Serum PD-L1 and outcomes in CCTG MA.31 phase 3 trial of anti-HER2 therapy in first-line HER2+ metastatic breast cancer patients (trastuzumab arm only).

Authors

null

Kim Leitzel

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

Organizations

Penn State Hershey Medical Center, Hershey, PA, Lebanon VAMC, Lebanon, PA, Canadian Cancer Trials Group, Kingston, ON, Canada, NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada, Queen's University, Canadian Cancer Trials Group, Kingston, Ontario, CA, Kingston, ON, Canada, NCIC Clinical Trials Group, Kingston, ON, Canada, British Columbia Cancer Agency, Vancouver, BC, Canada, University of British Columbia, BC Cancer Agency, Vancouver, BC, Canada, ProteinSimple, San Jose, CA

Research Funding

Other

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.

Multivariate significant independent covariates for OS (186 patients).

Covariatep-valueHazard RatioLower 95% CIHigher 95% CI
Prior adjuvant/metastatic
endocrine therapy (yes vs no)
0.0014.071.759.46
Performance status (0 vs 1 or 2)0.0020.300.140.65
Central Review ER status
(continuous IHC score)
0.0060.990.980.99
Serum PD-L1 (pretreatment)
( > median vs < median)
0.0062.911.366.25
Prior adjuvant / metastatic radiotherapy
(yes vs no)
0.0490.440.190.99

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Abstract Details

Meeting

2018 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Breast Cancer—Metastatic

Track

Breast Cancer

Sub Track

HER2-Positive

Citation

J Clin Oncol 36, 2018 (suppl; abstr 1031)

DOI

10.1200/JCO.2018.36.15_suppl.1031

Abstract #

1031

Poster Bd #

112

Abstract Disclosures