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
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 Disclosures
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