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TP53 genomics predict higher clinical and pathologic tumor response in operable early-stage breast cancer treated with docetaxel-capecitabine ± trastuzumab

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Abstract

To determine rates of pathologic complete response (pCR) and near-complete response (npCR) in operable early-stage breast cancer using neoadjuvant capecitabine plus docetaxel, with or without trastuzumab, and investigate biomarkers of pathologic response. Women with operable early-stage breast cancer were enrolled in a multicenter study of neoadjuvant therapy for four 21-day cycles with capecitabine 825 mg/m2 plus docetaxel 75 mg/m2 if human epidermal growth factor receptor 2 (HER2)-negative, and additionally, a standard trastuzumab dose if HER2-positive. Primary endpoint was rate of pCR and npCR. Secondary endpoints were potential associations between response and TP53 mutational analysis using the AmpliChip TP53 assay or immunohistochemical (IHC) staining, and genomic subtyping using the PAM50 assay. In patients who completed treatment and surgery, pCR and npCR rates were 15.8% in patients with HER2-negative and 50% in patients with HER2-positive tumors. Stratified by genomic subtype, patients of HER2-enriched subtype had the best response (72.2%), and luminal A (9.1%) and B (4.8%) subtypes, the poorest. Of 147 patients tested for TP53 mutations using the AmpliChip assay, 78 variants were detected; 55 were missense. Response rate among TP53-mutated patients was 30%, significantly higher than TP53 wild-type patients (10%; P = 0.0032). Concordance between AmpliChip mutation status versus TP53 IHC staining was 65%, with AmpliChip status predictive of response and IHC status not predictive. Capecitabine plus docetaxel in HER2-negative, and with trastuzumab in HER2-positive patients, provided a good response rate with four cycles of non-anthracycline-containing therapy. TP53 mutational analysis and genomic subtyping were predictive.

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Acknowledgments

The XeNA study was sponsored by Roche, Nutley, NJ. The authors wish to thank H. Jeffrey Lawrence for help with study design, implementation, and writing; Debu Tripathy for help with design and initiation of the study; and Nancy Patten, Sim Truong, and Aarthi Balasubramanyan for help with implementation, statistical analysis, and writing. Editorial assistance was provided by Insight Medical Communications Inc., New York, NY, which was funded by Roche-Genentech.

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Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, 1475 NW 12th Ave., Suite 3510, Miami, FL, 33136, USA

    Stefan Glück & Eli Avisar

  2. Albany Medical Center, 43 New Scotland Avenue, Albany, NY, 12208, USA

    Jeffrey S. Ross

  3. University of New Mexico Cancer Research and Treatment Center, 7801 Academy, Albuquerque, NM, 87109, USA

    Melanie Royce

  4. Roche Inc., 340 Kingsland Street, Nutley, NJ, 07110, USA

    Edward F. McKenna Jr.

  5. Lineberger Comprehensive Cancer Center and University of North Carolina at Chapel Hill, CB 7295, Chapel Hill, NC, 27599, USA

    Charles M. Perou

  6. Roche Molecular Diagnostics, 4300 Hacienda Drive, Pleasanton, CA, 94588, USA

    Lin Wu

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  1. Stefan Glück
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Correspondence to Stefan Glück.

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Glück, S., Ross, J.S., Royce, M. et al. TP53 genomics predict higher clinical and pathologic tumor response in operable early-stage breast cancer treated with docetaxel-capecitabine ± trastuzumab. Breast Cancer Res Treat 132, 781–791 (2012). https://doi.org/10.1007/s10549-011-1412-7

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