quality Improvement Project Database, had 1 chest CT scan within 6 months of initial visit, and at least 1 subsequent CT. Data extracted from the medical record included: demographics, menopausal status, diagnosis date, cancer characteristics/treatment, recurrence/vital status, family history of BC, and tobacco/alcohol use. All BMI measured on patients were collected. Baseline BMI was defined as the closest measurement to BC diagnosis between 1 year prior and 1 month after diagnosis. We estimated time to overweight/obesity from diagnosis using the Kaplan Meier method and compared between subgroups with the log rank test. Patients who were overweight/obese at diagnosis were included in the analysis with an event time of zero.
Results: Among 222 patients, 110 patients (50%) had newly diagnosed early-stage BC, 98 (44%) had de-novo or recurrent metastatic BC, and 14 (6.3%) had locally recurrent BC. Most patients were women (98%) and non-Hispanic (93%). Patients identified as White (62%), Black (23%), and Asian (8%). Among 34% with alcohol use, 5% reported ≥8 drinks/week. There were current (6%) and former smokers (34%). Family history of BC was present in 10%. Among those with early-stage primary BC, most were postmenopausal (61%) and received chemotherapy (61%). Hormone receptor (HR)-positive, HER2-positive and triple negative subtypes were 70%, 24% and 19%, respectively. For those with metastatic BC, most were postmenopausal (62%). Hormone receptor (HR)-positive, HER2-positive and triple negative subtypes were 71%, 12% and 24%. At diagnosis, 73% of the whole cohort had BMI ≥25 kg/m2, with the whole cohort and subgroups having mean BMI ≥25 kg/m2. The incidence of elevated BMI increased in all groups and overall, over 5 years (Table 1). Weight gain was significantly associated with premenopausal status (p=0.04). Stage at diagnosis, smoking/alcohol use, receipt of chemotherapy/radiation/endocrine therapy, and subtype were not associated with weight gain.
Conclusion: Patients with early stage and metastatic BC have elevated BMI at diagnosis, and this risk increases over 5 years, especially for those who are premenopausal. Further investigation of the implications of these changes is needed. Additionally, while BMI is accessible, it may underestimate body fat in older people and others who have lost muscle, does not identify fat distribution (a major factor in metabolic health risk), and may not be equally valid across gender, race and ethnicities and age groups. We will assess body composition by CT scan and report correlations with BMI and cancer-related outcomes.
Prevalence of BMI≥25 kg/m2 in patients with breast cancer at diagnosis and by 1-, 2-, and 5-years after Prevalence of BMI≥25 kg/m2 increased over 5 years post-diagnosis. Premenopausal status was more associated with BMI≥25 kg/m2 versus postmenopausal status.
Citation Format: Terrence Tsou, Amanda L. Blackford, Vered Stearns, Jennifer Y. Sheng. Overweight and obesity trends over 5 years in early stage and metastatic breast cancer patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-22.
Collapse
|
18
|
Pagani O, Walley BA, Fleming GF, Colleoni M, Láng I, Gomez HL, Tondini C, Burstein HJ, Goetz MP, Ciruelos EM, Stearns V, Bonnefoi HR, Martino S, Geyer CE, Chini C, Puglisi F, Spazzapan S, Ruhstaller T, Winer EP, Ruepp B, Loi S, Coates AS, Gelber RD, Goldhirsch A, Regan MM, Francis PA. Adjuvant Exemestane With Ovarian Suppression in Premenopausal Breast Cancer: Long-Term Follow-Up of the Combined TEXT and SOFT Trials. J Clin Oncol 2023; 41:1376-1382. [PMID: 36521078 PMCID: PMC10419413 DOI: 10.1200/jco.22.01064] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/08/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The combined analysis of SOFT-TEXT compared outcomes in 4,690 premenopausal women with estrogen/progesterone receptor-positive (ER/PgR+) early breast cancer randomly assigned to 5 years of exemestane + ovarian function suppression (OFS) versus tamoxifen + OFS. After a median follow-up of 9 years, exemestane + OFS significantly improved disease-free survival (DFS) and distant recurrence-free interval (DRFI), but not overall survival, compared with tamoxifen + OFS. We now report DFS, DRFI, and overall survival after a median follow-up of 13 years. In the intention-to-treat (ITT) population, the 12-year DFS (4.6% absolute improvement, hazard ratio [HR], 0.79; 95% CI, 0.70 to 0.90; P < .001) and DRFI (1.8% absolute improvement, HR, 0.83; 95% CI, 0.70 to 0.98; P = .03), but not overall survival (90.1% v 89.1%, HR, 0.93; 95% CI, 0.78 to 1.11), continued to be significantly improved for patients assigned exemestane + OFS over tamoxifen + OFS. Among patients with human epidermal growth factor receptor 2-negative tumors (86.0% of the ITT population), the absolute improvement in 12-year overall survival with exemestane + OFS was 2.0% (HR, 0.85; 95% CI, 0.70 to 1.04) and 3.3% in those who received chemotherapy (45.9% of the ITT population). Overall survival benefit was clinically significant in high-risk patients, eg, women age < 35 years (4.0%) and those with > 2 cm (4.5%) or grade 3 tumors (5.5%). These sustained reductions of the risk of recurrence with adjuvant exemestane + OFS, compared with tamoxifen + OFS, provide guidance for selecting patients for whom exemestane should be preferred over tamoxifen in the setting of OFS.[Media: see text].
Collapse
Affiliation(s)
- Olivia Pagani
- Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Vaud, Switzerland
- Geneva University Hospitals, Lugano University and Swiss Group for Clinical Cancer Research (SAKK), Vaud, Switzerland
| | - Barbara A. Walley
- University of Calgary and Canadian Cancer Trials Group, Calgary, AB, Canada
| | - Gini F. Fleming
- The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, IL
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, and International Breast Cancer Study Group, Milan, Italy
| | - István Láng
- Clinexpert-research, Budapest, Hungary (prior affiliation)
- National Institute of Oncology and International Breast Cancer Study Group, Budapest, Hungary
| | - Henry L. Gomez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
- International Breast Cancer Study Group, Lima, Peru
| | - Carlo Tondini
- Osp. Papa Giovanni XXIII and International Breast Cancer Study Group, Bergamo, Italy
| | - Harold J. Burstein
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Harvard Medical School and Alliance for Clinical Trials in Oncology, Boston, MA
| | - Matthew P. Goetz
- Mayo Clinic and Alliance for Clinical Trials in Oncology, Rochester, MN
| | - Eva M. Ciruelos
- Medical Oncology Department, University Hospital 12 de Octubre and SOLTI Breast Cancer Research Cooperative Group, Madrid, Spain
| | - Vered Stearns
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center and ECOG-ACRIN, Baltimore, MD
| | - Hervé R. Bonnefoi
- Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U1312, and European Organisation for Research and Treatment of Cancer (EORTC), Bordeaux, France
| | - Silvana Martino
- The Angeles Clinic and Research Institute and SWOG, Santa Monica, CA
| | - Charles E. Geyer
- University of Pittsburgh Medical Center Hillman Cancer Center and NRG Oncology, Pittsburgh, PA
| | - Claudio Chini
- Deaprment of Medical Oncology, Ospedale di Circolo e Fondazione, Lombardy, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Italy and Department of Medical Oncology, IRCCS, Centro di Riferimento Oncologico CRO di Aviano, Aviano, Italy
| | - Simon Spazzapan
- Department of Medical Oncology, IRCCS, Centro di Riferimento Oncologico CRO di Aviano, Aviano, Italy
| | - Thomas Ruhstaller
- University of Basel, Swiss Group for Clinical Cancer Research (SAKK) and International Breast Cancer Study Group, Basel, Switzerland
| | - Eric P. Winer
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Harvard Medical School and Alliance for Clinical Trials in Oncology, Boston, MA
- Yale Cancer Center, Yale School of Medicine; Smilow Cancer Hospital, New Haven, CT (prior affiliation)
| | - Barbara Ruepp
- International Breast Cancer Study Group Coordinating Center, Bern, Switzerland
| | - Sherene Loi
- International Breast Cancer Study Group and Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Victoria, Australia
| | - Alan S. Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - Richard D. Gelber
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, MA
| | - Aron Goldhirsch
- European Institute of Oncology, IRCCS, International Breast Cancer Study Group, Milan, Italy
- Deceased
| | - Meredith M. Regan
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Prudence A. Francis
- Peter MacCallum Cancer Center, St Vincent's Hospital, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Breast Cancer Trials Australia & New Zealand, University of Newcastle, Australia; International Breast Cancer Study Group, Melbourne, Australia
| |
Collapse
|
19
|
Parsons HA, Blewett T, Chu X, Sridhar S, Santos K, Xiong K, Abramson V, Patel A, Cheng J, Brufsky AM, Rhoades J, Force J, Liu R, Traina TA, Carey L, Rimawi M, Elkhanany A, Stearns V, Specht JM, Burstein H, Wolff AC, Winer E, Tayob N, Krop I, Golub T, Mayer EL, Adalsteinsson V. Abstract PD11-06: PD11-06 Circulating tumor DNA association with residual cancer burden after neoadjuvant therapy in triple negative breast cancer in TBCRC 030. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd11-06] [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: 03/06/2023]
Abstract
Abstract
Background. Patients (pts) with early triple negative breast cancer (eTNBC) are at increased risk of breast cancer recurrence and death. Recent studies have focused on escalation of therapy, with current treatment standard of at least five drugs – and associated toxicities - for eTNBC. Though presence of residual disease after neoadjuvant therapy (NAT) as measured by residual cancer burden (RCB) helps guide addition of adjuvant treatment, more effective tools to tailor therapy are limited. Persistence of circulating tumor DNA (ctDNA) in the setting of residual disease is associated with high risk of distant recurrence. However, more sensitive minimal residual disease (MRD) assays are needed to potentially guide optimization of systemic therapy.
Methods. TBCRC 030 is a phase II randomized study of 12 weeks of NAT single agent cisplatin or paclitaxel for stage II-III TNBC, followed by surgery. The primary objective of the parent study was to correlate baseline biomarker for homologous recombination deficiency and RCB by study arm. From this group, responders (RCB 0/1) and non-responders (RCB 2/3) from both study arms who did not receive additional NAT prior to surgery were selected for analysis from the study cohort, matched on baseline nodal status and tumor size. As a post hoc study amendment, available pts were followed for event free survival (EFS). Plasma samples were collected prior to treatment initiation (W0), at three weeks (W3), and at twelve weeks, prior to surgery (W12). Whole genome sequencing (WGS) was performed on primary tumor tissue to identify somatic mutations and design for each pt a tumor-informed, ctDNA assay tracking up to 1000 mutations to detect MRD. Detection limit was computed for each tested sample as previously described. For each sample assayed, we report tumor fraction (TFx) when MRD was detected and the detection limit at 90% power when MRD was not detected.
Results. Of 139 study pts, 68 had complete tissue and plasma samples and no receipt of additional NAT. Of these, 22 were responders. These responders, and 22 matched non-responders were identified for analysis. Data from 22 pts – 11 responders, 11 non-responders - are described here; full analysis on all 44 pts will be presented at the meeting. Personalized ctDNA assays were designed targeting 434 to 1000 variants (median 1000) and applied to 66 plasma samples. At W0, 100% (22/22) were positive for ctDNA; 73% (16/22) and 55% (12/22) were positive at W3, and W12, respectively. In pts with T1-T2 tumors median TFx was 4.1e-3(7.8e-6, 3.4e-2) and 4.7e-1(4.3e-2, 9.0e-1) in pts with T3-T4 tumors. TFx decreased from W0 to W3 and from W0 to W12 in responders (Table 1). By W12, ctDNA had cleared in 7/8 pts with RCB 0, 1/3 with RCB 1, 2/8 with RCB 2, and 0/3 with RCB 3. Overall, ctDNA levels were broad with median TFx of 1.5e-3 (range 2.9e-6 to 0.90). Detection limit at 90% power for all tested samples was a median of 8.8e-6 (range 9.9e-7 to 6.8e-3).
To investigate whether ctDNA persistence after NAT was associated with BC recurrence, we analyzed a separate group of all 8 pts with known recurrence and with complete data and samples. All pts had persistent ctDNA at W12 (median TFx 6.8e-3, [2.9e-6 to 6.6e-2]).
Conclusions. After 3 weeks of NAT for eTNBC, ctDNA TFx decreased, with a 3900-fold change in responders and 18-fold change in non-responders. By W3, TFx for most pts with RCB 0/1 were below the 1 in 10,000 limit of detection for many currently available assays, emphasizing the need for sensitive tests to potentially guide therapy. Additional studies will determine if ctDNA-guided approaches in eTNBC can improve pt outcomes.
Table 1: Tumer Fraction and Tumer Fraction Fold Change by Response to Neoadjuvant Therapy
Citation Format: Heather A. Parsons, Timothy Blewett, Xiangying Chu, Sainetra Sridhar, Katheryn Santos, Kan Xiong, Vandana Abramson, Ashka Patel, Ju Cheng, Adam M. Brufsky, Justin Rhoades, Jeremy Force, Ruolin Liu, Tiffany A. Traina, Lisa Carey, Mothaffar Rimawi, Ahmed Elkhanany, Vered Stearns, Jennifer M. Specht, Harold Burstein, Antonio C. Wolff, Eric Winer, Nabihah Tayob, Ian Krop, Todd Golub, Erica L. Mayer, Viktor Adalsteinsson. PD11-06 Circulating tumor DNA association with residual cancer burden after neoadjuvant therapy in triple negative breast cancer in TBCRC 030 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD11-06.
Collapse
Affiliation(s)
- Heather A. Parsons
- 1Dana Farber Cancer Institute; Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Ashka Patel
- 8Department of Pathology, Brigham and Women’s Hospital
| | | | - Adam M. Brufsky
- 10UPMC Hillman Cancer Center, University of Pittsburgh Medical Center
| | | | - Jeremy Force
- 12Duke University Medical Center/Duke Cancer Institute, Durham, NC, USA
| | - Ruolin Liu
- 13Broad Institute, Cambridge, Massachusetts
| | | | - Lisa Carey
- 15UNC-Lindberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | | | | | | | | | | | - Ian Krop
- 24Yale School of Medicine, New Haven, Connecticut
| | - Todd Golub
- 25Broad Institute/Dana-Farber Cancer Institute
| | | | | |
Collapse
|
20
|
Oza H, Grabinski V, Ibanez H, Godet I, Gilkes D, Cimino-Mathews A, Gabrielson E, Shah M, Zhi WI, Pipa Z, Lehman J, Ke S, Tsai HL, Stearns V, Santa-Maria CA. Abstract P2-20-14: Relationship of HIF-1α and tumor infiltrating lymphocytes in patients with HER2-negative early-stage breast cancer treated with neoadjuvant chemotherapy. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-20-14] [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: 03/06/2023]
Abstract
Abstract
Title: Relationship of HIF-1α and tumor infiltrating lymphocytes in patients with HER2-negative early-stage breast cancer treated with neoadjuvant chemotherapy Authors: Grabinski VF, Oza HH, Gilkes DM, Shah MY, Cimino-Mathews A, Gabrielson E, Zhi I, Pipa Z, Lehman J, Ibanez HE, Ke S, Tsai HL, Stearns V, Santa-Maria CA Introduction: Hypoxia inducible factor 1α (HIF-1α) is an oxygen-dependent transcription factor expressed in areas of hypoxia associated with regulation of immune escape mechanisms, metabolism (CAIX), and results in cancer treatment resistance. High stromal tumor infiltrating lymphocytes (sTILs) are associated with pathologic complete response (pCR) to neoadjuvant chemotherapy (NACT) in breast cancer. We investigated associations between HIF-1α, sTILs and their relationship with pCR after NACT in patients with HER2-negative early-stage breast cancer. Methods: We identified patients with early-stage HER2-negative breast cancer at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center from 2000-2009 who received NACT, and had accessible breast tissue from biopsy and/or surgery. A pathologist scored nuclear HIF-1α (0, 1, 2, or 3), membranous CAIX (0, 1, 2, or 3), sTILs (0-100) from baseline (ie pre-NACT) and surgical tissue (if non-pCR). Statistical analysis considered the following variables: age, histology, race, menopausal status, tumor size, and node status. Chemotherapy regimens were divided into either anthracycline AND taxane versus anthracycline OR taxane. Wilcoxon rank-sum, Fisher exact, and Jonckheere trends tests were utilized to assess differences between groups. Results: 43 patients met the predefined criteria and were included in the analysis, 16% (n=7) obtained a pCR. Patient race, ethnicity, clinical tumor size, histology, clinical subtype (estrogen receptor positive (ER+) vs. triple negative (TN)), and NACT regimen were not associated with pCR. Older age (p=0.019), postmenopausal status (p=0.009), smaller surgical tumor size (p < 0.001), and surgical node-negative status (p < 0.001) were associated with pCR. Mean TILs score was 32.5% in patients achieving pCR versus 20% in those with non-pCR (p=0.46); mean HIF-1α was 2.42 in pCR group versus 2.57 in non-pCR (p=0.84). There was a trend of lower baseline sTILs with increasing nuclear HIF-1α score (p=0.085). Membranous CAIX was not associated with nuclear HIF-1α or baseline TILs, however, in the small proportion of patients (n=11) with CAIX scoring, higher membranous CAIX score at baseline (1 vs. 0) was associated with pCR (p=0.024). Conclusions: We observed that patients with pCR had a numerically higher sTILs level at baseline consistent with other studies, but did not find a correlation of HIF-1α and pCR. Patients with higher HIF-1α scores tended to have lower sTILS, suggesting that hypoxia may be leading to an immunosuppressive tumor microenvironment. Further characterizing the HIF-1α pathway and its effects on the immune microenvironment may help identify resistance mechanisms to chemotherapy and immunotherapy.
Citation Format: Harsh Oza, Victoria Grabinski, Hector Ibanez, Ines Godet, Daniele Gilkes, Ashley Cimino-Mathews, Edward Gabrielson, Mirat Shah, W. Iris Zhi, Zoe Pipa, Jennifer Lehman, Suqi Ke, Hua-Ling Tsai, Vered Stearns, Cesar Augusto Santa-Maria. Relationship of HIF-1α and tumor infiltrating lymphocytes in patients with HER2-negative early-stage breast cancer treated with neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-20-14.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Zoe Pipa
- 9Johns Hopkins Women’s Malignancies Program
| | | | - Suqi Ke
- 11Johns Hopkins School of Medicine Division of Biostatistics
| | - Hua-Ling Tsai
- 12Johns Hopkins School of Medicine Division of Biostatistics
| | | | | |
Collapse
|
21
|
Furukawa N, Stearns V, Santa-Maria CA, Popel AS. The tumor microenvironment and triple-negative breast cancer aggressiveness: shedding light on mechanisms and targeting. Expert Opin Ther Targets 2022; 26:1041-1056. [PMID: 36657483 PMCID: PMC10189896 DOI: 10.1080/14728222.2022.2170779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION In contrast to other breast cancer subtypes, there are currently limited options of targeted therapies for triple-negative breast cancer (TNBC). Immense research has demonstrated that not only cancer cells but also stromal cells and immune cells in the tumor microenvironment (TME) play significant roles in the progression of TNBC. It is thus critical to understand the components of the TME of TNBC and the interactions between the various cell populations. AREAS COVERED The components of the TME of TNBC identified by single-cell technologies are reviewed. Furthermore, the molecular interactions between the cells and the potential therapeutic targets contributing to the progression of TNBC are discussed. EXPERT OPINION Single-cell omics studies have contributed to the classification of cells in the TME and the identification of important cell types involved in the progression and the treatment of the tumor. The interactions between cancer cells and stromal cells/immune cells in the TME have led to the discovery of potential therapeutic targets. Experimental data with spatial and temporal resolution will further boost the understanding of the TME of TNBC.
Collapse
Affiliation(s)
- Natsuki Furukawa
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Vered Stearns
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Cesar A. Santa-Maria
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Aleksander S. Popel
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, USA
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
22
|
Leal JP, Rowe SP, Stearns V, Connolly RM, Vaklavas C, Liu MC, Storniolo AM, Wahl RL, Pomper MG, Solnes LB. Automated lesion detection of breast cancer in [ 18F] FDG PET/CT using a novel AI-Based workflow. Front Oncol 2022; 12:1007874. [PMID: 36457510 PMCID: PMC9705734 DOI: 10.3389/fonc.2022.1007874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/20/2022] [Indexed: 09/10/2023] Open
Abstract
UNLABELLED Applications based on artificial intelligence (AI) and deep learning (DL) are rapidly being developed to assist in the detection and characterization of lesions on medical images. In this study, we developed and examined an image-processing workflow that incorporates both traditional image processing with AI technology and utilizes a standards-based approach for disease identification and quantitation to segment and classify tissue within a whole-body [18F]FDG PET/CT study. METHODS One hundred thirty baseline PET/CT studies from two multi-institutional preoperative clinical trials in early-stage breast cancer were semi-automatically segmented using techniques based on PERCIST v1.0 thresholds and the individual segmentations classified as to tissue type by an experienced nuclear medicine physician. These classifications were then used to train a convolutional neural network (CNN) to automatically accomplish the same tasks. RESULTS Our CNN-based workflow demonstrated Sensitivity at detecting disease (either primary lesion or lymphadenopathy) of 0.96 (95% CI [0.9, 1.0], 99% CI [0.87,1.00]), Specificity of 1.00 (95% CI [1.0,1.0], 99% CI [1.0,1.0]), DICE score of 0.94 (95% CI [0.89, 0.99], 99% CI [0.86, 1.00]), and Jaccard score of 0.89 (95% CI [0.80, 0.98], 99% CI [0.74, 1.00]). CONCLUSION This pilot work has demonstrated the ability of AI-based workflow using DL-CNNs to specifically identify breast cancer tissue as determined by [18F]FDG avidity in a PET/CT study. The high sensitivity and specificity of the network supports the idea that AI can be trained to recognize specific tissue signatures, both normal and disease, in molecular imaging studies using radiopharmaceuticals. Future work will explore the applicability of these techniques to other disease types and alternative radiotracers, as well as explore the accuracy of fully automated and quantitative detection and response assessment.
Collapse
Affiliation(s)
- Jeffrey P. Leal
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Vered Stearns
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Roisin M. Connolly
- Cancer Research @ UCC, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Christos Vaklavas
- Huntsville Cancer Institute, University of Alabama, Birmingham, AL, United States
| | - Minetta C. Liu
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Anna Maria Storniolo
- Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN, United States
| | - Richard L. Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Martin G. Pomper
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lilja B. Solnes
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
23
|
Vrselja A, Latifi A, Baber RJ, Stuckey BGA, Walker MG, Stearns V, Hickey M, Davis SR. Q-122 as a novel, non-hormonal, oral treatment for vasomotor symptoms in women taking tamoxifen or an aromatase inhibitor after breast cancer: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet 2022; 400:1704-1711. [PMID: 36366886 PMCID: PMC10084785 DOI: 10.1016/s0140-6736(22)01977-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/23/2022] [Accepted: 09/23/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Vasomotor symptoms (hot flushes and night sweats) are experienced by more than two-thirds of women with breast cancer taking oral adjuvant endocrine therapy. Safe and effective treatments are lacking. Q-122 is a novel, non-hormonal compound that has shown promise for reducing vasomotor symptoms by modulation of oestrogen-responsive neurons in the hypothalamus. We aimed to assess the efficacy and safety of Q-122 in women with breast cancer taking oral adjuvant endocrine therapy and experiencing vasomotor symptoms. METHODS We conducted a multicentre, randomised, double-blind, placebo-controlled, proof-of-concept, phase 2 trial at 18 sites in Australia, New Zealand, and the USA. Eligible participants were women, aged 18-70 years, taking a stable dose of tamoxifen or an aromatase inhibitor following breast cancer and experiencing at least 50 self-reported moderate to severe vasomotor symptoms per week. Participants were randomly assigned (1:1) using an interactive web response system to oral Q-122 100 mg or identical placebo, twice daily for 28 days. Randomisation was stratified by BMI (≤30 kg/m2 or >30 kg/m2) and use of any of a selective serotonin reuptake inhibitor, selective norepinephrine reuptake inhibitor, gabapentin, or pregabalin. Q-122 and placebo capsules were identical in appearance and containers identically labelled. During the double-blind treatment and analysis phases, the participants, investigators, clinical research organisation staff, and sponsor were masked to treatment allocation. The primary outcome was the difference in the mean percentage change from baseline in the Vasomotor Symptom Severity Score of moderate and severe hot flushes and night sweats (msVMS-SS) between Q-122 and placebo after 28 days of treatment. Primary analysis was by modified intention-to-treat and safety was assessed in all participants receiving at least one dose of study drug. This study is registered at ClinicalTrials.gov, NCT03518138. FINDINGS Between Oct 24, 2018, and Sept 9, 2020, 243 patients were screened, 131 of whom were randomly assigned and received treatment (Q-122 n=65 and placebo n=66). Q-122 resulted in a significantly greater mean percentage change in msVMS-SS from baseline over 28 days of treatment compared with placebo (least squares mean: Q-122 -39% [95% CI -46 to -31] vs placebo -26% [-33 to -18]; p=0·018). Treatment-emergent adverse events were generally mild to moderate and similar between the two groups (treatment-related treatment-emergent adverse events in 11 [17%] of 65 patients in the Q-122 group vs nine [14%] of 66 in the placebo group); zero patients in the Q-122 group and two (3%) patients in the placebo group had serious adverse events. INTERPRETATION Q-122 is an effective and well tolerated non-hormonal oral treatment for vasomotor symptoms in women taking oral adjuvant endocrine therapy after breast cancer. Our results support the conduct of larger and longer studies of Q-122, with potential use extending to postmenopausal women who require an alternative to menopausal hormone therapy. FUNDING QUE Oncology.
Collapse
Affiliation(s)
| | | | - Rodney J Baber
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Bronwyn G A Stuckey
- Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, School of Medicine, University of Western Australia, Nedlands, WA, Australia
| | | | - Vered Stearns
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia
| |
Collapse
|
24
|
Verma N, Blackford AL, Thorner E, Lehman J, Snyder C, Stearns V, Smith KL. Factors associated with worsening sexual function during adjuvant endocrine therapy in a prospective clinic-based cohort of women with early-stage breast cancer. Breast Cancer Res Treat 2022; 196:535-547. [PMID: 36197536 PMCID: PMC10084786 DOI: 10.1007/s10549-022-06750-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/17/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Sexual function problems are common but under-reported among women receiving adjuvant endocrine therapy for breast cancer. Worsening scores on patient-reported outcomes (PROs) may identify those at risk for sexual function problems during treatment. We performed a secondary analysis of prospectively collected PROs in women receiving adjuvant endocrine therapy to identify factors associated with worsening sexual function. METHODS Women with stage 0-III breast cancer initiating adjuvant endocrine therapy participating in a prospective cohort completed PROs at baseline, 3, 6, 12, 24, 36, 48, and 60 months. Sexual function was evaluated by the MOS-SP measure. Other measures included PROMIS pain interference, fatigue, depression, anxiety, physical function, and sleep disturbance and the Endocrine Symptom Subscale of the FACT-ES. We evaluated associations between score worsening of at least the minimal important difference (MID) in PROMIS T-scores (4 points) and FACT-ES scores (5 points) with score worsening of at least the MID in MOS-SP scores (8 points) using logistic regression. RESULTS Among 300 participants, 45.7% experienced ≥ 8-point worsening of MOS-SP score at any time point compared to baseline. Worsening endocrine symptoms (OR 1.34, 95% CI 1.22-1.49, p < 0.001), worsening physical function (OR 1.09, 95% CI 1.00-1.18, p = 0.06), and prior mastectomy (OR 1.45, 95% CI 0.94-2.23, p = 0.09) were associated with MOS-SP score worsening by at least the MID. CONCLUSION Worsening endocrine symptoms and physical function identified on PROs are associated with worsening sexual function during adjuvant endocrine therapy. Routine assessment of these domains with PROs may identify women at risk for sexual function problems. TRIAL REGISTRATION NUMBER NCT01937052; Date of Registration: 09/09/2013.
Collapse
Affiliation(s)
- Neha Verma
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Elissa Thorner
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Lehman
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vered Stearns
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Lisa Smith
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Medical Oncology, Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, First Floor, Building B, 5255 Loughboro Road, NW, Washington, DC, 20016, USA.
| |
Collapse
|
25
|
Hertz DL, Douglas JA, Miller RM, Kidwell KM, Gersch CL, Desta Z, Storniolo AM, Stearns V, Skaar TC, Hayes DF, Henry NL, Rae JM. Genome-wide association study of aromatase inhibitor discontinuation due to musculoskeletal symptoms. Support Care Cancer 2022; 30:8059-8067. [PMID: 35776183 PMCID: PMC9529953 DOI: 10.1007/s00520-022-07243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Aromatase inhibitors (AIs) are commonly used to treat hormone receptor positive (HR +) breast cancer. AI-induced musculoskeletal syndrome (AIMSS) is a common toxicity that causes AI treatment discontinuation. The objective of this genome-wide association study (GWAS) was to identify genetic variants associated with discontinuation of AI therapy due to AIMSS and attempt to replicate previously reported associations. METHODS In the Exemestane and Letrozole Pharmacogenetics (ELPh) study, postmenopausal patients with HR + non-metastatic breast cancer were randomized to letrozole or exemestane. Genome-wide genotyping of germline DNA was conducted followed by imputation. Each imputed variant was tested for association with time-to-treatment discontinuation due to AIMSS using a Cox proportional hazards model assuming additive genetic effects and adjusting for age, baseline pain score, prior taxane treatment, and AI arm. Secondary analyses were conducted within each AI arm and analyses of candidate variants previously reported to be associated with AIMSS risk. RESULTS Four hundred ELPh participants were included in the combined analysis. Two variants surpassed the genome-wide significance level in the primary analysis (p value < 5 × 10-8), an intronic variant (rs79048288) within CCDC148 (HR = 4.42, 95% CI: 2.67-7.33) and an intergenic variant (rs912571) upstream of PPP1R14C (HR = 0.30, 95% CI: 0.20-0.47). In the secondary analysis, rs74418677, which is known to be associated with expression of SUPT20H, was significantly associated with discontinuation of letrozole therapy due to AIMSS (HR = 5.91, 95% CI: 3.16-11.06). We were able to replicate associations for candidate variants previously reported to be associated with AIMSS in this cohort, but were not able to replicate associations for any other variants previously reported in other patient cohorts. CONCLUSIONS Our GWAS findings identify several candidate variants that may be associated with AIMSS risk from AI generally or letrozole specifically. Validation of these associations in independent cohorts is needed before translating these findings into clinical practice to improve treatment outcomes in patients with HR + breast cancer.
Collapse
Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church St., Room 3054, Ann Arbor, MI, 48109-1065, USA.
| | - Julie A Douglas
- Department of Mathematics and Statistics, Skidmore College, Saratoga Springs, NY, 12866, USA
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Robert M Miller
- Department of Mathematics and Statistics, Skidmore College, Saratoga Springs, NY, 12866, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Christina L Gersch
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Vered Stearns
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Todd C Skaar
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel F Hayes
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - N Lynn Henry
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Rae
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
26
|
Stearns V, Montanari A, Sheng JY, Coughlin J. Behavioral and psychosocial quality improvement project in patients with early-stage breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.361] [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
361 Background: Cancer treatments often result in unfavorable early and late side effects that impact quality of life. Many forms of cancer, including some types of breast cancer, are also associated with obesity, which may be mediated by lifestyle behaviors. Providing comprehensive cancer treatment and prevention requires assessment and management of both behavioral and psychosocial domains. We initiated a quality improvement project to determine the feasibility of collecting patient-reported outcomes electronically and to identify behavioral and psychosocial needs and interests of women with early stage breast cancer (ESBC) receiving treatment at Johns Hopkins. Methods: We reviewed the outpatient schedules of 2 medical oncologists at different Johns Hopkins sites and identified 169 patients with ESBC who completed a lumpectomy or mastectomy. Using the electronic medical records (EMR) patient portal and/or email, we sent messages to women approximately 3 days prior to an oncology visit with a survey link to a behavioral battery. The battery included assessment of behavioral/psychosocial domains including: nutrition/eating behaviors, weight, pain, substance use, sleep, mental health, sexual health). Women were also asked if they desired additional information on specific behaviors. Results: A total of 100 women responded to the survey (59% response rate). Mean Age = 58.35 years (SD 11.54, range 33-78); 12% Asian, 18% Black, 68% White; 80% married; Mean BMI = 27.8 kg/m2 (SD 6.56). Main results are shown in the table. Behaviors most frequently identified as concerns that patients wanted additional resources for included nutrition (14%) and sleep (11%). Conclusions: Use of the patient portal to gauge patient concerns is feasible, and may help identify the most pressing issues of patients prior to scheduled visits. Our results will be used to develop an EMR-based dashboard and strategies for early interventions to improve wellness and survival outcomes in patients with ESBC.[Table: see text]
Collapse
Affiliation(s)
| | - Amanda Montanari
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | | | | |
Collapse
|
27
|
Raab R, Ismaila N, Andre F, Stearns V, Kalinsky K. Biomarkers for Adjuvant Endocrine and Chemotherapy in Early-Stage Breast Cancer: ASCO Guideline Update Q and A. JCO Oncol Pract 2022; 18:646-648. [DOI: 10.1200/op.22.00230] [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)
- Rachel Raab
- Messino Cancer Centers - A Division of American Oncology Partners, Asheville, NC
| | | | | | | | - Kevin Kalinsky
- Winship Cancer Institute at Emory University, Atlanta, GA
| |
Collapse
|
28
|
Hennessy M, Leal J, Huang CY, Solnes L, Denbow R, Abramson V, Carey L, Liu M, Rimawi M, Specht J, Storniolo A, Valero V, Vaklavas C, Winer E, Krop I, Wolff A, Cimino-Mathews A, Wahl R, Stearns V, Connolly R. 191P Correlation of early change in standardized uptake value (SUV) on positron emission tomography (PET/CT) with recurrence-free survival (RFS) and overall survival (OS) in patients with primary operable HER2-positive breast cancer (TBCRC026). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.226] [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: 11/01/2022] Open
|
29
|
Santa-Maria CA, O'Donnell M, Nunes R, Wright JL, Stearns V. Integrating Immunotherapy in Early-Stage Triple-Negative Breast Cancer: Practical Evidence-Based Considerations. J Natl Compr Canc Netw 2022; 20:738-744. [PMID: 35830893 PMCID: PMC10084783 DOI: 10.6004/jnccn.2022.7025] [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] [Received: 04/11/2022] [Accepted: 04/29/2022] [Indexed: 11/17/2022]
Abstract
The KEYNOTE-522 study is a practice-changing phase III randomized study that demonstrated that the addition of pembrolizumab to polychemotherapy improves outcomes in patients with high-risk early-stage triple-negative breast cancer (TNBC). This regimen is highly efficacious with unprecedented pathologic complete response (pCR) rates, and clinically meaningful improvements in event-free survival (EFS). However, the combination is also associated with significant high-grade treatment-related toxicity. The backbone regimen deviated from common practice, including the addition of carboplatin, lack of dose dense anthracyclines, and adjuvant capecitabine for residual disease, thus brining important questions regarding real-world translation of these results. This brief report practically addresses some of the most relevant questions physicians and patients face in optimizing care using the best available evidence.
Collapse
Affiliation(s)
- Cesar A Santa-Maria
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center.,Johns Hopkins Sibley Memorial Hospital, Baltimore, Maryland
| | | | - Raquel Nunes
- Johns Hopkins Sibley Memorial Hospital, Baltimore, Maryland
| | - Jean L Wright
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center.,Johns Hopkins Sibley Memorial Hospital, Baltimore, Maryland
| | - Vered Stearns
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| |
Collapse
|
30
|
Zhao F, Peipert J, Stearns V, Chang VTS, Jegede O, Ip E, Lee JW, O'Connell NS, Graham N, Henry NL, Loprinzi CL, Flynn PJ, Fisch MJ, Gareen IF, Carlos RC, Smith ML, Cella D, Sparano JA, Gray RJ, Wagner LI. Predictive value of baseline patient-rated treatment bother for early anastrozole discontinuation in a racially diverse cohort: Results from ECOG-ACRIN E1Z11. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12094] [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
12094 Background: The Functional Assessment of Cancer Therapy patient-reported outcomes (PRO) item GP5 (“I am bothered by side effects of treatment”) estimates treatment tolerability. We aimed to extend our previous finding that GP5 predicts early aromatase inhibitor (AI) discontinuation (E1Z03, 96% White) in the racially diverse E1Z11 trial cohort. Methods: E1Z11 was coordinated by the ECOG-ACRIN NCI Community Oncology Research Program (NCORP) Research Base. Postmenopausal women initiating anastrozole per clinical care for ER+ stage I-III breast cancer with a pain score 0-3/10 and no rheumatologic comorbidities were eligible. Accrual of a racially diverse cohort of 1,000 women, including Black and Asian women, was planned. GP5 was administered prior to initiating anastrozole (trial baseline) and at 3, 6, 9 and 12 months. GP5 was scored on a 5-point Likert scale from 0 (not at all) to 4 (very much) and dichotomized as no/little treatment bother (0/1) or moderate/high treatment bother (2-4), consistent with previous analyses. A univariate Cox proportional hazards model estimated baseline GP5’s association with treatment duration via hazard ratio (HR). Early treatment discontinuation status was defined as treatment duration < 12 months with discontinuation not attributed to disease progression or death (n = 4), consistent with previous analyses. Results: 1,046 women enrolled from 6/2013-10/2018 (640 White, 201 Black, 205 Asian), including 590 (56%) from NCORP Community or Minority/Underserved Sites. Approximately 10% (100/987 with GP5 data) reported moderate/high treatment bother prior to initiating anastrozole. Anastrozole discontinuation rate at 1-year was 26.2% overall; it was lower among women with no/little treatment bother (25.7%, GP5 = 0-1) compared to moderate/high treatment bother prior to initiating anastrozole (34.7%, GP5 = 2-4; HR = 1.50, 95% confidence interval [CI]:1.04-2.15, p = 0.027). Subgroup analyses by racial cohort showed a similar predictive effect of GP5 in the White (n = 606, HR = 1.76, 95% CI: 1.12-2.77, p = 0.014) and Black (n = 184, HR = 1.85, 95% CI: 0.92-3.71, p = 0.079) cohorts, but not in the Asian cohort (n = 197, HR = 0.40, 95% CI: 0.10-1.62, p = 0.20). Conclusions: Moderate/high treatment bother prior to starting anastrozole was observed in 10% of patients and associated with a higher risk of early discontinuation, except in Asian patients. Our findings support the presence of a treatment tolerability threshold which can be compromised by pre-treatment burden. Treatment tolerability may also be influenced by cultural and genetic factors, which will be explored in further analysis of genetic and PRO data. Clinical trial information: NCT01824836.
Collapse
Affiliation(s)
| | - John Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Victor Tsu-Shih Chang
- Section of Hematology/Oncology, Veterans Administration New Jersey Health Care System, East Orange, NJ
| | | | - Edward Ip
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | | | | | | | - Patrick J. Flynn
- NSABP/NRG Oncology, and Metro-Minnesota Community Oncology Research Consotrium (MMCORC), Minneapolis, MN
| | | | - Ilana F. Gareen
- Brown University–ECOG-ACRIN Biostatistics Center, Providence, RI
| | - Ruth C Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | | |
Collapse
|
31
|
Timms K, Lenz L, Cogan ES, Mayer EL, Kaklamani VG, Stearns V, Abramson VG, Falkson CI, Jankowitz RC, Marcom PKK, Tung NM, Gradishar WJ, Ford JM, Vinayak S, Boughey JC, Goetz MP, Storniolo AM, Connolly RM, Richardson AL, Telli ML. Exploring homologous recombination deficiency thresholds for predicting response to platinum-based treatment in triple negative breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.525] [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
525 Background: Homologous recombination deficiency (HRD) status can be used to identify patients who are eligible for treatment with DNA damaging agents. Using a 3-biomarker Genomic Instability Score (GIS) threshold of ≥42, studies have previously examined the association between HRD status and outcomes in patients with triple negative breast cancer (TNBC). However, evidence suggests that a GIS threshold of ≥33 may be more appropriate. Here, we conducted an exploratory analysis evaluating the ability of ≥33 and ≥42 GIS thresholds to predict response to platinum-based treatment in patients with TNBC. Methods: Patients across 5 cohorts (TBCRC0301, TBCRC0082, NCT013725793, PrECOG 01054, combined cisplatin cohort4) were included in this analysis if they had a primary TNBC diagnosis, received neoadjuvant platinum-based treatment, had a valid GIS, and had known pathologic complete response (pCR) status. GIS was determined by a combination of loss of heterozygosity, telomeric-allelic imbalance, and large-scale state transitions.4,5 BRCA mutation status was defined by loss of function resulting from a pathogenic variant in BRCA1 or BRCA2. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated by comparing binary threshold status and binary pCR status. Results: A total of 204 tumors (158 BRCAwt; 33 BRCAm; 13 unknown) were included; pCR to platinum-based treatment occurred in 55 cases (39 BRCAwt; 14 BRCAm; 2 unknown). Sensitivity, specificity, PPV, and NPV were comparable between the ≥33 and ≥42 GIS thresholds, with the ≥33 threshold producing higher sensitivity values. This was true when thresholds were applied to all samples and to BRCAwt samples only (Table). Among patients who achieved pCR in response to platinum-based treatment, 5.5% of patients in the full cohort and 7.7% of those in the BRCAwt cohort had a GIS between 33-41. Conclusions: To ensure that the majority of patients likely to benefit from treatment are identified, a GIS of ≥33 may be the most appropriate threshold to predict response to platinum-based treatment in patients with TNBC; however, a prospective trial will be needed to confirm these findings. Additional studies will be important to determine whether this threshold may be appropriate to determine eligibility for other DNA-damaging agents such as PARP inhibitors. 1. Ann Oncol. 2020;31(11):1518-25 2. J Nucl Med. 2015;56(1):31-7. 3. Breast Cancer Res Treat. 2015;151(3):629-38. 4. Clin Cancer Res. 2016;22(15):3764-73. 5. Breast Cancer Res Treat. 2014;16(6):1-9. [Table: see text]
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - James M. Ford
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | | | - Andrea L. Richardson
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | | |
Collapse
|
32
|
Fackler MJ, Tulac S, Venkatesan N, Aslam AJ, de Guzman T, Mercado-Rodriguez C, Cope LM, Downs BM, Vali AH, Ding W, Lehman J, Denbow R, Reynolds J, Buckley ME, Visvanathan K, Umbricht CB, Wolff AC, Stearns V, Bates M, Lai EW, Sukumar S. Development of an automated liquid biopsy assay for methylated markers in advanced breast cancer. Cancer Res Commun 2022; 2:391-401. [PMID: 36046124 PMCID: PMC9426415 DOI: 10.1158/2767-9764.crc-22-0133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/03/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022]
Abstract
Current molecular liquid biopsy assays to detect recurrence or monitor response to treatment require sophisticated technology, highly trained personnel, and a turnaround time of weeks. We describe the development and technical validation of an automated Liquid Biopsy for Breast Cancer Methylation (LBx-BCM) prototype, a DNA methylation detection cartridge assay that is simple to perform and quantitatively detects nine methylated markers within 4.5 h. LBx-BCM demonstrated high interassay reproducibility when analyzing exogenous methylated DNA (75-300 DNA copies) spiked into plasma (Coefficient of Variation, CV = 7.1 - 10.9%) and serum (CV = 19.1 - 36.1%). It also demonstrated high interuser reproducibility (Spearman r = 0.887, P < 0.0001) when samples of metastatic breast cancer (MBC, N = 11) and normal control (N = 4) were evaluated independently by two users. Analyses of interplatform reproducibility indicated very high concordance between LBx-BCM and the reference assay, cMethDNA, among 66 paired plasma samples (MBC N = 40, controls N = 26; Spearman r = 0.891; 95% CI = 0.825 - 0.933, P< 0.0001). LBx-BCM achieved a ROC AUC = 0.909 (95% CI = 0.836 - 0.982), 83% sensitivity and 92% specificity; cMethDNA achieved a ROC AUC = 0.896 (95% CI = 0.817 - 0.974), 83% sensitivity and 92% specificity in test set samples. The automated LBx-BCM cartridge prototype is fast, with performance levels equivalent to the highly sensitive, manual cMethDNA method. Future prospective clinical studies will evaluate LBx-BCM detection sensitivity and its ability to monitor therapeutic response during treatment for advanced breast cancer.
Collapse
Affiliation(s)
- Mary Jo Fackler
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | - Leslie M. Cope
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bradley M. Downs
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abdul Hussain Vali
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wanjun Ding
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Jennifer Lehman
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rita Denbow
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeffrey Reynolds
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Morgan E. Buckley
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kala Visvanathan
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Antonio C. Wolff
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vered Stearns
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Saraswati Sukumar
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
33
|
Joyce E, Kidwell KM, Stearns V, Hayes DF, Storniolo AM, Henry NL. Polypharmacy and premature aromatase inhibitor (AI) discontinuation in older women with breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6568] [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
6568 Background: Treatment with AI therapy for at least five years is recommended to reduce risk of cancer recurrence in postmenopausal women with hormone-positive breast cancer, but up to 50% prematurely discontinue their AI. Prior studies have demonstrated higher rates of nonadherence in older patients. Higher rates of comorbidities are also present in older patients, many of which require treatment with prescription medications. However, in prior studies, the impact of polypharmacy on AI persistence in older women has been variable. We evaluated the relationship between use of prescription and over-the-counter (OTC) medications and AI discontinuation in older women in a randomized controlled trial of AI therapy. Methods: In the Exemestane and Letrozole Pharmacogenetics (ELPh) trial, postmenopausal women with stage 0-III hormone-positive breast cancer were randomized to receive exemestane or letrozole and followed for two years. Prescription medication and OTC supplement usage was prospectively collected. Only enrolled participants at least 65 years of age were included in this analysis. Univariate and multivariable Cox proportional hazards models evaluated the association between baseline prescription medications, OTC medications, initial assigned AI medication, and time to discontinuation of initial AI. Results: 131 women at least 65 years old with baseline medication and OTC supplement information were identified. The average age was 70.4 (SD 5). 58 participants (44%) were randomized to exemestane and 73 (56%) to letrozole. 21% had previously received tamoxifen and 18% received taxane-based chemotherapy. The average number of prescription medications at AI initiation was 4.95, and 127 patients reported taking at least one. The average number of OTC medications was 3.23, and 107 patients reported taking at least one. There was no difference in number of prescription medications or OTC medications by study arm. As previously reported, exemestane was associated with premature discontinuation (HR 1.92 [95%CI 1.06-3.50], p = 0.032). Controlling for AI, the risk of discontinuation decreased by 12% for every additional prescription medication (HR 0.88 [95%CI 0.78-0.99], p = 0.038). OTC medication use was not significantly associated with AI duration. Conclusions: Increased prescription medication usage at AI initiation was associated with decreased risk of premature discontinuation of AI. Further research is needed to evaluate this interaction and identify characteristics that impact AI persistence in older women with breast cancer. Clinical trial information: NCT00228956.
Collapse
|
34
|
Smith KL, Verma N, Blackford AL, Lehman J, Westbrook K, Lim D, Fetting J, Wolff AC, Jelovac D, Miller RS, Connolly R, Armstrong DK, Nunes R, Visvanathan K, Riley C, Papathakis K, Zafman N, Sheng JY, Snyder C, Stearns V. Association of treatment-emergent symptoms identified by patient-reported outcomes with adjuvant endocrine therapy discontinuation. NPJ Breast Cancer 2022; 8:53. [PMID: 35449210 PMCID: PMC9023490 DOI: 10.1038/s41523-022-00414-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/14/2022] [Indexed: 11/08/2022] Open
Abstract
Many patients discontinue endocrine therapy for breast cancer due to intolerance. Identification of patients at risk for discontinuation is challenging. The minimal important difference (MID) is the smallest change in a score on a patient-reported outcome (PRO) that is clinically significant. We evaluated the association between treatment-emergent symptoms detected by worsening PRO scores in units equal to the MID with discontinuation. We enrolled females with stage 0-III breast cancer initiating endocrine therapy in a prospective cohort. Participants completed PROs at baseline, 3, 6, 12, 24, 36, 48, and 60 months. Measures included PROMIS pain interference, fatigue, depression, anxiety, physical function, and sleep disturbance; Endocrine Subscale of the FACT-ES; and MOS-Sexual Problems (MOS-SP). We evaluated associations between continuous PRO scores in units corresponding to MIDs (PROMIS: 4-points; FACT-ES: 5-points; MOS-SP: 8-points) with time to endocrine therapy discontinuation using Cox proportional hazards models. Among 321 participants, 140 (43.6%) initiated tamoxifen and 181 (56.4%) initiated aromatase inhibitor (AI). The cumulative probability of discontinuation was 23% (95% CI 18-27%) at 48 months. For every 5- and 4-point worsening in endocrine symptoms and sleep disturbance respectively, participants were 13 and 14% more likely to discontinue endocrine therapy respectively (endocrine symptoms HR 1.13, 95% CI 1.02-1.25, p = 0.02; sleep disturbance HR 1.14, 95% CI 1.01-1.29, p = 0.03). AI treatment was associated with greater likelihood of discontinuation than tamoxifen. Treatment-emergent endocrine symptoms and sleep disturbance are associated with endocrine therapy discontinuation. Monitoring for worsening scores meeting or exceeding the MID on PROs may identify patients at risk for discontinuation.
Collapse
Affiliation(s)
- Karen Lisa Smith
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Neha Verma
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Jennifer Lehman
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Westbrook
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - David Lim
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - John Fetting
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Antonio C Wolff
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniela Jelovac
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert S Miller
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- CancerLinQ, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Roisin Connolly
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Deborah K Armstrong
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raquel Nunes
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kala Visvanathan
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Cancer Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carol Riley
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie Papathakis
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nelli Zafman
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Y Sheng
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vered Stearns
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
35
|
Andre F, Ismaila N, Allison KH, Barlow WE, Collyar DE, Damodaran S, Henry NL, Jhaveri K, Kalinsky K, Kuderer NM, Litvak A, Mayer EL, Pusztai L, Raab R, Wolff AC, Stearns V. Biomarkers for Adjuvant Endocrine and Chemotherapy in Early-Stage Breast Cancer: ASCO Guideline Update. J Clin Oncol 2022; 40:1816-1837. [PMID: 35439025 DOI: 10.1200/jco.22.00069] [Citation(s) in RCA: 116] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To update recommendations on appropriate use of breast cancer biomarker assay results to guide adjuvant endocrine and chemotherapy decisions in early-stage breast cancer. METHODS An updated literature search identified randomized clinical trials and prospective-retrospective studies published from January 2016 to October 2021. Outcomes of interest included overall survival and disease-free or recurrence-free survival. Expert Panel members used informal consensus to develop evidence-based recommendations. RESULTS The search identified 24 studies informing the evidence base. RECOMMENDATIONS Clinicians may use Oncotype DX, MammaPrint, Breast Cancer Index (BCI), and EndoPredict to guide adjuvant endocrine and chemotherapy in patients who are postmenopausal or age > 50 years with early-stage estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative (ER+ and HER2-) breast cancer that is node-negative or with 1-3 positive nodes. Prosigna and BCI may be used in postmenopausal patients with node-negative ER+ and HER2- breast cancer. In premenopausal patients, clinicians may use Oncotype in patients with node-negative ER+ and HER2- breast cancer. Current data suggest that premenopausal patients with 1-3 positive nodes benefit from chemotherapy regardless of genomic assay result. There are no data on use of genomic tests to guide adjuvant chemotherapy in patients with ≥ 4 positive nodes. Ki67 combined with other parameters or immunohistochemistry 4 score may be used in postmenopausal patients without access to genomic tests to guide adjuvant therapy decisions. BCI may be offered to patients with 0-3 positive nodes who received 5 years of endocrine therapy without evidence of recurrence to guide decisions about extended endocrine therapy. None of the assays are recommended for treatment guidance in individuals with HER2-positive or triple-negative breast cancer. Treatment decisions should also consider disease stage, comorbidities, and patient preferences.Additional information is available at www.asco.org/breast-cancer-guidelines.
Collapse
Affiliation(s)
| | | | | | | | | | | | - N Lynn Henry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Komal Jhaveri
- Memorial Sloan Kettering Cancer Center, New York, NY.,Weill Cornell Medical College, New York, NY
| | - Kevin Kalinsky
- Winship Cancer Institute at Emory University, Atlanta, GA
| | | | - Anya Litvak
- Cancer Center at Saint Barnabas Medical Center, Livingston, NJ
| | | | | | - Rachel Raab
- Messino Cancer Centers-A Division of American Oncology Partners, Asheville, NC
| | | | | |
Collapse
|
36
|
Sheng JYS, Montanari A, Too F, Zahurak M, Rosner GL, Gudzune KA, Coughlin JW, Stearns V. YIA22-007: Adaptive Nutrition and Exercise Weight loss (A-NEW) Study for Breast Cancer Survivors With Overweight or Obesity. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7144] [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: 11/17/2022]
Affiliation(s)
| | | | - Faith Too
- 1 Johns Hopkins Hospital, Baltimore, MD
| | | | | | | | | | | |
Collapse
|
37
|
Sidiropoulos DN, Rafie CI, Jang JK, Castanon S, Baugh AG, Gonzalez E, Christmas BJ, Narumi VH, Davis-Marcisak EF, Sharma G, Bigelow E, Vaghasia A, Gupta A, Skaist A, Considine M, Wheelan SJ, Ganesan SK, Yu M, Yegnasubramanian S, Stearns V, Connolly RM, Gaykalova DA, Kagohara LT, Jaffee EM, Fertig EJ, Roussos Torres ET. Entinostat decreases immune suppression to promote anti-tumor responses in a HER2+ breast tumor microenvironment. Cancer Immunol Res 2022; 10:656-669. [PMID: 35201318 PMCID: PMC9064912 DOI: 10.1158/2326-6066.cir-21-0170] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/19/2021] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
Abstract
Therapeutic combinations to alter immunosuppressive, solid tumor microenvironments (TMEs), such as in breast cancer, are essential to improve responses to immune checkpoint inhibitors (ICIs). Entinostat, an oral histone deacetylase inhibitor (HDACi), has been shown to improve responses to ICIs in various tumor models with immunosuppressive TMEs. The precise and comprehensive alterations to the TME induced by entinostat remain unknown. Here, we employed single-cell RNA-sequencing on HER2-overexpressing breast tumors from mice treated with entinostat and ICIs in order to fully characterize changes across multiple cell types within the TME. This analysis demonstrates that treatment with entinostat induced a shift from a pro-tumor to an anti-tumor TME signature, characterized predominantly by changes in myeloid cells. We confirmed myeloid-derived suppressor cells (MDSCs) within entinostat-treated tumors associated with a less suppressive granulocytic (G)-MDSC phenotype and exhibited altered suppressive signaling that involved the NFkB and STAT3 pathways. In addition to MDSCs, tumor-associated macrophages were epigenetically reprogrammed from a pro-tumor M2-like phenotype toward an anti-tumor M1-like phenotype, which may be contributing to a more sensitized TME. Overall, our in-depth analysis suggests that entinostat-induced changes on multiple myeloid cell types reduce immunosuppression and increase anti-tumor responses, which, in turn, improve sensitivity to ICIs. Sensitization of the TME by entinostat could ultimately broaden the population of patients with breast cancer who could benefit from ICIs.
Collapse
Affiliation(s)
| | | | - Julie K Jang
- University of Southern California, Los Angeles, United States
| | | | - Aaron G Baugh
- University of Southern California, Los Angeles, United States
| | - Edgar Gonzalez
- University of Southern California, Los Angeles, United States
| | | | | | | | | | - Emma Bigelow
- Johns Hopkins University School of Medicine, United States
| | - Ajay Vaghasia
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Anuj Gupta
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutes, Baltimore, MD, United States
| | - Alyza Skaist
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutes, Baltimore, MD, United States
| | | | - Sarah J Wheelan
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Min Yu
- University of Southern California, Los Angeles, CA, United States
| | | | - Vered Stearns
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | | | | | | | - Elana J Fertig
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | |
Collapse
|
38
|
Regan MM, Walley BA, Fleming GF, Francis PA, Colleoni MA, Láng I, Gómez HL, Tondini CA, Burstein HJ, Goetz MP, Ciruelos EM, Stearns V, Bonnefoi HR, Martino S, Geyer CE, Chini C, Minisini AM, Spazzapan S, Ruhstaller T, Winer EP, Ruepp B, Loi S, Coates AS, Goldhirsch A, Gelber RD, Pagani O. Abstract GS2-05: Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): update of the combined TEXT and SOFT trials. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs2-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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 updated combined SOFT+TEXT analysis, after 9 years median follow-up (MFU), revealed that adjuvant E+OFS vs T+OFS significantly improved disease-free survival (DFS) and distant recurrence-free interval (DRFI) but not overall survival (OS) in premenopausal women with HR+ early BC (Francis et al NEJM 2018). Given the high rate of OS in both arms and the long-term risk of relapse in HR+ BC, continued follow-up is key to assessing treatment benefit. We report a planned update analysis including OS with database lock of May 2021, after 13 years MFU.. Methods TEXT and SOFT enrolled premenopausal women with HR+ early BC from November 2003 to April 2011 (2660 in TEXT, 3047 in SOFT intention-to-treat (ITT) populations). TEXT randomized women within 12 weeks of surgery to 5 years E+OFS vs T+OFS; chemotherapy (CT) was optional and concurrent with OFS. SOFT randomized women to 5 years E+OFS vs T+OFS vs T alone, within 12 weeks of surgery if no CT planned, or within 8 months of completing (neo)adjuvant CT. Both trials were stratified by CT use. For the combined analysis of E+OFS vs T+OFS, the primary endpoint was DFS defined as invasive local, regional, distant recurrence, contralateral BC, second malignancy, death. Secondary endpoints included invasive breast cancer-free interval (BCFI), DRFI and OS.. Results: At database lock there were 953 DFS events and 473 deaths among 4690 pts assigned to T+OFS or E+OFS. In the ITT population, DFS, BCFI and DRFI outcomes for pts assigned E+OFS (n=2346) continued to be significantly improved over T+OFS (n=2344). 12-yr DFS was 80.5% vs. 75.9% (4.6% absolute improvement; HR 0.79 95% CI 0.70-0.90), 12-yr BCFI was improved by 4.1% and 12-yr DRFI by 1.8%. At 12 years OS was excellent in both groups, 90.1% in pts assigned E+OFS vs 89.1% in pts assigned T+OFS (HR 0.93; 95% CI, 0.78-1.11). There was heterogeneity of relative treatment effect according to HER2 status. When enrollment commenced, anti-HER2 adjuvant therapy was not standard; 53% of 583 pts with HER2+ tumors received HER2-targeted therapy. Below are Kaplan-Meier 12-yr estimates for patients with HER2 negative tumors by trial and chemotherapy stratum and for those with high-grade tumours, as an example of high-risk feature (Table). There is an emerging OS benefit for E+OFS vs T+OFS in pts with HER2 negative tumors who received chemotherapy in both trials.In pts with HER2-negative tumors, clinically-relevant outcome benefits were also seen in other high-risk subgroups: 12-yr DFS and OS were improved by 7.4% and 2.7%, respectively, in pts with pN1a disease, and by 10.6% and 4.5%, respectively, in those with tumors >2cm.
Conclusions After 13 years MFU, adjuvant E+OFS, as compared with T+OFS, shows a sustained reduction in the risk of recurrence, more consistent in HER2 negative patients and in those with high-risk disease features, e.g., indication for adjuvant chemotherapy and G3 tumors. Oncologists may use this information to discuss potential benefits of E+OFS with individual patients. Follow-up continues for 5 additional years.
Chemotherapy HER2-negativeSOFTT+OFS (n=424)E+OFS (n=411)Absolute difference12-yr DFS67.4%74.1%6.7%12-yr OS81.1%84.4%3.3%TEXTT+OFS (n=656)E+OFS (n=661)Absolute difference12-yr DFS71.0%78.4%7.4%12-yr OS83.5%86.8%3.3%No chemotherapy HER2-negativeSOFTT+OFS (n=445)E+OFS (n=447)Absolute difference12-yr DFS82.9%88.2%5.3%12-yr OS96.1%96.9%0.9%TEXTT+OFS (n=499)E+OFS (n=492)Absolute difference12-yr DFS80.2%86.7%6.5%12-yr OS95.9%96.2%0.2%G3 HER2-negativeT+OFS (n=423)E+OFS (n=405)Absolute difference12-yr DFS62.7%73.0%10.3%12-yr OS78.1%83.6%5.5%
Citation Format: Meredith M Regan, Barbara A Walley, Gini F Fleming, Prudence A Francis, Marco A Colleoni, István Láng, Henry L Gómez, Carlo A Tondini, Harold J Burstein, Matthew P Goetz, Eva M Ciruelos, Vered Stearns, Hervé R Bonnefoi, Silvana Martino, Charles E Geyer, Jr, Claudio Chini, Alessandro M Minisini, Simon Spazzapan, Thomas Ruhstaller, Eric P Winer, Barbara Ruepp, Sherene Loi, Alan S Coates, Aron Goldhirsch, Richard D Gelber, Olivia Pagani. Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): update of the combined TEXT and SOFT trials [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS2-05.
Collapse
Affiliation(s)
- Meredith M Regan
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Barbara A Walley
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Gini F Fleming
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Prudence A Francis
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Marco A Colleoni
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - István Láng
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Henry L Gómez
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Carlo A Tondini
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Harold J Burstein
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Matthew P Goetz
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Eva M Ciruelos
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Vered Stearns
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Hervé R Bonnefoi
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Silvana Martino
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Charles E Geyer
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Claudio Chini
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Alessandro M Minisini
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Simon Spazzapan
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Thomas Ruhstaller
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Eric P Winer
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Barbara Ruepp
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Sherene Loi
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Alan S Coates
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Aron Goldhirsch
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Richard D Gelber
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Olivia Pagani
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| |
Collapse
|
39
|
Mohamed MA, Wang C, Buckley M, Lehman J, Canzoniero J, Gocke CD, Nunes R, Park BH, Smith KL, Tao J, Tukachinsky H, Wilkinson M, Wolff AC, Stearns V, Santa-Maria CA. Abstract P2-08-15: Clinical, pathologic, and molecular associations of tumor mutational burden in metastatic breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-08-15] [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: Tumor mutational burden (TMB) is a biomarker approved to predict response to immune checkpoint blockade (ICB) in solid tumors irrespective of their tissue of origin. However, there are limited data in patients with breast cancer and high TMB to support the use of ICB. The goal of this analysis is to describe clinical, pathological and molecular associations with TMB within a cohort of patients with metastatic breast cancer. Methods: We included patients enrolled onto an ongoing prospective study titled Individualized Molecular Analyses Guide Efforts (IMAGE)-II. Patients eligible for IMAGE-II have metastatic breast cancer of any subtype that had progressed on at least one standard-of-care therapy. Genetic profiling of tumor tissue was performed at the discretion of the treating team using one of several commercially available next generation sequencing platforms. For purposes of this analysis, only patients who underwent tissue-based Foundation Medicine analysis are included as TMB assessments are different across different platforms. Data are summarized by descriptive statistics. Linear and logistic regression analyses are conducted to evaluate the association between TMB and other clinical, pathological and molecular factors. We will present data on associations with specific mutations (i.e. ESR1, ERBB2, DNA repair, Pi3K signaling, TP53) and ctDNA TMB at a later time. Results:Of 117 patients in the IMAGE-II database, median age was 57 (range 23-86), 65% were White, 29% Black, and 6% Other. TMB data were available on 62 patients. Of those with both TMB and subtype information, 35 (70%) had ER+HER2- tumors, and 15 (30%) had ER-HER2- tumors. Median TMB was 4 mutations/megabase and ranged from 0 to 27. We did not observe significant differences in TMB in patients with ER+HER2- and those with ER-HER2- tumors (median TMB of 4 [0-27] and 5 [1-25], respectively), nor between White versus Black patients (median TMB of 4 [0-27] and 5 [0-12], respectively). However, we did observe that age was positively associated with higher TMB (p-value = 0.02). Additionally, we observed that the time between metastatic diagnosis and TMB measurement was positively associated with TMB (p-value < 0.01); this significant association was also observed in ER+HER2- patients (p-value < 0.01) but not in ER-HER2- patients. Median time to obtaining TMB since metastatic diagnosis was 1.1 (range -0.8 - 12.8) years. More lines of chemotherapy prior to TMB assessment was not observed to be associated with higher TMB. Conclusions: We observed that TMB was higher in patients who have had a longer disease course. Further research is required to understand changes in TMB over time, and how TMB is correlated with. other genomic and tumor microenvironment characteristics. A deeper understanding of TMB may help refine it as a predictive biomarker for ICB.
Citation Format: Mohamed A Mohamed, Chenghuang Wang, Morgan Buckley, Jennifer Lehman, Jenna Canzoniero, Christopher D Gocke, Raquel Nunes, Ben Ho Park, Karen L Smith, Jessica Tao, Hanna Tukachinsky, Mary Wilkinson, Antonio C Wolff, Vered Stearns, Cesar A Santa-Maria. Clinical, pathologic, and molecular associations of tumor mutational burden in metastatic breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-08-15.
Collapse
Affiliation(s)
| | | | - Morgan Buckley
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | - Raquel Nunes
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ben Ho Park
- Vanderbilt University Medical Center, Nashville, TN
| | - Karen L Smith
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jessica Tao
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Mary Wilkinson
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Vered Stearns
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | |
Collapse
|
40
|
Timms KM, Lenz L, Neff C, Solimeno C, Flake D, Boughey JC, Goetz MP, Richardson A, Storniolo AM, Gutin A, Connolly RM, Stearns V, Lanchbury JS. Abstract P5-13-09: Identifying homologous recombination deficiency in breast cancer: Genomic instability score thresholds differ in breast cancer subtypes. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-13-09] [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
Background: Patients with homologous recombin ation (HR) deficient tumors may benefit from treatment with DNA damaging agents. Markers of genomic instability can be used to identify HR deficiency, including a 3-biomarker Genomic Instability Score (GIS). For patients with ovarian cancer (OC), the FDA-approved GIS threshold for identifying HR deficiency is 42, set as the 5th percentile for BRCA deficient tumors. Recently, a lower 1st percentile cutoff of 33 was explored in OC; this threshold was significantly associated with improved outcome after platinum-based treatment.1,2 Determining an optimal GIS threshold for different types of tumors is crucial, as the GIS distribution may vary between different cancers and even between different cancer subtypes. We propose GIS thresholds for breast cancer separately for triple-negative breast cancer (TNBC) and estrogen receptor-positive (ER+) breast cancer, using the exploratory threshold of 33 for OC as a comparator. Methods: GISs in BRCA deficient tumors were determined for patients newly diagnosed with varying stages of OC, TNBC, or ER+ breast cancer across 5 cohorts (Timms et al,3 TCGA,4 Abkevich et al,5 TBCRC008,6 the OlympiaD trial7). GIS was determined as a combination of loss of heterozygosity, telomeric-allelic imbalance, and large-scale state transitions. BRCA deficiency was defined by loss of function resulting from a pathogenic variant in BRCA1 or BRCA2 or by methylation of the BRCA1 promoter region, with loss of heterozygosity in the affected gene. GIS distributions in different cancer types and subtypes were compared using the Kolmogorov-Smirnov test. A normal distribution was fit to GISs in BRCA deficient ER+ breast tumors. The 1st percentile of the fitted distribution was chosen as the threshold. Results: A total of 561 OC tumors (190 BRCA deficient), 99 TNBC tumors (44 BRCA deficient), and 406 ER+ breast tumors (76 BRCA deficient) were included across the 5 cohorts. When score distributions were evaluated for BRCA deficient tumors, the GIS distribution within ER+ breast cancer was significantly different than for OC (p=9.6x10-5) and TNBC (p=3.2x10-4). This indicates that different GIS thresholds are appropriate for breast cancer subtypes and that the GIS threshold developed for OC is not appropriate for ER+ breast cancer. The 1st percentile of a normal distribution fit in BRCA deficient ER+ breast cancer tumors yields a threshold of 24. Using this threshold, 45.1% (183/406; 75 BRCA deficient, 108 BRCA intact) of ER+ breast tumors were HR deficient. In contrast, the GIS distribution for TNBC was not significantly different than for OC (p=0.77). Using the exploratory threshold of 33, 63.6% (63/99; 44 BRCA deficient, 19 BRCA intact) of TNBC tumors were HR deficient. Conclusions: When compared to OC, the distribution of GIS in BRCA deficient tumors was different for ER+ breast cancer, but not for TNBC. These findings are consistent with the fact that OC and TNBC are known to have similar molecular signatures.8 Exploratory thresholds of 24 for ER+ breast cancer, and 33 for TNBC and OC could be examined to determine if these cutoffs are associated with a benefit from treatment with DNA targeting agents. Clinical validity and utility of these more inclusive 1% thresholds would require demonstration of correlation with clinical outcomes. The threshold difference observed between these cancer subtypes also suggests that cancer or cancer subtype specific thresholds may be needed as evaluations of HR deficiency expands beyond OC to identify candidates for PARP inhibitors. References: 1 Mol Cancer Res. 2018;16(7):1103-11. 2 Cancers. 2021;13(5):946. 3 Br J Cancer. 2012;107(10):1776-82. 4 Nature. 2012;490(7418):61-70. 5 Breast Cancer Res. 2014;16(145):1-9. 6 J Nucl Med. 2015;56(1):31-7. 7 NEJM. 2017;377(17):1700. 8 Int J Mol Sci. 2016;17(5):759.
Citation Format: Kirsten M Timms, Lauren Lenz, Chris Neff, Cara Solimeno, Darl Flake, Judy C Boughey, Matthew P Goetz, Andrea Richardson, Anna Maria Storniolo, Alexander Gutin, Roisin M Connolly, Vered Stearns, Jerry S Lanchbury. Identifying homologous recombination deficiency in breast cancer: Genomic instability score thresholds differ in breast cancer subtypes [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-13-09.
Collapse
Affiliation(s)
| | | | - Chris Neff
- Myriad Genetics, Inc., Salt Lake City, UT
| | | | - Darl Flake
- Myriad Genetics, Inc., Salt Lake City, UT
| | | | | | - Andrea Richardson
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | | | | | | | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | | |
Collapse
|
41
|
Sheng JY, Skuli SJ, Thorner ED, Zafman N, Riley CD, Ruck JM, Smith KC, Snyder C, Smith KL, Stearns V, Wolff AC. Late effects in a high-risk population of breast cancer survivors. Support Care Cancer 2022; 30:1749-1757. [PMID: 34586509 PMCID: PMC8732297 DOI: 10.1007/s00520-021-06597-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To better understand the impact of cancer and treatment on outcomes and guide program development, we evaluated breast cancer survivors at risk for long-term medical and psychosocial issues who participated in survivorship care visits (SVs) at Johns Hopkins Hospital. METHODS We conducted a prospective survey study of women with stage I-III breast cancer who participated in SVs from 2010-2016. The same 56-item questionnaire administered at SV and follow-up included an assessment of symptoms, social factors, demographics, anxiety, depression, and comorbidities. We added the Godin Exercise questionnaire to the follow-up. RESULTS In 2018, 74 participants were identified as disease-free and mailed a follow-up survey; 52 (70.3%) completed the survey. At a median follow-up time of 3.1 years after diagnosis, participants were less likely to be employed (54% vs. 67%) than at the SV. About two-thirds were sedentary, and this was associated with high body mass index (p = 0.02). Sufficiently active participants (≥ 150 min per week of moderate-intensity activity) were less likely to report pain (p = 0.02) or fatigue (p = 0.001). Although 19% had moderate/severe anxiety or depression at follow-up, participants who reported employment satisfaction were less likely to be depressed (p = 0.02). CONCLUSIONS Awareness of issues faced by survivors is critical for enhancing care and developing models to identify patients who might benefit most from targeted long-term interventions. IMPLICATIONS FOR CANCER SURVIVORS Interventions to address physical activity, persistent symptoms, and mental health are critical for breast cancer survivors.
Collapse
Affiliation(s)
- Jennifer Y Sheng
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA.
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, MD, USA.
| | - Sarah J Skuli
- Department of Medicine, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Elissa D Thorner
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Nelli Zafman
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Carol D Riley
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Jessica M Ruck
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Katherine C Smith
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen L Smith
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Vered Stearns
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, MD, USA
| | - Antonio C Wolff
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
42
|
Norman H, Lee KT, Stearns V, Alcorn SR, Mangini NS. Incidence and Severity of Myelosuppression With Palbociclib After Palliative Bone Radiation in Advanced Breast Cancer: A Single Center Experience and Review of Literature. Clin Breast Cancer 2022; 22:e65-e73. [PMID: 34419350 PMCID: PMC8916093 DOI: 10.1016/j.clbc.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/30/2021] [Accepted: 07/24/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Palbociclib is a cyclin-dependent kinase (CDK) 4/6 inhibitor with a primary toxicity of myelosuppression, especially neutropenia, due to cytostatic CDK6 inhibition on bone marrow. Preclinical studies suggest palbociclib may enhance radiation toxicity, but this was only evaluated in limited case series of palliative radiotherapy and not specific to radiation targeting bony metastases. PATIENTS AND METHODS This was a single institution retrospective cohort study. We included female patients who initiated palbociclib for advanced breast cancer between 2015 and 2019. The primary exposure was receipt of palliative radiation to bony metastases within 1 year prior to starting palbociclib. The primary outcome was the incidence and severity of myelosuppression during cycle one. Secondary outcomes include treatment interruptions and cycle 2 dose reductions, with subgroup analysis of radiation timing, type, dose, and location. RESULTS Of the 247 patients, 47 received radiation to bone metastases. Only absolute lymphocyte count (ALC) after cycle one of palbociclib was significantly lower in the group receiving radiation (median ALC 0.84 vs. 1.10 K/mm3, P < .001), with similar rates of neutropenia, anemia, and thrombocytopenia. Patients who received ≥10 fractions radiation were more likely to have cycle one interrupted than those receiving shorter radiation courses (42.9% vs. 11.1%, P = .03). No radiation characteristics were associated with other hematologic toxicities or dose reduction. CONCLUSION Palliative bone radiation within 1 year prior to palbociclib initiation was associated with greater lymphopenia during the first cycle than patients unexposed to radiation, but not neutropenia, anemia, or thrombocytopenia that would modify treatment.
Collapse
Affiliation(s)
- Haval Norman
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD
| | - Kimberley T. Lee
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD,Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL
| | - Vered Stearns
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sara R. Alcorn
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Neha S. Mangini
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD
| |
Collapse
|
43
|
Delahanty LM, Wadden TA, Goodwin PJ, Alfano CM, Thomson CA, Irwin ML, Neuhouser ML, Crane TE, Frank E, Spears PA, Gillis BP, Hershman DL, Paskett ED, Hopkins J, Bernstein V, Stearns V, White J, Hudis C, Winer EP, Carey LA, Partridge AH, Ligibel JA. The Breast Cancer Weight Loss trial (Alliance A011401): A description and evidence for the lifestyle intervention. Obesity (Silver Spring) 2022; 30:28-38. [PMID: 34932888 PMCID: PMC9186690 DOI: 10.1002/oby.23287] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023]
Abstract
The Breast Cancer Weight Loss (BWEL) trial is a randomized controlled trial designed to determine whether weight loss after a breast cancer diagnosis can reduce the risk of cancer recurrence in women with overweight or obesity. The BWEL trial will compare the efficacy of a telephone-based weight-loss intervention plus health education materials versus health education materials alone on invasive disease-free survival in 3,181 women with stage II or III breast cancer and BMI > 27 kg/m2 . This report provides a detailed description of the goals and methods of the lifestyle intervention and the evidence supporting the intervention used in the BWEL trial. The intervention's primary goal for participants is to achieve and maintain a weight loss ≥ 10% of baseline weight through increased physical activity and caloric restriction. The evidence supporting the diet, physical activity, and behavioral components of this telephone-based weight-loss intervention, as well as strategies to promote participant engagement and retention, is described. The intervention is provided through 42 sessions delivered by trained health coaches over a 2-year period. If the BWEL lifestyle intervention is successful in improving cancer outcomes, then weight loss will be incorporated into the care of thousands of breast cancer patients.
Collapse
Affiliation(s)
- Linda M. Delahanty
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas A. Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela J. Goodwin
- Mount Sinai Hospital/Lunenfeld Tanenbaum Research Institute, University of Toronto. Toronto, Ontario, Canada
| | - Catherine M. Alfano
- Northwell Health Cancer Institute; and Institute of Health System Science, Feinstein Institutes, for Medical Research; New York, NY, USA
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Melinda L. Irwin
- Yale School of Public Health,Yale University, New Haven, CT, USA
| | - Marian L. Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tracy E. Crane
- Biobehavioral Health Sciences Division, College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Elizabeth Frank
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Patricia A. Spears
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel, Hill, NC, USA
| | - Bonnie P. Gillis
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dawn L. Hershman
- Division of Medical Oncology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Electra D. Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Judith Hopkins
- Novant Health Cancer Institute/SCOR NCORP, Novant Health Oncology Specialists, Winston-Salem, NC, USA
| | - Vanessa Bernstein
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, Victoria BC, Canada
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Julia White
- Department of Radiation Oncology, the Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Clifford Hudis
- American Society of Clinical Oncology, Alexandria, VA, USA and Department of Medicine Memorial Sloan Kettering Cancer Center, New York, NY, NY, USA
| | - Eric P. Winer
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Lisa A. Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel, Hill, NC, USA
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Jennifer A. Ligibel
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| |
Collapse
|
44
|
Bleicher RJ, Moran MS, Ruth K, Edge SB, Dietz JM, Wilke LG, Stearns V, Kurtzman SH, Klein J, Yao KA. The Impact of Radiotherapy Delay in Breast Conservation Patients Not Receiving Chemotherapy and the Rationale for Dichotomizing the Radiation Oncology Time-Dependent Standard into Two Quality Measures. Ann Surg Oncol 2022; 29:469-481. [PMID: 34324114 PMCID: PMC9059503 DOI: 10.1245/s10434-021-10512-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/29/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The Commission on Cancer/National Quality Forum breast radiotherapy quality measure establishes that for women < 70 years, adjuvant radiotherapy after breast conserving surgery (BCS) should be started < 1 year from diagnosis. This was intended to prevent accidental radiotherapy omission or delay due to a long interval between surgery and chemotherapy completion, when radiation is delivered. However, the impact on patients not receiving chemotherapy, who proceed from surgery directly to radiotherapy, remains unknown. PATIENTS AND METHODS Patients aged 18-69, diagnosed with stage I-III breast cancer as their first and only cancer diagnosis (2004-2016), having BCS, for whom this measure would be applicable, were reviewed from the National Cancer Database. RESULTS Among 308,521 patients, the median age was 57.0 years, and > 99% of all patients were compliant with the measure. The cohort of interest included 186,650 (60.5%) patients not receiving chemotherapy, with a mean age of 57.9 years. Of these, 90.5% received external beam radiotherapy (EBRT) and 9.5% brachytherapy. Among them, 24.9% started radiotherapy > 8 weeks after surgery. In a multivariable model, delay from surgery to radiotherapy increased the hazard ratios for overall survival to 9.0% (EBRT) per month and 3.0% (brachytherapy) per week. CONCLUSION While 99.9% of patients undergoing BCS without chemotherapy remain compliant with the current quality measure, 25% have delays > 8 weeks to start radiation, which is associated with impaired survival. These data suggest that the current quality measure should be dichotomized into two, with or without chemotherapy, in order to impel prompt radiotherapy initiation and maximize outcomes in all patients.
Collapse
Affiliation(s)
- Richard J Bleicher
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA.
- The Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Meena S Moran
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Therapeutic Radiology, Yale University Medical Center, New Haven, CT, USA
| | - Karen Ruth
- The Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stephen B Edge
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgical Oncology and Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jill M Dietz
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Lee G Wilke
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Vered Stearns
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Scott H Kurtzman
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, Waterbury Hospital, Waterbury, CT, USA
| | - Jonah Klein
- The Department of Surgery, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA
| | - Katharine A Yao
- The Data Working Group of the National Accreditation Program for Breast Centers, Chicago, IL, USA
- The Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| |
Collapse
|
45
|
Walsh EM, Mangini N, Fetting J, Armstrong D, Chan IS, Connolly RM, Fiallos K, Lehman J, Nunes R, Petry D, Reynolds J, Shah M, Smith KL, Visvanathan K, Lauring J, Park BH, Stearns V, Wolff AC. Olaparib use in patients with metastatic breast cancer harboring somatic BRCA1/2 mutations or mutations in non-BRCA1/2, DNA damage repair genes. Clin Breast Cancer 2021; 22:319-325. [DOI: 10.1016/j.clbc.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/09/2021] [Accepted: 12/12/2021] [Indexed: 12/20/2022]
|
46
|
Roussos Torres ET, Rafie C, Wang C, Lim D, Brufsky A, LoRusso P, Eder JP, Chung V, Downs M, Geare M, Piekarz R, Streicher H, Anforth L, Rudek MA, Zhu Q, Besharati S, Cimino-Mathews A, Anders RA, Stearns V, Jaffee EM, Connolly RM. Phase I Study of Entinostat and Nivolumab with or without Ipilimumab in Advanced Solid Tumors (ETCTN-9844). Clin Cancer Res 2021; 27:5828-5837. [PMID: 34135021 PMCID: PMC8563383 DOI: 10.1158/1078-0432.ccr-20-5017] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/28/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Epigenetic modulators improve immune checkpoint inhibitor (ICI) efficacy and increase CD8+ effector:FoxP3+ regulatory T cell ratios in preclinical models. We conducted a multicenter phase I clinical trial combining the histone deacetylase inhibitor entinostat with nivolumab ± ipilimumab in advanced solid tumors. PATIENTS AND METHODS Patients received an entinostat run-in (5 mg, weekly × 2) prior to the addition of ICIs. Dose escalation followed a modified 3+3 design [dose level (DL)1/2: entinostat + nivolumab; DL 3/4: entinostat + nivolumab + ipilimumab]. Blood and tissue samples were collected at baseline, after entinostat run-in, and after 8 weeks of combination therapy. Primary endpoints included safety and tolerability, and the recommended phase II dose (RP2D). Secondary endpoints included antitumor activity and change in tumor CD8/FoxP3 ratio pre- and post-therapy. RESULTS Thirty-three patients were treated across four dose levels. Treatment-related adverse events (AE) included fatigue (65%), nausea (41%), anemia (38%), diarrhea (26%), and anorexia (26%). Grade 3/4 AEs included fatigue (n = 7, 21%), anemia (n = 9, 27%), and neutropenia (n = 4, 12%). The RP2D was 3 mg entinostat weekly, 3 mg/kg every 2 weeks nivolumab, and 1 mg/kg every 6 weeks ipilimumab (max four doses). The objective response rate by RECIST 1.1 was 16%, including a complete response in triple-negative breast cancer. A statistically significant increase in CD8/FoxP3 ratio was seen following the addition of ICIs to entinostat, but not post-entinostat alone. CONCLUSIONS The combination of entinostat with nivolumab ± ipilimumab was safe and tolerable with expected rates of immune-related AEs. Preliminary evidence of both clinical efficacy and immune modulation supports further investigation.
Collapse
Affiliation(s)
- Evanthia T Roussos Torres
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Christine Rafie
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
- University of Miami Miller School of Medicine, Miami, Florida
| | - Chenguang Wang
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - David Lim
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Adam Brufsky
- University of Pittsburgh Cancer Institute and UPMC Cancer Center, Pittsburgh, Pennsylvania
| | | | | | | | - Melinda Downs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Molly Geare
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Richard Piekarz
- Cancer Therapy Evaluation Program (CTEP), NCI, Bethesda, Maryland
| | - Howard Streicher
- Cancer Therapy Evaluation Program (CTEP), NCI, Bethesda, Maryland
| | - Leslie Anforth
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
- NIH Clinical Center, Bethesda, Maryland
| | - Michelle A Rudek
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Qingfeng Zhu
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sepideh Besharati
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ashley Cimino-Mathews
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Robert A Anders
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elizabeth M Jaffee
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Roisin M Connolly
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland.
- Cancer Research @ UCC, College of Medicine and Health, University College Cork, Ireland
| |
Collapse
|
47
|
Sinkar S, Too F, Carr K, Jelinek J, Saylor E, Bacon J, Fetting JH, Wilkinson M, Nunes R, Sheng JY, Stearns V, Smith KL. Patient-reported outcomes to assess symptoms in patients with metastatic breast cancer: Pilot implementation project. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.177] [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
177 Background: Use of patient-reported outcomes (PRO) to evaluate symptoms improves clinical outcomes. Best practices for implementing PROs into routine care may vary according to clinical scenario, site-specific resources and programmatic goals. Patients with metastatic breast cancer (MBC) often experience a variety of symptoms. Methods: As a quality improvement project, we are pilot testing incorporation of a battery of PRO measures into routine care for patients with MBC at Johns Hopkins in order to gain experience that will guide future broader implementation of PROs across our program. Participants complete the PROs on paper at baseline (BL), 3, and 6 months (mo). Measures include NCCN Distress Thermometer (BL only), Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder-7 (GAD-7), PRO-CTCAE Insomnia questions and a modified version of the revised Edmonton Symptom Assessment System (r-ESAS) questionnaire with 3 extra symptom domains. Project team members alert clinicians by email of scores that exceed severity thresholds as follows – Distress: ≥4, PHQ-8: ≥8, GAD-7: ≥10, any item on r-ESAS: ≥4 and PRO-CTCAE Insomnia: severe/very severe or quite a bit/very much. Results: From May 29, 2020 and April 5, 2021, 67 patients were approached for participation, and 40 (59.7%) completed the BL PROs. Median age was 64 (range 36-85). Most participants were White (70%), non-Hispanic (90%) and had hormone receptor-positive (93%) MBC. At BL, 22 (55%) had visceral disease and most were receiving endocrine-based regimens [21 (53%)] or chemotherapy [16 (40%)]. 27 (68%) participants had ≥1 BL alert. The most common BL alerts were for symptoms on the r-ESAS [23 participants (58%)]. The most frequent items on the r-ESAS for which participants had BL alerts were pain, tiredness, well-being, tingling/numbness and rash. Other BL alerts were: Distress [9 participants (23%)], PRO-CTCAE Insomnia [5 participants (13%)], PHQ-8 [4 participants (10%)] and GAD-7 [2 participants (5%)]. To date, 24 of 35 (69%) and 15 of 28 (54%) participants who have reached the 3 and 6 mo time points have completed the respective follow-up (FU) PROs. Most common FU alerts to date are on the r-ESAS [3 mo: 14 participants (58%), 6 mo: 9 participants (60%)]. The project team has successfully notified providers of all alerts to date. Clinical actions (phone calls, provider visits and/or referrals) have been taken within 30 days of notification for > 75% of alerts. Conclusions: Implementation of a PRO battery for patients receiving routine care for MBC led to detection of a range of symptoms, the majority of which were clinically actionable. Restrictions on in-person interactions during the COVID-19 pandemic may have contributed to low rates of PRO completion in this pilot project. Prior to broader implementation, we will consider strategies such as an electronic platform and a shorter battery to enhance patient engagement.
Collapse
Affiliation(s)
- Shruti Sinkar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Faith Too
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | - Kelly Carr
- Johns Hopkins SKCC at Sibley Memorial Hospital, Washington, DC
| | - Jessica Jelinek
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | - Elizabeth Saylor
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | - Jacqueline Bacon
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Mary Wilkinson
- Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins School of Medicine, Baltimore, MD
| | - Raquel Nunes
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | | | - Vered Stearns
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | - Karen L. Smith
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
48
|
Sinkar S, Too F, Carr K, Jelinek J, Saylor E, Bacon J, Stearns V, Smith KL. Assessing financial toxicity in patients with metastatic breast cancer: A single institution experience during the COVID-19 pandemic. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.176] [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
176 Background: Assessment of financial toxicity (FTox) is recommended as a component of comprehensive supportive care for patients with metastatic cancer. FTox is common in patients with metastatic breast cancer (MBC) and is associated with poor quality of life. Available data suggest many patients with cancer have faced financial hardship during the COVID-19 pandemic. Methods: We evaluated FTox using the COmprehensive Score for Financial Toxicity (COST) measure in patients with MBC at Johns Hopkins clinical sites. Respondents were patients with MBC who completed the COST measure as part of the baseline assessment for one of two IRB-approved quality improvement projects initiated during the COVID-19 pandemic: 1) a pilot project evaluating incorporation of patient-reported outcome (PRO) measures into routine care (RC), and 2) a needs assessment prior to attending a multi-disciplinary clinic (MultiD-C) focusing on supportive care. COST scores range from 0-44 with higher scores indicating better financial well-being. FTox was graded as: Grade 0 (G0): >26, Grade 1 (G1): >14-26, Grade 2 (G2): >0-14 and Grade 3 (G3): 0. Results: 40 patients with MBC completed the COST measure May 2020 through April 2021 as a component of RC and 17 patients with MBC completed the COST measure September 2020 through May 2021 in advance of anticipated attendance at the MultiD-C. Median age (range) for RC and MultiD-C respondents was 64 (36-85) and 55 (37-75) years, respectively. 4 (10%) and 4 (24%) of RC and MultiD-C respondents respectively reported household income < $50,000. The majority of respondents in both groups were White [RC: 28 (70%), MultiD-C: 14 (82%)], non-Hispanic [RC: 36 (90%), MultiD-C: 16 (94%)], had more than high school education [RC: 37 (93%), MultiD-C: 17 (100%)] and all were insured. 27 (68%) of RC respondents and 11 (65%) of MultiD-C respondents were receiving oral cancer therapies. COST scores and grading are shown in the Table. Approximately half of the respondents in each group reported their illness has been at least “a little bit” of a financial hardship [RC: 22 (55%), Multi-D: 8 (47%)]. Conclusions: Patients with MBC receiving care during the COVID-19 pandemic frequently report FTox. Implementation of routine assessment for FTox via PRO measures and identification of strategies to support patients with MBC experiencing FTox are priorities both during the pandemic and beyond.[Table: see text]
Collapse
Affiliation(s)
- Shruti Sinkar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Faith Too
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | - Kelly Carr
- Johns Hopkins SKCC at Sibley Memorial Hospital, Washington, DC
| | - Jessica Jelinek
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | - Elizabeth Saylor
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | - Jacqueline Bacon
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | - Vered Stearns
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | - Karen L. Smith
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
49
|
Puhalla SL, Diéras V, Arun BK, Kaufman B, Wildiers H, Han HS, Ayoub JP, Stearns V, Yuan Y, Helsten T, Riley-Gillis B, Murphy E, Kundu MG, Wu M, Maag D, Ratajczak CK, Ramathal CY, Friedlander M. Relevance of Platinum-free Interval and BRCA Reversion Mutations for Veliparib Monotherapy after Progression on Carboplatin/Paclitaxel for g BRCA Advanced Breast Cancer (BROCADE3 Crossover). Clin Cancer Res 2021; 27:4983-4993. [PMID: 34131001 PMCID: PMC9401555 DOI: 10.1158/1078-0432.ccr-21-0748] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Received: 02/24/2021] [Revised: 04/30/2021] [Accepted: 06/08/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Safety, efficacy, and exploratory biomarker analyses were evaluated in patients with advanced HER2-negative germline breast cancer susceptibility gene (gBRCA)-associated breast cancer enrolled in the BROCADE3 trial who received crossover veliparib monotherapy after disease progression on placebo plus carboplatin/paclitaxel. PATIENTS AND METHODS Eligible patients (N = 513) were randomized 2:1 to veliparib plus carboplatin/paclitaxel or placebo plus carboplatin/paclitaxel; patients had variable platinum-free intervals (PFI) at progression. In the placebo arm, patients were eligible to receive crossover veliparib monotherapy (300-400 mg twice daily continuous). Antitumor activity and adverse events were assessed during crossover veliparib treatment. BRCA reversion mutations at crossover were analyzed retrospectively using next-generation sequencing on plasma circulating tumor DNA (ctDNA). RESULTS Seventy-five patients in the placebo plus carboplatin/paclitaxel arm received ≥1 dose of crossover veliparib postprogression (mean treatment duration: 154 days). Eight of 50 (16%) patients with measurable disease had a RECIST v1.1 response. Activity was greater in patients with PFI ≥180 days compared with <180 days [responses in 23.1% (3/13) vs. 13.5% (5/37) of patients]. BRCA reversion mutations that restored protein function were detected in ctDNA from 4 of 28 patients tested, and the mean duration of crossover veliparib monotherapy was <1 month in these 4 patients versus 7.49 months in patients lacking reversion mutations. The most frequent adverse events were nausea (61%), vomiting (29%), and fatigue (24%). CONCLUSIONS Crossover veliparib monotherapy demonstrated limited antitumor activity in patients who experienced disease progression on placebo plus carboplatin/paclitaxel. PFI appeared to affect veliparib activity. BRCA reversion mutations may promote cross-resistance and limit veliparib activity following progression on platinum.
Collapse
Affiliation(s)
- Shannon L Puhalla
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, Pennsylvania.
| | - Véronique Diéras
- Institut Curie, Paris, France
- Centre Eugène Marquis, Rennes, France
| | - Banu K Arun
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Hyo S Han
- Moffitt Cancer Center, Tampa, Florida
| | - Jean-Pierre Ayoub
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Vered Stearns
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Yuan Yuan
- City of Hope Cancer Center, Duarte, California
| | - Teresa Helsten
- University of California San Diego Moores Cancer Center, La Jolla, California
| | | | | | | | | | | | | | | | - Michael Friedlander
- Prince of Wales Clinical School UNSW and Prince of Wales Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
50
|
Joe NS, Hodgdon C, Kraemer L, Redmond KJ, Stearns V, Gilkes DM. A common goal to CARE: Cancer Advocates, Researchers, and Clinicians Explore current treatments and clinical trials for breast cancer brain metastases. NPJ Breast Cancer 2021; 7:121. [PMID: 34521857 PMCID: PMC8440644 DOI: 10.1038/s41523-021-00326-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023] Open
Abstract
Breast cancer is the most commonly diagnosed cancer in women worldwide. Approximately one-tenth of all patients with advanced breast cancer develop brain metastases resulting in an overall survival rate of fewer than 2 years. The challenges lie in developing new approaches to treat, monitor, and prevent breast cancer brain metastasis (BCBM). This review will provide an overview of BCBM from the integrated perspective of clinicians, researchers, and patient advocates. We will summarize the current management of BCBM, including diagnosis, treatment, and monitoring. We will highlight ongoing translational research for BCBM, including clinical trials and improved detection methods that can become the mainstay for BCBM treatment if they demonstrate efficacy. We will discuss preclinical BCBM research that focuses on the intrinsic properties of breast cancer cells and the influence of the brain microenvironment. Finally, we will spotlight emerging studies and future research needs to improve survival outcomes and preserve the quality of life for patients with BCBM.
Collapse
Affiliation(s)
- Natalie S Joe
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cellular and Molecular Medicine Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine Hodgdon
- INSPIRE (Influencing Science through Patient-Informed Research & Education) Advocacy Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vered Stearns
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- INSPIRE (Influencing Science through Patient-Informed Research & Education) Advocacy Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniele M Gilkes
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Cellular and Molecular Medicine Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- INSPIRE (Influencing Science through Patient-Informed Research & Education) Advocacy Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Chemical and Biomolecular Engineering, The Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|