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Kingston B, Pearson A, Herrera-Abreu MT, Sim LX, Cutts RJ, Shah H, Moretti L, Kilburn LS, Johnson H, Macpherson IR, Ring A, Bliss JM, Hou Y, Toy W, Katzenellenbogen JA, Chandarlapaty S, Turner NC. ESR1 F404 Mutations and Acquired Resistance to Fulvestrant in ESR1-Mutant Breast Cancer. Cancer Discov 2024; 14:274-289. [PMID: 37982575 PMCID: PMC10850945 DOI: 10.1158/2159-8290.cd-22-1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/18/2023] [Accepted: 11/16/2023] [Indexed: 11/21/2023]
Abstract
Fulvestrant is used to treat patients with hormone receptor-positive advanced breast cancer, but acquired resistance is poorly understood. PlasmaMATCH Cohort A (NCT03182634) investigated the activity of fulvestrant in patients with activating ESR1 mutations in circulating tumor DNA (ctDNA). Baseline ESR1 mutations Y537S are associated with poor outcomes and Y537C with good outcomes. Sequencing of baseline and EOT ctDNA samples (n = 69) revealed 3/69 (4%) patients acquired novel ESR1 F404 mutations (F404L, F404I, and F404V), in cis with activating mutations. In silico modeling revealed that ESR1 F404 contributes to fulvestrant binding to estrogen receptor-alpha (ERα) through a pi-stacking bond, with mutations disrupting this bond. In vitro analysis demonstrated that single F404L, E380Q, and D538G models were less sensitive to fulvestrant, whereas compound mutations D538G + F404L and E380Q + F404L were resistant. Several oral ERα degraders were active against compound mutant models. We have identified a resistance mechanism specific to fulvestrant that can be targeted by treatments in clinical development. SIGNIFICANCE Novel F404 ESR1 mutations may be acquired to cause overt resistance to fulvestrant when combined with preexisting activating ESR1 mutations. Novel combinations of mutations in the ER ligand binding domain may cause drug-specific resistance, emphasizing the potential of similar drug-specific mutations to impact the efficacy of oral ER degraders in development. This article is featured in Selected Articles from This Issue, p. 201.
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Affiliation(s)
- Belinda Kingston
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Alex Pearson
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Maria Teresa Herrera-Abreu
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Li-Xuan Sim
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Rosalind J. Cutts
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Heena Shah
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Laura Moretti
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Lucy S. Kilburn
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Hannah Johnson
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Iain R. Macpherson
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Alistair Ring
- Breast Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Judith M. Bliss
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Yingwei Hou
- Department of Chemistry and Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Weiyi Toy
- Memorial Sloan Kettering Cancer Center, New York City, New York
- Department of Medicine, Weill Cornell Medical College, New York City, New York
| | - John A. Katzenellenbogen
- Department of Chemistry and Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Sarat Chandarlapaty
- Memorial Sloan Kettering Cancer Center, New York City, New York
- Department of Medicine, Weill Cornell Medical College, New York City, New York
| | - Nicholas C. Turner
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
- Breast Unit, The Royal Marsden Hospital, London, United Kingdom
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Kingston B, Pearson A, Herrera-Abreu MT, Cutts R, Moretti L, Kilburn L, Johnson H, MacPherson IR, Ring AE, Bliss J, Katzenellenbogen JA, Turner NC. ESR1 F404 mutations and acquired resistance to fulvestrant in the plasmaMATCH study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1009 Background: The selective estrogen receptor modulator (SERD) fulvestrant is commonly used to treat patients with hormone receptor positive advanced breast cancer, although potential mechanisms of acquired resistance are poorly understood. plasmaMATCH cohort A (NCT03182634) investigated the activity of fulvestrant in patients with activating ESR1 mutations in circulating tumor DNA (ctDNA). Here we present analysis of baseline and end-of-treatment (EOT) ctDNA to identify potential resistance mutations to fulvestrant. Methods: Paired baseline and EOT plasma samples from patients enrolled into plasmaMATCH underwent ctDNA sequencing (Guardant360, Guardant Health) to identify acquired mutations. For F404 analysis, MCF-7 cells were transiently transfected with estrogen receptor expression constructs containing either wildtype ESR1 (WT), single ESR1 mutations (D538G, E380Q, F404L), or compound mutations (D538G_F404L, E380Q_F404L), alongside an estrogen response element (ERE)-luciferase reporter construct. Transfected cells were treated with or without fulvestrant and ERE-luciferase activity compared. Results: Of 84 patients enrolled in cohort A, 69 had paired baseline and EOT sequencing. Patients with baseline ESR1 Y537S had shorter progression free survival (PFS), and Y537C longer PFS, than those wild-type for each respective mutation (p = 0.03 and p = 0.04). Patients frequently acquired mutations at EOT (n = 35, 51%), including potentially targetable mutations in 25% (including 3 PTEN, 3 BRCA1/2, 2 PIK3CA, 2 HER2, 1 BRAF). Three (4%) patients acquired ESR1 p.F404 mutations (F404L, F404I, F404V), with 7 mutations in total. Of 26 patients with PFS of ≥16 weeks, 3 patients (12%) acquired ESR1 F404. In 800 patients screened for entry to plasmaMATCH, one harbored a F404 mutation (0.13%), with a prior history of fulvestrant. F404 mutations resided in cis with E380Q in 6/7 assessable mutations. In vitro structural modelling revealed that ESR1 p.F404 resides within the ESR1 ligand binding domain, and contributes to estrogen and fulvestrant binding through a pi-stacking bond between the aromatic ring of phenylalanine and estrogen/fulvestrant, with all F404 mutations disrupting this bond. Transient transfection demonstrated that single mutations D538G, E380Q, F404L and wild-type ESR1 were sensitive to fulvestrant (p < 0.0001, p = 0.0006, p = 0.04 and p = 0.0001), whereas compound mutations D538G_F404L and E380Q_F404L were resistant. Further investigation of relative sensitivity of the F404 mutant ESR1 to other anti-estrogens will be presented. Conclusions: We have identified a novel resistance mechanism to fulvestrant, with F404 mutations acquired in patients with pre-existing activating ESR1 mutations. F404 confers fulvestrant resistance through the loss of a pi-stacking bond and likely reduced fulvestrant binding affinity, identifying a new potential target to overcome endocrine therapy resistance.
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Affiliation(s)
- Belinda Kingston
- Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, United Kingdom
| | - Alex Pearson
- Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, United Kingdom
| | | | - Ros Cutts
- Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, United Kingdom
| | - Laura Moretti
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom
| | - Lucy Kilburn
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom
| | | | | | | | - Judith Bliss
- The Institute of Cancer Research, Clinical Trials & Statistics Unit, London, United Kingdom
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Kingston B, Cutts RJ, Bye H, Beaney M, Walsh-Crestani G, Hrebien S, Swift C, Kilburn LS, Kernaghan S, Moretti L, Wilkinson K, Wardley AM, Macpherson IR, Baird RD, Roylance R, Reis-Filho JS, Hubank M, Faull I, Banks KC, Lanman RB, Garcia-Murillas I, Bliss JM, Ring A, Turner NC. Author Correction: Genomic profile of advanced breast cancer in circulating tumor DNA. Nat Commun 2021; 12:4479. [PMID: 34272402 PMCID: PMC8285402 DOI: 10.1038/s41467-021-24791-5] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Belinda Kingston
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Rosalind J Cutts
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Hannah Bye
- Centre for Molecular Pathology, Royal Marsden Hospital, London, UK
| | - Matthew Beaney
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Giselle Walsh-Crestani
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Sarah Hrebien
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Claire Swift
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | | | | | - Laura Moretti
- ICR-CTSU, The Institute of Cancer Research, London, UK
| | | | - Andrew M Wardley
- NIHR Manchester Clinical Research Facility at The Christie, Manchester Academic Health Science Centre & Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK
| | | | | | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Michael Hubank
- Centre for Molecular Pathology, Royal Marsden Hospital, London, UK
| | - Iris Faull
- Guardant Health, Inc., Redwood City, CA, USA
| | | | | | - Isaac Garcia-Murillas
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | | | - Alistair Ring
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK.
| | - Nicholas C Turner
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK.
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK.
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Kingston B, Cutts R, Beaney M, Walsh-Crestani G, Hrebien S, Kilburn L, Kernaghan S, Moretti L, Wilkinson K, MacPherson I, Baird R, Roylance R, Reis-Filho J, Hubank M, Faull I, Banks K, Garcia-Murillas I, Bliss J, Ring A, Turner N. 99P Analysis of ctDNA in advanced breast cancer reveals polyclonal disease associated with adverse outcome. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kingston B, Cutts RJ, Bye H, Beaney M, Walsh-Crestani G, Hrebien S, Swift C, Kilburn LS, Kernaghan S, Moretti L, Wilkinson K, Wardley AM, Macpherson IR, Baird RD, Roylance R, Reis-Filho JS, Hubank M, Faull I, Banks KC, Lanman RB, Garcia-Murillas I, Bliss JM, Ring A, Turner NC. Genomic profile of advanced breast cancer in circulating tumour DNA. Nat Commun 2021; 12:2423. [PMID: 33893289 PMCID: PMC8065112 DOI: 10.1038/s41467-021-22605-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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: 06/29/2020] [Accepted: 03/16/2021] [Indexed: 12/31/2022] Open
Abstract
The genomics of advanced breast cancer (ABC) has been described through tumour tissue biopsy sequencing, although these approaches are limited by geographical and temporal heterogeneity. Here we use plasma circulating tumour DNA sequencing to interrogate the genomic profile of ABC in 800 patients in the plasmaMATCH trial. We demonstrate diverse subclonal resistance mutations, including enrichment of HER2 mutations in HER2 positive disease, co-occurring ESR1 and MAP kinase pathway mutations in HR + HER2- disease that associate with poor overall survival (p = 0.0092), and multiple PIK3CA mutations in HR + disease that associate with short progression free survival on fulvestrant (p = 0.0036). The fraction of cancer with a mutation, the clonal dominance of a mutation, varied between genes, and within hotspot mutations of ESR1 and PIK3CA. In ER-positive breast cancer subclonal mutations were enriched in an APOBEC mutational signature, with second hit PIK3CA mutations acquired subclonally and at sites characteristic of APOBEC mutagenesis. This study utilises circulating tumour DNA analysis in a large clinical trial to demonstrate the subclonal diversification of pre-treated advanced breast cancer, identifying distinct mutational processes in advanced ER-positive breast cancer, and novel therapeutic opportunities.
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Affiliation(s)
- Belinda Kingston
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Rosalind J Cutts
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Hannah Bye
- Centre for Molecular Pathology, Royal Marsden Hospital, London, UK
| | - Matthew Beaney
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Giselle Walsh-Crestani
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Sarah Hrebien
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Claire Swift
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | | | | | - Laura Moretti
- ICR-CTSU, The Institute of Cancer Research, London, UK
| | | | - Andrew M Wardley
- NIHR Manchester Clinical Research Facility at The Christie, Manchester Academic Health Science Centre & Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK
| | | | | | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Michael Hubank
- Centre for Molecular Pathology, Royal Marsden Hospital, London, UK
| | - Iris Faull
- Guardant Health, Inc., Redwood City, CA, USA
| | | | | | - Isaac Garcia-Murillas
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | | | - Alistair Ring
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK.
| | - Nicholas C Turner
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK.
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK.
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Pascual J, Cutts RJ, Kingston B, Hrebien S, Kilburn LS, Kernaghan S, Moretti L, Wilkinson K, Wardley AM, Macpherson IR, Baird RD, Roylance R, Hubank M, Walsh G, Faull I, Banks KC, Lanman RB, Garcia-Murillas I, Bliss JM, Ring A, Turner NC. Abstract PS5-02: Assessment of early ctDNA dynamics to predict efficacy of targeted therapies in metastatic breast cancer: Results from plasmaMATCH trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps5-02] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Early changes in circulating tumour DNA (ctDNA) levels may identify which patients respond to therapy earlier than imaging, with ctDNA levels falling rapidly in patients who respond to therapy. The plasmaMATCH trial assessed the utility of ctDNA testing with an error-corrected 73-gene targeted panel (Guardant360, Guardant Health) to allocate patients to four mutation matched therapy cohorts. ESR1-extended fulvestrant (A), HER2-neratinib +/- fulvestrant (B), AKT1-capivasertib + fulvestrant (C), AKT basket-capivasertib (D). Here, we report paired baseline and early on treatment ctDNA analysis from plasmaMATCH, to establish the optimal criteria for predicting progression free survival (PFS). Methods: In plasmaMATCH treatment cohorts, plasma samples were collected for ctDNA analysis pre-treatment at cycle 1-day 1 (C1D1) and cycle 2-day 1 (C2D1) timepoints, and sequenced with the Guardant 360 assay. Patients were included if they had a minimum of 14 days of treatment in the first cycle. Multiple different methods were investigated to integrate variant allele fractions (VAF) of mutations identified at each timepoint to estimate the level of ctDNA, including maximum VAF, mean VAF and weighted mean VAF, and weighted mean VAF of clonal mutations at C1D1. Variants with a VAF <0.3%, set as the limit of detection, in C1D1 were excluded. Genes frequently mutated in CHIP were excluded (GNAS, JAK2, IDH1, IDH2 and ATM) from the weighted mean VAF of clonal mutations method. The circulating DNA ratio (CDR) was calculated as the ratio of C2D1 level relative to C1D1 level. The optimal cut-point for predicting PFS was assessed by fitting a range of cutpoints for each VAF integration method, identifying the cut-point with the highest Harrell’s C-index. Results: A total of 142 patients were enrolled into plasmaMATCH cohorts A-D, 79 patients had samples sent for paired C1D1-C2D1 plasma ctDNA sequencing, 1 failed sequencing and 1 insufficient treatment, and 77 (54%) patients had assessable C1D1-C2D1 plasma ctDNA sequencing results (45 cohort A, 12 cohort B, 12 cohort C, 8 cohort D). A weighted mean of clonal mutations in C1D1 ctDNA sequencing was the optimal method for integrating VAF, with peak C-Index 0.67. At the optimal C-index cutoff of 0.132, median PFS with high ctDNA CDR was 2.4 months (95% CI 2.0-3.7) and with suppressed ctDNA CDR was 9.9 months (95% CI 7.0-13.7) (HR 4.3, 95% CI 2.4-7.6, p<0.0001). Early changes in ctDNA level were also predictive in cohorts A extended dose fulvestrant alone (HR 5.8, 95% CI 2.2-16, p=0.0001) and cohorts B-D of targeted therapy (HR 3.8, 95% CI 1.7-8.6, p=0.00063). In analysis that was not pre-planned, patients with undetectable ctDNA at C2D1 had a particularly good outcome (p<0.0001, table 1). Conclusions: We identify an optimal methodology for assessing early dynamic changes in ctDNA that predicts treatment efficacy in patients with metastatic breast cancer. This methodology will require validation in independent data-sets, and if validated would allow trials of adapting therapy on the basis of early ctDNA dynamics.
Table 1ctDNA dynamics categoryMedian PFS months (95%CI)6-month PFSORRUndetectable (N=11) CDR=018.2 (10.2-NA)91%9/11 (82%)Suppressed (N=14) CDR <0.132 and >05.4 (4.6-NA)48%6/14 (43%)High (N=52) CDR >=0.1322.4 (2.0-3.7)8%4/52 (8%)
Citation Format: Javier Pascual, Rosalind J Cutts, Belinda Kingston, Sarah Hrebien, Lucy S Kilburn, Sarah Kernaghan, Laura Moretti, Katie Wilkinson, Andrew M Wardley, Iain R Macpherson, Richard D Baird, Rebecca Roylance, Michael Hubank, Giselle Walsh, Iris Faull, Kimberly C Banks, Richard B Lanman, Isaac Garcia-Murillas, Judith M Bliss, Alistair Ring, Nicholas C Turner. Assessment of early ctDNA dynamics to predict efficacy of targeted therapies in metastatic breast cancer: Results from plasmaMATCH trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS5-02.
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Affiliation(s)
- Javier Pascual
- 1The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | | | - Sarah Hrebien
- 2The Institute of Cancer Research, London, United Kingdom
| | - Lucy S Kilburn
- 2The Institute of Cancer Research, London, United Kingdom
| | | | - Laura Moretti
- 2The Institute of Cancer Research, London, United Kingdom
| | | | | | - Iain R Macpherson
- 4Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Richard D Baird
- 5Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Rebecca Roylance
- 6University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Michael Hubank
- 2The Institute of Cancer Research, London, United Kingdom
| | - Giselle Walsh
- 2The Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | - Judith M Bliss
- 2The Institute of Cancer Research, London, United Kingdom
| | - Alistair Ring
- 1The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Nicholas C Turner
- 1The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
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Turner NC, Kingston B, Kilburn LS, Kernaghan S, Wardley AM, Macpherson IR, Baird RD, Roylance R, Stephens P, Oikonomidou O, Braybrooke JP, Tuthill M, Abraham J, Winter MC, Bye H, Hubank M, Gevensleben H, Cutts R, Snowdon C, Rea D, Cameron D, Shaaban A, Randle K, Martin S, Wilkinson K, Moretti L, Bliss JM, Ring A. Circulating tumour DNA analysis to direct therapy in advanced breast cancer (plasmaMATCH): a multicentre, multicohort, phase 2a, platform trial. Lancet Oncol 2020; 21:1296-1308. [PMID: 32919527 PMCID: PMC7599319 DOI: 10.1016/s1470-2045(20)30444-7] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Circulating tumour DNA (ctDNA) testing might provide a current assessment of the genomic profile of advanced cancer, without the need to repeat tumour biopsy. We aimed to assess the accuracy of ctDNA testing in advanced breast cancer and the ability of ctDNA testing to select patients for mutation-directed therapy. METHODS We did an open-label, multicohort, phase 2a, platform trial of ctDNA testing in 18 UK hospitals. Participants were women (aged ≥18 years) with histologically confirmed advanced breast cancer and an Eastern Cooperative Oncology Group performance status 0-2. Patients had completed at least one previous line of treatment for advanced breast cancer or relapsed within 12 months of neoadjuvant or adjuvant chemotherapy. Patients were recruited into four parallel treatment cohorts matched to mutations identified in ctDNA: cohort A comprised patients with ESR1 mutations (treated with intramuscular extended-dose fulvestrant 500 mg); cohort B comprised patients with HER2 mutations (treated with oral neratinib 240 mg, and if oestrogen receptor-positive with intramuscular standard-dose fulvestrant); cohort C comprised patients with AKT1 mutations and oestrogen receptor-positive cancer (treated with oral capivasertib 400 mg plus intramuscular standard-dose fulvestrant); and cohort D comprised patients with AKT1 mutations and oestrogen receptor-negative cancer or PTEN mutation (treated with oral capivasertib 480 mg). Each cohort had a primary endpoint of confirmed objective response rate. For cohort A, 13 or more responses among 78 evaluable patients were required to infer activity and three or more among 16 were required for cohorts B, C, and D. Recruitment to all cohorts is complete and long-term follow-up is ongoing. This trial is registered with ClinicalTrials.gov, NCT03182634; the European Clinical Trials database, EudraCT2015-003735-36; and the ISRCTN registry, ISRCTN16945804. FINDINGS Between Dec 21, 2016, and April 26, 2019, 1051 patients registered for the study, with ctDNA results available for 1034 patients. Agreement between ctDNA digital PCR and targeted sequencing was 96-99% (n=800, kappa 0·89-0·93). Sensitivity of digital PCR ctDNA testing for mutations identified in tissue sequencing was 93% (95% CI 83-98) overall and 98% (87-100) with contemporaneous biopsies. In all cohorts, combined median follow-up was 14·4 months (IQR 7·0-23·7). Cohorts B and C met or exceeded the target number of responses, with five (25% [95% CI 9-49]) of 20 patients in cohort B and four (22% [6-48]) of 18 patients in cohort C having a response. Cohorts A and D did not reach the target number of responses, with six (8% [95% CI 3-17]) of 74 in cohort A and two (11% [1-33]) of 19 patients in cohort D having a response. The most common grade 3-4 adverse events were raised gamma-glutamyltransferase (13 [16%] of 80 patients; cohort A); diarrhoea (four [25%] of 20; cohort B); fatigue (four [22%] of 18; cohort C); and rash (five [26%] of 19; cohort D). 17 serious adverse reactions occurred in 11 patients, and there was one treatment-related death caused by grade 4 dyspnoea (in cohort C). INTERPRETATION ctDNA testing offers accurate, rapid genotyping that enables the selection of mutation-directed therapies for patients with breast cancer, with sufficient clinical validity for adoption into routine clinical practice. Our results demonstrate clinically relevant activity of targeted therapies against rare HER2 and AKT1 mutations, confirming these mutations could be targetable for breast cancer treatment. FUNDING Cancer Research UK, AstraZeneca, and Puma Biotechnology.
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Affiliation(s)
- Nicholas C Turner
- Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK; Breast Unit, Royal Marsden National Health Service (NHS) Foundation Trust, London, UK.
| | - Belinda Kingston
- Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK
| | - Lucy S Kilburn
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK
| | - Sarah Kernaghan
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK
| | - Andrew M Wardley
- National Institute for Health Research Manchester Clinical Research Facility, Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK
| | | | | | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | | | - Olga Oikonomidou
- Cancer Research UK Edinburgh Centre, Edinburgh Cancer Centre, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | | | - Mark Tuthill
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Matthew C Winter
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Hannah Bye
- Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Michael Hubank
- National Institute for Health Research Centre for Molecular Pathology, Institute of Cancer Research, London, UK; Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Ros Cutts
- Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK
| | - Claire Snowdon
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK
| | - Daniel Rea
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David Cameron
- Cancer Research UK Edinburgh Centre, Edinburgh Cancer Centre, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Abeer Shaaban
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Sue Martin
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK
| | - Katie Wilkinson
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK
| | - Laura Moretti
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK
| | - Judith M Bliss
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK
| | - Alistair Ring
- Breast Unit, Royal Marsden National Health Service (NHS) Foundation Trust, London, UK
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Roylance R, Kilburn L, Kernaghan S, Wardley AM, Macpherson I, Baird RD, Stephens P, Oikonomidou O, Braybrooke JP, Tuthill M, Abraham J, Winter MC, Kingston B, Wilkinson K, Ring A, Bliss JM, Turner N. Abstract P1-19-11: Results from plasmaMATCH trial treatment cohort C: A phase II trial of capivasertib plus fulvestrant in ER positive breast cancer patients with an AKT1 mutation identified via ctDNA screening (CRUK/15/010). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-19-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: AKT1 mutation occurs in approximately 3% of breast cancer (BC), enriched in advanced BC. The AKT1 E17K mutation results in constitutive activation of AKT1, associated with sensitivity to AKT inhibitor capivasertib in pre-clinical models, and in a prior phase I trial with AKT1 mutations identified through tumour testing. The plasmaMATCH trial Cohort C assessed the efficacy of capivasertib and fulvestrant in ER positive BC patients with an AKT1 mutation in ctDNA testing.
Methods: The plasmaMATCH trial was an open-label, multi-centre, multi-cohort platform trial, consisting of ctDNA testing in ~1000 patients with advanced BC. Patients with an AKT1 mutation identified via ctDNA testing were registered to Cohort C. Patients were treated with capivasertib 400mg BID 4 days on - 3 days off, plus fulvestrant 500mg intramuscularly on Cycle 1 Days 1 and 15, and Cycle 2 onwards every 28 days. The primary endpoint for Cohort C was confirmed objective response rate as defined by RECIST v1.1. Using a single stage A’Hern design with a target response rate of 25%, unacceptable response rate of 5%, alpha=5% and power=80%, at least 3 responses out of 16 evaluable patients were required to infer efficacy.
Results: Following ctDNA testing, 18 patients enrolled in Cohort C (42% of patients with AKT1 mutations identified in ctDNA testing). All were ER positive, 1 (5.6%) was HER2 amplified, and 17 (94%) had visceral metastases. Mutation was AKT1 E17K in 17 patients and AKT1 L52R in 1 patient. All patients were evaluable with a confirmed response rate of 22.2% (95%CI 6.4-47.6%, 4/18) (first 16 evaluable patients: 3/16, 18.8% (95%CI 4.0-45.6)). A further 4 patients had an unconfirmed partial response. Median progression free survival was 10.2 months (IQR 3.2-18.2 months) and the median duration of response was 7.5 months (IQR 4.1-9.8 months) with 4 patients continuing on treatment. The most common clinically significant grade 3 or 4 adverse events were fatigue (22%), rash (17%), diarrhoea (11%) and hyperglycaemia (11%).
Conclusions: Capivasertib plus fulvestrant was active in patients with ER positive breast cancer and AKT1 mutations identified in ctDNA testing, meeting the pre-specified threshold for efficacy
Citation Format: Rebecca Roylance, Lucy Kilburn, Sarah Kernaghan, Andrew M Wardley, Iain Macpherson, Richard D Baird, Peter Stephens, Olga Oikonomidou, Jeremy P Braybrooke, Mark Tuthill, Jacinta Abraham, Matthew C Winter, Belinda Kingston, Katie Wilkinson, Alistair Ring, Judith M Bliss, Nicholas Turner, on behalf of the plasmaMATCH Trial Management Group. Results from plasmaMATCH trial treatment cohort C: A phase II trial of capivasertib plus fulvestrant in ER positive breast cancer patients with an AKT1 mutation identified via ctDNA screening (CRUK/15/010) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-19-11.
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Affiliation(s)
- Rebecca Roylance
- 1University College London Hospitals NHS Foundation Trust and NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Lucy Kilburn
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Sarah Kernaghan
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Andrew M Wardley
- 3The NIHR Manchester Clinical Research Facility at The Christie NHS Foundation Trust and Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Manchester, United Kingdom
| | - Iain Macpherson
- 4The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Richard D Baird
- 5Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Peter Stephens
- 6Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Olga Oikonomidou
- 7Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | | | - Mark Tuthill
- 9Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Matthew C Winter
- 11Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Katie Wilkinson
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Alistair Ring
- 13The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Judith M Bliss
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Nicholas Turner
- 14The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Kingston B, Bye H, Hubank M, Walsh G, Swift C, Beaney M, Kilburn L, Kernaghan S, Wardley AM, Macpherson I, Baird RD, Roylance R, Wilkinson K, Garcia-Murillas I, Bliss JM, Turner N, Ring A. Abstract GS3-07: The genomic landscape of breast cancer based on ctDNA analysis: Data from the plasmaMATCH trial. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-gs3-07] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Circulating tumor DNA (ctDNA) is found in the plasma of over 90% of patients with advanced breast cancer (BC). ctDNA analysis can establish the current genomic profile of an individual’s cancer and identify potentially targetable mutations. The genomic landscape of advanced BC and clinical associations has yet to be fully defined. This analysis describes the genomic landscape of ctDNA in patients screened for the UK plasmaMATCH study. Methods: The plasmaMATCH trial was an open-label, multi-centre, multi-cohort platform trial, consisting of ctDNA testing in ~1000 patients with advanced BC. The trial consists of parallel treatment cohorts (Cohorts A-E) with therapies matched to mutations identified in ctDNA testing. The genomic landscape of ctDNA in advanced BC was prospectively analysed for hotspot PIK3CA,AKT1, HER2 and ESR1 mutations using digital droplet PCR (ddPCR, Bio-Rad), and using an error-corrected 73-gene targeted panel (Guardant360, Guardant Health) prospectively from part-way through the trial, and retrospectively for the remaining patients. Results: Entry into ctDNA testing for Cohorts A-D was closed on 26/Apr/2019, at which time 1044 patients had been registered and 1025 tested with ddPCR. 800 patients had targeted panel ctDNA sequencing (364 prospective, 436 retrospective) (Table 1). Targeted sequencing identified a somatic alteration in 92.9% of patients (743/800). The most frequent mutations were TP53 (44.1%), PIK3CA (34.9%), ESR1 (33.1%), GATA3 (11.0%) and ARID1A (7.8%). ESR1 (33.1%) and KRAS (4.1%) alterations occurred at higher frequency in ctDNA compared to a metastatic tissue sequencing series (q<0.0001, q<0.001, respectively). Five genes had different mutation frequency by tumor subtype. Mutations in ERBB2 were enriched in human epidermal growth factor (HER2) amplified disease (13.5%, q = 0.02), mutations in PIK3CA, ESR1 and GATA3 in hormone receptor positive (HR+) HER2 non-amplified disease (q=0.0001, q<0.0001 and q<0.0001, respectively), and TP53 in triple negative disease (q<0.0001). PIK3CA (22.6%) and ERBB2 (17.6%) frequently had multiple mutations per patient. In HR+ BC, recurrent novel second hotspot mutations occurred in PIK3CA at APOBEC mutagenesis sites. Comparison of ctDNA results with paired tissue sequencing data will be presented. Conclusions: Targeted ctDNA sequencing identified distinct genomic profiles of pre-treated advanced BC. ERBB2 mutations are common in HER2 amplified advanced BC, with recurrent second novel mutations in PIK3CA common in HR+ BC.
Genomic AlterationddPCR*Targeted Panel**All % n = 1025HR+ HER2-% n = 658HR+ HER2+ % n = 62HR- HER2+ % n = 36TNBC % n = 172All % n = 800HR+ HER2- % n = 515HR+ HER2+ % n = 48HR- HER2+ % n = 26TNBC % n = 136PIK3CA mutation25.829.933.919.49.334.939.041.734.614.7ESR1 mutation27.737.819.40033.143.522.900.7AKT1 mutation4.24.01.604.75.05.22.104.4ERBB2 mutation2.73.208.31.26.46.612.515.42.2PTEN mutationNANANANANA6.98.54.23.84.4ERBB2 amplificationNANANANANA5.81.931.357.71.5MSI highNANANANANA1.10.42.101.5* Phenotype data based on 928 patients with known phenotype tested by ddPCR for targetable hotspot mutations.** Phenotype data based on 725 patients with known phenotype sequenced by targeted panel. All pathogenic mutations are shown, including mutations not tested by ddPCR.
Citation Format: Belinda Kingston, Hannah Bye, Michael Hubank, Giselle Walsh, Claire Swift, Matthew Beaney, Lucy Kilburn, Sarah Kernaghan, Andrew M Wardley, Iain Macpherson, Richard D Baird, Rebecca Roylance, Katie Wilkinson, Isaac Garcia-Murillas, Judith M Bliss, Nicholas Turner, Alistair Ring, on behalf of the plasmaMATCH Trial Management Group. The genomic landscape of breast cancer based on ctDNA analysis: Data from the plasmaMATCH trial [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr GS3-07.
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Affiliation(s)
| | - Hannah Bye
- 2The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Michael Hubank
- 3The Royal Marsden NHS Foundation Trust, Sutton and The Institute of Cancer Research, London, United Kingdom
| | - Giselle Walsh
- 1The Institute of Cancer Research, London, United Kingdom
| | - Claire Swift
- 1The Institute of Cancer Research, London, United Kingdom
| | - Matthew Beaney
- 1The Institute of Cancer Research, London, United Kingdom
| | - Lucy Kilburn
- 4Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Sarah Kernaghan
- 4Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Andrew M Wardley
- 5The NIHR Manchester Clinical Research Facility at The Christie NHS Foundation Trust and Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Iain Macpherson
- 6The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Richard D Baird
- 7Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Rebecca Roylance
- 8University College London Hospitals NHS Foundation Trust, and NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Katie Wilkinson
- 4Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | | | - Judith M Bliss
- 4Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Nicholas Turner
- 9The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alistair Ring
- 2The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Wardley AM, Kilburn L, Kernaghan S, Macpherson I, Baird RD, Roylance R, Stephens P, Oikonomidou O, Braybrooke JP, Tuthill M, Abraham J, Winter MC, Kingston B, Wilkinson K, Bliss JM, Ring A, Turner N. Abstract P1-19-07: Results from plasmaMATCH trial treatment cohort B: A phase II trial of neratinib plus fulvestrant in ER positive breast cancer or neratinib alone in ER negative breast cancer in patients with a HER2 mutation identified via ctDNA screening (CRUK/15/010). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-19-07] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: HER2 mutations occur in approximately 3% of HER2 non-amplified cancers and include missense substitutions and indels within the tyrosine kinase domain resulting in oncogenic HER2 activation. Neratinib, an irreversible EGFR, HER2 and ERBB4 tyrosine kinase inhibitor, has demonstrated activity in pre-clinical HER2 mutant models, and in a prior phase I trial with HER2 mutations identified through tumour testing. The plasmaMATCH trial Cohort B assessed the efficacy of neratinib in BC patients with a HER2 mutation identified in ctDNA testing.
Methods: The plasmaMATCH trial was an open-label, multi-centre, multi-cohort platform trial, consisting of ctDNA testing in ~1000 patients with advanced BC. Patients with a HER2 mutation identified via ctDNA testing were registered to Cohort B. Patients were treated with 240mg neratinib once daily. Patients with ER positive BC were also treated with fulvestrant 500mg intramuscularly on Cycle 1 Days 1 and 15, and Cycle 2 onwards every 28 days. The primary endpoint for Cohort B was confirmed objective response rate as defined by RECIST v1.1. Using a single stage A’Hern design with a target response rate of 25%, unacceptable response rate of 5%, alpha=5% and power=80%, at least 3 responses out of 16 evaluable patients were required to infer efficacy.
Results: Following ctDNA testing, 21 patients enrolled in Cohort B (58% of patients with HER2 mutations identified in ctDNA testing). Eighteen (86%) were ER positive, 2 (10%) were HER2 amplified, and 18 (86%) had visceral metastases. The most common HER2 mutations detected in baseline plasma were L755S (47.6%), V777L (19%), and S310F (14.3%). In the 20 evaluable patients, confirmed response rate was 25.0% (95%CI 8.7-49.1%, 5/20) (first 16 evaluable patients: 4/16, 25.0% (95%CI 7.3-52.4)). One patient had a complete response, ongoing at 29 months duration, and three additional patients had unconfirmed partial responses. Median progression free survival was 5.4 months (IQR 3.4-9.1) and median duration of response was 5.7 months (IQR 3.7-9.7 months) with 3 patients continuing on treatment. The most common clinically significant grade 3 or 4 adverse events were diarrhoea (20%) and hypertension (15%).
Conclusions: Neratinib, with or without fulvestrant, was active in advanced BC patients with HER2 mutations identified in ctDNA testing, meeting the pre-specified threshold for efficacy.
Citation Format: Andrew M Wardley, Lucy Kilburn, Sarah Kernaghan, Iain Macpherson, Richard D Baird, Rebecca Roylance, Peter Stephens, Olga Oikonomidou, Jeremy P Braybrooke, Mark Tuthill, Jacinta Abraham, Matthew C Winter, Belinda Kingston, Katie Wilkinson, Judith M Bliss, Alistair Ring, Nicholas Turner, on behalf of the plasmaMATCH Trial Management Group. Results from plasmaMATCH trial treatment cohort B: A phase II trial of neratinib plus fulvestrant in ER positive breast cancer or neratinib alone in ER negative breast cancer in patients with a HER2 mutation identified via ctDNA screening (CRUK/15/010) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-19-07.
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Affiliation(s)
- Andrew M Wardley
- 1The NIHR Manchester Clinical Research Facility at The Christie NHS Foundation Trust and Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Manchester, United Kingdom
| | - Lucy Kilburn
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Sarah Kernaghan
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Iain Macpherson
- 3The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Richard D Baird
- 4Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Rebecca Roylance
- 5University College London Hospitals NHS Foundation Trust and NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Peter Stephens
- 6Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Olga Oikonomidou
- 7Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | | | - Mark Tuthill
- 9Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Matthew C Winter
- 11Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Katie Wilkinson
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Judith M Bliss
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Alistair Ring
- 13The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Nicholas Turner
- 14The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Turner N, Kingston B, Kilburn L, Kernaghan S, Wardley AM, Macpherson I, Baird RD, Roylance R, Stephens P, Oikonomidou O, Braybrooke JP, Tuthill M, Abraham J, Winter MC, Bye H, Hubank M, Snowdon C, Rea D, Cameron D, Shaaban A, Randle K, Wilkinson K, Moretti L, Bliss JM, Ring A. Abstract GS3-06: Results from the plasmaMATCH trial: A multiple parallel cohort, multi-centre clinical trial of circulating tumour DNA testing to direct targeted therapies in patients with advanced breast cancer (CRUK/15/010). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-gs3-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: Circulating tumour DNA (ctDNA) testing may provide a more current assessment of the genetic profile of advanced breast cancer (BC) compared with analysis of the primary tumour, with repeat advanced disease biopsy conducted infrequently in routine clinical practice. The plasmaMATCH trial was designed to assess the clinical utility of using ctDNA testing to select patients for targeted therapies.
Methods: The plasmaMATCH trial was an open-label, multi-centre, multi-cohort platform trial, consisting of ctDNA testing in ~1000 patients with advanced BC, with patients recruited into four parallel treatment cohorts with therapies matched to mutations identified in ctDNA (A: ESR1 mutation - extended-dose fulvestrant 500mg every 2 weeks, B: HER2 mutation - neratinib +/- fulvestrant (standard dosing), C: AKT1 in ER positive BC -capivasertib + fulvestrant (standard dosing), D: AKT1 in ER negative BC or PTEN inactivating mutation - capivasertib). A fifth cohort (E) recruited patients with triple negative BC with no actionable mutation to receive olaparib + AZD6738, and will be reported separately. Each cohort had a specific phase II single arm design. ctDNA testing was conducted with two technologies: digital droplet PCR (ddPCR) at a central laboratory prospectively in all patients, and error corrected sequencing with Guardant360 prospectively from part-way through recruitment and retrospectively for the remaining patients. Tumour sequencing from an advanced disease biopsy was conducted retrospectively, not influencing cohort entry. The primary endpoint for Cohorts A-D is confirmed objective response rate by RECIST v1.1. Secondary endpoints include clinical benefit rate, progression-free survival, safety and frequency of mutations identified in ctDNA screening.
Results: Entry into ctDNA testing for Cohorts A-D was closed on 26/Apr/2019 with 1044 patients registered. ctDNA screening results were received for 1033 patients (99%), with 142 patients entered into Cohorts A-D (A 84, B 21, C 18, D 19). Agreement between ctDNA digital PCR and sequencing results was high (individual gene level agreement 95.5%-99.4%, kappa 0.89-0.93). Predefined efficacy criteria were met in Cohorts B (neratinib for HER2 mutations) and C (capivasertib for AKT mutations), with exploratory analysis of Cohort D identifying activity of capivasertib in AKT1 mutations (Table 1). Efficacy criteria were not met in Cohort A (extended-dose fulvestrant for ESR1 mutations). Adverse events were consistent with prior reports, with extended-dose fulvestrant well tolerated.
Table 1: Efficacy results from plasmaMATCHMutationCohortConfirmed response rate, % (95%CI; n/N)Median PFS (IQR), monthsAll patientsFirst 16 evaluable patients*ESR1A8.1% (3.0-16.8; 6/74)-2.2 (1.7-5.3)HER2B25.0% (8.7-49.1; 5/20)25.0% (7.3-52.4; 4/16)5.4 (3.4-9.1)AKT1C22.2% (6.4-47.6; 4/18)18.8% (4.0-45.6; 3/16)10.2 (3.2-18.2)AKT basketD10.5% (1.3-33.1; 2/19)12.5% (1.6-38.3; 2/16)3.4 (1.8-5.5)AKT133.3% (4.3-77.7; 2/6)--PTEN0 % (0/13)--*Predefined cohort efficacy thresholds for response were set: 13/78 (A); 3/16 (B, C, D)
Conclusion: Circulating tumour DNA testing offers accurate tumour genotyping, sufficient for routine clinical practice. This approach can be used to identify patients with rare HER2 and AKT1 mutations, who have clinically relevant response rates with matched targeted therapies.
Citation Format: Nicholas Turner, Belinda Kingston, Lucy Kilburn, Sarah Kernaghan, Andrew M Wardley, Iain Macpherson, Richard D Baird, Rebecca Roylance, Peter Stephens, Olga Oikonomidou, Jeremy P Braybrooke, Mark Tuthill, Jacinta Abraham, Matthew C Winter, Hannah Bye, Michael Hubank, Claire Snowdon, Daniel Rea, David Cameron, Abeer Shaaban, Katrina Randle, Katie Wilkinson, Laura Moretti, Judith M Bliss, Alistair Ring, on behalf of the plasmaMATCH Trial Management Group. Results from the plasmaMATCH trial: A multiple parallel cohort, multi-centre clinical trial of circulating tumour DNA testing to direct targeted therapies in patients with advanced breast cancer (CRUK/15/010) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr GS3-06.
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Affiliation(s)
- Nicholas Turner
- 1The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Lucy Kilburn
- 3Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Sarah Kernaghan
- 3Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Andrew M Wardley
- 4The NIHR Manchester Clinical Research Facility at The Christie NHS Foundation Trust and Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Manchester, United Kingdom
| | - Iain Macpherson
- 5The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Richard D Baird
- 6Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Rebecca Roylance
- 7University College London Hospitals NHS Foundation Trust and NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Peter Stephens
- 8Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Olga Oikonomidou
- 9Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Jeremy P Braybrooke
- 10University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Mark Tuthill
- 11Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Matthew C Winter
- 13Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Hannah Bye
- 14The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Michael Hubank
- 15The Royal Marsden NHS Foundation Trust, Sutton and The Institute of Cancer Research, London, United Kingdom
| | - Claire Snowdon
- 3Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Daniel Rea
- 16University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - David Cameron
- 9Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Abeer Shaaban
- 16University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Katrina Randle
- 17Independent Cancer Patients' Voice, London, United Kingdom
| | - Katie Wilkinson
- 3Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Laura Moretti
- 3Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Judith M Bliss
- 3Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Alistair Ring
- 14The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Macpherson I, Kilburn L, Kernaghan S, Wardley AM, Baird RD, Roylance R, Stephens P, Oikonomidou O, Braybrooke JP, Tuthill M, Abraham J, Winter MC, Kingston B, Wilkinson K, Ring A, Bliss JM, Turner N. Abstract P1-19-04: Results from plasmaMATCH trial treatment cohort A: A phase II trial of extended-dose fulvestrant in patients with an ESR1 mutation identified via ctDNA screening (CRUK/15/010). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-19-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Ligand binding domain ESR1 mutations are acquired in ER positive cancers during prior aromatase inhibitor therapy for advanced ER positive breast cancer (BC). ESR1 mutant cancer models are sensitive to fulvestrant at high concentrations, however standard dose fulvestrant may not achieve the concentration required to fully inhibit mutant ESR1 in the clinic. The plasmaMATCH trial Cohort A assessed the efficacy of extended-dose fulvestrant (double the current standard dose achieved by doubling the frequency of administration) in patients with an ESR1 mutation identified via ctDNA testing.
Methods: The plasmaMATCH trial was an open-label, multi-centre, multi-cohort platform trial, consisting of ctDNA testing in ~1000 patients with advanced BC. Patients with an ESR1 mutation identified in ctDNA testing were potentially eligible to enter Cohort A. Patients were treated with fulvestrant 500mg intramuscularly on Cycle 1 Days 1, 8 and 15 of a 28 day cycle, and from Cycle 2 onwards every 15 days. Pharmacokinetics samples were collected pre-dose on Day 1 of Cycles 2, 3 and 4. The primary endpoint for Cohort A was confirmed objective response rate as defined by RECIST v1.1. The original planned sample size was 40 patients, to detect a 25% response rate, assuming predominantly clonally dominant mutations. As the trial progressed it became apparent that ctDNA screening may also detect sub clonal ESR1 mutations, which were expected to have a lower response rate. Using a single-stage A’Hern design with a target response rate of 20%, unacceptable response rate of 10%, alpha=5%, power=80, the sample size was increased to 78 evaluable patients with 13 or more responses required to infer efficacy.
Results: Following ctDNA testing, 84 patients enrolled in Cohort A (38% of patients with ESR1 mutations identified in ctDNA testing). All were ER positive, seven were HER2 amplified, 78 (93%) had visceral metastases. The most common ESR1 mutations detected in baseline plasma were D538G (52.4%), Y537S (35.7%), E380Q (33.3%). In the 74 evaluable patients, confirmed response rate was 8.1% (95%CI 3.0-16.8%, 6/74). One additional patient had an unconfirmed partial response. Median progression free survival was 2.2 months (IQR 1.7-5.3 months) and median duration of response was 7.0 months (IQR 3.7-8.3 months) with 4 patients continuing on treatment. In exploratory analysis, 39 patients had clonally dominant ESR1 mutations in baseline ctDNA analysis whilst 25 patients had subclonal mutations and 10 had unknown clonality. The response rate in those with clonally dominant ESR1 mutations was 10% (95%CI: 2.9-24.2%, 4/39) with no confirmed responses in those with subclonal mutations. The most common clinically significant grade 3 or 4 adverse event was hypertension (13%). Pharmacokinetic analysis was consistent with elevated fulvestrant exposure compared to approved 500mg PopPk model (pre-dose Cycle 3, 71% increase, and pre-dose Cycle 4 66% increase).
Conclusion: In the pre-treated population studied, the response rate of extended-dose fulvestrant did not meet pre-specified criteria for efficacy in patients with ESR1 mutations identified in ctDNA testing. Extended-dose fulvestrant was well tolerated and enhanced exposure was observed. Assessment of clonal dominance of ESR1 mutations in ctDNA may identify patients who are more likely to benefit from extended-dose fulvestrant therapy.
Citation Format: Iain Macpherson, Lucy Kilburn, Sarah Kernaghan, Andrew M Wardley, Richard D Baird, Rebecca Roylance, Peter Stephens, Olga Oikonomidou, Jeremy P Braybrooke, Mark Tuthill, Jacinta Abraham, Matthew C Winter, Belinda Kingston, Katie Wilkinson, Alistair Ring, Judith M Bliss, Nicholas Turner, on behalf of the plasmaMATCH Trial Management Group. Results from plasmaMATCH trial treatment cohort A: A phase II trial of extended-dose fulvestrant in patients with an ESR1 mutation identified via ctDNA screening (CRUK/15/010) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-19-04.
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Affiliation(s)
- Iain Macpherson
- 1The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Lucy Kilburn
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Sarah Kernaghan
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Andrew M Wardley
- 3The NIHR Manchester Clinical Research Facility at The Christie NHS Foundation Trust and Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Manchester, United Kingdom
| | - Richard D Baird
- 4Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Rebecca Roylance
- 5University College London Hospitals NHS Foundation Trust and NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Peter Stephens
- 6Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Olga Oikonomidou
- 7Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom
| | | | - Mark Tuthill
- 9Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Matthew C Winter
- 11Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Katie Wilkinson
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Alistair Ring
- 13The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Judith M Bliss
- 2Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Nicholas Turner
- 14The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Kingston B, Bailleux C, Delaloge S, Schiavon G, Scott V, Lacroix-Triki M, Carr TH, Kozarewa I, Gevensleben H, Kemp Z, Pearson A, Turner N, André F. Exceptional Response to AKT Inhibition in Patients With Breast Cancer and Germline PTEN Mutations. JCO Precis Oncol 2019; 3:PO.19.00130. [PMID: 32923864 PMCID: PMC7446515 DOI: 10.1200/po.19.00130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | - Gaia Schiavon
- AstraZeneca, IMED Oncology, Cambridge, United Kingdom
| | | | | | | | | | | | - Zoe Kemp
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alex Pearson
- Institute of Cancer Research, London, United Kingdom
| | - Nicholas Turner
- Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Pearson A, Proszek P, Pascual J, Fribbens C, Shamsher MK, Kingston B, O'Leary B, Herrera-Abreu MT, Cutts RJ, Garcia-Murillas I, Bye H, Walker BA, Gonzalez De Castro D, Yuan L, Jamal S, Hubank M, Lopez-Knowles E, Schuster EF, Dowsett M, Osin P, Nerurkar A, Parton M, Okines AF, Johnston SR, Ring A, Turner NC. Inactivating NF1 Mutations Are Enriched in Advanced Breast Cancer and Contribute to Endocrine Therapy Resistance. Clin Cancer Res 2019; 26:608-622. [DOI: 10.1158/1078-0432.ccr-18-4044] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 07/23/2019] [Accepted: 10/02/2019] [Indexed: 11/16/2022]
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Battisti NML, Kingston B, Mohammed K, Johnston SRD. Toxicity and efficacy of Palbociclib with endocrine therapy of physician’s choice in fourth line and beyond for hormone receptor-positive HER2-negative advanced breast cancer: A single centre experience. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Kabir Mohammed
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Kingston B, Kayhanian H, Brooks C, Cox N, Chaabouni N, Redana S, Kalaitzaki E, Smith I, O'Brien M, Johnston S, Parton M, Noble J, Stanway S, Ring A, Turner N, Okines A. Treatment and prognosis of leptomeningeal disease secondary to metastatic breast cancer: A single-centre experience. Breast 2017; 36:54-59. [PMID: 28968585 DOI: 10.1016/j.breast.2017.07.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 06/12/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Leptomeningeal disease (LMD) is an uncommon complication of advanced breast cancer. The prognosis is poor, and although radiotherapy (RT), systemic and intra-thecal (IT) chemotherapy are accepted treatment modalities, efficacy data are limited. This study was designed to evaluate potential predictors of survival in this patient group. METHODS Breast cancer patients with LMD diagnosed by MRI in a 10-year period (2004-2014) were identified from electronic patient records. PFS and OS estimates were calculated using Kaplan-Meier method, with planned sub-group analysis by treatment modality. Cox regression was employed to identify significant prognostic variables. RESULTS We identified 182 eligible patients; all female, median age at LMD diagnosis 52.5 years (range 23-80). Ninety patients (49.5%) were ER positive/HER2 negative; 48 (26.4%) were HER2 positive, and 27 (14.8%) were triple negative. HER2 status was unknown in 17 (9.3%). Initial management of LMD was most commonly whole or partial brain RT in 62 (34.1%), systemic therapy in 45 (24.7%) or supportive care alone in 37 (20.3%). Fourteen patients (7.7%) underwent IT chemotherapy, of whom two also received IT trastuzumab. From diagnosis of LMD, the median PFS was 3.9 months (95%CI 3.2-5.0) and median OS was 5.4 months (95%CI 4.2-6.6). Patients treated with systemic therapy had the longest OS (median 8.8 months, 95%CI 5.5-11.1), compared to RT; 6.1 months (95%CI 4.2-7.9 months), IT therapy; 2.9 months (95%CI 1.2-5.8) and supportive care; 1.7 months (95%CI 0.9-3.0). On multivariable analysis, triple negative histology, concomitant brain metastases, and LMD involving both the brain and spinal cord were associated with poor OS. CONCLUSIONS Breast cancer patients with triple negative LMD, concomitant brain metastases or LMD affecting both the spine and brain have the poorest prognosis. Clinical trials to identify more effective treatments for these patients are urgently needed.
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Affiliation(s)
| | | | - Chloe Brooks
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Nicola Cox
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Narda Chaabouni
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Stefania Redana
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | - Ian Smith
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Mary O'Brien
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | - Marina Parton
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Jill Noble
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Susie Stanway
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Alistair Ring
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Nicholas Turner
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Alicia Okines
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK.
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Kingston B, Charbouni N, Doody C, Irfan T, Okines A, Johnston S. Toxicity and Efficacy of ≥4th Line Palbociclib with Endocrine Therapy of Physician’s Choice: a Single Centre Experience. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Karrar S, Shiwen X, Nikotorowicz-Buniak J, Abraham DJ, Denton C, Stratton R, Bayley R, Kite KA, Clay E, Smith JP, Kitas GD, Buckley C, Young SP, Ye L, Zhang L, Goodall J, Gaston H, Xu H, Lutalo PM, Zhao Y, Meng Choong L, Sangle S, Spencer J, D'Cruz D, Rysnik OJ, McHugh K, Bowness P, Rump-Goodrich L, Mattey D, Kehoe O, Middleton J, Cartwright A, Schmutz C, Askari A, Middleton J, Gardner DH, Jeffery LE, Raza K, Sansom DM, Clay E, Bayley R, Fitzpatrick M, Wallace G, Young S, Shaw J, Hatano H, Cauli A, Giles JL, McHugh K, Mathieu A, Bowness P, Kollnberger S, Webster S, Ellis L, O'Brien LM, Fitzmaurice TJ, Gaston H, Goodall J, Nazeer Moideen A, Evans L, Osgood L, Williams A, Jones S, Thomas C, O'Donnell V, Nowell M, Ouboussad L, Savic S, Dickie LJ, Hintze J, Wong CH, Cook GP, Buch M, Emery P, McDermott MF, Hardcastle SA, Gregson CL, Deere K, Davey Smith G, Dieppe P, Tobias JH, Dennison E, Edwards M, Bennett J, Coggon D, Palmer K, Cooper C, McWilliams D, Young A, Kiely PD, Walsh D, Taylor HJ, Harding I, Hutchinson J, Nelson I, Blom A, Tobias J, Clark E, Parker J, Bukhari M, McWilliams D, Jayakumar K, Young A, Kiely P, Walsh D, Diffin J, Lunt M, Marshall T, Chipping J, Symmons D, Verstappen S, Taylor HJ, Harding I, Hutchinson J, Nelson I, Tobias J, Clark E, Bluett J, Bowes J, Ho P, McHugh N, Buden D, Fitzgerald O, Barton A, Glossop JR, Nixon NB, Emes RD, Dawes PT, Farrell WE, Mattey DL, Scott IC, Steer S, Seegobin S, Hinks AM, Eyre S, Morgan A, Wilson AG, Hocking L, Wordsworth P, Barton A, Worthington J, Cope A, Lewis CM, Guerra S, Ahmed BA, Denton C, Abraham D, Fonseca C, Robinson J, Taylor J, Haroon Rashid L, Flynn E, Eyre S, Worthington J, Barton A, Isaacs J, Bowes J, Wilson AG, Barrett JH, Morgan A, Kingston B, Ahmed M, Kirwan JR, Marshall R, Chapman K, Pearson R, Heycock C, Kelly C, Rynne M, Saravanan V, Hamilton J, Saeed A, Coughlan R, Carey JJ, Farah Z, Matthews W, Bell C, Petford S, Tibbetts LM, Douglas KMJ, Holden W, Ledingham J, Fletcher M, Winfield R, Price Z, Mackay K, Dixon C, Oppong R, Jowett S, Nicholls E, Whitehurst D, Hill S, Hammond A, Hay E, Dziedzic K, Righetti C, Lebmeier M, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Nikiphorou E, Morris S, James D, Kiely P, Walsh D, Young A, Wong EC, Long J, Fletcher A, Fletcher M, Holmes S, Hockey P, Abbas M, Chattopadhyay C, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, Robson J, Kiran A, Maskell J, Arden N, Hutchings A, Emin A, Culliford D, Dasgupta B, Hamilton W, Luqmani R, Jethwa H, Rowczenio D, Trojer H, Russell T, Loeffler J, Hawkins P, Lachmann H, Verma I, Syngle A, Krishan P, Garg N, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, McGowan SP, Gerrard DT, Chinoy H, Ollier WE, Cooper RG, Lamb JA, Taborda L, Correia Azevedo P, Isenberg D, Leyland KM, Kiran A, Judge A, Hunter D, Hart D, Javaid MK, Arden N, Cooper C, Edwards MH, Litwic AE, Jameson KA, Deeg D, Cooper C, Dennison E, Edwards MH, Jameson KA, Cushnaghan J, Aihie Sayer A, Deeg D, Cooper C, Dennison E, Jagannath D, Parsons C, Cushnaghan J, Cooper C, Edwards MH, Dennison E, Stoppiello L, Mapp P, Ashraf S, Wilson D, Hill R, Scammell B, Walsh D, Wenham C, Shore P, Hodgson R, Grainger A, Aaron J, Hordon L, Conaghan P, Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N, Drexler M, Mor A, Segal G, Lahad A, Haim A, Rath U, Morgensteren DM, Salai M, Elbaz A, Vasishta VG, Derrett-Smith E, Hoyles R, Khan K, Abraham DJ, Denton C, Ezeonyeji A, Takhar G, Denton C, Ong V, Loughrey L, Bissell LA, Hensor E, Abignano G, Redmond A, Buch M, Del Galdo F, Hall FC, Malaviya A, Nisar M, Baker S, Furlong A, Mitchell A, Godfrey AL, Ruddlesden M, Hadjinicolaou A, Hughes M, Moore T, O'Leary N, Tracey A, Ennis H, Dinsdale G, Roberts C, Herrick A, Denton CP, Guillevin L, Hunsche E, Rosenberg D, Schwierin B, Scott M, Krieg T, Anderson M, Hall FC, Herrick A, McHugh N, Matucci-Cerinic M, Alade R, Khan K, Xu S, Denton C, Ong V, Nihtyanova S, Ong V, Denton CP, Clark KE, Tam FWK, Unwin R, Khan K, Abraham DJ, Denton C, Stratton RJ, Nihtyanova S, Schreiber B, Ong V, Denton CP, Seng Edwin Lim C, Dasgupta B, Corsiero E, Sutcliffe N, Wardemann H, Pitzalis C, Bombardieri M, Tahir H, Donnelly S, Greenwood M, Smith TO, Easton V, Bacon H, Jerman E, Armon K, Poland F, Macgregor A, van der Heijde D, Sieper J, Elewaut D, Pangan AL, Nguyen D, Badenhorst C, Kirby S, White D, Harrison A, Garcia JA, Stebbings S, MacKay JW, Aboelmagd S, Gaffney K, van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany T, Han C, Inman RD, Cooper-Moss N, Packham J, Strauss V, Freeston JE, Coates L, Nam J, Moverley AR, Helliwell P, Hensor E, Wakefield R, Emery P, Conaghan P, Mease P, Fleischmann R, Wollenhaupt J, Deodhar A, Kielar D, Woltering F, Stach C, Hoepken B, Arledge T, van der Heijde D, Gladman D, Fleischmann R, Coteur G, Woltering F, Mease P, Kavanaugh A, Gladman D, van der Heijde D, Purcaru O, Mease P, McInnes I, Kavanaugh A, Gottlieb AB, Puig L, Rahman P, Ritchlin C, Li S, Wang Y, Mendelsohn A, Doyle M, Tillett W, Jadon D, Shaddick G, Cavill C, Robinson G, Sengupta R, Korendowych E, de Vries C, McHugh N, Thomas RC, Shuto T, Busquets-Perez N, Marzo-Ortega H, McGonagle D, Tillett W, Richards G, Cavill C, Sengupta R, Shuto T, Marzo-Ortega H, Thomas RC, Bingham S, Coates L, Emery P, John Hamlin P, Adshead R, Cambridge S, Donnelly S, Tahir H, Suppiah P, Cullinan M, Nolan A, Thompson WM, Stebbings S, Mathieson HR, Mackie SL, Bryer D, Buch M, Emery P, Marzo-Ortega H, Krutikov M, Gray L, Bruce E, Ho P, Marzo-Ortega H, Busquets-Perez N, Thomas RC, Gaffney K, Keat A, Innes W, Pandit R, Kay L, Lapshina S, Myasoutova L, Erdes S, Wallis D, Waldron N, McHugh N, Korendowych E, Thorne I, Harris C, Keat A, Garg N, Syngle A, Vohra K, Khinchi D, Verma I, Kaur L, Jones A, Harrison N, Harris D, Jones T, Rees J, Bennett A, Fazal S, Tugnet N, Barkham N, Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DR, Flossmann O, McLaren J, Kumar V, Reid DM, Macfarlane GJ, Jones G, Yates M, Watts RA, Igali L, Mukhtyar C, Macgregor A, Robson J, Doll H, Yew S, Flossmann O, Suppiah R, Harper L, Hoglund P, Jayne D, Mukhtyar C, Westman K, Luqmani R, Win Maw W, Patil P, Williams M, Adizie T, Christidis D, Borg F, Dasgupta B, Robertson A, Croft AP, Smith S, Carr S, Youssouf S, Salama A, Pusey C, Harper L, Morgan M. Basic Science * 208. Stem Cell Factor Expression is Increased in the Skin of Patients with Systemic Sclerosis and Promotes Proliferation and Migration of Fibroblasts in vitro. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Hawton K, Bancroft J, Catalan J, Kingston B, Stedeford A, Welch N. Domiciliary and out-patient treatment of self-poisoning patients by medical and non-medical staff. Psychol Med 1981; 11:169-177. [PMID: 7208740 DOI: 10.1017/s0033291700053381] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In a study of domiciliary and out-patient treatment of self-poisoning patients, using a brief problem-orientated approach, it was found that domiciliary treatment resulted in much higher attendance rates but no difference in outcome. Patients who completed out-patient treatment had a better outcome than those who failed to attend treatment sessions. Completion of out-patient treatment was more frequent among higher social class patients. Domiciliary treatment may be more appropriate in some cases for married patients and for those of lower social class. Medical and non-medical staff proved to be equally effective therapists. Future research should be concerned with evaluation of alternative methods of provision of help and further identification of patients who are most likely to benefit from treatment.
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Bancroft J, Hawton K, Simkin S, Kingston B, Cumming C, Whitwell D. The reasons people give for taking overdoses: a further inquiry. Br J Med Psychol 1979; 52:353-65. [PMID: 508651 DOI: 10.1111/j.2044-8341.1979.tb02536.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A representative sample of 41 cases of self-poisoning was studied in depth. In each case 'reasons' for taking the overdose, both stated spontaneously and chosen from a presented list, were recorded. The commonest spontaneous reason was the 'wish to die'. Nearly one-third indicated some non-suicidal purpose early in the interview and consistently denied suicidal intent subsequently. Apart from suicidal intent, reasons chosen from the list bore little resemblance to reasons that had been offered earlier in the interview and are therefore of uncertain relevance. Three psychiatric judges attributed reasons for each case based on common-sense criteria. Several reasons were seldom or never chosen by them; four were chosen frequently with good agreement, i.e. communicating hostility, influencing others, relieving a state of mind and suicidal intent. The first two were the most frequently chosen, attributed to 71 per cent and 54 per cent of cases respectively. They were the reasons chosen least frequently by the self-poisoners themselves. Of 23 (56 per cent) subjects indicating suicidal intent, 12 (29 per cent) were judged to be suicidal by psychiatrists. These were not clearly distinguishable on the basis of their original interviews, except that those judged suicidal tended to indicate suicidal intent early in the interviews. The clinical and research implications of these findings are discussed.
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Kingston B, Hawton K. Another paracetamol tragedy. Nurs Times 1977; 73:272. [PMID: 840720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Chapman D, Peel WE, Kingston B, Lilley TH. Lipid phase transitions in model biomembranes. The effect of ions on phosphatidylcholine bilayers. Biochim Biophys Acta 1977; 464:260-75. [PMID: 831797 DOI: 10.1016/0005-2736(77)90002-5] [Citation(s) in RCA: 125] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Differential scanning calorimetry has been used to study the endothermic phase behaviour of some model biomembranes (i.e. phosphatidylcholine-water systes) in the presence of a wide range of alkaline, alkaline earth and heavy metal salts. Studies and comparisons were made of both cation and anion effects. Shifts occur in the temperatures of both the pre-transition and main transition endotherms. The observed shifts are smaller than those which have been reported for charged lipids, and no evidence has been found for the formation of specific complexes. Electron microscopic studies on freez-fractured dispersions of phosphatidylcholine-water-salt systems show that with some salts the typical rippled surface observed with L-alpha-dimyristoyl phosphatidylcholine, when in the gel state, is replaced by a smooth surface.
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