Endocrine Therapy Response and 21-Gene Expression Assay for Therapy Guidance in HR+/HER2- Early Breast Cancer
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Endocrine Therapy Response and 21-Gene Expression Assay for Therapy Guidance in HR+/HER2- Early Breast Cancer. / Nitz, Ulrike A; Gluz, Oleg; Kümmel, Sherko; Christgen, Matthias; Braun, Michael; Aktas, Bahriye; Lüdtke-Heckenkamp, Kerstin; Forstbauer, Helmut; Grischke, Eva-Maria; Schumacher, Claudia; Darsow, Maren; Krauss, Katja; Nuding, Benno; Thill, Marc; Potenberg, Jochem; Uleer, Christoph; Warm, Mathias; Fischer, Hans Holger; Malter, Wolfram; Hauptmann, Michael; Kates, Ronald E; Gräser, Monika; Würstlein, Rachel; Shak, Steven; Baehner, Frederick; Kreipe, Hans H; Harbeck, Nadia.
in: J CLIN ONCOL, Jahrgang 40, Nr. 23, 10.08.2022, S. 2557-2567.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Endocrine Therapy Response and 21-Gene Expression Assay for Therapy Guidance in HR+/HER2- Early Breast Cancer
AU - Nitz, Ulrike A
AU - Gluz, Oleg
AU - Kümmel, Sherko
AU - Christgen, Matthias
AU - Braun, Michael
AU - Aktas, Bahriye
AU - Lüdtke-Heckenkamp, Kerstin
AU - Forstbauer, Helmut
AU - Grischke, Eva-Maria
AU - Schumacher, Claudia
AU - Darsow, Maren
AU - Krauss, Katja
AU - Nuding, Benno
AU - Thill, Marc
AU - Potenberg, Jochem
AU - Uleer, Christoph
AU - Warm, Mathias
AU - Fischer, Hans Holger
AU - Malter, Wolfram
AU - Hauptmann, Michael
AU - Kates, Ronald E
AU - Gräser, Monika
AU - Würstlein, Rachel
AU - Shak, Steven
AU - Baehner, Frederick
AU - Kreipe, Hans H
AU - Harbeck, Nadia
PY - 2022/8/10
Y1 - 2022/8/10
N2 - PURPOSE: To our knowledge, WSG-ADAPT-HR+/HER2- (ClinicalTrials.gov identifier: NCT01779206; n = 5,625 registered) is the first trial combining the 21-gene expression assay (recurrence score [RS]) and response to 3-week preoperative endocrine therapy (ET) to guide systemic therapy in early breast cancer.MATERIALS AND METHODS: Baseline and postendocrine Ki67 (Ki67post) were evaluated centrally. In the endocrine trial, all patients received exclusively ET: patients with pathologic regional lymph node status (pN) 0-1 (ie, 0-3 involved lymph nodes) entered control arm if RS ≤ 11 and experimental arm if RS12-25 with ET response (Ki67post ≤ 10%). All other patients (including N0-1 RS12-25 without ET response) received dose-dense chemotherapy (CT) followed by ET in the CT trial. Primary end point of the endocrine trial was noninferiority of 5-year invasive disease-free survival (5y-iDFS) in experimental (v control) arm; secondary end points included distant DFS, overall survival, and translational research.RESULTS: Intention-to-treat population comprised 2,290 patients (n = 1,422 experimental v n = 868 control): 26.3% versus 34.6% premenopausal and 27.4% versus 24.0% pN1. One-sided 95% lower confidence limit of the 5y-iDFS difference was -3.3%, establishing prespecified noninferiority (P = .05). 5y-iDFS was 92.6% (95% CI, 90.8 to 94.0) in experimental versus 93.9% (95% CI, 91.8 to 95.4) in control arm; 5-year distant DFS was 95.6% versus 96.3%, and 5-year overall survival 97.3% versus 98.0%, respectively. Differences were similar in age and nodal subgroups. In N0-1 RS12-25, outcome of ET responders (ET alone) was comparable with that of ET nonresponders (CT) for age > 50 years and superior for age ≤ 50 years. ET response was more likely with aromatase inhibitors (mostly postmenopausal) than with tamoxifen (mostly premenopausal): 78.1% versus 41.1% (P < .001). ET response was 78.8% in RS0-11, 62.2% in RS12-25, and 32.7% in RS > 25 (n = 4,203, P < .001).CONCLUSION: WSG-ADAPT-HR+/HER2- demonstrates that guiding systemic treatment by both RS and ET response is feasible in clinical routine and spares CT in pre- and postmenopausal patients with ≤ 3 involved lymph nodes.
AB - PURPOSE: To our knowledge, WSG-ADAPT-HR+/HER2- (ClinicalTrials.gov identifier: NCT01779206; n = 5,625 registered) is the first trial combining the 21-gene expression assay (recurrence score [RS]) and response to 3-week preoperative endocrine therapy (ET) to guide systemic therapy in early breast cancer.MATERIALS AND METHODS: Baseline and postendocrine Ki67 (Ki67post) were evaluated centrally. In the endocrine trial, all patients received exclusively ET: patients with pathologic regional lymph node status (pN) 0-1 (ie, 0-3 involved lymph nodes) entered control arm if RS ≤ 11 and experimental arm if RS12-25 with ET response (Ki67post ≤ 10%). All other patients (including N0-1 RS12-25 without ET response) received dose-dense chemotherapy (CT) followed by ET in the CT trial. Primary end point of the endocrine trial was noninferiority of 5-year invasive disease-free survival (5y-iDFS) in experimental (v control) arm; secondary end points included distant DFS, overall survival, and translational research.RESULTS: Intention-to-treat population comprised 2,290 patients (n = 1,422 experimental v n = 868 control): 26.3% versus 34.6% premenopausal and 27.4% versus 24.0% pN1. One-sided 95% lower confidence limit of the 5y-iDFS difference was -3.3%, establishing prespecified noninferiority (P = .05). 5y-iDFS was 92.6% (95% CI, 90.8 to 94.0) in experimental versus 93.9% (95% CI, 91.8 to 95.4) in control arm; 5-year distant DFS was 95.6% versus 96.3%, and 5-year overall survival 97.3% versus 98.0%, respectively. Differences were similar in age and nodal subgroups. In N0-1 RS12-25, outcome of ET responders (ET alone) was comparable with that of ET nonresponders (CT) for age > 50 years and superior for age ≤ 50 years. ET response was more likely with aromatase inhibitors (mostly postmenopausal) than with tamoxifen (mostly premenopausal): 78.1% versus 41.1% (P < .001). ET response was 78.8% in RS0-11, 62.2% in RS12-25, and 32.7% in RS > 25 (n = 4,203, P < .001).CONCLUSION: WSG-ADAPT-HR+/HER2- demonstrates that guiding systemic treatment by both RS and ET response is feasible in clinical routine and spares CT in pre- and postmenopausal patients with ≤ 3 involved lymph nodes.
KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
KW - Breast Neoplasms/drug therapy
KW - Chemotherapy, Adjuvant
KW - Disease-Free Survival
KW - Female
KW - Gene Expression Profiling
KW - Humans
KW - Ki-67 Antigen
KW - Middle Aged
KW - Receptor, ErbB-2/metabolism
KW - Tamoxifen/therapeutic use
U2 - 10.1200/JCO.21.02759
DO - 10.1200/JCO.21.02759
M3 - SCORING: Journal article
C2 - 35404683
VL - 40
SP - 2557
EP - 2567
JO - J CLIN ONCOL
JF - J CLIN ONCOL
SN - 0732-183X
IS - 23
ER -