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Abstract PO1-05-01: Cyclin-dependent Kinase 4/6 Inhibitors Combined with Radiotherapy in the Management of Brain Metastases in HR-positive/HER2-negative Breast Cancer Patients 摘要 PO1-05-01:细胞周期蛋白依赖性激酶4/6抑制剂联合放疗治疗HR阳性/HER2阴性乳腺癌患者的脑转移瘤
IF 11.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-02 DOI: 10.1158/1538-7445.sabcs23-po1-05-01
M. Kubeczko, Dorota Gabryś, A. Polakiewicz-Gilowska, A. Krzywon, Donata Gräupner, Barbara Łanoszka, M. Mianowska-Malec, A. Leśniak, K. Świderska, Konstanty Chomik, B. Grandys, Michał Jarząb
Purpose: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) plus endocrine therapy demonstrated overall survival benefits in advanced breast cancer patients (ABC), hormone receptor-positive, HER2-negative (HR+/HER2-) and remains the mainstay in the first and second-line treatment. Brain metastases are rare at the beginning of treatment in this group of patients and are found more often during subsequent lines of treatment and other subtypes of breast cancer. However, there is a paucity of data on the safety and efficacy of multimodality CDK4/6i and radiotherapy treatment in the management of brain metastases. Thus, we performed a retrospective analysis of ABC patients (pts) treated at our institution with radiation therapy to the brain and CDK4/6i. Pts who received radiotherapy before CDK4/6i initiation or concurrently with CDK4/6i (group 1) were compared to the patients who progressed in the brain during CDK4/6i treatment and then received radiotherapy (group 2). The primary endpoint was progression-free survival (PFS) in group 1 vs. group 2; the secondary endpoints were local control (LC) within the brain in group 1 vs. group 2 and severe toxicity. Materials/Methods: Among 379 pts who received CDK4/6i, 26 pts (6.9%) received radiotherapy to the brain. 17 pts received radiotherapy before or concurrent with CDK4/6i and were included in group 1. Nine pts received radiotherapy after CDK4/6i discontinuation due to disease progression and comprised group 2. Results: The median age was 51.5 years (IQR range 41-62). Six pts had de novo metastatic disease. The majority of patients were treated in the first-line setting (15 pts, 58%). 17 pts received ribociclib, 7 palbociclib, and 2 abemaciclib. 15 pts received letrozole as an endocrine compound and 11 pts fulvestrant. 19 pts (73%) received previous chemotherapy. Six pts had an ECOG performance status of 0, 15 pts ECOG 1, and 5 pts ECOG 2. The most common local treatment was whole-brain radiotherapy with a total dose of 20 Gy delivered in 5 fractions (fr) (11 pts: 4 pts VMAT, 2 pts IMRT, 3 pts 3D, and 2 pts 2D). Eight pts received stereotactic radiation therapy (6 pts with Linac: 2 pts 24 Gy/2 fr, 2 pts 24 Gy/3 fr, 2 pts 25 Gy/5 fr; 1 pt GammKnife 20 Gy/1 fr, 1 pt Cyberknife 15 Gy/3 fr). Six- and 12-month PFS in group 1 was 88.2% (95% CI74.1-100) and 58.8% (95% CI: 37.7- 91.8), respectively, whereas in group 2, six- and 12-month PFS was 55.6% (95%CI: 31- 99.7) and 44.4% (95% CI: 21- 92.2), respectively. Six- and 12-month LC in group 1 was 92.3% (95%CI: 78.9-100) and 83.9% (65.7-100), respectively. LC in group 2 was poor: 3-month LC was only 66.7 (30-100). At a median follow-up of 8.8 months, no unanticipated toxicity was reported. Conclusion: Multimodality treatment with CDK4/6i and radiotherapy to the brain is safe and effective. Patients who developed metastases during CDK4/6i treatment tend to have a worse prognosis in comparison to those who received prior radiotherapy. CDK4/6i following radiotherapy
目的:在激素受体阳性、HER2-阴性(HR+/HER2-)的晚期乳腺癌患者(ABC)中,细胞周期蛋白依赖性激酶4/6抑制剂(CDK4/6i)加内分泌治疗显示了总体生存率的优势,目前仍是一线和二线治疗的主流。这类患者在治疗初期很少出现脑转移,而在后续治疗和其他亚型乳腺癌的治疗中,脑转移则更为常见。然而,关于多模式 CDK4/6i 和放疗治疗脑转移的安全性和有效性的数据却很少。因此,我们对在本院接受脑部放疗和 CDK4/6i 治疗的 ABC 患者(pts)进行了回顾性分析。我们将在 CDK4/6i 开始前或与 CDK4/6i 同时接受放疗的患者(第 1 组)与在 CDK4/6i 治疗期间脑部出现进展、随后接受放疗的患者(第 2 组)进行了比较。主要终点是第1组与第2组的无进展生存期(PFS);次要终点是第1组与第2组的脑局部控制率(LC)和严重毒性。材料/方法:在接受 CDK4/6i 治疗的 379 例患者中,有 26 例(6.9%)接受了脑部放疗。17例患者在CDK4/6i之前或与CDK4/6i同时接受放疗,被归入第1组;9例患者因疾病进展而停用CDK4/6i后接受放疗,被归入第2组。研究结果中位年龄为51.5岁(IQR范围为41-62岁)。6名患者患有新发转移性疾病。大多数患者接受了一线治疗(15 例,58%)。17名患者接受了ribociclib治疗,7名患者接受了palbociclib治疗,2名患者接受了abemaciclib治疗。15名患者接受来曲唑作为内分泌化合物治疗,11名患者接受氟维司群治疗。19名患者(73%)曾接受过化疗。6例患者的ECOG表现为0,15例患者的ECOG表现为1,5例患者的ECOG表现为2。最常见的局部治疗是全脑放疗,总剂量为20 Gy,分5次放疗(11例:4例VMAT,2例IMRT,3例3D,2例2D)。8例患者接受了立体定向放射治疗(6例使用Linac:2例24 Gy/2 fr,2例24 Gy/3 fr,2例25 Gy/5 fr;1例GammKnife 20 Gy/1 fr,1例Cyberknife 15 Gy/3 fr)。第1组的6个月和12个月PFS分别为88.2%(95% CI74.1-100)和58.8%(95% CI:37.7- 91.8),而第2组的6个月和12个月PFS分别为55.6%(95%CI:31- 99.7)和44.4%(95% CI:21- 92.2)。第 1 组患者的 6 个月和 12 个月生存率分别为 92.3% (95%CI: 78.9-100) 和 83.9% (65.7-100)。第 2 组的 LC 较差:3 个月的 LC 仅为 66.7(30-100)。中位随访时间为 8.8 个月,无意外毒性报告。结论CDK4/6i 和脑部放疗的多模式治疗安全有效。与之前接受放疗的患者相比,在 CDK4/6i 治疗期间出现转移的患者预后较差。在这种特殊的转移性乳腺癌人群中,放疗后使用CDK4/6i似乎是一种有效且有价值的治疗方案。引用格式:Marcin Kubeczko, Dorota Gabryś, Anna Polakiewicz-Gilowska, Aleksandra Krzywon, Donata Gräupner, Barbara Łanoszka, Marta Mianowska-Malec, Aleksandra Leśniak, Katarzyna Świderska, Konstanty Chomik, Barbara Grandys, Michał Jarząb.Cyclin-dependent Kinase 4/6 Inhibitors Combined with Radiotherapy in the Management of Brain Metastases in HR-positive/HER2 negative Breaster Cancer Patients [abstract].在:2023 年圣安东尼奥乳腺癌研讨会论文集;2023 年 12 月 5-9 日;德克萨斯州圣安东尼奥。费城(宾夕法尼亚州):AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-05-01.
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引用次数: 0
Abstract PO1-15-09: Vitamin A Metabolism Induces Ferroptosis to Enhance Immune Therapy Efficacy in HR+/HER2- Breast Cancer 摘要 PO1-15-09:维生素 A 代谢诱导铁蛋白沉积以增强 HR+/HER2- 乳腺癌的免疫治疗效果
IF 11.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-02 DOI: 10.1158/1538-7445.sabcs23-po1-15-09
Yi-Fan Zhou, Hu-Yun-Long Zhang, X. Jin, Yizhou Jiang, Zhiming Shao
Background: Immune checkpoint blockade (ICB) has substantially improved patient overall and progression-free survival in triple-negative breast cancer (TNBC), but its efficacy remains to be elucidated in the hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer, which is characterized by generally impotent lymphocytic infiltration. In the I-SPY2 trial (NCT01042379), pembrolizumab- or durvalumab-containing neoadjuvant therapy increased the pathologic complete response of HR+/HER2- patients. However, pembrolizumab-containing therapy failed to improve the survival of metastatic HR+/HER2- breast cancer patients (NCT03051659). These inconsistent results underscored the necessity of the investigation of predictive biomarkers to pinpoint potential ICB responders in HR+/HER2- breast cancer. Method: In this study, we collected pretreatment tumor samples from 16 patients in two respective clinical trials (NCT: 04215003 and 04355858) and profiled droplet-based single-cell sequencing, bulk RNA-Seq. Patients were treated with camrelizumab (PD-1 inhibitor)-containing therapy, and five of them achieved partial relief after an 8-week course. We also leveraged the bulk RNA-Seq data from the I-SPY2 trial and Fudan University Shanghai Cancer Center (FUSCC) TNBC ICB trials (NCT04418154 and NCT04613674) for external validation. Another FUSCC transcriptome dataset consisting of 933 treatment-naïve HR+/HER2- or TNBC breast cancer patients was used to detect the abundance of cell types. In vitro and in vivo experiments were used to explore mechanisms of anti-tumor immune response. Results: Based on the single-cell sequencing results, we comprehensively delineated the microenvironmental landscape of HR+/HER2- breast cancer. We discovered responders of immunotherapy showed a higher presence of CXCL9/10+ M1-like macrophages and exhibited enrichment of tumor cells with ferroptosis. We further identified the upregulation of vitamin A metabolism and the vitamin A metabolic gene CRABP1 in tumor cells with ferroptosis. We verified the vitamin A metabolism could induce ferroptosis in HR+/HER2- breast cancers rather than TNBC by CRABP1-ERK axis, which could further recruit CXCL9/10+ M1-like macrophages and promote anti-tumor immune response in HR+/HER2- breast cancer. Combining anti-PD1 with enhancing vitamin A metabolism via retinoid acid possessed greater therapeutic efficacy than monotherapy in HR+/HER2- breast cancers. Finally, we developed an immune therapy response score and validated its reliability in predicting the immunotherapy efficacy for HR+/HER2-breast cancers through both internal and external cohorts. Conclusion: Our study represents the earliest efforts to decipher the microenvironmental landscape and the mechanisms underlying the response to ICB in HR+/HER2- breast cancer at single-cell resolution. We unraveled a HR+/HER2- breast cancer-specific Vitamin A-ferroptosis axis that mediated immunotherapy response
背景:免疫检查点阻断(ICB)大大提高了三阴性乳腺癌(TNBC)患者的总生存期和无进展生存期,但其对激素受体阳性(HR+)/人表皮生长因子受体2阴性(HER2-)乳腺癌的疗效仍有待阐明,这种乳腺癌的特点是淋巴细胞浸润普遍不明显。在I-SPY2试验(NCT01042379)中,含有pembrolizumab或durvalumab的新辅助治疗提高了HR+/HER2-患者的病理完全反应率。然而,含有pembrolizumab的疗法未能改善转移性HR+/HER2-乳腺癌患者的生存率(NCT03051659)。这些不一致的结果凸显了研究预测性生物标志物的必要性,以确定HR+/HER2-乳腺癌的潜在ICB应答者。研究方法在这项研究中,我们收集了两项临床试验(NCT:04215003 和 04355858)中 16 例患者的预处理肿瘤样本,并进行了基于液滴的单细胞测序和批量 RNA-Seq 分析。患者接受了含有坎瑞珠单抗(PD-1抑制剂)的治疗,其中5名患者在8周疗程后病情得到部分缓解。我们还利用了I-SPY2试验和复旦大学上海癌症中心(FUSCC)TNBC ICB试验(NCT04418154和NCT04613674)的大量RNA-Seq数据进行外部验证。另一个复旦大学上海癌症中心转录组数据集由933名未经治疗的HR+/HER2-或TNBC乳腺癌患者组成,用于检测细胞类型的丰度。体外和体内实验用于探索抗肿瘤免疫反应的机制。结果基于单细胞测序结果,我们全面描述了HR+/HER2-乳腺癌的微环境图谱。我们发现,免疫疗法应答者体内有较多的 CXCL9/10+ M1 样巨噬细胞,并且肿瘤细胞富含铁突变。我们进一步发现,在具有铁变态反应的肿瘤细胞中,维生素 A 代谢和维生素 A 代谢基因 CRABP1 上调。我们验证了维生素A代谢可通过CRABP1-ERK轴诱导HR+/HER2-乳腺癌而非TNBC的铁突变,从而进一步招募CXCL9/10+ M1样巨噬细胞,促进HR+/HER2-乳腺癌的抗肿瘤免疫反应。在HR+/HER2-乳腺癌中,将抗PD1与通过维甲酸促进维生素A代谢相结合比单一疗法具有更高的疗效。最后,我们制定了免疫治疗反应评分,并通过内部和外部队列验证了其在预测HR+/HER2-乳腺癌免疫治疗疗效方面的可靠性。结论我们的研究是最早以单细胞分辨率解读HR+/HER2-乳腺癌微环境格局和对ICB反应机制的研究。我们揭示了介导免疫治疗反应的HR+/HER2-乳腺癌特异性维生素A-铁蛋白轴,并根据该维生素A-铁蛋白轴构建了稳健的免疫治疗疗效预测评分。引用格式:英文周一凡,张虎云龙,金曦,蒋一舟,邵志明。维生素A代谢诱导铁凋亡增强HR+/HER2-乳腺癌的免疫治疗效果[摘要].In:2023年圣安东尼奥乳腺癌研讨会论文集;2023年12月5-9日;德克萨斯州圣安东尼奥。费城(宾夕法尼亚州):AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-15-09.
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引用次数: 0
Abstract PO2-08-07: Evaluating chemotherapy receipt and candidacy for PARP inhibitors in germline BRCA1/2 carriers with early and locally advanced breast cancer 摘要 PO2-08-07:评估患有早期和局部晚期乳腺癌的种系 BRCA1/2 携带者接受化疗的情况和 PARP 抑制剂的适用性
IF 11.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-02 DOI: 10.1158/1538-7445.sabcs23-po2-08-07
Stephanie M. Wong, Carla Apostolova, Amina Ferroum, Basmah Alhassan, Ipshita Prakash, M. Basik, K. Martel, Sarkis Meterissian, David Fleiszer, Nora Wong, Talia Malagon, William Foulkes, J. Boileau
Introduction: While enhanced breast screening of germline BRCA1/2 carriers results in earlier stage at diagnosis, the impact of tumour biology and BRCA mutation on chemotherapy receipt in early stage disease remains understudied. Methods: We retrospectively reviewed treatment administered following a first diagnosis of BRCA1/2-associated breast cancer between 2003-2023 at our institution. Chemotherapy receipt (neoadjuvant or adjuvant) was evaluated according to tumor size, biologic subtype, and BRCA mutation. Current guidelines for PARP inhibitor use were applied to estimate the proportion of affected BRCA1/2 carriers that would be deemed eligible for targeted therapy in the future. Results: Overall, 251 affected BRCA1/2 carriers were included; 137 (54.6%) BRCA1 (median age 40 years, range 19-72) and 114 (45.4%) BRCA2 (median age 43, range, 24-80 years). Chemotherapy was administered in 70.1% of index breast cancer cases and was significantly associated with clinical tumor size (36.7% T1a-T1b, 90.9% T1c, 95.2% T2, 95.3% T3-T4, p< 0.001), nodal status (71.8% cN0 vs. 100% cN1-2, p=0.004), and biologic subtype (90.0% TNBC vs. 75.0% ER+HER2-, p=0.02). BRCA1-associated breast cancers were less likely to present with DCIS or T1 tumours (%Tis/T1; 46.7% BRCA1 vs. 70.8% BRCA2, p< 0.001) and more likely to present with triple negative disease (71.4% BRCA1 vs. 24.6% BRCA2, p< 0.001). BRCA1 carriers were more likely to require chemotherapy for index breast cancer (81.8% BRCA1 vs. 56.1% BRCA2, p< 0.001). In subgroup analysis of early stage, T1N0 disease, chemotherapy was administered in 79.0% BRCA1 and 52.2% BRCA2 patients (p=0.03). If recent guidelines incorporating biologic subtype, nodal involvement, and response to neoadjuvant chemotherapy were retrospectively applied to the cohort, 33.6% would be deemed eligible for PARP inhibitors in the adjuvant setting, including 40.9% BRCA1 and 17.5% BRCA2 affected carriers (p < 0.001). Conclusion: Chemotherapy receipt is high in BRCA-associated breast cancers including in early stage, node-negative disease. Overall, one third of affected carriers are expected to be eligible for PARP inhibitors in the adjuvant setting. Future studies exploring how this information may impact decisions around risk-reducing mastectomy are warranted. Citation Format: Stephanie Wong, Carla Apostolova, Amina Ferroum, Basmah Alhassan, Ipshita Prakash, Mark Basik, Karyne Martel, Sarkis Meterissian, David Fleiszer, Nora Wong, Talia Malagon, William Foulkes, Jean-Francois Boileau. Evaluating chemotherapy receipt and candidacy for PARP inhibitors in germline BRCA1/2 carriers with early and locally advanced breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-08-07.
导言:虽然加强对生殖系 BRCA1/2 基因携带者的乳腺筛查可使诊断阶段提前,但肿瘤生物学和 BRCA 基因突变对早期疾病化疗接收的影响仍未得到充分研究。方法:我们回顾性分析了本院 2003-2023 年间首次确诊 BRCA1/2 相关乳腺癌后的治疗情况。根据肿瘤大小、生物亚型和 BRCA 基因突变对接受化疗(新辅助或辅助)的情况进行了评估。采用当前的 PARP 抑制剂使用指南来估算未来有资格接受靶向治疗的受影响 BRCA1/2 携带者的比例。结果:总共纳入了 251 名受影响的 BRCA1/2 基因携带者;其中 137 名(54.6%)为 BRCA1 基因携带者(中位年龄 40 岁,年龄范围 19-72 岁),114 名(45.4%)为 BRCA2 基因携带者(中位年龄 43 岁,年龄范围 24-80 岁)。70.1%的指标乳腺癌病例接受了化疗,化疗与临床肿瘤大小(36.7% T1a-T1b、90.9% T1c、95.2% T2、95.3% T3-T4,p< 0.001)、结节状态(71.8% cN0 vs. 100% cN1-2,p=0.004)和生物亚型(90.0% TNBC vs. 75.0% ER+HER2-,p=0.02)显著相关。BRCA1相关乳腺癌出现DCIS或T1肿瘤的几率较低(%Tis/T1;46.7% BRCA1 vs. 70.8% BRCA2,p< 0.001),出现三阴性疾病的几率较高(71.4% BRCA1 vs. 24.6% BRCA2,p< 0.001)。BRCA1 携带者更有可能需要对指数乳腺癌进行化疗(81.8% 的 BRCA1 与 56.1% 的 BRCA2 相比,p< 0.001)。在早期 T1N0 疾病的亚组分析中,79.0% 的 BRCA1 患者和 52.2% 的 BRCA2 患者接受了化疗(P=0.03)。如果将生物亚型、结节受累和对新辅助化疗的反应等最新指南回顾性地应用于该群组,33.6%的患者将被认为符合在辅助治疗中使用PARP抑制剂的条件,其中包括40.9%的BRCA1和17.5%的BRCA2携带者(P<0.001)。结论:BRCA相关乳腺癌患者接受化疗的比例很高,包括早期结节阴性疾病。总体而言,预计三分之一的受影响携带者有资格在辅助治疗中使用 PARP 抑制剂。今后有必要开展研究,探讨这一信息如何影响有关降低风险的乳房切除术的决策。引用格式:Stephanie Wong, Carla Apostolova, Amina Ferroum, Basmah Alhassan, Ipshita Prakash, Mark Basik, Karyne Martel, Sarkis Meterissian, David Fleiszer, Nora Wong, Talia Malagon, William Foulkes, Jean-Francois Boileau.评估早期和局部晚期乳腺癌种系 BRCA1/2 携带者接受化疗的情况和 PARP 抑制剂的候选资格 [摘要].In:2023 年圣安东尼奥乳腺癌研讨会论文集;2023 年 12 月 5-9 日;德克萨斯州圣安东尼奥。费城(宾夕法尼亚州):AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-08-07.
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引用次数: 0
Abstract PO5-24-02: Interferon-induced bone marrow stromal antigen 2 (BST2) is a functional tumor-initiating cell marker in triple-negative breast cancer PO5-24-02摘要:干扰素诱导的骨髓基质抗原2(BST2)是三阴性乳腺癌的功能性肿瘤启动细胞标志物
IF 11.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-02 DOI: 10.1158/1538-7445.sabcs23-po5-24-02
Eric Souto, Ping Gong, John D. Landua, Ram Srinivasan, L. Dobrolecki, Abhinaya Ganesan, Michael Lewis
Background: A subpopulation of tumor cells known to have intrinsic resistance to therapies and contribute to metastasis function as “cancer stem”, or tumor-initiating, cells (TICs). TICs can be identified by various biomarkers, including fluorescent reporters for signaling pathways that regulate TIC function such as STAT signaling. However, standard TIC reporters have limitations. Their expression is unstable and there is no established method to follow TICs as they undergo cell state changes. Furthermore, we do not completely understand the transcriptional features of TICs. Improved methods of identifying TICs as well as the development of high-resolution transcriptional signatures are essential to understand TIC biology. An improved understanding of TIC biology can inform the development of novel therapeutics to selectively ablate the TIC compartment, thus improving response to standard cancer therapies. Methods: We screened a panel of PDX models to determine whether a STAT reporter identifies TICs in patient-derived xenograft (PDX) models. To augment existing STAT TIC reporters, we developed a two-component STAT signaling-specific lineage-tracing (LT) system. The first component labels active STAT signaling cells by expression of enhanced green fluorescent protein (EGFP+), followed by a self-cleaving P2A peptide and a TAM-inducible Cre-recombinase (4M67-EGFP-P2A-CreERT2). The second component is a constitutively expressed dual-color switching Cre-dependent reporter vector (EFS-loxPdsRedloxP-mNeptune2). We determined which LT cell populations (EGFP+/mNeptune2+, EGFP+/dsRed+, EGFP−/mNeptune2+, and EGFP−/dsRed+) from SUM159 xenografts functioned as TICs. To probe TIC transcriptional features, we performed scRNA seq on the two tumor models with STAT TICs and a PDX model that did not have STAT TICs. We performed lineage trajectory analysis and differential gene expression analysis to characterize candidate TIC transcriptional signatures. To confirm whether these transcriptional features are associated with TICs, we identified a biomarker of this cell state (bone marrow stromal antigen 2 [BST2]) and explored the relationship between this biomarker and TICs. Results: We identified four PDX models with STAT reporter activity, one of which had STAT TICs. We validated our LT system in several models both in vitro and in vivo, then demonstrated EGFP+/mNeptune2+ from SUM159 xenografts are enriched for TICs and that lineage-tagged cells (mNeptune2+) function as proliferative early progenitor cells. scRNA seq of three xenograft models uncovered a distinct antiviral cell state in all three models that represent a more highly enriched TIC subpopulation. Critically, transcriptional features were shared between the antiviral cell states across xenograft models. To determine whether cells in this antiviral state represent TICs, we FACS-enriched BST2 cells (an IFN-stimulated cell surface protein that was a marker of the antiviral cell state) and demonstrated
背景:众所周知,肿瘤细胞中有一个亚群对治疗具有内在抵抗力,并能促进转移,即 "癌症干细胞 "或肿瘤启动细胞(TIC)。TIC可通过各种生物标记物来识别,包括调节TIC功能的信号通路(如STAT信号)的荧光报告物。然而,标准的 TIC 报告有其局限性。它们的表达不稳定,也没有成熟的方法来跟踪 TIC 的细胞状态变化。此外,我们还不完全了解 TIC 的转录特征。改进识别 TIC 的方法以及开发高分辨率转录特征对于了解 TIC 的生物学特性至关重要。加深对 TIC 生物学的了解有助于开发新型疗法,选择性地消除 TIC 区,从而改善对标准癌症疗法的反应。方法:我们筛选了一组 PDX 模型,以确定 STAT 报告器是否能识别患者异种移植 (PDX) 模型中的 TIC。为了增强现有的 STAT TIC 报告器,我们开发了一种由两部分组成的 STAT 信号特异性谱系追踪(LT)系统。第一部分通过表达增强型绿色荧光蛋白(EGFP+)标记活跃的 STAT 信号转导细胞,然后表达自裂解 P2A 肽和 TAM 诱导的 Cre-重组酶(4M67-EGFP-P2A-CreERT2)。第二部分是组成型表达的双色切换 Cre 依赖性报告载体(EFS-loxPdsRedloxP-mNeptune2)。我们确定了哪些来自 SUM159 异种移植的 LT 细胞群(EGFP+/mNeptune2+、EGFP+/dsRed+、EGFP-/mNeptune2+ 和 EGFP-/dsRed+)具有 TIC 的功能。为了探究TIC的转录特征,我们对两个有STAT TIC的肿瘤模型和一个没有STAT TIC的PDX模型进行了scRNA序列分析。我们进行了谱系轨迹分析和差异基因表达分析,以确定候选 TIC 转录特征。为了证实这些转录特征是否与 TIC 相关,我们确定了这种细胞状态的生物标志物(骨髓基质抗原 2 [BST2]),并探讨了该生物标志物与 TIC 之间的关系。结果:我们发现了四个具有 STAT 报告活性的 PDX 模型,其中一个具有 STAT TIC。我们在多个模型的体外和体内验证了我们的LT系统,然后证明了SUM159异种移植物中的EGFP+/mNeptune2+富集了TICs,并且系标记细胞(mNeptune2+)具有增殖性早期祖细胞的功能。重要的是,不同异种移植模型中的抗病毒细胞状态具有共同的转录特征。为了确定这种抗病毒状态下的细胞是否代表TIC,我们对BST2细胞(一种IFN刺激的细胞表面蛋白,是抗病毒细胞状态的标记)进行了FACS富集,并通过乳球形成试验和限制稀释移植证明了TIC群体的富集。我们证明,化疗后残留的 PDX 肿瘤中 BST2 表达增加。此外,我们还证明人类乳腺癌 scRNA 序列数据集中也存在类似的抗病毒细胞状态。结论:这些数据表明,在一些三阴性乳腺癌中,TIC 采用了抗病毒细胞状态,而 BST2 是处于这种细胞状态的 TIC 的功能标记。因此,靶向与这种细胞状态或相关抗病毒通路有关的基因可能是消除某些乳腺癌中 TIC 的治疗漏洞。引用格式:埃里克-索托、龚平、约翰-兰杜瓦、拉姆-斯里尼瓦桑、莱西-多布罗莱基、阿比纳亚-加内桑、迈克尔-刘易斯干扰素诱导的骨髓基质抗原 2(BST2)是三阴性乳腺癌的功能性肿瘤启动细胞标志物[摘要]。在:2023 年圣安东尼奥乳腺癌研讨会论文集;2023 年 12 月 5-9 日;德克萨斯州圣安东尼奥。费城(宾夕法尼亚州):AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-24-02。
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引用次数: 0
Abstract PO1-15-12: Circulating tumor DNA (ctDNA) for prediction of pathologic complete response (pCR) after 12 weeks of pembrolizumab + trastuzumab + pertuzumab in HER2-enriched early breast cancer: WSG-Keyriched-1 trial 摘要PO1-15-12:循环肿瘤DNA(ctDNA)用于预测HER2富集的早期乳腺癌患者接受12周pembrolizumab + trastuzumab + pertuzumab治疗后的病理完全应答(pCR):WSG-Keyriched-1试验
IF 11.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-02 DOI: 10.1158/1538-7445.sabcs23-po1-15-12
M. Graeser, S. Kuemmel, O. Gluz, Christopher Schroeder, Leon Schuetz, Olga Kelemen, Stephan Ossowski, K. Jóźwiak, M. Reinisch, A. Kostara, I. Scheffen, K. Lüdtke-Heckenkamp, Felix Hilpert, Angela Kentsch, Carsten Ziske, Reinhard Depenbusch, Michael Braun, J. Blohmer, M. Christgen, S. Bartels, H. Kreipe, E. Pelz, U. Nitz, Peter Schmid, Nadia Harbeck, A. Hartkopf
Background ctDNA testing is emerging as an important biomarker in early breast cancer (eBC). However, its value in prediction of tumor response to de-escalated, chemotherapy-free neoadjuvant therapy (NAT) remains underexplored. In WSG-Keyriched-1 (NCT03988036), a single-arm phase 2 trial, we investigated for the first time a chemotherapy-free NAT with dual HER2 blockade and pembrolizumab in HER2- enriched HER2+ eBC. In this pre-specified translational analysis, we evaluated whether ctDNA measurement could predict pCR. Methods 48 patients (pts) with HER2 2+ (ISH+) or 3+ eBC (stage I-III) and HER2-enriched subtype by PAM50 were included. Pts received pembrolizumab (200 mg), trastuzumab biosimilar (loading dose (LD) 8 mg/kg bodyweight (BW), maintenance dose (MD) 6 mg/kg BW), and pertuzumab (LD 840 mg/kg BW, MD 420 mg/kg BW) q3w for 12 weeks. Primary objective was pCR (ypT0/is ypN0). ctDNA was analyzed in 92 plasma samples collected from 31 pts at baseline (BL) and week 3 of NAT and 30 pts at end of treatment (EOT). Sequencing libraries with unique molecular identifiers were constructed from cell-free DNA and hybridization panels with ≤50 patient-specific somatic mutations from tumor sequencing were used for enrichment. Libraries were sequenced to an ultra-high depth of 100,000×. Sequencing data was analyzed using a combination of public pipelines (megSAP and umiVar2 for mapping and deduplication) and custom in-house scripts (to extract the allele counts for patient-specific variants). To reduce the error rate, only corrected reads with ≥4 duplicates were used. p-value for ctDNA detection was calculated using the total variant count, depth and sample-specific error. Association between ctDNA with pCR and other clinical parameters were assessed with Chi-square or Fisher’s exact test and univariable logistic regression. Additionally, bivariable logistic regressions for pCR were performed with ctDNA and either cT, cN, or grade. Results ctDNA was detected (ctDNA+) in 58.0% (n=18/31) of pts at BL, 9.7% (n=3/31) at week 3, and 10% (n=3/30) at EOT. ctDNA was cleared by week 3 in 83.3% of pts (n=15/18). Compared with ctDNA-negative cases (ctDNA-) at BL, those ctDNA+ more often had cT2-3 disease (94.4%, n=17/18, vs 38.5%, n=5/13; p=.001) and lymph node involvement (61.1%, n=11/18, vs 0%, n=0/13; p< .001). 72.2% (n=13/18) of ctDNA+ and 61.5% (n=8/13) of ctDNA- cases at BL were grade 3 (p=.53). Each of the 3 pts who remained ctDNA+ at week 3 was node-positive; all pts remaining ctDNA- at week 3 were node-negative. pCR rate was 38.9% (n=7/18) in ctDNA+ vs 76.9% (n=10/13) in ctDNA- pts at BL (p=.067), 0% (n=0/3) in ctDNA+ vs 60.7% (n=17/28) in ctDNA- at week 3 (p=.081), and 33.3% (n=1/3) in ctDNA+ vs 59.3% (n=16/27) in ctDNA- at EOT (p=.565). pCR rate was highest in pts who remained ctDNA- throughout week 3 (76.9%, n=10/13), compared to pts with ctDNA cleared by week 3 (46.7%, n=7/15), and pts remaining ctDNA+ (0%, n=0/3, p=.024). ctDNA at BL was pred
背景 ctDNA 检测正逐渐成为早期乳腺癌(eBC)的重要生物标志物。然而,它在预测肿瘤对去升级、无化疗的新辅助治疗(NAT)反应方面的价值仍未得到充分探索。在WSG-Keyriched-1(NCT03988036)这项单臂2期试验中,我们首次研究了在HER2-富集的HER2+ eBC中使用HER2双阻断和pembrolizumab的无化疗NAT。在这项预先指定的转化分析中,我们评估了ctDNA测量是否能预测pCR。方法 纳入48例HER2 2+(ISH+)或3+ eBC(I-III期)且PAM50显示HER2富集亚型的患者(pts)。患者接受 pembrolizumab(200 毫克)、曲妥珠单抗生物类似物(负荷剂量 (LD) 8 毫克/千克体重 (BW)、维持剂量 (MD) 6 毫克/千克体重 (BW))和 pertuzumab(负荷剂量 (LD) 840 毫克/千克体重 (BW)、维持剂量 (MD) 420 毫克/千克体重 (BW))治疗,每天 3 次,每次 12 周。在基线(BL)和 NAT 第 3 周时收集了 31 例患者的血浆样本,在治疗结束(EOT)时收集了 30 例患者的血浆样本,对这些样本中的 92 个 ctDNA 进行了分析。从无细胞DNA中构建了具有独特分子标识符的测序文库,并使用肿瘤测序中≤50个患者特异性体细胞突变的杂交板进行富集。对文库进行了 100,000 倍的超高深度测序。测序数据的分析结合使用了公共管道(megSAP 和 umiVar2,用于映射和重复数据删除)和自定义内部脚本(提取患者特异性变异的等位基因数)。为了降低错误率,只使用了重复≥4次的校正读数。ctDNA检测的p值是根据总变异数、深度和样本特异性错误计算得出的。ctDNA与pCR和其他临床参数之间的关系采用Chi-square或Fisher精确检验和单变量逻辑回归进行评估。此外,还对 pCR 与 ctDNA 和 cT、cN 或分级之间的关系进行了双变量逻辑回归。结果 58.0% 的患者(n=18/31)在BL期、9.7% 的患者(n=3/31)在第3周、10% 的患者(n=3/30)在EOT期检测到ctDNA(ctDNA+)。与BL期ctDNA阴性病例(ctDNA-)相比,ctDNA+病例更常患有cT2-3疾病(94.4%,n=17/18,vs 38.5%,n=5/13;p=.001)和淋巴结受累(61.1%,n=11/18,vs 0%,n=0/13;p< .001)。72.2%(n=13/18)的ctDNA+病例和61.5%(n=8/13)的ctDNA-病例在BL期为3级(p=.53)。第 3 周时仍为 ctDNA+ 的 3 例患者均为结节阳性;第 3 周时仍为 ctDNA- 的所有患者均为结节阴性。9%(n=10/13),第3周时ctDNA+的pCR率为0%(n=0/3),ctDNA-的pCR率为60.7%(n=17/28)(p=.081),EOT时ctDNA+的pCR率为33.3%(n=1/3),ctDNA-的pCR率为59.3%(n=16/27)(p=.565)。在单变量分析中,BL时的ctDNA可预测pCR(几率比,OR 0.22,95%CI 0.04- 0.93,曲线下面积,AUC=0.69)。包括ctDNA和分级在内的双变量模型在分析BL时的ctDNA(AUC=0.77)、第3周时的ctDNA(AUC=0.79)以及从BL到第3周时的ctDNA变化(AUC=0.87)时准确性最高。结论 在NAT之前和期间不存在ctDNA,以及ctDNA的早期清除与HER2富集固有亚型eBC受试者接受无化疗pembrolizumab加双HER2阻断治疗的较高pCR率有关。这些结果与之前在HER2+ eBC的I-SPY 2和NeoALTTO试验中采用更强化治疗的数据一致,表明在NAT期间进行ctDNA分析似乎可以实时监测治疗反应,并可用于指导升级/降级策略。需要进行更多患者和预先设计的随访试验,以确认ctDNA在预测肿瘤反应和复发方面的作用。引用格式:Monika Graeser, Sherko Kuemmel, Oleg Gluz, Christopher Schroeder, Leon Schuetz, Olga Kelemen, Stephan Ossowski, Katarzyna Jozwiak, Mattea Reinisch, Athina Kostara, Iris Scheffen, Kerstin Lüdtke-Heckenkamp, Felix Hilpert、循环肿瘤DNA(ctDNA)用于预测HER2富集的早期乳腺癌患者接受12周pembrolizumab + trastuzumab + pertuzumab治疗后的病理完全应答(pCR):WSG-Keyriched-1试验[摘要]。In:2023 年圣安东尼奥乳腺癌研讨会论文集;2023 年 12 月 5-9 日;德克萨斯州圣安东尼奥。费城(宾夕法尼亚州):AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-15-12.
{"title":"Abstract PO1-15-12: Circulating tumor DNA (ctDNA) for prediction of pathologic complete response (pCR) after 12 weeks of pembrolizumab + trastuzumab + pertuzumab in HER2-enriched early breast cancer: WSG-Keyriched-1 trial","authors":"M. Graeser, S. Kuemmel, O. Gluz, Christopher Schroeder, Leon Schuetz, Olga Kelemen, Stephan Ossowski, K. Jóźwiak, M. Reinisch, A. Kostara, I. Scheffen, K. Lüdtke-Heckenkamp, Felix Hilpert, Angela Kentsch, Carsten Ziske, Reinhard Depenbusch, Michael Braun, J. Blohmer, M. Christgen, S. Bartels, H. Kreipe, E. Pelz, U. Nitz, Peter Schmid, Nadia Harbeck, A. Hartkopf","doi":"10.1158/1538-7445.sabcs23-po1-15-12","DOIUrl":"https://doi.org/10.1158/1538-7445.sabcs23-po1-15-12","url":null,"abstract":"\u0000 Background\u0000 ctDNA testing is emerging as an important biomarker in early breast cancer (eBC). However, its value in prediction of tumor response to de-escalated, chemotherapy-free neoadjuvant therapy (NAT) remains underexplored. In WSG-Keyriched-1 (NCT03988036), a single-arm phase 2 trial, we investigated for the first time a chemotherapy-free NAT with dual HER2 blockade and pembrolizumab in HER2- enriched HER2+ eBC. In this pre-specified translational analysis, we evaluated whether ctDNA measurement could predict pCR.\u0000 Methods\u0000 48 patients (pts) with HER2 2+ (ISH+) or 3+ eBC (stage I-III) and HER2-enriched subtype by PAM50 were included. Pts received pembrolizumab (200 mg), trastuzumab biosimilar (loading dose (LD) 8 mg/kg bodyweight (BW), maintenance dose (MD) 6 mg/kg BW), and pertuzumab (LD 840 mg/kg BW, MD 420 mg/kg BW) q3w for 12 weeks. Primary objective was pCR (ypT0/is ypN0).\u0000 ctDNA was analyzed in 92 plasma samples collected from 31 pts at baseline (BL) and week 3 of NAT and 30 pts at end of treatment (EOT). Sequencing libraries with unique molecular identifiers were constructed from cell-free DNA and hybridization panels with ≤50 patient-specific somatic mutations from tumor sequencing were used for enrichment. Libraries were sequenced to an ultra-high depth of 100,000×. Sequencing data was analyzed using a combination of public pipelines (megSAP and umiVar2 for mapping and deduplication) and custom in-house scripts (to extract the allele counts for patient-specific variants). To reduce the error rate, only corrected reads with ≥4 duplicates were used. p-value for ctDNA detection was calculated using the total variant count, depth and sample-specific error.\u0000 Association between ctDNA with pCR and other clinical parameters were assessed with Chi-square or Fisher’s exact test and univariable logistic regression. Additionally, bivariable logistic regressions for pCR were performed with ctDNA and either cT, cN, or grade.\u0000 Results\u0000 ctDNA was detected (ctDNA+) in 58.0% (n=18/31) of pts at BL, 9.7% (n=3/31) at week 3, and 10% (n=3/30) at EOT. ctDNA was cleared by week 3 in 83.3% of pts (n=15/18).\u0000 Compared with ctDNA-negative cases (ctDNA-) at BL, those ctDNA+ more often had cT2-3 disease (94.4%, n=17/18, vs 38.5%, n=5/13; p=.001) and lymph node involvement (61.1%, n=11/18, vs 0%, n=0/13; p&lt; .001). 72.2% (n=13/18) of ctDNA+ and 61.5% (n=8/13) of ctDNA- cases at BL were grade 3 (p=.53). Each of the 3 pts who remained ctDNA+ at week 3 was node-positive; all pts remaining ctDNA- at week 3 were node-negative.\u0000 pCR rate was 38.9% (n=7/18) in ctDNA+ vs 76.9% (n=10/13) in ctDNA- pts at BL (p=.067), 0% (n=0/3) in ctDNA+ vs 60.7% (n=17/28) in ctDNA- at week 3 (p=.081), and 33.3% (n=1/3) in ctDNA+ vs 59.3% (n=16/27) in ctDNA- at EOT (p=.565). pCR rate was highest in pts who remained ctDNA- throughout week 3 (76.9%, n=10/13), compared to pts with ctDNA cleared by week 3 (46.7%, n=7/15), and pts remaining ctDNA+ (0%, n=0/3, p=.024).\u0000 ctDNA at BL was pred","PeriodicalId":12,"journal":{"name":"ACS Chemical Health & Safety","volume":"57 11","pages":""},"PeriodicalIF":11.2,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141017934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Abstract PO3-24-04: Altered epigenetic modifications and genome architecture reshape lipid metabolism during secondary trastuzumab resistance formation of HER2-positive breast cancer 摘要 PO3-24-04:HER2阳性乳腺癌继发性曲妥珠单抗耐药性形成过程中表观遗传修饰和基因组结构的改变重塑了脂质代谢
IF 11.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-02 DOI: 10.1158/1538-7445.sabcs23-po3-24-04
Ningjun Duan, Y. Hua, Yongmei Yin
Title Altered epigenetic modifications and genome architecture reshape lipid metabolism during secondary trastuzumab resistance formation of HER2-positive breast cancer Background Secondary trastuzumab resistance seriously affects the treatment of HER2-positive breast cancer. Although studies have demonstrated several key cellular properties that are closely accompanied with trastuzumab resistance formation, we still have poor knowledge on the genetic and epigenetic variations that promote such transformation. Here we suggested that the epigenetic modification changes on histone H3 together with altered chromatin architecture promote lipid metabolism reprogramming during secondary trastuzumab formation. Materials and methods Induced secondary trastuzumab-resistant SKBR3_HR cell line together with the original trastuzumab-sensitive SKBR3 cell line were applied in this study. Total RNA was collected for transcriptome analysis. Anti-H3K4me3 and K27me3 antibodies were chosen for CUT&Tag sequencing library preparation. Total genome DNA was prepared for Micro-C sequencing library preparation. Activity score of metabolism pathway was calculated as relative gene expression value averaged over all genes in this pathway in certain cell types. Results Upregulation of arachidonic acid metabolism and downregulation of unsaturated fatty acid synthesis, which are mainly characterized by the activation of PTGS1 and PTGES genes and the repression of FASN and SCD genes, respectively, were observed during the formation of secondary trastuzumab resistance from SKBR3 cell to SKBR3_HR cells. Variations of H3k4me3 instead of H3k27me3 regulate the expression of these 4 genes. The accumulation of H3k4me3 was detected at the promoters of PTGS1 and PTGES genes while they were removed from the promoters of FASN and SCD genes in SKBR3_HR cells. More intra-chromosomal interactions were constituted during resistance formation. In detail, 4626 and 4394 topological associated domains, 3125 and 5824 DNA loops were founded in SKBR3 and SKBR3_HR cells, respectively. Furthermore, the lost and gained DNA loops between SCD and PTGS1 genes and distant genome regions may indicate the weaken and strengthen interactions with transcriptional regulators located there. Conclusions During trastuzumab resistance formation, altered histone modifications as well as higher genome structure could regulate the expression of key genes in lipid metabolism pathways, which may further affect cell properties and interactions with cells in tumor microenvironment. Citation Format: Ningjun Duan, Yijia Hua, Yongmei Yin. Altered epigenetic modifications and genome architecture reshape lipid metabolism during secondary trastuzumab resistance formation of HER2-positive breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-24-04.
标题 HER2 阳性乳腺癌继发性曲妥珠单抗耐药形成过程中表观遗传修饰和基因组结构的改变重塑了脂质代谢 背景 继发性曲妥珠单抗耐药严重影响了 HER2 阳性乳腺癌的治疗。虽然已有研究证实了与曲妥珠单抗耐药性形成密切相关的几种关键细胞特性,但我们对促进这种转变的遗传和表观遗传变异仍然知之甚少。在此,我们认为组蛋白 H3 的表观遗传修饰变化以及染色质结构的改变促进了继发性曲妥珠单抗形成过程中的脂质代谢重编程。材料与方法 本研究采用了诱导的继发性曲妥珠单抗耐药 SKBR3_HR 细胞系和原始的曲妥珠单抗敏感 SKBR3 细胞系。收集总 RNA 进行转录组分析。选用抗 H3K4me3 和 K27me3 抗体制备 CUT&Tag 测序文库。总基因组 DNA 用于 Micro-C 测序文库的制备。新陈代谢通路的活性分值按该通路所有基因在特定细胞类型中的平均相对基因表达值计算。结果 从SKBR3细胞到SKBR3_HR细胞,在形成曲妥珠单抗继发性耐药性的过程中,观察到花生四烯酸代谢的上调和不饱和脂肪酸合成的下调,其主要特征分别是PTGS1和PTGES基因的激活以及FASN和SCD基因的抑制。H3k4me3而非H3k27me3的变化调控着这4个基因的表达。在SKBR3_HR细胞中,PTGS1和PTGES基因的启动子上检测到了H3k4me3的积累,而FASN和SCD基因的启动子上则没有H3k4me3。在抗药性形成过程中,更多的染色体内相互作用发生了。具体而言,在 SKBR3 和 SKBR3_HR 细胞中分别形成了 4626 和 4394 个拓扑相关域、3125 和 5824 个 DNA 环。此外,SCD和PTGS1基因与遥远的基因组区域之间DNA环的丢失和获得可能表明与位于该区域的转录调节因子的相互作用减弱或增强。结论 在曲妥珠单抗耐药性形成过程中,组蛋白修饰的改变以及基因组结构的升高可能会调控脂质代谢通路中关键基因的表达,从而进一步影响细胞的特性以及与肿瘤微环境中细胞的相互作用。引用格式:段宁军,华益嘉,尹咏梅.HER2阳性乳腺癌继发性曲妥珠单抗耐药形成过程中表观遗传修饰和基因组结构的改变重塑脂质代谢[摘要].In:2023 年圣安东尼奥乳腺癌研讨会论文集;2023 年 12 月 5-9 日;德克萨斯州圣安东尼奥。费城(宾夕法尼亚州):AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-24-04.
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引用次数: 0
Abstract PO4-13-02: Molecular Expression Assays Improve the Prediction of Local and Invasive Local Recurrence after Breast Conserving Surgery for DCIS 摘要 PO4-13-02:分子表达测定可提高对DCIS保乳术后局部和侵袭性局部复发的预测能力
IF 11.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-02 DOI: 10.1158/1538-7445.sabcs23-po4-13-02
Ezra Hahn, R. Sutradhar, L. Paszat, Lena Nguyen, Danielle Rodin, S. Nofech-Mozes, Sabina Trebinjac, Cindy Fong, E. Rakovitch
Introduction Ductal carcinoma in situ (DCIS) is routinely treated with adjuvant radiotherapy (RT) after breast conserving surgery (BCS) in order to reduce the risk of local recurrence (LR) and invasive LR. Nomograms based on clinicopathological features (CPF) and molecular expression assays have been developed in an effort to provide individualized risk estimates and personalize decision-making. However, molecular assays are costly and it remains unclear if they provide more accurate recurrence risk estimates compared to algorithms based on CPF alone. We examined the impact of the 12-Gene DCIS Score (DS) and the 21-Gene Recurrence Score (RS) molecular expression assays, in addition to CPF, on the accuracy of predicting 10-year LR and invasive LR risk compared to predicted estimates based on CPF alone. In addition, we examined if a model including the 21-Gene RS improves the 10-year predicted risks of invasive LR after BCS for DCIS compared to estimates based on the DS+CPF or CPF alone. Methods We used a population-based cohort diagnosed with pure DCIS treated with BCS +/- RT from 1994-2003. All cases had expert pathology review providing contemporary assessment of diagnosis, margin status, margin width, multifocality, presence and extent of comedo necrosis, subtype, nuclear grade, and tumor size. For each case, a representative tissue block or unstained slide was sent to measure the 12-Gene DS and 21-Gene RS. Predictive models were developed using multivariable Cox regression analyses with backward selection and included all CPF, treatment with RT, and interactions. The performance of each model was evaluated based on c-statistic, -2log likelihood estimate (-2LLE), and Akaike information criterion (AIC). Calibration was performed using bootstrap resamples, with replacement. We compared the performance of the best model derived from CPF alone, the 12-Gene DS with CPF, and the 21-Gene RS with CPF on their ability to predict the 10 year risks of LR and invasive LR measured against outcomes observed in the cohort. Results The population-based cohort includes 1226 women, 514 were treated with BCS alone and 712 were treated with BCS + RT. Median age was 56 years. Median follow-up was 10 years. Fifty-two percent of tumors were between 1 and 2.5 cm, 35% were ≤1cm, and 13% were >2.5 cm. Comedo necrosis was present in 68%, and nuclear grade was low, moderate, and high in 7%, 54%, and 39%, respectively. Margins were negative in 90.5% of cases (N=1109). The 12-Gene DS was low, intermediate, and high in 53.5%, 20.9%, and 25.6% and the 21-Gene RS was >25 in 30% of patients. 194 women (15.8%) experienced ipsilateral LR as a first event; 112 were invasive LR. Models including either the DS or RS expression assays performed better in predicting the 10-year risk of LR after BCS compared to the model based on CPFs alone, demonstrating higher c-statistics (0.705, 0.699, and 0.662, respectively), lower AIC and lower -2LLE. The two molecular-based predictive m
导言 乳腺导管原位癌(DCIS)通常在保乳手术(BCS)后进行辅助放疗(RT),以降低局部复发(LR)和浸润性 LR 的风险。目前已开发出基于临床病理特征(CPF)和分子表达检测的提名图,以提供个体化的风险估计和个性化的决策。然而,分子检测成本高昂,而且与仅基于 CPF 的算法相比,分子检测是否能提供更准确的复发风险估计仍不清楚。我们研究了除 CPF 之外的 12 基因 DCIS 评分(DS)和 21 基因复发评分(RS)分子表达检测对 10 年 LR 和侵袭性 LR 风险预测准确性的影响,与仅基于 CPF 的预测相比。此外,我们还研究了与基于 DS+CPF 或仅基于 CPF 的估计值相比,包含 21 基因 RS 的模型是否能提高 DCIS BCS 后 10 年浸润性 LR 的预测风险。方法 我们使用了 1994-2003 年期间诊断为纯 DCIS 并接受 BCS +/- RT 治疗的人群队列。所有病例都经过了专家病理审查,对诊断、边缘状态、边缘宽度、多发性、合并坏死的存在和程度、亚型、核分级和肿瘤大小进行了当代评估。每个病例都要送去一个有代表性的组织块或未染色的切片,以测量 12 基因 DS 和 21 基因 RS。采用多变量考克斯回归分析和反向选择建立预测模型,包括所有 CPF、RT 治疗和交互作用。根据 c 统计量、-2log 似然估计值(-2LLE)和 Akaike 信息准则(AIC)对每个模型的性能进行评估。校准使用带替换的引导重采样进行。我们比较了由 CPF 单独得出的最佳模型、带有 CPF 的 12 基因 DS 和带有 CPF 的 21 基因 RS 预测 10 年 LR 和侵袭性 LR 风险的能力,并与队列中观察到的结果进行了比较。结果 基于人群的队列包括 1226 名女性,其中 514 人只接受了 BCS 治疗,712 人接受了 BCS + RT 治疗。中位年龄为 56 岁。随访时间中位数为10年。52%的肿瘤在1到2.5厘米之间,35%的肿瘤小于1厘米,13%的肿瘤大于2.5厘米。68%的肿瘤出现 Comedo 坏死,7%、54% 和 39% 的肿瘤核分级为低、中和高。90.5%的病例(N=1109)边缘呈阴性。53.5%、20.9%和25.6%的患者的12基因DS为低、中和高,30%的患者的21基因RS大于25。194名女性(15.8%)首次出现同侧LR,其中112例为侵袭性LR。与仅基于 CPFs 的模型相比,包含 DS 或 RS 表达检测的模型在预测 BCS 后 10 年 LR 风险方面表现更好,显示出更高的 c 统计量(分别为 0.705、0.699 和 0.662)、更低的 AIC 和更低的 -2LLE。与 CPF 模型相比,两种基于分子的预测模型在预测侵袭性 LR 风险方面的表现也更好,但 c 统计量(分别为 0.684、0.683 和 0.667)、AIC 或 -2LLE 的差异较小。与 12 基因 DS + CPF 模型相比,基于 21 基因 RS 与 CPF 的预测模型在预测 10 年侵袭性 LR 风险方面表现不佳。所有模型均校准良好。结论 与仅基于 CPF 的模型相比,基于 12 基因 DS 和 CPF 的预测模型能更准确地预测 BCS 后 10 年的 LR 和侵袭性 LR 风险。纳入带有 CPF 的 21 基因 RS 并没有改善对 LR 或侵袭性 LR 10 年风险的预测。这表明,包含 12 基因检测和 CPF 的提名图能对 BCS 后的复发风险提供更准确的个体化估计,有助于改善 DCIS 管理中的个性化决策。引用格式:Ezra Hahn、Rinku Sutradhar、Lawrence Paszat、Lena Nguyen、Danielle Rodin、Sharon Nofech-Mozes、Sabina Trebinjac、Cindy Fong、Eileen Rakovitch。分子表达测定改善了DCIS保乳术后局部和侵袭性局部复发的预测 [摘要].在:2023 年圣安东尼奥乳腺癌研讨会论文集;2023 年 12 月 5-9 日;德克萨斯州圣安东尼奥。费城(宾夕法尼亚州):AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-13-02.
{"title":"Abstract PO4-13-02: Molecular Expression Assays Improve the Prediction of Local and Invasive Local Recurrence after Breast Conserving Surgery for DCIS","authors":"Ezra Hahn, R. Sutradhar, L. Paszat, Lena Nguyen, Danielle Rodin, S. Nofech-Mozes, Sabina Trebinjac, Cindy Fong, E. Rakovitch","doi":"10.1158/1538-7445.sabcs23-po4-13-02","DOIUrl":"https://doi.org/10.1158/1538-7445.sabcs23-po4-13-02","url":null,"abstract":"\u0000 Introduction\u0000 Ductal carcinoma in situ (DCIS) is routinely treated with adjuvant radiotherapy (RT) after breast conserving surgery (BCS) in order to reduce the risk of local recurrence (LR) and invasive LR. Nomograms based on clinicopathological features (CPF) and molecular expression assays have been developed in an effort to provide individualized risk estimates and personalize decision-making. However, molecular assays are costly and it remains unclear if they provide more accurate recurrence risk estimates compared to algorithms based on CPF alone. We examined the impact of the 12-Gene DCIS Score (DS) and the 21-Gene Recurrence Score (RS) molecular expression assays, in addition to CPF, on the accuracy of predicting 10-year LR and invasive LR risk compared to predicted estimates based on CPF alone. In addition, we examined if a model including the 21-Gene RS improves the 10-year predicted risks of invasive LR after BCS for DCIS compared to estimates based on the DS+CPF or CPF alone.\u0000 Methods\u0000 We used a population-based cohort diagnosed with pure DCIS treated with BCS +/- RT from 1994-2003. All cases had expert pathology review providing contemporary assessment of diagnosis, margin status, margin width, multifocality, presence and extent of comedo necrosis, subtype, nuclear grade, and tumor size. For each case, a representative tissue block or unstained slide was sent to measure the 12-Gene DS and 21-Gene RS. Predictive models were developed using multivariable Cox regression analyses with backward selection and included all CPF, treatment with RT, and interactions. The performance of each model was evaluated based on c-statistic, -2log likelihood estimate (-2LLE), and Akaike information criterion (AIC). Calibration was performed using bootstrap resamples, with replacement. We compared the performance of the best model derived from CPF alone, the 12-Gene DS with CPF, and the 21-Gene RS with CPF on their ability to predict the 10 year risks of LR and invasive LR measured against outcomes observed in the cohort.\u0000 Results\u0000 The population-based cohort includes 1226 women, 514 were treated with BCS alone and 712 were treated with BCS + RT. Median age was 56 years. Median follow-up was 10 years. Fifty-two percent of tumors were between 1 and 2.5 cm, 35% were ≤1cm, and 13% were &gt;2.5 cm. Comedo necrosis was present in 68%, and nuclear grade was low, moderate, and high in 7%, 54%, and 39%, respectively. Margins were negative in 90.5% of cases (N=1109). The 12-Gene DS was low, intermediate, and high in 53.5%, 20.9%, and 25.6% and the 21-Gene RS was &gt;25 in 30% of patients. 194 women (15.8%) experienced ipsilateral LR as a first event; 112 were invasive LR.\u0000 Models including either the DS or RS expression assays performed better in predicting the 10-year risk of LR after BCS compared to the model based on CPFs alone, demonstrating higher c-statistics (0.705, 0.699, and 0.662, respectively), lower AIC and lower -2LLE. The two molecular-based predictive m","PeriodicalId":12,"journal":{"name":"ACS Chemical Health & Safety","volume":"83 7","pages":""},"PeriodicalIF":11.2,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141017984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Abstract PO5-05-09: Testing AI-Predicted Protein Motifs that Direct Constitutive Genomic AR Activity in Endocrine Resistant Breast Cancer 摘要 PO5-05-09:测试人工智能预测的引导内分泌耐药乳腺癌基因组AR活性的蛋白质基元
IF 11.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-02 DOI: 10.1158/1538-7445.sabcs23-po5-05-09
A. Khan, Anthony S Peidl, Shaymaa Bahnassy, Henry Vo, Micah Castillo, Sarah Herzog, S. Fuqua, Preethi H Gunaratne, Xiaolian Gao, Subash Pakhrin, Tasneem Bawa-Khalfe
Testing AI-Predicted Protein Motifs that Direct Constitutive Genomic AR Activity in Endocrine-Resistant Breast Cancer Ashfia F. Khan 1,2, Anthony S. Peidl 1,2, Shaymaa Bahnassy 3, Henry Vo2, Micah B. Castillo 2, Sarah K Herzog4,5, Suzanne AW Fuqua4,6, Preethi Gunaratne 2, Xiaolian Gao 2, Subash C. Pakhrin7, Tasneem Bawa-Khalfe1,2 1 Center for Nuclear Receptors & Cell Signaling, University of Houston, Houston, TX 2 Department of Biology & Biochemistry, University of Houston, Houston, TX 3 Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 4 Lester & Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 5 Program in Integrative Molecular and Biomedical Sciences, Baylor College of Medicine, Houston, TX 6 Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 7 Department of Computer Science & Engineering Technology, University of Houston-Downtown, Houston, TX Background: Endocrine therapy (ET) remains the first-line treatment for hormone-receptor positive (HR+) breast cancer (BCa). Approximately 15–20% of HR+ BCa are intrinsically resistant to ET, and 30–40% of patients acquire resistance. Resistance to ET (ET-R) supports cancer progression with reduced disease-free survival and greater incidence of metastatic disease. Hence, therapeutic strategies for ET-R HR+ BCa remain an overarching challenge. The androgen receptor (AR) is emerging as an attractive alternative target for BCa subtypes, and elevated AR levels drive HR+ BCa progression. Targeting AR in HR+ BCa is proving difficult with preclinical studies showing conflicting results for AR antagonists. Yet clinical trials with several AR-targeting drugs are ongoing. Our recent report highlights a unique constitutively active modified AR population that drives HR+ BCa metastatic properties and is insensitive to AR inhibitors. Our current objectives are to 1) use a novel machine-learning model to predict AR modifications and 2) establish a strategy to identify patients with high modified AR levels. Methods: An advanced artificial intelligence (AI) tool and mid-throughput microfluidic peptide array technology were used to map modification domains on AR. SUMO post-translational modification of AR (SUMO-AR) was eliminated in HR+ BCa using CRISPR-Cas9 technology. RNA-seq was employed to identify a unique gene signature for SUMO-AR, and comparative bioinformatic analysis stratified patients with high versus low SUMO-AR. Results: A novel deep-learning AI platform SumoPred-PLM is trained to identify consensus, non-consensus, and SUMO2/3-specific motifs on AR. We verified SUMO2/3-specific sites on AR with a mid-throughput microfluidic peptide array. The identified SUMO2/3-acceptor site of AR is important for HR+ BCa cell pathophysiology; loss of this SUMO2/3-acceptor site impacts endogenous AR SUMOylation, cell morphology, and proliferation/apoptosis. Using both high and low SUMO-AR BCa lines, a unique SUMO-AR gene profi
测试 AI 预测的引导内分泌耐受性乳腺癌基因组 AR 活性的蛋白质基元 Ashfia F. Khan 1,2, Anthony S. Peidl 1,2, Shaymaa Bahnassy 3, Henry Vo2, Micah B. Castillo 2, Sarah K Herzog4,5, Suzanne AW Fuqua4,6, Preethi Gunaratne 2, Xiaolian Gao 2, Subash C. Pakhrin7, Tasneem Bawa-Khalfe1,2 1 休斯顿大学核受体与细胞信号中心 2 休斯顿大学生物与生物化学系 3.Pakhrin7, Tasneem Bawa-Khalfe1,2 1 德克萨斯州休斯顿休斯顿大学核受体与细胞信号中心 2 德克萨斯州休斯顿休斯顿大学生物与生物化学系 3 华盛顿特区乔治敦大学隆巴迪综合癌症中心肿瘤学系 4 莱斯特与苏-史密斯乳腺中心、德克萨斯州休斯顿贝勒医学院 5 德克萨斯州休斯顿贝勒医学院分子与生物医学综合科学项目 6 德克萨斯州休斯顿贝勒医学院 Dan L Duncan 综合癌症中心 7 德克萨斯州休斯顿市中心大学计算机科学与工程技术系 背景:内分泌治疗(ET)仍然是激素受体阳性(HR+)乳腺癌(BCa)的一线治疗方法。大约 15-20% 的 HR+ BCa 对 ET 有内在耐药性,30-40% 的患者会产生耐药性。对 ET 的耐药性(ET-R)会导致癌症进展,降低无病生存率,增加转移性疾病的发病率。因此,ET-R HR+ BCa 的治疗策略仍是一项重大挑战。雄激素受体(AR)正在成为BCa亚型的一个有吸引力的替代靶点,AR水平的升高推动了HR+ BCa的进展。临床前研究显示,AR拮抗剂的治疗结果相互矛盾,因此很难在HR+ BCa中靶向AR。然而,几种AR靶向药物的临床试验正在进行中。我们最近的报告强调了一种独特的组成型活性修饰AR群体,它具有驱动HR+ BCa转移的特性,并且对AR抑制剂不敏感。我们目前的目标是:1)使用新型机器学习模型来预测AR修饰;2)建立一种策略来识别高修饰AR水平的患者。方法:使用先进的人工智能(AI)工具和中通量微流控肽阵列技术绘制AR上的修饰域。利用CRISPR-Cas9技术消除HR+ BCa中AR的SUMO翻译后修饰(SUMO-AR)。利用RNA-seq技术确定了SUMO-AR的独特基因特征,并通过生物信息学比较分析对高SUMO-AR和低SUMO-AR患者进行了分层。研究结果一个新颖的深度学习人工智能平台SumoPred-PLM经过训练可识别AR上的共识、非共识和SUMO2/3特异性图案。我们利用中通量微流控肽阵列验证了AR上的SUMO2/3特异性位点。已确定的AR SUMO2/3受体位点对HR+ BCa细胞的病理生理学非常重要;该SUMO2/3受体位点的缺失会影响内源性AR SUMOylation、细胞形态和增殖/凋亡。利用高SUMO-AR和低SUMO-AR BCa品系,建立了独特的SUMO-AR基因谱。我们的 SUMO-AR 基因特征可识别出更易发生转移的 HR+ BCa 患者。结论我们的研究提出了一种独特的方法,该方法结合了深度学习人工智能技术,可识别AR中的易感基因,用于未来的药物发现。目前正在进行药物筛选。此外,我们还建立了一个 SUMO-AR 基因特征,可将高/低 SUMO-AR 的 HR+ BCa 患者分层,并预测疾病进展。我们希望这些结果能在目前的临床试验中用于识别AR抑制剂的应答者。引用格式:Ashfia Khan, Anthony Peidl, Shaymaa Bahnassy, Henry Vo, Micah Castillo, Sarah Herzog, Suzanne Fuqua, Preethi Gunaratne, Xiaolian Gao, Subash Pakhrin, Tasneem Bawa-Khalfe.测试人工智能预测的引导内分泌耐药乳腺癌基因组AR活性的蛋白质结构[摘要]。In:2023 年圣安东尼奥乳腺癌研讨会论文集;2023 年 12 月 5-9 日;德克萨斯州圣安东尼奥。费城(宾夕法尼亚州):AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-05-09.
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引用次数: 0
Abstract PO3-12-12: Axial Neuropathy in Two Breast Cancer Patients receiving Fam-trastuzumab deruxtecan: A Case Report 摘要PO3-12-12:两名乳腺癌患者在接受Fam-trastuzumab deruxtecan治疗后出现轴神经病变:病例报告
IF 11.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-02 DOI: 10.1158/1538-7445.sabcs23-po3-12-12
Lauren Botero, Katharine McNeill, Della Makower
Introduction. Fam-trastuzumab deruxtecan (T-DXd) is FDA approved for metastatic HER2-positive (HER2+) and HER2-low breast cancer (BC). Peripheral neuropathy is a side effect of T-DXd, with an incidence of 13%. Here we discuss two BC patients (pts) who presented with paresthesias of the trunk after receiving T-DXd. Case 1. A 51-year-old female with Stage IIIB cT4N2M0 left BC, estrogen receptor positive (ER+), progesterone receptor positive (PR+) and HER2+ was treated with neoadjuvant docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP), followed by mastectomy and axillary lymph node dissection, with downstaging to ypT3N2a disease. She was enrolled on a clinical trial comparing T-DXd with standard treatment for HER2+ BC with residual disease after neoadjuvant therapy, and was randomized to T-DXd arm. She also received adjuvant proton radiation therapy to the chest wall. One week after her third cycle of T-DXd she developed Grade 3 paresthesias on her trunk and proximal upper and lower extremities, stating she could not bend over or perform activities of daily living. She did not experience associated weakness or peripheral neuropathy. Symptoms improved to Grade 1 after initiation of gabapentin and delay of cycle 4 T-DXd by one week. She resumed T-DXd with dose reduction per protocol, and increase in gabapentin dose. She was seen by neurology who localized her sensory findings to T5-T9. She was recommended to undergo MRI spine, but was unable to do so, due to presence of tissue expander. Paresthesias have been controlled on dose reduced T-DXd and continued gabapentin. Case 2. A 56-year-old female with ER+, PR+, HER2-negative BC initially diagnosed in 1990, with local recurrence in 2005, treated with mastectomy, adjuvant chemotherapy, and adjuvant endocrine therapy, followed by development of metastatic disease to lung, liver, bone and skin in 2017. She received multiple lines of endocrine therapy, including aromatase inhibitors and fulvestrant, with cdk4/6 inhibitors and everolimus, but either progressed or was intolerant to all treatments. Skin biopsy in 2022 confirmed metastatic BC, which was ER+, PR+, and HER2 low (IHC2+, FISH nonamplified). She then received T-DXd, with clinical and radiographic response to treatment. After cycle 8 T-DXd, the patient was hospitalized for severe burning pain of her trunk and skin. Radiologic evaluation, including CT chest, abdomen, pelvis, and MRI spine, did not show an etiology of her pain, and showed stable metastatic disease to liver and bones, without evidence of cord or nerve root compression. Symptoms improved on pregabalin. She received an additional cycle of T-DXd with dose reduction, but ultimately declined further treatment. Symptoms resolved within 5 months of discontinuation of T-DXd. Discussion. These cases represent unusual events of axial neuropathy in two BC patients receiving T-DXd. Given the similarity of their symptoms, these findings may represent an unusual adverse effect of T-DXd.
简介Fam-trastuzumab deruxtecan(T-DXd)已获美国 FDA 批准用于治疗 HER2 阳性(HER2+)和 HER2 低的转移性乳腺癌(BC)。周围神经病变是 T-DXd 的副作用之一,发生率为 13%。在此,我们将讨论两名在接受 T-DXd 治疗后出现躯干麻痹的 BC 患者(pts)。病例 1.一名 51 岁女性,左侧乳腺癌 IIIB cT4N2M0 期,雌激素受体阳性(ER+)、孕激素受体阳性(PR+)和 HER2+,接受了多西他赛、卡铂、曲妥珠单抗和百妥珠单抗(TCHP)新辅助治疗,随后进行了乳房切除术和腋窝淋巴结清扫术,病情降级为 ypT3N2a。她参加了一项临床试验,对新辅助治疗后有残留疾病的 HER2+ BC 进行 T-DXd 与标准治疗的比较,并被随机分配到 T-DXd 组。她还接受了胸壁质子辅助放射治疗。在服用 T-DXd 第三个周期一周后,她的躯干和上下肢近端出现了 3 级麻痹,称她无法弯腰或进行日常生活活动。她没有出现相关的乏力或周围神经病变。在开始使用加巴喷丁并将第 4 周期的 T-DXd 推迟一周后,她的症状改善到了 1 级。她恢复了 T-DXd,并按照方案减少了剂量,同时增加了加巴喷丁的剂量。神经科医生将她的感觉症状定位在 T5 至 T9。医生建议她进行脊柱核磁共振成像检查,但由于存在组织扩张器而无法进行。减量服用 T-DXd 和继续服用加巴喷丁后,麻痹症状得到了控制。病例 2.女性,56 岁,ER+、PR+、HER2 阴性 BC,最初于 1990 年确诊,2005 年局部复发,接受乳房切除术、辅助化疗和辅助内分泌治疗,2017 年出现肺、肝、骨和皮肤转移性疾病。她接受了多线内分泌治疗,包括芳香化酶抑制剂和氟维司群,以及 cdk4/6 抑制剂和依维莫司,但要么病情进展,要么不能耐受所有治疗。2022 年的皮肤活检证实了转移性乳腺癌,ER+、PR+、HER2 低(IHC2+、FISH 非扩增)。随后,她接受了 T-DXd,临床和影像学对治疗均有反应。T-DXd 第 8 个周期后,患者因躯干和皮肤剧烈灼痛而住院。包括胸部、腹部、骨盆 CT 和脊柱 MRI 在内的放射学评估未发现疼痛的病因,并显示肝脏和骨骼的转移性疾病稳定,没有脊髓或神经根受压的迹象。服用普瑞巴林后症状有所改善。她又接受了一个周期的T-DXd治疗,并减少了剂量,但最终拒绝了进一步治疗。停用 T-DXd 5 个月后症状缓解。讨论。这些病例代表了两名接受 T-DXd 治疗的 BC 患者发生轴性神经病变的不寻常事件。鉴于他们的症状相似,这些发现可能是 T-DXd 的异常不良反应。随着 T-DXd 适应症的不断扩大,临床医生应注意这种不常见的潜在毒性。引用格式:Lauren Botero, Katharine McNeill, Della Makower.接受法莫芦单抗德鲁替康治疗的两名乳腺癌患者的轴神经病变:病例报告[摘要]。In:2023 年圣安东尼奥乳腺癌研讨会论文集;2023 年 12 月 5-9 日;德克萨斯州圣安东尼奥。费城(宾夕法尼亚州):AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-12-12.
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引用次数: 0
Abstract PO1-09-12: Cancer health disparities among patients with early-stage estrogen receptor-positive (ER+) breast cancer treated in public or private practices in Brazil 摘要 PO1-09-12:巴西在公立或私立医疗机构接受治疗的早期雌激素受体阳性(ER+)乳腺癌患者的癌症健康差异
IF 11.2 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-05-02 DOI: 10.1158/1538-7445.sabcs23-po1-09-12
R. Barroso-Sousa, Daniele Assad-Suzuki, D. Santos, Fernanda Moura, S. Oliveira, Anna Luiza Galvão, Bruno Souza, Amanda Castro, Monalisa Andrade, Andrea Shimada, Yuri Beckedorff, M. C. Magalhães, C. Souza, Carlos Paiva, Heloísa Resende, Daniela Pereira, Angelica Rodrigues, Daniela Rosa
Background Cancer registries in Brazil are deficient and data about patients’ profiles and cancer treatment patterns are scarce in the country. Moreover, while 30% of population has access to private insurance, almost 70% of population uses publicly health services. The objective of this work was to describe the sociodemographic and clinicopathological characteristics of women with early-stage ER+ breast cancer on adjuvant ET in different regions of Brazil, and to describe treatment patterns for this disease according public and private institutions. Methodology: We performed a real-world data analysis in different institution regions of Brazil. Women with a history of early-stage ER+ invasive carcinoma of the breast on adjuvant endocrine therapy for at least 6 months were invited to participate of this study in 12 centers in four different regions in Brazil. Demographic and clinicopathologic information was retrieved from medical records. In order to compare healthcare insurance type, we considered patients who were treated under the Brazilian public health system as publicly insured, and women who had private insurance or paid for their treatment as privately insured. High education level was defined by completed high school. Data collection was done with RedCap software. Qualitative variables were compared between groups using the Chi-square or exact Chi-square test and for quantitative variables the non-parametric Mann-Whitney test was used. P < 0.05 was considered significant. Analyzes were performed in SAS 9.4; Results: From June 2021 to May 2023, a total of 461 women with ER+, early BC, were included in this analysis. A total of 233 (50.6%) came from private institutions, the mean age was 56.02 years (range 22-93), 47.69% were non-white, 61.3% were post-menopause, 61.7% lived with a partner, and 76.2% were highly educated and 66.81% had comorbidities. Tumor staging at diagnosis was classified as III, II and I respectively in 21.26%, 43.17% and 35.57% of all cases. Regarding treatment received, 62.4% of patients underwent lumpectomy, 32.2% had axillary dissection, 67.6% received (neo)adjuvant chemotherapy, 45.2% were on aromatase inhibitors and 14.19% were on ovarian function suppression plus ET . Median duration of ET use was 2.78 years (range 6 months- 9.61 years). Publicly health insurance was associated significantly associated with younger age at diagnosis (< 60 yo), premenopausal status, to live alone, lower educational level, more advanced tumors, prior mastectomy, prior axillary dissection, prior neo-adjuvant chemotherapy, prior radiotherapy, lower use of aromatase inhibitors, ovarian function suppression plus ET, and CDK4/6 inhibitors, while higher use of concomitant medications. Conclusion: The study shows significant health disparities among women with early-stage ER+ breast cancer treated in private versus public institutions in Brazil. Importantly, despite having more advanced tumors, women in public institution had less acce
背景 巴西的癌症登记处很不完善,有关患者概况和癌症治疗模式的数据也很少。此外,虽然 30% 的人口可以享受私人保险,但近 70% 的人口使用公共医疗服务。这项研究旨在描述巴西不同地区早期ER+乳腺癌妇女接受ET辅助治疗的社会人口学和临床病理学特征,并根据公立和私立机构的情况描述该疾病的治疗模式。研究方法:我们对巴西不同地区的机构进行了真实世界数据分析。巴西四个不同地区的 12 个中心邀请了接受辅助内分泌治疗至少 6 个月的早期ER+浸润性乳腺癌妇女参与这项研究。研究人员从医疗记录中获取了人口统计学和临床病理学信息。为了比较医疗保险类型,我们将在巴西公共医疗系统下接受治疗的患者视为公共保险患者,而将拥有私人保险或自费接受治疗的女性视为私人保险患者。高中毕业即为高学历。数据收集采用 RedCap 软件。组间定性变量的比较采用卡方检验或精确卡方检验,定量变量的比较采用非参数曼-惠特尼检验。P<0.05为差异显著。分析在 SAS 9.4 中进行;结果:从 2021 年 6 月到 2023 年 5 月,共有 461 名患有 ER+、早期 BC 的女性被纳入本次分析。共有 233 人(50.6%)来自私立机构,平均年龄为 56.02 岁(22-93 岁不等),47.69% 为非白人,61.3% 为绝经后女性,61.7% 与伴侣同居,76.2% 接受过高等教育,66.81% 有合并症。在所有病例中,21.26%、43.17% 和 35.57% 的患者在确诊时的肿瘤分期分别为 III、II 和 I 期。在接受的治疗方面,62.4%的患者接受了肿块切除术,32.2%的患者进行了腋窝清扫术,67.6%的患者接受了(新)辅助化疗,45.2%的患者服用了芳香化酶抑制剂,14.19%的患者服用了卵巢功能抑制剂加ET。使用 ET 的中位时间为 2.78 年(6 个月至 9.61 年不等)。公共医疗保险与以下因素明显相关:确诊时年龄较小(小于 60 岁)、绝经前状态、独居、教育水平较低、肿瘤较晚期、既往接受过乳房切除术、既往接受过腋窝切除术、既往接受过新辅助化疗、既往接受过放疗、芳香化酶抑制剂、卵巢功能抑制剂加 ET 和 CDK4/6 抑制剂的使用率较低,而同时使用的药物较多。结论研究显示,在巴西,在私立与公立医疗机构接受治疗的早期ER+乳腺癌妇女在健康方面存在明显差异。重要的是,尽管晚期肿瘤更多,但在公立机构接受卵巢抑制剂、CDK4/6 抑制剂治疗的女性更少,而且接受的手术治疗更具侵略性。政府、立法者、医疗服务提供者和患者应展开深入讨论,努力缩小上述差距。巴西雌激素受体阳性乳腺癌患者在接受辅助治疗时的特征和治疗模式(根据医疗保险) ALND:腋窝淋巴结清扫术;CDK4/6i:CDK4/6抑制剂;ELISA:ELISA抑制剂:CDK4/6i:CDK4/6抑制剂;ET:内分泌治疗;OS:卵巢抑制。引用格式:Romualdo Barroso-Sousa、Daniele Assad-Suzuki、Danielle Santos、Fernanda Moura、Sulene Oliveira、Anna Luiza Galvão、Bruno Souza、Amanda Castro、Monalisa Andrade、Andrea Shimada、Yuri Beckedorff、Maria Cristina Magalhães、Cristiano Souza、Carlos Paiva、Heloísa Resende、Daniela Pereira、Angelica Rodrigues、Daniela Rosa。巴西在公立或私立医院接受治疗的早期雌激素受体阳性(ER+)乳腺癌患者的癌症健康差异[摘要]。In:2023 年圣安东尼奥乳腺癌研讨会论文集;2023 年 12 月 5-9 日;德克萨斯州圣安东尼奥。费城(宾夕法尼亚州):AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-12。
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