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Poster Discussion - Breast cancer, early stage

4042 - Utility of the CPS+EG scoring system in triple-negative breast cancer treated with neoadjuvant chemotherapy

Date

28 Sep 2019

Session

Poster Discussion - Breast cancer, early stage

Presenters

Frederik Marmé

Citation

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

Authors

F. Marmé1, C. Solbach2, L. Michel3, P.A. Fasching4, A. Schneeweiss5, J. Blohmer6, M. Rezai7, J. Huober8, C. Jackisch9, V. Nekljudova10, T. Link11, K. Rhiem12, C. Denkert13, C. Hanusch14, H. Tesch15, B. Lederer10, S. Loibl16, M. Untch17

Author affiliations

  • 1 Gynecologic Oncology, University Hospital Mannheim, 68167 - Mannheim/DE
  • 2 Klinik Für Frauenheilkunde Und Geburtshilfe, Universitätsklinik Frankfurt, Frankfurt/DE
  • 3 Frauenheilkunde Und Geburtshilfe, Universitätsklinikum Heidelberg, 69120 - Heidelberg/DE
  • 4 Gynecology And Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen/DE
  • 5 Gynecologic Oncology, Nationales Centrum für Tumorerkrankungen Heidelberg, 69115 - Heidelberg/DE
  • 6 Gynäkologie Mit Brustzentrum, Charité-Universitätsmedizin, Berlin, 10113 - Berlin/DE
  • 7 Europäisches Brustzentrum, Luisenkrankenhaus, 40235 - Düsseldorf/DE
  • 8 Dept Of Gynecology, Breast Center, Universitaetsfrauenklinik Ulm, 89075 - Ulm/DE
  • 9 Oncology Department, Sana Klinikum, 63069 - Offenbach/DE
  • 10 Medicine & Research, German Breast Group (GBG) Forschungs GmbH, 63263 - Neu-Isenburg/DE
  • 11 Frauenheilkunde Und Geburtshilfe, Universitätsklinikum Dresden, Dresden/DE
  • 12 Zentrum Familiärer Brust- Und Eierstockkrebs, Uniklinik Köln, 50931 - Köln/DE
  • 13 Institut Für Pathologie Ukgm, Universitätsklinikum Marburg, 35037 - Marburg/DE
  • 14 Gynäkologie Und Geburtshilfe, Klinikum zum Roten Kreuz München, Germany, 80634 - München/DE
  • 15 Centrum Für Hämatologie Und Onkologie, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, 60389 - Frankfurt am Main/DE
  • 16 Department Of Medicine And Research, German Breast Group (GBG) Forschungs GmbH, 63263 - Neu-Isenburg/DE
  • 17 Clinic For Gynecology, Gynecologic Oncology And Obstetrics, Helios Klinikum Berlin Buch, 13125 - Berlin/DE

Resources

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Abstract 4042

Background

Pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) is associated with superior disease free (DFS) and overall survival (OS). This association is strongest in triple-negative breast cancer (TNBC). The CPS+EG system, based on pre-treatment clinical (CS) and post-treatment pathologic stage (PS), grade and estrogen receptor status, leads to a refined estimate of prognosis after NACT in all comers and HR+/HER2- (Marmé et al Eur J Cancer 2016). Here we investigate if CPS+EG scoring provides a superior estimate of prognosis in TNBC after NACT to select patients (pts) for post-neoadjuvant therapy.

Methods

We calculated the CPS+EG score for 1795 pts with TNBC from 9 prospective German trials. Pts with missing variables were excluded. 5-year DFS estimates were calculated using the Kaplan Meier method.

Results

Pts who achieved a pCR had a 5-year DFS of 86% (n = 822, 45.8%), whereas pts with residual stage I had a 5-yr DFS of 77.5% (n = 383; 21.3%). CPS+EG score was unable to identify non-pCR pts with a sufficiently good prognosis, to avoid post neoadjuvant therapy. The best prognostic CPS+EG groups (score 1/2) in non-pCR pts had a 5-year DFS of 77.5% and 74.4%, respectively (n = 362; 37.2%). CPS+EG identified a small group (n = 26; 3.2%) at high risk of recurrence despite pCR, mainly based on initial stage (CS+EG score > 3; 5-year DFS 61.4%) that might benefit from additional treatment. However, prognosis of pts with a CPS+EG score of 3 (5-year DFS: 64%), could be further discriminated by pCR (5-year DFS: 83.9% vs 49.7%). Detailed results are presented in the Table.Table:

182PD

pathologic stage: All patientsCPS+EG: All patientsCPS+EG: non-pCR patientsCPS+EG: pCR patients
PS (N = 1795)5-year DFS rate*95% CIN%CPS-EG (N = 1795)5-year DFS rate*95% CIN%CPS-EG (N = 973)5-year DFS rate*95% CIN%CPS-EG (N = 822)5-year DFS rate*95% CIN%
00.860.840.8982245.800.000.000.000000.000.000.000000.000.000.0000
I0.780.730.8238321.310.830.770.8918910.510.780.680.87889.010.880.810.9510112.3
IIA0.490.430.5529216.320.840.810.8676142.420.740.690.8027428.220.890.860.9248759.2
IIB0.390.290.50895.030.640.590.6949727.730.500.440.5628929.730.840.780.8920825.3
IIIA0.240.150.331096.140.410.340.4725214.040.380.320.4522623.240.610.420.81263.2
IIIB0.190.020.36211.250.160.070.25714.050.160.070.25717.350.000.000.0000.0
IIIC0.120.040.20794.460.000.000.00251.460.000.000.00252.660.000.000.0000.0

Conclusions

pCR remains the strongest and most clinically useful prognostic factor after NACT in TNBC. The CPS-EG score does not add additional information beyond pCR and ypT/N staging in TNBC patients. Other factors than those used beyond staging might be needed in TNBC.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

GBG.

Funding

Has not received any funding.

Disclosure

F. Marmé: Honoraria (self): Roche; Honoraria (self): AstraZeneca; Honoraria (self): Pfizer; Honoraria (self): Tesaro; Honoraria (self): Novartis; Honoraria (self): Amgen; Honoraria (self): PharmaMar; Honoraria (self): GenomicHealth; Honoraria (self): CureVac; Honoraria (self): EISAI; Honoraria (self): Clovis; Honoraria (self): Celgene. P.A. Fasching: Research grant / Funding (institution): Novartis; Research grant / Funding (institution): BionTech; Honoraria (self): Novartis; Honoraria (self): Roche; Honoraria (self): Pfizer; Honoraria (self): Celgene; Honoraria (self): Daiichi-Sankyo; Honoraria (self): TEVA; Honoraria (self): AstraZeneca; Honoraria (self): Merck Sharp & Dohme; Honoraria (self): Myelo Therapeutics; Honoraria (self): Macrogenics; Honoraria (self): Eisai; Honoraria (self): Puma; Research grant / Funding (institution): Cepheid. A. Schneeweiss: Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Celgene; Honoraria (self), Speaker Bureau / Expert testimony, Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Research grant / Funding (institution): AbbVie; Research grant / Funding (institution): Molecular Partner; Honoraria (self): Novartis; Honoraria (self), Speaker Bureau / Expert testimony: AstraZeneca; Honoraria (self): MSD; Honoraria (self): Tesaro; Honoraria (self): Lilly; Honoraria (self), Travel / Accommodation / Expenses: Pfizer. J. Blohmer: Honoraria (self): Amgen; Honoraria (self): AstraZeneca; Honoraria (self): Genomic Health; Honoraria (self): MSD Oncology; Honoraria (self): Myriad Genetics; Honoraria (self): Novratis/Pfizer; Honoraria (self): Pfizer; Honoraria (self): Rpche; Honoraria (self): Sonoscape. J. Huober: Honoraria (self), Travel / Accommodation / Expenses: Lilly; Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Novartis; Honoraria (self), Travel / Accommodation / Expenses: Roche; Honoraria (self), Travel / Accommodation / Expenses: Pfizer; Honoraria (self): Hexal; Honoraria (self): AstraZeneca; Honoraria (self): MSD; Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Celgene; Honoraria (self): Abbie. C. Jackisch: Travel / Accommodation / Expenses: Celgene; Honoraria (self): Roche. T. Link: Honoraria (self): Amgen; Non-remunerated activity/ies: AstraZeneca; Honoraria (self), Non-remunerated activity/ies: Pfizer; Non-remunerated activity/ies: PharmaMar; Non-remunerated activity/ies: Daiichi Sankyo; Honoraria (self): MSD; Honoraria (self): Novartis; Honoraria (self): Teva; Honoraria (self): Tesaro; Honoraria (self), Non-remunerated activity/ies: Roche. K. Rhiem: Honoraria (self): Tesaro; Honoraria (self): AstraZeneca; Honoraria (self): Pfizer. C. Denkert: Shareholder / Stockholder / Stock options: Sividon Diagnostics; Honoraria (self): Teva; Honoraria (self): Novartis; Honoraria (self): Pfizer; Honoraria (self): Roche; Honoraria (self), Advisory / Consultancy: Amgen; Advisory / Consultancy: MSD Oncology; Advisory / Consultancy: Daiichi Sankyo; Licensing / Royalties: VMScope digital pathology software; Licensing / Royalties: Patent application: EP18209672 - cancer immunotherapy; Licensing / Royalties: Patent application EP20150702464 - therapy response; Licensing / Royalties: Patent application EP20150702464 - therapy response. C. Hanusch: Honoraria (self): Roche; Honoraria (self): Pfizer; Honoraria (self): Novartis; Honoraria (self): Celgene; Honoraria (self): Lilly; Honoraria (self): AstraZeneca. H. Tesch: Honoraria (self): Vifor; Honoraria (self): Roche; Honoraria (self): Amgen. S. Loibl: Research grant / Funding (institution): Roche; Research grant / Funding (institution): Abbvie; Research grant / Funding (institution): Amgen; Research grant / Funding (institution): AstraZeneca; Research grant / Funding (institution): Celgene; Research grant / Funding (institution): Novartis; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): Roche; Research grant / Funding (institution): Seattle Genetics; Research grant / Funding (institution): Teva; Research grant / Funding (institution): Vifor; Research grant / Funding (institution): PRIME; Research grant / Funding (institution): Daiichi; Licensing / Royalties: EP14153692.0 pending. M. Untch: Honoraria (self), Non-remunerated activity/ies: Abbvie; Honoraria (self), Non-remunerated activity/ies: Amgen GmbH; Honoraria (self), Non-remunerated activity/ies: AstraZeneca; Honoraria (self), Non-remunerated activity/ies: Celgene GmbH; Honoraria (self): BMS; Honoraria (self), Non-remunerated activity/ies: Daiji Sankyo; Honoraria (self), Non-remunerated activity/ies: Eisai GmbH; Honoraria (self), Non-remunerated activity/ies: Janssen Cilag; Honoraria (self), Non-remunerated activity/ies: TEVA Pharmaceuticals Ind Ltd; Honoraria (self), Non-remunerated activity/ies: Sividon Diagnostics; Honoraria (self), Non-remunerated activity/ies: Lilly; Honoraria (self), Non-remunerated activity/ies: MSD Merck; Honoraria (self), Non-remunerated activity/ies: Mundipharma; Honoraria (self), Non-remunerated activity/ies: Myriad Genetics; Honoraria (self), Non-remunerated activity/ies: Odonate; Honoraria (self), Non-remunerated activity/ies: Pfizer GmbH; Honoraria (self): PUMA Biotechnology; Honoraria (self), Non-remunerated activity/ies: Novartis; Honoraria (self), Non-remunerated activity/ies: Roche Pharma AG; Honoraria (self), Non-remunerated activity/ies: Sanofi Aventis Deutschland GmbH. All other authors have declared no conflicts of interest.

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