Molecular subtype to predict pathologic complete response in HER2-positive breast cancer in the I-SPY2 trial.

Authors

Alexandra Thomas

Alexandra Thomas

Wake Forest Comprehensive Cancer Center, Winston-Salem, NC

Alexandra Thomas , Amy Sanders Clark , Christina Yau , Denise M. Wolf , Laura van 't Veer , Emily H. Douglas , Amy Jo Chien , Laura Ann Huppert , Hope S. Rugo , Rebecca Arielle Shatsky , Claudine Isaacs , Donald A. Berry , Douglas Yee , Angela DeMichele , Laura Esserman

Organizations

Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, University of Pennsylvania, Philadelphia, PA, University of California-San Francisco, San Francisco, CA, UC San Francisco, San Francisco, CA, Agendia, The University of California San Francisco, San Francsico, CA, Wake Forest Baptist Health, Winston-Salem, NC, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, CA, Department of Medicine, University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, UCSD Medcl Ctr, San Diego, CA, Georgetown University Medical Center, Washington, DC, Berry Consultants, Austin, TX, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA

Research Funding

U.S. National Institutes of Health
Other Foundation, Pharmaceutical/Biotech Company

Background: HER2-positive breast cancer (bc) is a very heterogenous disease. We hypothesized that molecular subtype may predict disease response to investigational agents in HER2+ bc. Here, we report the pathologic complete response (pCR) rate in the first six agents tested in HER2+ bc in the I-SPY 2 trial for the full HER2+ cohort, by molecular subtype, and by disease receptor status. Methods: Women with HER2+ tumors which were > 2.5 cm were eligible. The I-SPY2 platform trial tests novel agents given neoadjuvantly with a backbone of taxol (T) and trastuzumab (H) followed by doxorubicin and cyclophosphamide. Agents investigated in HER2+ bc were TH (control), MK2206, AMG386, pertuzumab (P), neratinib (N (given in place of H), and TDM1+P (given in place of TH). An investigational arm graduated if there was >85% chance of success compared to control in a 300-person phase 3 neoadjuvant trial. Further details of the I-SPY2 methods have been previously published. Molecular subtyping based on gene expression was utilized to categorize tumors into 5 response predictive subtypes (RPS) (HER2-/Immune-/DRD (DNA repair deficiency)-, HER2-/Immune+, HER2-/Immune-/DRD+, HER2+/Her2_or_Basal and HER2+/Luminal). Results: For the full HER2+ cohort (N=245) pCR rate was higher in all investigational arms than control (Table). By tumor receptor status, HER2+/HR- tumors (N=89) had a higher pCR rate than HER2+/HR+ tumors (N=156; 63% vs 37%, p = 0.0001). In HER2+/HR- tumors N, MK2206, P and TDM1/P graduated. In HER2+/HR+ tumors P and TDM1/P graduated. 76% (185/245) of I-SPY 2 HER2+ patients were classified as HER2+/Her2_or_Basal and 24% (60/245) were HER2+Luminal. pCR rate was significantly higher in the HER2+/Her2_or_Basal group than in the HER2+/Luminal group (57% vs 15%, p < 0.0001). All agents, except for MK2206, where numbers were small, showed greater efficacy in the HER2+/Her2_or_Basal group than in the HER2+/Luminal group. HER2+/Luminal appeared to be more sensitive to the AKT inhibitor MK2206 than to targeted HER2 agents, though numbers are small. Conclusions: pCR rates for patients with HER2+ bc treated with investigational agents, particularly dual HER2-blockade, were promising. Molecular response predictive subtype classification provides insight on how to better target therapy. The HER2+/Luminal group had low pCR rates with dual HER2-blockade but may have higher pCR rate with the addition of an AKT inhibitor and identifies a subgroup of HER2+ tumors in need of novel approaches. AKT inhibition for HER2/Luminal is being tested in I-SPY 2.2. Clinical trial information: NCT01042379.

Full HER2+ cohort
Genomic Subtype
Tumor Receptors
HER2+/Her2_or_
Basal
HER2+/Luminal
HER2+/HR-
HER2+/HR+

N
pCR %
N
pCR %
N
pCR %
N
pCR %
N
pCR %
TH
31
26
18
39
13
8
12
42
19
16
N
65
40
56
46
9
0
23
57
42
31
MK2206
34
50
29
48
5
60
18
67
16
31
AMG386
19
37
15
40
4
25
4
50
15
33
THP
44
59
32
78
12
8
15
80
29
48
TDM1/P
52
58
35
77
17
18
17
71
35
51
Total
245
47
185
57
60
15
89
63
156
37

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Abstract Details

Meeting

2022 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

NCT01042379

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 510)

DOI

10.1200/JCO.2022.40.16_suppl.510

Abstract #

510

Poster Bd #

282

Abstract Disclosures