Higher Tumor-Infiltrating Lymphocyte Level Associated With Better Outcomes in HER2-Positive Early Breast Cancer Independent of Neoadjuvant Treatment

“In an analysis of the NeoALTTO trial reported in JAMA Oncology, Salgado et al found that a higher level of tumor-infiltrating lymphocytes was associated with improved pathologic compete response rate and event-free survival independent of neoadjuvant treatment received in patients with HER2-positive early breast cancer.

“In NeoALTTO, 455 patients were randomly assigned to receive neoadjuvant trastuzumab (Herceptin), lapatinib (Tykerb), or the combination for 6 weeks followed by the addition of weekly paclitaxel for 12 weeks and three cycles of fluorouracil, epirubicin, and cyclophosphamide after surgery. Percentage of tumor-infiltrating lymphocytes were measured by hematoxylin-eosin stained core biopsy sections taken at diagnosis.”


Study: Breast Ca Patients Need Better Cardiac Monitoring

“Breast cancer patients received suboptimal cardiac monitoring during treatment with trastuzumab (Herceptin), according to a large population-based study.

“Among more than 2,000 patients, only 36% of evaluable participants received adequate monitoring for cardiotoxicity in accordance with current guidelines, reported Mariana Chavez-MacGregor, MD, of the MD Anderson Cancer Center in Houston, and colleagues.

“Interestingly, physician characteristics had more influence than patient factors on cardiac monitoring, they wrote in the Journal of Clinical Oncology

” ‘We suspected that the rates of cardiac monitoring were going to be low, but we were surprised on how low, particularly in this high-risk group of patients,’ Chavez-MacGregor, a medical oncologist, told MedPage Today in a separate interview. ‘Of particular concern was that even among patients with cardiac comorbidities the rates of cardiac monitoring were not higher.’ “


High TIL Levels Predict Positive Outcomes in HER-2–Positive Breast Cancer

“High levels of tumor-infiltrating lymphocytes served as an independent positive predictive marker for EFS and pathological complete response in HER-2–positive early breast cancer treated with chemotherapy and anti-HER–2 agents, according a secondary analysis of the NeoALTTO trial.

“ ‘Increasingly, oncogenic addiction, in which tumors become dependent on a sole oncogenic pathway for growth, is thought to promote a tumor microenvironment conducive to immune escape,’ Sherene Loi, MD, PhD, of the Peter MacCallum Cancer Centre at the University of Melbourne, and colleagues wrote. ‘Although this had not been shown yet for HER-2 oncogenic signaling, one could speculate that anti-HER–2 therapy may not only work in a cell-intrinsic manner but may also reserve HER-2–induced immunosuppression as a mechanism for action.’

“The NeoALTTO trial included 455 women with HER-2–positive early-stage breast cancer between 2008 and 2010. The researchers randomly assigned patients to neoadjuvant treatment with trastuzumab (Herceptin, Genentech), lapatinib (Tykerb, GlaxoSmithKline) or both.

“Patients received the initial treatment for 6 weeks, followed by weekly paclitaxel for 12 weeks and three treatment cycles of fluorouracil, epirubicin and cyclophosphamide after surgery.”


MM-302 Shows Promise in Heavily Pretreated HER2-Positive Breast Cancer

“A phase I study of MM-302, an antibody-drug conjugated human epidermal growth factor receptor 2 (HER2)-targeted liposomal doxorubicin, as a monotherapy or in combination with trastuzumab or trastuzumab and cyclophosphamide had a manageable safety profile and encouraging efficacy results in a group of heavily pretreated women with HER2-positive metastatic breast cancer.

“The results of the study were presented by Patricia LoRusso, DO, professor of medicine in the division of oncology at Yale University in New Haven, Connecticut, at the American Association for Cancer Research (AACR) Annual Meeting.

“Patients in the study who received at least 30 mg/m2 of MM-302 plus trastuzumab had a median progression-free survival of 7.6 months (95% confidence interval [CI], 3.6–10.9); those treated with the addition of cyclophosphamide had a median progression-free survival of 10.6 months (95% CI, 1.8–10.6).

“ ‘We are encouraged by these data on the safety and promising clinical activity of MM-302 in patients who have exhausted many therapeutic options for their disease. Our results support the further evaluation of MM-302 in an anthracycline-naive population in the HERMIONE trial,’ said LoRusso in a prepared statement.”


New Antibody-Drug Conjugate Shows Early Promise for Patients with Metastatic HER2-Positive Breast Cancer

“An investigational antibody-drug conjugate called MM-302 was safe, tolerable, and showed signs of clinical activity in heavily pretreated patients with metastatic, HER2-positive breast cancer, according to data from a phase I clinical trial presented here at the AACR Annual Meeting 2015, April 18-22.

“MM-302 is an antibody-drug conjugate composed of a HER2-targeted antibody linked to the cytotoxic chemotherapy liposomal doxorubicin. The HER2 antibody delivers the liposomal doxorubicin to HER2-positive breast cancer cells.

” ‘The main purpose of our study was to establish whether MM-302, alone or in combination with trastuzumab, was safe and tolerable for patients with metastatic, HER2-positive breast cancer whose disease had progressed following numerous prior treatments,’ said Patricia LoRusso, DO, associate director of innovative medicine and professor of medicine (medical oncology) at Yale Cancer Center in New Haven, Connecticut, and professor of medicine in the Division of Oncology at Yale University. ‘We found that the drug was well tolerated when administered to these women.’ “


Risks, Benefits Must Be Balanced When Choosing Optimal Therapy for Node-Negative, HER-2–Positive Breast Cancer

“On May 16, 2005, at about 1:30 p.m. local time, I was one of several hundred fortunate persons crowded into a conference hall at the ASCO Annual Meeting when the wide separation of the DFS curves in the joint analysis of NCCTG 9831 and NSABP B-31 was first shown.

“The benefit of adjuvant trastuzumab was dramatic, and the results changed clinical practice that very next Monday morning.

“Because there was a known cardiac risk of trastuzumab, patients with smaller lymph node-negative breast cancers either were excluded or underrepresented in the initial adjuvant trastuzumab studies, thus making extrapolation of these impressive results somewhat problematic for patients at lower risk for invasive recurrence.”


Tykerb Still Falls Short in HER2-Positive Breast Ca

“In HER2-positive breast cancer, lapatinib (Tykerb) combined with a taxane was linked to shorter progression-free survival (PFS) and more toxicity compared with trastuzumab (Herceptin) plus a taxane, according to results from an international trial.

“In the National Cancer Institute of Canada (NCIC) Clinical Trials Group (CTG) MA.31 study, the median intention-to-treat (ITT) PFS was 9.0 months with lapatinib versus 11.3 months with trastuzumab when paired with a taxane, according to Karen A. Gelmon, MD, of the British Columbia Cancer Agency in Vancouver, and colleagues.

“In addition, lapatinib plus a taxane was associated with more toxicity in patients with centrally confirmed HER2-positive tumors, and overall survival (OS) was worse in the confirmed HER2-positive group treated with lapatinib (ITT hazard ratio 1.28, 95% CI 0.95-1.72, P=0.11), they wrote in the Journal of Clinical Oncology.

” ‘Our results support the use of trastuzumab over lapatinib in the HER2 treatment-naive first-line metastatic setting,’ Gelmon’s group stated. ‘The NCIC CTG MA.31 trial was the first head-to-head comparison to our knowledge of trastuzumab and lapatinib in locally determined metastatic HER2-positive breast cancer, with separate analysis for centrally determined HER2 disease.’ “


Puma Biotechnology Initiates Phase II Trial of PB272 in Early Stage HER2-Positive Breast Cancer

“Puma Biotechnology, Inc. PBYI, +2.74% a development stage biopharmaceutical company, announced the initiation of a Phase II trial of Puma’s investigational drug PB272 (neratinib) for the extended adjuvant treatment of breast cancer.

“The 70 patient study will be an open label single arm Phase II trial of PB272 monotherapy administered to patients with HER2-positive early stage breast cancer who have previously received adjuvant treatment with trastuzumab. Patients will receive extended adjuvant treatment with neratinib for a period of one year. Patients will receive primary prophylaxis with high dose loperamide (16 mg per day initially) in order to attempt to reduce the neratinib-related diarrhea. The primary endpoint of the trial is reduction in the incidence and severity of diarrhea.

“ ‘We are pleased to initiate this Phase II trial,’ said Alan H. Auerbach, Chief Executive Officer and President. ‘Because the ExteNET Phase III trial was run prior to the implementation of loperamide prophylaxis in clinical trials of neratinib, in the ExteNET Phase III trial neratinib was administered without loperamide prophylaxis. The results from this Phase II study will give us a better understanding of the safety of neratinib in the extended adjuvant setting with concurrent high dose loperamide administered and, importantly, to what degree the grade 3 neratinib-related diarrhea can be reduced. We anticipate that initial results from this trial should be available by yearend 2015 and would enable us to include this data in our NDA filing for neratinib in the extended adjuvant setting, which is currently anticipated for the first quarter of 2016.’ “


Kadcyla given after Chemotherapy Does Not Cause Cardiac Side Effects

“In a study reported in the Journal of Clinical Oncology, Krop et al found that ado-trastuzumab emtansine (Kadcyla) had an acceptable cardiac safety profile when used after anthracycline-based (neo)adjuvant therapy in women with early-stage HER2-positive breast cancer.

“In the study, 153 patients with a pretreatment left ventricular ejection fraction > 55% received (neo)adjuvant doxorubicin-cyclophosphamide for four cycles or fluorouracil, epirubicin, and cyclophosphamide for three or four cycles followed by ado-trastuzumab emtansine 3.6 mg/kg every 3 weeks for four cycles. Patients could then receive three or four cycles of docetaxel with or without trastuzumab (Herceptin). Ado-trastuzumab emtasine treatment was then resumed with optional sequential or concurrent radiotherapy for up to 1 year (17 cycles)…

“The investigators concluded: ‘Use of [ado-trastuzumab emtansine] for approximately 1 year after anthracycline-based chemotherapy was feasible and generally well tolerated by patients with HER2-positive [early-stage breast cancer], providing support for phase III trials of [ado-trastuzumab emtansine] in this setting.’ “