Abstract PD2-3: ARTemis: A randomised trial of bevacizumab with neo-adjuvant chemotherapy for patients with HER2-negative early breast cancer
Authors: Earl Helena M , Hiller Louise , Dunn Janet A , Blenkinsop Clare , Grybowicz Louise , Vallier Anne-Laure , Abraham Jean , Thomas Jeremy , Provenzano Elena , Hughes-Davies Luke , McAdam Karen , Chan Stephen , Ahmad Rizvana , Hickish Tamas , Houston Stephen , Rea Daniel , Bartlett John , Caldas Carlos , Cameron David , Hayward Larry 
Published: May 2015

Abstract
Background: Bevacizumab (bev) has been used with neo-adjuvant chemotherapy (NACT) in breast cancer trials. Geparquinto reported benefit for bev in triple negative (neg) patients (pts) (pathological complete response (pCR) 36.4% vs 27.8% p=0.02), as did CALGB 40603 (pCR 52% vs 44%, p=0.057), although NSABP-B40 showed benefit in ER positive (pos) pts (pCR 23.3% vs 15.2%, p=0.008).
Methods: ARTemis is a randomised phase 3 trial adding bev to NACT (docetaxel (D)-FEC). Pts with HER2-neg invasive breast cancer were eligible. Stratification was by age, ER status (neg:weak pos:strong pos), tumour size (T2:T3/4), clinical involvement of axillary nodes and inflammatory/locally advanced disease. Pts were randomised (1:1) to bev+D-FEC or D-FEC. The primary endpoint was pCR, defined as no residual invasive cancer in the breast or axillary lymph nodes after NACT. 800 pts were required to detect 10% differences in pCR rates; 85% power, 5% alpha level.
Results: 800 pts were randomised from 66 UK centres (May 2009 to Jan 2013). 68% were &lt;50 years old, 19% had inflammatory and/or locally advanced disease, 79% of tumours &lt;50mm, 52% clinical node pos and 33% ER-neg. A 2-reader independent review of pathology reports determined whether pCR had been achieved or, at least, minimal residual disease (MRD) status. Significantly more pts on bev+D-FEC had a pCR (22% vs 17%; adjusted p=0.03) (see table). pCR rates differed significantly across ER groups (neg 38%, weak pos 39%, strong pos 7%; p&lt;0.0001). Treatment effect of bev remained significant after adjustment for ER (p=0.03). Similarly significantly more pts on bev+D-FEC had a pCR or MRD (36% vs 29%; adjusted p=0.035). Rates differed significantly across ER groups (neg 51%, weak pos 58%, strong pos 18%; p&lt;0.0001). Treatment effect of bev remained significant after adjustment for ER (p=0.03).
D→FECBev+D→FEC % (95%CI)% (95%CI)p *$pCR in all breast tumours AND absence of disease in ax LNs in all breast tumours(n=66/393)(n=87/388) 17% (13-21%)22% (18-27%)0.03 ER neg (Allred 0-2) (n=253)32% (24-41)44% (36-54) ER weak pos (Allred 3-5) (n=67)26% (13-44)52% (34-69) ER strong pos (Allred 6-8) (n=461)7% (4-11)6% (3-10) pCR or MRD in all breast tumours(n=114/394)(n=138/388) 29% (25-34%)36% (31-41%)0.035 ER neg (Allred 0-2) (n=254)45% (36-54)56% (47-65) ER weak pos (Allred 3-5) (n=67)44% (27-62)73% (54-87) ER strong pos (Allred 6-8) (n=461)18% (13-23)19% (14-24) * Adjusted for stratification variables. $ Primary endpoint for the ARTemis trial
Conclusions: ARTemis showed a significant improvement in both pCR and MRD rates with the addition of bev to D-FEC. ER-neg and ER-weak pos / HER2-neg breast cancer pts appeared to benefit most from bev, whilst pCR and MRD rates in ER-strong pos pts were lower and did not appear to benefit from bev. Our results are similar to those reported in Geparquinto and CALGB 40603.
Citation Format: Helena M Earl, Louise Hiller, Janet A Dunn, Clare Blenkinsop, Louise Grybowicz, Anne-Laure Vallier, Jean Abraham, Jeremy Thomas, Elena Provenzano, Luke Hughes-Davies, Karen McAdam, Stephen Chan, Rizvana Ahmad, Tamas Hickish, Stephen Houston, Daniel Rea, John Bartlett, Carlos Caldas, David Cameron, Larry Hayward. ARTemis: A randomised trial of bevacizumab with neo-adjuvant chemotherapy for patients with HER2-negative early breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr PD2-3.