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Correlative Analysis of Genetic Alterations and Everolimus Benefit in Hormone Receptor-Positive, HER2-Negative Advanced Breast Cancer: Results From BOLERO-2

Hortobagyi, Gabriel and Chen, David and Piccart, Martine and Rugo, Hope and Burris , Howard and Pritchard, Kathleen and Campone, Mario and Noguchi, Shinzaburo and Perez, Alejandra and Deleu, Ines and Shtivelband, Mikhail and Masuda, Norikazu and Dakhil, Shaker and Anderson, Ian and Robinson, Douglas and He, Wei and Garg, Abhishek and Mcdonald Iii, Earl and Derti, Adnan and Bitter, Hans and Huang, Alan and Taran, Tetiana and Bachelot, Thomas and Lebrun, Fabienne and Lebwohl, David and Baselga, Jose (2015) Correlative Analysis of Genetic Alterations and Everolimus Benefit in Hormone Receptor-Positive, HER2-Negative Advanced Breast Cancer: Results From BOLERO-2. Journal of Clinical Oncology, 34 (5). pp. 419-426. ISSN 0732-183X1527-7755

Abstract

Purpose
To explore the genetic landscape of tumors from patients enrolled in the BOLERO-2 trial to identify potential correlations between genetic alterations and efficacy of everolimus treatment. The BOLERO-2 trial has previously demonstrated that adding everolimus to exemestane prolonged progression-free survival (PFS) by greater than twofold in patients with hormone receptor-positive, human epidermal growth factor receptor-2–negative advanced breast cancer previously treated with nonsteroidal aromatase inhibitors.

Methods
Next-generation sequencing was used to analyze genetic status of cancer-related genes in 302 archival tumor specimens from patients representative of the BOLERO-2 study population. Correlations between the most common somatic alterations and degree of chromosomal instability, and treatment effect of everolimus were investigated.

Results
Progression-free survival benefit with everolimus was maintained regardless of alteration status of PIK3CA, CCND1, and TP53 genes or the pathways of which they are components. However, quantitative differences in everolimus benefit were observed between patient subgroups defined by the mutation locations in PIK3CA (exon 20 and other exons). In addition, the degree of chromosomal instability correlated with treatment efficacy in the everolimus arm.

Conclusion
The data suggest that adding everolimus to exemestane results in marked prolongation of PFS in postmenopausal women with hormone receptor-positive breast cancer whose tumors have limited chromosomal instabilities and abnormalities in potentially compensatory signaling pathways controlling growth/survival, cell-cycle progression, or DNA damage/repair. (Funded by Novartis; BOLERO-2 ClinicalTrials.gov number, NCT00863655.)

Item Type: Article
Keywords: Clinical trial, Biomarker, Next Generation Sequencing, Targeted Sequencing, Everolimus, ER+/HER2- Breast Cancer, Chromosomal instability, Signaling pathway
Date Deposited: 12 Oct 2016 00:45
Last Modified: 12 Oct 2016 00:45
URI: https://oak.novartis.com/id/eprint/24003

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