S. Pernas Simon (Hospitalet de Llobregat, Spain)

ICO - Institut Català d'Oncologia l'Hospitalet (Hospital Duran i Reynals)

Author Of 3 Presentations

 On-Demand ePoster Display

14P - Immunomodulatory effect of denosumab in early breast cancer: preliminary results of a randomized window-opportunity clinical trial D-Biomark (NCT03691311).

Abstract

Background

Most breast cancers (BC) exhibit low immune infiltration and are unresponsive to immunotherapy. Hence, the urgency to find new mechanisms of immune activation, postulating receptor activator of nuclear factor kappa-Β ligand (RANKL) and its receptor RANK as potential immunomodulator. Our previous data demonstrated that RANK pathway inhibitors, such as denosumab, used for the treatment of bone metastasis, could also prevent and/or treat BC and regulate the tumour immune crosstalk. However, the population of breast cancer patients who may benefit from denosumab remains to be identified.

Methods

Patients with early-stage HER2-negative BC, candidates to tumour excision as first therapeutic approach are included. Patients are randomized 2:1 to denosumab: control (no treatment); experimental arm received 2 doses of 120 mg subcutaneous denosumab (once per week) before surgery (2-4 weeks later). Putative changes in tumour cell proliferation by Ki67 immunohistochemistry (IHC), cell survival by cleaved caspase 3 IHC (primary endpoints) and stromal tumour infiltrating lymphocytes (TILs) quantified in the haematoxylin and eosin by between baseline (biopsy sample) and surgery are evaluated. Specific antibodies will be used to characterize infiltrating immune populations. Denosumab driven gene expression changes in tumour samples will be analysed and tools such as CIBERSORT will be used to characterize the immune infiltrate.

Results

We present results from the first 36 patients enrolled out of 60. Clinical and tumour characteristics were well balanced between the groups. No relevant toxicities were reported. No clinically significant differences in Ki67 and cleaved caspase-3 were observed after denosumab treatment. Interestingly, a statistically significant increase in TILs was observed in the denosumab treated group (p=0.03, Paired t test) but not in the control group (p=0.80). A 33% of patients treated denosumab showed a ≥10% increase in TILs vs 0% in the control group (p =0.05).

Conclusions

Short term neoadjuvant denosumab increases TILs in early BC.

Clinical trial identification

NCT03691311.

Legal entity responsible for the study

The authors.

Funding

Amgen Juan de la Cierva. Postdoctoral contract. IJCI-2017-31564 Río Hortega (CM19/00148) Instituto de Salud Carlos III / Ministerio de Ciencia, Innovación y Universidades. ERC-Consolidator grant PLEIO-RANK European Research Council.

Disclosure

All authors have declared no conflicts of interest.

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73TiP - SOLTI1710 PROMETEO II: Palbociclib in combination with letrozole in Hormone Receptor-positive (HR+)/HER2-negative residual disease after standard neoadjuvant chemotherapy (NAC)

Abstract

Background

The combination of cyclin-dependent kinase inhibitors (CDK4/6i) with first or second-line endocrine therapy are the standard of care for HR+/HER2-negative metastatic breast cancer (BC); its role in the early-setting is being evaluated in several studies with discordant results. In HR+/HER2-negative BC, pathologic complete response (pCR) rates after NAC are around 15%. Additional therapeutic strategies to eradicate these residual tumor cells are needed. To characterize the biological effect of CDK4/6i in residual disease (RD) after NAC, could help to better understand their role in early BC.

Trial design

SOLTI-1710 PROMETEO II is an open-label, multicenter window of opportunity trial of Palbociclib and letrozole tested in patients with HR+/HER-negative RD after completing anthracycline/taxane-based NAC. PROMETEO II will include 22 patients. Invasive RD must be confirmed by core-biopsy and have a diameter ≥ 10mm measured by ultrasound. Adequate organ function and ECOG PS 0-1 are required. A short course of Palbociclib is administered at a dose of 125 mg/day for 21 days and letrozole 2.5 mg/day continuously until surgery. BC surgery is carried out 1 week after the last dose of palbociclib. The primary objective of the trial is to evaluate the antitumor activity by the Complete Cell Cycle Arrest (CCCA) rate determined by Ki67 ≤2.7%, centrally assessed at surgery. Secondary endpoints include pCR rate, RCB and safety. To date, 12 patients have been included at 8 sites in Spain.

Clinical trial identification

NCT04130152.

Legal entity responsible for the study

SOLTI.

Funding

Pfizer.

Disclosure

E. Ciruelos: Advisory/Consultancy, Non-remunerated activity/ies: Pfizer; Advisory/Consultancy: Roche; Advisory/Consultancy: Lilly; Advisory/Consultancy: AstraZeneca; Advisory/Consultancy: Novartis; Advisory/Consultancy: MSD. X. González-Farré: Advisory/Consultancy: SOLTI Breast Cancer Group; Advisory/Consultancy, Non-remunerated activity/ies: Roche; Advisory/Consultancy: Eisai. P. Villagrasa: Honoraria (self): NanoString. A. Prat: Honoraria (self), Advisory/Consultancy: Pfizer; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Roche; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Novartis; Honoraria (self), Advisory/Consultancy: MSD Oncology; Honoraria (self), Advisory/Consultancy: Lilly; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Daiichi Sankyo; Research grant/Funding (self): NanoString Technologies; Advisory/Consultancy: Oncolytics Biotech; Advisory/Consultancy: Amgen; Advisory/Consultancy: PUMA. S. Pernas Simon: Advisory/Consultancy, Travel/Accommodation/Expenses: Novartis; Advisory/Consultancy: AstraZeneca; Advisory/Consultancy: Daiichi Sankyo; Advisory/Consultancy: Polyphor; Advisory/Consultancy: Seattle Genetics; Advisory/Consultancy: Roche. All other authors have declared no conflicts of interest.

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130TiP - SOLTI-1303 PATRICIA II randomized phase II trial of palbociclib plus trastuzumab and endocrine therapy (ET) versus treatment of physician's choice (TPC) in metastatic HER2-positive and hormone receptor-positive (HER2+/HR+) breast cancer (BC) with PAM50 luminal intrinsic subtype

Abstract

Background

PATRICIA phase II trial showed that Palbociclib in combination with trastuzumab is safe and exhibits promising survival outcomes in trastuzumab pretreated HER2+/HR+ advanced breast cancer with a PAM50 Luminal A or B subtype (Ciruelos E. et al, CCR 2020). Based on these results, PATRICIA II was designed to include only patients with HER2+/HR+, PAM50 Luminal A/B tumors to receive palbociclib, trastuzumab and ET versus treatment of physician’s choice (TPC).

Trial design

PATRICIA II is a randomized open-label, adaptive design, phase II study. Patients must have centrally confirmed HER2+/HR+ and PAM50 Luminal A or B tumors and have received at least 1 (and no more than 4) prior lines of anti-HER2 regimens for locally advanced or metastatic BC. Patients are randomized 1:1 to receive trastuzumab plus palbociclib at a standard dose of 125 mg/day orally 3 weeks on/ 1 week off and ET (Cohort C1) or TPC (cohort C2). ET options in cohort 1 are either an aromatase inhibitor, fulvestrant or tamoxifen +/- ovarian suppression. TPC options in cohort C2 are T-DM1 or chemotherapy (gemcitabine, vinorelbine, capecitabine, eribulin, paclitaxel or docetaxel) plus trastuzumab. Stratification factors include number of previous regimens for advanced or metastatic BC (1-2 vs 3-4) and the presence of visceral disease (yes vs no). Primary endpoint is to compare the progression-free survival between two arms. The study has an 80% power with two-sided alpha=0.05 to detect a HR of 0.62 in favor of the palbociclib cohort. Secondary endpoints include response rate, overall survival, safety, and quality of life. Tumor tissue and blood samples will be collected for biomarker analyses. An estimated total of 516 patients will be screened to include 232 patients with HER2+/HR+ PAM50 Luminal A or B tumors. The recruitment is ongoing in 20 sites in Spain and as of February 3rd, 2021, 107 patients were screened and 30 were enrolled in the trial.

Clinical trial identification

NCT02448420.

Legal entity responsible for the study

SOLTI.

Funding

Pfizer.

Disclosure

E.M. Ciruelos: Advisory/Consultancy, Non-remunerated activity/ies: Pfizer; Advisory/Consultancy: Roche; Advisory/Consultancy: Lilly; Advisory/Consultancy: AstraZeneca; Advisory/Consultancy: Novartis; Advisory/Consultancy: MSD. S. Pernas Simon: Advisory/Consultancy, Travel/Accommodation/Expenses: Novartis; Advisory/Consultancy: AstraZeneca; Advisory/Consultancy: Daiichi Sankyo; Advisory/Consultancy: Polyphor; Advisory/Consultancy: Seattle Genetics; Advisory/Consultancy: Roche. M. Oliveira: Advisory/Consultancy, Research grant/Funding (institution): AstraZeneca; Research grant/Funding (institution): Philips Healthcare; Advisory/Consultancy, Research grant/Funding (institution): Genentech; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche; Research grant/Funding (institution): Immunomedics; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Seattle Genetics; Advisory/Consultancy, Research grant/Funding (institution): GSK; Research grant/Funding (institution): Boehringer Ingelheim; Research grant/Funding (institution): Puma Biotechnology; Research grant/Funding (institution): Zenith Epigenetics; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Novartis; Advisory/Consultancy: Puma Biotechnology; Travel/Accommodation/Expenses: Pierre Fabre; Travel/Accommodation/Expenses: Eisai. B. Bermejo De Las Heras: Advisory/Consultancy, Travel/Accommodation/Expenses: Roche; Advisory/Consultancy: Palex; Advisory/Consultancy: MSD; Advisory/Consultancy: Novartis; Advisory/Consultancy: Pfizer. X. González-Farré: Advisory/Consultancy: SOLTI Breast Cancer Group; Advisory/Consultancy, Non-remunerated activity/ies: Roche; Advisory/Consultancy: Eisai. P. Villagrasa: Honoraria (self): NanoString. A. Prat: Honoraria (self), Advisory/Consultancy: Pfizer; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Novartis; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Roche; Honoraria (self), Advisory/Consultancy: MSD Oncology; Honoraria (self), Advisory/Consultancy: Lilly; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Daiichi Sankyo; Advisory/Consultancy, Research grant/Funding (self): NanoString Technologies; Advisory/Consultancy: Oncolytics Biotech; Advisory/Consultancy: Amgen; Advisory/Consultancy: Puma. All other authors have declared no conflicts of interest.

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