tbuckley/cabot-search huggingface dataset:
Efficacy and safety of recombinant humanized anti-HER2 antibody-MMAE conjugate (RC48) in neoadjuvant for HER2-positive breast cancer: A single-arm phase II study.
Authors: Jixin Yang, Yuqing Yang, Xinxin Wen, Jiang Wu, Jing Yu, Lei Wang, Wenyu Hu, Dongdong Xu, Jialing Luo, Wen Ma, Nanlin Li
Journal: Journal of Clinical Oncology (2024)

e12636 Background: Breast cancer patients who achieve pCR after neoadjuvant therapy have a relatively good prognosis. Whether antibody‐drug conjugates (ADCs) can replace traditional chemotherapy combined with dual-target therapy in neoadjuvant therapy still needs to be explored. RC48 is a novel recombinant human anti-HER2 monoclonal antibody conjugated with a microtubule inhibitor (MMAE) via a cleavable linker, which can effectively kill HER2-positive tumors as well as tumors with low or heterogeneous HER2 expression through the bystander effect. The purpose of this study was to evaluate the efficacy and safety of RC48 in neoadjuvant treatment of HER2-positive breast cancer. Methods: Patients with HER2-positive breast cancer (size&gt;20mm) or confirmed axillary lymph node metastasis were eligible and received RC48 at a dose of 2.5mg/kg alone every 2 weeks for 6 cycles followed by surgery. EC was administered postoperatively every 21 days for 4 cycles. Trastuzumab combined with pertuzumab was administered for 1 year in the adjuvant setting. The primary endpoints were ORR and pCR rates. Results: 23 patients had been enrolled, and all of them had completed surgical treatment. The median age was 45(38-70) years. The current results showed that 13.0% (3/23) achieved pCR, 78.3% (18/23) achieved PR, and 8.7% (2/23) experienced PD. The ORR was 91.3%. 42% (5/12) of patients with initially positive axillary lymph nodes turned negative after surgery. 11.8% (2/17) HR-/HER2+ patients achieved pCR. According to the proportion of target lesion reduction, patients were divided into mild response (0-50%) and moderate-to-severe response (51%-100%). In the HR-/HER2+ subtype group, 23.5% (4/17) had a mild response, and 76.5% (13/17) had a moderate-to-severe response. 6 patients with HR+ have been enrolled, and 16.7% (1/6) of them achieved pCR. All of HR+ subtypes had a moderate-to-severe response. No relevant serious (grade 3/4) toxicity has been reported. Conclusions: The present data showed an acceptable pCR rate with RC48 in HER2-positive breast cancer. Although the pCR rate was lower than the traditional chemotherapy combined with targeted therapy, the effect of rapid reduction of tumor volume was better (the moderate-severe remission rate was 82.6%). For HR+/HER2+ breast cancer, the ORR in this study reached 100%, indicating that the novel ADC had a significant inhibitory effect on the crosstalk between ER and HER2. And it was expected that the Destiny Breast 11 study would show similar results. This scheme had a good negative conversion rate for patients with positive axillary lymph nodes. Finally, RC48 provided a neoadjuvant treatment option with low toxicity and high patient compliance for HER2-positive breast cancer. Clinical trial information: NCT05134519 .
Genomic testing and uptake of alteration-targeted therapies among patients with hormone-receptor positive (HR+) metastatic breast cancer (MBC).
Authors: Himil Mahadevia, Simran Chandra, Kensey Gosch, Ibrahim Khamees, Parth Sharma, Kelly C. Gast, Timothy J. Pluard, Whitney L. Hensing
Journal: Journal of Clinical Oncology (2024)

e13084 Background: There is no recognized standard of care treatment after progression on first-line endocrine therapy plus CDK4/6 inhibitor in HR+ / HER2 negative MBC. Alteration-targeted therapies (ATT) have the potential to delay initiation of chemotherapy with more favorable toxicity, and perhaps improved efficacy. Next-generation sequencing (NGS) of tumor tissue or circulating tumor DNA (ctDNA) can identify actionable mutations for targeted therapy. In this study, we sought to assess the results of genomic testing and uptake of ATT among patients with HR+ / HER2-negative MBC. Methods: We studied a retrospective cohort of patients with MBC who received treatment in the Koontz Center for Advanced Breast Cancer (KABCC) at St. Luke’s Cancer Institute, a community-based health system in the Kansas City metro area. The analytic cohort included 125 patients with HR+ / HER2-negative MBC who received treatment after progression on first-line therapy. Genomic testing was performed as a standard of care from ctDNA or tumor-tissue using commercially available NGS assays. Targetable alterations were defined as those with FDA-approved or routinely used off-label treatment regimens in MBC ( PIK3CA, PTEN, AKT, ESR1, ERBB2, BRCA1, BRCA2, PALB2 mutations; TMB &gt;10 or PDL1+). We identified patients who received any ATT and compared them with those who did not. Overall survival (OS) and time to initiation of chemotherapy (TTC) were compared between the two groups using Kaplan-Meier analyses and the log-rank test. Results: Ninety-nine patients (79.2%) had genomic testing and 49 (39.2%) were tested prior to second-line therapy. Of those tested, 84% had at least one targetable alteration. ESR1 mutations were most common, detected in 36% of patients, followed by PIK3CA (31.2%), PTEN (12%), BRCA1/2 (7.2%) and ERBB2 (5.6%). A total of 35 patients received ATT, and around half of those (17 patients) received ATT in the second line. Alpelisib was the most common ATT (62.9%), followed by elacestrant (20%) and neratinib (14.3%). There was no significant difference in OS or TTC between the two groups. Conclusions: Approximately 80% of patients with HR+ / HER2-negative MBC in our cohort underwent genomic testing after progression on first-line therapy, and the vast majority had at least one targetable alteration identified. However, only 35 patients received ATT with most receiving alpelisib. We observed no significant improvement in OS or TTC among those who received ATT, although the numbers were small. There have been two new targeted therapies approved in the past year and many novel agents are currently under investigation in clinical trials. Newer therapies with distinct targets, improved tolerability and efficacy have the potential to improve the uptake and clinical benefit of targeted therapy in MBC.
SV-BR-1-GM after progression on ADC in patients with metastatic breast cancer.
Authors: Chaitali Singh Nangia, Carmen Julia Calfa, Blaise Bayer, Mingjin Chang, Tamar Aghajanian, William Williams, Giuseppe Del Priore, Charles L. Wiseman, Saranya Chumsri
Journal: Journal of Clinical Oncology (2024)

1087 Background: Antibody-drug conjugate (ADC) sequencing raises concerns of cross-resistance due to their shared targets and cytotoxic payloads. Consequently, treatments after ADCs in heavily pretreated MBC is uncertain. SV-BR-1-GM, a GM-CSF secreting, antigen-presenting immortalized breast cancer cell line, has emerged as a post ADC solution (1) based on a different MOA. We now report the results of SV-BR-1-GM in ADC treated patients. Methods: Post-hoc analysis of an ongoing randomized Phase 2 censored to the data-cut date prior to data lock. Bria-IMT (~20x106 SV-BR-1-GM cells, intradermally 48-72 hours after ctx (300 mg/m2), followed by interferon-alpha 2 days later) administered q3wks with a checkpoint inhibitor (CPI). Adverse events were classified according to their severity and relationship to treatment regimen. Results: Among 54 advanced MBC patients randomized, 23 who failed prior ADC therapy were identified. All were heavily pretreated (median 6 prior lines, range 3 – 13). Median age 62 (41-83). 14 pts had HR+/HER2-, 5 TNBC, and 2 HR+/HER2+ MBC. The remaining were HR-/HER2+ or HR-/HER2 low. 8 pts received &gt; 1 ADC. Prior ADCs included: 4 ado-trastuzumab emtansine, 14 trastuzumab deruxtecan, 13 sacituzumab govitecan. 7 pts had also received ≥ 1 prior CPI line. To date, pts received a median 3 cycles of Bria-IMT™ + CPI (2-8). Kaplan-Meier analysis revealed a median OS of 42 weeks with survival of 69% at 6 months. The subset experienced a median PFS of 74 days with 40% of pts demonstrating a Bria-IMT PFS (PFS2) similar to or &gt; their prior line PFS (PFS1). 39% of pts experienced a PFS2 ≥ their most recent line of ADC PFS. The disease control rate was 40% among evaluable pts. 43% of pts had a reduction in cancer-associated macrophage-like cell (CAML) levels; median reduction was 36% (22-98%) after 1 cycle. There were no toxicity-related treatment discontinuations. 43% (10/23) reported grade 3 or 4 AEs, independent of study drug causality. AEs included injection site reaction (39%), fatigue (26%), and nausea/vomiting (43%), mostly mild to moderate. One case of elevated lipase was the most clinically significant grade 4 AE. No interstitial lung disease (ILD) was reported. Conclusions: This subset analysis of the Bria-IMT regimen in ADC refractory MBC patients suggests a potential clinical benefit and treatment option for this patient population. The absence of serious AEs, notably interstitial lung disease (ILD), and no toxicity-related treatment discontinuations, underscores the regimen's favorable safety profile. Future studies are warranted to confirm these results and explore the potential of Bria-IMT™ in broad clinical settings of heavily pretreated contemporary MBC patients. 1. Kamaraju 2024 AACR. Clinical trial information: NCT03328026 .
Predicting CDK4/6 inhibitors outcomes in pts with HR+/HER2- metastatic breast cancer: A machine learning approach.
Authors: Enrico Moiso, Emanuela Ferraro, Luc Cabel, Anton Safonov, Mehnaj Ahmed, Julia Ah-Reum An, Komal L. Jhaveri, Larry Norton, Mark E. Robson, Shanu Modi, Sarat Chandarlapaty, Pedram Razavi
Journal: Journal of Clinical Oncology (2024)

1074 Background: CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) are the current standard of care for pts with newly diagnosed HR+/HER2- metastatic breast cancer (MBC). Although multiple pivotal trials showed a robust benefit of CDK4/6i over ET alone in all the subgroups, there is a subset of pts with a suboptimal response that is difficult to characterize. To predict the benefit on first line CDK4/6i in pts with HR+/HER2- MBC, we created a machine-learning (ML) model based on clinico-pathological features (CPFs) at baseline. Methods: We identified 854 consecutive pts with HR+/HER2- MBC receiving CDK4/6i as 1st line therapy between 12/2013 and 10/2023 from our MSK translational database. OncoCast-MPM ML framework was used to stratify pts based on progression-free survival (PFS) on 1st line CDK4/6i. CPFs of interest were selected as input for the models. Pts with missing data in any of the key inputs were excluded and used as hold out set. We tested 4 algorithms (GBM, ENET, LASSO and SVM), and selected the only model that returned predictions when tested on the hold out dataset containing missing data. The Kaplan-Meier estimator and the log-rank test were used to assess differences in PFS, and Cox regression was used to measure hazard ratios (HR) between groups. Results: Overall, 651 out of 854 pts and 15 CPFs were used in models' creation. The median PFS of the cohort was 15.95 months (95%CI: 14.04-17.95). Of the 4 tested architectures, GBM was the selected architecture based on its ability to be tested on the holdout cohort containing missing data. GBM identified 3 risk groups: good-response risk group (N=279), with a median PFS of 23.8 months (95%CI: 19.6-29.9), intermediate-response risk group (N=231), with a median PFS of 14.7 (I95%CI: 12.2-16.9), and poor-response risk group (N=141), with a median PFS 7.4 (95%CI: 5.3,9.1). The HR between good-response and poor-response RGs was 2.55 (95%CI: 2.0,3.2) with a of p = 2.54e-14. The first 5 CPFs by importance, sorted by Garson algorithm score are: disease-free interval, liver involvement, age at metastatic disease, adjuvant treatment-free interval, and progesterone receptor status. No statistically significant differences were observed between the 3 risk groups identified in the train-validation and tested in the holdout cohort, in terms of median, 1yr, 3yr survival times, as well as in HR. Conclusions: ML-based models have the potential to identify subsets of pts likely to poorly respond to first line CDK4/6i leveraging clinico-pathological features. Risk stratification can help clinicians to select pts who may benefit from short-term interval imaging and potential cfDNA monitoring, as well as to identify the right population to design clinical trials with escalating treatment approaches.
Ipatasertib (IPA) combined with non-taxane chemotherapy (CT) for patients (pts) with previously treated advanced triple-negative breast cancer (aTNBC): The PATHFINDER phase IIa trial.
Authors: Elena Lopez-Miranda, José Manuel Pérez García, Maria Gion, Nuria Ribelles, Patricia Cortez, Jose Luis Alonso Romero, María Martínez-García, Santiago Gonzalez- Santiago, Begoña Bermejo, Serafin Morales Murillo, Vicente Carañana, Laia Garrigós, Melissa Fernández, Olga Boix, Daniel Alcalá-López, Javier Cortes, Antonio Llombart
Journal: Journal of Clinical Oncology (2024)

1098 Background: New therapies are urgently needed for aTNBC. The PI3K/AKT/mTOR pathway and its link to chemoresistance warrant further investigation in pre-treated TNBC patients. The pan-AKT inhibitor IPA, alone or combined, has shown promise for treating advanced solid tumors. This study assessed the toxicity and efficacy of IPA with non-taxane CT in aTNBC pts. Methods: PATHFINDER (NCT04464174) is a multicenter, open-label, non-comparative, phase IIa trial with a safety run-in phase. Taxane-pretreated aTNBC pts with 1-2 prior CT lines for advanced disease and ECOG 0-1 were eligible. Based on prior treatment and available slots, pts received 21-day cycles of IPA (oral, 400 mg/d for 14 d) either with capecitabine (CA) (oral, 2 g/m2/d for 14 d) (arm A); eribulin (E) (IV, 1.23 mg/m2 on d1 and d8) (arm B); or carboplatin plus gemcitabine (CG) (IV, AUC 5 on d1 and 1000 mg/m2 on d1 and d8, respectively) (arm C) until disease progression (PD) or unacceptable toxicity. Initially, the safety run-in phase included 3 pts/arm to determine phase IIa doses based on the toxicity observed after 2 cycles. The primary endpoint was incidence of adverse events (AEs) as per NCI-CTCAE v.5.0. Key secondary endpoints included progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). Analysis was exploratory with no hypothesis testing. Results: From September 2020 to October 2022, 54 pts were assigned to arms A (n = 22), B (n = 25), and C (n = 7). In arm C, 4 additional pts received a lower dose level of IPA (300 mg/d) in the safety run-in phase. Based on the toxicity profile, this arm did not proceed with the expansion phase. At data cutoff (10 th November 2023), median follow-up was 13.8 (2.4-35.5, arm A) and 11.2 (0.2-36.9, arm B) months (mo). All pts discontinued treatment, mainly because of PD (74.1%). Discontinuations due to AEs were 4.5% and 4% in arms A and B, respectively. Incidence of treatment-related (1) any grade (G) TEAEs was 81.8% and 88% and (2) SAEs was 4.5% and 20% for arms A and B, respectively. G≥3 TEAEs occurring in ≥10% of pts are shown (Table). No treatment-related deaths were reported. Median PFS was 2.7 (95%CI, 1.5-4.1) and 3.8 (95%CI, 1.5-9.6) mo; median OS was 15.5 (95%CI, 11.8-19.2) and 11.5 (95%CI, 8.8-25.1) mo; and ORR was 9.1% and 36% for arms A and B, respectively. Conclusions: Combining IPA with CA and E presented an acceptable safety profile. However, adding IPA to CG was not tolerable. E + IPA showed promising efficacy regardless of PI3K/AKT status that merits further evaluation. Clinical trial information: NCT04464174 . [Table: see text]
The impact of COVID-19 and missed diagnosis of breast cancer.
Authors: Atharva Rohatgi, Cheng-I Liao, Caitlin Ruth Johnson, Daniel Stuart Kapp, John K Chan
Journal: Journal of Clinical Oncology (2024)

1118 Background: To evaluate the impact of COVID-19 pandemic on breast cancer diagnosis based on age, race, and regions within the US. Methods: Data on breast cancer incidence were obtained from the United States Cancer Statistics (USCS) program from 2001-2020. SEER*Stat 8.4.1.2 and Joinpoint regression program 5.0.2 were used to calculate estimated and actual incidence rates per 100,000 females. Rates were age-adjusted as appropriate. We compared actual breast cancer incidence rates in the year 2020 to estimated rates based on trends from 2001-2019 with sub-analyses for age, race, and region. Results: From 2001 to 2019, there were 4,005,763 identified cases of breast cancer in the United States. In 2019, prior to the pandemic, the incidence rate of breast cancer was 162.87 per 100,000 in females in the US. Based on the data from 2001 to 2019, breast cancer increased by 1.32% per year (p&lt;0.001). Using these prior trends, it was expected that the incidence of breast cancer to be 165.02 per 100,000 adults (265,206 total cases) in 2020. However, the reported incidence was only 147.77 per 100,000 (237,471). Thus, there were 10.46% (27,735) less breast cancer cases than expected. The missed diagnosis rate was more pronounced in older age groups with 15.89%, 14.75%, and 13.27% cases missed for the age groups 85+, 80-84, and 70-74 respectively. Based on racial and ethnic groups, we found that Hispanic females had the greatest number of missed cases at 13.04% compared to 12.68%, 10.57%, and 8.94% of Non-Hispanic Asians and Pacific Islander (NHAPI), Non-Hispanic White (NHW), and Non-Hispanic Black (NHB) females respectively. The discrepancy between expected and actual number of cases by U.S. region ranged from the highest in the Northeast (11.90%) followed by 11.83%, 10.60%, and 9.49% in the West, South, and Midwest regions respectively. An intersectionality analysis showed that 40–44-year-old Hispanic females residing in the Midwest region had the largest discrepancy at 27.01%. Conclusions: The reported breast cancer cases significantly declined during the pandemic. Older age, Hispanic race and ethnicity, and those residing in the Northeast region had the greatest number of missing cases. As breast cancer is the most common cancer in the United States, more mitigating factors are needed to improve the access to care for patients in these at-risk groups to improve detection of breast cancer and its associated mortality.
Efficacy and safety of dalpiciclib, fulvestrant, and pyrotinib in HR+ HER2-low advanced breast cancer following cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors and aromatase inhibitors (AIs): A Bayesian optimal phase II trial.
Authors: Chunfang Hao, Jing Shi, Jie Zhang, Wenjing Meng
Journal: Journal of Clinical Oncology (2024)

e13056 Background: Cross-line treatment with CDK4/6 inhibitors is a challenging topic. Currently, the MAINTAIN study, which involves switching CDK4/6 inhibitors and endocrine therapy, is the only one with positive results. Additionally, in vitro studies have demonstrated that the combination of anti-HER2 agents with CDK4/6 inhibitors, along with fulvestrant, can synergistically enhance inhibition in cell lines with low HER2 expression. The present study aims to assess the efficacy and safety of dalpiciclib, fulvestrant, and pyrotinib in patients with HR-positive and HER2-low advanced breast cancer (BC), who have experienced disease progression after treatment with CDK4/6 inhibitors and AIs. Methods: We propose a single-arm Bayesian optimal phase II design with a time-to-event endpoint. Key eligibility criteria include patients over 18 years of age with HR+, HER2-low advanced BC, disease progression following treatment with CDK4/6 inhibitors and AIs, no more than one line of chemotherapy. Patients who meet these criteria will receive oral dalpiciclib at a dose of 125 mg/day (three weeks on and one week off), intramuscular fulvestrant at a dose of 500 mg every four weeks, and oral pyrotinib at a dose of 320 mg/day until intolerance or disease progression. The primary endpoint of the study is progression-free survival (PFS), and the secondary endpoints include objective response rate (ORR), disease control rate (DCR), overall survival, safety, and biomarker analysis. The study aims to enroll up to 30 patients, and an interim analysis will be conducted after the enrollment of 15 patients to make a go/no-go decision based on the stopping boundaries of the total observation time (TOT). Results: From May 2023 to November 2023, a total of 15 patients were enrolled in the study. The median age of the patients was 50 years (range: 36-72). Among these patients, 7 (46.7%) had visceral metastasis, 11 (73.3%) had undergone previous chemotherapy, 12 (80.0%) received abemaciclib, and 3 (20%) received palbociclib. The median duration of prior treatment with CDK4/6 inhibitors was 14 months (range: 5-33). As of January 24, 2024, a total of 9 patients underwent efficacy evaluation, revealing an ORR of 44.44% (4/9) and a DCR of 66.67% (6/9), 4 patients experienced disease progression. The TOT was 49.50 months, exceeding the predetermined stopping boundary of 22.54 months. Currently, the survival data are immature. The median follow-up period is 3.20 months (95% CI: 2.33-NA), and the median PFS has not been reached. Grade 3 and above treatment-related adverse events were reported in 40% (6/15) of the patients. Conclusions: The preliminary results indicate a certain level of efficacy and manageable safety. Based on these findings, the study will continue to enroll up to 30 participants. Clinical trial information: NCT05806671 .
The impact of vitamin D levels on the progression-free survival of women with hormone receptor-positive, HER2-negative metastatic breast cancer treated with CDK4/6 inhibitors.
Authors: Alejandro Aranda-Gutierrez, Andres Meraz-Brenez, Hector Raul Gonzalez-Sanchez, Haydee Cristina Verduzco-Aguirre, Bertha Alejandra Martinez-Cannon
Journal: Journal of Clinical Oncology (2024)

e13075 Background: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) halt the transition from the G1 to the S phase, a process governed by the hyperphosphorylation of the retinoblastoma (Rb) protein. Similarly, vitamin D3 has been demonstrated to induce cell cycle arrest through the inhibition of various cyclin-dependent kinases, including those responsible for phosphorylating the Rb protein. Therefore, we hypothesized that suboptimal vitamin D levels may compromise the efficacy of CDK4/6i used to treat hormone receptor (HR)-positive, HER2-negative metastatic breast cancer (MBC). Methods: We conducted a retrospective single-center study of women diagnosed with HR-positive, HER2-negative MBC and treated with any CDK4/6i between 2020 and 2023. Eligible patients were those who received at least one cycle of CDK4/6i, had a baseline 25-OH vitamin D measurement, and had a follow-up period of more than three months. Independent samples T-test, X2, and Fisher’s exact tests were used to evaluate associations between variables. Progression-free survival (PFS) was calculated using the Kaplan-Meier method and compared according to vitamin D levels using the log-rank test. Results: Among 31 patients, the mean age at diagnosis was 53 years (SD 14), 24 (77%) received CDK4/6i in the first-line setting, and 9 (29%) had suboptimal vitamin D levels (&lt;20 ng/ml). Clinicopathological features based on vitamin D levels are shown (Table). The type of iCDK was different according to vitamin D levels (p = 0.036), with no other observed differences between groups. With a median follow-up of 26 months (95% CI 17-35) since iCDK initiation, median PFS was not reached for the entire cohort. A univariate analysis revealed that patients with suboptimal vitamin D levels had an inferior median PFS compared to patients with optimal levels (14 months [95%CI 4-24] vs. not reached [p=0.016]). Notably, no other parameter was associated with PFS in univariate analyses. Conclusions: In this cohort of Mexican patients with HR-positive, HER2-negativeMBC, suboptimal vitamin D levels adversely impacted PFS. Given the retrospective nature of this study and the limited number of patients, we emphasize the importance of studying these findings prospectively. [Table: see text]