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1. Multi-omic machine learning predictor of breast cancer therapy response

Author: Sammut, S-J, Crispin-Ortuzar, M, Chin, S-F, Provenzano, E, Bardwell, HA, Ma, W, Cope, W, Dariush, A, Dawson, S-J, Abraham, JE, Dunn, J, Hiller, L, Thomas, J, Cameron, DA, Bartlett, JMS, Hayward, L, Pharoah, PD, Markowetz, F, Rueda, OM, Earl, HM, Caldas, C, Sammut, S-J, Crispin-Ortuzar, M, Chin, S-F, Provenzano, E, Bardwell, HA, Ma, W, Cope, W, Dariush, A, Dawson, S-J, Abraham, JE, Dunn, J, Hiller, L, Thomas, J, Cameron, DA, Bartlett, JMS, Hayward, L, Pharoah, PD, Markowetz, F, Rueda, OM, Earl, HM, and Caldas, C
Abstract: Breast cancers are complex ecosystems of malignant cells and the tumour microenvironment1. The composition of these tumour ecosystems and interactions within them contribute to responses to cytotoxic therapy2. Efforts to build response predictors have not incorporated this knowledge. We collected clinical, digital pathology, genomic and transcriptomic profiles of pre-treatment biopsies of breast tumours from 168 patients treated with chemotherapy with or without HER2 (encoded by ERBB2)-targeted therapy before surgery. Pathology end points (complete response or residual disease) at surgery3 were then correlated with multi-omic features in these diagnostic biopsies. Here we show that response to treatment is modulated by the pre-treated tumour ecosystem, and its multi-omics landscape can be integrated in predictive models using machine learning. The degree of residual disease following therapy is monotonically associated with pre-therapy features, including tumour mutational and copy number landscapes, tumour proliferation, immune infiltration and T cell dysfunction and exclusion. Combining these features into a multi-omic machine learning model predicted a pathological complete response in an external validation cohort (75 patients) with an area under the curve of 0.87. In conclusion, response to therapy is determined by the baseline characteristics of the totality of the tumour ecosystem captured through data integration and machine learning. This approach could be used to develop predictors for other cancers.
Published: 2022

2. A network analysis to identify mediators of germline-driven differences in breast cancer prognosis

Author: Escala-Garcia, M, Abraham, J, Andrulis, IL, Anton-Culver, H, Arndt, V, Ashworth, A, Auer, PL, Auvinen, P, Beckmann, MW, Beesley, J, Behrens, S, Benitez, J, Bermisheva, M, Blomqvist, C, Blot, W, Bogdanova, NV, Bojesen, SE, Bolla, MK, Borresen-Dale, A-L, Brauch, H, Brenner, H, Brucker, SY, Burwinkel, B, Caldas, C, Canzian, F, Chang-Claude, J, Chanock, SJ, Chin, S-F, Clarke, CL, Couch, FJ, Cox, A, Cross, SS, Czene, K, Daly, MB, Dennis, J, Devilee, P, Dunn, JA, Dunning, AM, Dwek, M, Earl, HM, Eccles, DM, Eliassen, AH, Ellberg, C, Evans, DG, Fasching, PA, Figueroa, J, Flyger, H, Gago-Dominguez, M, Gapstur, SM, Garcia-Closas, M, Garcia-Saenz, JA, Gaudet, MM, George, A, Giles, GG, Goldgar, DE, Gonzalez-Neira, A, Grip, M, Guenel, P, Guo, Q, Haiman, CA, Hakansson, N, Hamann, U, Harrington, PA, Hiller, L, Hooning, MJ, Hopper, JL, Howell, A, Huang, C-S, Huang, G, Hunter, DJ, Jakubowska, A, John, EM, Kaaks, R, Kapoor, PM, Keeman, R, Kitahara, CM, Koppert, LB, Kraft, P, Kristensen, VN, Lambrechts, D, Le Marchand, L, Lejbkowicz, F, Lindblom, A, Lubinski, J, Mannermaa, A, Manoochehri, M, Manoukian, S, Margolin, S, Martinez, ME, Maurer, T, Mavroudis, D, Meindl, A, Milne, RL, Mulligan, AM, Neuhausen, SL, Nevanlinna, H, Newman, WG, Olshan, AF, Olson, JE, Olsson, H, Orr, N, Peterlongo, P, Petridis, C, Prentice, RL, Presneau, N, Punie, K, Ramachandran, D, Rennert, G, Romero, A, Sachchithananthan, M, Saloustros, E, Sawyer, EJ, Schmutzler, RK, Schwentner, L, Scott, C, Simard, J, Sohn, C, Southey, MC, Swerdlow, AJ, Tamimi, RM, Tapper, WJ, Teixeira, MR, Terry, MB, Thorne, H, Tollenaar, RAEM, Tomlinson, I, Troester, MA, Truong, T, Turnbull, C, Vachon, CM, van der Kolk, LE, Wang, Q, Winqvist, R, Wolk, A, Yang, XR, Ziogas, A, Pharoah, PDP, Hall, P, Wessels, LFA, Chenevix-Trench, G, Bader, GD, Doerk, T, Easton, DF, Canisius, S, Schmidt, MK, Escala-Garcia, M, Abraham, J, Andrulis, IL, Anton-Culver, H, Arndt, V, Ashworth, A, Auer, PL, Auvinen, P, Beckmann, MW, Beesley, J, Behrens, S, Benitez, J, Bermisheva, M, Blomqvist, C, Blot, W, Bogdanova, NV, Bojesen, SE, Bolla, MK, Borresen-Dale, A-L, Brauch, H, Brenner, H, Brucker, SY, Burwinkel, B, Caldas, C, Canzian, F, Chang-Claude, J, Chanock, SJ, Chin, S-F, Clarke, CL, Couch, FJ, Cox, A, Cross, SS, Czene, K, Daly, MB, Dennis, J, Devilee, P, Dunn, JA, Dunning, AM, Dwek, M, Earl, HM, Eccles, DM, Eliassen, AH, Ellberg, C, Evans, DG, Fasching, PA, Figueroa, J, Flyger, H, Gago-Dominguez, M, Gapstur, SM, Garcia-Closas, M, Garcia-Saenz, JA, Gaudet, MM, George, A, Giles, GG, Goldgar, DE, Gonzalez-Neira, A, Grip, M, Guenel, P, Guo, Q, Haiman, CA, Hakansson, N, Hamann, U, Harrington, PA, Hiller, L, Hooning, MJ, Hopper, JL, Howell, A, Huang, C-S, Huang, G, Hunter, DJ, Jakubowska, A, John, EM, Kaaks, R, Kapoor, PM, Keeman, R, Kitahara, CM, Koppert, LB, Kraft, P, Kristensen, VN, Lambrechts, D, Le Marchand, L, Lejbkowicz, F, Lindblom, A, Lubinski, J, Mannermaa, A, Manoochehri, M, Manoukian, S, Margolin, S, Martinez, ME, Maurer, T, Mavroudis, D, Meindl, A, Milne, RL, Mulligan, AM, Neuhausen, SL, Nevanlinna, H, Newman, WG, Olshan, AF, Olson, JE, Olsson, H, Orr, N, Peterlongo, P, Petridis, C, Prentice, RL, Presneau, N, Punie, K, Ramachandran, D, Rennert, G, Romero, A, Sachchithananthan, M, Saloustros, E, Sawyer, EJ, Schmutzler, RK, Schwentner, L, Scott, C, Simard, J, Sohn, C, Southey, MC, Swerdlow, AJ, Tamimi, RM, Tapper, WJ, Teixeira, MR, Terry, MB, Thorne, H, Tollenaar, RAEM, Tomlinson, I, Troester, MA, Truong, T, Turnbull, C, Vachon, CM, van der Kolk, LE, Wang, Q, Winqvist, R, Wolk, A, Yang, XR, Ziogas, A, Pharoah, PDP, Hall, P, Wessels, LFA, Chenevix-Trench, G, Bader, GD, Doerk, T, Easton, DF, Canisius, S, and Schmidt, MK
Abstract: Identifying the underlying genetic drivers of the heritability of breast cancer prognosis remains elusive. We adapt a network-based approach to handle underpowered complex datasets to provide new insights into the potential function of germline variants in breast cancer prognosis. This network-based analysis studies ~7.3 million variants in 84,457 breast cancer patients in relation to breast cancer survival and confirms the results on 12,381 independent patients. Aggregating the prognostic effects of genetic variants across multiple genes, we identify four gene modules associated with survival in estrogen receptor (ER)-negative and one in ER-positive disease. The modules show biological enrichment for cancer-related processes such as G-alpha signaling, circadian clock, angiogenesis, and Rho-GTPases in apoptosis.
Published: 2020

3. Genome-wide association study of germline variants and breast cancer-specific mortality

Author: Escala-Garcia, M, Guo, Q, Doerk, T, Canisius, S, Keeman, R, Dennis, J, Beesley, J, Lecarpentier, J, Bolla, MK, Wang, Q, Abraham, J, Andrulis, IL, Anton-Culver, H, Arndt, V, Auer, PL, Beckmann, MW, Behrens, S, Benitez, J, Bermisheva, M, Bernstein, L, Blomqvist, C, Boeckx, B, Bojesen, SE, Bonanni, B, Borresen-Dale, A-L, Brauch, H, Brenner, H, Brentnall, A, Brinton, L, Broberg, P, Brock, IW, Brucker, SY, Burwinkel, B, Caldas, C, Caldes, T, Campa, D, Canzian, F, Carracedo, A, Carter, BD, Castelao, JE, Chang-Claude, J, Chanock, SJ, Chenevix-Trench, G, Cheng, T-YD, Chin, S-F, Clarke, CL, Cordina-Duverger, E, Couch, FJ, Cox, DG, Cox, A, Cross, SS, Czene, K, Daly, MB, Devilee, P, Dunn, JA, Dunning, AM, Durcan, L, Dwek, M, Earl, HM, Ekici, AB, Eliassen, AH, Ellberg, C, Engel, C, Eriksson, M, Evans, DG, Figueroa, J, Flesch-Janys, D, Flyger, H, Gabrielson, M, Gago-Dominguez, M, Galle, E, Gapstur, SM, Garcia-Closas, M, Garcia-Saenz, JA, Gaudet, MM, George, A, Georgoulias, V, Giles, GG, Glendon, G, Goldgar, DE, Gonzalez-Neira, A, Alnaes, GIG, Grip, M, Guenel, P, Haeberle, L, Hahnen, E, Haiman, CA, Hakansson, N, Hall, P, Hamann, U, Hankinson, S, Harkness, EF, Harrington, PA, Hart, SN, Hartikainen, JM, Hein, A, Hillemanns, P, Hiller, L, Holleczek, B, Hollestelle, A, Hooning, MJ, Hoover, RN, Hopper, JL, Howell, A, Huang, G, Humphreys, K, Hunter, DJ, Janni, W, John, EM, Jones, ME, Jukkola-Vuorinen, A, Jung, A, Kaaks, R, Kabisch, M, Kaczmarek, K, Kerin, MJ, Khan, S, Khusnutdinova, E, Kiiski, J, Kitahara, CM, Knight, JA, Ko, Y-D, Koppert, LB, Kosma, V-M, Kraft, P, Kristensen, VN, Kruger, U, Kuehl, T, Lambrechts, D, Le Marchand, L, Lee, E, Lejbkowicz, F, Li, L, Lindblom, A, Lindstrom, S, Linet, M, Lissowska, J, Lo, W-Y, Loibl, S, Lubinski, J, Lux, MP, MacInnis, RJ, Maierthaler, M, Maishman, T, Makalic, E, Mannermaa, A, Manoochehri, M, Manoukian, S, Margolin, S, Martinez, ME, Mavroudis, D, McLean, C, Meindl, A, Middha, P, Miller, N, Milne, RL, Moreno, F, Mulligan, AM, Mulot, C, Nassir, R, Neuhausen, SL, Newman, WT, Nielsen, SF, Nordestgaard, BG, Norman, A, Olsson, H, Orr, N, Pankratz, VS, Park-Simon, T-W, Perez, JIA, Perez-Barrios, C, Peterlongo, P, Petridis, C, Pinchev, M, Prajzendanc, K, Prentice, R, Presneau, N, Prokofieva, D, Pylkas, K, Rack, B, Radice, P, Ramachandran, D, Rennert, G, Rennert, HS, Rhenius, V, Romero, A, Roylance, R, Saloustros, E, Sawyer, EJ, Schmidt, DF, Schmutzler, RK, Schneeweiss, A, Schoemaker, MJ, Schumacher, F, Schwentner, L, Scott, RJ, Scott, C, Seynaeve, C, Shah, M, Simard, J, Smeets, A, Sohn, C, Southey, MC, Swerdlow, AJ, Talhouk, A, Tamimi, RM, Tapper, WJ, Teixeira, MR, Tengstrom, M, Terry, MB, Thoene, K, Tollenaar, RAEM, Tomlinson, I, Torres, D, Truong, T, Turman, C, Turnbull, C, Ulmer, H-U, Untch, M, Vachon, C, van Asperen, CJ, van den Ouweland, AMW, van Veen, EM, Wendt, C, Whittemore, AS, Willett, W, Winqvist, R, Wolk, A, Yang, XR, Zhang, Y, Easton, DF, Fasching, PA, Nevanlinna, H, Eccles, DM, Pharoah, PDP, Schmidt, MK, Escala-Garcia, M, Guo, Q, Doerk, T, Canisius, S, Keeman, R, Dennis, J, Beesley, J, Lecarpentier, J, Bolla, MK, Wang, Q, Abraham, J, Andrulis, IL, Anton-Culver, H, Arndt, V, Auer, PL, Beckmann, MW, Behrens, S, Benitez, J, Bermisheva, M, Bernstein, L, Blomqvist, C, Boeckx, B, Bojesen, SE, Bonanni, B, Borresen-Dale, A-L, Brauch, H, Brenner, H, Brentnall, A, Brinton, L, Broberg, P, Brock, IW, Brucker, SY, Burwinkel, B, Caldas, C, Caldes, T, Campa, D, Canzian, F, Carracedo, A, Carter, BD, Castelao, JE, Chang-Claude, J, Chanock, SJ, Chenevix-Trench, G, Cheng, T-YD, Chin, S-F, Clarke, CL, Cordina-Duverger, E, Couch, FJ, Cox, DG, Cox, A, Cross, SS, Czene, K, Daly, MB, Devilee, P, Dunn, JA, Dunning, AM, Durcan, L, Dwek, M, Earl, HM, Ekici, AB, Eliassen, AH, Ellberg, C, Engel, C, Eriksson, M, Evans, DG, Figueroa, J, Flesch-Janys, D, Flyger, H, Gabrielson, M, Gago-Dominguez, M, Galle, E, Gapstur, SM, Garcia-Closas, M, Garcia-Saenz, JA, Gaudet, MM, George, A, Georgoulias, V, Giles, GG, Glendon, G, Goldgar, DE, Gonzalez-Neira, A, Alnaes, GIG, Grip, M, Guenel, P, Haeberle, L, Hahnen, E, Haiman, CA, Hakansson, N, Hall, P, Hamann, U, Hankinson, S, Harkness, EF, Harrington, PA, Hart, SN, Hartikainen, JM, Hein, A, Hillemanns, P, Hiller, L, Holleczek, B, Hollestelle, A, Hooning, MJ, Hoover, RN, Hopper, JL, Howell, A, Huang, G, Humphreys, K, Hunter, DJ, Janni, W, John, EM, Jones, ME, Jukkola-Vuorinen, A, Jung, A, Kaaks, R, Kabisch, M, Kaczmarek, K, Kerin, MJ, Khan, S, Khusnutdinova, E, Kiiski, J, Kitahara, CM, Knight, JA, Ko, Y-D, Koppert, LB, Kosma, V-M, Kraft, P, Kristensen, VN, Kruger, U, Kuehl, T, Lambrechts, D, Le Marchand, L, Lee, E, Lejbkowicz, F, Li, L, Lindblom, A, Lindstrom, S, Linet, M, Lissowska, J, Lo, W-Y, Loibl, S, Lubinski, J, Lux, MP, MacInnis, RJ, Maierthaler, M, Maishman, T, Makalic, E, Mannermaa, A, Manoochehri, M, Manoukian, S, Margolin, S, Martinez, ME, Mavroudis, D, McLean, C, Meindl, A, Middha, P, Miller, N, Milne, RL, Moreno, F, Mulligan, AM, Mulot, C, Nassir, R, Neuhausen, SL, Newman, WT, Nielsen, SF, Nordestgaard, BG, Norman, A, Olsson, H, Orr, N, Pankratz, VS, Park-Simon, T-W, Perez, JIA, Perez-Barrios, C, Peterlongo, P, Petridis, C, Pinchev, M, Prajzendanc, K, Prentice, R, Presneau, N, Prokofieva, D, Pylkas, K, Rack, B, Radice, P, Ramachandran, D, Rennert, G, Rennert, HS, Rhenius, V, Romero, A, Roylance, R, Saloustros, E, Sawyer, EJ, Schmidt, DF, Schmutzler, RK, Schneeweiss, A, Schoemaker, MJ, Schumacher, F, Schwentner, L, Scott, RJ, Scott, C, Seynaeve, C, Shah, M, Simard, J, Smeets, A, Sohn, C, Southey, MC, Swerdlow, AJ, Talhouk, A, Tamimi, RM, Tapper, WJ, Teixeira, MR, Tengstrom, M, Terry, MB, Thoene, K, Tollenaar, RAEM, Tomlinson, I, Torres, D, Truong, T, Turman, C, Turnbull, C, Ulmer, H-U, Untch, M, Vachon, C, van Asperen, CJ, van den Ouweland, AMW, van Veen, EM, Wendt, C, Whittemore, AS, Willett, W, Winqvist, R, Wolk, A, Yang, XR, Zhang, Y, Easton, DF, Fasching, PA, Nevanlinna, H, Eccles, DM, Pharoah, PDP, and Schmidt, MK
Abstract: BACKGROUND: We examined the associations between germline variants and breast cancer mortality using a large meta-analysis of women of European ancestry. METHODS: Meta-analyses included summary estimates based on Cox models of twelve datasets using ~10.4 million variants for 96,661 women with breast cancer and 7697 events (breast cancer-specific deaths). Oestrogen receptor (ER)-specific analyses were based on 64,171 ER-positive (4116) and 16,172 ER-negative (2125) patients. We evaluated the probability of a signal to be a true positive using the Bayesian false discovery probability (BFDP). RESULTS: We did not find any variant associated with breast cancer-specific mortality at P < 5 × 10-8. For ER-positive disease, the most significantly associated variant was chr7:rs4717568 (BFDP = 7%, P = 1.28 × 10-7, hazard ratio [HR] = 0.88, 95% confidence interval [CI] = 0.84-0.92); the closest gene is AUTS2. For ER-negative disease, the most significant variant was chr7:rs67918676 (BFDP = 11%, P = 1.38 × 10-7, HR = 1.27, 95% CI = 1.16-1.39); located within a long intergenic non-coding RNA gene (AC004009.3), close to the HOXA gene cluster. CONCLUSIONS: We uncovered germline variants on chromosome 7 at BFDP < 15% close to genes for which there is biological evidence related to breast cancer outcome. However, the paucity of variants associated with mortality at genome-wide significance underpins the challenge in providing genetic-based individualised prognostic information for breast cancer patients.
Published: 2019

4. Chemotherapy for ovarian cancer - a consensus statement on standard practice

Author: Adams, M, Calvert, AH, Carmichael, J, Clark, PI, Coleman, RE, Earl, HM, Gallagher, CJ, Ganesan, TS, Gore, ME, Graham, JD, Harper, PG, Jayson, GC, Kaye, SB, Ledermann, JA, Osborne, RJ, Perren, TJ, Poole, CJ, Radford, JA, Rustin, GJS, Slevin, ML, Smyth, JF, Thomas, H, and Wilkinson, PM
Published: 1998
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5. Abstract OT3-01-02: PARTNERING / PARTNER : Phase II sub-study to establish if the addition of combinations of new agents (olaparib, cell cycle and immune checkpoint inhibitors) can improve the rate of pathological complete response (pCR) and minimal residual disease (MRD) in triple negative breast cancer (TNBC) and / or germline BRCA mutated (gBRCAm) patients with evidence of residual disease after PARTNER therapy

Author: Abraham, JE, primary, Vallier, A-L, additional, Qian, W, additional, Machin, A, additional, Grybowicz, L, additional, Thomas, S, additional, Weiss, M, additional, Harvey, C, additional, McAdam, K, additional, Hughes-Davies, L, additional, Roberts, A, additional, Provenzano, E, additional, Pinilla, K, additional, Roylance, R, additional, Copson, E, additional, Armstrong, A, additional, McMurtry, E, additional, Tischkowitz, M, additional, and Earl, HM, additional
Published: 2019
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6. Abstract OT1-05-02: OPTIMA: A prospective randomized trial to validate the clinical utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in high clinical risk early breast cancer

Author: Stein, RC, primary, Hughes-Davies, L, additional, Makris, A, additional, Macpherson, IR, additional, Conefrey, C, additional, Rooshenas, L, additional, Pinder, SE, additional, Thomas, J, additional, Hall, PS, additional, Cameron, DA, additional, Earl, HM, additional, Naume, B, additional, Poole, CJ, additional, Rea, DW, additional, MacIntosh, SA, additional, Harmer, V, additional, Morgan, A, additional, Hulme, C, additional, McCabe, C, additional, Stallard, N, additional, Higgins, H, additional, Donovan, JL, additional, Bartlett, JM, additional, Marshall, A, additional, and Dunn, JA, additional
Published: 2019
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7. Disease-free and overall survival at 3.5 years for neoadjuvant bevacizumab added to docetaxel followed by fluorouracil, epirubicin and cyclophosphamide, for women with HER2 negative early breast cancer: ARTemis Trial

Author: Earl, HM, Hiller, L, Dunn, J, Blenkinsop, C, Grybowicz, L, Vallier, A-L, Gounaris, I, Abraham, J, Hughes-Davies, L, McAdam, K, Chan, S, Ahmad, R, Hickish, T, Rea, D, Caldas, C, Bartlett, JMS, Cameron, DA, Provenzano, E, Thomas, J, Hayward, RL, ARTemis Investigators Group, Earl, Helena [0000-0003-1549-8094], Abraham, Jean [0000-0003-0688-4807], Caldas, Carlos [0000-0003-3547-1489], and Apollo - University of Cambridge Repository
Subjects: breast cancer, bevacizumab, ARTemis, neoadjuvant chemotherapy
Abstract: $\textbf{Background:}$ The ARTemis trial previously reported that addition of neoadjuvant bevacizumab (Bev) to docetaxel (D) followed by fluorouracil, epirubicin and cyclophosphamide (D-FEC) in HER2 negative breast cancer improved the pathological complete response (pCR) rate. We present disease-free survival (DFS) and overall survival (OS) with central pathology review. $\textbf{Patients and methods:}$ Patients were randomized to 3 cycles of D followed by 3 cycles of FEC (D-FEC), $\pm$4 cycles of Bev (Bev + D-FEC). DFS and OS were analyzed by treatment and by central pathology reviewed pCR and Residual Cancer Burden (RCB) class. $\textbf{Results:}$ A total of 800 patients were randomized [median follow-up 3.5 years (IQR 3.2–4.4)]. DFS and OS were similar across treatment arms [DFS hazard ratio (HR)=1.18 (95% CI 0.89–1.57), P = 0.25; OS HR = 1.26 (95% CI 0.90–1.76), P = 0.19). Both local pathology report review and central histopathology review confirmed a significant improvement in DFS and OS for patients who achieved a pCR [DFS HR = 0.38 (95% CI 0.23–0.63), P < 0.001; OS HR = 0.43 (95% CI 0.24–0.75), P = 0.003]. However, significant heterogeneity was observed (P = 0.02); larger improvements in DFS were obtained with a pCR achieved with D-FEC than a pCR achieved with Bev + D-FEC. As RCB class increased, significantly worse DFS and OS was observed (P for trend
Published: 2017

8. Exploratory Analysis of $\textit{TP53}$ Mutations in Circulating Tumour DNA as Biomarkers of Treatment Response for Patients with Relapsed High-Grade Serous Ovarian Carcinoma: A Retrospective Study

Author: Parkinson, CA, Gale, D, Piskorz, AM, Biggs, H, Hodgkin, C, Addley, H, Freeman, S, Moyle, P, Sala, E, Sayal, K, Hosking, K, Gounaris, I, Jimenez-Linan, M, Earl, HM, Qian, W, Rosenfeld, N, Brenton, JD, Gale, Davina [0000-0002-4521-8199], Hodgkin, Charlotte [0000-0002-2240-1740], Sala, Evis [0000-0002-5518-9360], Earl, Helena [0000-0003-1549-8094], Qian, Wendi [0000-0002-4238-3471], Rosenfeld, Nitzan [0000-0002-2825-4788], Brenton, James [0000-0002-5738-6683], and Apollo - University of Cambridge Repository
Subjects: Adult, Aged, 80 and over, Ovarian Neoplasms, Carcinoma, DNA, Neoplasm, Middle Aged, Neoplastic Cells, Circulating, Mutation, Biomarkers, Tumor, Humans, Female, Tumor Suppressor Protein p53, Aged, Retrospective Studies
Abstract: $\textbf{Background:}$ Circulating tumour DNA (ctDNA) carrying tumour-specific sequence alterations may provide a minimally invasive means to dynamically assess tumour burden and response to treatment in cancer patients. Somatic $\textit{TP53}$ mutations are a defining feature of high-grade serous ovarian carcinoma (HGSOC). We tested whether these mutations could be used as personalised markers to monitor tumour burden and early changes as a predictor of response and time to progression (TTP). $\textbf{Methods and Findings:}$ We performed a retrospective analysis of serial plasma samples collected during routine clinical visits from 40 patients with HGSOC undergoing heterogeneous standard of care treatment. Patient-specific $\textit{TP53}$ assays were developed for 31 unique mutations identified in formalin-fixed paraffin-embedded tumour DNA from these patients. These assays were used to quantify ctDNA in 318 plasma samples using microfluidic digital PCR. The $\textit{TP53}$ mutant allele fraction (TP53MAF) was compared to serum CA-125, the current gold-standard response marker for HGSOC in blood, as well as to disease volume on computed tomography scans by volumetric analysis. Changes after one cycle of treatment were compared with TTP. The median TP53MAF prior to treatment in 51 relapsed treatment courses was 8% (interquartile range [IQR] 1.2%-22%) compared to 0.7% (IQR 0.3%-2.0%) for seven untreated newly diagnosed stage IIIC/IV patients. TP53MAF correlated with volumetric measurements (Pearson $r$ = 0.59, $p$ < 0.001), and this correlation improved when patients with ascites were excluded ($r$ = 0.82). The ratio of TP53MAF to volume of disease was higher in relapsed patients (0.04% per cm$^3$) than in untreated patients (0.0008% per cm$^3$, $p$ = 0.004). In nearly all relapsed patients with disease volume > 32 cm$^3$, ctDNA was detected at ≥20 amplifiable copies per millilitre of plasma. In 49 treatment courses for relapsed disease, pre-treatment TP53MAF concentration, but not CA-125, was associated with TTP. Response to chemotherapy was seen earlier with ctDNA, with a median time to nadir of 37 d (IQR 28-54) compared with a median time to nadir of 84 d (IQR 42-116) for CA-125. In 32 relapsed treatment courses evaluable for response after one cycle of chemotherapy, a decrease in TP53MAF of >60% was an independent predictor of TTP in multivariable analysis (hazard ratio 0.22, 95% CI 0.07-0.67, $p$ = 0.008). Conversely, a decrease in TP53MAF of ≤60% was associated with poor response and identified cases with TTP < 6 mo with 71% sensitivity (95% CI 42%-92%) and 88% specificity (95% CI 64%-99%). Specificity was improved when patients with recent drainage of ascites were excluded. Ascites drainage led to a reduction of TP53MAF concentration. The limitations of this study include retrospective design, small sample size, and heterogeneity of treatment within the cohort. $\textbf{Conclusions:}$ In this retrospective study, we demonstrated that ctDNA is correlated with volume of disease at the start of treatment in women with HGSOC and that a decrease of ≤60% in TP53MAF after one cycle of chemotherapy was associated with shorter TTP. These results provide evidence that ctDNA has the potential to be a highly specific early molecular response marker in HGSOC and warrants further investigation in larger cohorts receiving uniform treatment.
Published: 2017
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9. Body mass index and breast cancer survival: a Mendelian randomization analysis

Author: Guo, Q, Burgess, S, Turman, C, Bolla, MK, Wang, Q, Lush, M, Abraham, J, Aittomäki, K, Andrulis, IL, Apicella, C, Arndt, V, Barrdahl, M, Benitez, J, Berg, CD, Blomqvist, C, Bojesen, SE, Bonanni, B, Brand, JS, Brenner, H, Broeks, A, Burwinkel, B, Caldas, C, Campa, D, Canzian, F, Chang-Claude, J, Chanock, SJ, Chin, S-F, Couch, FJ, Cox, A, Cross, SS, Cybulski, C, Czene, K, Darabi, H, Devilee, P, Diver, WR, Dunning, AM, Earl, HM, Eccles, DM, Ekici, AB, Eriksson, M, Evans, DG, Fasching, PA, Figueroa, J, Flesch-Janys, D, Flyger, H, Gapstur, SM, Gaudet, MM, Giles, GG, Glendon, G, Grip, M, Gronwald, J, Haeberle, L, Haiman, CA, Hall, P, Hamann, U, Hankinson, S, Hartikainen, JM, Hein, A, Hiller, L, Hogervorst, FB, Holleczek, B, Hooning, MJ, Hoover, RN, Humphreys, K, Hunter, DJ, Hüsing, A, Jakubowska, A, Jukkola-Vuorinen, A, Kaaks, R, Kabisch, M, Kataja, V, Investigators, Kconfab/Aocs, Knight, JA, Koppert, LB, Kosma, V-M, Kristensen, VN, Lambrechts, D, Le Marchand, L, Li, J, Lindblom, A, Lindström, S, Lissowska, J, Lubinski, J, Machiela, MJ, Mannermaa, A, Manoukian, S, Margolin, S, Marme, F, Martens, JWM, McLean, C, Menéndez, P, Milne, RL, Mulligan, A, Muranen, TA, Nevanlinna, H, Neven, P, Nielsen, SF, Nordestgaard, BG, Olson, JE, Perez, JIA, Peterlongo, P, Phillips, K-A, Poole, CJ, Pylkäs, K, Radice, P, Rahman, N, Rüdiger, T, Rudolph, A, Sawyer, EJ, Schumacher, F, Seibold, P, Seynaeve, C, Shah, M, Smeets, A, Southey, MC, Tollenaar, RAEM, Tomlinson, I, Tsimiklis, H, Ulmer, H-U, Vachon, C, Van Den Ouweland, AMW, Veer, LJ, Wildiers, H, Willett, W, Winqvist, R, Zamora, MP, Chenevix-Trench, G, Dörk, T, Easton, DF, García-Closas, M, Kraft, P, Hopper, JL, Zheng, W, Schmidt, MK, Pharoah, PDP, Medical Oncology, and Surgery
Subjects: Genetic Variation, Breast Neoplasms, Mendelian Randomization Analysis, Body mass index, Breast cancer survival, Epidemiology, Genetics, Mendelian randomization, Polymorphism, Single Nucleotide, Risk Assessment, Survival Analysis, White People, Causality, Europe, RC0254, Meta-Analysis as Topic, Receptors, Estrogen, SDG 3 - Good Health and Well-being, Risk Factors, breast cancer survival, Humans, Female, epidemiology, genetics, Cancer
Abstract: Background There is increasing evidence that elevated body mass index (BMI) is associated with reduced survival for women with breast cancer. However, the underlying reasons remain unclear. We conducted a Mendelian randomization analysis to investigate a possible causal role of BMI in survival from breast cancer. Methods We used individual-level data from six large breast cancer case-cohorts including a total of 36 210 individuals (2475 events) of European ancestry. We created a BMI genetic risk score (GRS) based on genotypes at 94 known BMI-associated genetic variants. Association between the BMI genetic score and breast cancer survival was analysed by Cox regression for each study separately. Study-specific hazard ratios were pooled using fixed-effect meta-analysis. Results BMI genetic score was found to be associated with reduced breast cancer-specific survival for estrogen receptor (ER)-positive cases [hazard ratio (HR) = 1.11, per one-unit increment of GRS, 95% confidence interval (CI) 1.01–1.22, P = 0.03). We observed no association for ER-negative cases (HR = 1.00, per one-unit increment of GRS, 95% CI 0.89–1.13, P = 0.95). Conclusions Our findings suggest a causal effect of increased BMI on reduced breast cancer survival for ER-positive breast cancer. There is no evidence of a causal effect of higher BMI on survival for ER-negative breast cancer cases.
Published: 2017

10. Abstract OT1-06-01: OPTIMA: A prospective randomized trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in early breast cancer

Author: Stein, RC, primary, Makris, A, additional, Hughes-Davies, L, additional, Macpherson, IR, additional, Hall, PS, additional, Cameron, DA, additional, Earl, HM, additional, Pinder, SE, additional, Poole, CJ, additional, Rea, DW, additional, McIntosh, S, additional, Harmer, V, additional, Morgan, A, additional, Rooshenas, L, additional, Conefrey, C, additional, Donovan, JL, additional, Hulme, C, additional, McCabe, C, additional, Stallard, N, additional, Campbell, A, additional, Higgins, H, additional, Bartlett, JMS, additional, Marshall, A, additional, and Dunn, JA, additional
Published: 2018
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11. A genomic approach to therapeutic target validation identifies a glucose-lowering GLP1R variant protective for coronary heart disease

Author: Scott, RA, Freitag, DF, Li, L, Chu, AY, Surendran, P, Young, R, Grarup, N, Stancáková, A, Chen, Y, Varga, TV, Yaghootkar, H, Luan, J, Zhao, JH, Willems, SM, Wessel, J, Wang, S, Maruthur, N, Michailidou, K, Pirie, A, Van Der Lee, SJ, Gillson, C, Al Olama, AA, Amouyel, P, Arriola, L, Arveiler, D, Aviles-Olmos, I, Balkau, B, Barricarte, A, Barroso, I, Garcia, SB, Bis, JC, Blankenberg, S, Boehnke, M, Boeing, H, Boerwinkle, E, Borecki, IB, Bork-Jensen, J, Bowden, S, Caldas, C, Caslake, M, Cupples, LA, Cruchaga, C, Czajkowski, J, Den Hoed, M, Dunn, JA, Earl, HM, Ehret, GB, Ferrannini, E, Ferrieres, J, Foltynie, T, Ford, I, Forouhi, NG, Gianfagna, F, Gonzalez, C, Grioni, S, Hiller, L, Jansson, JH, Jørgensen, ME, Jukema, JW, Kaaks, R, Kee, F, Kerrison, ND, Key, TJ, Kontto, J, Kote-Jarai, Z, Kraja, AT, Kuulasmaa, K, Kuusisto, J, Linneberg, A, Liu, C, Marenne, G, Mohlke, KL, Morris, AP, Muir, K, Müller-Nurasyid, M, Munroe, PB, and Navarro, C
Abstract: Copyright 2016 by the American Association for the Advancement of Science; all rights reserved. Regulatory authorities have indicated that new drugs to treat type 2 diabetes (T2D) should not be associated with an unacceptable increase in cardiovascular risk. Human genetics may be able to guide development of antidiabetic therapies by predicting cardiovascular and other health endpoints. We therefore investigated the association of variants in six genes that encode drug targets for obesity or T2D with a range of metabolic traits in up to 11, 806 individuals by targeted exome sequencing and follow-up in 39, 979 individuals by targeted genotyping, with additional in silico follow-up in consortia. We used these data to first compare associations of variants in genes encoding drug targets with the effects of pharmacological manipulation of those targets in clinical trials. We then tested the association of those variants with disease outcomes, including coronary heart disease, to predict cardiovascular safety of these agents. A low-frequency missense variant (Ala316Thr; rs10305492) in the gene encoding glucagon-like peptide-1 receptor (GLP1R), the target of GLP1R agonists, was associated with lower fasting glucose and T2D risk, consistent with GLP1R agonist therapies. The minor allele was also associated with protection against heart disease, thus providing evidence that GLP1R agonists are not likely to be associated with an unacceptable increase in cardiovascular risk. Our results provide an encouraging signal that these agents may be associated with benefit, a question currently being addressed in randomized controlled trials. Genetic variants associated with metabolic traits and multiple disease outcomes can be used to validate therapeutic targets at an early stage in the drug development process.
Published: 2016

12. Abstract OT2-01-15: PARTNER - Randomised, phase II/III trial to evaluate the safety and efficacy of the addition of olaparib to platinum-based neoadjuvant chemotherapy in triple negative and/or germline BRCA mutated breast cancer patients

Author: Abraham, JE, primary, Vallier, A-L, additional, Qian, W, additional, Grybowicz, L, additional, Thomas, S, additional, Mahmud, S, additional, Harvey, C, additional, McAdam, K, additional, Hughes-Davies, L, additional, Roylance, R, additional, Copson, E, additional, Brown, J, additional, Provenzano, E, additional, Tischkowitz, M, additional, and Earl, HM, additional
Published: 2017
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13. Identification of novel genetic markers of breast cancer survival

Author: Guo, Q, Schmidt, Mk, Kraft, P, Canisius, S, Chen, C, Khan, S, Tyrer, J, Bolla, Mk, Wang, Q, Dennis, J, Michailidou, K, Lush, M, Kar, S, Beesley, J, Dunning, Am, Shah, M, Czene, K, Darabi, H, Eriksson, M, Lambrechts, D, Weltens, C, Leunen, K, Bojesen, Se, Nordestgaard, Bg, Nielsen, Sf, Flyger, H, Chang Claude, J, Rudolph, A, Seibold, P, Flesch Janys, D, Blomqvist, C, Aittomäki, K, Fagerholm, R, Muranen, Ta, Couch, Fj, Olson, Je, Vachon, C, Andrulis, Il, Knight, Ja, Glendon, G, Mulligan, Am, Broeks, A, Hogervorst, Fb, Haiman, Ca, Henderson, Be, Schumacher, F, Le Marchand, L, Hopper, Jl, Tsimiklis, H, Apicella, C, Southey, Mc, Cox, A, Cross, Ss, Reed, Mw, Giles, Gg, Milne, Rl, Mclean, C, Winqvist, R, Pylkäs, K, Jukkola Vuorinen, A, Grip, M, Hooning, Mj, Hollestelle, A, Martens, Jw, van den Ouweland, Am, Marme, F, Schneeweiss, A, Yang, R, Burwinkel, B, Figueroa, J, Chanock, Sj, Lissowska, J, Sawyer, Ej, Tomlinson, I, Kerin, Mj, Miller, N, Brenner, H, Dieffenbach, Ak, Arndt, V, Holleczek, B, Mannermaa, A, Kataja, V, Kosma, Vm, Hartikainen, Jm, Li, J, Brand, Js, Humphreys, K, Devilee, P, Tollenaar, Ra, Seynaeve, C, Radice, P, Peterlongo, P, Bonanni, B, Mariani, P, Fasching, Beckmann, Mw, Hein, A, Ekici, Ab, Chenevix Trench, G, Balleine, R, Kconfab, Investigators, Phillips, Ka, Benitez, J, Zamora, Mp, Arias Perez, Ji, Menéndez, P, Jakubowska, A, Lubinski, J, Jaworska Bieniek, K, Durda, K, Hamann, U, Kabisch, M, Ulmer, Hu, Rüdiger, T, Margolin, S, Kristensen, V, Nord, S, Evans, Dg, Abraham, Je, Earl, Hm, Hiller, L, Dunn, Ja, Bowden, S, Berg, C, Campa, Daniele, Diver, Wr, Gapstur, Sm, Gaudet, Mm, Hankinson, Se, Hoover, Rn, Hüsing, A, Kaaks, R, Machiela, Mj, Willett, W, Barrdahl, M, Canzian, F, Chin, Sf, Caldas, C, Hunter, Dj, Lindstrom, S, García Closas, M, Hall, P, Easton, Df, Eccles, Dm, Rahman, N, Nevanlinna, H, and Pharoah, P. d.
Subjects: GENOME-WIDE ASSOCIATION, SINGLE-NUCLEOTIDE POLYMORPHISMS, GENOTYPE IMPUTATION, PROGNOSIS, RISK, LOCI, CYCLOPHOSPHAMIDE, METAANALYSIS, PROGRESSION, EPIRUBICIN
Published: 2015

14. The somatic mutation profiles of 2,433 breast cancers refines their genomic and transcriptomic landscapes

Author: Pereira, B, Chin, S-F, Rueda, OM, Vollan, H-KM, Provenzano, E, Bardwell, HA, Pugh, M, Jones, L, Russell, R, Sammut, S-J, Tsui, DWY, Liu, B, Dawson, S-J, Abraham, J, Northen, H, Peden, JF, Mukherjee, A, Turashvili, G, Green, AR, McKinney, S, Oloumi, A, Shah, S, Rosenfeld, N, Murphy, L, Bentley, DR, Ellis, IO, Purushotham, A, Pinder, SE, Borresen-Dale, A-L, Earl, HM, Pharoah, PD, Ross, MT, Aparicio, S, Caldas, C, Pereira, B, Chin, S-F, Rueda, OM, Vollan, H-KM, Provenzano, E, Bardwell, HA, Pugh, M, Jones, L, Russell, R, Sammut, S-J, Tsui, DWY, Liu, B, Dawson, S-J, Abraham, J, Northen, H, Peden, JF, Mukherjee, A, Turashvili, G, Green, AR, McKinney, S, Oloumi, A, Shah, S, Rosenfeld, N, Murphy, L, Bentley, DR, Ellis, IO, Purushotham, A, Pinder, SE, Borresen-Dale, A-L, Earl, HM, Pharoah, PD, Ross, MT, Aparicio, S, and Caldas, C
Abstract: The genomic landscape of breast cancer is complex, and inter- and intra-tumour heterogeneity are important challenges in treating the disease. In this study, we sequence 173 genes in 2,433 primary breast tumours that have copy number aberration (CNA), gene expression and long-term clinical follow-up data. We identify 40 mutation-driver (Mut-driver) genes, and determine associations between mutations, driver CNA profiles, clinical-pathological parameters and survival. We assess the clonal states of Mut-driver mutations, and estimate levels of intra-tumour heterogeneity using mutant-allele fractions. Associations between PIK3CA mutations and reduced survival are identified in three subgroups of ER-positive cancer (defined by amplification of 17q23, 11q13-14 or 8q24). High levels of intra-tumour heterogeneity are in general associated with a worse outcome, but highly aggressive tumours with 11q13-14 amplification have low levels of intra-tumour heterogeneity. These results emphasize the importance of genome-based stratification of breast cancer, and have important implications for designing therapeutic strategies.
Published: 2016

15. Abstract OT3-02-02: ROSCO: A randomised phase III, stratified CEP17/TOP2A biomarker trial of neo-adjuvant 5-flourouracil, epirubicin and cyclophosphamide vs docetaxel and cyclophosphamide chemotherapy

Author: Rea, DW, primary, Haywood, L, additional, Francis, AM, additional, Bowden, SJ, additional, Brookes, CM, additional, MacKenzie, M, additional, Cameron, D, additional, Stein, R, additional, Earl, HM, additional, Thomas, J, additional, Abraham, J, additional, Stanley, A, additional, Starczinski, J, additional, McGoldrick, T, additional, Treharne-Jones, P, additional, Billingham, L, additional, and Bartlett, JM, additional
Published: 2016
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16. Abstract OT3-02-12: OPTIMA (optimal personalised treatment of early breast cancer usIng multi-parameter analysis), a prospective trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions

Author: Stein, RC, primary, Marshall, A, additional, Hall, PS, additional, Bartlett, JMS, additional, Rooshenas, L, additional, Campbell, A, additional, Cameron, DA, additional, Rea, D, additional, Macpherson, I, additional, Earl, HM, additional, Poole, CJ, additional, Francis, A, additional, Morgan, A, additional, Harmer, V, additional, Pinder, SE, additional, Stallard, N, additional, Donovan, J, additional, Hulme, C, additional, McCabe, C, additional, Hughes-Davies, L, additional, Makris, A, additional, and Dunn, JA, additional
Published: 2016
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17. A central review of histopathology reports after breast cancer neoadjuvant chemotherapy in the neo-tango trial

Author: Provenzano, E, Vallier, A-L, Champ, R, Walland, K, Bowden, S, Grier, A, Fenwick, N, Abraham, J, Iddawela, M, Caldas, C, Hiller, L, Dunn, J, Earl, HM, Provenzano, E, Vallier, A-L, Champ, R, Walland, K, Bowden, S, Grier, A, Fenwick, N, Abraham, J, Iddawela, M, Caldas, C, Hiller, L, Dunn, J, and Earl, HM
Abstract: BACKGROUND: Neo-tAnGo, a National Cancer Research Network (NCRN) multicentre randomised neoadjuvant chemotherapy trial in early breast cancer, enroled 831 patients in the United Kingdom. We report a central review of post-chemotherapy histopathology reports on the surgical specimens, to assess the presence and degree of response. METHODS: A central independent two-reader review (EP and HME) of histopathology reports from post-treatment surgical specimens was performed. The quality and completeness of pathology reporting across all centres was assessed. The reviews included pathological response to chemotherapy (pathological complete response (pCR); minimal residual disease (MRD); and lesser degrees of response), laterality, the number of axillary metastases and axillary nodes, and the type of surgery. A consensus was reached after discussion. RESULTS: In all, 825 surgical reports from 816 patients were available for review. Out of 4125 data items there were 347 discrepant results (8.4% of classifications), which involved 281 patients. These involved grading of breast response (169 but only 9 involving pCR vs MRD); laterality (6); presence of axillary metastasis (35); lymph node counts (108); and type of axillary surgery (29). Excluding cases with pCR, only 45% of reports included any comment regarding response in the breast and 30% in the axillary lymph nodes. CONCLUSION: We found considerable variability in the completeness of reporting of surgical specimens within this national neoadjuvant breast cancer trial. This highlights the need for consensus guidelines among trial groups on histopathology reporting, and the participation of histopathologists throughout the development and analysis of neoadjuvant trials.
Published: 2013

18. Abstract OT1-1-08: PERSEPHONE: Duration of trastuzumab with chemotherapy in women with HER-2+ve early breast cancer

Author: Earl, HM, primary, Vallier, A-L, additional, Ogburn-Storey, E, additional, Cameron, DA, additional, Wardley, AM, additional, Miles, D, additional, Loi, S, additional, Hiller, L, additional, Higgins, HB, additional, and Dunn, JA, additional
Published: 2013
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19. Abstract P3-08-05: Title: Copy number variation and risk of chemotherapy-related infection.

Author: Abraham, JE, primary, Rueda, OM, additional, Chin, S-F, additional, Guo, Q, additional, Harrington, P, additional, Earl, HM, additional, Pharoah, PD, additional, and Caldas, C, additional
Published: 2012
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20. Abstract OT1-1-03: PERSEPHONE: Duration of Trastuzumab with Chemotherapy in women with HER2 positive early breast cancer.

Author: Earl, HM, primary, Cameron, DA, additional, Miles, D, additional, Wardley, AM, additional, Ogburn, ERM, additional, Vallier, A-L, additional, Loi, S, additional, Higgins, HB, additional, Hiller, L, additional, and Dunn, JA, additional
Published: 2012
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21. Abstract OT3-3-09: ARTemis trial - randomised trial with neo-adjuvant chemotherapy for patients with early breast cancer

Author: Earl, HM, primary, Blenkinsop, C, additional, Grybowicz, L, additional, Vallier, A-L, additional, Cameron, DA, additional, Bartlett, JMS, additional, Murray, N, additional, Caldas, C, additional, Thomas, J, additional, Dunn, JA, additional, Higgins, HB, additional, Hiller, L, additional, and Hayward, L, additional
Published: 2012
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22. OT1-02-08: The PERSEPHONE Trial: Duration of Trastuzumab with Chemotherapy in Women with HER2 Positive Early Breast Cancer. Changing the Randomisation Point To Address Potential Barriers to Recruitment.

Author: Earl, HM, primary, Loi, S, additional, Vallier, A-L, additional, Hiller, L, additional, Ogburn-Storey, E, additional, Higgins, H, additional, and Dunn, J, additional
Published: 2011
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23. Cytochrome P450 2D6 variants and their association with breast cancer survival.

Author: Abraham, JE, primary, Maranian, M, additional, Driver, K, additional, Greenberg, D, additional, Shah, MN, additional, Earl, HM, additional, Dunning, AM, additional, Pharoah, PP, additional, and Caldas, C, additional
Published: 2009
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24. Sentinel lymph node biopsy (SLNB) prior to primary chemotherapy (PC) in breast cancer patients.

Author: Wishart, GC, primary, Benson, JR, additional, Absar, MS, additional, Vallier, AL, additional, Hiller, L, additional, Fenwick, N, additional, Champ, R, additional, Provenzano, E, additional, Caldos, C, additional, and Earl, HM, additional
Published: 2009
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25. A phase I/II trial of recombinant human granulocyte-macrophage colony-stimulating factor in the intensification of cisplatin and cyclophosphamide chemotherapy for advanced ovarian cancer

Author: Kehoe, S, primary, Poole, CJ, additional, Stanley, A, additional, Earl, HM, additional, and Blackledge, GRP, additional
Published: 1994
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26. Apparent diffusion coefficient and vascular signal fraction measurements with magnetic resonance imaging: feasibility in metastatic ovarian cancer at 3 Tesla: technical development.

Author: Sala E, Priest AN, Kataoka M, Graves MJ, McLean MA, Joubert I, Griffiths JR, Crawford RA, Jimenez-Linan M, Earl HM, Brenton JD, Lomas DJ, Sala, Evis, Priest, Andrew N, Kataoka, Masako, Graves, Martin J, McLean, Mary A, Joubert, Ilse, Griffiths, John R, and Crawford, Robin A F
Abstract: This prospective study aims to evaluate the feasibility of DWI at 3 Tesla in patients with advanced ovarian cancer and investigate the differences in vascular signal fraction (VSF) and apparent diffusion coefficient (ADC) values between primary ovarian mass and metastatic disease. Twenty patients with suspected advanced ovarian carcinoma were enrolled in the study. High-resolution T2W FRFSE images were used to confirm the position of three marker lesions: primary ovarian mass, omental cake and peritoneal deposit. Multislice DWI was acquired in a single breath-hold using multiple b-values. The three marker lesions were outlined by an experienced radiologist on ADC and VSF maps. Ovarian lesions showed the highest ADC values. The mean ADC value for peritoneal deposits was significantly lower than for both ovarian lesions (p = 0.03) and omental cake (p = 0.03). The VSF for omental cake was significantly higher than for ovarian lesions (p = 0.01) and peritoneal deposits (p = 0.04). There was a significant positive correlation between ADC and VSF for peritoneal deposits (p = 0.04). DWI in advanced ovarian cancer is feasible at 3 T. There are significant differences in baseline ADC and VSF values between ovarian cancer, omental cake and peritoneal deposits that may explain the mixed treatment response that occurs at different disease sites. [ABSTRACT FROM AUTHOR]
Published: 2010
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27. A randomised trial of planned versus as required chemotherapy in small cell lung cancer: a Cancer Research Campaign trial

Author: Earl, HM, primary, Rudd, RM, additional, Spiro, SG, additional, Ash, CM, additional, James, LE, additional, Law, CS, additional, Tobias, JS, additional, Harper, PG, additional, Geddes, DM, additional, Eraut, D, additional, Partridge, MR, additional, and Souhami, RL, additional
Published: 1991
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28. Epirubicin and cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy for early breast cancer.

Author: Poole CJ, Earl HM, Hiller L, Dunn JA, Bathers S, Grieve RJ, Spooner DA, Agrawal RK, Fernando IN, Brunt AM, O'Reilly SM, Crawford SM, Rea DW, Simmonds P, Mansi JL, Stanley A, Harvey P, McAdam K, Foster L, and Leonard RCF
Published: 2006

29. The response of cerebral metastases in small cell lung cancer to systemic chemotherapy

Author: Twelves, CJ, primary, Souhami, RL, additional, Harper, PG, additional, Ash, CM, additional, Spiro, SG, additional, Earl, HM, additional, Tobias, JS, additional, Quinn, H, additional, and Geddes, DM, additional
Published: 1990
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30. Practice point. Conformal radiotherapy facilitates the delivery of concurrent chemotherapy and radiotherapy: a case of primitive neuroectodermal tumour of the chest wall.

Author: Coles CE, Twyman N, Earl HM, and Burnet NG
Abstract: We illustrate the principle of conformal radiotherapy by discussing the case of a patient with a primitive neuroectodermal tumour of the chest wall. Recent advances in radiotherapy planning enable precise localization of the planning target volume (PTV) and normal organs at risk of irradiation. Customized blocks are subsequently designed to produce a treatment field that 'conforms' to the PTV.The use of conformal radiotherapy (CRT) in this case facilitated the delivery of concurrent chemotherapy and radiotherapy by significantly reducing the volume of red marrow irradiated. The lack of acute and late toxicities was attributed to optimal exclusion of normal tissues from the treatment field, made possible by CRT. [ABSTRACT FROM AUTHOR]
Published: 2000
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31. Patients at risk of chemotherapy-associated toxicity in small cell lung cancer.

Author: Morittu, L, Earl, HM, Souhami, RL, Ash, CM, Tobias, JS, Geddes, DM, Harper, PG, Spiro, SG, Earl, H M, Souhami, R L, Ash, C M, Tobias, J S, Geddes, D M, Harper, P G, and Spiro, S G
Published: 1989
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32. A prospective evaluation of pulmonary, cardiac, and hepatic function (fn) in 'tAnGo': A randomized phase III trial of gemcitabine (G) in paclitaxel (T)-containing, epirubicin/cyclophosphamide (EC)-based, adjuvant chemotherapy (CT) for early stage breast cancer

Author: Poole, Cj, Howard, Hc, Hiller, L., Dunn, Ja, Andrew Wardley, Bowman, A., Coleman, Re, Fernando, In, Ritchie, Dm, and Earl, Hm

33. Reporting of adjuvant breast cancer trials: when is the right time?

Author: Earl HM and Earl, Helena M
Published: 2012
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34. The PARTNER trial of neoadjuvant olaparib with chemotherapy in triple-negative breast cancer.

Author: Abraham JE, Pinilla K, Dayimu A, Grybowicz L, Demiris N, Harvey C, Drewett LM, Lucey R, Fulton A, Roberts AN, Worley JR, Chhabra A, Qian W, Vallier AL, Hardy RM, Chan S, Hickish T, Tripathi D, Venkitaraman R, Persic M, Aslam S, Glassman D, Raj S, Borley A, Braybrooke JP, Sutherland S, Staples E, Scott LC, Davies M, Palmer CA, Moody M, Churn MJ, Newby JC, Mukesh MB, Chakrabarti A, Roylance RR, Schouten PC, Levitt NC, McAdam K, Armstrong AC, Copson ER, McMurtry E, Tischkowitz M, Provenzano E, and Earl HM
Subjects: Adult, Aged, Female, Humans, Middle Aged, Anthracyclines therapeutic use, Anthracyclines administration & dosage, Carboplatin administration & dosage, Carboplatin therapeutic use, Genes, BRCA1, Genes, BRCA2, Paclitaxel administration & dosage, Paclitaxel therapeutic use, Pathologic Complete Response, Progression-Free Survival, Prospective Studies, Survival Analysis, Time Factors, Adolescent, Young Adult, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Neoadjuvant Therapy, Phthalazines administration & dosage, Phthalazines therapeutic use, Piperazines administration & dosage, Piperazines therapeutic use, Triple Negative Breast Neoplasms drug therapy, Triple Negative Breast Neoplasms metabolism, Triple Negative Breast Neoplasms surgery
Abstract: PARTNER is a prospective, phase II-III, randomized controlled clinical trial that recruited patients with triple-negative breast cancer 1,2 , who were germline BRCA1 and BRCA2 wild type 3 . Here we report the results of the trial. Patients (n = 559) were randomized on a 1:1 basis to receive neoadjuvant carboplatin-paclitaxel with or without 150 mg olaparib twice daily, on days 3 to 14, of each of four cycles (gap schedule olaparib, research arm) followed by three cycles of anthracycline-based chemotherapy before surgery. The primary end point was pathologic complete response (pCR) 4 , and secondary end points included event-free survival (EFS) and overall survival (OS) 5 . pCR was achieved in 51% of patients in the research arm and 52% in the control arm (P = 0.753). Estimated EFS at 36 months in the research and control arms was 80% and 79% (log-rank P > 0.9), respectively; OS was 90% and 87.2% (log-rank P = 0.8), respectively. In patients with pCR, estimated EFS at 36 months was 90%, and in those with non-pCR it was 70% (log-rank P < 0.001), and OS was 96% and 83% (log-rank P < 0.001), respectively. Neoadjuvant olaparib did not improve pCR rates, EFS or OS when added to carboplatin-paclitaxel and anthracycline-based chemotherapy in patients with triple-negative breast cancer who were germline BRCA1 and BRCA2 wild type. ClinicalTrials.gov ID: NCT03150576 ., (© 2024. The Author(s).)
Published: 2024
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35. Safe de-escalation of chemotherapy in HER2-positive early breast cancer.

Author: Earl HM
Subjects: Humans, Female, Trastuzumab therapeutic use, Trastuzumab administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Antineoplastic Combined Chemotherapy Protocols adverse effects, Breast Neoplasms drug therapy, Receptor, ErbB-2 metabolism
Abstract: Competing Interests: I declare no competing interests.
Published: 2024
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36. Magnetization transfer imaging of ovarian cancer: initial experiences of correlation with tissue cellularity and changes following neoadjuvant chemotherapy.

Author: Deen SS, McLean MA, Gill AB, Crawford RAF, Latimer J, Baldwin P, Earl HM, Parkinson CA, Smith S, Hodgkin C, Jimenez-Linan M, Brodie CR, Patterson I, Addley HC, Freeman SJ, Moyle PM, Graves MJ, Sala E, Brenton JD, and Gallagher FA
Abstract: Objectives: To investigate the relationship between magnetization transfer (MT) imaging and tissue macromolecules in high-grade serous ovarian cancer (HGSOC) and whether MT ratio (MTR) changes following neoadjuvant chemotherapy (NACT)., Methods: This was a prospective observational study. 12 HGSOC patients were imaged before treatment. MTR was compared to quantified tissue histology and immunohistochemistry. For a subset of patients ( n = 5), MT imaging was repeated after NACT. The Shapiro-Wilk test was used to assess for normality of data and Spearman's rank-order or Pearson's correlation tests were then used to compare MTR with tissue quantifications. The Wilcoxon signed-rank test was used to assess for changes in MTR after treatment., Results: Treatment-naïve tumour MTR was 21.9 ± 3.1% (mean ± S.D.). MTR had a positive correlation with cellularity, rho = 0.56 ( p < 0.05) and a negative correlation with tumour volume, ρ = -0.72 ( p = 0.01). MTR did not correlate with the extracellular proteins, collagen IV or laminin ( p = 0.40 and p = 0.90). For those patients imaged before and after NACT, an increase in MTR was observed in each case with mean MTR 20.6 ± 3.1% (median 21.1) pre-treatment and 25.6 ± 3.4% (median 26.5) post-treatment ( p = 0.06)., Conclusion: In treatment-naïve HGSOC, MTR is associated with cellularity, possibly reflecting intracellular macromolecular concentration. MT may also detect the HGSOC response to NACT, however larger studies are required to validate this finding., Advances in Knowledge: MTR in HGSOC is influenced by cellularity. This may be applied to assess for cell changes following treatment., Competing Interests: Competing interests: The authors have no conflicts of interest to declare., (© 2022 The Authors. Published by the British Institute of Radiology.)
Published: 2022
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37. Multi-omic machine learning predictor of breast cancer therapy response.

Author: Sammut SJ, Crispin-Ortuzar M, Chin SF, Provenzano E, Bardwell HA, Ma W, Cope W, Dariush A, Dawson SJ, Abraham JE, Dunn J, Hiller L, Thomas J, Cameron DA, Bartlett JMS, Hayward L, Pharoah PD, Markowetz F, Rueda OM, Earl HM, and Caldas C
Subjects: Female, Genomics, Humans, Machine Learning, Neoadjuvant Therapy, Tumor Microenvironment, Breast Neoplasms drug therapy, Breast Neoplasms genetics, Ecosystem
Abstract: Breast cancers are complex ecosystems of malignant cells and the tumour microenvironment 1 . The composition of these tumour ecosystems and interactions within them contribute to responses to cytotoxic therapy 2 . Efforts to build response predictors have not incorporated this knowledge. We collected clinical, digital pathology, genomic and transcriptomic profiles of pre-treatment biopsies of breast tumours from 168 patients treated with chemotherapy with or without HER2 (encoded by ERBB2)-targeted therapy before surgery. Pathology end points (complete response or residual disease) at surgery 3 were then correlated with multi-omic features in these diagnostic biopsies. Here we show that response to treatment is modulated by the pre-treated tumour ecosystem, and its multi-omics landscape can be integrated in predictive models using machine learning. The degree of residual disease following therapy is monotonically associated with pre-therapy features, including tumour mutational and copy number landscapes, tumour proliferation, immune infiltration and T cell dysfunction and exclusion. Combining these features into a multi-omic machine learning model predicted a pathological complete response in an external validation cohort (75 patients) with an area under the curve of 0.87. In conclusion, response to therapy is determined by the baseline characteristics of the totality of the tumour ecosystem captured through data integration and machine learning. This approach could be used to develop predictors for other cancers., (© 2021. The Author(s).)
Published: 2022
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38. Optimising the Duration of Adjuvant Trastuzumab in Early Breast Cancer in the UK.

Author: Earl HM, Hiller L, Dunn J, Macpherson I, Rea D, Hughes-Davies L, McAdam K, Hall P, Mansi J, Wheatley D, Abraham JE, Caldas C, Gasson S, O'Riordan E, Wilcox M, Miles D, Cameron DA, and Wardley A
Published: 2021
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39. Weekly platinum-based chemotherapy versus 3-weekly platinum-based chemotherapy for newly diagnosed ovarian cancer (ICON8): quality-of-life results of a phase 3, randomised, controlled trial.

Author: Blagden SP, Cook AD, Poole C, Howells L, McNeish IA, Dean A, Kim JW, O'Donnell DM, Hook J, James EC, White IR, Perren T, Lord R, Dark G, Earl HM, Hall M, Kaplan R, Ledermann JA, and Clamp AR
Subjects: Adolescent, Adult, Aged, Aged, 80 and over, Carboplatin administration & dosage, Carcinoma, Ovarian Epithelial pathology, Cross-Sectional Studies, Drug Administration Schedule, Female, Follow-Up Studies, Humans, Middle Aged, Ovarian Neoplasms pathology, Paclitaxel administration & dosage, Prognosis, Survival Rate, Young Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Ovarian Epithelial drug therapy, Ovarian Neoplasms drug therapy, Quality of Life
Abstract: Background: The ICON8 study reported no significant improvement in progression-free survival (a primary endpoint) with weekly chemotherapy compared with standard 3-weekly treatment among patients with epithelial ovarian cancer. All ICON8 patients were eligible to take part in the accompanying health-related quality-of-life study, which measured the effect of treatment on self-reported wellbeing, reported here., Methods: In this open-label, randomised, controlled, phase 3, three-arm, Gynecologic Cancer Intergroup (GCIG) trial done at 117 hospital sites in the UK, Australia, New Zealand, Mexico, South Korea, and Republic of Ireland, women (aged at least 18 years) with newly diagnosed, histologically confirmed International Federation of Gynecology and Obstetrics stage IC-IV ovarian cancer and an Eastern Cooperative Oncology Group performance status of 0-2 were randomly assigned (1:1:1) centrally using minimisation to group 1 (intravenous carboplatin area under the curve [AUC]5 or AUC6 and 175 mg/m 2 intravenous paclitaxel every 3 weeks), group 2 (carboplatin AUC5 or AUC6 every 3 weeks and 80 mg/m 2 paclitaxel weekly), or group 3 (carboplatin AUC2 weekly and 80 mg/m 2 paclitaxel weekly). Randomisation was stratified by GCIG group, disease stage, and outcome and timing of surgery. Patients and clinicians were not masked to treatment assignment. Patients underwent immediate or delayed primary surgery according to clinicians' choice. Patients were asked to complete European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OV28 questionnaires at enrolment, before each chemotherapy cycle, then 6-weekly up to 9 months, 3-monthly up to 2 years, and 6-monthly up to 5 years. Quality of life was a prespecified secondary outcome of the ICON8 study. Within the quality-of-life study, the co-primary endpoints were QLQ-C30 global health score at 9 months (cross-sectional analysis) and mean QLQ-C30 global health score from randomisation to 9 months (longitudinal analysis). Data analyses were done on an intention-to-treat basis. The trial is registered on ClinicalTrials.gov, NCT01654146 and ISRCTN Registry, ISRCTN10356387, and is currently in long-term follow up., Findings: Between June 6, 2011, and Nov 28, 2014, 1566 patients were recruited into ICON8 (522 were included in group 1, 523 in group 2, and 521 in group 3). Baseline quality-of-life questionnaires were completed by 1438 (92%) of 1566 patients and 9-month questionnaires by 882 (69%) of 1280 patients. We observed no significant difference in global health score at 9 months (cross-sectional analysis) between study groups (group 2 vs group 1, difference in mean score 2·3, 95% CI -0·4 to 4·9, p=0·095; group 3 vs group 1, -0·8, -3·8 to 2·2, p=0·61). Using longitudinal analysis, we found lower global health scores for those receiving weekly paclitaxel than for those receiving 3-weekly chemotherapy (group 2 vs group 1, mean difference -1·8, 95% CI -3·6 to -0·1, p=0·043; group 3 vs group 1, -2·9, -4·7 to -1·1, p=0·0018)., Interpretation: We found no evidence of a difference in global quality of life between treatment groups at 9 months; however, patients receiving weekly treatment reported lower mean quality of life across the 9-month period after randomisation. Taken together with the lack of progression-free survival benefit, these findings do not support routine use of weekly paclitaxel-containing regimens in the management of newly diagnosed ovarian cancer., Funding: Cancer Research UK, Medical Research Council, Health Research Board Ireland, Irish Cancer Society, and Cancer Australia., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Published: 2020
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40. Protective strategies to prevent trastuzumab-induced cardiotoxicity - Authors' reply.

Author: Earl HM, Hiller L, Plummer C, Miles D, Wardley AM, Cameron DA, and Dunn JA
Subjects: Humans, Receptor, ErbB-2, Trastuzumab, Breast Neoplasms, Cardiotoxicity
Published: 2020
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41. A network analysis to identify mediators of germline-driven differences in breast cancer prognosis.

Author: Escala-Garcia M, Abraham J, Andrulis IL, Anton-Culver H, Arndt V, Ashworth A, Auer PL, Auvinen P, Beckmann MW, Beesley J, Behrens S, Benitez J, Bermisheva M, Blomqvist C, Blot W, Bogdanova NV, Bojesen SE, Bolla MK, Børresen-Dale AL, Brauch H, Brenner H, Brucker SY, Burwinkel B, Caldas C, Canzian F, Chang-Claude J, Chanock SJ, Chin SF, Clarke CL, Couch FJ, Cox A, Cross SS, Czene K, Daly MB, Dennis J, Devilee P, Dunn JA, Dunning AM, Dwek M, Earl HM, Eccles DM, Eliassen AH, Ellberg C, Evans DG, Fasching PA, Figueroa J, Flyger H, Gago-Dominguez M, Gapstur SM, García-Closas M, García-Sáenz JA, Gaudet MM, George A, Giles GG, Goldgar DE, González-Neira A, Grip M, Guénel P, Guo Q, Haiman CA, Håkansson N, Hamann U, Harrington PA, Hiller L, Hooning MJ, Hopper JL, Howell A, Huang CS, Huang G, Hunter DJ, Jakubowska A, John EM, Kaaks R, Kapoor PM, Keeman R, Kitahara CM, Koppert LB, Kraft P, Kristensen VN, Lambrechts D, Le Marchand L, Lejbkowicz F, Lindblom A, Lubiński J, Mannermaa A, Manoochehri M, Manoukian S, Margolin S, Martinez ME, Maurer T, Mavroudis D, Meindl A, Milne RL, Mulligan AM, Neuhausen SL, Nevanlinna H, Newman WG, Olshan AF, Olson JE, Olsson H, Orr N, Peterlongo P, Petridis C, Prentice RL, Presneau N, Punie K, Ramachandran D, Rennert G, Romero A, Sachchithananthan M, Saloustros E, Sawyer EJ, Schmutzler RK, Schwentner L, Scott C, Simard J, Sohn C, Southey MC, Swerdlow AJ, Tamimi RM, Tapper WJ, Teixeira MR, Terry MB, Thorne H, Tollenaar RAEM, Tomlinson I, Troester MA, Truong T, Turnbull C, Vachon CM, van der Kolk LE, Wang Q, Winqvist R, Wolk A, Yang XR, Ziogas A, Pharoah PDP, Hall P, Wessels LFA, Chenevix-Trench G, Bader GD, Dörk T, Easton DF, Canisius S, and Schmidt MK
Subjects: Apoptosis, Circadian Clocks, Computational Biology, Female, GTP-Binding Protein alpha Subunits genetics, GTP-Binding Protein alpha Subunits, Gq-G11 genetics, Gene Regulatory Networks, Genotype, Humans, Prognosis, Receptors, Estrogen genetics, Signal Transduction, Breast Neoplasms genetics, Genetic Variation, Genome-Wide Association Study, Germ Cells
Abstract: Identifying the underlying genetic drivers of the heritability of breast cancer prognosis remains elusive. We adapt a network-based approach to handle underpowered complex datasets to provide new insights into the potential function of germline variants in breast cancer prognosis. This network-based analysis studies ~7.3 million variants in 84,457 breast cancer patients in relation to breast cancer survival and confirms the results on 12,381 independent patients. Aggregating the prognostic effects of genetic variants across multiple genes, we identify four gene modules associated with survival in estrogen receptor (ER)-negative and one in ER-positive disease. The modules show biological enrichment for cancer-related processes such as G-alpha signaling, circadian clock, angiogenesis, and Rho-GTPases in apoptosis.
Published: 2020
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42. Weekly dose-dense chemotherapy in first-line epithelial ovarian, fallopian tube, or primary peritoneal carcinoma treatment (ICON8): primary progression free survival analysis results from a GCIG phase 3 randomised controlled trial.

Author: Clamp AR, James EC, McNeish IA, Dean A, Kim JW, O'Donnell DM, Hook J, Coyle C, Blagden S, Brenton JD, Naik R, Perren T, Sundar S, Cook AD, Gopalakrishnan GS, Gabra H, Lord R, Dark G, Earl HM, Hall M, Banerjee S, Glasspool RM, Jones R, Williams S, Swart AM, Stenning S, Parmar M, Kaplan R, and Ledermann JA
Subjects: Aged, Asian People, Carboplatin administration & dosage, Carcinoma drug therapy, Carcinoma pathology, Carcinoma, Ovarian Epithelial pathology, Chemotherapy, Adjuvant, Chemotherapy-Induced Febrile Neutropenia epidemiology, Cytoreduction Surgical Procedures, Fallopian Tube Neoplasms pathology, Female, Gynecologic Surgical Procedures, Humans, Middle Aged, Neoadjuvant Therapy, Neoplasm Grading, Neoplasm Staging, Ovarian Neoplasms pathology, Paclitaxel administration & dosage, Peripheral Nervous System Diseases chemically induced, Peripheral Nervous System Diseases epidemiology, Peritoneal Neoplasms pathology, Progression-Free Survival, Proportional Hazards Models, White People, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Carcinoma, Ovarian Epithelial drug therapy, Fallopian Tube Neoplasms drug therapy, Ovarian Neoplasms drug therapy, Peritoneal Neoplasms drug therapy
Abstract: Background: Carboplatin and paclitaxel administered every 3 weeks is standard-of-care first-line chemotherapy for epithelial ovarian cancer. The Japanese JGOG3016 trial showed a significant improvement in progression-free and overall survival with dose-dense weekly paclitaxel and 3-weekly carboplatin. In this study, we aimed to compare efficacy and safety of two dose-dense weekly regimens to standard 3-weekly chemotherapy in a predominantly European population with epithelial ovarian cancer., Methods: In this phase 3 trial, women with newly diagnosed International Federation of Gynecology and Obstetrics stage IC-IV epithelial ovarian cancer were randomly assigned to group 1 (carboplatin area under the curve [AUC]5 or AUC6 and 175 mg/m 2 paclitaxel every 3 weeks), group 2 (carboplatin AUC5 or AUC6 every 3 weeks and 80 mg/m 2 paclitaxel weekly), or group 3 (carboplatin AUC2 and 80 mg/m 2 paclitaxel weekly). Written informed consent was provided by all women who entered the trial. The protocol had the appropriate national research ethics committee approval for the countries where the study was conducted. Patients entered the trial after immediate primary surgery, or before neoadjuvant chemotherapy with subsequent planned delayed primary surgery. The trial coprimary outcomes were progression-free survival and overall survival. Data analyses were done on an intention-to-treat basis, and were powered to detect a hazard ratio of 0·75 in progression-free survival. The main comparisons were between the control group (group 1) and each of the weekly research groups (groups 2 and 3)., Findings: Between June 6, 2011, and Nov 28, 2014, 1566 women were randomly assigned to treatment. 72% (365), completed six protocol-defined treatment cycles in group 1, 60% (305) in group 2, and 63% (322) in group 3, although 90% (454), 89% (454), and 85% (437) completed six platinum-based chemotherapy cycles, respectively. Paclitaxel dose intensification was achieved with weekly treatment (median total paclitaxel dose 1010 mg/m 2 in group 1; 1233 mg/m 2 in group 2; 1274 mg/m 2 in group 3). By February, 2017, 1018 (65%) patients had experienced disease progression. No significant progression-free survival increase was observed with either weekly regimen (restricted mean survival time 24·4 months [97·5% CI 23·0-26·0] in group 1, 24·9 months [24·0-25·9] in group 2, 25·3 months [23·9-26·9] in group 3; median progression-free survival 17·7 months [IQR 10·6-not reached] in group 1, 20·8 months [11·9-59·0] in group 2, 21·0 months [12·0-54·0] in group 3; log-rank p=0·35 for group 2 vs group 1; group 3 vs 1 p=0·51). Although grade 3 or 4 toxic effects increased with weekly treatment, these effects were predominantly uncomplicated. Febrile neutropenia and sensory neuropathy incidences were similar across groups., Interpretation: Weekly dose-dense chemotherapy can be delivered successfully as first-line treatment for epithelial ovarian cancer but does not significantly improve progression-free survival compared with standard 3-weekly chemotherapy in predominantly European populations., Funding: Cancer Research UK, Medical Research Council, Health Research Board in Ireland, Irish Cancer Society, Cancer Australia., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Published: 2019
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43. Diffusion kurtosis MRI as a predictive biomarker of response to neoadjuvant chemotherapy in high grade serous ovarian cancer.

Author: Deen SS, Priest AN, McLean MA, Gill AB, Brodie C, Crawford R, Latimer J, Baldwin P, Earl HM, Parkinson C, Smith S, Hodgkin C, Patterson I, Addley H, Freeman S, Moyle P, Jimenez-Linan M, Graves MJ, Sala E, Brenton JD, and Gallagher FA
Subjects: Adult, Aged, Aged, 80 and over, Cystadenocarcinoma, Serous drug therapy, Cystadenocarcinoma, Serous pathology, Environmental Biomarkers, Female, Humans, Middle Aged, Neoadjuvant Therapy methods, Ovarian Neoplasms drug therapy, Ovarian Neoplasms pathology, Ovary diagnostic imaging, Ovary pathology, Treatment Outcome, Cystadenocarcinoma, Serous diagnostic imaging, Diffusion Magnetic Resonance Imaging methods, Ovarian Neoplasms diagnostic imaging
Abstract: This study assessed the feasibility of using diffusion kurtosis imaging (DKI) as a measure of tissue heterogeneity and proliferation to predict the response of high grade serous ovarian cancer (HGSOC) to neoadjuvant chemotherapy (NACT). Seventeen patients with HGSOC were imaged at 3 T and had biopsy samples taken prior to any treatment. The patients were divided into two groups: responders and non-responders based on Response Evaluation Criteria In Solid Tumours (RECIST) criteria. The following imaging metrics were calculated: apparent diffusion coefficient (ADC), apparent diffusion (D app ) and apparent kurtosis (K app ). Tumour cellularity and proliferation were quantified using histology and Ki-67 immunohistochemistry. Mean K app before therapy was higher in responders compared to non-responders: 0.69 ± 0.13 versus 0.51 ± 0.11 respectively, P = 0.02. Tumour cellularity correlated positively with K app (rho = 0.50, P = 0.04) and negatively with both ADC (rho = -0.72, P = 0.001) and D app (rho = -0.80, P < 0.001). Ki-67 expression correlated with K app (rho = 0.53, P = 0.03) but not with ADC or D app . In conclusion, K app was found to be a potential predictive biomarker of NACT response in HGSOC, which suggests that DKI is a promising clinical tool for use oncology and radiology that should be evaluated further in future larger studies.
Published: 2019
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44. 6 versus 12 months of adjuvant trastuzumab for HER2-positive early breast cancer (PERSEPHONE): 4-year disease-free survival results of a randomised phase 3 non-inferiority trial.

Author: Earl HM, Hiller L, Vallier AL, Loi S, McAdam K, Hughes-Davies L, Harnett AN, Ah-See ML, Simcock R, Rea D, Raj S, Woodings P, Harries M, Howe D, Raynes K, Higgins HB, Wilcox M, Plummer C, Mansi J, Gounaris I, Mahler-Araujo B, Provenzano E, Chhabra A, Abraham JE, Caldas C, Hall PS, McCabe C, Hulme C, Miles D, Wardley AM, Cameron DA, and Dunn JA
Subjects: Adult, Aged, Aged, 80 and over, Antineoplastic Agents, Immunological adverse effects, Breast Neoplasms metabolism, Chemotherapy, Adjuvant, Disease-Free Survival, Drug Administration Schedule, Female, Humans, Infusions, Intravenous, Injections, Subcutaneous, Middle Aged, Prospective Studies, Receptor, ErbB-2 metabolism, Trastuzumab adverse effects, Treatment Outcome, United Kingdom, Young Adult, Antineoplastic Agents, Immunological administration & dosage, Breast Neoplasms drug therapy, Trastuzumab administration & dosage
Abstract: Background: Adjuvant trastuzumab significantly improves outcomes for patients with HER2-positive early breast cancer. The standard treatment duration is 12 months but shorter treatment could provide similar efficacy while reducing toxicities and cost. We aimed to investigate whether 6-month adjuvant trastuzumab treatment is non-inferior to the standard 12-month treatment regarding disease-free survival., Methods: This study is an open-label, randomised phase 3 non-inferiority trial. Patients were recruited from 152 centres in the UK. We randomly assigned patients with HER2-positive early breast cancer, aged 18 years or older, and with a clear indication for chemotherapy, by a computerised minimisation process (1:1), to receive either 6-month or 12-month trastuzumab delivered every 3 weeks intravenously (loading dose of 8 mg/kg followed by maintenance doses of 6 mg/kg) or subcutaneously (600 mg), given in combination with chemotherapy (concurrently or sequentially). The primary endpoint was disease-free survival, analysed by intention to treat, with a non-inferiority margin of 3% for 4-year disease-free survival. Safety was analysed in all patients who received trastuzumab. This trial is registered with EudraCT (number 2006-007018-39), ISRCTN (number 52968807), and ClinicalTrials.gov (number NCT00712140)., Findings: Between Oct 4, 2007, and July 31, 2015, 2045 patients were assigned to 12-month trastuzumab treatment and 2044 to 6-month treatment (one patient was excluded because they were double randomised). Median follow-up was 5·4 years (IQR 3·6-6·7) for both treatment groups, during which a disease-free survival event occurred in 265 (13%) of 2043 patients in the 6-month group and 247 (12%) of 2045 patients in the 12-month group. 4-year disease-free survival was 89·4% (95% CI 87·9-90·7) in the 6-month group and 89·8% (88·3-91·1) in the 12-month group (hazard ratio 1·07 [90% CI 0·93-1·24], non-inferiority p=0·011), showing non-inferiority of the 6-month treatment. 6-month trastuzumab treatment resulted in fewer patients reporting severe adverse events (373 [19%] of 1939 patients vs 459 [24%] of 1894 patients, p=0·0002) or stopping early because of cardiotoxicity (61 [3%] of 1939 patients vs 146 [8%] of 1894 patients, p<0·0001)., Interpretation: We have shown that 6-month trastuzumab treatment is non-inferior to 12-month treatment in patients with HER2-positive early breast cancer, with less cardiotoxicity and fewer severe adverse events. These results support consideration of reduced duration trastuzumab for women at similar risk of recurrence as to those included in the trial., Funding: UK National Institute for Health Research, Health Technology Assessment Programme., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Published: 2019
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45. Sodium MRI with 3D-cones as a measure of tumour cellularity in high grade serous ovarian cancer.

Author: Deen SS, Riemer F, McLean MA, Gill AB, Kaggie JD, Grist JT, Crawford R, Latimer J, Baldwin P, Earl HM, Parkinson CA, Smith SA, Hodgkin C, Moore E, Jimenez-Linan M, Brodie CR, Addley HC, Freeman SJ, Moyle PL, Sala E, Graves MJ, Brenton JD, and Gallagher FA
Abstract: The aim of this study was to assess the feasibility of rapid sodium MRI ( 23 Na-MRI) for the imaging of peritoneal cancer deposits in high grade serous ovarian cancer (HGSOC) and to evaluate the relationship of 23 Na-MRI with tumour cellularity. 23 Na-MRI was performed at 3 T on twelve HGSOC patients using a 3D-cones acquisition technique. Tumour biopsies specimens were collected after imaging and cellularity was measured from histology. Total 23 Na-MRI scan time for each patient was approximately 11 min. At an isotropic resolution of 5.6 mm, signal-to-noise ratios (SNRs) of 82.2 ± 15.3 and 15.1 ± 7.1 (mean ± standard deviation) were achieved for imaging of tumour tissue sodium concentration (TSC) and intracellular weighted sodium concentration (IWS) respectively. Tumour TSC and IWS concentrations were: 56.8 ± 19.1 mM and 30.8 ± 9.2 mM respectively and skeletal muscle TSC and IWS concentrations were 33.2 ± 16.3 mM and 20.5 ± 9.9 mM respectively. There were significant sodium concentration differences between cancer and skeletal muscle, Wilcoxon signed-rank test, P < 0.001 for TSC and P = 0.01 for IWS imaging. Tumour cellularity displayed a strong negative correlation with TSC, Spearman's rho = -0.92, P < 0.001, but did not correlate with IWS. This study demonstrates that 23 Na-MRI using 3D-cones can rapidly assess sodium concentration in peritoneal deposits of HGSOC and that TSC may serve as a biomarker of tumour cellularity.
Published: 2019
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46. Genome-wide association study of germline variants and breast cancer-specific mortality.

Author: Escala-Garcia M, Guo Q, Dörk T, Canisius S, Keeman R, Dennis J, Beesley J, Lecarpentier J, Bolla MK, Wang Q, Abraham J, Andrulis IL, Anton-Culver H, Arndt V, Auer PL, Beckmann MW, Behrens S, Benitez J, Bermisheva M, Bernstein L, Blomqvist C, Boeckx B, Bojesen SE, Bonanni B, Børresen-Dale AL, Brauch H, Brenner H, Brentnall A, Brinton L, Broberg P, Brock IW, Brucker SY, Burwinkel B, Caldas C, Caldés T, Campa D, Canzian F, Carracedo A, Carter BD, Castelao JE, Chang-Claude J, Chanock SJ, Chenevix-Trench G, Cheng TD, Chin SF, Clarke CL, Cordina-Duverger E, Couch FJ, Cox DG, Cox A, Cross SS, Czene K, Daly MB, Devilee P, Dunn JA, Dunning AM, Durcan L, Dwek M, Earl HM, Ekici AB, Eliassen AH, Ellberg C, Engel C, Eriksson M, Evans DG, Figueroa J, Flesch-Janys D, Flyger H, Gabrielson M, Gago-Dominguez M, Galle E, Gapstur SM, García-Closas M, García-Sáenz JA, Gaudet MM, George A, Georgoulias V, Giles GG, Glendon G, Goldgar DE, González-Neira A, Alnæs GIG, Grip M, Guénel P, Haeberle L, Hahnen E, Haiman CA, Håkansson N, Hall P, Hamann U, Hankinson S, Harkness EF, Harrington PA, Hart SN, Hartikainen JM, Hein A, Hillemanns P, Hiller L, Holleczek B, Hollestelle A, Hooning MJ, Hoover RN, Hopper JL, Howell A, Huang G, Humphreys K, Hunter DJ, Janni W, John EM, Jones ME, Jukkola-Vuorinen A, Jung A, Kaaks R, Kabisch M, Kaczmarek K, Kerin MJ, Khan S, Khusnutdinova E, Kiiski JI, Kitahara CM, Knight JA, Ko YD, Koppert LB, Kosma VM, Kraft P, Kristensen VN, Krüger U, Kühl T, Lambrechts D, Le Marchand L, Lee E, Lejbkowicz F, Li L, Lindblom A, Lindström S, Linet M, Lissowska J, Lo WY, Loibl S, Lubiński J, Lux MP, MacInnis RJ, Maierthaler M, Maishman T, Makalic E, Mannermaa A, Manoochehri M, Manoukian S, Margolin S, Martinez ME, Mavroudis D, McLean C, Meindl A, Middha P, Miller N, Milne RL, Moreno F, Mulligan AM, Mulot C, Nassir R, Neuhausen SL, Newman WT, Nielsen SF, Nordestgaard BG, Norman A, Olsson H, Orr N, Pankratz VS, Park-Simon TW, Perez JIA, Pérez-Barrios C, Peterlongo P, Petridis C, Pinchev M, Prajzendanc K, Prentice R, Presneau N, Prokofieva D, Pylkäs K, Rack B, Radice P, Ramachandran D, Rennert G, Rennert HS, Rhenius V, Romero A, Roylance R, Saloustros E, Sawyer EJ, Schmidt DF, Schmutzler RK, Schneeweiss A, Schoemaker MJ, Schumacher F, Schwentner L, Scott RJ, Scott C, Seynaeve C, Shah M, Simard J, Smeets A, Sohn C, Southey MC, Swerdlow AJ, Talhouk A, Tamimi RM, Tapper WJ, Teixeira MR, Tengström M, Terry MB, Thöne K, Tollenaar RAEM, Tomlinson I, Torres D, Truong T, Turman C, Turnbull C, Ulmer HU, Untch M, Vachon C, van Asperen CJ, van den Ouweland AMW, van Veen EM, Wendt C, Whittemore AS, Willett W, Winqvist R, Wolk A, Yang XR, Zhang Y, Easton DF, Fasching PA, Nevanlinna H, Eccles DM, Pharoah PDP, and Schmidt MK
Subjects: Bayes Theorem, Breast Neoplasms metabolism, Chromosomes, Human, Pair 7, Female, Genetic Variation, Genome-Wide Association Study, Humans, Prognosis, Proportional Hazards Models, Receptors, Estrogen genetics, Receptors, Estrogen metabolism, White People genetics, Breast Neoplasms genetics, Breast Neoplasms mortality
Abstract: Background: We examined the associations between germline variants and breast cancer mortality using a large meta-analysis of women of European ancestry., Methods: Meta-analyses included summary estimates based on Cox models of twelve datasets using ~10.4 million variants for 96,661 women with breast cancer and 7697 events (breast cancer-specific deaths). Oestrogen receptor (ER)-specific analyses were based on 64,171 ER-positive (4116) and 16,172 ER-negative (2125) patients. We evaluated the probability of a signal to be a true positive using the Bayesian false discovery probability (BFDP)., Results: We did not find any variant associated with breast cancer-specific mortality at P < 5 × 10 -8 . For ER-positive disease, the most significantly associated variant was chr7:rs4717568 (BFDP = 7%, P = 1.28 × 10 -7 , hazard ratio [HR] = 0.88, 95% confidence interval [CI] = 0.84-0.92); the closest gene is AUTS2. For ER-negative disease, the most significant variant was chr7:rs67918676 (BFDP = 11%, P = 1.38 × 10 -7 , HR = 1.27, 95% CI = 1.16-1.39); located within a long intergenic non-coding RNA gene (AC004009.3), close to the HOXA gene cluster., Conclusions: We uncovered germline variants on chromosome 7 at BFDP < 15% close to genes for which there is biological evidence related to breast cancer outcome. However, the paucity of variants associated with mortality at genome-wide significance underpins the challenge in providing genetic-based individualised prognostic information for breast cancer patients.
Published: 2019
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47. Adjuvant trastuzumab duration trials in HER2 positive breast cancer - what results would be practice-changing? Persephone investigator questionnaire prior to primary endpoint results.

Author: Hiller L, Dunn JA, Loi S, Vallier AL, Howe DL, Cameron DA, Miles D, Wardley AM, and Earl HM
Subjects: Antineoplastic Agents, Immunological administration & dosage, Antineoplastic Agents, Immunological adverse effects, Breast Neoplasms metabolism, Breast Neoplasms pathology, Cardiotoxicity, Chemotherapy, Adjuvant, Female, Humans, Perception, Receptor, ErbB-2 metabolism, Surveys and Questionnaires, Trastuzumab administration & dosage, Trastuzumab adverse effects, Treatment Outcome, Antineoplastic Agents, Immunological therapeutic use, Breast Neoplasms drug therapy, Breast Neoplasms epidemiology, Receptor, ErbB-2 antagonists & inhibitors, Trastuzumab therapeutic use
Abstract: Background: Twelve months treatment is the current standard of care for adjuvant trastuzumab in patients with HER2 positive early breast cancer however the optimal duration is not known. Persephone is a non-inferiority randomised controlled trial comparing 6- to 12-months of trastuzumab. In this trial there will be a trade-off between a possible small decrease in disease-free survival (DFS) with 6-months and reduced cardiotoxicity and cost., Methods: A structured questionnaire asked clinicians who had recruited patients into the Persephone trial about their prior beliefs with regards to the clinical effectiveness of trastuzumab and cardiotoxicity profile, in the comparison of 6- and 12-month durations., Results: Fifty-one clinicians from 40 of the 152 Persephone sites completed the questionnaire. 30/50 responders (60%) believed that 6-months trastuzumab would give the same 4-year DFS rate as 12-months trastuzumab, with 21/50 (42%) holding this belief across all breast cancer subsets. In addition, 46/49 responders (94%) reported expecting to change their clinical practice to 6-months, with their prior beliefs (most commonly 85% 4-year DFS rate with 6-months) being greater than their lowest acceptable rate (most commonly 83% 4-year DFS rate with 6-months). Low levels of cardiotoxicity were expected with both 6 and 12-months trastuzumab, with the majority expecting lower levels with 6-months. With increasing hypothesised differences of cardiotoxicity rates between the two durations, significantly lower levels of 4-year DFS with 6-months trastuzumab were deemed acceptable (p < 0.0001)., Conclusion: Most responders believe that 6-months trastuzumab is adequate, both overall and within each subset of breast cancer, and plan to change their clinical practice if the Persephone results support their prior belief. An individual patient meta-analysis of the duration trials would give greater precision to estimates of the differences in efficacy and toxicity, and adequate statistical power to establish a 2% level of non-inferiority for 6-months adjuvant trastuzumab.
Published: 2018
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48. Body mass index and breast cancer survival: a Mendelian randomization analysis.

Author: Guo Q, Burgess S, Turman C, Bolla MK, Wang Q, Lush M, Abraham J, Aittomäki K, Andrulis IL, Apicella C, Arndt V, Barrdahl M, Benitez J, Berg CD, Blomqvist C, Bojesen SE, Bonanni B, Brand JS, Brenner H, Broeks A, Burwinkel B, Caldas C, Campa D, Canzian F, Chang-Claude J, Chanock SJ, Chin SF, Couch FJ, Cox A, Cross SS, Cybulski C, Czene K, Darabi H, Devilee P, Diver WR, Dunning AM, Earl HM, Eccles DM, Ekici AB, Eriksson M, Evans DG, Fasching PA, Figueroa J, Flesch-Janys D, Flyger H, Gapstur SM, Gaudet MM, Giles GG, Glendon G, Grip M, Gronwald J, Haeberle L, Haiman CA, Hall P, Hamann U, Hankinson S, Hartikainen JM, Hein A, Hiller L, Hogervorst FB, Holleczek B, Hooning MJ, Hoover RN, Humphreys K, Hunter DJ, Hüsing A, Jakubowska A, Jukkola-Vuorinen A, Kaaks R, Kabisch M, Kataja V, Knight JA, Koppert LB, Kosma VM, Kristensen VN, Lambrechts D, Le Marchand L, Li J, Lindblom A, Lindström S, Lissowska J, Lubinski J, Machiela MJ, Mannermaa A, Manoukian S, Margolin S, Marme F, Martens JWM, McLean C, Menéndez P, Milne RL, Marie Mulligan A, Muranen TA, Nevanlinna H, Neven P, Nielsen SF, Nordestgaard BG, Olson JE, Perez JIA, Peterlongo P, Phillips KA, Poole CJ, Pylkäs K, Radice P, Rahman N, Rüdiger T, Rudolph A, Sawyer EJ, Schumacher F, Seibold P, Seynaeve C, Shah M, Smeets A, Southey MC, Tollenaar RAEM, Tomlinson I, Tsimiklis H, Ulmer HU, Vachon C, van den Ouweland AMW, Van't Veer LJ, Wildiers H, Willett W, Winqvist R, Zamora MP, Chenevix-Trench G, Dörk T, Easton DF, García-Closas M, Kraft P, Hopper JL, Zheng W, Schmidt MK, and Pharoah PDP
Subjects: Causality, Europe epidemiology, Female, Genetic Variation, Humans, Mendelian Randomization Analysis, Meta-Analysis as Topic, Polymorphism, Single Nucleotide, Risk Assessment, Risk Factors, Survival Analysis, Body Mass Index, Breast Neoplasms genetics, Breast Neoplasms mortality, Receptors, Estrogen genetics, White People statistics & numerical data
Abstract: Background: There is increasing evidence that elevated body mass index (BMI) is associated with reduced survival for women with breast cancer. However, the underlying reasons remain unclear. We conducted a Mendelian randomization analysis to investigate a possible causal role of BMI in survival from breast cancer., Methods: We used individual-level data from six large breast cancer case-cohorts including a total of 36 210 individuals (2475 events) of European ancestry. We created a BMI genetic risk score (GRS) based on genotypes at 94 known BMI-associated genetic variants. Association between the BMI genetic score and breast cancer survival was analysed by Cox regression for each study separately. Study-specific hazard ratios were pooled using fixed-effect meta-analysis., Results: BMI genetic score was found to be associated with reduced breast cancer-specific survival for estrogen receptor (ER)-positive cases [hazard ratio (HR) = 1.11, per one-unit increment of GRS, 95% confidence interval (CI) 1.01-1.22, P = 0.03). We observed no association for ER-negative cases (HR = 1.00, per one-unit increment of GRS, 95% CI 0.89-1.13, P = 0.95)., Conclusions: Our findings suggest a causal effect of increased BMI on reduced breast cancer survival for ER-positive breast cancer. There is no evidence of a causal effect of higher BMI on survival for ER-negative breast cancer cases., (© The Author 2017. Published by Oxford University Press on behalf of the International Epidemiological Association)
Published: 2017
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49. Disease-free and overall survival at 3.5 years for neoadjuvant bevacizumab added to docetaxel followed by fluorouracil, epirubicin and cyclophosphamide, for women with HER2 negative early breast cancer: ARTemis Trial.

Author: Earl HM, Hiller L, Dunn JA, Blenkinsop C, Grybowicz L, Vallier AL, Gounaris I, Abraham JE, Hughes-Davies L, McAdam K, Chan S, Ahmad R, Hickish T, Rea D, Caldas C, Bartlett JMS, Cameron DA, Provenzano E, Thomas J, and Hayward RL
Subjects: Breast Neoplasms pathology, Cyclophosphamide therapeutic use, Docetaxel, Early Diagnosis, Epirubicin therapeutic use, Female, Fluorouracil therapeutic use, Genes, erbB-2, Humans, Middle Aged, Neoadjuvant Therapy, Remission Induction, Survival Analysis, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bevacizumab therapeutic use, Breast Neoplasms drug therapy, Taxoids therapeutic use
Abstract: Background: The ARTemis trial previously reported that addition of neoadjuvant bevacizumab (Bev) to docetaxel (D) followed by fluorouracil, epirubicin and cyclophosphamide (D-FEC) in HER2 negative breast cancer improved the pathological complete response (pCR) rate. We present disease-free survival (DFS) and overall survival (OS) with central pathology review., Patients and Methods: Patients were randomized to 3 cycles of D followed by 3 cycles of FEC (D-FEC), ±4 cycles of Bev (Bev + D-FEC). DFS and OS were analyzed by treatment and by central pathology reviewed pCR and Residual Cancer Burden (RCB) class., Results: A total of 800 patients were randomized [median follow-up 3.5 years (IQR 3.2-4.4)]. DFS and OS were similar across treatment arms [DFS hazard ratio (HR)=1.18 (95% CI 0.89-1.57), P = 0.25; OS HR = 1.26 (95% CI 0.90-1.76), P = 0.19). Both local pathology report review and central histopathology review confirmed a significant improvement in DFS and OS for patients who achieved a pCR [DFS HR = 0.38 (95% CI 0.23-0.63), P < 0.001; OS HR = 0.43 (95% CI 0.24-0.75), P = 0.003]. However, significant heterogeneity was observed (P = 0.02); larger improvements in DFS were obtained with a pCR achieved with D-FEC than a pCR achieved with Bev + D-FEC. As RCB class increased, significantly worse DFS and OS was observed (P for trend <0.0001), which effect was most marked in the ER negative group., Conclusions: The addition of short course neoadjuvant Bev to standard chemotherapy did not demonstrate a DFS or OS benefit. Achieving a pCR with D-FEC is associated with improved DFS and OS but not when pCR is achieved with Bev + D-FEC. At the present time therefore, Bev is not recommended in early breast cancer., Clinicaltrials.gov Number: NCT01093235., (© The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
Published: 2017
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50. Central pathology review with two-stage quality assurance for pathological response after neoadjuvant chemotherapy in the ARTemis Trial.

Author: Thomas JSJ, Provenzano E, Hiller L, Dunn J, Blenkinsop C, Grybowicz L, Vallier AL, Gounaris I, Abraham J, Hughes-Davies L, McAdam K, Chan S, Ahmad R, Hickish T, Houston S, Rea D, Caldas C, Bartlett JM, Cameron DA, Hayward RL, and Earl HM
Subjects: Adult, Aged, Breast Neoplasms pathology, Chemotherapy, Adjuvant, Clinical Trials, Phase III as Topic, Female, Humans, Middle Aged, Neoadjuvant Therapy, Randomized Controlled Trials as Topic, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Breast Neoplasms drug therapy, Neoplasm, Residual epidemiology, Pathology, Clinical standards, Quality Assurance, Health Care
Abstract: The ARTemis Trial tested standard neoadjuvant chemotherapy±bevacizumab in the treatment of HER2-negative early breast cancer. We compare data from central pathology review with report review and also the reporting behavior of the two central pathologists. Eight hundred women with HER2-negative early invasive breast cancer were recruited. Response to chemotherapy was assessed from local pathology reports for pathological complete response in breast and axillary lymph nodes. Sections from the original core biopsy and surgical excision were centrally reviewed by one of two trial pathologists blinded to the local pathology reports. Pathologists recorded response to chemotherapy descriptively and also calculated residual cancer burden. 10% of cases were double-reported to compare the central pathologists' reporting behavior. Full sample retrieval was obtained for 681 of the 781 patients (87%) who underwent surgery within the trial and were evaluable for pathological complete response. Four hundred and eighty-three (71%) were assessed by JSJT, and 198 (29%) were assessed by EP. Residual cancer burden calculations were possible in 587/681 (86%) of the centrally reviewed patients, as 94/681 (14%) had positive sentinel nodes removed before neoadjuvant chemotherapy invalidating residual cancer burden scoring. Good concordance was found between the two pathologists for residual cancer burden classes within the 65-patient quality assurance exercise (kappa 0.63 (95% CI: 0.57-0.69)). Similar results were obtained for the between-treatment arm comparison both from the report review and the central pathology review. For pathological complete response, report review was as good as central pathology review but for minimal residual disease, report review overestimated the extent of residual disease. In the ARTemis Trial central pathology review added little in the determination of pathological complete response but had a role in evaluating low levels of residual disease. Calculation of residual cancer burden was a simple and reproducible method of quantifying response to neoadjuvant chemotherapy as demonstrated by performance comparison of the two pathologists.
Published: 2017
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