Breast Cancer—Local/Regional/Adjuvant

Josephine Lopes Cardozo, Caroline Drukker, Marjanka Schmidt, et al.
This prospective study demonstrates, that patients with an ultralow risk 70-gene signature have an excellent prognosis with 8-year BCSS above 99%. This is regardless of their clinical risk status. The 8-year distant metastasis-free interval is 95-98%.
Eleftherios P. Mamounas, Hanna Bandos, Priya Rastogi, et al.
BCI HOXB13/IL17BR (BCI-H/I) ratio prediction of extended letrozole therapy (ELT) benefit on recurrence-free interval was not confirmed in this study. In time-dependent distant recurrence analyses, BCI-H/I-High patients benefitted statistically significantly from ELT after four years, while BCI-H/I-Low patients did not. Observed ELT benefit on breast cancer-free interval in BCI-H/I-Low patients was primarily driven by second primary breast cancers. The study authors favor additional follow-ups to further characterize the BCI-H/I predictive ability in this study. Clinical trial information: NCT00382070
Priya Rastogi, Hanna Bandos, Peter C. Lucas, et al.
Statistically significant extended letrozole therapy benefit was observed for The 70-gene MammaPrint (MP)-Low-Risk (MP score > 0.000), but not MP-High Risk (MP score ≤0.000). The treatment by risk group interaction was not statistically significant for distant recurrence, but it was for disease-free survival and breast cancer-free interval. The benefit appears to be stronger in MP-L but not MP-UL (MP-LNUL) (MP score > 0.000, ≤0.355) than in MP Ultralow Risk (MP-UL) (MP score > 0.355). NCT: 00382070.
Nadia Harbeck, Oleg Gluz, Matthias Christgen, et al.
The study authors demonstrated for the first time both excellent pathological complete response (pCR) and survival in patients treated by de-escalated neoadjuvant CT+P+T irrespective of further CT use in a prospective multicenter study. CT-free therapies may only need to be evaluated and administered in selected patients (e.g. with high HER2 expression / non-basal-like tumors). The authors mention, that In ADAPT HR-/HER2+, early pCR after only 12 weeks of neoadjuvant P+T+pac was strongly associated with improved outcome and may thus serve as a predictive clinical marker for further treatment (de)-escalation. Clinical trial information: NCT01779206
Oleg Gluz, Ulrike Nitz, Matthias Christgen, et al.
First results  from a phase III ADAPT trial with a prospective high-risk cohort show evidence for good prognosis in some patients with over 4 positive lymph nodes and e.g. low RS. The authors conclude, that the combination of lower post-endocrine Ki-67 and limited tumor burden may be a promising criterion for CT de-escalation strategies even in patients with high RS. Clinical trial information: NCT01779206
Jennifer Keating Litton, Joseph Thaddeus Beck, Jason M. Jones, et al.
According to the authors, monotherapy with the poly(ADP-ribose) polymerase inhibitor talazoparib in the neoadjuvant setting was active and showed pathologic complete response rates comparable to those observed with combination anthracycline and taxane-based CT-regimens.The treatment was generally well tolerated. Clinical trial information: NCT03499353
Sibylle Loibl, Andreas Schneeweiss, Jens Bodo Huober, et al.
The study shows, that the anti-PD-L1 checkpoint inhibitor Durvalumab added to neoadjuvant chemotherapy in triple-negative breast cancer improved long-term outcome significantly despite a small increase of pathologic complete response and no continuation after surgery. The authors ask whether adjuvant therapy with a checkpoint inhibitor is needed at all. Clinical trial information: NCT02685059
Amy Jo Chien, Hatem Hussein Soliman, Cheryl Ann Ewing, et al.
SD-101 is an investigational Toll-like receptor 9 (TLR9) agonist CpG-C class oligodeoxynucleotide. The study demonstrates that the SD-101+Pembrolizumab 4 regimen was active but the pre-specified threshold for graduation in I-SPY 2 was not met. Pathologic complete response/Residual Cancer Burden analysis suggests improved response in the HR+/HER-negative signature vs. control. The clinical relevance of these results must be weighed against the potential immune-mediated toxicity risk. Clinical trial information: NCT01042379
Ingrid A. Mayer, Fengmin Zhao, Carlos L. Arteaga, et al.
The study demonstrates, that Patients with residual triple-negative breast cancer after neoadjuvant chemotherapy (NAC) had a lower than expected 3-year invasive disease-free survival regardless of study treatment. According to the available data, it seems very unlikely that the study would be able to establish non-inferiority of platinum-based chemotherapy (P) to capecitabine (C). Severe toxicities were more commonly seen with P. In patients with triple-negative breast cancer, particularly basal subtype, with at least 1 cm residual disease after NAC and high recurrence risk, adjuvant P use does not improve outcomes. Clinical trial information: NCT02445391