Penn State Hershey Medical Center, Hershey, PA
Kim Leitzel , Suhail M. Ali , Lois E. Shepherd , Wendy R. Parulekar , Liting Zhu , Shakeel Virk , Dora Nomikos , Samuel Aparicio , Karen A. Gelmon , Joseph J. Drabick , Leah Cream , E Scott Halstead , Hyma Vani Polimera , Ashok Maddukuri , Aamnah Ali , Urmeel Hasmukh Patel , Joyson Poulose , Howard Spiegel , Bingshu E. Chen , Allan Lipton
Background: In MA.31 the lapatinib-taxane combination led to shorter PFS than trastuzumab-taxane in HER2+ metastatic breast cancer. We previously reported the positive prognostic utility of pretreatment serum PD-L1 in 63 trastuzumab-treated patients (ASCO 2017, #1024), and here we evaluated it in the trastuzumab arm of MA.31. Methods: MA.31 accrued 652 centrally and/or locally-identified HER2-positive patients; in the trastuzumab arm 186 patients had pretreatment serum available.TheELLA immunoassay platform (ProteinSimple, San Jose, CA) was used to quantitate serum PD-L1. Stratified step-wise forward Cox multivariate analysis was used for PFS and OS. Results: In univariate analysis for PFS, serum PD-L1 was not a significant biomarker for PFS. In univariate analysis for OS, higher serum PD-L1 was a significant biomarker for shorter OS (continuous PD-L1: HR 3.86, p = 0.044; quartiles of PD-L1: HR 1.55, p = 0.002; median cutpoint PD-L1: HR 2.16, p = 0.014). In multivariate analysis for OS [14 covariates included: age, race, ECOG status, anthracyclines, other chemo, endocrine, radio, other prior adjuvant therapy, disease status, ER status, PR status, Ki67 (log transformed), CK5, EGFR, serum PD-L1], elevated serum PD-L1 was a significant independent covariate [continuous PD-L1: HR 22.7, p = 0.001; median cutpoint PD-L1: HR 2.91, p = 0.0061 (Table)]. Conclusions: In the CCTG MA.31 trial, elevated pretreatment serum PD-L1was associated with a shorter OS (but not PFS) with trastuzumab treatment. Immune evasion by the tumor may decrease the effectiveness of trastuzumab therapy. Elevated serum PD-L1 may identify patients who would benefit from addition of an immune checkpoint inhibitor.
Covariate | p-value | Hazard Ratio | Lower 95% CI | Higher 95% CI |
---|---|---|---|---|
Prior adjuvant/metastatic endocrine therapy (yes vs no) | 0.001 | 4.07 | 1.75 | 9.46 |
Performance status (0 vs 1 or 2) | 0.002 | 0.30 | 0.14 | 0.65 |
Central Review ER status (continuous IHC score) | 0.006 | 0.99 | 0.98 | 0.99 |
Serum PD-L1 (pretreatment) ( > median vs < median) | 0.006 | 2.91 | 1.36 | 6.25 |
Prior adjuvant / metastatic radiotherapy (yes vs no) | 0.049 | 0.44 | 0.19 | 0.99 |
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Abstract Disclosures
2019 ASCO Annual Meeting
First Author: Prashanth Reddy Moku
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2023 ASCO Annual Meeting
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2018 ASCO Annual Meeting
First Author: Stephen K. L. Chia