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Nanda, Rita

https://orcid.org/0000-0001-5248-0876

Mayo Clinic

University of Chicago

Citations 85

Abstract OT1-18-08: Randomized phase II trial of pembrolizumab/carboplatin vs. carboplatin alone for breast cancer with chest wall recurrence: TBCRC044
Vidula, Neelima , Nanda, Rita , Miller, Kathy, Emens, Leisha A. , Park, Ben, Liu, Minetta C. , Goga, Andrei , Rugo, Hope, Abramson, Vandana G.

Cancer Research | March 8, 2022 | Volume: 82 | Issue: 4_Supplement | Pages: OT1-18-08-OT1-18-08

10.1158/1538-7445.sabcs21-ot1-18-08 Get It

Abstract Background: A significant number of patients with breast cancer may develop chest wall recurrence, which can be difficult to treat, and is associated with a poor prognosis. Given the inflammatory nature of chest wall disease, and the association of chest wall disease with lymphovascular invasion, we hypothesized that immunotherapy may be beneficial in this setting. Furthermore, combining immunotherapy and chemotherapy may have a synergistic effect; indeed, the combination of the anti-programmed cell death 1 (PD-1) antibody, pembrolizumab, with chemotherapy has been approved for metastatic triple negative breast cancer (TNBC). Consequently, in this study, we are evaluating the combination of pembrolizumab/carboplatin vs. carboplatin alone for chest wall recurrence. Trial design: This is a phase II study of patients with chest wall disease from breast cancer. Patients are randomized in a 2:1 manner to pembrolizumab/carboplatin x 6 cycles (Arm A) with the option to continue pembrolizumab +/- carboplatin after 6 cycles (Arm Ax) vs. carboplatin alone (Arm B) with the option to cross-over to pembrolizumab +/- carboplatin on progression (Arm Bx). Carboplatin is dosed at AUC 5 IV every 3 weeks, and pembrolizumab at 200 mg IV every 3 weeks. Trastuzumab may be continued with study treatment in patients with HER2 positive disease. Imaging scans (CT chest, abdomen, and pelvis, and bone scan) occur at baseline and every 3 cycles. Chest wall biopsies and peripheral blood is collected at baseline and after completing 2 cycles of treatment for correlative studies. Eligibility criteria: Patients must have chest wall disease from breast cancer. Distant metastases are allowed. TNBC, hormone receptor positive/HER2 negative disease (after 2 prior hormone therapies), and HER2 positive disease (progressed on standard HER2 directed treatment) are eligible. Any number of prior lines of chemotherapy are acceptable, including a prior platinum chemotherapy in the absence of disease progression on the platinum. Specific Aims: Primary aim is to determine disease control rate in the chest wall and other distant sites at 18 weeks of treatment with RECIST 1.1. Secondary aims including determining toxicity, progression-free survival, response based on irRECIST, and response based on tumor PD-L1 expression. Exploratory aims include studying changes in: 1) immune composition of tumor and peripheral blood, 2) peripheral blood cell-free DNA and circulating tumor cells, 3) soluble PD-L1 expression, and 4) association of MYC with PD-1 and immune markers, based on preclinical data demonstrating that MYC upregulates these markers. Statistical Methods: 84 patients (Arm A: 56, Arm B: 28) are being enrolled at 7 sites in the Translational Breast Cancer Research Consortium. The study is powered to identify a 20% difference in disease control rates between Arms A and B (HR 0.52, α= 0.10, ß=0.20). A futility analysis will occur for Arm B after 18 patients are enrolled to allow for early closure if lack of efficacy. Accrual: Present accrual is 57 patients (Arm A: 39, Arm B: 18). (NCT03095352). This trial is partly funded by grants from Merck and University of California San Francisco. Contact information: Neelima Vidula, MD, Massachusetts General Hospital, nvidula@mgh.harvard.edu Citation Format: Neelima Vidula, Rita Nanda, Kathy Miller, Leisha Emens, Vandana Abramson, Ben Park, Minetta C. Liu, Andrei Goga, Hope Rugo. Randomized phase II trial of pembrolizumab/carboplatin vs. carboplatin alone for breast cancer with chest wall recurrence: TBCRC044 [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-18-08.
Abstract GS4-02: Analysis of clinical outcomes and expression-based immune signatures by race in the I-SPY 2 trial
Kyalwazi, Beverly , Olopade, Olufunmilayo, Chien, A. Jo , Forero‐Torres, Andres , Ellis, Erin M. , Albain, Kathy S. , Haley, Barbara , Elias, A. , Clark, Amy S. , Nanda, Rita , Yung, Rachel L. , Edmiston, Kristen K., Viscusi, Rebecca K., Northfelt, Donald W. , Khan, Qamar J. , Sanil, Ashish, Asare, Smita , Wilson, Amy , Hirst, Gillian L. , Melisko, Michelle , Perlmutter, Jane , Rugo, Hope, Symmans, Fraser, Veer, Laura van ‘t , Berry, Donald A. , Hirst, Gillian L , Yau, Christina , Olopade, Olufunmilayo I. , Wallace, Anne M. , Pusztai, Lajos , Ellis, Erin, Blaes, Anne , Boughey, Judy C. , Isaacs, Claudine , Han, Hyo S , Tripathy, Debu , Berry, Scott , Hylton, Nola M. , Symmans, W. Fraser , Veer, Laura J. van’t , Esserman, Laura J.

Cancer Research | March 8, 2022 | Volume: 82 | Issue: 4_Supplement | Pages: GS4-02-GS4-02

10.1158/1538-7445.sabcs21-gs4-02 Get It

Abstract Background Transcriptomic immune-related gene signatures have been associated with achievement of pathologic complete response (pCR) and prognosis in the neoadjuvant setting. I-SPY 2 is a multicenter, phase 2 platform trial using response-adaptive randomization within subtypes defined by receptor status (HR/HER2) and MammaPrint (MP) risk to evaluate novel agents as neoadjuvant therapy for women with high-risk breast cancer. Given racial disparities in mortality from breast cancer and the paucity of racial demographic data from clinical trials, we aimed to evaluate the association between racial groups and baseline characteristics, including expression-based subtypes and immune signatures, treatment response, and prognosis of patients enrolled in the I-SPY 2 TRIAL. Methods Our study population included 990 I-SPY 2 patients. 15 patients identified as part of a racial group with <10 patients enrolled in the trial and were excluded from analysis. Pre-treatment expression data was available for 971 patients. Follow-up data was available for 907 patients; median follow-up time of 4.4 yrs. Chi-square test was used to assess associations between racial groups and pre-treatment SBR grade, HR/HER2 defined subtypes, intrinsic subtype (defined by BluePrint 80-gene molecular subtyping) and residual cancer burden (RCB) class. Logistic regression was used to evaluate race association with pCR. Cox proportional hazard modeling was used to assess the association between racial groups and event free survival (EFS) in a univariate setting, adjusting for pCR status. Association between racial groups and 28 expression signatures related to immune, proliferation, ER and HER2 pathway was analyzed using ANOVA with post-hoc Tukey test in the overall population and in each receptor subtype. Results Of 975 patients included in our analysis, 787 (81%) were White, 68 (7%) were Asian, and 120 (12%) were Black or African American. No significant associations between race and pre-treatment SBR grade (p=0.49), HR/HER2 defined subtypes (p=0.09), or expression-based subtypes (p=0.25) were observed. pCR rates do not significantly differ by racial groups (Odds ratio of pCR relative to White: 1.00 for Asian and 0.89 for Black or African American); and no significant differences in RCB class distribution by race was observed (p=0.88). Event free survival was not associated with patient racial group in a univariate Cox model (Hazard ratio relative to White: 1.10, p=0.73 for Asian and 1.37, p=0.13 for Black or African American). Among the 28 expression signatures evaluated, four were differentially expressed among racial groups within the overall population (F-test p<0.05): IFN module, B cell signature, Dendritic cell signature, and Mitotic score. Pairwise comparisons between racial groups with post-hoc Tukey test identified significant differences in IFN module expression between Black or African American vs. White (p=0.019) and Dendritic cell signature expression between Asian vs White (p=0.047). Among patients in the TNBC subtype, three signatures (dendritic cell signature, macrophage signature and ERBB2 module) were differentially expressed between Black or African American and White patients (p=0.002, 0.016 and 0.007). Conclusion Our analysis demonstrates that among women with high risk breast cancer, race does not affect subtype specific response rates nor event free survival. Distribution of subtypes previously shown to be associated with pCR in the I-SPY2 trial did not significantly differ among racial groups indicating race is less likely than tumor biology to predict response. The decreased expression of immune signatures observed in Black or African American women with TNBC suggests possible differential sensitivity to immunotherapy plus combination chemotherapy. Tumor immune multiplex studies are underway to further investigate. Citation Format: Beverly Kyalwazi, Christina Yau, Olufunmilayo Olopade, A. Jo Chien, Anne Wallace, Andres Forero-Torres, Lajos Pusztai, Erin Ellis, Kathy Albain, Anne Blaes, Barbara Haley, Judy Boughey, Anthony Elias, Amy Clark, Claudine Isaacs, Rita Nanda, Hyo Han, Rachel Yung, Debu Tripathy, Kristen Edmiston, Rebecca Viscusi, Donald Northfelt, Qamar Khan, Ashish Sanil, Scott Berry, Smita Asare, Amy Wilson, Gillian Hirst, Nola Hylton, Michelle Melisko, Jane Perlmutter, Hope Rugo, Fraser Symmans, Laura van ‘t Veer, Donald Berry, Laura Esserman. Analysis of clinical outcomes and expression-based immune signatures by race in the I-SPY 2 trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS4-02.
Multiplatform Analysis of Primary and Metastatic Breast Tumors from the AURORA US Network identifies microenvironment and epigenetics drivers of metastasis
Perou, Charles M. , Hinoue4, Toshinori, Wheeler, Gregory , Kelly, Benjamin , Garrido-Castro, Ana C. , Cubas, Aguirre De, Rajkovic, Andrei, Karaesmen, Ezgi , Fan, Cheng, Creighton, Chad J. , Leraas, Kristen , Burns, Robyn, Coppens, Sara E. , Wheless, Amy, Rezk, Salma, Garrett, Amy, Foy, Kelly K. , Park, Ben, Krop, Ian E. , Anders, Carey K. , Rimawi, Mothaffar F. , Nanda, Rita , Storniolo, Anna Maria , Chandran, Uma , Davis, Michael J. , Ropelewski, Alexander J. , Liu, Minetta C. , Richardson, Andrea L. , Symmans, W. Fraser , Davidson, Nancy E. , King, Tari A. , Perou, Charles M , Rimawi, Mothaffar , Symmans, W Fraser , García‐Recio, Susana , Hinoue4, Toshinori, Pascual, Tomás , Xia, Youli , McClure, Marni B. , Smith, Markia A. , Fan, Cheng, Bowen, Jay , Parker, Joel S. , Shen, Hui , Gastier‐Foster, Julie M. , Lin, Nancy U. , Isaacs, Claudine , Marcom, Paul Kelly , Couch, Fergus J. , Silverstein, Jonathan C. , Hilsenbeck, Susan Galloway , Norton, Larry , Wolff, Antonio C. , Carey, Lisa A. , Lee, Adrian V. , Balko, Justin M. , Hoadley, Katherine A. , Laird, Peter W. , Mardis, Elaine R.

No container title available | January 11, 2022 | Volume: No volume available | Issue: No issue available | Pages: No page available

10.21203/rs.3.rs-1221704/v1 Get It

Abstract Patients with metastatic breast cancer (MBC) typically have short survival times and their successful treatment represents one of most challenging aspects of patient care. This poor prognostic behavior is in part due to molecular features including increased tumor cell clonal heterogeneity, multiple drug resistance mechanisms, and alterations of the tumor microenvironment. The AURORA US Metastasis Project was established with the goal to identify molecular features specifically associated with metastasis. We therefore collected and molecularly characterized specimens from 55 metastatic breast cancer (BC) patients representing 51 primary cancers and 102 metastases. The 153 unique tumors were assayed using RNAseq, tumor/germline DNA exomes and low pass whole genome sequencing, and global DNA methylation microarrays. We found intrinsic molecular subtype differences between primary tumors and their matched metastases to be rare in triple negative breast cancer (TNBC)/Basal-like subtype tumors. Conversely, tumor subtype changes were relatively frequent in estrogen receptor positive (ER+) cancers where ~30% of Luminal A cases switched to Luminal B or HER2-enriched (HER2E) subtypes. Clonal evolution studies identified changes in expression subtype coincident with DNA clonality shifts, especially involving HER2 amplification and/or the HER2E expression subtype. We further found evidence for ER-mediated downregulation of genes involved in cell-cell adhesion in metastases. Microenvironment differences varied according to tumor subtype where ER+/Luminal metastases had lower fibroblast and endothelial cell content, while TNBC/Basal-like metastases showed a dramatic decrease in B cells and T cells. In 17% of metastatic tumors, we identified DNA hypermethylation and/or focal DNA deletions near HLA-A that were associated with its’ significantly reduced expression, and with lower immune cell infiltrates. We also identified low immune cell features in brain and liver metastases when compared to other metastatic sites, even within the same patient. These findings have direct implications for the treatment of metastatic breast cancer patients with immune- and HER2-targeting therapies and suggest potential novel therapeutic avenues for the improvement of outcomes for some patients with MBC.
Chemotherapy and Targeted Therapy for Patients With Human Epidermal Growth Factor Receptor 2–Negative Metastatic Breast Cancer That is Either Endocrine-Pretreated or Hormone Receptor–Negative: ASCO Guideline Update
Moy, Beverly, Rumble, R. Bryan, Come, Steven E. , Davidson, Nancy E., Leo, Angelo Di , Gralow, Julie R. , Hortobágyi, Gabriel N. , Yee, Douglas , Smith, Ian E., Chávez‐MacGregor, Mariana , Nanda, Rita , McArthur, Heather L. , Reeder‐Hayes, Katherine E. , Ruddy, Kathryn J. , Unger, Paul S. , Vinayak, Shaveta, Irvin, William J., Armaghani, Avan, Danso, Michael A., Dickson, Natalie R. , Turner, Sophie S., Perkins, Cheryl L., Di Leo, Angelo , Spring, Laura , Reeder-Hayes, Katherine , Ruddy, Kathryn J , Unger, Paul S , Dickson, Natalie , Carey, Lisa A , Come, Steven , Hortobagyi, Gabriel N , Gralow, Julie R , Yee, Douglas , Chavez-MacGregor, Mariana , Moy, Beverly, Rumble, R. Bryan, Davidson, Nancy E., Smith, Ian E., Nanda, Rita , McArthur, Heather , Vinayak, Shaveta, Irvin, William J., Armaghani, Avan, Danso, Michael A., Turner, Sophie S., Perkins, Cheryl L.

Journal of Clinical Oncology | July 29, 2021 | Volume: 39 | Issue: 35 | Pages: 3938-3958

10.1200/jco.21.01374 Get It

PURPOSE This guideline updates recommendations of the ASCO guideline on chemotherapy and targeted therapy for patients with human epidermal growth factor receptor 2–negative metastatic breast cancer (MBC) that is either endocrine-pretreated or hormone receptor (HR)–negative. METHODS An Expert Panel conducted a targeted systematic literature review guided by a signals approach to identify new, potentially practice-changing data that might translate into revised guideline recommendations. RESULTS The Expert Panel reviewed abstracts from the literature review and retained 14 articles. RECOMMENDATIONS Patients with triple-negative, programmed cell death ligand-1–positive MBC may be offered the addition of immune checkpoint inhibitor to chemotherapy as first-line therapy. Patients with triple-negative, programmed cell death ligand-1–negative MBC should be offered single-agent chemotherapy rather than combination chemotherapy as first-line treatment, although combination regimens may be offered for life-threatening disease. Patients with triple-negative MBC who have received at least two prior therapies for MBC should be offered treatment with sacituzumab govitecan. Patients with triple-negative MBC with germline BRCA mutations previously treated with chemotherapy may be offered a poly (ADP-ribose) polymerase inhibitor rather than chemotherapy. Patients with HR-positive human epidermal growth factor receptor 2–negative MBC for whom chemotherapy is being considered should be offered single–agent chemotherapy rather than combination chemotherapy, although combination regimens may be offered for highly symptomatic or life-threatening disease. Patients with HR-positive MBC with disease progression on an endocrine agent may be offered treatment with either endocrine therapy with or without targeted therapy or single-agent chemotherapy. Patients with HR-positive MBC with germline BRCA mutations no longer benefiting from endocrine therapy may be offered a poly (ADP-ribose) polymerase inhibitor rather than chemotherapy. No recommendation regarding when a patient's care should be transitioned to hospice or best supportive care alone is possible. Additional information is available at www.asco.org/breast-cancer-guidelines .
Adjuvant Trastuzumab Emtansine Versus Paclitaxel in Combination With Trastuzumab for Stage I HER2-Positive Breast Cancer (ATEMPT): A Randomized Clinical Trial
Tolaney, Sara M. , Tayob, Nabihah , Dang, Chau T. , Isakoff, Steven J. , Valero, Vicente , Faggen, Meredith, Mulvey, Therese M. , Bose, Ron , Hu, Jiani , Weckstein, Douglas, Reeder‐Hayes, Katherine E. , Rugo, Hope S. , Ramaswamy, Bhuvaneswari , Zuckerman, Dan Sayam , Hart, Lowell L., Gadi, Vijayakrishna K. , Constantine, Michael, Cheng, Kit , Briccetti, Frederick , Schneider, Bryan P. , Garrett, Audrey Merrill, Marcom, Kelly, Albain, Kathy S. , DeFusco, Patricia, Ardman, Blair, Nanda, Rita , Jankowitz, Rachel C. , Rimawi, Mothaffar F. , Abramson, Vandana G. , Pohlmann, Paula R. , Poznak, Catherine Van , Forero‐Torres, Andres , Liu, Minetta C. , Ruddy, Kathryn J. , Rosenberg, Shoshana M. , Gelber, Richard D. , Trippa, Lorenzo , Barry, William T., DeMeo, Michelle K. , Burstein, Harold J. , Krop, Ian E. , Isakoff, Steven J , Mulvey, Therese Marie , Bose, Ron , Wolff, Antonio C , Reeder-Hayes, Katherine , Rugo, Hope S , Zuckerman, Dan , Gadi, Vijayakrishna K , Cheng, Kit , Briccetti, Frederick , Schneider, Bryan , Marcom, Paul Kelly , Albain, Kathy , Tung, Nadine , Nanda, Rita , Jankowitz, Rachel C , Rimawi, Mothaffar , Abramson, Vandana G , Van Poznak, Catherine , Forero-Torres, Andres , Liu, Minetta , Ruddy, Kathryn J , Zheng, Yue , Rosenberg, Shoshana , Trippa, Lorenzo , Partridge, Ann H , Winer, Eric , Krop, Ian E , Pohlmann, Paula , Yardley, Denise Aysel , Wolff, Antonio C. , Tung, Nadine , Zheng, Yue , Partridge, Ann H. , Winer, Eric P.

Journal of Clinical Oncology | June 2, 2021 | Volume: 39 | Issue: 21 | Pages: 2375-2385

10.1200/jco.20.03398 Get It

PURPOSE The ATEMPT trial was designed to determine if treatment with trastuzumab emtansine (T-DM1) caused less toxicity than paclitaxel plus trastuzumab (TH) and yielded clinically acceptable invasive disease-free survival (iDFS) among patients with stage I human epidermal growth factor receptor 2–positive (HER2+) breast cancer (BC). METHODS Patients with stage I centrally confirmed HER2+ BC were randomly assigned 3:1 to T-DM1 or TH and received T-DM1 3.6 mg/kg IV every 3 weeks for 17 cycles or T 80 mg/m 2 IV with H once every week × 12 weeks (4 mg/kg load →2 mg/kg), followed by H × 39 weeks (6 mg/kg once every 3 weeks). The co-primary objectives were to compare the incidence of clinically relevant toxicities (CRTs) in patients treated with T-DM1 versus TH and to evaluate iDFS in patients receiving T-DM1. RESULTS The analysis population includes all 497 patients who initiated protocol therapy (383 T-DM1 and 114 TH). CRTs were experienced by 46% of patients on T-DM1 and 47% of patients on TH ( P = .83). The 3-year iDFS for T-DM1 was 97.8% (95% CI, 96.3 to 99.3), which rejected the null hypothesis ( P < .0001). Serially collected patient-reported outcomes indicated that patients treated with T-DM1 had less neuropathy and alopecia and better work productivity compared with patients on TH. CONCLUSION Among patients with stage I HER2+ BC, one year of adjuvant T-DM1 was associated with excellent 3-year iDFS, but was not associated with fewer CRT compared with TH.
Abstract PD9-02: Personalized ctDNA as a predictive biomarker in high-risk early stage breast cancer (EBC) treated with neoadjuvant chemotherapy (NAC) with or without pembrolizumab (P)
Magbanua, Mark Jesus M. , Renner, Derrick , Shchegrova, Svetlana, Wu, Hsin-Ta, Kalashnikova, Ekaterina , Tin, Antony , Salari, Raheleh, Rodriguez, Angel , Aleshin, Alexey , Billings, Paul R. , Liu, Minetta C. , Nanda, Rita , Veer, Laura van ‘t , Investigators, I-SPY 2, Wolf, Denise M. , Swigart, Lamorna Brown , Yau, Christina , Hirst, Gillian L. , Delson, Amy , Yee, Douglas , DeMichele, Angela , Zimmermann, Bernhard G , Sethi, Himanshu , Esserman, Laura J. , Veer, Laura J. van’t , Investigators, I-SPY 2

Cancer Research | February 15, 2021 | Volume: 81 | Issue: 4_Supplement | Pages: PD9-02-PD9-02

10.1158/1538-7445.sabcs20-pd9-02 Get It

Abstract Background: In the I-SPY 2 TRIAL, the addition of P to standard NAC resulted in more than doubling of the pathologic complete response (pCR) rates for both hormone receptor-positive (HR+)/HER2- and triple-negative (TN) early breast cancer (EBC) patients (pts) compared to NAC only (Nanda et al, JAMA Oncol, 2020). At 3 years, distant recurrence-free survival (DRFS) rates in pts with pCR following NAC+P was &gt;95%. We hypothesized that ctDNA can serve as a predictive biomarker of response and survival in pts treated with NAC. Methods: A personalized ctDNA test (Signatera) was performed on 511 serial plasma samples from 138 pts with high-risk HR+/HER2- (n=77) or TN (n=61) stage II/III EBC. Pts received P with paclitaxel (Tx) followed by AC (P arm, n=42) or standard NAC only (n=96), an exploratory subset of pts evaluated for P efficacy. Plasma was collected; pretreatment (T0), 3 weeks after treatment initiation (T1), between Tx+/-P and AC regimens (T2), and prior to surgery (T3). ctDNA was deemed positive with a minimum of 2 of the pt specific tumor mutation fragments detected in cfDNA. Association of ctDNA with response and survival was analyzed using logistic and Cox regressions with pCR and DRFS as endpoints. Median follow-up was 2.8 years. Results: Detection of ctDNA decreased over time (P arm: T0-81%, T1-50%, T2-19%, T3-3%) and NAC only: T0-82%, T1-65%, T2-26%, T3-10%). ctDNA data at T0 and T1 was available for 96% (132/138) of pts in P arm or NAC only (Table). Among ctDNA+ patients at baseline, clearance at T1 was significantly associated with pCR (OR=1.92, ctDNA+/-; OR=0.27, ctDNA+/+; LR p&lt;0.001). This association remained significant after adjustment for HR status and treatment (LR p&lt;0.001) and P arm or NAC only (P: LR p=0.03; NAC: LR p=0.01). ctDNA data at T0, T1, and T2 was available for 86% (118/138) pts. (Table). Among all ctDNA+ pts at baseline, dynamics through T2 was associated with pCR (OR=1.44, ctDNA+/-/-; OR=0.33, ctDNA+/+/-, OR=0.12, ctDNA+/+/+; LR p=0.0011). This association remained significant when adjusted for HR status and treatment (LR p&lt;0.001). Analysis within individual treatments showed significant association for NAC (LR p=0.040) and a non-significant trend in NAC+P (LR p=0.063), likely due to smaller sample size. All pts who achieved pCR were ctDNA- at T3 (n=34). Among those who failed to achieve pCR (n=81), DRFS was significantly better in ctDNA- (n=72/81; 20 in P and 52 in NAC) versus ctDNA+ pts (n=9/81; 1 in P and 8 in NAC) (adjusted HR 0.13; 95% CI 0.05-0.37). Conclusions: These exploratory results align with our previous findings that early clearance of ctDNA during NAC treatment was significantly associated with increased likelihood of achieving pCR. Additionally, we show that ctDNA clearance can be an early surrogate marker for therapy response assessment. Residual ctDNA after neoadjuvant treatment was a significant predictor of metastatic recurrence and death. Personalized monitoring of ctDNA during the course of NAC is feasible and provides information that can be combined with imaging and pathology, and may help to optimize decision making for de-escalation or escalation of therapy. Larger studies are ongoing. ctDNA dynamics and pCRctDNA status at T0 and T1 (n=132)ctDNA status at T0, T1, and T2 (n=118)ctDNA-/-ctDNA+/-ctDNA+/+ctDNA-/-/-ctDNA+/-/-ctDNA+/+/-ctDNA+/+/+Total, n (%)24 (18)28 (21)80 (61)22 (19)24 (20)43 (36)27 (23)pCR, n (%)9 (38)15 (54)11 (14)9 (41)12 (50)8 (19)2 (7)No pCR, n (%)15 (63)13 (46)69 (86)13 (59)12 (50)35 (81)25 (93) Citation Format: Mark Jesus M Magbanua, Denise Wolf, Derrick Renner, Svetlana Shchegrova, Lamorna Brown Swigart, Christina Yau, Gillian Hirst, Hsin-Ta Wu, Ekaterina Kalashnikova, Antony Tin, Amy Delson, Douglas Yee, Angela DeMichele, Raheleh Salari, Angel Rodriguez, Bernhard Zimmermann, Himanshu Sethi, Alexey Aleshin, Paul Billings, Laura Esserman, Minetta Liu, Rita Nanda, Laura van ‘t Veer, I-SPY 2 Investigators. Personalized ctDNA as a predictive biomarker in high-risk early stage breast cancer (EBC) treated with neoadjuvant chemotherapy (NAC) with or without pembrolizumab (P) [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 PD9-02.
Abstract OT-13-09: Translational breast cancer research consortium 044 trial: Randomized phase 2 study of pembrolizumab and carboplatin versus carboplatin alone for chest wall recurrence of breast cancer
Vidula, Neelima , Nanda, Rita , Emens, Leisha A. , Liu, Minetta C. , Goga, Andrei , Miller, Kathy D. , Pohlmann, Paula R. , Abramson, Vandana G. , Park, Ben Ho , Rugo, Hope S.

Cancer Research | February 15, 2021 | Volume: 81 | Issue: 4_Supplement | Pages: OT-13-09-OT-13-09

10.1158/1538-7445.sabcs20-ot-13-09 Get It

Abstract Background: Chest wall recurrence may occur in up to 30% of patients with breast cancer, and is associated with a high morbidity and mortality. We hypothesized that immunotherapy may be beneficial in this setting because of the inflammatory nature of this disease, and the association of chest wall disease with lymphovascular invasion. Combination immunotherapy and chemotherapy may have a synergistic effect. In this study, we combined pembrolizumab, an anti-programmed cell death 1 (PD-1) antibody with carboplatin, in patients with chest wall disease. This combination has previously been shown to be effective in advanced lung cancer. Trial design: This is a 2:1 randomized phase II study of pembrolizumab and carboplatin (Arm A) versus carboplatin alone (Arm B) in patients with chest wall involvement from breast cancer. Pembrolizumab is dosed at 200 mg IV every 3 weeks, and carboplatin is dosed at AUC 5 IV every 3 weeks. Patients on Arm A have the option to continue on pembrolizumab alone after 6 cycles of combination treatment (Arm Ax). Patients on Arm B have the option to cross-over to pembrolizumab (+/- carboplatin) after 6 cycles of carboplatin alone (Arm Bx). Patients with HER2 positive disease may continue trastuzumab in addition to the study treatment. Patients undergo chest wall biopsies and peripheral blood collection for correlative studies at enrollment and after 2 cycles of treatment, and also imaging with CT chest, abdomen, and pelvis, and bone scan every 3 cycles. Eligibility criteria: Patients must have chest wall involvement from breast cancer, with or without distant metastases. Patients may have triple-negative breast cancer, hormone receptor positive, HER2- disease (after two prior lines of hormone therapy), or refractory HER2 positive disease. Patients may have received any number of lines of prior chemotherapy. A prior platinum is allowed as long as there was not disease progression on this agent. Specific Aims: 1. (Primary aim) Disease control rate in the chest wall and other distant sites at 18 weeks of treatment using RECIST 1.1 criteria, 2. progression-free survival, 3. toxicity, 4. response based on tumor PD-L1 expression, and 5. response based on irRECIST. Exploratory aims include evaluating: 1. Soluble PD-L1 expression, 2. changes in tumor and peripheral blood immune composition, 3. peripheral blood circulating tumor cells, 4. peripheral blood cell-free DNA, and 5. the association of MYC with PD-1 and TIM-3 on tumor cells, based on preclinical data to suggest that MYC may upregulate these inflammatory markers. Statistical Methods: 84 patients (56 in Arm A and 28 in Arm B) are being enrolled at 7 sites in the Translational Breast Cancer Research Consortium. The study is powered to determine a 20% difference in disease control rates between arms (HR 0.52, α= 0.10, ß=0.20). A futility analysis was originally planned to occur for Arm B after 18 patients are enrolled, but a subsequent amendment has enabled an earlier assessment after 14 patients were enrolled. Accrual: Present accrual is 40 patients. (NCT03095352). This trial is funded in part by Merck and a Development Program Grant from the University of California San Francisco. Contact information: Neelima Vidula, MD, Massachusetts General Hospital, nvidula@mgh.harvard.edu Citation Format: Neelima Vidula, Rita Nanda, Kathy Miller, Paula Pohlmann, Vandana Abramson, Leisha A. Emens, Ben H. Park, Minetta C. Liu, Andrei Goga, Hope S. Rugo. Translational breast cancer research consortium 044 trial: Randomized phase 2 study of pembrolizumab and carboplatin versus carboplatin alone for chest wall recurrence of breast cancer [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 OT-13-09.
Abstract CT011: Evaluation of durvalumab in combination with olaparib and paclitaxel in high-risk HER2 negative stage II/III breast cancer: Results from the I-SPY 2 TRIAL
Haddad, Tufia C. , Stringer-Reasor, Erica , Chien, A. Jo , Borges, Virginia, Nanda, Rita , Albain, Kathy S. , Müller, Aixa , Kemmer, Kathleen, Clark, Amy S. , Perlmutter, Jane , Melisko, Michelle , Schwab, Richard B. , Wilson, Amy , Singhrao, Ruby , Asare, Smita , Veer, Laura J. van’t , Sanil, Ashish, Berry, Donald A. , Pusztai, Lajos , Han, Hyo S , Yau, Christina , Wolf, Denise M. , Wallace, Anne M. , Shatsky, Rebecca , Helsten, Teresa L. , Boughey, Judy C. , Falkson, Carla I. , Mukhtar, Rita A. , Elias, Anthony , Yee, Douglas , Kalinsky, Kevin M. , Isaacs, Claudine , Thomas, Alexandra , Hylton, Nola M. , Symmans, W. Fraser , Rugo, Hope S. , DeMichele, Angela , Esserman, Laura J.

Cancer Research | September 4, 2020 | Volume: 80 | Issue: 16_Supplement | Pages: CT011-CT011

10.1158/1538-7445.am2020-ct011 Get It

Abstract Background: I-SPY2 is a multicenter, phase 2 trial using response-adaptive randomization within molecular subtypes defined by receptor status and MammaPrint risk to evaluate novel agents as neoadjuvant therapy for breast cancer. The primary endpoint is pathologic complete response (pCR, ypT0/is ypN0)). DNA repair deficiency in cancer cells can lead to immunogenic neoantigens, activation of the STING pathway, and PARP inhibition can also upregulate PD-L1 expression. Based on these rationales we tested the combination of durvalumab (anti-PDL1), olaparib (PARP inhibitor) and paclitaxel in I-SPY2. Methods: Women with tumors ≥ 2.5 cm were eligible for screening. Only HER2 negative (HER2-) patients were eligible for this treatment, hormone receptor positive (HR+) patients had to have MammaPrint high molecular profile. Treatment included durvalumab 1500 mg every 4 weeks x 3, olaparib 100 mg twice daily through weeks 1-11 concurrent with paclitaxel 80 mg/m2 weekly x 12 (DOP) followed by doxorubicin/cyclophosphamide (AC) x 4. The control arm was weekly paclitaxel x 12 followed by AC x 4. All patients undergo serial MRI imaging and imaging response at 3 & 12 weeks combined with accumulating pCR data are used to estimate, and continuously update, predicted pCR rate for the trial arm. Regimens “graduation with success” when the Bayesian predictive probability of success in a 300-patient phase 3 neoadjuvant trial in the appropriate biomarker groups reaches &gt; 85%. Results: A total of 73 patients received DOP treatment including 21 HR- tumors (i.e. triple-negative breast cancer, TNBC) and 52 HR+ tumors between May 2018 - June 2019. The control group included 299 patients with HER2- tumors. The DOP arm graduated in June 2019, 13 months after enrollment had started, for all HER2- negative and the HR+/HER2- cohorts with &gt; 0.85% predictive probabilities of success. 72 patient completed surgery and evaluable for pCR, the final predicted probabilities of success in a future phase III trial to demonstrate higher pCR rate with DOP compared to control are 81% for all HER2- cancers (estimated pCR rate 37%), 80% for TNBC (estimated pCR rate 47%) and 74.5% for HR+/HER2- patients (estimated pCR rate 28%). Association between pCR and germline BRCA status and immune gene expression including PDL1 will be presented at the meeting. No unexpected toxicities were seen, but 10 patients (14%) had possibly immune or olaparib related grade 2/3 AEs (3 pneumonitis, 2 adrenal insufficiency, 1 colitis, 1 pancreatitis, 2 elevated LFT, 1 skin toxicity, 2 hypothyroidism, 1 hyperthyroidism, 1 esophagitis). Conclusion: I-SPY2 demonstrated a significant improvement in pCR with durvalumab and olaparib included with paclitaxel compared to chemotherapy alone in women with stage II/III high-risk, HER2-negative breast cancer, improvement was seen in both the HR+ and TNBC subsets. Citation Format: Lajos Pusztai, Hyo S. Han, Christina Yau, Denise Wolf, Anne M. Wallace, Rebecca Shatsky, Teresa Helsten, Judy C. Boughey, Tufia Haddad, Erica Stringer-Reasor, Carla Falkson, A. Jo Chien, Rita Mukhtar, Anthony Elias, Borges Virginia, Rita Nanda, Douglas Yee, Kevin Kalinsky, Kathy S. Albain, Aixa Soyano Muller, Kathleen Kemmer, Amy S. Clark, Claudine Isaacs, Alexandra Thomas, Nola Hylton, W. Fraser Symmans, Jane Perlmutter, Michelle Melisko, Hope S. Rugo, Richard Schwab, Amy Wilson, Amy Wilson, Ruby Singhrao, Smita Asare, Laura J. van't Veer, Angela M. DeMichele, Ashish Sanil, Donald A. Berry, Laura J. Esserman, Trial Consortium I-SPY 2. Evaluation of durvalumab in combination with olaparib and paclitaxel in high-risk HER2 negative stage II/III breast cancer: Results from the I-SPY 2 TRIAL [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT011.
Association of Event-Free and Distant Recurrence–Free Survival With Individual-Level Pathologic Complete Response in Neoadjuvant Treatment of Stages 2 and 3 Breast Cancer
Yee, Douglas , Symmans, W. Fraser , Albain, Kathy S. , Chen, Yunn-Yi, Krings, Gregor , Wei, Shi , Harada, Shuko , Datnow, Brian, Fadare, Oluwole , Klein, Molly, Chen, Beiyun, Adamson, Kathi, Sams, Sharon B. , Mhawech‐Fauceglia, Paulette , Magliocco, Anthony M., Feldman, Mike, Rendi, Mara H. , Sattar, Husain, Zeck, Jay , Ocal, Idris Tolgay, Tawfik, Ossama , LeBeau, Lauren, Sahoo, Sunati , Vinh, Tuyethoa N., Chien, A. Jo , Forero‐Torres, Andres , Stringer-Reasor, Erica , Ellis, Erin D. , Lu, Janice , Lang, Julie E. , Clark, Amy S. , Nanda, Rita , Northfelt, Donald W. , Khan, Qamar J. , Viscusi, Rebecca K., Euhus, David , Edmiston, Kirsten K., Kemmer, Kathleen, Park, John W., Liu, Minetta C. , Olopade, Olufunmilayo I. , Leyland‐Jones, Brian , Tripathy, Debasish , Moulder, Stacy L. , Schwab, Richard B. , Lo, Shelly S. , Beckwith, Heather , Haugen, Patricia, Veer, Laura J. van’t , Perlmutter, Jane , Melisko, Michelle , Wilson, Amy , Peterson, Garry , Buxton, Meredith , Paoloni, Melissa, Clennell, Julia L. , Hirst, Gillian L. , Singhrao, Ruby , Steeg, Katherine, Matthews, Jeffrey B. , Asare, Smita , Sanil, Ashish, Esserman, Laura J. , Berry, Donald A. , Tripathy, Debu , Ocal, Idris T, Olopade, Olufunmilayo I , Symmans, W Fraser , Esserman, Laura J , Hirst, Gillian L , Yee, Douglas , DeMichele, Angela , Yau, Christina , Isaacs, Claudine , Chen, Yunn‐Yi , Krings, Gregor, Pambuccian, Stefan E. , Wallace, Anne M. , Pusztai, Lajos , Boughey, Judy C. , Elias, Anthony , Han, Hyo S , Chui, Stephen Y., Rugo, Hope S. , Helsten, Teresa L. , Hylton, Nola M. , Asare, Adam L. , Matthews, Jeffrey B., Berry, Scott

JAMA Oncology | July 23, 2020 | Volume: 6 | Issue: 9 | Pages: 1355

10.1001/jamaoncol.2020.2535 Get It