Exome analysis of oncogenic pathways and tumor mutational burden (TMB) in triple-negative breast cancer (TNBC): Results of the translational biomarker program of the neoadjuvant double-blind placebo controlled GeparNuevo trial.

Authors

Sibylle Loibl

Sibylle Loibl

German Breast Group (GBG) and Centre for Haematology and Oncology Bethanien, Frankfurt, Neu-Isenburg, Germany

Sibylle Loibl , Bruno Valentin Sinn , Thomas Karn , Michael Untch , Hans-Peter Sinn , Karsten Ernst Weber , Claus Hanusch , Jens Bodo Huober , Peter Staib , Ralf Lorenz , Jens Uwe Blohmer , Frederik Marmé , Wolfgang D Schmitt , Kerstin Rhiem , Marion van Mackelenbergh , Peter A. Fasching , Song Wu , Brandon W. Higgs , Andreas Schneeweiss , Carsten Denkert

Organizations

German Breast Group (GBG) and Centre for Haematology and Oncology Bethanien, Frankfurt, Neu-Isenburg, Germany, Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany, Helios Klinikum Berlin-Buch, Berlin, Germany, University Hospital Heidelberg, Heidelberg, Germany, German Breast Group, Neu-Isenburg, Germany, Rotkreuzklinikum, Frauenklinik, Munich, Germany, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany, St Antonius Hospital, Eschweiler, Germany, Gemeinschaftspraxis Lorenz-Hecker-Wesche, Braunschweig, Germany, Department of Gynecology/Breast Center of the Charité, Berlin, Germany, Allgemeine Frauenheilkunde und Geburtshilfe, Universitätsklinikum Heidelberg, Heidelberg, Germany, Institut für Pathologie, Charité-Universitätsmedizin Berlin, Berlin, Germany, Center for Familial Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany, Universitätsklinikum Kiel, Kiel, Germany, University Hospital Erlangen, Erlangen, Germany, MedImmune, Gaithersburg, MD, National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany, Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg, Marburg, Germany

Research Funding

Pharmaceutical/Biotech Company

Background: GeparNuevo (G9) showed a numerical increase in pCR rate of 53% vs 44%; p = 0.287 compared to placebo in TNBC with the addition of the anti-PD-L1 antibody durvalumab (D) to a neoadjuvant anthracycline-taxane containing chemotherapy (Loibl S et al. ASCO 2018). Somatic mutations in malignant cells manifest over the evolutionary history of a tumor. Reports in selected tumor types suggest that TMB may predict clinical outcomes on immune-checkpoint inhibitors (ICI). The clinical relevance of TMB in breast cancer has not been studied widely. Here, we investigated the hypothesis that TMB predicts response to ICI. Methods: Whole exome sequencing was conducted on patient-matched fresh-frozen core biopsies and blood samples with Illumina (n = 149/174). SNVs and indels were called with Mutect and pureCN was used for copy number calls. Mutational signatures were identified as described by Alexandrov et al. (Cell Rep. 3, 2013). Data from G9 were compared to The Cancer Genome Atlas (TCGA) TNBC cohort. Results: A similar genomic landscape was observed between G9 and TCGA with primary mutations in TP53 (69%), c-MYC (26%), BRCA1 (13%), BRCA2 (6%), PIK3CA (11%) and PTEN (11%). Median TMB was 1.52 mut/MB. TMB in G9 was slightly lower than TCGA TNBC. TMB correlated with older age, higher mutation rates in BRCA2, ARID1A, and TP53, and higher burden in variant signatures such as DDR, HRD, GFRs, APOBEC and Alexandrov’s signatures 3 and 6. Continuous TMB predicted pCR in univariate (OR = 1.62, 95%-CI: 1.20 - 2.20, p = 0.0018) and multivariate (OR = 2.06, 95%-CI: 1.33 - 3.20, p = 0.0012) logistic regression models, but did not predict a D effect. After dichotomisation of TMB at the top tertile, 50 patients had high TMB and 29 of these (58%) achieved a pCR, while 99 had low TMB and only 38 of these (38%) had a pCR (p = 0.0242). Conclusions: Results show that TMB may predict pCR in primary TNBC. The trial was financially supported by Astra Zeneca and Celgene. Clinical trial information: NCT02685059

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Breast Cancer—Local/Regional/Adjuvant

Track

Breast Cancer

Sub Track

Neoadjuvant Therapy

Clinical Trial Registration Number

NCT02685059

Citation

J Clin Oncol 37, 2019 (suppl; abstr 509)

DOI

10.1200/JCO.2019.37.15_suppl.509

Abstract #

509

Poster Bd #

1

Abstract Disclosures