Event-free and overall survival following neoadjuvant weekly paclitaxel and dose-dense AC +/-...
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Transcript of Event-free and overall survival following neoadjuvant weekly paclitaxel and dose-dense AC +/-...
Event-free and overall survival following neoadjuvant weekly paclitaxel
and dose-dense AC +/- carboplatin and/or bevacizumab in triple-negative
breast cancer: outcomes from CALGB 40603 (Alliance)
William M Sikov, Donald A Berry, Charles M Perou, Baljit Singh, Constance T Cirrincione, Sara M Tolaney, George Somlo, Elisa R Port, Rubina Qamar, Keren Sturtz, Eleftherios Mamounas,
Mehra Golshan, Jennifer R Bellon, Deborah Collyar, Olwen M Hahn, Lisa A Carey, Clifford A Hudis, Eric P Winer for the CALGB/Alliance
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
CALGB 40603: Schema – Randomized phase II
Paclitaxel 80 mg/m2 wkly x 12 ddAC x 4
Bevacizumab 10 mg/kg q2wks x 9
Bevacizumab 10 mg/kg q2wks x 9
Carboplatin AUC 6 q3wks x 4
Carboplatin AUC 6 q3wks x 4
Paclitaxel 80mg/m2 weekly x 12
Surgery&*
XRT*
No Adjuvant Systemic Treatment Planned*
Paclitaxel 80 mg/m2 wkly x 12
Paclitaxel 80 mg/m2 wkly x 12
Paclitaxel 80 mg/m2 wkly x 12
Research biopsies-
frozen and fixed
2 X 2 Randomization
ddAC x 4
ddAC x 4
ddAC x 4&Research biopsies if residual tumor *MD discretion
CALGB 40603: Schema – Randomized Phase II
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
B
A
C
D
Arm
San Antonio Breast Cancer Symposium – Cancer Therapy and Research Center at UT Health Science Center December 8-12, 2015
This presentation is the intellectual property of William Sikov, MD. Contact at [email protected] for permission to reprint or distribute.
CALGB 40603 – pCR Results by factor
pCR Breast ypT0/is (%, 95% CI) Overall Carbo No Carbo OR p-value
53 (49-58)60 (54-66) 46 (40-53) 1.76 0.0018
Bev No Bev OR p-value 59 (52-65) 48 (41-54) 1.58 0.0089
pCR Breast/Axilla ypT0/is ypN0 (%, 95% CI) Overall Carbo No Carbo OR p-value
48 (43-53) 54 (48-61) 41 (35-48) 1.71 0.0029
Bev No Bev OR p-value 52 (45-58) 44 (38-51) 1.29 0.0570
Sikov et al, J Clin Oncol 2015
Definition of endpoints •Event-free survival (EFS) – Study entry to ipsilateral invasive breast or other locoregional recurrence, distant recurrence or death from any cause•Overall Survival (OS) – Study entry to death from any cause
Median follow-up: 39 months (maximum 66 months)110 EFS events and 77 OS deaths •Data on systemic treatment received in adjuvant setting (if any) was not collected
CALGB 40603 – Long-term follow-up
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
CALGB 40603 – Event-Free and Overall Survival
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
pCR Breast pCR Breast/Axilla
pCR Breast/Axilla
or RCB I*
Yes/No N (%) 231 (52%)/212 (48%)
207 (47%)/236 (53%)
266 (60%)/177 (40%)
EFS-HR 0.33 (0.22-0.50) 0.30 (0.19-0.46) 0.29 (0.20-0.43)
OS-HR 0.28 (0.17-0.46) 0.20 (0.11-0.36) 0.21 (0.13-0.34)
CALGB 40603 – EFS and OS by Response
* RCB I = Residual Cancer Burden Class I per Symmans et al, JCO 2007
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
CALGB 40603 – EFS by pCR Breast/Axilla
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
CALGB 40603 – OS by pCR Breast/Axilla
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
From FDA-requested meta-analysis
Cortazar et al Lancet 2014
Impact of pCR Breast/Axilla on EFS in TNBC San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
From meta-analysis; CALGB 40603 superimposed
pCR rates 47.8% (40603)vs. 33.6% (meta-analysis)
CALGB 40603 – EFS/OS Events by Response
San Antonio Breast Cancer Symposium, December 8-12, 2015
• At 3 years, patients who achieved pCR Breast/Axilla
(47% overall) had much lower rates of
– Ipsilateral invasive breast recurrences 2.9% (vs 13.3%)
– Other locoregional recurrences 1.5% (vs. 6.6%)
– Distant recurrences 9.2% (vs. 26.5%)
– All deaths 6.8% (vs. 28.3%)
– Breast cancer attributed deaths 5.8% (vs. 25.2%)
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
Carboplatin Bevacizumab
Yes No Yes No
EFS3-year 76% 71% 75% 72%
HR 0.84 (0.58-1.22) 0.80 (0.55-1.17)
OS3-year 81% 85% 85% 81%
HR 1.15 (0.74-1.79) 0.76 (0.49-1.19)
CALGB 40603 – EFS and OS by Factor
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
CALGB 40603 – EFS for carboplatin vs. not
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
CALGB 40603 – EFS for bevacizumab vs. not
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
∆pCR Breast/Axilla vs. predicted EFS HR in TNBC
Derived from Cortazar et al
Adapted from Berry & Hudis, JAMA Oncology 2015
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
Event type OverallFactor
Carbo No Carbo Bev No Bev
Patients 443 225 218 222 221EFS Events 109 52 57 50 59 Ipsilateral Inv Br Rec 36 14 22 13 23 Other LRR 18 7 11 8 10 Distant Recurrence 80 40 40 40 40OS Events 79 43 36 35 44 Breast Cancer Death 70 38 32 32 38 Non-BC, non-Rx Death 4 3 1 1 3 Unknown Death 5 2 3 2 3
CALGB 40603 – EFS/OS Events by Factor
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
CALGB/Alliance 40603: Summary
• Achievement of pCR with weekly paclitaxel followed by ddAC +/- carboplatin and/or bevacizumab is associated with significant improvements in EFS and OS
• Addition of RCB I patients does not diminish the prognostic significance associated with pCR Breast/Axilla
– Substantial reductions are seen in both LRR and DR
– Inferior outcomes are seen in clinical stage III disease with failure to achieve a pCR and in clinically node-positive patients with persistently positive axillary LNs after NACT
Results are consistent with the FDA-requested meta-analysis
CALGB/Alliance 40603: Conclusions
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.
CALGB/Alliance 40603: Summary
• Our study was underpowered to determine whether the increases in the pCR rates seen with the addition of carboplatin and bevacizumab improve EFS or OS
• Previous studies (BEATRICE, E5103, GeparQuinto, NSABP B-40) have failed to demonstrate improvements in long-term outcomes (EFS, RFS or OS with the addition of bevacizumab to a control (neo)adjuvant chemotherapy regimen in stage I-III TNBC
• Results from other completed (GeparSixto) and ongoing (BrighTNess, NRG-003) studies in the neoadjuvant and adjuvant settings should help to clarify whether the addition of carboplatin benefits patients with early stage TNBC
CALGB/Alliance 40603: Conclusions
San Antonio Breast Cancer Symposium, December 8-12, 2015
This presentation is the intellectual property of the authors. Contact them at [email protected] for permission to reprint and/or distribute.