1. Durable response to palbociclib and letrozole in ovarian cancer withCDKN2Aloss
- Author
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Sophie Clément, Pierre O. Chappuis, Alexandre Bodmer, Krisztian Homicsko, Yann Christinat, Melinda Charrier, Olivier Michielin, Petros Tsantoulis, Daniele Frisone, Thomas Alexander Mckee, and Laure Thouvenin
- Subjects
0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,endocrine system diseases ,ddc:616.07 ,Palbociclib ,03 medical and health sciences ,0302 clinical medicine ,Cyclin D1 ,CDKN2A ,Internal medicine ,Gene duplication ,medicine ,neoplasms ,ddc:616 ,Pharmacology ,Retinoblastoma ,business.industry ,Letrozole ,medicine.disease ,Antineoplastic Combined Chemotherapy Protocols/therapeutic use ,Biomarkers, Tumor/genetics ,Cyclin E/genetics ,Cyclin-Dependent Kinase Inhibitor p16/genetics ,Cystadenocarcinoma, Serous/drug therapy ,Cystadenocarcinoma, Serous/genetics ,Cystadenocarcinoma, Serous/pathology ,Female ,Gene Amplification ,Humans ,Letrozole/administration & dosage ,Middle Aged ,Neoplasm Recurrence, Local/drug therapy ,Neoplasm Recurrence, Local/genetics ,Neoplasm Recurrence, Local/pathology ,Oncogene Proteins/genetics ,Ovarian Neoplasms/drug therapy ,Ovarian Neoplasms/genetics ,Ovarian Neoplasms/pathology ,Piperazines/administration & dosage ,Prognosis ,Pyridines/administration & dosage ,Retinoblastoma Binding Proteins/genetics ,Sequence Deletion ,Ubiquitin-Protein Ligases/genetics ,CDK4/6 inhibitors ,CDKN2A loss ,Ovarian cancer ,palbociblib ,precision oncology ,030104 developmental biology ,030220 oncology & carcinogenesis ,Molecular Medicine ,Biomarker (medicine) ,business ,medicine.drug - Abstract
Alterations of the Retinoblastoma (Rb) pathway are frequent in ovarian cancer, typically resulting from CDKN2A down-regulation, CCNE1 amplification, CCND1/2 amplification, and RB1 loss. However, bi-allelic CDKN2A mutation or homozygous deletion is a very rare event, concerning less than 5% of patients.Initial trials with palbociclib in serous ovarian cancer have shown very modest benefit in unselected patient populations, thus underlining the need for a biomarker predicting response. We report the case of a heavily pre-treated patient with a serous ovarian tumor harboring a homozygous deletion of the CDKN2A gene that derived significant, prolonged clinical benefit from palbociclib, a CDK4/6 oral inhibitor, with letrozole. Treatment with palbociclib and letrozole started on February 2018, with an ongoing response after 12 months.In conclusion, homozygous CDKN2A deletion is rare and could be used to predict response to CDK4/6 inhibitors in association with other genomic features. We encourage further trials in this direction.
- Published
- 2019