Triple negative breast cancer Biology and targeted therapy MR SCI MED DR I BOŽOVIĆ -SPASOJEVIĆ INSTITUT ZA ONKOLOGIJU I RADIOLOGIJU SRBIJE I VA N A B O Z O V I C @ O U T L O O K. C O M
Current challanges in defining optimal regiments for TNBC Biological Intrinsic heterogeneity within TNBC Lack of targeted therapies Clinical Higher risk and lower treshold for therapy The question is not yes/no but which CT? Analytical Small number of trials Post hoc and subset analysis with lack of power
Prognosis of TNBC
PATTERNS OF RELAPSE According to Molecular BC Subtype 100 80 60 71 30 18 14 12 40 20 0 Bone Lung Liver Brain Pleura Luminal B Luminal A HER2 Normal Basal Smid M Cancer Res 2008
Curigliano G ESMO Masterclas 2015
Why targeting TNBC is important?
Association of pcr and Survival in TNBC CTCneoBC Cortazar et al Lancet 2014
Biology of TNBC
Biology of TNBC not all TNBC are BLBC and vice versa
pcr pcr in taxane treated patients
BASAL like LAR Mesenhimal like
Abstract #528 The prognostic role of androgen receptor in earlystage breast cancer patients: A meta-analysis Ivana Božović Spasojević 1, Dimitrios Zardavas 1, Evandro de Azambuja 1, Lieveke Ameye 2, Christos Sotiriou 3, Martine Piccart 1, Marianne Paesmans 2 1 Breast Data Centre, Medical Oncology Department, Institut Jules Bordet, Brussels, Belgium 2 Data Centre, Institut Jules Bordet, Brussels, Belgium 3 Breast Cancer Translational Research Laboratory, Jules Bordet Institute, Brussels, Belgium
EVALUABLE ELIGIBLE SCREENING Flow chart of the study # of studies identified and screened n= 493 # of studies excluded n= 473 # of studies with reported AR status in correlation with clinical outcome n= 20 # of eligible studies excluded n=7 -Insufficient statistical information to estimate survival # of studies assessed for eligibility n=13 Total of 6525 patients Presented by:
AR Prognostic Impact in all BC Patients UNIVARIATE Analysis HR 95% CI p DFS (12 studies, N=5658) 0.65 0.50-0.76 OS (12 studies, N=6525) 0.60 0.47-0.78 p<0.001 for both MULTIVARIATE Analysis DFS (5 studies, N=3207) 0.37 0.29-0.47 OS (6 studies, N=4671) 0.44 0.27-0.72 p<0.001 for both Presented by:
AR Prognostic Impact within different BC subgroups UNIVARIATE analysis HR 95% CI p ER+ DFS (5 studies, N=2048) 0.52 0.42-0.65 <0.001 OS (5 studies, N=3047) 0.58 0.47-0.71 <0.001 ER- DFS (2 studies, N=316) 0.33 0.04-2.49 0.45 OS (3 studies, N=620) 1.38 1.01-1.88 0.04 HER2+/ER- DFS (3 studies, N=358) 1.21 0.86-1.7 0.26 OS (3 studies, N=358) 1.50 1.01-2.22 0.04 Triple negative DFS (5 studies, N=536) 0.52 0.34-0.79 0.002 OS (4 studies, N=495) 0.49 0.28-0.86 0.01 Presented by:
Targeted therapy
663 pts TNBC
Sikov et al. JCO 2014
PARP Inhibitors In Breast Cancer Clear activity of PARP inhibitors as single agents in BRCA-associated breast cancer Triple negative breast cancer shares many features with BRCAassociated tumors Alterations in x-chromosomeinactivation Range of molecular markers Clinical behavior Genomic instability O Shaughnessy J, et al. ASCO 2009. Abstract 3..
Conclusions 1. Inter and intra-tumoral heterogeneity of TNBC, may explain, at least in part, disappointing results from early trials with targeted agents in unselected TNBC. 2. PARP inhibition show promising efficasy in early stage clinical trials, however phase III trials are still lacking. 3. The absence of known predictive factors for bevacizumab efficacy renders recommendations on its use difficult. 4. Novel trials are underway with different targeted agents, PD1 pathway, antiandrogen
Thank you for your attention! Institute for Oncolgy and Radiology of Serbia Daily ChemoTherapy hospital Pasterova 14, Belgrade ivanabozovic@outlook.com ivanabs@ncrc.ac.rs
Back-up
Liedke C, AIBCC 2015
Neoadjuvant Bevacizumab in HER2 - BC Phase III NSABP-B40 Study dosing: q3w (4 cycles Docetaxel + 4 cycles AC) Patients with operable HER2-BC Chemo-naïve & primary tumors 2cm N = 1206 R A N D O M I Z E Bevacizumab Docetaxel AC Docetaxel Bevacizumab Xeloda +Docetaxel Xeloda +Docetaxel AC Bevacizumab Gemcitabine +Docetaxel AC AC AC S U R G E R Y Bevacizumab q3 wk x 10 Bevacizumab q3 wk x 10 Bevacizumab q3 wk x 10 End points: pcr rate AC, Adriamycin and cyclophosphamide Gemcitabine+Docetaxel Neoadjuvant treatment AC Adjuvant treatment Bear HD, Tang G, Rastogi P, J Clin Oncol, 2011; 29 (suppl) Abstract LBA1005
pcr* % Early signal in HR+ Bevacizumab regimens Docetaxel-AC 60 P=0.44 50 40 p=0.027 30 p=0.008 47.3 51.3 20 10 34.5 28.4 23.3 15.2 0 *pcr = breast + LN All BC Subtypes N=1180 ER+ ER-
A Note of CAUTION Which is correct? GeparQuinto Bevacizumab achieves higher pcr rates in TNBC NSABP-40 Bevacizumab achieves higher pcr rates in ER+
CBDCA
Neoadjuvant results with bevacizumab very confusing and probably not helpful
Biology of TNBC what is new?
Elsamany et al. Med Oncol 2014
Meta-analysis
Cytokeratins 5/6, P-catherin, EGFR