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O’Sullivan, Ciara C.

https://orcid.org/0000-0001-6069-9800

Mayo Clinic

Mayo Clinic

Citations 81

Pathologic Complete Response (pCR) Rate and Predictors of Response to Taxane, Trastuzumab, and Pertuzumab in HER2‑Positive Breast Cancer: Secondary Analyses of EA1181/CompassHER2 pCR
Tung, Nadine , DeMichele, Angela , Winer, Eric P. , Wright, Jean L. , Recht, Abram , Weiss, Anna C., Tjoe, Judy A., Feldman, Sheldon M. , Smith, Mary Lou , O’Sullivan, Ciara C. , Sardesai, Sagar D., Irvin, W. J., Battelli, Chiara, Krie, Amy, D’Abreo, Nina , Shah, Payal D. , DeMichele, Angela , Prat, Aleix , Winer, Eric , Wright, Jean L , Recht, Abram , Rocque, Gabrielle , O'Sullivan, Ciara Catherine , Tang, Shou-Ching , Modi, Shanu , Bagegni, Nusayba , Krie, Amy K , Telli, Melinda L , Borges, Virginia F , D'Abreo, Nina , Shah, Payal D , Villagrasa, Patricia , Badve, Sunil S , Partridge, Ann H , Miller, Kathy D , Carey, Lisa A , Wolff, Antonio C , Tung, Nadine , Zhao, Fengmin , Weiss, Anna , Tjoe, Judy A., Rocque, Gabrielle B. , Sardesai, Sagar , Modi, Shanu , Irvin, William , Unni, Nisha G , George, Mridula Annette , Telli, Melinda L. , Borges, Virginia F. , Badve, Sunil , Partridge, Ann H. , Miller, Kathy D. , Carey, Lisa A. , Wolff, Antonio C.

Journal of Clinical Oncology | August 20, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available

10.1200/jco-25-02255 Get It

PURPOSE EA1181 (ClinicalTrials.gov identifier: NCT04266249 ) is a single-arm trial evaluating neoadjuvant taxane, trastuzumab, and pertuzumab (THP) in patients with clinical stage II/IIIa human epidermal growth factor receptor 2 (HER2)–positive breast cancer. This report focuses on the secondary end points of pathologic complete response (pCR) rates and associated factors. The primary end point—3-year recurrence-free survival among patients achieving a pCR (ypT0/Tis, ypN0)—will be reported when data mature. METHODS Patients received four cycles of trastuzumab and pertuzumab (HP) with either once per week paclitaxel (12 weeks) or docetaxel (every 3 weeks for four cycles), followed by surgery. Clinicopathologic characteristics were assessed in all patients. The HER2DX pCR score was determined using diagnostic biopsy samples in a representative subset. Logistic regression models identified factors associated with pCR. RESULTS A total of 2,175 patients were enrolled (781 HER2+/estrogen receptor‑negative [ER–]; 1,394 HER2+/ER+). Of 2,141 patients who initiated THP, the overall pCR rate was 43.8%: 63.7% in HER2+/ER– and 32.4% in HER2+/ER+ tumors. Higher pCR rates were observed in tumors that were ER-negative or low ER expressing, progesterone receptor-negative or low expressing, HER2 immunohistochemistry (IHC) 3+, and in patients treated with once per week paclitaxel. T3 disease was associated with a lower pCR rate in HER2+/ER– tumors; otherwise, tumor (T) and nodal (N) stage did not significantly affect pCR. Among 569 patients assessed for HER2DX pCR scores, a high score was independently associated with higher pCR rates, after adjustment for clinicopathologic variables. CONCLUSION Neoadjuvant THP achieved pCR in nearly two-thirds of patients with HER2+/ER– and one third with HER2+/ER+ breast cancer. Low hormone receptor expression, HER2 IHC 3+ status, once per week paclitaxel use, and a high HER2DX pCR score were independent predictors of pCR. These findings should help optimize risk stratification and treatment personalization for patients with HER2-positive breast cancer.
Factors Associated With Alcohol Intake in Patients With Newly Diagnosed Breast Cancer
Rajput, Sanjna , Vierkant, Robert A., Larson, Nicole L. , Stan, Daniela L., Mussallem, Dawn M. , D’Andre, Stacy D. , Couch, F, Olson, Janet E., O’Sullivan, Ciara C., Ruddy, Kathryn J. , Vierkant, Robert A., Couch, Fergus J. , Olson, Janet E. , O’Sullivan, Ciara C.

Cancer Medicine | June 17, 2026 | Volume: 15 | Issue: 6 | Pages: No page available

10.1002/cam4.72031 Get It

ABSTRACT Background Alcohol intake is a modifiable risk factor for breast cancer, yet patterns of alcohol intake in women with breast cancer remain underexplored. This study evaluates demographic and clinical predictors of alcohol intake in patients with breast cancer. Methods Patients at Mayo Clinic Rochester diagnosed with breast cancer (Stage 0–3) between July 2014 to March 2022 were surveyed about their average alcohol intake over the 10 years prior to their diagnosis. Alcohol intake was categorized as < 1, 1–4, 5–14, and ≥ 15 drinks per week. Demographic, behavioral, and clinical data were analyzed using univariate Fisher exact tests and multivariate multinomial logistic regression. Results Of 2030 participants (mean age at diagnosis: 59 years; 99.3% female; 95.9% White), 29% consumed < 1 drink/week, 48% reported 1–4 drinks/week, 20% consumed 5–14 drinks/week, and 3% reported ≥ 15 drinks/week. Older age at diagnosis (≥ 60 years), non‐White race, financial difficulty, and never smoking were associated with less alcohol intake. Patients who reported higher levels of mild–moderate intensity exercise reported more alcohol intake. Tumor stage, tumor receptors, and BRCA mutation status were not associated with alcohol intake. PROMIS‐10 physical health scores correlated with alcohol intake in univariate but not multivariate models. Conclusion Alcohol intake is more common prior to a breast cancer diagnosis for patients who are younger, White, financially secure, exercising, and smoking. These findings may inform alcohol intake‐related breast cancer prevention efforts and highlight patient subgroups who could benefit from targeted counseling at the time of diagnosis.
Neoadjuvant rilvegostomig (R) + trastuzumab deruxtecan (T-DXd) in high-risk HER2-negative breast cancer: Results from the I-SPY 2.2 trial.
O'Sullivan, Ciara Catherine, Kalinsky, Kevin, Yau, C, Wallace, Anne M., Chien, Jo, Yee, D, Nanda, Rita, Isaacs, C, Omene, Coral, Kulkarni, T, Swigart, Lamorna Brown, Perlmutter, J, Hylton, N, Borowsky, Alexander D., Rugo, H S, Veer, Laura van't, Esserman, L J, O’Sullivan, Ciara C. , Kalinsky, Kevin M. , Yau, Christina , Yee, Douglas , Boughey, Judy C. , Borges, Virginia F. , Isaacs, Claudine , Omene, Coral , Kulkarni, Tejaswini , Swigart, Lamorna Brown , Hylton, Nola, Shatsky, Rebecca , Veer, Laura J. van’t

Journal of Clinical Oncology | June 3, 2026 | Volume: 44 | Issue: 17_suppl | Pages: No page available

10.1200/jco.2026.44.17_suppl.lba514 Get It

LBA514 Background: Preclinical and clinical data show that antibody-drug conjugates (ADCs) such as T-DXd may synergize with immunotherapy. Rilvegostomig (R) is a monovalent, Fc-reduced, dual checkpoint bispecific IgG1 monoclonal antibody against PD-1 and TIGIT receptors. R + T-DXd was evaluated as neoadjuvant therapy for up to 4 cycles. Methods: I-SPY2.2 is a phase II neoadjuvant trial with three neoadjuvant sequences (Blocks A/B/C). All HER2-negative subtypes were eligible for R + T-DXd in Block A. Predicted responders at the end of Block A or B could undergo surgery; otherwise, they continued to Block B +/- C. Block B pts received paclitaxel +/- carboplatin +/- pembrolizumab and Block C pts doxorubicin + cyclophosphamide (AC) +/- pembrolizumab, HR+ immune+ received IO in Blocks B/C. Results are analyzed by receptor and response predictive subtypes (RPS), that include expression-based immune, and luminal signatures with hormone receptor (HR) and HER2 status. Some pts were randomized to a control regimen (skipping R + T-DXd in block A and starting in block B). To minimize risk of interstitial lung disease (ILD) that could lead to treatment discontinuation, pts underwent pulmonary function tests and high-resolution chest CTs every 6 weeks. Abnormalities were reviewed in real time. The primary endpoint was pathologic complete response (pCR), within each RPS and HR/HER2 signature, with estimated pCR (EpCR) rates compared to subtype-specific block A goal rates and control pts in those groups. Other endpoints included safety and treatment discontinuation. Results: 105 pts were treated with R + T-DXd in block A, while 31 pts were randomized to the control regimen. Block A EpCR rate was 57% in the 12 HR+Immune+ pts vs a pre-specified goal of 15% (posterior probability, PP > .99). In 35 HR-Immune+ pts EpCR was 52% vs a pre-specified goal of 40% (PP = .87). No other groups (Immune-) had a PP > .85 for their respective pCR goal rate. HER2-IHC was 0 (27.6%), 1+ (49.5%) and 2+ (22.9%) in the treatment arm vs. 37.7%, 37.7%, and 24.7% in the control arm, with no difference in distribution between arms in immune subtypes. The most common adverse events in Block A were fatigue (84.8%), nausea (81.0%) and alopecia (58.1%). ILD was the most common adverse event of special interest in Block A and overall, occurring in 12 pts (11.4%; 7G1, 4G2, 1G3) during Block A and in 3 pts (G1, 2.9%) in other Blocks. 8 pts discontinued T-DXd + R due to ILD and proceeded to the next Block. Conclusions: When considering the full treatment strategy including block B and C regimens, experimental strategies had similar EpCR rates vs. controls in immune+ subtypes but block A rates exceeded pre-defined goal thresholds. This infers that treatment beginning with R + T-DXd has equivalent efficacy to standard of care for immune+ pts, but 64% pts with pCR skip chemotherapy (Block B) and 97% avoid AC (Block C). R + T-DXd participants avoided persistent ILD. Clinical trial information: NCT01042379 .
EA1181: Accuracy of pre-surgery MRI to predict pathologic complete response after taxane, trastuzumab, and pertuzumab (THP) in HER2-positive breast cancer.
Tung, NM, Zhao, Fengmin, Partridge, Savannah C., Wright, Jean, Recht, Abram, Weiss, Anna, Tjoe, Judy A., Feldman, Sheldon M. , Smith, Mary Lou , O'Sullivan, Ciara Catherine, Sardesai, Sagar D., Winer, Eric P., Partridge, Ann H., Carey, L, DeMichele, Angela, Tung, Nadine , Zhao, Fengmin , Partridge, Savannah C , Recht, Abram , Weiss, Anna, Tjoe, Judy A., Rocque, Gabrielle B. , O’Sullivan, Ciara C. , Sardesai, Sagar , Badve, Sunil , Winer, Eric P. , Miller, Kathy D. , Partridge, Ann H. , Carey, Lisa A. , Rahbar, Habib , DeMichele, Angela , Wolff, Antonio C.

Journal of Clinical Oncology | May 27, 2026 | Volume: 44 | Issue: 16_suppl | Pages: 603-603

10.1200/jco.2026.44.16_suppl.603 Get It

603 Background: Accurate prediction of pathologic complete response (pCR) after preoperative therapy for HER2-positive (HER2+) breast cancer can help triage patients to immediate surgery vs additional preoperative therapy. Pre-surgery (i.e., after neoadjuvant therapy) imaging studies may help estimate the likelihood of pCR. In EA1181, patients (pts) with stage II-IIIA HER2+ breast cancer received four cycles of preoperative taxane, trastuzumab, and pertuzumab (THP×4). Pre-surgery imaging was required, though the specific imaging modality was not mandated. Here, we report the accuracy of pre-surgery breast MRI to predict pCR (ypT0/Tis, ypN0). Methods: Among 2,141 pts treated with THPx4, 1,378 had pre-surgery breast MRI and were representative of the overall cohort, although T3 tumors were more common (16% vs 9%). MRI reports were available for 1,351 pts; all reports were centrally reviewed and classified as radiologic complete response (rCR; no residual tumor enhancement and normalization of lymph nodes, if applicable) or radiologic residual disease (rRD). Reports with indeterminate radiologic response were independently reviewed by two study radiologists blinded to pathology outcomes. Among pts with rCR who had pathologic residual disease (pRD), we also assessed the extent of residual disease by residual cancer burden (RCB) score. Among pts with rRD who had a pCR, we determined the proportion who only had residual ductal carcinoma in situ (DCIS). Results: See Table. Conclusions: After neoadjuvant therapy, preoperative MRI accurately predicted pCR in 86% of patients with HER2+/ER− disease and may help identify patients who can proceed directly to surgery. MRI is insufficient to predict pCR for pts with HER2+/ER+ disease, as only 55% with complete response on MRI had a pCR at surgery. A pre-surgery MRI that indicated residual disease was accurate in 80% of pts with HER2+/ER+ disease, but in only 45% of pts with HER2+/ER- cancer. Accurately predicting residual disease after THPx4 allows for consideration of additional therapy that may increase the chance of pCR. Combining imaging like MRI with other biomarkers, such as tissue-based markers or circulating tumor DNA, may improve prediction of pCR and facilitate personalization of treatment decisions in HER2+ breast cancer. All pts with pre-surgery MRI (n=1351)pCR rate overall in this cohort = 47% MRI result Pathology pCR pRD rCR 70.6% (341/483) 29.4%(142/483) 78% had RCB1 rRD 34%(295/868) 21% of 295 had DCIS only 66.01% (573/868) ER- (n=589)*Overall pCR rate in ER- subset = 68% MRI result Pathology pCR pRD rCR 86.1% (205/238) 13.9% (33/238) 85% had RCB1 rRD 55.3% (194/351) 19% of 194 had only DCIS 44.7% (157/351) ER+ (n= 762)*Overall pCR rate in ER+ subset = 31% MRI result Pathology pCR pRD rCR 55.5% (136/245) 44.5% (109/245) 76% had RCB1 rRD 19.5% (101/517) 26% of 101 had only DCIS 80.5% (416/517)
TBCRC 050: A phase 1b/2 trial of niraparib and trastuzumab in HER2-positive metastatic breast cancer (MBC): Efficacy and correlative analyses.
Stringer-Reasor, Erica , Xin, Haichang , Jones, Kyla, O'Sullivan, Ciara Catherine, Giridhar, Karthik, Dees, Elizabeth Claire , Nanda, Rita, Hunter, Natasha, Clark, Amy S. , Zhang, Jianqing, Krop, Ian E., Lin, Nancy U., Rimawi, Mothaffar, Yang, Eddy S. , Jones, Kyla R, Rocque, Gabrielle B. , O’Sullivan, Ciara C. , Nanda, Rita , Hunter, Natasha B. , Zhang, Jianqing , Wolff, Antonio C. , Krop, Ian E. , Lin, Nancy U.

Journal of Clinical Oncology | May 27, 2026 | Volume: 44 | Issue: 16_suppl | Pages: 1056-1056

10.1200/jco.2026.44.16_suppl.1056 Get It

1056 Background: Resistance to HER2-directed therapies remains a major challenge in HER2-positiveMBC. In preclinical models, HER2+ tumors overexpress poly (ADP-ribose) polymerase (PARP), and PARP inhibition induces apoptosis through NF-κB suppression even in the absence of pathogenic mutations in BRCA 1/2 . We evaluated the safety, efficacy, and translational correlates of niraparib combined with trastuzumab in patients (pts) with refractory HER2+ MBC. Methods: This open-label Phase 1b/2 trial (NCT03368729) enrolled pts with HER2+ MBC (IHC 3+ and/or FISH amplified), measurable disease, LVEF ≥50%, and progression on ≥1 prior HER2-targeted therapy; stable CNS disease was allowed. Pts with germline BRCA1/2 mutations or prior PARP inhibitor exposure were excluded. Niraparib 300 mg orally was administered on Days 1–21 of a 21-day cycle with trastuzumab 6 mg/kg IV every 3 weeks (loading dose 8 mg/kg on cycle 1). The Phase 2 portion used a Gehan/Simon two-stage design with early stopping for futility (P0=24%); ≥1 response among the first 20 patients triggered expansion to 40 patients. ORR was assessed by RECIST v1.1, meeting the primary endpoint and allowing response rate estimation with <7% standard error and a two-sided 95% exact CI width of 0.28. Gene expression profiling of paired tumor tissue and peripheral blood mononuclear cells (PBMCs) was performed using the NanoString nCounter Tumor Signaling 360 panel at pretreatment compared to cycle 2. Results: Forty-six pts were enrolled (9/2019–2/2025); 41 were evaluable for response. Pts were heavily pretreated (median 3 prior regimens), including trastuzumab deruxtecan in 22 pts; 33% had brain metastases. Treatment-related adverse events were predominantly grade 1–2 and manageable. Clinical benefit rate (CBR) was 44% (18/41) including 1 complete response, 2 partial responses, and 15 stable disease. Eleven patients achieved disease control ≥ 6 months; 1 patient remained on treatment at data cutoff. Tumor profiling revealed enrichment of a B-cell–driven tertiary lymphoid structure signature with reduced hypoxia signaling in responders. Matched PBMC analyses demonstrated coordinated downregulation of interferon signaling, DNA damage response, metabolic activation, angiogenesis, and resistance pathways in clinical responders, whereas non-responders retained signatures of chronic stress and immune exhaustion. Conclusions: Niraparib plus trastuzumab demonstrated a favorable safety profile and durable clinical benefit in heavily pretreated HER2+ MBC. Integrated tumor and blood-based analyses identify immune-organized tumor microenvironments and systemic immune normalization as key correlates of prolonged response, supporting further investigation of PARP inhibition strategies. Clinical trial information: NCT03368729 .
Efficacy and safety of tucatinib (TUC) vs placebo (PBO) combined with trastuzumab and pertuzumab (HP) as maintenance therapy for HER2+ metastatic breast cancer by stratified subgroups.
Hamilton, Erika P., Curigliano, G, M, Casado Martín, Lerebours, Florence, Tsurutani, Junji , Hu, Xichun, Aquino, Luciana Carla Martins de, O'Sullivan, Ciara Catherine, Tokunaga, Eriko , Okines, Alicia Frances Clare, Huang, Chiun-Sheng, Jacot, W, Sohn, J, Mueller, Volkmar, Viala, Helene, Tan, Qianwen, Feng, Wentao, Shen, Qi , Dieras, V, Curigliano, Giuseppe , Lerebours, Florence , Savard, Marie-France , Hu, Xichun , O’Sullivan, Ciara C. , Okines, Alicia , Jacot, William , Sohn, Joohyuk , Shen, Qi, Dièras, Véronique

Journal of Clinical Oncology | May 27, 2026 | Volume: 44 | Issue: 16_suppl | Pages: 1005-1005

10.1200/jco.2026.44.16_suppl.1005 Get It

1005 Background: In the phase 3 HER2CLIMB-05 study (NCT05132582), TUC + maintenance HP demonstrated a statistically significant improvement in progression-free survival (PFS) vs control treatment (Tx) (hazard ratio: 0.641, P < 0.0001) in patients (pts) with HER2+ locally advanced or metastatic breast cancer (MBC). Here we report additional efficacy and safety outcomes by stratified subgroups. Methods: Pts with centrally confirmed HER2+ MBC without evidence of progression following chemotherapy-based induction Tx (taxane + HP) were randomly assigned 1:1 to TUC (300 mg) or PBO BID + HP. Randomization was stratified by diagnosis ( de novo /recurrent), hormone receptor (HR) status (positive/negative), and presence or history of brain metastases (BM; yes/no). Endocrine therapy (ET) is permitted for pts with HR+ disease. The primary endpoint is investigator-assessed PFS. Confirmed objective response rate (cORR), duration of response (DOR), and safety were evaluated in stratified subgroups. Results: Among pts assigned to TUC + HP (n = 326) or PBO + HP (n = 328), ∼69% had de novo MBC, ∼53% had HR+ status with ∼45% having received concurrent ET, and ∼12% had baseline BM. At data cutoff (Sep 5, 2025), median PFS was longer with TUC than PBO + HP in all stratified subgroups; TUC + HP consistently improved cORR vs PBO + HP (Table). Safety outcomes in subgroups aligned with the overall population. Conclusions: TUC + HP demonstrated clinically meaningful efficacy vs PBO + HP in pts with de novo or recurrent disease, HR+ or HR− disease, and baseline BM or not, with no new safety signals identified. Results were consistent with the overall population and support TUC + HP as a potential new maintenance therapy across pts with HER2+ MBC. Clinical trial information: NCT05132582 . Efficacy outcomes. Overall De novo Recurrent HR+ (± ET) † HR− BM (yes) BM (no) TUC+HP(n=326) PBO+HP(n=328) TUC+HP(n=227) PBO+HP(n=226) TUC+HP(n=99) PBO+HP(n=102) TUC+HP(n=168) PBO+HP(n=176) TUC+HP(n=158) PBO+HP(n=152) TUC+HP(n=41) PBO+HP(n=40) TUC+HP(n=285) PBO+HP(n=288) Median PFS, mos (95% CI) 24.9(21.3−NE) 16.3(12.6−18.7) 28.9(22.7−NE) 16.8(12.9−19.2) 21.3(15.6−27.2) 12.7(8.3−18.1) 25.0(16.5−NE) 18.1(13.0−20.8) 24.9(19.4−NE) 12.6(9.4−16.8) 8.5(4.2−16.5) 4.2(2.2−8.1) 27.2(24.3−NE) 18.1(14.8−20.7) cORR*, % (95% CI) 22.6(18.0−27.8) 15.2(11.3−19.7) 26.1(20.2−32.7) 18.5(13.5−24.4) 15.1(8.5−24.0) 7.0(2.6−14.6) 20.1(14.0−27.5) 12.9(8.2−19.0) 25.2(18.4−33.0) 17.9(11.8−25.5) 15.0(5.7−29.8) 8.3(1.8−22.5) 23.8(18.7−29.5) 16.1(11.9−12.1) Median DOR*, mos (95% CI) 20.9(16.4−NE) 16.9(12.3−NE) NR(16.4−NE) 16.3(10.4−NE) 17.9(8.3−NE) NR(7.2−NE) 20.9(12.6−NE) 18.7(7.8−NE) NR(8.6−NE) 14.5(10.4−NE) 12.6(8.1−NE) 16.3(12.5−NE) 20.9(16.4−NE) 18.7(10.4−NE) *ORR and DOR were assessed in patients with target or non-target lesions at baseline. † Data on HR+ w/ ET will be presented.
Tucatinib (TUC) combined with trastuzumab and pertuzumab (HP) as first-line (1L) maintenance therapy for HER2+ metastatic breast cancer (MBC): An in-depth safety analysis of HER2CLIMB-05.
Dieras, V, Curigliano, G, M, Casado Martín, Lerebours, Florence, Tsurutani, Junji , Jerzak, Katarzyna J. , Hu, Xichun, Aquino, Luciana Carla Martins de, O'Sullivan, Ciara Catherine, Tokunaga, Eriko , Okines, Alicia Frances Clare, Huang, Chiun-Sheng, Sohn, J, Cronemberger, Eduardo , Mueller, Volkmar, Kaur, Manjot, Viala, Helene, Yang, Shan, Hamilton, Erika P., Dièras, Véronique , Curigliano, Giuseppe , Lerebours, Florence , Savard, Marie-France , Hu, Xichun , O’Sullivan, Ciara C. , Okines, Alicia , Sohn, Joohyuk

Journal of Clinical Oncology | May 27, 2026 | Volume: 44 | Issue: 16_suppl | Pages: 1042-1042

10.1200/jco.2026.44.16_suppl.1042 Get It

1042 Background: The primary analysis of the phase 3 HER2CLIMB-05 study (NCT05132582) showed the addition of TUC to 1L maintenance HP yielded a statistically significant improvement in progression-free survival (per investigator) versus control treatment (hazard ratio: 0.641, P < 0.0001) in patients with HER2+ MBC. Here we report our findings from an in-depth safety analysis of HER2CLIMB-05. Methods: Patients with centrally confirmed HER2+ MBC without evidence of progression following chemotherapy-based induction treatment (taxane + HP) were randomly assigned 1:1 to TUC (300 mg) or placebo (PBO) BID, both in combination with HP. The safety analysis set included all randomly assigned patients who received ≥1 dose of any study treatment. Treatment-emergent adverse events (TEAEs), laboratory values, and TUC/PBO dose modifications and discontinuations were examined. Results: Among patients in the safety analysis set (TUC arm = 326; PBO arm = 324), median treatment durations of TUC and PBO were 17.1 months (range: 0.4–36.5) and 15.5 months (range: 0.5–41.3), respectively. Grade (G) ≥3 TEAEs occurred in 42.3% of patients in the TUC arm and 24.4% in the PBO arm; the most frequent G ≥3 TEAEs in the TUC arm were elevated alanine aminotransferase (ALT; 13.5%) and aspartate aminotransferase (AST; 7.1%). TUC was discontinued in 13.5% of patients due to a TEAE. Cardiac TEAEs were similar between TUC and PBO arms (4.3% vs 6.2%). TEAEs of hepatic events (43.6% vs 15.7%) and diarrhea (72.7% vs 51.2%) occurred at higher incidence in the TUC arm versus the PBO arm (Table). In the TUC arm, increased ALT (28.2%) and AST (25.8%) accounted for the majority of hepatic TEAEs. Most hepatic and diarrhea TEAEs were managed with TUC dose modifications and/or discontinuation; 7.7% of patients discontinued TUC due to hepatic TEAEs and 1.5% discontinued due to diarrhea (Table). Among the patients with a TEAE of diarrhea, 57.7% and 29.9%, respectively, in the TUC and PBO arms used antidiarrheals; the most used medication was loperamide. Further details of the in-depth safety analysis will be presented. Conclusions: TUC addition to 1L HP maintenance therapy may be an effective option for HER2+ MBC with a clinically manageable safety profile. Clinical trial information: NCT05132582 . TEAEs* Any Any hepatic Increased ALT/AST Diarrhea Arm TUC PBO TUC PBO TUC PBO TUC PBO Any G, % 99.1 96.6 43.6 15.7 28.2/25.8 7.1/9.0 72.7 51.2 G ≥3 42.3 24.4 18.1 1.2 13.5/7.1 0.6/0.6 6.1 4.0 Any G: Median time to onset (days) 34.5 85.0 11.0 32.0 Median time to resolution (days) 25.0 22.0 2.0 5.0 Any G: TUC/PBO dose hold, % 49.4 25.3 19.3 2.5 12.6/4.0 0.6/0.6 8.6 3.4 TUC/PBO dose reduction, % 29.1 11.1 16.3 0.9 11.7/2.8 0.3/0.6 6.4 3.1 TUC/PBO discontinuation, % 13.5 2.2 7.7 0 4.0/0.3 0/0 1.5 0.9 *As of data cutoff, Sep 5, 2025.
Associations of spousal support with career attrition in academic medicine: a multi-specialty cross-sectional survey study
O’Sullivan, Ciara C. , Jenkins, Sarah M. , Hunderfund, Andrea Leep, Ruddy, Kathryn J. , Marshall, Ariela L. , Hunderfund, Andrea L, Marshall, Ariela , Hunderfund, Andrea N. Leep , West, Colin P.

BMJ Leader | May 25, 2026 | Volume: No volume available | Issue: No issue available | Pages: leader-2025-001407

10.1136/leader-2025-001407 Get It

Importance Little is known about how factors external to the workplace, such as spousal support, influence physician attrition. Objectives To explore associations of spousal support among married/partnered physicians with both ‘hard’ attrition ((HA), considering leaving academic medicine within 2 years) and ‘soft’ attrition ((SA), having ever considered part-time work), before and after adjusting for demographic variables, burnout and satisfaction with work-life integration (WLI). Design This cross-sectional survey study was conducted among faculty physicians employed at Mayo Clinic. Outcomes and measures Survey items measured demographics, spousal support (five items), HA, SA, satisfaction with WLI (single-item measure) and burnout (two-item measure). Check-all-that-apply questions explored reasons for considering attrition. We investigated associations of spousal career support with attrition consideration using logistic regression analyses, adjusting for demographic variables then for WLI satisfaction and burnout. Results 739/2103 physicians responded (response rate 35.1%); 666 (90.1%) were married or partnered and responded to the HA question. 42.5% (283/666) reported considering HA and 60.9% of full-time employees (288/473) had ever considered SA. 65.5% (437/666) considered any attrition (AA). Respondents reporting more frequent spousal career support had lower odds of HA (OR 0.80, 95% CI 0.68 to 0.94, p=0.006), though this was not significant when considering AA (OR 0.85, 95% CI 0.71 to 1.01, p=0.07). Neither association was significant after adjusting for WLI satisfaction and burnout (OR 1.01, 95% CI 0.80 to 1.29, p=0.91 (HA), OR 1.10, 95% CI 0.86 to 1.37, p=0.45 (any attrition)). Conclusions While spousal support was no longer significantly associated with attrition after adjusting for WLI satisfaction and burnout, it may mitigate attrition.
CLO26-104: TBCRC 050: A Phase 1b/2 Trial of Niraparib and Trastuzumab in HER2+ Metastatic Breast Cancer (MBC): Safety and Efficacy
Stringer-Reasor, Erica, Li, Yufeng , Zhang, Jianqing , Rocque, Gabrielle, Jones, Kyla R, O'Sullivan, C. C., Dees, Elizabeth Claire , Nanda, Rita, Hunter, Natasha, Clark, Amy S. , Wolff, Antonio, Krop, Ian E. , Lin, Nancy, Yang, Eddy S. , O'Sullivan, Ciara, Giridhar, Karthik, Stringer-Reasor, Erica , Rocque, Gabrielle B. , O’Sullivan, Ciara C. , Giridhar, Karthik V. , Hunter, Natasha B. , Wolff, Antonio C. , Rimawi, Mothaffar F.

Journal of the National Comprehensive Cancer Network | March 27, 2026 | Volume: 24 | Issue: 3.5 | Pages: No page available

10.6004/jnccn.2025.7190 Get It

Abstract PS5-11-10: Implementing an Our Practice Advisory (OPA) to provide clinical decision support for adjuvant CDK4/6 inhibitors in early-stage hormone receptor positive breast cancer: The Mayo Clinic Experience
Premji, Sarah , Advani, Pooja , Chumsri, Saranya , Mina, Lida A. , Taraba, Jodi L. , Carroll, J., Hoppenworth, Jenna, Cathcart-Rake, E., Haddad, TC, Rudder, B., Choong, G., Idossa, D., O’Sullivan, Ciara C. , Yadav, S., Ruddy, K. J., Peethambaram, P., Hobday, T., Goetz, M. P., Rao, R., Leon-Ferre, R. A., Tevaarwerk, A., Giridhar, K. V., Taraba, Jodi L , Cathcart-Rake, Elizabeth , Rudder, B., Choong, G. M., Idossa, Damé , Yadav, S., Ruddy, Kathryn J. , Peethambaram, Prema P. , Hobday, Timothy J. , Ernst, Brenda , Batalini, Felipe , Leon‐Ferre, Roberto A. , Tevaarwerk, Amyé

Clinical Cancer Research | February 17, 2026 | Volume: 32 | Issue: 4_Supplement | Pages: PS5-11-10-PS5-11-10

10.1158/1557-3265.sabcs25-ps5-11-10 Get It

Abstract Introduction: An Our Practice Advisory (OPA), formerly known as Best Practice Advisory (BPA), is an electronic health record (EHR) tool. OPAs identify key parameters to alert providers of potential interventions that could enhance quality of care. Such functionality is increasingly relevant given the rapid pace of new drug approvals. Within the Mayo Clinic system, we previously identified that amongst Mayo Clinic patients (pts) meeting the MonarchE criteria, 28% of pts did not undergo a documented discussion with their provider regarding the role of adjuvant abemaciclib (Premji, SABCS 2024). Further, a Flatiron study identified that only 40% of eligible pts received abemaciclib (Sandoval, Miami Breast 2025). To address this practice gap, in 2024 we began to implement EHR clinical decision support by creating an OPA trigger for pts eligible for an adjuvant CDK 4/6 inhibitor (CDK 4/6i). Here we report on ‘action taken’ versus not for the OPA and the most common reasons for re-prompts. Methods: The Mayo Breast Disease Group designed an OPA including pts who are within 14 months of a clinical or pathologic diagnosis of high-risk early-stage breast cancer. We leveraged structured data captured in the Epic staging forms (Epic Systems) to identify pts with clinical or pathologic T-stage, N-stage, grade, ± Ki-67/ multigene signature to identify ER+/HER2- pts eligible for adjuvant ribociclib or abemaciclib based on FDA approvals. The OPA was triggered by a patient encounter in oncology when endocrine therapy (but not CDK4/6i) was on the active medication list resulting in a hard stop. The OPA gathered limited details about whether adjuvant CDK4/6 inhibitors were discussed and whether the provider followed a link that resulted in prescribing one—considered an indicator of action taken. In this IRB-exempt quality improvement project, we describe the responses captured in the OPA trigger utilizing Epic tools. Results: The OPA went live on 1/10/2025. Over a 5-month period post OPA initiation, we identified 517 OPA alerts among 332 unique pts. Their median age was 62.5 years, and the majority were female (97%). The median time to resolve the OPA was 17.5 seconds (range 2-567 seconds). 12.6% (65/517) of the time there was ‘action taken’ by selecting the hyperlink to potentially start a treatment plan. Providers selected the following OPA pre-set responses: ‘re-prompt in one month’ 248 (48%), ‘patient not a candidate for therapy’ 48 (9%), ‘patient declines’ 69 (13%), ‘outside oncologist will prescribe’ 36 (7%), ‘not discussed’ 44 (9%), and unknown 72 (14%). The most common free text comments among the 517 OPA alerts (summarized) included: ‘revisit in future’ 108 (21%), ‘too early’ 65 (13%), ‘patient declines’ 66 (13%), ‘outside oncologist will start’ 31 (6%), ‘not a candidate’ 26 (5%), and ‘co-morbidities’ 18 (3%). Erroneous OPA prompting occurred in 14 (3%) who previously failed a CDK4/6i due to toxicity and in 18 (3%) for pts currently on a CDK4/6i. 30 (6%) OPA comments noted that they discussed or started therapy that day. Conclusion: The OPA offered clinical decision support and ensured that clinicians considered prescribing CDK 4/6i in all pts identified as eligible, and captured deferrals. Refinements are needed to ensure appropriate timing of OPA and minimize erroneous firing. The OPA remains active and captures the reason for deferral of adjuvant CDK 4/6i prescription. This data pairs real world decision making to better understand clinically meaningful application of improved invasive disease-free survival (iDFS). Citation Format: S. Premji, P. Advani, S. Chumsri, L. Mina, J. Taraba, J. Carroll, J. Hoppenworth, E. Cathcart-Rake, T. Haddad, B. Rudder, G. Choong, D. Idossa, C. O’Sullivan, S. Yadav, K. Ruddy, P. Peethambaram, T. Hobday, M. Goetz, R. Rao, B. Ernst, F. Batalini, R. Leon-Ferre, A. Tevaarwerk, K. Giridhar. Implementing an Our Practice Advisory (OPA) to provide clinical decision support for adjuvant CDK4/6 inhibitors in early-stage hormone receptor positive breast cancer: The Mayo Clinic Experience [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-11-10.