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25 citation(s) found for "Isakoff, SJ".

A randomized phase II trial of folate receptor alpha peptide vaccine in early-stage triple-negative breast cancer.
Knutson, Keith L., Hillman, DW, Cogen, Davitte , Moreno-Aspitia, Alvaro, Northfelt, Donald W. , Ernst, Brenda, Isakoff, Steven J. , Tolaney, Sara M., Calfa, Carmen, Nanda, Rita, Cole, John T., Fagbemi, Seth, Rowland, Kendrith M., Perez, EA, Chumsri, Saranya, Ruddy, Kathryn Jean, Knutson, Keith L. , Hillman, David W. , Moreno‐Aspitia, Alvaro , Ernst, Brenda , Tolaney, Sara M. , Calfa, Carmen, Nanda, Rita , Mortimer, Joanne , Fagbemi, Seth O., Perez, EA, Norton, Nadine , Chumsri, Saranya , Ruddy, Kathryn J.

Journal of Clinical Oncology | May 27, 2026 | Volume: 44 | Issue: 16_suppl | Pages: 536-536

10.1200/jco.2026.44.16_suppl.536 Get It

536 Background: Folate receptor alpha (FRα) is overexpressed in ~80% of triple-negative breast cancers (TNBC). We previously demonstrated that patients (pts) with breast cancer naturally mount immune responses to FRα. In prior Phase I and II studies, a GM-CSF-adjuvanted FRα peptide vaccine (FRPV) was safe and induced durable FRα-specific T-cell immunity in 83–90% of pts with breast and ovarian cancer. Methods: Eligible pts were women ≥18 years with TNBC (ER/PR ≤10%) with 1+ of the following: stage ≥T1c disease, node-positivity, or residual disease after neoadjuvant chemotherapy. Pts were randomized 2:1 to receive FRPV or placebo (GM-CSF alone) every 28 days for cycles 2-7 and then every six months for 7 booster doses, with cycle 1 consisting of cyclophosphamide 50mg orally twice daily for days 1-7 and 15-21 (in both arms). Randomization was stratified by chemotherapy setting (adjuvant only vs neoadjuvant) and stage (I/II vs III). FRα expression was evaluated by immunohistochemistry. The study was designed to detect (at 30 months after the last pt enrolled) a disease-free survival (DFS) difference of 14% assuming a 3.5-year DFS rate of 70% in the control group and with 78% power. Results: 280 pts were enrolled (median age 52). The majority had stage I or II tumors (n = 219, 78%). There were numerically more node-positive tumors in the vaccine arm, 78 (41%) vs 27 (32%), p = 0.15. Median follow-up was 3.5 years, and 33 (FRPV: 25, placebo: 8) DFS events were observed; 3.5-year DFS rate was 88% with FRPV and 90% with placebo (HR 1.42, 95% CI 0.64–3.15; p = 0.39). Overall survival (OS) also did not differ by arm (HR 2.48, 95% CI 0.55–11.20; p = 0.22). Among node-positive pts (n = 105), DFS did not differ between arms (HR 0.95, 95% CI 0.34–2.66; p = 0.92). However, a numerical DFS event rate improvement (14% for vaccine vs. 26% for placebo) was observed in 61 patients with stage III disease (HR 0.51, 95% CI 0.16–1.68; p = 0.26). DFS did not differ by chemotherapy setting or by receipt of anthracycline, capecitabine, and/or an immune checkpoint inhibitor. FRPV was well tolerated, with predominantly grade 1–2 adverse events (AEs) and no vaccine-related grade ≥4 AEs. FRα expression was available from tumor in 230 pts, with 72% expressing > 0. Overall, DFS was not significantly associated with FRα expression (0 vs > 0; HR 0.55, 95% CI 0.21–1.44; p = 0.21), and no significant differences in DFS by FRα expression were observed between treatment arms. Conclusions: FRPV following oral cyclophosphamide was safe, with no vaccine-related high-grade AEs. While no significant improvement in DFS or OS was observed overall, a numeric trend toward improved DFS was observed in pts with stage III TNBC. This finding is hypothesis-generating and supports further evaluation of FRα-targeted vaccination in higher-risk TNBC. Immune correlative analyses are ongoing to better define vaccine immunogenicity and its relationship to clinical outcomes. Clinical trial information: W81XWH-15-1-0293.
TROP2/claudin program mediates immune exclusion to impede checkpoint blockade in breast cancer
Wu, Bogang , Thant, Win , Bitman, Elena , Liu, T., Liu, Jie, Paschalis, E., Patel, B., Nawrocki, Cole , Xu, K., Nieman, Linda T, Ting, David T, Cheng, Yang, Sun, Fengfei, Thimmiah, Nayana , Sun, S., Abelman, R. O., Bossuyt, Veerle , Isakoff, Steven J. , Spring, L., Bardia, Aditya, Ellisen, Leif W. , Wu, Bogang , de Gois Macedo, Bruna, Paschalis, Eleftherios I. , Patel, Bidish K. , Nieman, Linda T. , Ting, David T. , Macedo, Bruna de Gois , Jiang, Kevin , Abelman, Rachel O. , Bardia, Aditya

Journal for ImmunoTherapy of Cancer | April 3, 2026 | Volume: 14 | Issue: 4 | Pages: e012265

10.1136/jitc-2025-012265 | PMID 41932810 Get It

Background Immune exclusion inhibits antitumor immunity and response to immunotherapy, but its mechanisms remain poorly defined. In triple-negative breast cancer (TNBC), an aggressive and generally immune-rich subtype, an immune-cold microenvironment predicts poor prognosis due to a limited response to chemotherapy and immune checkpoint inhibitors. This study aimed to identify mechanisms regulating immune infiltration in TNBC. Methods We performed spatial transcriptomic analysis comparing immune-enriched versus immune-cold treatment-naïve TNBCs. Functional analyses, including loss-of-function and reconstitution experiments, were conducted to investigate the role of trophoblast cell-surface antigen 2 (TROP2), a key target of anticancer antibody drug conjugates (ADCs), in promoting TNBC progression. A humanized TROP2 syngeneic TNBC model was used to assess the effects of TROP2-targeting in combination with anti-programmed cell death protein 1 (PD-1) therapy. Additionally, data from patients treated with immune checkpoint blockade were used to test hypotheses from the preclinical findings. Results We reveal that TROP2 controls barrier-mediated immune exclusion in TNBC through claudin 7 association and tight junction regulation. TROP2 expression is inversely correlated with T-cell infiltration and predicts poor outcomes in TNBC. We demonstrate that TROP2 is sufficient to drive tumor progression in vivo in a CD8 T cell-dependent manner, while its loss deregulates expression and localization of multiple tight junction proteins, enabling T-cell infiltration. We show that TROP2 targeting via hRS7, the antibody component of the ADC sacituzumab govitecan, enhances the anti-PD-1 response and improves T-cell accessibility and effector function. Correspondingly, TROP2 expression is highly associated with lack of response to anti-PD-1 therapy in human breast cancer. Conclusions This study defines a new mechanism of barrier-mediated immune exclusion in cancer controlled by TROP2-dependent tight junctions. This mechanism drives tumor progression but can be targeted via TROP2-directed therapy to activate antitumor immunity and enhance immunotherapy response.
Abstract RF5-02: Tbcrc 056: a phase 2 study of neoadjuvant niraparib with dostarlimab for patients with BRCA- or PALB2-mutated breast cancer: results from the TNBC cohorts
Mayer, E. L., Leon-Ferre, R. A., Rozenblit, M., Santa-Maria, C. A., Isakoff, S., Specht, J. M., Tung, NM, Abramson, V., Desrosiers, Jennifer, Schubert, Adrian , Koca, Beyza , Tolaney, S. M., Winer, E. P., Krop, I. E., Wolff, A. C., Shapiro, G. I., Tayob, Nabihah, Guerriero, J. L., Graham, Noah , Leon‐Ferre, Roberto A. , Rozenblit, M., Santa-Maria, C.A., Specht, Jennifer M. , Tung, Nadine , Abramson, V., Schubert, A., Tolaney, Sara M. , Winer, E. P., Krop, I. E., Wolff, A.

Clinical Cancer Research | February 17, 2026 | Volume: 32 | Issue: 4_Supplement | Pages: RF5-02-RF5-02

10.1158/1557-3265.sabcs25-rf5-02 Get It

Abstract Background PARP inhibitors (PARPi) are active in patients (pts) with germline BRCA1/2 or PALB2 mutated (gBRCA1/2; gPALB2m) breast cancer (BC). Preclinical data suggest PARPi leads to intratumoral activation of the proinflammatory cGAS/STING pathway, recruiting CD8+ T cells, and sensitizing gBRCAm cancers to immune-targeted therapy. Prolonged preoperative treatment with PARPi monotherapy has demonstrated notable pathologic complete response (pCR) rates. The randomized phase II TBCRC 056 study evaluates the PARPi niraparib (N) with the anti-PD-1 antibody dostarlimab (D) as neoadjuvant treatment of gBRCAm or gPALB2mHER2-negative BC, with cohorts for both triple negative BC (TNBC, Arms A and B) and estrogen receptor positive (ER+) BC (Arm C). Results from Arms A and B are being presented. Methods Eligible pts (gBRCA1/2m/gPALB2m BC, T >1.0 cm, ER- (<10%), HER2-) were randomized to either Arm A: upfront combination N 200 mg orally QD and D 500 mg IV every 3 weeks (wks) for 18 wks (1 cycle = 3 wks), or Arm B: N monotherapy for 3 wks, followed by combination N plus D for 15 wks, with baseline (BL) and wk 3 tumor biopsies. After 18 wks, pts either underwent surgery or received additional preoperative systemic therapy (per MD choice) after an end of treatment biopsy if residual disease present. The primary study objectives are to evaluate pCR in Arms A and B combined, as well as change in stromal tumor infiltrating lymphocytes (sTILs) from BL to 3 wks in each Arm separately; 46 pts and a target pCR rate of 50% provides 85% power to reject the null hypothesis of pCR < 30%. Results A total of 46 pts with TNBC enrolled to Arms A and B (38 gBRCA1m (82.6%), 8 gBRCA2m (17.4%), 0 gPALB2m). Median age was 39.3 years (range 24.8-72.8); 84.8% self-reported White, 6.5% Black, 4.3% Asian, and 8.7% Hispanic. Clinical stage distribution was 37.0% stage I, 45.7% stage II, and 17.4% stage III; most had ER- BC (42 ER <1%, and 4 ER 1-10%). Among all pts, 38 (82.6%) completed the target number of cycles of D, with mean cycles received 5.1. Five pts discontinued D early (3 inadequate response/progression, 2 unacceptable AE: LFTs, rash). A total of 38 pts (82.6%) completed 6 cycles of N, with mean cycles received 5.7. Seven pts discontinued N early (3 inadequate response/progression, 4 unacceptable AE: LFTs, anemia, rash (2)). Most common AEs (> grade 2) with D+N were anemia (26.1%), fatigue (21.7%), hypertension (15.2%), hypothyroidism (15.2%), and neutropenia (15.2%). Most common Grade >3 AEs with D+N were anemia (17%) and neutropenia (6.5%). Among all pts, 23 (50%) had a pCR at surgery (90% CI 37.1% - 62.9%), 12 (26.1%) had residual disease (4 RCB-I, 5 RCB-II, 2 RCB-III, 1 RCB not calculable), and 11 (23.9%) crossed over to additional preoperative therapy. The pCR rate exceeded the protocol efficacy criterion of >43%, a significant increase over null hypothesis. pCR rates were the same on Arms A (50%, 90% CI 31.1% - 68.9%) and B (50%, 90% CI 31.9% - 68.1%). Among 15 pts on Arm A with evaluable sTILs at BL and 3 wks, mean sTILs at BL was 16% (range 1% - 40%), and at 3 wks was 27.4% (range 0.5% - 60%), for an average increase of 11.4% (p=0.009). Among 22 pts on Arm B with evaluable sTILs at BL and 3 wks, mean sTILs at BL was 19.5% (range 1% - 75%), and at 3 wks was 42.1% (range 1% - 85%), for an average increase of 22.7% (p=0.0003). Among all pts, BL sTILs (continuous) were significantly higher among those who achieved pCR than those who did not (median 15% vs. 5%, p=0.03). There was no relationship between pCR and BL PD-L1 score, or pCR and ER-0 vs. ER-low. Conclusions In pts with gBRCAm early TNBC, 18 wks of targeted therapy using PARPi and anti-PD1 agents, with or without 3-week PARPi lead-in, resulted in a pCR rate of 50%, and a statistically significant increase in sTILs from BL to 3 wks. Further ongoing correlative work may identify best candidates for this non-chemotherapy-based approach. Citation Format: E. L. Mayer, N. Graham, R. A. Leon-Ferre, M. Rozenblit, C. A. Santa-Maria, S. Isakoff, J. Specht, N. Tung, V. Abramson, J. Desrosiers, A. Schubert, B. Koca, S. M. Tolaney, E. P. Winer, I. E. Krop, A. C. Wolff, G. I. Shapiro, N. Tayob, J. L. Guerriero. Tbcrc 056: a phase 2 study of neoadjuvant niraparib with dostarlimab for patients with BRCA- or PALB2-mutated breast cancer: results from the TNBC cohorts [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 RF5-02.
A Phase 2 Trial of RANKL Antibody, Denosumab, in Two Cohorts of Patients with Recurrent/Refractory Osteosarcoma, a Report from the Children’s Oncology Group
Janeway, Katherine A. , Buxton, Allen, Reid, Joel M. , Isakoff, Michael S. , Hingorani, Pooja , Lee, Jill L., Doski, John J. , Hall, Laura, Randall, R. Lor , DuBois, Steven G. , Krailo, Mark , Grier, Holcombe E. , Chou, Alexander J , Buxton, Allen , Reid, Joel M , Isakoff, Michael S , Kopp, Lisa , Hingorani, Pooja , Lee, Jill L , Doski, John , Daldrup-Link, Heike , Hall, Laura , Randall, Robert Lor , Reed, Damon R , DuBois, Steven G , Krailo, Mark , Grier, Holcombe , Gorlick, Richard , Kopp, Lisa M. , Reed, Damon R. , Görlick, Richard

Clinical Cancer Research | October 29, 2025 | Volume: 32 | Issue: 1 | Pages: 36-44

10.1158/1078-0432.ccr-24-2885 | PMID 41159913 Get It

Abstract Purpose: Mouse models demonstrate a role for RANK and its ligand, RANKL, in osteosarcoma. The primary objective of this single-arm, open-label phase 2 trial was to determine whether denosumab, a RANKL mAb, improved disease control in recurrent osteosarcoma relative to benchmarks derived from historic Children’s Oncology Group clinical trial data. Patients and Methods: Skeletally mature patients ages 11 to 49 years old with measurable disease were eligible for cohort 1, and those with complete surgical resection of all sites of disease were eligible for cohort 2. Patients received denosumab 120 mg subcutaneously every 4 weeks with calcium and vitamin D supplementation. The primary endpoints were RECIST response and remaining event-free for 4 months for cohort 1 and remaining event-free for 12 months for cohort 2. Toxicity, pharmacokinetics, and pharmacodynamic effects were additional endpoints. Results: Fifteen patients in cohort 1 and 38 in cohort 2 were eligible and evaluable for the primary endpoint. One of 15 cohort 1 patients remained event-free at 4 months. There were no objective responses. Ten of 38 cohort 2 patients were event-free at 12 months. The predefined efficacy criteria were not met in either cohort. The most common ≥ grade 3 adverse events were hypocalcemia and hypophosphatemia (8% and 11%, respectively). At steady state, mean serum denosumab trough concentrations were 23.7 to 31 μg/mL in cycles 2 to 7. Serum c-telopeptide and urine n-telopeptide decreased on treatment. Conclusions: Denosumab was well-tolerated with anticipated side effects and pharmacokinetic and pharmacodynamic parameters but had insufficient activity for further development in osteosarcoma.
Optimizing Ewing Sarcoma and Osteosarcoma Biopsy Acquisition: A Children’s Oncology Group Bone Tumor Committee Consensus Statement
Dietz, Matthew S. , Al‐Ibraheemi, Alyaa , Craig, Brian T. , Dasgupta, Roshni, Geller, David S. , Shulman, David S. , Whiteway, Susan L. , Slotkin, Emily K. , Albert, Catherine M. , Montgomery, Nicole I. , Sandberg, Jesse K. , Grier, Holcombe E. , Krailo, Mark , Isakoff, Michael S. , Rubin, Elyssa, Lawlor, Elizabeth R. , DuBois, Steven G. , Grohar, Patrick J. , Janeway, Katherine A. , Roberts, Ryan D. , Dasgupta, Roshni , Ahmed, Safia K. , Dasgupta, Roshni , Roberts, Ryan D , Davis, Jessica L. , Hawkins, C. Matthew , Cohen‐Gogo, Sarah , Gupta, Ajay Kumar , Heske, Christine M. , Indelicato, Daniel J. , Mascarenhas, Leo , Binitie, Odion , Reed, Damon R. , Bailey, Kelly M.

Journal of the National Comprehensive Cancer Network | December 27, 2024 | Volume: 23 | Issue: 1 | Pages: No page available

10.6004/jnccn.2024.7063 | PMID 39729709 Get It

Trends in diagnostic biopsy sample collection approaches for primary bone sarcomas have shifted in the past 2 decades. Although open/incisional biopsies used to be the predominant approach to obtain diagnostic material for Ewing sarcoma and osteosarcoma, image-guided core needle biopsies have increased in frequency and are safe for patients. These procedures are less invasive and reduce recovery times but have potential limitations. The quantity and quality of tissue obtained through these procedures vary between institutions. Acquired viable tissue volumes can be low, limiting the conduct of downstream expanded clinical workup, molecular analyses, and research. Patients with advanced Ewing sarcoma and osteosarcoma continue to have overall poor outcomes despite dose-intensive cytotoxic chemotherapy. The biology of treatment resistance is not currently well understood, partly due to limited availability of relevant tissue to study. There is a need for access to quality tumor specimens for molecular and other analyses to identify high-risk tumor subsets and drive discovery to improve patient outcomes. Given broad variability in bone tumor tissue procurement and processing across member institutions, the Children’s Oncology Group Bone Tumor Committee convened a multidisciplinary group of experts to outline the current and near-future tissue needs for optimal clinical care and access to research platforms. The goal of this working group was to provide high-level guidance on biopsy practices that safely meet these evolving needs. Harmonizing tissue collection practices is paramount to improving the care of children, adolescents, and young adults diagnosed with Ewing sarcoma and osteosarcoma.
A TROP2/Claudin Program Mediates Immune Exclusion to Impede Checkpoint Blockade in Breast Cancer
Wu, Bogang , Thant, Win , Bitman, Elena , Liu, Ting , Liu, Jie , Patel, Bidish K., Nawrocki, Cole, Xu, Katherine , Nieman, Linda T., Ting, David T., Macedo, Bruna de Gois, Cheng, Yang, Jiang, Kevin, Sun, Fengfei, Thimmiah, Nayana, Sun, Sheng , Bossuyt, Veerle I., Isakoff, Steven J. , Bardia, Aditya, Wu, Bogang , Liu, T., Liu, Jie, Paschalis, Eleftherios I. , Patel, Bidish K. , Nawrocki, Cole , Xu, K., Nieman, Linda T. , Ting, David T. , Macedo, Bruna de Gois , Cheng, Yang, Jiang, Kevin , Sun, Fengfei, Thimmiah, Nayana , Sun, S., Abelman, Rachel O. , Bossuyt, Veerle , Spring, L., Bardia, Aditya , Ellisen, Leif W.

No container title available | December 5, 2024 | Volume: No volume available | Issue: No issue available | Pages: No page available

10.1101/2024.12.02.626446 | PMID 39677819 Get It

ABSTRACT Background Immune exclusion inhibits anti-tumor immunity and response to immunotherapy, but its mechanisms remain poorly defined. In triple-negative breast cancer (TNBC), an aggressive and generally immune-rich subtype, an immune-cold microenvironment predicts poor prognosis due to a limited response to chemotherapy and immune checkpoint inhibitors. This study aimed to identify mechanisms regulating immune infiltration in TNBC. Methods We performed spatial transcriptomic analysis comparing immune-enriched versus immune-cold treatment-naïve TNBCs. Functional analyses, including loss-of-function and reconstitution experiments, were conducted to investigate the role of Trophoblast Cell-Surface Antigen 2 (TROP2), a key target of anti-cancer Antibody Drug Conjugates (ADCs), in promoting TNBC progression. A humanized TROP2 syngeneic TNBC model was used to assess the effects of TROP2-targeting in combination with anti-PD1 therapy. Additionally, data from patients treated with immune checkpoint blockade were used to test hypotheses from the preclinical findings. Results We reveal that TROP2 controls barrier-mediated immune exclusion in TNBC through Claudin 7 association and tight junction regulation. TROP2 expression is inversely correlated with T cell infiltration and predicts poor outcomes in TNBC. We demonstrate that TROP2 is sufficient to drive tumor progression in vivo in a CD8 T cell-dependent manner, while its loss deregulates expression and localization of multiple tight junction proteins, enabling T cell infiltration. We show that TROP2 targeting via hRS7, the antibody component of the ADC Sacituzumab govitecan (SG), enhances the anti-PD1 response and improves T cell accessibility and effector function. Correspondingly, TROP2 expression is highly associated with lack of response to anti-PD1 therapy in human breast cancer. Conclusions This study defines a new mechanism of barrier-mediated immune exclusion in cancer controlled by TROP2-dependent tight junctions. This mechanism drives tumor progression but can be targeted via TROP2-directed therapy to activate anti-tumor immunity and enhance immunotherapy response. What is already known on this topic Barrier-mediated immune exclusion is emerging as a mechanism of immune evasion in cancer such as triple-negative breast cancer (TNBC), but its molecular underpinnings remain poorly understood. TROP2 is a surface glycoprotein targeted by antibody-drug conjugates such as Sacituzumab govitecan, yet its functional role beyond drug delivery has been unclear. What this study adds This study identifies TROP2 as a key regulator of tight junction-mediated immune exclusion in TNBC, independent of its intracellular signaling function. TROP2 promotes an immune-cold tumor microenvironment by enforcing mechanical barriers that limit T cell infiltration. How this study might affect research, practice or policy These findings establish TROP2 as a functional driver of immune evasion and provide a mechanistic rationale for combining TROP2-targeting therapies with immune checkpoint inhibitors to overcome resistance in immune-excluded tumors.
Adjuvant Trastuzumab Emtansine Versus Paclitaxel Plus Trastuzumab for Stage I Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer: 5-Year Results and Correlative Analyses From ATEMPT
Tarantino, Paolo , Tayob, Nabihah , Villacampa, Guillermo , Dang, Chau T. , Isakoff, Steven J. , Valero, Vicente , Faggen, Meredith, Mulvey, Therese M. , Bose, Ron , Weckstein, Douglas, Reeder‐Hayes, Katherine E. , Ramaswamy, Bhuvaneswari , Zuckerman, Dan Sayam , Hart, Lowell L., Gadi, Vijayakrishna K. , Constantine, Michael, Cheng, Kit , Garrett, Audrey Merrill, Albain, Kathy S. , DeFusco, Patricia, Ardman, Blair, Nanda, Rita , Jankowitz, Rachel C. , Rimawi, Mothaffar F. , Pohlmann, Paula R. , Poznak, Catherine Van , Forero‐Torres, Andres , Liu, Minetta C. , Ruddy, Kathryn J. , Waks, Adrienne G., DeMeo, Michelle K. , Burstein, Harold J. , Dell’Orto, Patrizia , Russo, Leila, Krause, Emma , Newhouse, Daniel , Schneider, Bryan P. , Krop, Ian E. , Tolaney, Sara M. , Curigliano, Giuseppe , Hui, Winnie W. , Kirkup, Christian , Viale, Giuseppe , Prat, Aleix , Isakoff, Steven J , Mulvey, Therese Marie , Bose, Ron , Wolff, Antonio C , Reeder-Hayes, Katherine , Rugo, Hope S , Zuckerman, Dan , Gadi, Vijayakrishna K , Cheng, Kit , 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 , Burstein, Harold J , Partridge, Ann H , Krause, Emma , Kurt, Busem Binboğa , Mittendorf, EA , Schneider, Bryan , Prat, Aleix , Winer, Eric , Krop, Ian E , Tolaney, Sara , Prat, Aleix , Curigliano, Giuseppe , Pohlmann, Paula , Yardley, Denise Aysel , Wolff, Antonio C. , Rugo, Hope S. , Tung, Nadine , Abramson, Vandana G. , Waks, Adrienne G. , Partridge, Ann H. , Winer, Eric P. , Barroso‐Sousa, Romualdo , DiLullo, Molly K. , Zheng, Yue

Journal of Clinical Oncology | June 27, 2024 | Volume: 42 | Issue: 31 | Pages: 3652-3665

10.1200/jco.23.02170 | PMID 38935923 Get It

PURPOSE Long-term outcomes of patients with stage I human epidermal growth factor receptor 2 (HER2)–positive breast cancer receiving adjuvant trastuzumab emtansine (T-DM1) remain undefined, and prognostic predictors represent an unmet need. METHODS In the ATEMPT phase II trial, patients with stage I centrally confirmed HER2-positive breast cancer were randomly assigned 3:1 to adjuvant T-DM1 for 1 year or paclitaxel plus trastuzumab (TH). Coprimary objectives were to compare the incidence of clinically relevant toxicities between arms and to evaluate invasive disease-free survival (iDFS) with T-DM1. Correlative analyses included the HER2DX genomic tool, multiomic evaluations of HER2 heterogeneity, and predictors of thrombocytopenia. RESULTS After a median follow-up of 5.8 years, 11 iDFS events were observed in the T-DM1 arm, consistent with a 5-year iDFS of 97.0% (95% CI, 95.2 to 98.7). At 5 years, the recurrence-free interval (RFI) was 98.3% (95% CI, 97.0 to 99.7), the overall survival was 97.8% (95% CI, 96.3 to 99.3), and the breast cancer-specific survival was 99.4% (95% CI, 98.6 to 100). Comparable iDFS was observed with T-DM1 irrespective of tumor size, hormone receptor status, centrally determined HER2 immunohistochemical score, and receipt of T-DM1 for more or less than 6 months. Although ATEMPT was not powered for this end point, the 5-year iDFS in the TH arm was 91.1%. Among patients with sufficient tissue for HER2DX testing (n = 187), 5-year outcomes significantly differed according to HER2DX risk score, with better RFI (98.1% v 81.8%, hazard ratio [HR], 0.10, P = .01) and iDFS (96.3% v 81.8%, HR, 0.20, P = .047) among patients with HER2DX low-risk versus high-risk tumors, respectively. CONCLUSION Adjuvant T-DM1 for 1 year leads to outstanding long-term outcomes for patients with stage I HER2-positive breast cancer. A high HER2DX risk score predicted a higher risk of recurrence in ATEMPT.
Interim update of the ATRC-101 phase 1b trial in advanced solid tumors.
Weroha, Saravut J., Doroshow, Deborah B. , Valdes, Frances, Powderly, John D. , Recio‐Boiles, Alejandro , Xing, Yan , Khurana, Sudha, Bishop, Philippe C., Isakoff, Steven J. , Chmielowski, Bartosz , Ulahannan, Susanna Varkey , Bekaii‐Saab, Tanios , Berlin, Jordan D. , Weinberg, Benjamin A.

Journal of Clinical Oncology | June 4, 2023 | Volume: 41 | Issue: 16_suppl | Pages: 2505-2505

10.1200/jco.2023.41.16_suppl.2505 Get It

2505 Background: ATRC-101 monoclonal antibody targets tumor-specific ribonucleoprotein complex (RNP) and elicits anti-tumor immunity, innate and adaptive, in preclinical models. Methods: Phase 1b is evaluating ATRC-101 as monotherapy, every 3 (3M) or 2 (2M) weeks (wk), and ATRC-101 in combination with pembrolizumab (3P) in participants (pts) with advanced solid tumors. ATRC-101 target expression is determined by CAP-CLIA IHC assay. For pts described herein, pre-treatment (tx) tumor biopsies were assessed for target expression by IHC retrospectively or prospectively. Enrollment in 3M and 3P is currently open to pts who are target positive (RNP+ve) by IHC with an H-score ≥ 50. Objectives are safety (primary), PK, immunogenicity, recommended dose for expansion, activity by RECIST1.1 and biomarker analyses in pre-tx and on-tx tumors. Results: As of Nov 18th, 2022, 67 pts received ≥1 dose of ATRC-101 (median prior tx 5, range 1-12). Tumor types were colorectal (CRC, 28), ovarian (10), breast (9), melanoma (8), non-small cell lung (NSCLC, 6), head and neck squamous cell (3), urothelial (1), esophageal (1) and small bowel (1). Tx emergent adverse events (TEAEs) Grade ≥3 occurred in 22 (33%) pts and were related to ATRC-101 in 2 (3%). No tx discontinuations or dose reductions related to ATRC-101. RECIST1.1 best overall responses in efficacy evaluable 61 pts included 1 complete response (CR) in RNP+ve melanoma (3P, 10mg/kg), and 1 partial response (PR) in RNP+ve NSCLC (3M, 30mg/kg). Further, disease stabilized (SD) in 24 pts (39%) and 35 pts had disease progression (PD, 57%) with evidence of association between anti-tumor activity and target expression. Of 24 SD, 22 were in monotherapy cohorts and included 9 CRC pts with highly refractory disease. Conclusions: ATRC-101 alone and in combination with pembrolizumab continues to be well tolerated with evidence of anti-tumor activity. Interim data support ongoing enrollment of pts with RNP+ve pre-tx tumors. Updated and new data including durability of disease control will be presented. Clinical trial information: NCT04244552 . [Table: see text]
Abstract PD18-01: Adjuvant Trastuzumab Emtansine Versus Paclitaxel plus Trastuzumab for Stage I HER2+ Breast Cancer: 5-year results and correlative analyses from ATEMPT (TBCRC033)
Tayob, Nabihah , Dang, Chau T. , Isakoff, Steven J. , Valero, Vicente , Faggen, Meredith, Mulvey, Therese M. , Bose, Ron , Weckstein, Douglas, Reeder‐Hayes, Katherine E. , Rugo, Hope, Ramaswamy, Bhuvaneswari , Zuckerman, Dan Sayam , Hart, Lowell L., Gadi, Vijayakrishna K. , Constantine, Michael, Cheng, Kit , Garrett, Audrey Merrill, Albain, Kathy S. , DeFusco, Patricia, Tung, Nadine, Ardman, Blair, Nanda, Rita , Jankowitz, Rachel C. , Rimawi, Mothaffar F. , Pohlmann, Paula R. , Poznak, Catherine Van , Forero-Torres, Andres , Liu, Minetta C. , Ruddy, Kathryn, Waks, Adrienne G. , DeMeo, Michelle K. , Burstein, Harold J. , Partridge, Ann, Viale, Giuseppe , Hui, Winnie W. , Schneider, Bryan P. , Krop, Ian E. , Tolaney, Sara M. , Rimawi, Mothaffar , Pohlmann, Paula , Tarantino, Paolo , Yardley, Denise Aysel , Wolff, Antonio C. , Marcom, Paul Kelly , Tung, Nadine , Abramson, Vandana G. , Ruddy, Kathryn J. , Zheng, Yue , Barroso‐Sousa, Romualdo , DiLullo, Molly K. , Curigliano, Giuseppe , Winer, Eric P. , Mittendorf, EA , Prat, Aleix

Cancer Research | March 2, 2023 | Volume: 83 | Issue: 5_Supplement | Pages: PD18-01-PD18-01

10.1158/1538-7445.sabcs22-pd18-01 Get It

Abstract Background: The ATEMPT trial primary analysis found that one year of adjuvant trastuzumab emtansine (T-DM1) achieved a 3-year iDFS of 97.8% for patients with stage I HER2+ breast cancer, but was not associated with fewer clinically relevant toxicities (CRTs) compared with paclitaxel and trastuzumab (TH). In this end-of-study analysis, we report 5-year survival outcomes and correlative analyses from the trial. Methods: Patients with stage I centrally confirmed HER2+ breast cancer were randomly assigned 3:1 to adjuvant T-DM1 for one year or TH and received T-DM1 3.6 mg/kg IV every 3 weeks for 17 cycles or paclitaxel 80 mg/m2 IV with weekly trastuzumab IV followed by trastuzumab for 9 months. The co-primary objectives were to compare the incidence of CRTs between the 2 arms and to evaluate iDFS in patients receiving T-DM1. To investigate proteomic correlates of recurrence, spatial proteomic analyses were performed on samples from 13 patients experiencing iDFS events (cases) and 24 matched controls using the NanoString GeoMx Digital Spatial Profiler. The impact of HER2 heterogeneity on outcomes was investigated among 17 cases and 51 matched controls by fluorescence in-situ hybridization (FISH). HER2 genetic heterogeneity was assessed by scrutinizing the whole tumor area and defined as the occurrence of HER2 gene amplification in >5% but < 50% invasive tumor cells. The risk of recurrence was evaluated centrally with the HER2DX genomic assay from 225 primary tumor samples. Germline whole genome sequencing (WGS) was conducted among 55 patients experiencing T-DM1-induced thrombocytopenia and/or bleeding and 55 matched controls to identify genomic correlates for this side effect. Results: A total of 497 patients who initiated protocol therapy were included in this analysis (383 T-DM1 and 114 TH). After a median follow up 5.8 years, among patients receiving T-DM1 there were a total of 11 iDFS events, with 3 distant recurrences. The 5-year iDFS for T-DM1 was 97.0% (95% CI, 95.3-98.8%), the 5-year recurrence-free interval (RFI) was 98.6% (95% CI: 97.4-99.8%) and the 5-year overall survival (OS) for T-DM1 was 97.8 % (95% CI, 96.3-99.3%). Although the study was not powered to evaluate the efficacy of TH, among the 114 patients receiving TH, a total of 9 iDFS events were observed, including 2 distant events; the 5-year iDFS with TH was 91.3% (95% CI: 86.0-96.9%), 5-year RFI was 93.3% (95% CI: 88.6-98.2%) and 5-year OS was 97.9% (95% CI: 95.2-100%). A total of 56 samples were evaluable for heterogeneity analyses, among which 14% (n=8) harbored HER2 genetic heterogeneity. Spatial proteomic analyses found that NF1 (adjusted p=0.72 × 10-6) and CTLA-4 (adjusted p=0.15 × 10-3) were significantly upregulated in primary samples from cases, while cleaved caspase 9, CD25, GITR, ICOS, p53 and PD-L2 were significantly upregulated in controls (all with adjusted p< 0.05). Germline WGS found that the top gene associations with thrombocytopenia and thrombocytopenia or bleeding were ALMS1 (p=0,19 × 10-3) and APBA3 (p=0,23 × 10-3), respectively, although none reaching the threshold for genome wide significance. rs62143195 and rs114169776 were the top single nucleotide polymorphisms associated with thrombocytopenia and thrombocytopenia or bleeding, respectively. Data on the impact of HER2 heterogeneity and of HER2DX score on survival outcomes will be presented. Conclusion: With longer follow-up, adjuvant T-DM1 confirmed outstanding long-term outcomes among patients with stage I HER2+ breast cancer, demonstrating a 5-year RFI of 98.6%. Spatial proteomic analyses identified a potential association between NF1 and CTLA-4 expression with recurrence. Details on the impact of HER2 heterogeneity and HER2DX assay on prognosis will be presented. Citation Format: Paolo Tarantino, Nabihah Tayob, Chau T Dang, Denise Yardley, Steven J. Isakoff, Vicente Valero, Meredith Faggen, Therese Mulvey, Ron Bose, Douglas Weckstein, Antonio C. Wolff, Katherine Reeder-Hayes, Hope Rugo, Bhuvaneswari Ramaswamy, Dan Zuckerman, Lowell Hart, Vijayakrishna K. Gadi, Michael Constantine, Kit Cheng, Audrey Merrill Garrett, Paul K. Marcom, Kathy S. Albain, Patricia DeFusco, Nadine Tung, Blair Ardman, Rita Nanda, Rachel C. Jankowitz, Mothaffar Rimawi, Vandana Abramson, Paula R. Pohlmann, Catherine Van Poznak, Andres Forero-Torres, Minetta C. Liu, Kathryn Ruddy, Yue Zheng, Romualdo Barroso-Sousa, Adrienne Waks, Michelle K. DeMeo, Molly K. DiLullo, Giuseppe Curigliano, Harold Burstein, Ann Partridge, Eric Winer, Giuseppe Viale, Winnie Hui, Elizabeth A. Mittendorf, Bryan P. Schneider, Aleix Prat, Ian Krop, Sara Tolaney. Adjuvant Trastuzumab Emtansine Versus Paclitaxel plus Trastuzumab for Stage I HER2+ Breast Cancer: 5-year results and correlative analyses from ATEMPT (TBCRC033) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD18-01.
Joint Adult and Pediatric Working Group as a Successful Platform to Strengthen Adolescent and Young Adult (AYA) Clinical Trial Collaboration: A Report from the NCTN/SARC AYA Clinical Trials Sarcoma Working Group
Whiteway, Susan L. , Allen‐Rhoades, Wendy , Avutu, Viswatej , Indelicato, Daniel J. , Isakoff, Michael S. , Janeway, Katherine A. , Patel, Shreyaskumar , Riedel, Richard F. , Thornton, Katherine A., Ahmed, Safia K. , Avutu, Viswatej , Reed, Damon R , Riedel, Richard F , Allen-Rhoades, Wendy A , Indelicato, Daniel J , Weiss, Aaron R. , Cardona, Kenneth , Davis, Lara E. , Davis, Elizabeth J. , Livingston, J. Andrew , Reed, Damon R. , Kopp, Lisa M.

Journal of Adolescent and Young Adult Oncology | February 1, 2023 | Volume: 12 | Issue: 5 | Pages: 792-793

10.1089/jayao.2022.0179 | PMID 36724495 Get It