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Robinson HR, Messersmith WA, Lentz RW. HER2-Positive Metastatic Colorectal Cancer. Curr Treat Options Oncol 2024; 25:585-604. [PMID: 38539034 DOI: 10.1007/s11864-024-01183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 04/24/2024]
Abstract
OPINION STATEMENT Targeted treatment strategies are available for human epidermal growth factor receptor 2 (HER2)-positive (amplified and/or overexpressed) metastatic colorectal cancer (mCRC), and HER2 testing is indicated in patients with mCRC. At present, standard of care first-line treatment for those with HER2-positive mCRC remains chemotherapy in combination with epidermal growth factor receptor (EGFR) inhibitors or bevacizumab, depending on RAS/BRAF mutational status and tumor sidedness. HER2-targeted agents should be considered for those with RAS/BRAF wild-type disease in subsequent-line treatment and in first-line treatment for patients not appropriate for intensive therapy. While the choice of anti-HER2 therapy is empiric given lack of head-to-head comparisons, the combination of trastuzumab plus tucatinib has received FDA accelerated approval for use in this setting and is generally the authors' preference. Trastuzumab plus lapatinib, trastuzumab plus pertuzumab, and trastuzumab deruxtecan (T-DXd) also have evidence of efficacy in this setting. As T-DXd has demonstrated activity following treatment with other HER2-targeted regimens and carries an increased risk of high-grade toxicities, the authors favor reserving it for use after progression on prior anti-HER2 therapy. HER2-targeted therapies that inhibit signal transduction appear to have limited activity in those with RAS mutations, including trastuzumab-containing regimens. However, the antibody drug conjugate T-DXd has some data showing efficacy in this setting, and the authors would consider T-DXd in subsequent-line therapy for HER2-positive, RAS-mutated mCRC. Several areas of uncertainty remain regarding how to best utilize HER2-targeted therapies in mCRC. These include the optimal sequence of anti-HER2 therapies with chemotherapy and anti-EGFR therapies, the optimal combination partners for anti-HER2 therapies, and the incorporation of predictive biomarkers to guide use of anti-HER2 therapies. Results of ongoing studies may thus alter the treatment paradigm above in the coming years.
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Affiliation(s)
- Hannah R Robinson
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E. 17Th Avenue, Aurora, CO, 80045, USA
| | - Wells A Messersmith
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E. 17Th Avenue, Aurora, CO, 80045, USA
| | - Robert W Lentz
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E. 17Th Avenue, Aurora, CO, 80045, USA.
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Martínez-Sáez O, Cortés J, Ciruelos E, Marín-Aguilera M, González G, Paré L, Herrera A, Villagrasa-González P, Prat A, Martín M. Management of early-stage HER2-positive breast cancer and attitudes towards HER2DX test in Spain: insights from a nationwide survey. Clin Transl Oncol 2024:10.1007/s12094-024-03409-4. [PMID: 38653928 DOI: 10.1007/s12094-024-03409-4] [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: 10/18/2023] [Accepted: 02/12/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE This study aimed to investigate the current therapeutic management of patients with early-stage HER2-positive (HER2+) breast cancer in Spain, while also exploring the perceptions surrounding HER2DX in terms of its credibility, clinical relevance, and impact on therapeutic decision-making. Understanding these aspects is crucial for optimizing treatment strategies and enhancing patient outcomes in the context of HER2+ breast cancer. METHODS An online questionnaire was conducted by an independent third-party between April and May 2022 across 70 medical oncologists highly specialized in breast cancer management in Spain. The survey included 37 questions regarding treatment decision making in HER2+ early breast cancer. RESULTS The management of patients with HER2+ early breast cancer exhibited a high degree of heterogeneity. Among the interviewed oncologists, 53% would recommend upfront surgery for node negative tumors measuring 1 cm or less. Interestingly, 69% and 56% of interviewers were open to deescalate the duration of adjuvant trastuzumab in pT1a and pT1b N0 tumors, respectively. Certain clinicopathological characteristics, such as high grade, high Ki-67, and young age, influenced the decision to prescribe neoadjuvant treatment for patients with clinical stage 1 disease. In cases where neoadjuvant treatment was prescribed for cT1-2 N0 tumors, there was a wide variation in the choice of chemotherapeutic and anti-HER2 regimens. Regarding the use of adjuvant trastuzumab emtansine (T-DM1) in patients with residual disease after neoadjuvant therapy, there was diversity in practice, and a common concern emerged that T-DM1 might be overtreating some patients. HER2DX, as a diagnostic tool, was deemed trustworthy, and the reported scores were considered clinically useful. However, 86% of interviewees believed that a prospective trial was necessary before fully integrating the test into routine clinical practice. CONCLUSION In the context of early-stage HER2+ breast cancer in Spain, a notable diversity in therapeutic approaches was observed. The majority of interviewed medical oncologists acknowledged HER2DX as a clinically valuable test for specific patients, in line with the 2022 SEOM-GEICAM-SOLTI clinical guidelines for early-stage breast cancer. To facilitate the full integration of HER2DX into clinical guidelines, conducting prospective studies to further validate its efficacy and utility was recommended.
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Affiliation(s)
- Olga Martínez-Sáez
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Javier Cortés
- International Breast Cancer Center, Pangaea Oncology Quironsalud Group, Barcelona, Spain
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Eva Ciruelos
- Department of Medical Oncology, Hospital Universitario, 12 de Octubre, Madrid, Spain
- HM Hospitales, Madrid, Spain
- SOLTI Group, Barcelona, Spain
| | | | | | | | | | | | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
- Reveal Genomics, Barcelona, Spain
- Institute of Oncology (IOB)-Hospital Quironsalud, Barcelona, Spain
| | - Miguel Martín
- Department of Medical Oncology, Hospital Gregorio Marañón, Madrid, Spain.
- CIBERONC, Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain.
- GEICAM, Grupo Español de Investigación en Cáncer de Mama, Madrid, Spain.
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Wu H, Liu Y, Zhou J, Meng X, Jiang H, Shi W, Qian H. Discovery of novel HER2 targeting peptide-camptothecin conjugates with effective suppression for selective cancer treatment. Bioorg Chem 2024; 147:107371. [PMID: 38643564 DOI: 10.1016/j.bioorg.2024.107371] [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: 01/07/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/23/2024]
Abstract
Due to the strong selectivity and permeability of tumor tissue, anti-cancer peptide-drug conjugates (PDCs) can accumulate high concentration of toxic payloads at the target, effectively killing tumor cells. This approach holds great promise for tumor-targeted treatment. In our previous study, we identified the optimal peptide P1 (NPNWGRSWYNQRFK) targeting HER2 from pertuzumab, a monoclonal antibody that blocks the HER2 signaling pathway. Here, a series of PDCs were constructed through connecting P1 and CPT with different linkers. Among these, Z8 emerged as the optimal compound, demonstrating good antitumor activity and targeting ability in biological activity tests. Z8 exhibited IC50 values of 1.04 ± 0.24 μM and 1.91 ± 0.71 μM against HER2-positive SK-BR-3 and NCI-N87 cells, respectively. Moreover, superior antitumor activity and higher biosafety of Z8 were observed compared to the positive control CPT in vivo, suggesting a novel idea for the construction of PDCs.
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Affiliation(s)
- Hanyu Wu
- Centre of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Yunxiao Liu
- Centre of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Jiaqi Zhou
- Centre of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Xiqi Meng
- Centre of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Hongyu Jiang
- Centre of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Wei Shi
- Centre of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China.
| | - Hai Qian
- Centre of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China; Jiangsu Key Laboratory of Drug Discovery for Metabolic Disease, China Pharmaceutical University, Nanjing 210009, China.
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Bao YF, Yang JZ, Li XF, Zhu JJ. Real-world clinical study of Trastuzumab biosimilar (Zercepac) and Pertuzumab (Perjeta) in combination with chemotherapy for neoadjuvant treatment of HER-2-positive breast cancer. Asian J Surg 2024:S1015-9584(24)00493-7. [PMID: 38522990 DOI: 10.1016/j.asjsur.2024.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
- Yu-Fei Bao
- Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014040, Inner Mongolia, China
| | - Jin-Zhe Yang
- Department of Breast Surgery, Baotou Cancer Hospital, Baotou, 014030, Inner Mongolia, China
| | - Xiu-Feng Li
- Department of Breast Surgery, Baotou Cancer Hospital, Baotou, 014030, Inner Mongolia, China
| | - Jing-Jun Zhu
- Department of Breast Surgery, Baotou Cancer Hospital, Baotou, 014030, Inner Mongolia, China; Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014040, Inner Mongolia, China.
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Ginzac A, Molnar I, Durando X, Motte Rouge TDL, Petit T, D'hondt V, Campone M, Bonichon-Lamichhane N, Venat Bouvet L, Levy C, Augereau P, Pistilli B, Arsene O, Jouannaud C, Nguyen S, Cayre A, Tixier L, Mahier Ait Oukhatar C, Nabholtz JM, Penault-Llorca F, Mouret-Reynier MA. Neoadjuvant anthracycline-based (5-FEC) or anthracycline-free (docetaxel/carboplatin) chemotherapy plus trastuzumab and pertuzmab in HER2 + BC patients according to their TOP2A: a multicentre, open-label, non-randomized phase II trial. Breast Cancer Res Treat 2024:10.1007/s10549-024-07285-y. [PMID: 38453781 DOI: 10.1007/s10549-024-07285-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Previous studies have reported the benefit of dual HER2-targeting combined to neoadjuvant chemotherapy in HER2-amplified breast cancer (HER2 + BC). Moreover, besides the cardiac toxicity following their association to Trastuzumab, anthracyclines chemotherapy may not profit all patients. The NeoTOP study was designed to evaluate the complementary action of Trastuzumab and Pertuzumab, and the relevance of an anthracycline-based regimen according to TOP2A amplification status. METHODS Open-label, multicentre, phase II study. Eligible patients were aged ≥ 18 with untreated, operable, histologically confirmed HER2 + BC. After centralized review of TOP2A status, TOP2A-amplified (TOP2A+) patients received FEC100 for 3 cycles then 3 cycles of Trastuzumab (8 mg/kg then 6 mg/kg), Pertuzumab (840 mg/kg then 420 mg/kg), and Docetaxel (75mg/m2 then 100mg/m2). TOP2A-not amplified (TOP2A-) patients received 6 cycles of Docetaxel (75mg/m2) and Carboplatin (target AUC 6 mg/ml/min) plus Trastuzumab and Pertuzumab. Primary endpoint was pathological Complete Response (pCR) using Chevallier's classification. Secondary endpoints included pCR (Sataloff), Progression-Free Survival (PFS), Overall Survival (OS), and toxicity. RESULTS Out of 74 patients, 41 and 33 were allocated to the TOP2A + and TOP2A- groups respectively. pCR rates (Chevallier) were 74.4% (95%CI: 58.9-85.4) vs. 71.9% (95%CI: 54.6-84.4) in the TOP2A + vs. TOP2A- groups. pCR rates (Sataloff), 5-year PFS and OS were 70.6% (95%CI: 53.8-83.2) vs. 61.5% (95%CI: 42.5-77.6), 82.4% (95%CI: 62.2-93.6) vs. 100% (95%CI: 74.1-100), and 90% (95%CI: 69.8-98.3) vs. 100% (95%CI: 74.1-100). Toxicity profile was consistent with previous reports. CONCLUSION Our results showed high pCR rates with Trastuzumab and Pertuzumab associated to chemotherapy. They were similar in TOP2A + and TOP2A- groups and the current role of neoadjuvant anthracycline-based chemotherapy remains questioned. TRIAL REGISTRATION NUMBER NCT02339532 (registered on 14/12/14).
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Affiliation(s)
- Angeline Ginzac
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, Clermont-Ferrand, F- 63000, France.
- Centre d'Investigation Clinique UMR501, Clermont-Ferrand, F-63000, France.
- Département de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand, F-63000, France.
| | - Ioana Molnar
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, Clermont-Ferrand, F- 63000, France
- Centre d'Investigation Clinique UMR501, Clermont-Ferrand, F-63000, France
- Département de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand, F-63000, France
| | - Xavier Durando
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, Clermont-Ferrand, F- 63000, France
- Centre d'Investigation Clinique UMR501, Clermont-Ferrand, F-63000, France
- Département de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand, F-63000, France
- Service d'oncologie médicale, Centre Jean PERRIN, Clermont-Ferrand, F-63000, France
| | | | - Thierry Petit
- Service d'oncologie médicale, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Véronique D'hondt
- Service d'oncologie médicale, Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France
| | - Mario Campone
- Service d'oncologie médicale, Institut de Cancérologie de l'Ouest, René GAUDUCHEAU, Saint Herblain, France
| | | | | | - Christelle Levy
- Service d'oncologie médicale, Centre François BACLESSE, Caen, France
| | - Paule Augereau
- Service d'oncologie médicale, Institut de Cancérologie de l'Ouest, René GAUDUCHEAU, Saint Herblain, France
| | - Barbara Pistilli
- Service d'oncologie médicale, Institut Gustave ROUSSY, Villejuif, France
| | - Olivier Arsene
- Service d'oncologie médicale, Centre Hospitalier de Blois, Blois, France
| | | | - Suzanne Nguyen
- Service d'oncologie médicale, Centre Hospitalier de Pau, Pau, France
| | - Anne Cayre
- Service d'anatomopathologie, Centre Jean PERRIN, Clermont-Ferrand, France
| | - Lucie Tixier
- Service d'anatomopathologie, Centre Jean PERRIN, Clermont-Ferrand, France
| | | | - Jean-Marc Nabholtz
- Centre d'oncologie, Université King Saud (Medical City), Riyadh, Arabi Saoudite
| | - Frédérique Penault-Llorca
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, Clermont-Ferrand, F- 63000, France
- Service d'anatomopathologie, Centre Jean PERRIN, Clermont-Ferrand, France
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Geurts SME, Ibragimova KIE, Ding N, Meegdes M, Erdkamp F, Heijns JB, Tol J, Vriens BEPJ, Dercksen MW, Aaldering KNA, Pepels MJAE, van de Winkel L, Peters NAJB, van de Wouw AJ, Maaskant SAJG, Teeuwen-Dedroog NJA, van Nijnatten TJA, de Boer M, Tjan-Heijnen VCG. Time trends in real-world treatment patterns and survival in patients diagnosed with de novo HER2+ metastatic breast cancer: an analysis of the SONABRE registry. Breast Cancer Res Treat 2024:10.1007/s10549-023-07235-0. [PMID: 38381274 DOI: 10.1007/s10549-023-07235-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/14/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE The aim was to determine whether the real-world first-line progression-free survival (PFS) of patients diagnosed with de novo human epidermal growth factor receptor 2 positive (HER2+) advanced breast cancer (ABC) has improved since the introduction of pertuzumab in 2013. In addition to PFS, we aimed to determine differences in overall survival (OS) and the use of systemic and locoregional therapies. METHODS Included were patients systemically treated for de novo HER2+ ABC in ten hospitals in 2008-2017 from the SONABRE Registry (NCT-03577197). First-line PFS and OS in 2013-2017 versus 2008-2012 was determined using Kaplan-Meier analyses and multivariable Cox proportional hazards modelling. First-given systemic therapy and the use of locoregional therapy within the first year following diagnosis were determined per period of diagnosis. RESULTS Median and five-year PFS were 26.6 months and 24% in 2013-2017 (n = 85) versus 14.5 months and 10% in 2008-2012 (n = 81) (adjusted HR = 0.65, 95%CI:0.45-0.94). Median and five-year OS were 61.2 months and 51% in 2013-2017 versus 26.1 months and 28% in 2008-2012 (adjusted HR = 0.55, 95%CI:0.37-0.81). Of patients diagnosed in 2013-2017 versus 2008-2012, 84% versus 60% received HER2-targeted therapy and 59% versus 0% pertuzumab-based therapy as first-given therapy. Respectively, 27% and 23% of patients underwent locoregional breast surgery, and 6% and 7% surgery of a metastatic site during the first year following diagnosis. CONCLUSION The prognosis of patients with de novo HER2 + ABC has improved considerably. Since 2013 one in four patients were alive and free from progression on first-given therapy for at least five years.
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Affiliation(s)
- Sandra M E Geurts
- Department of Medical Oncology, GROW- School for Oncology and Reproduction, Maastricht University Medical Center, PO BOX 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Khava I E Ibragimova
- Department of Medical Oncology, GROW- School for Oncology and Reproduction, Maastricht University Medical Center, PO BOX 5800, 6202 AZ, Maastricht, The Netherlands
| | - Nan Ding
- Department of Medical Oncology, GROW- School for Oncology and Reproduction, Maastricht University Medical Center, PO BOX 5800, 6202 AZ, Maastricht, The Netherlands
| | - Marissa Meegdes
- Department of Medical Oncology, GROW- School for Oncology and Reproduction, Maastricht University Medical Center, PO BOX 5800, 6202 AZ, Maastricht, The Netherlands
| | - Frans Erdkamp
- Department of Internal Medicine, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Joan B Heijns
- Department of Medical Oncology, Amphia, Breda, The Netherlands
| | - Jolien Tol
- Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Birgit E P J Vriens
- Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Marcus W Dercksen
- Department of Medical Oncology, Máxima Medical Center, Eindhoven, The Netherlands
| | | | - Manon J A E Pepels
- Department of Internal Medicine, Elkerliek Hospital, Helmond, The Netherlands
| | | | | | - Agnes J van de Wouw
- Department of Internal Medicine, Viecuri Medical Centre, Venlo, The Netherlands
| | | | - Nathalie J A Teeuwen-Dedroog
- Department of Medical Oncology, GROW- School for Oncology and Reproduction, Maastricht University Medical Center, PO BOX 5800, 6202 AZ, Maastricht, The Netherlands
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maaike de Boer
- Department of Medical Oncology, GROW- School for Oncology and Reproduction, Maastricht University Medical Center, PO BOX 5800, 6202 AZ, Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW- School for Oncology and Reproduction, Maastricht University Medical Center, PO BOX 5800, 6202 AZ, Maastricht, The Netherlands
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Ibragimova KIE, Geurts SME, Laczkó D, Meegdes M, Erdkamp F, Heijns JB, Tol J, Vriens BEPJ, Aaldering KNA, Dercksen MW, Pepels MJAE, Peters NAJB, van de Winkel LMH, van de Wouw AJ, de Fallois A, van Kats MACE, Tjan-Heijnen VCG. Trastuzumab Resistance in Patients With HER2-Positive Advanced Breast Cancer: Results From the SONABRE Registry. Clin Breast Cancer 2024; 24:103-111. [PMID: 38007349 DOI: 10.1016/j.clbc.2023.10.009] [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: 04/03/2023] [Revised: 09/08/2023] [Accepted: 10/30/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND This study aims to explore whether first-line pertuzumab use modifies the effect of prior use of (neo-) adjuvant trastuzumab on the PFS of first-line HER2-targeted therapy in patients with human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer (ABC). METHODS Patients diagnosed with HER2-positive ABC in 2008 to 2018 in 9 Dutch hospitals were derived from the SONABRE Registry (NCT03577197). Patients diagnosed with de novo metastatic breast cancer were excluded. Patients receiving first-line trastuzumab-based therapy for ABC were selected and divided into trastuzumab naïve (n = 113) and trastuzumab pretreated (n = 112). Progression-free survival (PFS) was compared using multivariable Cox proportional hazard models. The interaction effect of first-line pertuzumab was tested using the likelihood-ratio test. RESULTS The median follow-up time was 47 months (95% confidence interval [CI]: 42-52). When comparing trastuzumab pretreated with trastuzumab naïve patients, the hazard ratio for first-line progression was 2.07 (CI:1.47-2.92). For trastuzumab pretreated patients who received first-line trastuzumab without pertuzumab, the hazard ratio for progression was 2.60 (95% CI:1.72-3.93), whereas for those who received first-line trastuzumab with pertuzumab the hazard ratio was 1.43 (95% CI: 0.81-2.52) (P interaction = .10). CONCLUSIONS Prior use of trastuzumab as (neo-)adjuvant treatment had a negative impact on PFS of first-line HER2-targeted therapy outcomes. Adding pertuzumab to first-line trastuzumab-based therapy decreased the negative impact of prior (neo-)adjuvant trastuzumab use on first-line PFS. Further studies are needed to assess the effect of prior (neo-)adjuvant pertuzumab use on the outcomes of first-line pertuzumab-based therapy.
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Affiliation(s)
- Khava I E Ibragimova
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Sandra M E Geurts
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Dávid Laczkó
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marissa Meegdes
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Frans Erdkamp
- Department of Internal Medicine, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Joan B Heijns
- Department of Medical Oncology, Amphia, Breda, The Netherlands
| | - Jolien Tol
- Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Birgit E P J Vriens
- Department of Internal Medicine, Catharina hospital, Eindhoven, The Netherlands
| | | | - Marcus W Dercksen
- Department of Medical Oncology, Máxima Medical Center, Eindhoven, The Netherlands
| | - Manon J A E Pepels
- Department of Internal Medicine, Elkerliek hospital, Helmond, The Netherlands
| | | | | | - Agnes J van de Wouw
- Department of Internal Medicine, Viecuri Medical Centre, Venlo, The Netherlands
| | - Aude de Fallois
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maartje A C E van Kats
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
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Sharma R, Mukherjee A, Kumar A, Sarma HD. Evaluation of 177Lu-Labeled Pertuzumab F(ab') 2 Fragments for HER2-Positive Cancer Targeting: A Comparative In Vitro and In Vivo Study. Cancer Biother Radiopharm 2024; 39:64-74. [PMID: 38363819 DOI: 10.1089/cbr.2023.0108] [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] [Indexed: 02/18/2024] Open
Abstract
Background: Radiolabeled antibody fragments present a promising opportunity as theranostic agents, offering distinct advantages over whole antibodies. In this study, the authors investigate the potential of [177Lu]Lu-DTPA-F(ab')2-pertuzumab as a theranostic agent for precise targeting of human epidermal growth factor receptor 2 (HER2)-positive cancers. Additionally, the authors aim to quantitatively assess the binding synergism in the presence of cold trastuzumab. Materials and Methods: F(ab')2-pertuzumab was prepared by pepsin digestion and conjugated with a bifunctional chelator. The immunoconjugate was radiolabeled with 177Lu and characterized by chromatography techniques. Binding parameters (affinity, specificity, and immunoreactivity) and cellular binding enhancement studies were evaluated in HER2-overexpressing and triple-negative cell lines. The in vivo enhancement in tumor uptake of the radiolabeled immunoformulation was assessed in severe combined immunodeficient (SCID) mice bearing tumors, both in the presence and absence of unlabeled trastuzumab. Results: The formulation of [177Lu]Lu-DTPA-F(ab')2-pertuzumab could be prepared in high yields and with consistent radiochemical purity, ensuring reproducibility. Comprehensive in vitro and in vivo evaluation studies confirmed high specificity and immunoreactivity of the formulation toward HER2 receptors. Binding synergism of radiolabeled pertuzumab fragments in the presence of trastuzumab to HER2 receptors was observed. Conclusions: The radioformulation of [177Lu]Lu-DTPA-F(ab')2-pertuzumab holds great promise as a targeted approach for addressing HER2-positive cancers. A potentially effective strategy to amplify therapeutic efficacy involves dual epitope targeting by combining radiolabeled pertuzumab with cold trastuzumab.
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Affiliation(s)
- Rohit Sharma
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC), Mumbai, India
- Department of Life Sciences, Homi Bhabha National Institute, Mumbai, India
| | - Archana Mukherjee
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC), Mumbai, India
- Department of Life Sciences, Homi Bhabha National Institute, Mumbai, India
| | - Anuj Kumar
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre (BARC), Mumbai, India
| | - Haladhar Dev Sarma
- Radiation Biology & Health Sciences Division, Bhabha Atomic Research Centre (BARC), Mumbai, India
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9
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Zhou J, Xie Z, Wang J, Zeng Z, Hu Z, Zhong L, Yang Q, Shi W, Qian H. Design, synthesis and bioactivity evaluation of novel fusion peptides and their CPT conjugates inducing effective anti-tumor responses on HER2 positive tumors. Eur J Med Chem 2024; 264:116032. [PMID: 38104378 DOI: 10.1016/j.ejmech.2023.116032] [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: 10/27/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
Human epidermal growth factor receptor 2 (HER2) represents an ideal target for antibody drug development, abnormal expression of the HER2 gene is associated with multiple tumor types. Pertuzumab, as the first monoclonal antibody inhibitor of HER2 dimerization, has been FDA-approved for HER2-positive patients. In order to enhance the activity of HER2-targeted peptide-drug conjugates (PDCs) developed based on pertuzumab, a novel class of conjugates 1-9 was designed and synthesized by fusing the N-terminal peptide sequence of the second mitochondria-derived activator of caspases (SMAC) with P1, followed by conjugation with CPT molecules. Compound 4 exhibited excellent in vitro anti-tumor activity across the three HER2-positive cell lines, comparable to the activity of CPT. Apoptosis induction assays indicated that the synergistic effect of the SMAC sequence enhanced the pro-apoptotic activity of the conjugate. Western Blot analysis and Caspase activity studies validated the mechanism through which SMAC peptides, in synergy with CPT, enhance the activity of PDCs. In vivo studies demonstrated that compound 4 possesses superior anti-tumor activity compared to CPT and can effectively mitigate potential renal toxicity associated with free SMAC peptides. In conclusion, conjugate 4 exhibited excellent anti-tumor activity both in vitro and in vivo, offering potential for further development as a novel peptide-conjugated drug.
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Affiliation(s)
- Jiaqi Zhou
- Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, PR China
| | - Zhancheng Xie
- Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, PR China
| | - Jialing Wang
- Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, PR China
| | - Zeqi Zeng
- Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, PR China
| | - Zhipeng Hu
- Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, PR China
| | - Li Zhong
- Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, PR China
| | - Qimeng Yang
- Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, PR China
| | - Wei Shi
- Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, PR China.
| | - Hai Qian
- Center of Drug Discovery, State Key Laboratory of Natural Medicines, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, PR China; Jiangsu Key Laboratory of Drug Discovery for Metabolic Disease, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, PR China.
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10
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Gu S, Dusza S, Quigley E, Haliasos H, Markova A, Marchetti M, Moy AP, Dang C, Modi S, Lake D, Noor S, Lacouture ME. Pruritus related to trastuzumab and pertuzumab in HER2 + breast cancer patients. Breast Cancer Res Treat 2024; 203:271-280. [PMID: 37833451 PMCID: PMC10787687 DOI: 10.1007/s10549-023-07143-3] [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: 03/11/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE The combination of trastuzumab and pertuzumab (HP) as part of a taxane-based regimen has shown benefit in the adjuvant and metastatic HER2 + breast cancer setting. In the CLEOPATRA trial, pruritus was reported in 11-17.6% of patients. The clinical phenotype and potential treatment strategies for this event have not been reported. METHODS A retrospective review of 2583 patients receiving trastuzumab and pertuzumab for the treatment of HER2 + breast cancer from 11/23/2011 to 6/21/2021 was performed at Memorial Sloan Kettering Cancer Center (MSKCC). Patient demographics, pruritus characteristics, and treatments as documented in the electronic medical record (EMR) were included in this analysis. RESULTS Of 2583 pts treated with HP, 122 (4.72%) with pruritus were identified. On average, patients experienced pruritus 319.0 days (8-3171) after initiation of HP. The upper extremities (67.4%), back (29.3%), lower extremities (17.4%), and shoulders (14.1%) were the most commonly affected regions. Grade 1/2 pruritus (97.6%) occurred in most cases. Patients responded primarily to treatment with topical steroids (52.2%), antihistamines (29.9%), emollients (20.9%), and gabapentinoids (16.4%). Of those with pruritus, 4 patients (3.3%) required treatment interruption or discontinuation. CONCLUSIONS Pruritus is uncommon in patients on trastuzumab and pertuzumab, generally a chronic condition, with gabapentinoids or antihistamines representing effective therapies.
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Affiliation(s)
- Stephanie Gu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
| | - Stephen Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
| | - Elizabeth Quigley
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
| | - Helen Haliasos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
| | - Michael Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
| | - Andrea P Moy
- Dermatopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Chau Dang
- Breast Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Shanu Modi
- Breast Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Diana Lake
- Breast Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Sarah Noor
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA.
- Department of Dermatology, Weill Cornell Medical College, New York, USA.
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11
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Röwer C, Olaleye OO, Bischoff R, Glocker MO. Mass Spectrometric ITEM-ONE and ITEM-TWO Analyses Confirm and Refine an Assembled Epitope of an Anti- Pertuzumab Affimer. Biomolecules 2023; 14:24. [PMID: 38254624 PMCID: PMC10813730 DOI: 10.3390/biom14010024] [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: 10/18/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Intact Transition Epitope Mapping-One-step Non-covalent force Exploitation (ITEM-ONE) analysis reveals an assembled epitope on the surface of Pertuzumab, which is recognized by the anti-Pertuzumab affimer 00557_709097. It encompasses amino acid residues NSGGSIYNQRFKGR, which are part of CDR2, as well as residues FTLSVDR, which are located on the variable region of Pertuzumab's heavy chain and together form a surface area of 1381.46 Å2. Despite not being part of Pertuzumab's CDR2, the partial sequence FTLSVDR marks a unique proteotypic Pertuzumab peptide. Binding between intact Pertuzumab and the anti-Pertuzumab affimer was further investigated using the Intact Transition Epitope Mapping-Thermodynamic Weak-force Order (ITEM-TWO) approach. Quantitative analysis of the complex dissociation reaction in the gas phase afforded a quasi-equilibrium constant (KD m0g#) of 3.07 × 10-12. The experimentally determined apparent enthalpy (ΔHm0g#) and apparent free energy (ΔGm0g#) of the complex dissociation reaction indicate that the opposite reaction-complex formation-is spontaneous at room temperature. Due to strong binding to Pertuzumab and because of recognizing Pertuzumab's unique partial amino acid sequences, the anti-Pertuzumab affimer 00557_709097 is considered excellently suitable for implementation in Pertuzumab quantitation assays as well as for the accurate therapeutic drug monitoring of Pertuzumab in biological fluids.
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Affiliation(s)
- Claudia Röwer
- Proteome Center Rostock, Medical Faculty and Natural Science Faculty, University of Rostock, 18057 Rostock, Germany
| | - Oladapo O. Olaleye
- Department of Analytical Biochemistry, Faculty of Science & Engineering, University of Groningen, 9713 AV Groningen, The Netherlands
| | - Rainer Bischoff
- Department of Analytical Biochemistry, Faculty of Science & Engineering, University of Groningen, 9713 AV Groningen, The Netherlands
| | - Michael O. Glocker
- Proteome Center Rostock, Medical Faculty and Natural Science Faculty, University of Rostock, 18057 Rostock, Germany
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12
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Zhang R, Liu X, Song G, Zhang Y, Li H. Trastuzumab Biosimilar (HLX02), Pertuzumab Plus Chemotherapy in Patients with HER2-Positive Metastatic Breast Cancer after Progression of Trastuzumab: A Prospective, Phase II Study. Cancer Res Treat 2023:crt.2023.1151. [PMID: 38147816 DOI: 10.4143/crt.2023.1151] [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: 10/20/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose This study aims to evaluate the efficacy and safety of trastuzumab biosimilar (HLX02) in combination with pertuzumab and chemotherapy in patients with HER2-positive metastatic breast cancer (MBC) after progression of trastuzumab. Materials and Methods In this prospective, single-arm, phase II study, patients with HER2-positive MBC after progression of tratuzumab received pertuzuamb, HLX02 and chemotherapy (PTC) in Beijing Cancer Hospital from March 2020 to December 2022. The primary endpoint was progression free survival (PFS), and secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety. The study was registered with ClinicalTrials.gov (NCT05188495). Results A total of 45 patients were included in this study. 12(26.7%) patients were treated in second line and 33(73.3%) patients were in third-line and later setting. 80% and 15.5% patients had previously received pyrotinib/lapatinib and T-DM1, respectively. With a median follow-up of 24.4 months (range: 1.2-43.9), the median PFS was 7.6 months (95% confidence interval [CI],4.3- 10.9m), OS was not reached, the ORR was 31.1%, and DCR was 91.1%. The treatment was well tolerated. Conclusion The combination of trastuzumab biosimilar HLX02, pertuzumab, and chemotherapy exhibited promising efficacy and a favorable safety profile as second- and beyond line treatment in HER2-positive metastatic breast cancer.
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Affiliation(s)
- Ruyan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaoran Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Guohong Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yan Zhang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing, China
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13
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Zou SP, Yang HY, Ouyang ML, Cheng Q, Shi X, Sun MH. A disproportionality analysis of adverse events associated to pertuzumab in the FDA Adverse Event Reporting System (FAERS). BMC Pharmacol Toxicol 2023; 24:62. [PMID: 37957717 PMCID: PMC10642055 DOI: 10.1186/s40360-023-00702-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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Pertuzumab is widely used for the treatment of HER2 + breast cancer. But its safety in the real world should be continuously monitored. So, we evaluated the safety of pertuzumab by pharmacovigilance analyze based on related adverse events (AEs) from the FDA Adverse Event Reporting System (FAERS) and find whether potential or uncertain adverse events were present. METHODS In disproportionality analysis, four algorithms were employed to detect the signals of pertuzumab from the FAERS between 2012 and 2022. In addition, we also used MYSQL 8.0, Navicat Premium 15, and Microsoft EXCEL 2019 to analyze the potential and high-ROR (reporting odds ratio) signals of pertuzumab. We also collected the onset times of pertuzumab-associated AEs. RESULTS From January 2012 to December 2022, there are 39,190,598 AEs reported from the FAERS database, of which 14,707 AEs listed pertuzumab as the 'primary suspected (PS)' drug. A total of 115 (46 potential) significant disproportionality preferred terms (PTs) conforming to the four algorithms were retained. Finally, we detected that the pertuzumab-induced AEs occurred in 12 organ systems. For pertuzumab, unexpected and significant PTs of AEs were found, including but not limited to below PTs: haematotoxicity, cardiotoxicity, cardiomyopathy, mitral valve incompetence, tachycardia, intestinal perforation, hemorrhoids, erysipelas, dehydration, pneumonitis, skin toxicity, onychomadesis, cyanosis, and circulatory collapse. We found there were 9 strong signals (5 potential safety signals) and 68 medium intensity signals (21 potential safety signals) according to IC025 (information component). The potential strong signals (IC025 > 3.0) were myelosuppression, cardiotoxicity, cardiac dysfunction, ejection fraction decreased, interstitial lung disease, and onychomadesis. Excluding unreported or unreasonable onset time reports, a total of 2016 AEs reported onset time and the median onset time was 117 days (4, 96), as median (Q1, Q3). Notably, most of the all AEs (n = 1133, 56%) and cardiac-related events (n = 405, 53%) all occurred within one month after pertuzumab therapy. CONCLUSION Analysis of FAERS data identified pertuzumab-associated AEs, and our findings supported continuous clinical monitoring, pharmacovigilance, and further studies of pertuzumab. A significant association was detected between pertuzumab and some potential adverse events which should be regarded with some care. We have to pay attention to the first month after pertuzumab therapy and prepare emergency measures, especially for the elderly and patients with cardiovascular diseases.
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Affiliation(s)
- Shu-Peng Zou
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan, Hubei Province, 430000, China
| | - Hai-Yun Yang
- School of Pharmacy, Lanzhou University, Lanzhou, Gansu Province, 730000, China
| | - Meng-Ling Ouyang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan, Hubei Province, 430000, China
| | - Qian Cheng
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan, Hubei Province, 430000, China
| | - Xuan Shi
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan, Hubei Province, 430000, China
| | - Ming-Hui Sun
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan, Hubei Province, 430000, China.
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14
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Ducharme M, Mansur A, Sligh L, Ulaner GA, Lapi SE, Sorace AG. Human Epidermal Growth Factor Receptor 2/Human Epidermal Growth Factor Receptor 3 PET Imaging: Challenges and Opportunities. PET Clin 2023; 18:543-555. [PMID: 37339919 DOI: 10.1016/j.cpet.2023.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 06/22/2023]
Abstract
Human epidermal growth factor receptor 2 (HER2) and HER3 provide actionable targets for both therapy and imaging in breast cancer. Further, clinical trials have shown the prognostic impact of receptor status discordance in breast cancer. Intra- and intertumoral heterogeneity of both HER and hormone receptor expression contributes to inherent errors in tissue sampling, and single biopsies are incapable of identifying discordance in biomarker expression. Numerous PET radiopharmaceuticals have been developed to evaluate (or target for therapy) HER2 and HER3 expression. This review seeks to inform on challenges and opportunities in HER2 and HER3 PET imaging in both clinical and preclinical settings.
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Affiliation(s)
- Maxwell Ducharme
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ameer Mansur
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luke Sligh
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Irvine, CA, USA; Department of Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | - Suzanne E Lapi
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Chemistry, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Anna G Sorace
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA.
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15
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Zambelli A, Cazzaniga M, La Verde N, Munzone E, Antonazzo IC, Mantovani LG, Di Cosimo S, Mancuso A, Generali D, Cortesi PA. A cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in HER2-positive high-risk early breast cancer in Italy. Breast 2023; 71:113-121. [PMID: 37573652 PMCID: PMC10428118 DOI: 10.1016/j.breast.2023.08.005] [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: 04/29/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Clinical trials confirmed the beneficial effects of adding pertuzumab (P) to the combination of trastuzumab-chemotherapy (TC) in the (neo)adjuvant setting of high-risk HER2-positive early breast cancer (HER2+BC). We evaluated the clinical, economic and societal impact of adding pertuzumab to neoadjuvant TC combination (TPC) in Italy. METHODS A cost-consequence analysis comparing TPC vs. TC was performed developing a cohort-based multi-state Markov model to estimate the clinical, societal and economic impact of the neoadjuvant therapy of TPC versus TC in HER2+BC at high-risk of recurrence. The model works on a cycle length of 1 month and 5-years-time horizon. Literature review-based data were used to populate the model. The following clinical and economic outcomes were estimated: cumulative incidence of loco-regional/distant recurrences, life of years and QALY and both direct and indirect costs (€). Finally, sensitivity analyses were performed. RESULTS TPC was associated with a 75,630 € saved of direct costs. Specifically, it was associated with an initial increase of treatment costs (+4.8%) followed by reduction of recurrence management cost (-20.4%). TPC was also associated with an indirect cost reduction of 1.40%, as well as decreased incidence of distant recurrence (-20.14%), days of work lost (-1.53%) and days lived with disability (-0.50%). Furthermore, TPC reported 10,47 QALY gained (+2.77%) compared to TC. The probability to achieve the pathological complete response (pCR) was the parameter that mostly affected the results in the sensitivity analysis. CONCLUSION Our findings suggested that TPC combination could be a cost-saving option in patients with HER2+BC at high-risk of recurrence.
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Affiliation(s)
- Alberto Zambelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marina Cazzaniga
- Phase 1 Research Centre, ASST-Monza (MB), 20900, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Nicla La Verde
- Department of Oncology, Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | - Serena Di Cosimo
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Daniele Generali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127, Trieste, Italy; Multidisciplinary Unit of Breast Pathology and Translational Research, ASST of Cremona Hospital, 26100, Cremona, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
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16
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Garutti M, Cucciniello L, Arpino G, Fabi A, Livi L, Munzone E, Staropoli N, Zamagni C, Zambelli A, Puglisi F. Risk-Based Therapeutic Strategies for HER2-Positive Early Breast Cancer: A Consensus Paper. Clin Breast Cancer 2023; 23:e458-e469. [PMID: 37543499 DOI: 10.1016/j.clbc.2023.07.006] [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: 05/12/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023]
Abstract
Breast cancer represents the most commonly diagnosed neoplasm worldwide and the HER2-positive subtype accounts for nearly 1 in 5 breast cancers. The majority of patients with breast cancer present with an early-stage disease upon diagnosis, which is thus susceptible to virtually curative treatment strategies. For a stage, I T1a/b N0 HER2-positive disease, upfront surgery followed by adjuvant therapy is the preferred approach. However, there is some uncertainty regarding the appropriate management of stage cT1c cN0, as both the neoadjuvant approach and upfront surgery have been proven to be feasible therapeutic options. The aim of this Delphi consensus was to define the best strategies for the treatment of early HER2-positive breast cancer. This work may help clinicians in the management of early HER2-positive breast cancer.
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Affiliation(s)
- Mattia Garutti
- CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Linda Cucciniello
- CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alessandra Fabi
- Precision Medicine in Breast Cancer Unit, Department of Woman and Child Health and Public Health, IRCCS, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicoletta Staropoli
- Medical Oncology and Translational Medical Oncology Units, Department of Experimental and Clinical Medicine, Magna Graecia University, AOU Materdomini Catanzaro, Campus Salvatore Venuta, Catanzaro, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Zambelli
- Department of Biomedical Sciences Humanitas University and IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Fabio Puglisi
- CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
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Al-Jazairi AS, Bahammam N, Aljuaid D, Almutairi L, Alshahrani S, Albuhairan N, Cahusac PMB, Korayem GB. Cardiovascular adverse events of antineoplastic monoclonal antibodies among cancer patients: real-world evidence from a tertiary healthcare system. Cardiooncology 2023; 9:35. [PMID: 37749652 PMCID: PMC10519122 DOI: 10.1186/s40959-023-00184-z] [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] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/04/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Antineoplastic monoclonal antibodies (mAbs), such as trastuzumab, bevacizumab, and pertuzumab have been the mainstay of therapy in cancer patients. Despite proven efficacy of the monoclonal antibodies, cardiovascular-induced adverse events such as heart failure, hypertension, ischemic heart disease, arrhythmias, thromboembolic events, and hemorrhage remain a major complication. The European society of cardiology address that concern with antineoplastic monoclonal antibodies issuing a guideline to manage and monitor chemotherapy-induced cardiotoxicity. There is limited evidence of the real-world prevalence of cardiovascular (CV) events induced by monoclonal antibodies among patients with cancer in Saudi Arabia. OBJECTIVE To evaluate the prevalence of cardiovascular adverse events among patients with cancer treated with monoclonal antibodies in Saudi Arabia. METHODS This is a retrospective study conducted in a tertiary care hospital, Riyadh, Saudi Arabia. Data were obtained from an electronic medical record of patients with cancer treated with one of the selected monoclonal antibodies, who met the inclusion criteria between January 2005 until June 2015 and have been followed up for at least one year. Patients were stratified into groups according to monoclonal antibodies treatment: trastuzumab, bevacizumab, pertuzumab, and combined mAbs. RESULTS A total of 1067 patient were included in the study, within the pre-determined study period. The prevalence of cardiovascular disease among patients with cancer treated with monoclonal antibodies was 16.3%. The prevalence of heart failure was relatively higher in the trastuzumab group (46/626 patients, 7.3%). Among 418 patients treated with bevacizumab, hypertension was the most frequent adverse event, reported in 38 patients (9.1%), followed by thromboembolism reported in 27 patients (6.5%). Treatment discontinuation owing to cardiovascular adverse events was reported in 42/1,067 patients (3.9%). CONCLUSION AND RELEVANCE Prevalence of antineoplastic monoclonal antibody induced cardiovascular adverse events among patients with cancer is substantially high in Saudi Arabia. There is an urgent need to streamline the practice for identifying high risk patients and flexible referral system for cardio-oncology care.
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Affiliation(s)
- Abdulrazaq S Al-Jazairi
- Division of Clinical Trials Transformation Initiative, King Faisal Specialist Hospital & Research Centre, PO Box 3354, Riyadh, 11211, Kingdom of Saudi Arabia.
- College of Pharmacy and Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Kingdom of Saudi Arabia.
| | - Nahlah Bahammam
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 101283, 11655, Riyadh, Saudi Arabia
| | - Dhai Aljuaid
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 101283, 11655, Riyadh, Saudi Arabia
| | - Lama Almutairi
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 101283, 11655, Riyadh, Saudi Arabia
| | - Shroog Alshahrani
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 101283, 11655, Riyadh, Saudi Arabia
| | - Norah Albuhairan
- King Faisal Specialist Hospital & Research Centre, PO Box 3354, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Peter M B Cahusac
- College of Pharmacy and Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Kingdom of Saudi Arabia
| | - Ghazwa B Korayem
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
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Sussell JA, Press DJ, Hansen SA, Kim E, Du Toit Y, Fung A. Impact of Pertuzumab and Ado-Trastuzumab Emtansine on Cumulative Avoidance of Recurrence Among Women Treated for Locally Advanced, Inflammatory, or Early-Stage Nonmetastatic HER2-Positive Breast Cancer in the United States. Adv Ther 2023; 40:3857-3874. [PMID: 37358705 PMCID: PMC10427558 DOI: 10.1007/s12325-023-02554-6] [Citation(s) in RCA: 1] [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: 02/21/2023] [Accepted: 05/15/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION We assessed the impact of HER2-positive early breast cancer (EBC) treatment landscape changes following the introduction of pertuzumab and ado-trastuzumab emtansine (T-DM1) on cumulative population-level recurrences avoided since 2013 (first pertuzumab approval for EBC in the United States; US). METHODS We constructed a multi-year epidemiologic population treatment-impact model to estimate annual recurrences between 2013 and 2031. Parameters were: BC incidence; stage I-III proportion; HER2-positive disease proportion; treatment proportions for neoadjuvant-only, adjuvant-only, and neoadjuvant-adjuvant continuation; and therapeutic agent proportions within each of those settings (chemotherapy only, trastuzumab ± chemotherapy, pertuzumab with trastuzumab ± chemotherapy, or T-DM1). The primary endpoint was cumulative recurrences, estimated by incorporating extrapolated clinical trial data for each regimen of interest into the model under four scenarios. RESULTS Approximately 889,057 women were predicted to be diagnosed with stage I-III HER2-positive BC from 2006 to 2031 in the US and potentially indicated for HER2-targeted treatment. In steady-state equilibrium, the model estimated that real-world utilization of pertuzumab and T-DM1 will reduce the population-level number of recurrences by approximately 32%, with 7226 recurrences predicted in 2031 based on current utilization rates. In different modeled scenarios, use of neoadjuvant pertuzumab, continuation of pertuzumab in the adjuvant setting, and T-DM1 in the adjuvant setting in women with residual disease after neoadjuvant treatment were all predicted to reduce the number of recurrences. CONCLUSION Given the improvement of HER2-targeted treatments, alongside increases in BC disease burden, we expect that the population-level impact of HER2-targeted treatments will accelerate over the next decade. Our results suggest that utilization of HER2-targeted treatments in the US has the potential to change the epidemiology of HER2-positive EBC by preventing a substantial number of women from experiencing disease recurrence. These improvements may help to inform our understanding of the future disease and economic burden of HER2-positive BC in the US.
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Affiliation(s)
- Jesse A Sussell
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA.
| | - David J Press
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Svenn A Hansen
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Eunice Kim
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Yolande Du Toit
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Anita Fung
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
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19
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Abstract
OPINION STATEMENT Approximately 20% of breast cancers overexpress human epidermal growth factor receptor 2 (HER2+), conferring a particularly aggressive subtype of the disease with an increased risk for the development of systemic and brain metastases. However, the advent of trastuzumab and more recently several other HER2-targeting novel therapies has led to significant improvements in the prognosis, making the diagnosis a "double-edged sword." The current standard first-line therapy for patients with HER2+ metastatic breast cancer (MBC) is a taxane combined with trastuzumab and pertuzumab. Trastuzumab deruxtecan should be used preferentially in the second line, with the only caveat being patients with CNS involvement where the tucatinib, capecitabine, and trastuzumab regimen could be considered. In the third line setting, given the survival benefits demonstrated with the tucatinib regimen in patients with and without CNS metastases, this is the preferred strategy. In the fourth line and beyond, there is no clear standard. Options include margetuximab in combination with chemotherapy, neratinib + capecitabine, or trastuzumab + chemotherapy. There are several novel therapies under investigation reporting promising results in the late-line setting. The treatment landscape of HER2-positive advanced disease is evolving constantly, with several active therapies being moved to the early-stage setting. Accordingly, it will be critical to identify biomarkers and mechanisms of resistance to optimize therapy selection and maximize patient outcomes and quality of life. Here, we provide an overview of the current and future management of HER2-positive advanced breast cancer and address the specific scenarios which may impact treatment selection including triple-positive breast cancer and the presence of brain metastases. Finally, we highlight promising novel treatments and ongoing trials that may impact future treatment sequencing.
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Affiliation(s)
- Naomi Dempsey
- Miami Cancer Institute, 8900 Kendall Drive, Miami, FL, USA
| | - Ana Sandoval
- Miami Cancer Institute, 8900 Kendall Drive, Miami, FL, USA
| | - Reshma Mahtani
- Miami Cancer Institute, 8900 Kendall Drive, Miami, FL, USA.
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20
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Cheng S, Wang J, Wang Y, Qi L, Li F, Liu J, Chen J, Fan Y, Xie L. Longitudinal assessment of cardiac parameters through MRI in breast cancer patients treated with anti-HER2 therapy. Eur Radiol Exp 2023; 7:22. [PMID: 37183212 PMCID: PMC10183380 DOI: 10.1186/s41747-023-00338-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND We evaluated the early changes in left ventricular (LV) volumetric, functional, and tissue characteristics in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients treated with trastuzumab and/or pertuzumab at cardiac magnetic resonance imaging (MRI). METHODS HER2-positive breast cancer patients undergoing planned anti-HER2 therapy and nonanthracycline-based chemotherapy were enrolled and subdivided into dual anti-HER2 (trastuzumab plus pertuzumab) group and trastuzumab group. Cardiac MRI was performed before treatment and three months after starting, covering ventricular volumes, cardiac function, systolic myocardial strain, myocardial oedema, and T1 and T2 relaxation times. Cardiac dysfunction was primarily defined as a > 10% reduction in LV ejection fraction (LVEF) to < 55% and/or a > 15% global longitudinal strain (GLS) change at the follow-up MRI examination. RESULTS Twenty-four HER2-positive patients were evaluated (16 in the dual anti-HER2 group, 8 in the trastuzumab group). Six patients developed cardiac dysfunction at follow-up, five of them in the dual anti-HER2 group. One patient developed symptomatic heart failure, and five patients developed asymptomatic cardiac dysfunction. Patients displayed significantly decreased systolic function and increased T1 and T2 relaxation time at follow-up (p ≤ 0.031). Systolic dysfunction remained significant in the dual anti-HER2 group. The decrease in GLS in the trastuzumab group was not significant (p = 0.169). T1 and T2 relaxation times tended to increase, but this was not significant at subgroup analysis. CONCLUSIONS Cardiac MRI scans showed frequent signs of subclinical cardiotoxicity after short-term anti-HER2 therapy and nonanthracycline-based chemotherapy; the effect was slightly stronger in patients treated with dual therapy. KEY POINTS • A frequent subclinical cardiotoxicity was detected by cardiac magnetic resonance imaging after short-term anti-human epidermal growth factor receptor 2 (HER2) therapy. • The change in myocardial strain was more marked in patients treated with dual (trastuzumab plus pertuzumab) than with trastuzumab only anti-HER2 therapy. • Cardiotoxicity surveillance through MRI is an interesting option particularly in patients treated with dual anti-HER2 therapy.
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Affiliation(s)
- Sainan Cheng
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jianwei Wang
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Yawen Wang
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Linlin Qi
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Fenglan Li
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jianing Liu
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jiaqi Chen
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yang Fan
- MR Research China, GE Healthcare, Beijing, China
| | - Lizhi Xie
- MR Research China, GE Healthcare, Beijing, China
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21
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Ibragimova KIE, Geurts SME, Meegdes M, Erdkamp F, Heijns JB, Tol J, Vriens BEPJ, Dercksen MW, Aaldering KNA, Pepels MJAE, van de Winkel L, Peters NAJB, Teeuwen-Dedroog NJA, Vriens IJH, Tjan-Heijnen VCG. Outcomes for the first four lines of therapy in patients with HER2-positive advanced breast cancer: results from the SONABRE registry. Breast Cancer Res Treat 2023; 198:239-251. [PMID: 36635428 PMCID: PMC10020272 DOI: 10.1007/s10549-022-06832-9] [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: 10/17/2022] [Accepted: 12/01/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE We assessed the systemic treatment choices and outcomes in patients diagnosed with human epidermal growth factor receptor-2-positive (HER2 +) advanced breast cancer (ABC), for the first four lines of systemic therapy and by hormone receptor (HR) status. METHODS We identified 330 patients diagnosed with HER2 + ABC in 2013-2018 in the Southeast of The Netherlands, of whom 64% with HR + /HER2 + and 36% with HR-/HER2 + disease. Overall survival (OS) from start of therapy was calculated using the Kaplan-Meier method. RESULTS In real world, 95% of patients with HR + /HER2 + and 74% of patients with HR-/HER2 + disease received systemic therapy. In HR + /HER2 + disease, use of endocrine, chemo- and HER2-targeted therapy was , respectively, 64%, 46% and 60% in first line, and 39%, 64% and 75% in fourth line. In HR-/HER2 + disease, 91-96% of patients received chemotherapy and 77-91% HER2-targeted therapy, irrespective of line of therapy. In patients with HR + /HER2 + disease, median OS was 34.9 months (95%CI:25.8-44.0) for the first line and 12.8 months (95%CI:10.7-14.9) for the fourth line. In HR-/HER2 + disease, median OS was 39.9 months (95%CI:23.9-55.8) for the first line and 15.2 months (95%CI:10.9-19.5) for the fourth line. For patients treated with first-line pertuzumab, trastuzumab plus chemotherapy, median OS was not reached at 56.0 months in HR + /HER2 + disease and 48.4 months (95%CI:32.6-64.3) in HR-/HER2 + disease. CONCLUSION Survival times for later lines of therapy are surprisingly long and justify the use of multiple lines of systemic therapy in well-selected patients with HER2 + ABC. Our real-world evidence adds valuable observations to the accumulating evidence that within HER2 + ABC, the HR status defines two distinct disease subtypes.
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Affiliation(s)
- Khava I E Ibragimova
- Department of Medical Oncology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, PO BOX 5800, 6202 AZ, Maastricht, the Netherlands
| | - Sandra M E Geurts
- Department of Medical Oncology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, PO BOX 5800, 6202 AZ, Maastricht, the Netherlands
| | - Marissa Meegdes
- Department of Medical Oncology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, PO BOX 5800, 6202 AZ, Maastricht, the Netherlands
| | - Frans Erdkamp
- Department of Internal Medicine, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - Joan B Heijns
- Department of Medical Oncology, Amphia, Breda, the Netherlands
| | - Jolien Tol
- Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - Birgit E P J Vriens
- Department of Internal Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Marcus W Dercksen
- Department of Medical Oncology, Máxima Medical Center, Eindhoven, the Netherlands
| | | | - Manon J A E Pepels
- Department of Internal Medicine, Elkerliek Hospital, Helmond, the Netherlands
| | | | - Natascha A J B Peters
- Department of Internal Medicine, Sint Jans Gasthuis Hospital, Weert, the Netherlands
| | - Nathalie J A Teeuwen-Dedroog
- Department of Medical Oncology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, PO BOX 5800, 6202 AZ, Maastricht, the Netherlands
| | - Ingeborg J H Vriens
- Department of Medical Oncology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, PO BOX 5800, 6202 AZ, Maastricht, the Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, PO BOX 5800, 6202 AZ, Maastricht, the Netherlands.
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22
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Collet L, Eberst L, Ludovic G, Debled M, Hrab L, Mouret-Reynier MA, Desmoulins I, Goncalves A, Campone M, Ferrero JM, Brain E, Uwer L, Eymard JC, Dieras V, Simon G, Leheurteur M, Dalenc F, Vanlemmens L, Darlix A, Arnedos M, Bachelot T. Clinical outcome of patients with isolated central nervous system progression on first-line pertuzumab and trastuzumab treatment for HER2-positive metastatic breast cancer in a real-life cohort. Breast Cancer 2023; 30:329-41. [PMID: 36630013 DOI: 10.1007/s12282-022-01427-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND More than 10% of HER2-positive metastatic breast cancer (mBC) will develop Central Nervous System (CNS) metastases as first and isolated site of relapse on trastuzumab and pertuzumab first-line therapy. However, few clinical data are available to guide the best strategy in this setting. METHODS Patients experiencing isolated CNS progression on trastuzumab and pertuzumab first-line therapy were retrospectively identified from the French Epidemiological Strategy and Medical Economics (ESME) real-life database between 2008 and 2016. RESULTS Among 995 patients treated with first-line trastuzumab and pertuzumab for HER2-positive mBC, 132 patients (13%) experienced isolated CNS progression with a median time of 12 months after mBC diagnosis. Twelves patients did not receive any treatment and were excluded from the analysis. Among the 120 patients considered, 76 (63%) received CNS-directed local therapy, 73 (60%) continued trastuzumab and pertuzumab, whereas 47 (39%) started another systemic treatment. After a median follow-up of 21 months, there was no difference in progression-free survival for patient who continued trastuzumab-pertuzumab or switched to another systemic treatment. In multivariate analysis, trastuzumab-pertuzumab continuation was associated with longer OS (HR 0,28 IC 95%: 0,14-0,54 p < 0,001). mOS was not reached (95% 37.6-NE) and was 23.2 months (95% CI 15.5-53.6) in patients who continued trastuzumab and pertuzumab therapy and in patients who switched for another systemic therapy, respectively. CONCLUSION In this real-life cohort, trastuzumab-pertuzumab continuation after local treatment for isolated CNS progression did not negatively impact PFS and OS. Prospective trials and assessment of new strategies are warranted in this specific situation.
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23
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Kafa G, Horani M, Musa F, Al-Husban A, Hegab M, Asir N. Marginal Corneal Infiltration Following Treatment for Metastatic Breast Cancer with Triple Chemotherapy of Trastuzumab, Pertuzumab & Docetaxel. Ocul Immunol Inflamm 2023; 31:431-436. [PMID: 35113748 DOI: 10.1080/09273948.2022.2027460] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To report a case of bilateral marginal corneal infiltration upon treatment with trastuzumab, pertuzumab, and docetaxel via novel proposed mechanisms. CASE DESCRIPTION A patient, diagnosed with metastatic breast cancer and positive for human epidermal growth factor receptor 2 (HER2) with high Ki67, presented with bilateral severe marginal corneal infiltration upon undergoing first cycle of triple chemotherapy: trastuzumab, pertuzumab, and docetaxel. Treatment with topical corticosteroids and antibiotics was unsuccessful and was replaced by allogeneic serum eye drops (SED). The case improved significantly 10 days upon starting allogeneic SED. CONCLUSIONS We propose that trastuzumab, pertuzumab, and docetaxel suppress HER2 and Ki67 in the cornea and lacrimal gland. To the best of our knowledge, our report is the first to highlight the potential impact of this triple chemotherapy on the lacrimal gland and cornea and the first to highlight the proposed role of Ki67 suppression in damaging corneal integrity.
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Affiliation(s)
- Ghyath Kafa
- Rochdale Infirmary, Northern Care Alliance NHS Group, Manchester, UK
| | - Mania Horani
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fayyaz Musa
- Rochdale Infirmary, Northern Care Alliance NHS Group, Manchester, UK
| | - Ahmad Al-Husban
- Rochdale Infirmary, Northern Care Alliance NHS Group, Manchester, UK
| | - Mohamed Hegab
- Rochdale Infirmary, Northern Care Alliance NHS Group, Manchester, UK
| | - Noor Asir
- Rochdale Infirmary, Northern Care Alliance NHS Group, Manchester, UK
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24
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de Haas SL, Slamon DJ, Martin M, Press MF, Lewis GD, Lambertini C, Prat A, Lopez-Valverde V, Boulet T, Hurvitz SA. Tumor biomarkers and efficacy in patients treated with trastuzumab emtansine + pertuzumab versus standard of care in HER2-positive early breast cancer: an open-label, phase III study (KRISTINE). Breast Cancer Res 2023; 25:2. [PMID: 36631725 PMCID: PMC9832665 DOI: 10.1186/s13058-022-01587-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 12/02/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND KRISTINE is an open-label, phase III study of trastuzumab emtansine + pertuzumab (T-DM1 + P) versus docetaxel + carboplatin + trastuzumab + pertuzumab (TCH + P) in patients with HER2-positive, stage II-III breast cancer. We investigated the association of biomarkers with clinical outcomes in KRISTINE. METHODS Patients were randomized to receive neoadjuvant T-DM1 + P or TCH + P and assessed for pathologic complete response (pCR; ypT0/is, ypN0). HER2 status (per central assessment), hormone receptor status, PIK3CA mutation status, HER2/HER3 mRNA levels, tumor-infiltrating lymphocyte levels, PD-L1 status, and NanoString data were analyzed. pCR rates by treatment arm were compared across biomarker subgroups. Analyses were descriptive. RESULTS Biomarker analyses included data from all 444 patients (T-DM1 + P, n = 223; TCH + P, n = 221) enrolled in KRISTINE. Biomarker distribution was balanced across treatment arms. All subgroups with higher HER2 amplification/expression and immune marker levels showed numerically higher pCR rates in both arms. Mutated versus non-mutated PIK3CA tumors were associated with numerically lower pCR rates in the T-DM1 + P arm but not in the TCH + P arm. In a multivariate analysis, Prediction Analysis of Microarray with the 50-gene classifier (PAM50) HER2-enriched subtype, HER2 gene ratio ≥ 4, and PD-L1-positive status positively influenced the pCR rate. Biomarkers associated with lower pCR rates (e.g., low HER2 levels, positive hormone receptor status, mutated PIK3CA) were more likely to co-occur. Dynamic on-treatment biomarker changes were observed. Differences in the treatment effects for T-DM1 + P versus TCH + P were similar to those observed in the intent-to-treat population for the majority of the biomarker subgroups. CONCLUSIONS Although our biomarker analysis did not identify a subgroup of patients that benefited from neoadjuvant T-DM1 + P versus TCH + P, the data revealed that patients with higher HER2 amplification/expression and immune marker levels had improved response irrespective of treatment arm. These analyses confirm the role of HER2 tumor biology and the immune microenvironment in influencing pCR in the neoadjuvant setting and reaffirm the molecular diversity of HER2-positive breast cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT02131064. Registered 06 May 2014.
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Affiliation(s)
- Sanne L de Haas
- Oncology Biomarker Development, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Dennis J Slamon
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Miguel Martin
- Medical Oncology Service, Hospital Gregorio Marañón, Universidad Complutense, CIBERONC, Madrid, Spain
| | - Michael F Press
- Department of Pathology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Gail D Lewis
- Discovery Oncology, Genentech, Inc., South San Francisco, CA, USA
| | - Chiara Lambertini
- Oncology Biomarker Development, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
- Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Thomas Boulet
- Product Development Biometrics Biostatistics, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Sara A Hurvitz
- Division of Hematology-Oncology, David Geffen School of Medicine, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
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25
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Tabuchi Y, Tsujimoto M, Yamamoto K, Kosaka T, Sakaguchi K, Dobuchi N, Nishiguchi K, Shikata K. Incidence and risk factors of infusion reactions in patients with breast cancer administered trastuzumab plus pertuzumab-based regimen. Cancer Chemother Pharmacol 2023; 91:25-31. [PMID: 36401659 DOI: 10.1007/s00280-022-04492-6] [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: 06/17/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Pertuzumab (Per) is a humanized monoclonal antibody used in combination with trastuzumab (Tra) in the treatment of human epidermal growth factor receptor-2 (HER2)-positive breast cancer. The administration of biologics, such as Tra and Per, frequently causes infusion reactions (IRs) with fever and chills. This study aimed to clarify the characteristics of and risk factors for IRs in Tra + Per combination therapy. METHODS Between March 2013 and December 2019, 64 patients with breast cancer who started Tra + Per combination therapy were included in the study. The severity of IRs was graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. RESULTS The incidence of IRs in the Tra + Per combination therapy was 48.4% (31/64). The severity of IRs in the Tra + Per combination therapy was Grade 1 (9 patients) and Grade 2 (22 patients). Lymphocyte counts were significantly different between the IR and non-IR groups in patients receiving Tra + Per combination therapy (univariate analysis, p = 0.006; multivariate analysis, p = 0.050). ROC curve analysis found the cutoff value of lymphocyte counts were 1.60 (× 103/µL). The incidence of IRs in the lymphocyte counts ≥ 1.60 group was significantly higher than that in the lymphocyte counts < 1.60 group (p < 0.001). CONCLUSION Our study indicates that the severity of IRs in most patients is moderate or less and the risk of IRs is higher in patients with higher lymphocyte counts (≥ 1.60 × 103/µL).
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Affiliation(s)
- Yusuke Tabuchi
- Department of Pharmacy, University Hospital, Kyoto Prefectural University of Medicine, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan. .,Department of Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan.
| | - Masayuki Tsujimoto
- Department of Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Kosuke Yamamoto
- Department of Pharmacy, University Hospital, North Medical Center Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tadashi Kosaka
- Department of Pharmacy, University Hospital, Kyoto Prefectural University of Medicine, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Koichi Sakaguchi
- Department of Endocrine and Breast Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoya Dobuchi
- Department of Pharmacy, University Hospital, North Medical Center Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kohshi Nishiguchi
- Department of Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Keisuke Shikata
- Department of Pharmacy, University Hospital, Kyoto Prefectural University of Medicine, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
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Xu B, Li W, Zhang Q, Li Q, Wang X, Li H, Sun T, Yin Y, Zheng H, Feng J, Zhu H, Siddiqui A, Macharia H, Knott A. Pertuzumab, trastuzumab, and docetaxel for Chinese patients with previously untreated HER2-positive locally recurrent or metastatic breast cancer (PUFFIN): final analysis of a phase III, randomized, double-blind, placebo-controlled study. Breast Cancer Res Treat 2023; 197:503-13. [PMID: 36463547 DOI: 10.1007/s10549-022-06775-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/13/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE PUFFIN (NCT02896855), a Chinese bridging study in patients with previously untreated HER2-positive locally recurrent or metastatic breast cancer, assessed consistency of efficacy and safety of pertuzumab plus trastuzumab and docetaxel versus placebo, trastuzumab, and docetaxel, with CLEOPATRA (NCT00567190). METHODS Eligible patients, n = 243, were randomized 1:1, stratified by visceral disease and hormone receptor status, to pertuzumab, trastuzumab, and docetaxel or placebo, trastuzumab, and docetaxel. PRIMARY ENDPOINT investigator-assessed progression-free survival (PFS). Secondary endpoints: safety and overall survival (OS). After primary analysis, patients could cross over to the pertuzumab arm. RESULTS Updated median PFS: 16.5 months (pertuzumab arm) and 12.5 months (placebo arm), with a hazard ratio (HR) of 0.60 [95% confidence interval (CI) 0.45, 0.81; p = 0.0008]. Median OS was not reached in either arm; the OS HR was 0.68 (95% CI 0.45, 1.03; p = 0.0658). Safety was similar in both arms with no new safety signals: 73.8% (pertuzumab arm) and 69.2% (placebo arm) experienced grade ≥ 3 adverse events. No heart failure, symptomatic left ventricular systolic dysfunction, or left ventricular ejection fraction decline of < 40% were reported. CONCLUSIONS The PUFFIN final analysis showed, per the primary analysis, that overall efficacy of pertuzumab plus trastuzumab and docetaxel was consistent with CLEOPATRA. Safety remained consistent with the known pertuzumab profile. Overall, PUFFIN contributes to the totality of data with pertuzumab in previously untreated HER2-positive locally recurrent or metastatic breast cancer and supports the favorable benefit-risk profile of pertuzumab in Chinese patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT02896855, registered 7 September 2016.
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Swain SM, Tan AR, Gianni L, Kuemmel S, Dang CT, Schneeweiss A, O'Shaughnessy J, Liu H, Aguila C, Heeson S, Macharia H, Yang K, Restuccia E, Loibl S. Incidence and severity of anaphylaxis and hypersensitivity in trials of intravenous pertuzumab plus trastuzumab or the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection for HER2-positive breast cancer. Eur J Cancer 2023; 178:70-81. [PMID: 36410207 DOI: 10.1016/j.ejca.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022]
Abstract
AIM To characterise risk of anaphylaxis/hypersensitivity with intravenous pertuzumab plus trastuzumab (PH IV), the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (PH FDC SC) or concomitant chemotherapy to support potential administration of PH FDC SC by healthcare professionals outside clinics. METHODS A cumulative search for anaphylaxis/hypersensitivity (Roche Standard Adverse Event Group Terms) was performed for all pivotal trials cited in the current EMA P IV/PH FDC SC summaries of product characteristics: MBC: NCT00567190, NCT02402712; EBC: NCT01358877, NCT00545688, NCT00976989, NCT02132949, NCT03493854 and NCT03674112. Occurrence, incidence and severity of events were analysed and a time-trend analysis (by cycle) was performed. RESULTS This analysis includes 4772 patients who received PH IV and/or PH FDC SC. Incidence of all-grade (grade ≥3) anaphylaxis/hypersensitivity events: 3-11% (≤2%) for PH IV MBC trials; 1-13% (0-3%) for PH IV EBC trials; and 2-3% (<1%; not related to PH FDC SC) for PH FDC SC EBC trials. Discontinuations due to anaphylaxis/hypersensitivity were rare for PH IV (generally <1% except two arms of TRYPHAENA: 1% and 3%); no discontinuations of PH FDC SC have been recorded so far. Time-trend analysis showed that most events were reported during the first 6-8 cycles with concurrent chemotherapy, with a decrease in later cycles (except MetaPHER). CONCLUSION PH IV and PH FDC SC were well tolerated, with few grade ≥3 anaphylaxis/hypersensitivity events reported with PH IV and no grade ≥3 related events with PH FDC SC. Most events occurred during chemotherapy.
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Tabernero J, Hoff PM, Shen L, Ohtsu A, Shah MA, Siddiqui A, Heeson S, Kiermaier A, Macharia H, Restuccia E, Kang YK. Pertuzumab, trastuzumab, and chemotherapy in HER2-positive gastric/gastroesophageal junction cancer: end-of-study analysis of the JACOB phase III randomized clinical trial. Gastric Cancer 2023; 26:123-131. [PMID: 36066725 PMCID: PMC9813086 DOI: 10.1007/s10120-022-01335-4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dual-targeted anti-HER2 therapy significantly improves outcomes in HER2-positive breast cancer and could be beneficial in other HER2-positive cancers. JACOB's end-of study analyses aimed to evaluate the long-term efficacy and safety of pertuzumab plus trastuzumab and chemotherapy for previously untreated HER2-positive metastatic gastric or gastroesophageal junction cancer. METHODS Eligible patients were randomized 1:1 to pertuzumab/placebo plus trastuzumab and chemotherapy every 3 weeks. PRIMARY ENDPOINT overall survival (OS). Secondary endpoints included progression-free survival (PFS), objective response rate (ORR), duration of response (DoR), and safety. RESULTS The intention-to-treat population comprised 388 patients in the pertuzumab arm and 392 in the placebo arm. The safety population comprised 385 and 388 patients, respectively. Median follow-up was ≥ 44.4 months. Median OS was increased by 3.9 months (hazard ratio 0.85 [95% confidence intervals, 0.72-0.99]) and median PFS by 1.3 months (hazard ratio 0.73 [95% confidence intervals, 0.62-0.85]) in the pertuzumab vs. the placebo arm. ORR was numerically higher (57.0% vs. 48.6%) and median DoR 1.8 months longer with pertuzumab treatment. There was a trend for more favorable hazard ratios in certain subgroups related to HER2 amplification/overexpression. Safety was comparable between arms, except for serious and grade 3-5 adverse events, and any-grade diarrhea, which were more frequent with pertuzumab. CONCLUSIONS JACOB did not meet its primary endpoint. Nonetheless, the study continues to demonstrate some, albeit limited, evidence of treatment activity and an acceptable safety profile for pertuzumab plus trastuzumab and chemotherapy in previously untreated HER2-positive metastatic gastric or gastroesophageal junction cancer after long-term follow-up. Trial registration NCT01774786; https://clinicaltrials.gov/ct2/show/NCT01774786 .
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Affiliation(s)
- Josep Tabernero
- Medical Oncology Department, Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO), UVic-UCC, IOB-Quirón, Passeig de la Vall d'Hebron 119-129, Barcelona, 08035, Spain.
| | - Paulo M Hoff
- IDOR, Hospital Vila Nova Star, Rede D'Or-Sao Luiz, Sao Paulo, Brazil
| | - Lin Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Haidian District, Beijing, People's Republic of China
| | - Atsushi Ohtsu
- Exploratory Oncology Research & Clinical Trial Center, National Cancer Center Hospital, Kashiwa, Japan
| | - Manish A Shah
- Meyer Cancer Center at Weill Cornell Medical College, New York, NY, USA
| | - Asna Siddiqui
- Product Development Oncology, Roche Products Limited, Welwyn Garden City, UK
| | - Sarah Heeson
- Product Development Oncology, Roche Products Limited, Welwyn Garden City, UK
| | - Astrid Kiermaier
- Pharmaceutical Research and Early Development (pRED), F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Eleonora Restuccia
- Product Development Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Medina EAG, Caballero BB, Miguel KL, Gutiérrez ZA, Fernández BM, Tul LEA, Rodríguez LEM, Guerrero OV, Varela IGS, Bernardo MDLCC, Montero YC, Ortiz MR, Carrasco JM, Torres KP, Prado YID, Rubio MC, Braojo IMP. Neoadjuvant Trastuzumab and Pertuzumab in Combination with Standard Chemotherapy for HER2-Positive Early Breast Cancer: Real-World Practice in Cuba. Cancer Treat Res Commun 2023; 34:100670. [PMID: 36549232 DOI: 10.1016/j.ctarc.2022.100670] [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: 09/16/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Dual HER2 blockade chemotherapy is the standard of care for localized HER2+ breast cancer (BC). However, despite the efficacy of neoadjuvant therapy, relapses occurring in around 10% of patients highlight the need to improve its clinical approach. Therefore, this study aimed to evaluate the effectiveness/safety of neoadjuvant therapy with subcutaneous (SC) trastuzumab- pertuzumab chemotherapy (real world) to extend the evidence, which comes mainly from clinical trials (selected population; intravenous [IV] trastuzumab). MATERIALS AND METHODS A prospective, longitudinal, observational study in a Cuban hospital. POPULATION women aged ≥18 years with histologically confirmed HER2+ early-stage BC (2017-2021) eligible for neoadjuvant treatment (IV pertuzumab, SC trastuzumab, taxane-based chemotherapy). The aim was to determine the pathological complete response (pCR) rate to this scheme, its safety, and the impact of patient's characteristics on the outcomes. RESULTS Eighty-seven women were included: n=29 (DPT [docetaxel-IV pertuzumab- SC trastuzumab 600 mg; 4 cycles]); n=58 (ddAC-DPT [dose-dense anthracycline-based scheme+DPT]; 8 cycles). The median age was 57 years (range 30-83), ECOG 0: 97%. Time from diagnosis to treatment (median) was 28 days. The overall pCR rate was 62.1% (55.2%, DPT; 66.5%, ddAC-DPT; p =0.351); HR+, 47.7% vs. HR-, 76.7% (p=0.006). There were no statistically significant differences based on nodal status, stage, or Ki-67 levels. Overall, 94.2% of patients experienced ≥1 adverse event related to treatment, all of them grade 1-3 and more common with ddAC-DPT. The main cause of treatment delays (n=19; ddAC-DPT, 16; DPT, 3) was treatment-related toxicities. CONCLUSION Neoadjuvant trastuzumab (SC) and pertuzumab plus chemotherapy for HER2+ early-stage BC showed benefits in a real-life setting, with an acceptable safety profile.
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Affiliation(s)
- Elías A Gracia Medina
- Instituto Nacional de Oncología y Radiobiología (Cuba). Medical Oncology Department.
| | | | - Karen López Miguel
- Instituto Nacional de Oncología y Radiobiología (Cuba). Medical Oncology Department
| | | | | | - Luis E Alsina Tul
- Instituto Nacional de Oncología y Radiobiología (Cuba). Medical Oncology Department
| | | | | | | | | | | | - Mónica Ramos Ortiz
- Instituto Nacional de Oncología y Radiobiología (Cuba). Mastology Service
| | | | - Keytia Peña Torres
- Instituto Nacional de Oncología y Radiobiología (Cuba). Mastology Service
| | - Yenia I Díaz Prado
- Instituto Nacional de Oncología y Radiobiología (Cuba). Mastology Service
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Futamura M, Ishihara K, Nagao Y, Ogiso A, Niwa Y, Nakada T, Kawaguchi Y, Ikawa A, Kumazawa I, Mori R, Kitazawa M, Hosono Y, Kuno M, Kawajiri M, Nakakami A, Takeuchi M, Morikawa A, Tokumaru Y, Katagiri Y, Asano Y, Mushika Y, Shimokawa T, Matsuhasih N. Neoadjuvant chemotherapy using nanoparticle albumin-bound paclitaxel plus trastuzumab and pertuzumab followed by epirubicin and cyclophosphamide for operable HER2-positive primary breast cancer: a multicenter phase II clinical trial (PerSeUS-BC04). Breast Cancer 2023; 30:293-301. [PMID: 36609911 PMCID: PMC9950177 DOI: 10.1007/s12282-022-01425-2] [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: 08/19/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Nanoparticle albumin-bound paclitaxel (nab-PTX) is a promising antibody partner for anti-human epidermal growth factor receptor 2 (HER2). We performed neoadjuvant chemotherapy (NAC) for HER2-positive breast cancer (BC) using nab-PTX plus trastuzumab (T-mab) and pertuzumab (P-mab), followed by epirubicin and cyclophosphamide (EC). METHODS In this multicenter phase II clinical trial (January 2019-July 2020), patients with stage I (T1c)-IIIB HER2-positive primary BC were treated with four cycles of nab-PTX plus T-mab and P-mab, followed by four cycles of EC. The primary endpoint was the pathological complete response (pCR) rate. Secondary endpoints were clinical response rate (RR), adverse events (AE), and tumor-infiltrating lymphocytes (TILs) in biopsy samples. RESULTS In total, 43 patients were enrolled (mean age, 54 years). Twenty-two patients had HER2, and 21 patients had luminal/HER2-subtypes. The overall pCR rate was 53.5% (23/43, 95% CI: 42.6-64.1%, p = 0.184), whilst the pCR for HER2 was 68.2% (15/22, 95% CI: 45.1-86.1) and 38.1% for luminal/HER2 (8/21, 95% CI: 18.1-61.6%). The RR was 100% [clinical (c) CR:25, partial response (PR): 18]. AEs (≥ G3) included neutropenia (23.3%), leukopenia (7.0%), liver dysfunction (7.0%), and peripheral neuropathy (4.7%) when nab-PTX was administered. EC administration resulted in leukopenia (34.2%), neutropenia (31.6%), and febrile neutropenia (15.8%). The TILs in preoperative biopsy samples were significantly higher in pCR compared to non-pCR samples. CONCLUSION Nab-PTX plus T-mab and P-mab induced a high pCR rate in HER2-positive BC, particularly in the HER2-subtype. Given that AEs are acceptable, this regimen is safe and acceptable as NAC for HER2-positive BC.
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Affiliation(s)
- Manabu Futamura
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | | | - Yasuko Nagao
- Department of Surgery, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Atsuko Ogiso
- Department of Surgery, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yoshimi Niwa
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Takumi Nakada
- Department of Breast Surgery, Gifu Municipal Hospital, Gifu, 500-8513 Japan
| | - Yoshihiro Kawaguchi
- Department of Breast Surgery, Asahi University Hospital, Gifu, 500-8523 Japan
| | - Ai Ikawa
- Department of Surgery, Takayama Red Cross Hospital, Takayama, 506-8550 Japan
| | - Iwao Kumazawa
- Department of Surgery, Gifu-Seino Medical Center, Ibi Hospital, Ibi, 501-0696 Japan
| | - Ryutaro Mori
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Mai Kitazawa
- Department of Breast Surgery, Asahi University Hospital, Gifu, 500-8523 Japan
| | - Yoshiki Hosono
- Department of Breast Surgery, Gifu Municipal Hospital, Gifu, 500-8513 Japan
| | - Masashi Kuno
- Department of Surgery, Gihoku Kosei Hospital, Gifu, 501-2105 Japan
| | - Mana Kawajiri
- Department of Surgery, Gihoku Kosei Hospital, Gifu, 501-2105 Japan
| | - Akira Nakakami
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Makoto Takeuchi
- Department of Breast Surgery, Central Japan International Medical Center, Minokamo, 505-8510 Japan
| | - Akemi Morikawa
- Department of Breast Surgery, Central Japan International Medical Center, Minokamo, 505-8510 Japan
| | - Yoshihisa Tokumaru
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Yasuo Katagiri
- Department of Pathology, Gifu University Hospital, Gifu, 501-1194 Japan
| | - Yoshimasa Asano
- Department of Surgery, Municipal Ena Hospital, Ena, 509-7201 Japan
| | - Yoshinori Mushika
- Department of Breast Surgery, Daiyukai General Hospital, Ichinomiya, 491-8551 Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, 614-8509 Japan
| | - Nobuhisa Matsuhasih
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu, 501-1194 Japan
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Pohlmann PR, Graham D, Wu T, Ottaviano Y, Mohebtash M, Kurian S, McNamara D, Lynce F, Warren R, Dilawari A, Rao S, Mainor C, Swanson N, Tan M, Isaacs C, Swain SM. HALT-D: a randomized open-label phase II study of crofelemer for the prevention of chemotherapy-induced diarrhea in patients with HER2-positive breast cancer receiving trastuzumab, pertuzumab, and a taxane. Breast Cancer Res Treat 2022; 196:571-581. [PMID: 36280642 PMCID: PMC9633499 DOI: 10.1007/s10549-022-06743-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE To assess whether crofelemer would prevent chemotherapy-induced diarrhea (CID) diarrhea in patients with HER2-positive, any-stage breast cancer receiving trastuzumab (H), pertuzumab (P), and a taxane (T; docetaxel or paclitaxel), with/without carboplatin (C; always combined with docetaxel rather than paclitaxel). METHODS Patients scheduled to receive ≥ 3 consecutive TCHP/THP cycles were randomized to crofelemer 125 mg orally twice daily during chemotherapy cycles 1 and 2 or no scheduled prophylactic medication (control). All received standard breakthrough antidiarrheal medication (BTAD) as needed. The primary endpoint was incidence of any-grade CID for ≥ 2 consecutive days. Secondary endpoints were incidence of all-grade and grade 3/4 CID by cycle/stratum; time to onset and duration of CID; stool consistency; use of BTAD; and quality of life (Functional Assessment of Chronic Illness Therapy for Patients With Diarrhea [FACIT-D] score). RESULTS Fifty-one patients were randomized to crofelemer (n = 26) or control (n = 25). There was no statistically significant difference between arms for the primary endpoint; however, incidence of grade ≥ 2 CID was reduced with crofelemer vs control (19.2% vs 24.0% in cycle 1; 8.0% vs 39.1%, in cycle 2). Patients receiving crofelemer were 1.8 times more likely to see their diarrhea resolved and had less frequent watery diarrhea. CONCLUSION Despite the choice of primary endpoint being insensitive, crofelemer reduced the incidence and severity of CID in patients with HER2-positive breast cancer receiving P-based therapy. These data are supportive of further testing of crofelemer in CID. TRIAL REGISTRATION Clinicaltrials.gov, NCT02910219, prospectively registered September 21, 2016.
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Affiliation(s)
- Paula R Pohlmann
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deena Graham
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Tianmin Wu
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
| | | | | | - Shweta Kurian
- Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Donna McNamara
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Robert Warren
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- MedStar Georgetown University Hospital, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
| | - Asma Dilawari
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- MedStar Georgetown University Hospital, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
- FDA Center for Drug Evaluation and Research, Silver Spring, MD, USA
| | - Suman Rao
- Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Candace Mainor
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- MedStar Georgetown University Hospital, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
| | - Nicole Swanson
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
| | - Ming Tan
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
| | - Sandra M Swain
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA.
- MedStar Health, Washington, DC, USA.
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Thill M, Wimberger P, Grafe A, Klare P, Luedtke-Heckenkamp K, Reichert D, Zaiss M, Ziegler-Löhr K, Eckl T, Schneeweiss A. Dual HER2 blockade with pertuzumab (P) and trastuzumab (T) in patients with HER2-positive metastatic breast cancer (mBC) relapsing after adjuvant treatment with T: results from a German non-interventional study (NIS) HELENA (NCT01777958). Breast Cancer Res Treat 2022; 196:311-321. [PMID: 36094611 PMCID: PMC9581869 DOI: 10.1007/s10549-022-06710-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
Purpose NIS HELENA documented outcomes in clinical routine practice of first-line therapy with P plus T and docetaxel (D) of patients with advanced HER2-positive BC and prior (neo)adjuvant T. Methods Between 06/2013 through 07/2016, 126 patients (in-label use of P at study start = full analysis set, FAS) in 81 German study sites were included. Intense documentation period was limited to 28 treatment cycles. Maximum follow-up (FU) was 24 months (mos). Safety was assessed in the safety set (SAF = eligible patients with at least one dose of P, n = 132). Median progression-free survival (PFS) was the main parameter of interest. Results Mean age of FAS patients was 55.1 [30.7–80.2] years, 81.7% (95.2%) were < 65 (75) years of age. 51.6% of the FAS patients were hormone receptor-positive (HR+), 91.3% had distant, 73.0% visceral, and 18.3% non-visceral metastases. Median disease-free interval was 40.2 [6.6–95.9] mos. Effectiveness (FAS): Median PFS was 18.8 [15.1; 24.2] mos. Overall response rate was 64.3% (55.6; 72.1). Median overall survival was 55.9 mos [41.2, not reached]. Safety (SAF): 93.9% of patients had an adverse event (AE), 32.6% a serious AE (SAE). AEs related to P occurred in 53.8% of SAF, SAEs related to P in 13.6%. Diarrhea was the most frequently reported related (S)AE. There were 8 (6.1%) patients with a fatal AE. Conclusion Based on the outcomes from NIS HELENA, results of dual blockade with P+T in patients relapsing after (neo)adjuvant T as reported from the CLEOPATRA study (NCT01777958) can be transferred to routine clinical practice. No new safety signals were detected.
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Affiliation(s)
- Marc Thill
- Department of Gynecology and Gynecological Oncology, Agaplesion Markus Hospital, Frankfurt A. M, Germany.
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Andrea Grafe
- Medical Center Nordhausen gGmbH, Nordhausen, Germany
| | - Peter Klare
- Gynecological Out-Patient Clinic, Berlin, Germany
| | - Kerstin Luedtke-Heckenkamp
- Center for Oncology and Hematology, Niels-Stensen-Clinics, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| | | | - Matthias Zaiss
- Practice for Interdisciplinary Oncology & Hematology, Freiburg, Germany
| | | | - Tanja Eckl
- Roche Pharma AG, Grenzach-Wyhlen, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
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Allahyari A, Ehsanpour A, Ansarinejad N, Mehrzad V, Kalantari B, Raafat J, Ghadiany M, Shahi F, Gharib B, Moazed V, Khosravi A, Mirpour MH, Salari S, Mortazavizadeh S, Nekoyi A, Khani M, Sadeghi A, Gharib S, Bary A, Mirzania M, Haghighat S, Razavi SM, Emami SAH, Hosseinzadeh M, Mirbolouk M, Sadighi S, Shahrasbi A, Esfahani A, Gity M, Anjidani N, Kafi H, Najafi S. Comparing efficacy and safety of P013, a proposed pertuzumab biosimilar, with the reference product in HER2-positive breast cancer patients: a randomized, phase III, equivalency clinical trial. BMC Cancer 2022; 22:960. [PMID: 36071409 PMCID: PMC9450379 DOI: 10.1186/s12885-022-09895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer is the most frequently diagnosed cancer and the leading reason for cancer-related death among women. Neoadjuvant treatment with dual-HER2 (human epidermal growth factor receptor 2) blockade has shown promising effects in this regard. The present study aimed to compare the efficacy and safety of a proposed pertuzumab biosimilar with the reference pertuzumab. METHODS This randomized, phase III, multicenter, equivalency clinical trial was conducted on chemotherapy-naive women with HER2-positive breast cancer. Patients were randomly assigned (1:1) to receive six cycles of either P013 (CinnaGen, Iran) or the originator product (Perjeta, Roche, Switzerland) along with trastuzumab, carboplatin, and docetaxel every 3 weeks. Patients were stratified by cancer type (operable, locally advanced, inflammatory) and hormone receptor status. The primary endpoint was breast pathologic complete response (bpCR). Secondary endpoints included comparisons of total pCR, overall response rate (ORR), breast-conserving surgery (BCS), safety, and immunogenicity. RESULTS Two hundred fourteen patients were randomized to treatment groups. bpCR rate in the per-protocol population was 67.62% in the P013 and 71.57% in the reference drug groups. Based on bpCR, P013 was equivalent to the reference pertuzumab with a mean difference of - 0.04 (95% CI: - 0.16, 0.09). Secondary endpoints were also comparable between the two groups. CONCLUSIONS The proposed biosimilar P013 was equivalent to the reference product in terms of efficacy. The safety of both medications was also comparable.
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Affiliation(s)
- Abolghasem Allahyari
- grid.411583.a0000 0001 2198 6209Hematology Oncology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Ehsanpour
- grid.411230.50000 0000 9296 6873Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nafiseh Ansarinejad
- grid.411746.10000 0004 4911 7066Department of Hematology & Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - Valiollah Mehrzad
- Hematology and Oncology Department, Isfahan Medical School, Isfahan, Iran
| | - Behjat Kalantari
- grid.412105.30000 0001 2092 9755Hematology & Oncology, Department of Internal Medicine, School of Medicine, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Mojtaba Ghadiany
- grid.411600.2Department of Hematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Shahi
- grid.414574.70000 0004 0369 3463Department of Hematology and Medical Oncology, Breast Disease Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, TUMS, Tehran, Iran
| | - Behrooz Gharib
- Department of Medical Oncology & Hematology, Naft Hospital, Tehran, Iran
| | - Vahid Moazed
- grid.412105.30000 0001 2092 9755Hematology & Oncology Kerman University of Medical Sciences, Kerman, Iran
| | - Adnan Khosravi
- grid.411600.2Hematology & Oncology, Department of Adult Hematology & Oncology, School of Medicine, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Dr. Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mir Hossein Mirpour
- grid.415733.7Medical Oncology Guilan University of Medical Sciences, Razi Hospital, Fuman, Iran
| | - Sina Salari
- grid.411600.2Medical Oncology, Hematology Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amirabbas Nekoyi
- grid.411036.10000 0001 1498 685XDepartment of Hematology and Medical Oncology, Seyyed-al-shohada Hospital, Esfahan University of Medical Sciences, Tehran, Iran
| | | | - Alireza Sadeghi
- grid.411036.10000 0001 1498 685XDepartment of Hematology-Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sirus Gharib
- grid.411874.f0000 0004 0571 1549Hematology, Oncology Department of Internal Medicine, Guilan University of Medical Sciences, Guilan, Iran
| | - Alireza Bary
- grid.415529.eDepartment of Hematology & Oncology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrzad Mirzania
- grid.414574.70000 0004 0369 3463Department of Hematology and Medical Oncology, Cancer Research Center, Cancer Institute of Iran, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Haghighat
- grid.412571.40000 0000 8819 4698Hematology Research Center, Hematology and Medical Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seyed Amir Hossein Emami
- grid.411705.60000 0001 0166 0922Medical Oncology, Cancer Institute, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Hosseinzadeh
- grid.411230.50000 0000 9296 6873Hematology, Oncology Department of Internal Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Sanambar Sadighi
- grid.411705.60000 0001 0166 0922Internal Medicine Group TUMS Faculty of Cancer Institute of Iran, Tehran, Iran
| | - Abdolali Shahrasbi
- grid.411463.50000 0001 0706 2472Bouali Hospital, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Ali Esfahani
- grid.412888.f0000 0001 2174 8913Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoumeh Gity
- grid.411705.60000 0001 0166 0922Advanced Diagnostic and Interventional Radiology Research Center, Breast Disease Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamidreza Kafi
- Medical Department, Orchid Pharmed Company, Tehran, Iran
| | - Safa Najafi
- grid.417689.5Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
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Wildiers H, Meyskens T, Marréaud S, Lago LD, Vuylsteke P, Curigliano G, Waters S, Brouwers B, Meulemans B, Sousa B, Poncet C, Brain E. Long term outcome data from the EORTC 75111-10114 ETF/BCG randomized phase II study: Pertuzumab and trastuzumab with or without metronomic chemotherapy for older patients with HER2-positive metastatic breast cancer, followed by T-DM1 after progression. Breast 2022; 64:100-111. [PMID: 35636341 PMCID: PMC9157551 DOI: 10.1016/j.breast.2022.05.004] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Older patients are at higher risk of chemotherapy-induced toxicity, raising interest in less toxic anti-HER2 regimens for older persons with HER2-positive (HER2+) metastatic breast cancer (MBC). PATIENTS AND METHODS This phase II study randomized (1:1) patients with HER2+ MBC, aged 70+ or frail 60+, to first line chemotherapy with metronomic oral cyclophosphamide (M) + Trastuzumab (T) and Pertuzumab (P) or TP alone. T-DM1 was offered in case of progression. RESULTS In total, 39 and 41 patients were randomized to TP and TPM arm respectively. Median follow-up is 54.0 months. 24-month PFS was 18.7% (95% CI 8.2-32.4) and 28.7% (95% CI 15.8-43.0), respectively. A total of 49 (61.3%) patients died of whom 37 (75.5%) from disease progression; number of deaths per arm was 27 (69.2%) for TP and 22 (53.7%) for TPM. There was no significant difference in OS between the two arms (median OS TP vs TPM: 32.1 vs 37.5 months, p 0.25). Among the 40 patients who have started T-DM1 after disease progression on TP/TPM, PFS rate at 6 months after start of T-DM1 was 43.6% (95% CI: 27.7-58.5) and grade 3 or higher AE occurred in 18 pts (45%). CONCLUSIONS Metronomic chemotherapy-based dual blockade (TPM), followed by T-DM1 after progression, provides an active and relatively well tolerated treatment option in an older/frail HER2+ MBC population, with a median survival of over 3 years. Nevertheless, the majority of this older/frail population died from breast cancer, highlighting the need for well tolerated and efficacious treatments in these patients.
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Affiliation(s)
- Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium.
| | - Thomas Meyskens
- European Organization for Research and Treatment of Cancer (EORTC) - Headquarters, Brussels, Belgium
| | - Sandrine Marréaud
- European Organization for Research and Treatment of Cancer (EORTC) - Headquarters, Brussels, Belgium
| | | | | | - Giuseppe Curigliano
- Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, Italy; University of Milano, Milan, Italy
| | | | - Barbara Brouwers
- Department of Medical Oncology, AZ Sint-Jan Hospital, Brugge, Belgium
| | - Bart Meulemans
- European Organization for Research and Treatment of Cancer (EORTC) - Headquarters, Brussels, Belgium
| | - Berta Sousa
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Coralie Poncet
- European Organization for Research and Treatment of Cancer (EORTC) - Headquarters, Brussels, Belgium
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie - Hôpital René Huguenin, Saint-Cloud, France
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35
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Loi M, Salvatore G, Sottili M, Calosi L, Desideri I, Becherini C, Salvestrini V, Ciccone LP, Stocchi G, Meattini I, Francolini G, Mangoni M, Livi L. Tumor-associated macrophages (TAMs) modulate response to HER2-targeted agents in a humanized mouse model of breast cancer. Clin Transl Oncol 2022; 24:1395-1402. [PMID: 35212924 DOI: 10.1007/s12094-022-02785-z] [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: 10/06/2021] [Accepted: 01/20/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Tumor-associated macrophages (TAM) may participate to antitumor activity of anti-HER2-targeted therapies (Pertuzumab, Trastuzumab) in breast cancers harbouring HER-2 overexpression through antibody-dependent phagocytosis. Additive antitumor effect of concurrent cytotoxic chemotherapies, including Paclitaxel, may be counterbalanced by alteration in TAM infiltrate. The aim of this study is to evaluate the role of TAM in tumor response to anti-HER2-targeted therapies and chemotherapy in an experimental model of HER2-amplified breast cancer. METHODS A xenograft mouse model was built by subcutaneous injection of the SKBR-3 human HER2-amplified breast cancer cell line in Hu-CD34+ mice. Animals were randomized to receive weekly administration of Cremophor (control), Trastuzumab+Pertuzumab (TP), and Paclitaxel+Trastuzumab+Pertuzumab (PTP) with or without macrophage depletion with clodronate (C). At week 4, mice were euthanised and tumors were harvested for immunohistochemical analysis of TAM infiltration (RBP-J CD163 and CD68 for M1, M2, and overall TAM, respectively). RESULTS Tumor size was significantly lower in mice treated with TP, PTP, and PTP+C as compared to control, while no meaningful difference was observed in the TP+C arm. Analysis of TAM infiltrate showed significantly lower CD68 and CD163 expression in PTP, TP+C, and PTP+C as compared to TP and control arm. RBP-J expression was significantly decreased in mice treated with clodronate depletion. CONCLUSIONS Activity of TP is modulated by TAM infiltrate, that is inhibited by concurrent administration of Paclitaxel. To enhance the effect of anti-HER2-targeted therapies and minimize chemotherapy-related side effects, modulation of TAM should be considered in novel therapeutic combinations.
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Affiliation(s)
- M Loi
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy.
| | - G Salvatore
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy
| | - M Sottili
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy
| | - L Calosi
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, Research Unit of Histology an Embryology, University of Florence, Florence, Italy
| | - I Desideri
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy
- Department of Biomedical and Experimental Sciences, University of Florence, Florence, Italy
| | - C Becherini
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy
| | - V Salvestrini
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy
| | - L P Ciccone
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy
| | - G Stocchi
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy
| | - I Meattini
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy
- Department of Biomedical and Experimental Sciences, University of Florence, Florence, Italy
| | - G Francolini
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy
| | - M Mangoni
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy
- Department of Biomedical and Experimental Sciences, University of Florence, Florence, Italy
| | - L Livi
- Radiotherapy Department, University of Florence, 3, Largo Brambilla, 50124, Florence, Italy
- Department of Biomedical and Experimental Sciences, University of Florence, Florence, Italy
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36
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Yamamoto Y, Iwata H, Taira N, Masuda N, Takahashi M, Yoshinami T, Ueno T, Toyama T, Yamanaka T, Takano T, Kashiwaba M, Tsugawa K, Hasegawa Y, Tamura K, Tada H, Hara F, Fujisawa T, Niikura N, Saji S, Morita S, Toi M, Ohno S. Pertuzumab retreatment for HER2-positive advanced breast cancer: a randomized, open-label phase III study (PRECIOUS). Cancer Sci 2022; 113:3169-3179. [PMID: 35754298 PMCID: PMC9459345 DOI: 10.1111/cas.15474] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/25/2022] [Accepted: 06/16/2022] [Indexed: 11/26/2022] Open
Abstract
No standard options existed for human epidermal growth factor receptor 2 (HER2)‐positive advanced breast cancer that progresses after second‐line trastuzumab emtansine therapy before 2020. The purpose of this study was to examine the efficacy of pertuzumab retreatment after disease progression following pertuzumab‐containing therapy for HER2‐positive locally advanced or metastatic breast cancer for the first time. This randomized, open‐label, multicenter phase III trial was undertaken in 93 sites in Japan. Eligible patients with HER2‐positive breast cancer who had received pertuzumab, trastuzumab, and chemotherapy as first‐ and/or second‐line therapy were randomly assigned (1:1) to: (i) pertuzumab, trastuzumab, and physician's choice chemotherapy (PTC), or (ii) trastuzumab and physician's choice chemotherapy (TC). The primary end‐point was investigator‐assessed progression‐free survival (PFS). Between August 1, 2015 and December 31, 2018, 219 patients were randomized to PTC (n = 110) or TC (n = 109). Median follow‐up was 14.2 months (interquartile range, 9.0–22.2), and median PFS was 5.3 months (95% confidence interval [CI], 4.0–6.6) with PTC and 4.2 months (95% CI, 3.2–4.8) with TC (stratified hazard ratio 0.76 [95% CI upper limit 0.967]; p = 0.022). Progression‐free survival was improved by adding pertuzumab in all prespecified subgroups. The PTC arm showed a trend towards better overall survival and duration of response, but similar objective response and health‐related quality of life. The incidence of treatment‐related adverse events was similar between groups except for diarrhea. Pertuzumab retreatment contributes to disease control for HER2‐positive locally advanced or metastatic breast cancer previously treated with pertuzumab‐containing regimens.
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Affiliation(s)
- Yutaka Yamamoto
- Department of Breast and Endocrine Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi, Nagoya, Japan
| | - Naruto Taira
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Norikazu Masuda
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Formerly at Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan during conduct of this trial
| | - Masato Takahashi
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Tetsuhiro Yoshinami
- Department of Medical Oncology, Osaka, Osaka, Japan.,Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takayuki Ueno
- Breast Surgical Oncology, Breast Oncology Center, The Cancer Institute Hospital of the JFCR, Tokyo, Japan
| | - Tatsuya Toyama
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takashi Yamanaka
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Toshimi Takano
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan.,Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Masahiro Kashiwaba
- Department of Breast Surgery, Social Medical Corporation Hakuaikai, Sagara Hospital, Kagoshima, Japan.,Department of Breast Surgery, Adachi Breast Clinic, Kyoto, Japan
| | - Koichiro Tsugawa
- Department of Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshie Hasegawa
- Department of Breast Surgery, Hirosaki Municipal Hospital, Aomori, Japan
| | - Kenji Tamura
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Medical Oncology, Shimane University Hospital, Shimane, Japan
| | - Hiroshi Tada
- Department of Breast and Endocrine Surgical Oncology, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Fumikata Hara
- Breast Medical Oncology, Breast Oncology Center, The Cancer Institute Hospital of JFCR, Tokyo, Japan.,Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Tomomi Fujisawa
- Department of Breast Oncology, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University Hospital, Kanagawa, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital of the JFCR, Tokyo, Japan
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Omarini C, Piacentini F, Sperduti I, Cerma K, Barbolini M, Canino F, Nasso C, Isca C, Caggia F, Dominici M, Moscetti L. T-DM1 efficacy in trastuzumab- pertuzumab pre-treated HER2 positive metastatic breast cancer patients: a meta-analysis. BMC Cancer 2022; 22:623. [PMID: 35672679 PMCID: PMC9172020 DOI: 10.1186/s12885-022-09556-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Current guidelines consider T-DM1 the standard 2nd line therapy for HER2 positive metastatic breast cancer (MBC) patients following trastuzumab (T) + pertuzumab (P) and taxane 1st line treatment. Despite this, there are no prospective studies supporting this sequence. Methods We performed a meta-analysis using real world data to determine the efficacy of T-DM1 after 1st line TP in HER2 positive MBC patients. We used a random-effect model to find differences in the rate of 1-year progression free survival (PFS) between TP pre-treated population and the EMILIA phase III pivotal trial. Results Seven studies were eligible. The meta-analysis showed a combined 1-year PFS risk difference for T-DM1 efficacy after TP in 2nd or more lines of -0.122, with lower and upper limits of -0.253 and 0.010, respectively (p = 0.07), with low heterogeneity among studies (I2 0.01%, p = 0.836). Considering the four studies on T-DM1 in 2nd line setting, 1-year PFS risk was -0.034 (95% CI -0.207 – 0,139; p = 0.701) (I2 0.01%, p = 0.91). Conclusion Overall, the efficacy of T-DM1 after TP seems to be similar to that previously reported in the EMILIA trial. In the second line setting, data are not mature enough to confirm T-DM1 efficacy in TP pre-treated population. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09556-7.
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Affiliation(s)
- Claudia Omarini
- Division of Medical Oncology, University Hospital of Modena, Via del Pozzo 71, 41122, Modena, Italy.
| | - Federico Piacentini
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Isabella Sperduti
- Department of Bio-Statistics, RCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Krisida Cerma
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Monica Barbolini
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Fabio Canino
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Cecilia Nasso
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Christel Isca
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Federica Caggia
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Massimo Dominici
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Luca Moscetti
- Division of Medical Oncology, University Hospital of Modena, Via del Pozzo 71, 41122, Modena, Italy
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Ma J, Chen W, Hu Z, Huang J, Guo C, Zou C, Yang G. Rare ocular toxicity induced by pertuzumab/QL1209 in healthy chinese subjects: case reports and whole-exome sequencing analysis. Invest New Drugs 2022; 40:861-867. [PMID: 35596833 DOI: 10.1007/s10637-022-01256-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022]
Abstract
Pertuzumab is a recombinant anti-HER2 humanized monoclonal antibody widely used for the adjuvant treatment of HER2-positive breast cancer. Its safety is well established with the most common adverse effects being diarrhea and rash. To our knowledge, severe pertuzumab-induced ocular adverse events have never been reported. Herein, we describe several cases of pertuzumab/QL1209 (pertuzumab biosimilar)-induced blurred vision in healthy Chinese male subjects after a single injection of 420 mg pertuzumab/QL1209. Persistent optic nerve damage and vision loss occurred in the most severe case even after ophthalmic treatment. We conducted whole-exome sequencing (WES) of DNA samples from 5 cases and 13 controls to analyze the potential genetic factors and identified some associated variants (rs80303690 in RBM24, rs117375173 in CASR, rs1805097 in IRS2, and rs1227049 in CDH23). Furthermore, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways and Gene Ontology (GO) terms gene enrichment analyses were carried out for differentially expressed genes clustered in the PI3K/AKT/mTOR and Ras/Raf/MAPK signaling pathways, which were exactly activated by HER2 phosphorylation. In summary, this is the first report describing the occurrence of ocular toxicity induced by pertuzumab in the Chinese population and exploring the possible genetic mechanisms. These findings could provide evidence for clinicians to raise concerns about the risk of ocular toxicity with the clinical use of pertuzumab.
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Affiliation(s)
- Junlong Ma
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Wenjing Chen
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Zhanqing Hu
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Jie Huang
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Chengxian Guo
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Chan Zou
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
| | - Guoping Yang
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410013, Hunan, China.
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39
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Bernat-Peguera A, Trigueros M, Ferrando-Díez A, Ibáñez C, Bystrup S, Martínez-Cardús A, Margelí M, Martínez-Balibrea E. Efficacy of CT-P6 (trastuzumab biosimilar) versus reference trastuzumab in combination with pertuzumab in HER2-positive early-stage breast cancer: Preclinical and real-life clinical data. Breast 2022; 62:1-9. [PMID: 35078146 PMCID: PMC8787779 DOI: 10.1016/j.breast.2022.01.007] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/03/2022] Open
Abstract
After the expiration of trastuzumab data exclusivity, biosimilar drugs were approved by regulatory agencies; among them, CT-P6 which was approved for the treatment of HER2-positive early- and advanced-breast cancer (BC) in 2018. Yet, reference trastuzumab (RTZ) is often combined with pertuzumab in early BC (EBC) patients treated with chemotherapy as it significantly improves the pathological complete response rate. Unfortunately, scarce preclinical and clinical data exists about the combination of CT-P6, pertuzumab and chemotherapy. Therefore, our aim was to study in vitro and in a retrospective cohort of EBC patients, whether CT-P6 was equivalent to RTZ when combined with pertuzumab with or without taxanes. In BT-474 and SKBR3 HER2+ cells we found that CT-P6 alone or in combination with pertuzumab had the same negative effect on cell proliferation, colony formation and HER2 downregulation as well as downstream activation, as RTZ. Adding paclitaxel to these treatments increased their effectivity to a similar extent. In HER2 1+ neuregulin-secreting MB-MDA-175 cells, combinations of CT-P6 or RTZ with pertuzumab were also effective, and mainly dependent on HER3:HER2 heterodimerization. In a retrospective cohort of 44 EBC HER2+ patients treated with neoadjuvant RTZ or CT-P6 in combination with pertuzumab and chemotherapy, we found no differences in efficacy or in adverse events. Moreover, the costs of CT-P6-based treatments were reduced by 1474.07 €/patient. All together we provide pre-clinical and clinical evidence of the equivalence of CT-P6 in combination with pertuzumab and chemotherapy and suggest studying these combinations also in HER2 low/negative BC patients.
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Affiliation(s)
- Adrià Bernat-Peguera
- Germans Trias i pujol Research Institute (IGTP), Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain; B-ARGO Group, Catalan Institute of Oncology, Carretera del Canyet s/n, 08916, Badalona, Spain
| | - Macedonia Trigueros
- Germans Trias i pujol Research Institute (IGTP), Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain
| | - Angélica Ferrando-Díez
- Germans Trias i pujol Research Institute (IGTP), Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain; B-ARGO Group, Catalan Institute of Oncology, Carretera del Canyet s/n, 08916, Badalona, Spain; Medical Oncology Service, Catalan Institute of Oncology, Carretera del Canyet s/n, 08916, Badalona, Spain
| | - Cristina Ibáñez
- Pharmacy Unit, Catalan Institute of Oncology, Carretera del Canyet s/n, 08916, Badalona, Spain; Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Sara Bystrup
- Germans Trias i pujol Research Institute (IGTP), Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain
| | - Anna Martínez-Cardús
- Germans Trias i pujol Research Institute (IGTP), Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain; B-ARGO Group, Catalan Institute of Oncology, Carretera del Canyet s/n, 08916, Badalona, Spain
| | - Mireia Margelí
- Germans Trias i pujol Research Institute (IGTP), Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain; B-ARGO Group, Catalan Institute of Oncology, Carretera del Canyet s/n, 08916, Badalona, Spain; Medical Oncology Service, Catalan Institute of Oncology, Carretera del Canyet s/n, 08916, Badalona, Spain.
| | - Eva Martínez-Balibrea
- Germans Trias i pujol Research Institute (IGTP), Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain; ProCURE Program, Catalan Institute of Oncology, Carretera de can ruti, cami de les escoles s/n, Badalona, Spain.
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Harbeck N. Neoadjuvant and adjuvant treatment of patients with HER2-positive early breast cancer. Breast 2022; 62 Suppl 1:S12-S16. [PMID: 35148934 PMCID: PMC9097807 DOI: 10.1016/j.breast.2022.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 01/03/2023] Open
Abstract
The availability of HER2-targeted therapy has dramatically improved patient outcome in HER2-positive (HER2+) early breast cancer (EBC) as recently demonstrated by the EBCTCTG metaanalysis on trastuzumab in HER2+ EBC: Adding trastuzumab to chemotherapy has reduced recurrence rates and breast-cancer related mortality by a third [1]. Today, neoadjuvant therapy has become standard of care for women with stage II or III tumors as pathological complete response (pCR) status after surgery can be used to individualize adjuvant systemic therapy. pCR is correlated with favorable patient outcome, particularly in hormone receptor (HR) negative HER2+ EBC, as demonstrated by the FDA meta-analysis. Moreover, for patients with non-pCR, 14 cycles of adjuvant T-DM1 have become a new adjuvant therapy standard based on the results of the KATHERINE trial. Primary surgery can be offered to patients with low tumor burden (cN0 cT1). For this low-risk subgroup, 12 weeks of adjuvant paclitaxel + trastuzumab for one year are correlated with excellent outcome based on the APT trial results. A multidisciplinary team is essential right from the beginning for optimal locoregional and systemic therapy in such a complex neoadjuvant - adjuvant continuum of care. Clinical trials in HER2+ EBC are currently evaluating further therapy de-escalation in low-risk disease or patients with pCR whereas for patients with non-pCR, escalation trials are also ongoing. Newly approved drugs for HER2+ MBC like tucatinib or trastuzumab-deruxtecan or even immunotherapy combinations are being evaluated to improve upon efficacy of T-DM1 alone in the non-pCR setting. Regarding de-escalation, the WSG ADAPT trial demonstrated feasibility of avoiding overtreatment and individualizing neoadjuvant therapy without compromising outcome. Further de-escalation trials (e.g. DECRESCENDO, COMPASS-HER2) are currently ongoing.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Dept OB&GYN and CCCMunich, LMU University Hospital, Marchioninistrasse 15, 81377, Munich, Germany.
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Sussell JA, Roth JA, Meyer CS, Fung A, Hansen SA. Assessment of the Cost-Effectiveness of HER2-Targeted Treatment Pathways in the Neoadjuvant Treatment of High-Risk HER2-Positive Early-Stage Breast Cancer. Adv Ther 2022; 39:1375-1392. [PMID: 35094298 DOI: 10.1007/s12325-022-02047-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study aims to assess differences in costs and benefits of treatment strategies for high-risk human epidermal growth factor receptor 2 positive (HER2+) early-stage breast cancer (ESBC). METHODS We used a hybrid decision-tree/Markov model to simulate costs and outcomes across six health states: Invasive disease-free, non-metastatic recurrence, remission, first-line and second-line metastatic cancer, and death. We considered several strategies, defined by four attributes: (1) Neoadjuvant targeted therapy (infused pertuzumab and trastuzumab (PH) versus subcutaneous fixed-dose combination (FDC) of pertuzumab and trastuzumab versus trastuzumab alone (H)); (2) adjuvant targeted therapy if pathological complete response (pCR) is achieved (PH, FDC, or H); (3) adjuvant targeted therapy (T-DM1 or H) in the case of residual disease (RD); and (4) use of branded or biosimilar H. Transition probabilities were derived from relevant clinical trials. We included drug costs and costs associated with adverse events and administration. Health state utilities were obtained from clinical trials and the literature. RESULTS Strategies not containing T-DM1 were dominated (worse outcomes and greater costs) by strategies containing T-DM1. Among strategies with pertuzumab continuation in the case of pCR and T-DM1 in the case of RD, use of FDC was dominant (equivalent outcomes and lower costs), relative to strategies using infused therapies, regardless of biosimilar versus branded trastuzumab. Adjuvant continuation of FDC was also cost-effective (better outcomes at reasonable cost increases) relative to strategies which discontinued pertuzumab following pCR. CONCLUSION Dual targeted therapy via FDC (with transition to T-DM1 in the case of RD) is a cost-effective treatment strategy in high-risk HER2+ ESBC.
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Affiliation(s)
- Jesse A Sussell
- Evidence for Access, US Medical Affairs, Genentech, South San Francisco, CA, USA.
| | - Joshua A Roth
- Evidence for Access, US Medical Affairs, Genentech, South San Francisco, CA, USA
| | - Craig S Meyer
- Evidence for Access, US Medical Affairs, Genentech, South San Francisco, CA, USA
| | - Anita Fung
- US Medical Affairs, Genentech, South San Francisco, CA, USA
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Bartsch R, Gampenrieder SP, Rinnerthaler G, Petru E, Egle D, Petzer A, Balic M, Pluschnig U, Sliwa T, Singer C. Updated Austrian treatment algorithm in HER2+ metastatic breast cancer. Wien Klin Wochenschr 2022; 134:63-72. [PMID: 35089396 PMCID: PMC8813714 DOI: 10.1007/s00508-021-01987-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/08/2021] [Indexed: 12/21/2022]
Abstract
A group of Austrian breast cancer specialists met in December 2020 to establish a comprehensive clinical benefit-risk profile of available HER2-targeted therapies based on recent data and to develop an updated treatment algorithm by consensus over several months in 2021. A total of four scenarios were developed in which treatment strategies appropriate for specific patient profiles were evaluated. Consensus was established by detailed discussions of each scenario and by reaching full consensus.
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Affiliation(s)
- Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Simon Peter Gampenrieder
- Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Gabriel Rinnerthaler
- Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Edgar Petru
- University Hospital for Gynecology and Obstetrics, Clinical Department of Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Daniel Egle
- Department of Gynecology, Breast Cancer Center Tirol, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Andreas Petzer
- Barmherzige Schwestern, Elisabethinen, Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz GmbH, Seilerstätte 4, 4010, Linz, Austria
| | - Marija Balic
- Department of Internal Medicine, Division of Clinical Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Ursula Pluschnig
- Department of Internal Medicine and Hematology and Internal Oncology, Klagenfurt Hospital, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Thamer Sliwa
- 3rd Medical Department, Hematology and Oncology, Hanusch Hospital, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
| | - Christian Singer
- Department of Gynecology, Breast Cancer Center Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Uijen MJM, Lassche G, van Engen-van Grunsven ACH, Driessen CML, van Herpen CML. Case series of docetaxel, trastuzumab, and pertuzumab (DTP) as first line anti-HER2 therapy and ado-trastuzumab emtansine (T-DM1) as second line for recurrent or metastatic HER2-positive salivary duct carcinoma. Oral Oncol 2022; 125:105703. [PMID: 34995931 DOI: 10.1016/j.oraloncology.2021.105703] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Salivary duct carcinoma (SDC) overexpresses Human Epidermal growth factor Receptor 2 (HER2) in 29-46% of cases, favoring anti-HER2 therapy. Here, we present the results of patients with recurrent or metastatic HER2-positive SDC treated with docetaxel, trastuzumab, and pertuzumab (DTP) as first line anti-HER2 therapy and subsequently ado-trastuzumab emtansine (T-DM1) in second line. Furthermore, we searched for potential biomarkers. METHODS Retrospective case series from a tertiary hospital. First line anti-HER2 treatment consisted of DTP, after progression T-DM1 was considered for patients with an adequate performance status. Objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) were assessed and related to mRNA-based PI3K and MAPK signaling pathway activity scores. RESULTS Thirteen SDC HER2 + patients received DTP. In twelve evaluable patients, one complete response (CR) and six partial responses (PR) were observed (ORR 58%), with a median PFS of 6.9 months (95%-CI 5.3-8.5). Seven patients received subsequent T-DM1 in second line, resulting in four PR (ORR 57%), with a median PFS of 4.4 months (95%-CI 0-18.8). Median OS after start of DTP was 42.0 months (95%-CI 13.8-70.1). Grade ≥ 3 toxicity on DTP was seen in 39% of patients, and 14% on T-DM1. Highest combined PI3K and MAPK signaling was seen in the patient with CR and lowest in the patient with progressive disease on DTP. CONCLUSION In R/M HER2-positive SDC patients DTP followed by T-DM1 upon progression are promising treatments, leading to responses in the majority (58%) of the patients at an acceptable toxicity profile.
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Affiliation(s)
- M J M Uijen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - G Lassche
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - A C H van Engen-van Grunsven
- Department of Pathology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - C M L Driessen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - C M L van Herpen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands.
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Kadowaki H, Ishida J, Uehara M, Ishizuka M, Kiyosue A, Hatano M, Shimada S, Ono M, Akazawa H, Komuro I. Detection of Profound Myocardial Damage by Cardiac MRI in a Patient with Severe Cardiotoxicity Induced by Anti-HER2 Therapy. Int Heart J 2021; 62:1436-1441. [PMID: 34853231 DOI: 10.1536/ihj.21-388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Anti-HER2 therapy has greatly improved the long-term prognosis of patients with HER2-positive breast cancer. Meanwhile, by interfering with the protective effects of neuregulin-1/HER2 signaling on stressed cardiomyocytes, anti-HER2 therapy occasionally induces reversible cancer therapeutics-related cardiac dysfunction (CTRCD). Cardiac magnetic resonance (CMR) parametric mapping or myocardial feature-tracking, in combination with late gadolinium enhancement (LGE) imaging, has the potential to detect changes in the myocardium in anti-HER2 therapy-related cardiac dysfunction. Here we report a breast cancer patient who experienced life-threatening CTRCD after treatment with trastuzumab plus pertuzumab. This case showed multiple transmural LGE-positive myocardial lesions in CMR imaging and high native T1 and T2 values in CMR parametric mapping, which was apparently more extensive than those observed in most patients with anti-HER2 therapy-related cardiac dysfunction. Consistent with profound myocardial damage indicated by CMR, her cardiac function was not fully restored despite intensive care and cardioprotective drug therapy. These findings suggest the potential usefulness of LGE imaging and parametric mapping by CMR for the assessment of myocardial injury to determine the clinical severity of anti-HER2 therapy-related cardiac dysfunction.
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Affiliation(s)
| | - Junichi Ishida
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Masae Uehara
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Masato Ishizuka
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Arihiro Kiyosue
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Shogo Shimada
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroshi Akazawa
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo
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Cai JH, Zheng JH, Lin XQ, Lin WX, Zou J, Chen YK, Li ZY, Chen YX. Individualized treatment of breast cancer with chronic renal failure: A case report and review of literature. World J Clin Cases 2021; 9:10345-10354. [PMID: 34904109 PMCID: PMC8638037 DOI: 10.12998/wjcc.v9.i33.10345] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/05/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Studies have shown that patients with chronic renal failure (CRF) are more likely to suffer from breast cancer and other malignant tumors. To our knowledge, CRF can reduce drug excretion, thereby increase drug exposure and lead to increased toxicity, which will limit drug treatment and lead to tumor progression. Currently, there are few successful reports on the combination of docetaxel, trastuzumab, and pertuzumab (THP) as a neoadjuvant treatment regimen for breast cancer patients with CRF.
CASE SUMMARY We report a breast cancer (cT2N2M0, Her-2+/HR-) patient with CRF. It was a clinical stage IIIA tumor on the left breast. The patient had suffered from uremia for 2 years, and her heart function was normal. Based on the pathological type, molecular type, and clinical stage of breast cancer, and the patient’s renal function, the clinician analyzed the pharmacological and pharmacokinetic characteristics of the antitumor drugs after consulting the relevant literature, and prescribed the neoadjuvant regimen of THP (docetaxel 80 mg/m², trastuzumab 8 mg/kg for the first dose, and 6 mg/kg for the maintenance dose with pertuzumab 840 mg for the first dose and 420 mg for the maintenance dose), once every 3 wk, for a total of 6 courses. The neoadjuvant treatment had a good effect, and the patient then underwent surgery which was uneventful.
CONCLUSION CRF is not a contraindication for systemic treatment and surgery of breast cancer. The THP regimen without dose adjustment may be a safe and effective neoadjuvant treatment for HER-2 positive breast cancer patients with CRF.
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Affiliation(s)
- Jie-Hui Cai
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Jie-Hua Zheng
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Xiao-Qi Lin
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
- Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou 515041, Guangdong Province, China
| | - Wei-Xun Lin
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
- Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou 515041, Guangdong Province, China
| | - Juan Zou
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
- Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou 515041, Guangdong Province, China
| | - Yao-Kun Chen
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
- Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou 515041, Guangdong Province, China
| | - Zhi-Yang Li
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Ye-Xi Chen
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
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Rosier L, Wang Y, Lee JH, Daily K. Does definitive local therapy have a role in select HER2+ de novo metastatic breast cancer patients treated with dual anti-HER2 blockade? Breast Cancer Res Treat 2021. [PMID: 34787760 DOI: 10.1007/s10549-021-06440-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The role of surgery with curative intent in HER2+ de novo metastatic breast cancer (dnMBC) is uncertain in the era of dual antibody therapy. We sought to determine from existing retrospective data current practice patterns and if an association exists between surgery to the primary tumor and improved survival in HER2+ dnMBC patients treated with dual anti-HER2 blockade, accounting for selection bias. METHODS This study employed data from the National Cancer Database (NCDB) from the years 2013 to 2015. Study inclusion was limited to adult women with HER2+ dnMBC, who received immunotherapy/biologic response modifier drugs (BRM) as a first line treatment. Patients who received both systemic therapy and surgery to the primary breast tumor and patients who received systemic therapy alone were analyzed in two groups. Chi-square test for discrete variables and Wilcox on Rank-Sum test for numeric variables was used to compare the two groups based on patient, tumor, and treatment characteristics. The primary endpoint was overall survival from the time of diagnosis to the time of death. RESULTS 928 women with HER2+ dnMBC treated with BRM were identified with 43.5% (n = 404) receiving surgery and 56.5% (n = 524) receiving systemic therapy alone. The 3-year overall survival was superior for the surgery group (74.1%, 95% CI 67.9-79.2%) compared to the no surgery group (53.3%; 95% CI 47.6-58.6%). The no surgery group had median overall survival of 39.8 months (95% CI 34.1-44.9), while the surgery group had not yet reached median overall survival. CONCLUSION In a group of HER2+ dnMBC patients receiving systemic treatment in the era of dual antibody therapy, patients who underwent surgery had a superior 3-year survival rate than those who did not. There may be a role for a prospective trial in HER2+ dnMBC patients with an excellent response to dual HER2 blockade to investigate the contribution of curative intent local therapy to the primary tumor compared to systemic therapy alone.
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Al Rabadi LS, Cook MM, Kaempf AJ, Saraceni MM, Savin MA, Mitri ZI. Ado-trastuzumab for the treatment of metastatic HER2-positive breast cancer in patients previously treated with Pertuzumab. BMC Cancer 2021; 21:1150. [PMID: 34706686 PMCID: PMC8549287 DOI: 10.1186/s12885-021-08894-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Docetaxel in combination with two HER2-directed therapies, trastuzumab and pertuzumab, is the current standard frontline therapy for patients with metastatic HER2-positive breast cancer. Ado-trastuzumab (T-DM1), an antibody-drug conjugate of trastuzumab and a cytotoxic microtubule-inhibitory agent, emtansine, is approved in patients that have progressed with prior trastuzumab-based therapy. However, the benefit of T-DM1 in patients previously treated with pertuzumab therapy for metastatic breast cancer remains unclear. METHODS We identified thirty-three adults with metastatic HER2-positive breast cancer treated between March 2013 and July 2018 with T-DM1 either as subsequent therapy after progression on a pertuzumab-based regimen (i.e., "pertuzumab-pretreated") or without prior exposure to pertuzumab (i.e., "pertuzumab-naïve"). Collected data included patient demographics, treatment history, adverse events, and clinical outcomes. For both cohorts receiving T-DM1, the primary endpoint was PFS and secondary endpoints were overall survival (OS), overall response rate (ORR), clinical benefit rate (CBR), and T-DM1-related toxicity rate. RESULTS Pertuzumab-pretreated patients (n = 23, with 21 evaluable for T-DM1 efficacy) had a median PFS of 9.5 months (95% CI: 2.9-NA), 1-year OS rate of 67.4% (95% CI: 50.0-90.9%) with an unreached median, ORR of 14.3% (95% CI: 3.0-36.3%), and CBR of 52.4% (95% CI: 29.8-74.3%), with none of these measures being statistically different than those estimated for the pertuzumab-naïve group (n = 10). Treatment with T-DM1 after prior pertuzumab exposure (median T-DM1 duration 2.9 months) resulted in no grade ≥ 3 adverse events. CONCLUSIONS In our cohort, prior exposure to pertuzumab did not significantly impact T-DM1's clinical efficacy or safety profile as second- or later-line therapy in patients with metastatic HER2-positive breast cancer.
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Affiliation(s)
- Luai S Al Rabadi
- Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Road, OC14HO, Portland, OR, 97239, USA
| | - Madeline M Cook
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Andy J Kaempf
- Knight Cancer Institute, Biostatistics Shared Resource, Oregon Health & Science University, Portland, OR, USA
| | - Megan M Saraceni
- Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA
| | - Michael A Savin
- Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Road, OC14HO, Portland, OR, 97239, USA
| | - Zahi I Mitri
- Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Road, OC14HO, Portland, OR, 97239, USA.
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Borges A, Pereira F, Redondo P, Antunes L, Vieira C, Antunes P, Bento MJ, Sousa S, Lopes JM, Rocha-Gonçalves F, de Sousa JA, Pereira DS, Borges M. The addition of neoadjuvant pertuzumab for the treatment of HER2+ breast cancer: a cost estimate with real-world data. Health Econ Rev 2021; 11:33. [PMID: 34505956 PMCID: PMC8431932 DOI: 10.1186/s13561-021-00332-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Breast cancer (BC) is largely prevalent worldwide. HER2-positive BC account for roughly 20-25% of all BC cases and has an overall survival lower than other BC. Innovation on BC therapeutics is a constant, but novel therapies have higher costs. Therefore, cost-effectiveness research is essential to provide healthcare decision-makers with solid foundations for a resource allocation. This study aims to estimate the average direct medical costs/patient and cost-effectiveness of adding pertuzumab in neoadjuvant treatment (NeoT) for HER2-positive breast cancer (BC). METHODS Two retrospective real-world consecutive cohorts of ≥18yo female patients diagnosed with HER2-positive BC treated with NeoT at the Breast Clinic of IPO-Porto were studied. The AC-DH regimen (2012-2015) comprised 8 cycles of neoadjuvant therapy (4 cycles of doxorubicin + cyclosphosphamide followed by 4 cycles ofdocetaxel + trastuzumab), while the AC-DHP regimen (2015-2017) included also pertuzumab as NeoT. NeoT was followed by surgery and adjuvant trastuzumab. Micro-costing technique and a bottom-up approach was used comprising all medical direct costs from the hospital perspective. Unit costs were obtained from government official prices or from IPO-Porto costing system. Costs were adjusted to 2017 and are expressed in euros. Multivariable logistic regression models were used for effectiveness assessment, while generalized linear models with gamma distribution were used for costs. ICER was calculated using the pathological complete response (pCR) as the preferential measure of effectiveness. Sensitivity analysis was also performed. RESULTS AC-DHP (n = 40) and AC-DH (n = 54) cohorts had heterogenous patient profiles (median age 43y/53y; 67.5%/59.3% positive HR; 60.0%/27.8% operable; 25.0%/24.1% inflammatory, respectively). The AC-DHP average total cost/patient was 56,375€, with pertuzumab accounting for 13,978€ (24.79%) and increasing in 15,982€ the average cost/patient (p < 0.001). Clinical staging and hormone receptors (HR) were significantly associated with pCR. ICER was 1.370€ per percentage point of pCR. CONCLUSIONS ICER was more favourable in stage III HR negative BC patients compared to other patient profiles. Innovative treatments access is critical to deliver high-quality healthcare, but sustainability must be considered. These results suggest the importance of establishing a cost-effectiveness profile of Pertuzumab in NeoT for HER2-positive BC.
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Affiliation(s)
- Andreia Borges
- Outcomes Research Lab, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Management, Outcomes Research, and Economics in Healthcare Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Filipa Pereira
- Medical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Patrícia Redondo
- Outcomes Research Lab, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Management, Outcomes Research, and Economics in Healthcare Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Luís Antunes
- Department of Epidemiology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Cláudia Vieira
- Medical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Molecular Oncology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Antunes
- Surgical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Maria José Bento
- Department of Epidemiology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Department of Population Studies, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Susana Sousa
- Medical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - José Machado Lopes
- Outcomes Research Lab, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | | | - Joaquim Abreu de Sousa
- Surgical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Deolinda Sousa Pereira
- Medical Oncology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Marina Borges
- Outcomes Research Lab, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.
- Management, Outcomes Research, and Economics in Healthcare Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.
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Hanes V, Chow V, Stewart T, Puri A. A randomized, double-blind, single-dose study (LAVENDER) to assess the safety, tolerability, pharmacokinetics, and immunogenicity of a combined infusion of ABP 980 and pertuzumab in healthy subjects. Cancer Chemother Pharmacol 2021. [PMID: 34355250 DOI: 10.1007/s00280-021-04334-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/17/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE ABP 980 (KANJINTI™) is a biosimilar to reference product HERCEPTIN® (trastuzumab RP). The goal of this study was to characterize the safety, tolerability, and immunogenicity of ABP 980 plus pertuzumab (PERJETA®) when co-administered in a single infusion bag in healthy subjects. METHODS This randomized, double-blind, single-dose, 2-arm, parallel-group study (LAVENDER Study) evaluated an intravenous (IV) infusion of ABP 980 (6 mg/kg) plus pertuzumab (420 mg) combined in a single infusion bag relative to an IV infusion of trastuzumab RP (6 mg/kg) plus pertuzumab (420 mg) combined in a single infusion bag given over 60 min. The subjects were followed for 92 days post dosing. RESULTS A total of 42 subjects were enrolled in the study and treated with investigational product. Due to an operational issue during dosing, the first 6 subjects enrolled in the study were replaced. A total of 36 randomized subjects, n = 18 for ABP 980 plus pertuzumab and n = 18 for trastuzumab RP plus pertuzumab, were treated. Resulting serum concentrations of ABP 980 and trastuzumab RP were similar. There were no serious adverse events, no deaths, and no cardiac disorders during the study. No subject developed anti-drug antibodies throughout the study. CONCLUSIONS This study demonstrated the safety and tolerability of ABP 980 and pertuzumab admixture in a single infusion bag. The safety profiles and pharmacokinetic parameters of ABP 980 and pertuzumab were consistent with what is known for trastuzumab RP and pertuzumab. CLINICAL TRIAL LISTING EudraCT 2018-002903-33.
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Sekine C, Kawase K, Yoshida K. Sarcoid-like reaction in a HER2-positive breast cancer patient: A case report. Int J Surg Case Rep 2021; 85:106280. [PMID: 34393095 PMCID: PMC8361042 DOI: 10.1016/j.ijscr.2021.106280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Sarcoid-like reaction is a systemic granulomatous reaction that may develop in the lymph nodes and organs of cancer patients. Distinguishing a sarcoid-like reaction from metastasis is difficult. Accurate diagnosis of this reaction is key to preventing overtreatment. CASE PRESENTATION A 51-year-old woman presented with a lump in her left breast and swollen lymph nodes in her left axilla and infraclavicular fossa. A core biopsy was performed, leading to the diagnosis of grade 2 infiltrating ductal carcinoma, clinical stage T2N3M0 with estrogen and progesterone receptor negativity and human epidermal growth factor receptor-2 positivity. After neoadjuvant therapy, the tumor in her left breast reduced in size, but the lymph nodes remained swollen. Mastectomy and axillary lymph node dissections were performed. In the pathological findings, epithelioid cell granuloma was observed in the lymph nodes. Based on these findings, lymph node swelling was attributed to a sarcoid-like reaction. CLINICAL DISCUSSION SLRs have been reported in 4-14% of cancer patients. Although there are various imaging modalities for detecting swollen lymph nodes, the differential diagnosis of cancer metastasis is often difficult. CONCLUSION Histological evaluation of swollen lymph nodes is required to prevent overtreatment; especially in cases where the tumor size is reduced by chemotherapy, but the lymph nodes remain swollen.
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Affiliation(s)
- Chikako Sekine
- Department of Surgery, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Aoto, Katsushika ward, Tokyo 125-8506, Japan; Department of Breast Surgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda Narita, Chiba 286-8520, Japan.
| | - Kazumi Kawase
- Department of Surgery, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Aoto, Katsushika ward, Tokyo 125-8506, Japan
| | - Kazuhiko Yoshida
- Department of Surgery, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Aoto, Katsushika ward, Tokyo 125-8506, Japan
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