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Poster Display session 2

2551 - Efficacy of dose-dense (DD) adjuvant chemotherapy (CT) in hormone receptor positive/HER2-negative early breast cancer (BC) patients (pts) according to immunohistochemically (IHC) defined luminal subtypes: an exploratory analysis of the GIM2 trial.

Date

29 Sep 2019

Session

Poster Display session 2

Presenters

Benedetta Conte

Citation

Annals of Oncology (2019) 30 (suppl_5): v55-v98. 10.1093/annonc/mdz240

Authors

B. Conte1, M. Bruzzone2, M. Lambertini3, F. Poggio1, E. Blondeaux1, M. De Laurentiis4, E. Valle5, F. Cognetti6, C. Nisticò7, S. De Placido8, M.C. Merlano9, T. Gamucci10, F. Montemurro11, M. Ceppi2, L. Del Mastro3

Author affiliations

  • 1 Medical Oncology, Policlinico San Martino, 16132 - Genova/IT
  • 2 Clinical Epidemiology, Policlinico San Martino, 16132 - Genova/IT
  • 3 Department Of Internal Medicine And Medical Specialities, University of Genova, 16132 - Genova/IT
  • 4 Breast Unit, Istituto Nazionale Tumori – I.R.C.C.S - Fondazione Pascale, 80131 - Napoli/IT
  • 5 Medical Oncology, Businco Hospital, 09121 - Cagliari/IT
  • 6 Department Of Clinical And Molecolar Medicine, La Sapienza University, 00161 - Rome/IT
  • 7 Medical Oncology 1, Istituto Nazionale Tumori Regina Elena, 00144 - Rome/IT
  • 8 Clinical Medicine And Surgery, Azienda Universitaria Ospedaliera Federico II, 80131 - Napoli/IT
  • 9 Clinical Oncology, Azienda Ospedaliera St. Croce e Carle, 12100 - Cuneo/IT
  • 10 Medical Oncology Unit, Azienda Sanitaria Locale (ASL) Frosinone, Presidio Ospedaliero Servizi Sanitari (SS) Trinità, 03039 - Sora/IT
  • 11 Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, 10060 - Torino/IT
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Resources

Abstract 2551

Background

DD adjuvant CT improves disease free survival (DFS) and overall survival (OS) in high-risk, hormone receptor positive BC. Luminal A and luminal B subtypes have different sensitivity to (neo)adjuvant chemotherapy; however, their role in predicting DD efficacy in clinically high-risk setting is uncertain. This exploratory analysis of the GIM2 trial (Del Mastro et al, Lancet 2015) evaluated DD efficacy according to IHC defined luminal subtypes.

Methods

In the GIM2 trial, pts with node-positive early BC were randomized to receive 4 cycles of (fluorouracil) epirubicin/cyclophosphamide every 2 (DD) or every 3 (standard interval [SI]) weeks followed by 4 cycles of DD or SI paclitaxel. Luminal A-like and luminal B-like BC were identified according to 13h St Gallen definition as having a Ki67<20% and a PgR>/=20% (luminal A-like), and a Ki67>/=20% and/or a PgR<20% (luminal B-like). Pts with HER2-positive BC were excluded. The efficacy of DD CT in terms of DFS and OS was compared between the two subtypes.

Results

Of 2,003 pts enrolled in the GIM2 trial, 401 had luminal A-like and 657 luminal B-like BC. After a median follow-up of 8 years, DFS was 81.1% (95% Confidence Intervals [CI] 76.6-84.7) and 70.6% (66.6-74.1) in luminal A-like and B-like BC, respectively; OS was 91.6% (88.1-94.1) and 85% (81.7-87.7), respectively. There was no significant interaction between treatment and luminal subtypes (pinteraction=0.416 for DFS and pinteraction=0.313 for OS); however, the effect of DD CT appeared to be greater in luminal-B like BC (see table below).Table:

186P

8 year DFS SI8 year DFS DDHR (95% CI)
luminal A-like81.680.60.86 (0.56-1.30)
luminal B-like66.874.70.74 (0.55-0.98)
8 year OS SI8 year OS DD
Luminal A-like92.990.60.88 (0.47-1.67)
luminal B-like80.889.40.61 (0.40-0.93)

Conclusions

These long-term results confirm the prognostic value of IHC-defined luminal subtypes, with luminal B-like bearing a worse prognosis. In clinically high-risk, hormone receptor positive BC, luminal B-like subtype benefits more from DD CT both in terms of DFS and OS.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

M. Lambertini: Honoraria (self), speaker honoraria: Theramex; Advisory / Consultancy: Teva. M. De Laurentiis: Advisory / Consultancy: Pfizer; Advisory / Consultancy: Novartis; Advisory / Consultancy: Eisai; Advisory / Consultancy: Eli Lilly; Advisory / Consultancy: Roche; Advisory / Consultancy: Celgene. S. De Placido: Honoraria (self): Roche; Honoraria (self): Pfizer; Honoraria (self): AstraZeneca; Honoraria (self): Eisai; Honoraria (self): Novartis; Honoraria (self): Celgene; Honoraria (self): Eli Lilly. F. Montemurro: Honoraria (self), speaker honoraria: AstraZeneca; Honoraria (self), speaker honoraria: Pfizer; Honoraria (self), speaker honoraria: Novartis; Honoraria (self), speaker honoraria: Eli Lilly; Honoraria (self), Travel / Accommodation / Expenses, speaker honoraria, travel grant: Roche. L. Del Mastro: Honoraria (self): AstraZeneca; Honoraria (self): Novartis; Honoraria (self): Ipsen; Honoraria (self): Roche-Genentech; Honoraria (self): Takeda; Honoraria (self): Eli Lilly. All other authors have declared no conflicts of interest.

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