2
|
Ma CX, Gao F, Northfelt D, Goetz M, Forero A, Naughton M, Ademuyiwa F, Suresh R, Anderson KS, Margenthaler J, Aft R, Hobday T, Moynihan T, Gillanders W, Cyr A, Eberlein TJ, Hieken T, Krontiras H, Hoog J, Han J, Guo Z, Vij K, Mardis E, Al-Kateb H, Sanati S, Ellis MJ. Abstract S6-05: A phase II trial of neoadjuvant palbociclib, a cyclin-dependent kinase (CDK) 4/6 inhibitor, in combination with anastrozole for clinical stage 2 or 3 estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s6-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
ER+ BC is associated with activated CDK4/6. The CDK4/6 inhibitor palbociclib (P) markedly improves time to progression in advanced ER+HER2- BC. We conducted a neoadjuvant phase II trial to determine the activity of P in primary breast cancer as a prelude to adjuvant studies.
Methods
To assess molecular changes induced by anastrozole (A) or P+A, patients (pts) were treated initially with A alone (1mg PO daily) for 28 days in cycle 0 (C0) before the addition of P (125mg PO daily on D1-21 each cycle) on C1D1. P+A was administered for 4 28-day cycles followed by C5 with A alone for 2-4 weeks (wks) before surgery. P was added in C5 for 10-12 days immediately prior to surgery in the last 20 pts enrolled to assess molecular changes induced by A, either alone or in combination with P immediately prior to surgery, in resected tumor. Goserelin was added in premenopausal pts.
Research tumor biopsies were obtained at baseline, C1D1, and C1D15. Central Ki67 analysis was performed at all timepoints, those with Ki67 >10% at C1D15 went off study treatment.
The primary endpoint was complete cell cycle arrest (CCA), defined as Ki67 <2.7%, at C1D15. Patient stratification was based on PIK3CA mutation status with an initial focus on PIK3CA wild type (WT) disease. Pts with PIK3CA mutant (Mut) tumors enrolled to a separate cohort. A sample size of 33 pts in the PIK3CA WT cohort was chosen based on the Fleming's single-stage phase II design to test the hypothesis that P+A leads to > 50% improvement over A in CCA rate on C1D15 biopsy (44% with A alone based on historical data, vs 66% with P+A, power = 0.8, alpha=0.05). The primary endpoint is met if >20 pts achieved CCA in this cohort.
Correlative endpoints included assessment of markers of proliferation, apoptosis, senescence, Rb, gene expression microarray, intrinsic subtype, and next generation sequencing of 83-gene panels, which will be reported at the meeting.
Results
Between 4/23/2013 and 4/24/2015, 50 pts (33 PIK3CA WT, 11 PIK3CA Mut, 2 pending, 4 tissue quantity or quality not sufficient for sequencing (QNS)) were enrolled to the study. Median age was 57.5 (range: 34.1–79.6) years. Four pts, all with WT PIK3CA, went off study due to Ki67 >10% on C1D15 biopsy, 26 pts completed treatment and surgery, 1 refused surgery, 3 withdrew study treatment in C1, and 16 continued to receive study drug (2 in C0, 3 in C1, 4 in C2, 5 in C3, 1 in C4, and 1 in C5). Among the 40 pts currently evaluable for the primary endpoint (C1D15 Ki67), CCA occurred in 34 (85%) pts, including 9 of 9 (100%) PIK3CA Mut, 22 of 28 (78.5%) WT, and 3 of 3 QNS pts. Preliminary analysis of available data indicated a significantly lower Ki67 value after 2 wks of P+A (C1D15) compared to that on A alone (C1D1) (p=0.034, n=18).
Conclusion
This study met the primary endpoint demonstrating that P+A is a highly effective anti-proliferative combination. The sequential biopsy design clearly demonstrated that P+A increased cell cycle control over A alone. P+A was effective regardless of PIK3CA mutation status and these results support the evaluation of this combination in the adjuvant setting for ER+HER2- BC.
Citation Format: Ma CX, Gao F, Northfelt D, Goetz M, Forero A, Naughton M, Ademuyiwa F, Suresh R, Anderson KS, Margenthaler J, Aft R, Hobday T, Moynihan T, Gillanders W, Cyr A, Eberlein TJ, Hieken T, Krontiras H, Hoog J, Han J, Guo Z, Vij K, Mardis E, Al-Kateb H, Sanati S, Ellis MJ. A phase II trial of neoadjuvant palbociclib, a cyclin-dependent kinase (CDK) 4/6 inhibitor, in combination with anastrozole for clinical stage 2 or 3 estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S6-05.
Collapse
Affiliation(s)
- CX Ma
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - F Gao
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - D Northfelt
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - M Goetz
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - A Forero
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - M Naughton
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - F Ademuyiwa
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - R Suresh
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - KS Anderson
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - J Margenthaler
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - R Aft
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - T Hobday
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - T Moynihan
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - W Gillanders
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - A Cyr
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - TJ Eberlein
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - T Hieken
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - H Krontiras
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - J Hoog
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - J Han
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - Z Guo
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - K Vij
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - E Mardis
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - H Al-Kateb
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - S Sanati
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| | - MJ Ellis
- Washington University, Saint Louis, MO; Mayo Clinic, Scottsdale, AZ; Mayo Clinic, Rochester, MN; University of Alabama at Birmingham, Birmingham, AL; Baylor College of Medicine, Houston, TX
| |
Collapse
|
3
|
Labonté MÈ, Cyr A, Abdullah MM, Lépine MC, Vohl MC, Jones P, Couture P, Lamarche B. Dairy product consumption has no impact on biomarkers of inflammation among men and women with low-grade systemic inflammation. J Nutr 2014; 144:1760-7. [PMID: 25332474 DOI: 10.3945/jn.114.200576] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Randomized controlled trials specifically designed to assess inflammation-related outcomes in response to dairy consumption are lacking. OBJECTIVE We investigated the impact of dairy food consumption on biomarkers of inflammation in healthy men and women with low-grade systemic inflammation. METHODS In a multicenter randomized crossover study, 112 adult men and women with high-sensitivity C-reactive protein (hs-CRP) values >1 mg/L consumed 3 servings/d of dairy (375 mL low-fat milk, 175 g low-fat yogurt, and 30 g regular-fat cheddar cheese) or energy-matched control (fruit juice, vegetable juice, cashews, and 1 cookie) products as part of prudent 4-wk diets, each separated by a 4- to 8-wk washout period. Serum concentrations of inflammation biomarkers were measured at the beginning and end of each dietary phase. Expression levels of key inflammatory genes and transcription factors in whole blood cells were assessed at the end of each diet by real-time polymerase chain reaction in a random subset of 53 subjects. RESULTS Analysis of within-diet changes (post- vs. prediet values) showed a significant reduction in hs-CRP concentrations after the control diet (-11.7%, P = 0.05) but no change after the dairy diet (-7.3%, P = 0.47). As a result, changes in hs-CRP differed between the dairy and control diets (P = 0.04). Both the control and dairy diets similarly reduced interleukin-6 concentrations compared with diet-specific baseline values (-17.6% and -19.9%, respectively; P < 0.0001 for both, P = 0.77 for between-diet comparison). No between- or within-diet difference was observed in adiponectin concentrations, and there was also no between-diet difference in the expression of inflammatory genes and transcription factors. CONCLUSION Consistent with data from previous work, these results suggest that short-term consumption of a combination of low- and high-fat dairy products as part of a healthy diet has no adverse effects on inflammation. This trial was registered at www.clinicaltrials.gov as NCT01444326.
Collapse
Affiliation(s)
- Marie-Ève Labonté
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada; and
| | - Audrey Cyr
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada; and
| | - Mohammad M Abdullah
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, MB, Canada
| | - Marie-Claude Lépine
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada; and
| | - Marie-Claude Vohl
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada; and
| | - Peter Jones
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, MB, Canada
| | - Patrick Couture
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada; and
| | - Benoît Lamarche
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada; and
| |
Collapse
|