610 likes | 808 Vues
Joyce O'Shaughnessy, MD Co-Director, Breast Cancer Research ProgramBaylor-Charles A Sammons Cancer CenterTexas Oncology, PAUS OncologyDallas, Texas. Eric P Winer, MDThompson Investigator in Breast Cancer ResearchChief, Division of Women's Cancers Dana-Farber Cancer InstituteProfessor of MedicineHarvard Medical SchoolBoston, Massachusetts.
E N D
1. RTP TV: An 8-Part Live CME Webcast Series
3. Disclosures for Moderator Neil Love, MD
4. Disclosures for Joyce OShaughnessy, MD
5. Disclosures for Eric P Winer, MD
6. RTP TV: An 8-Part Live CME Webcast Series
7. Survey of 100 Practicing Oncologists 95% fraction who see patients with TNBC
10 median number of patients with metastatic TNBC currently in their practices
8. Survey of 100 Practicing Oncologists Fraction with a patient who has received
Iniparib 23%
Olaparib 16%
Veliparib 7%
9. Survey of 100 Practicing Oncologists If you were to attend a CME conference on breast cancer, to what extent would you be interested in learning about the following topics?
Response scale 0 10
0 = no interest
10 = very interested
10. TNBC: New Agents and Regimens
11. TNBC: PARP Inhibitors
12. Survey of 100 Practicing Oncologists What question(s) would you like to pose to a clinical investigator with expertise in the management of TNBC?
97 questions/cases received
13. When will newer agents be integrated into earlier lines of treatment?
14. When is BRCA testing indicated in a patient with TNBC?
15. Under what conditions should metastatic sites be biopsied?
16. Are there other new noncytotoxic, targeted agents in TNBC in addition to PARP inhibitors?
Naples, FL
18. Case 1 (Dr OShaughnessy) 50 yo woman with basal-like TNBC
Preoperative AC ? paclitaxel: pCR Tumor melts away after 1 cycle of AC
Locoregional RT
2 years later, very rapidly growing ipsilateral internal mammary node protruding from her chest and invading sternum and mediastinal LNs
Patient enrolls on a trial of gem/carbo iniparib*
Major response for 8 cycles (6 months)
Tissue harvested for total genome sequencing
Paclitaxel/bevacizumab
Response for 6 months but progressing
19. Progression with Regrowth of IpsilateralMammary Mass and Mediastinal Nodes
20. Phase II Study of Iniparib plus Gemcitabine/Carboplatin in mTNBC
21. A Randomized Phase III Study of Iniparib (BSI-201) in Combination with Gemcitabine and Carboplatin in Metastatic Triple-Negative Breast Cancer (mTNBC) OShaughnessy J et al. Proc ASCO 2011;Abstract 1007.
22. Phase II Study of Iniparib plus Gemcitabine/Carboplatin in mTNBC
23. Metastatic Triple-Negative Breast Cancer (mTNBC) 15% of breast cancers; clinically defined as ER-negative, PR-negative and HER2-non-overexpressing
Heterogeneous disease with generally virulent natural history
Shares gene expression profiles with basal-like, claudin-low and other molecular subtypes
No clinical implications of molecular subtypes at present
24. Iniparib (BSI-201)
A novel, investigational, anticancer agent
In triple-negative breast cancer cell lines:
Induces cell cycle arrest in the G2/M phase
Induces double strand DNA damage ?H2AX foci but does not inhibit PARP1 and 2 at physiologic drug concentrations
Potentiates cell-cycle arrest induced by DNA damaging agents, including platinum and gemcitabine
Physiologic targets of iniparib and its metabolites are under investigation
25. Preclinical Pharmacodynamic and Pathway Analysis of 3 Presumed PARP Inhibitors: ABT-888, AZD2281, BSI-201 ABT-888 and AZD2281 are mediated by PARP1 or PARP2.
Iniparib (BSI-201) suppressed genes in the telomere pathway, suggesting PARP5/6 as potential targets.
26. Schema
27. Study Objectives Primary:
Coprimary endpoints:
Overall survival (OS)
Progression-free survival (PFS)
Study considered positive if either endpoint met
Secondary:
Objective response rate (ORR)
Safety, tolerability and pharmacokinetics of GCI
28. Treatment-Emergent Adverse EventsSafety Population (Prior to crossover, >5% Grade 3/4 in GCI arm)
36. Deconstructing the molecular portraits of breast cancer
41. Case 2 (Dr Winer) 48 yo premenopausal, BRCA1/2-negative woman presents 6 years ago with weakly ER+, PR- T2N1 breast cancer
Neoadjuvant AC ? paclitaxel
Excision/re-excision plus RT
Tamoxifen
Ipsilateral breast recurrence 1 year later
Mastectomy
Waxing and waning supraclavicular adenopathy over next 18 months until diagnosed with local recurrence
Needle biopsy reveals metastatic TNBC, with small pulmonary nodule
Enrolled on TBCRC009: Phase II study of cisplatin or carboplatin for metastatic TNBC*
Clinical CR after 7 cycles of cisplatin
Treatment discontinued due to toxicity (fatigue, neuropathy)
No further therapy for past 2 years, 4 months
43. TBCRC009: A Multicenter Phase II Study of Cisplatin or Carboplatin for Metastatic Triple-Negative Breast Cancer and Evaluation of p63/p73 as a Biomarker of Response
44. Phase II Study of Cisplatin or Carboplatin for mTNBC 86 patients enrolled to physician's choice of either cisplatin or carboplatin
Overall RR: 30.2%, including 4 CR (4.7%) and 22 PR (25.6%)
RR by treatment (exploratory): 37% cisplatin
23% carboplatin
p63/p73 analysis is ongoing
45. Submitted CaseDr Frances de la Serna, Philippines 40 yo woman with axillary lymphadenopathy in 1/2010
Excisional biospy: Ductal carcinoma consistent with breast primary in 4 nodes
Ultrasound: 2 solid masses in breast (15.1 and 20.9 mm)
Neoadjuvant anthracycline/taxane-based therapy x 2 cycles ? surgery
No residual tumor or LVI in the breast
7/9 nodes positive
ER/PR-, HER2 1-2+ (FISH positive)
Receives chemotherapy/trastuzumab
46. Submitted Case (Continued) 12/2010: Neck mass
FNB: Metastatic carcinoma
Multiple enlarged lymph nodes in supraclavicular and jugular chains
Excisional biopsy: ER/PR/HER2-negative adenocarcinoma
Patient receives cisplatin/gemcitabine
Resolution of enlarged nodes
5/2011: Neck mass
Biopsy: Metastatic carcinoma
Multiple nodules on the skin flap
Plan: Continue cisplatin
47. Local versus Central Laboratory Discrepancies in TNBC Status (CIBOMA/2004-01/GEICAM/2003-11) N = 1,441 patient samples sent for central laboratory confirmation
In 130 cases (9%) tumors were found to not be TNBC by central determination
71% of discrepant results involved ER or PR status
22% of discrepant results involved HER2 status
51. TBCRC 018: Phase II Study of Iniparib plus Chemotherapy to Treat Triple-Negative Breast Cancer (TNBC) Brain Metastases (BM) Anders CK et al.
Proc ASCO 2011;Abstract TPS127: Trials in Progress.
54. Case 3 (Dr OShaughnessy) A woman in her mid-50s with locally advanced and metastatic TNBC
Enrolled in a study of total genome sequencing
Determined to have a high level BRAF amplicon
Enrolled on a Phase I trial of MEK plus AKT inhibitors*
Significant response in a very large, fungating breast
58. A Phase I Dose-Escalation Study of Oral MK-2206 (Allosteric AKT Inhibitor) with Oral Selumetinib (MEK Inhibitor) in Patients with Advanced or Metastatic Solid Tumors
61. Schedule of Events