Pathologic and molecular responses to neoadjuvant trastuzumab and/or lapatinib from a phase II randomized trial in HER2-positive breast cancer (TRIO-US B07)

Sara A. Hurvitz (), Jennifer L. Caswell-Jin, Katherine L. McNamara, Jason J. Zoeller, Gregory R. Bean, Robert Dichmann, Alejandra Perez, Ravindranath Patel, Lee Zehngebot, Heather Allen, Linda Bosserman, Brian DiCarlo, April Kennedy, Armando Giuliano, Carmen Calfa, David Molthrop, Aruna Mani, Hsiao-Wang Chen, Judy Dering, Brad Adams, Eran Kotler, Michael F. Press, Joan S. Brugge, Christina Curtis () and Dennis J. Slamon
Additional contact information
Sara A. Hurvitz: University of California Los Angeles
Jennifer L. Caswell-Jin: Stanford University School of Medicine
Katherine L. McNamara: Stanford University School of Medicine
Jason J. Zoeller: Harvard Medical School
Gregory R. Bean: Stanford University School of Medicine
Robert Dichmann: Central Coast Medical Oncology
Alejandra Perez: University of Miami Miller School of Medicine
Ravindranath Patel: Comprehensive Blood & Cancer Center
Lee Zehngebot: Florida Cancer Specialists & Research Institute
Heather Allen: Comprehensive Cancer Centers of Nevada
Linda Bosserman: City of Hope Comprehensive Cancer Center
Brian DiCarlo: University of California Los Angeles
April Kennedy: FCPP Hematology/Oncology
Armando Giuliano: Cedars-Sinai Medical Center
Carmen Calfa: University of Miami Miller School of Medicine
David Molthrop: Florida Cancer Specialists & Research Institute
Aruna Mani: Genentech
Hsiao-Wang Chen: University of California Los Angeles
Judy Dering: University of California Los Angeles
Brad Adams: University of California Los Angeles
Eran Kotler: Stanford University School of Medicine
Michael F. Press: Keck School of Medicine, University of Southern California
Joan S. Brugge: Harvard Medical School
Christina Curtis: Stanford University School of Medicine
Dennis J. Slamon: University of California Los Angeles

Nature Communications, 2020, vol. 11, issue 1, 1-15

Abstract: Abstract In this multicenter, open-label, randomized phase II investigator-sponsored neoadjuvant trial with funding provided by Sanofi and GlaxoSmithKline (TRIO-US B07, Clinical Trials NCT00769470), participants with early-stage HER2-positive breast cancer (N = 128) were recruited from 13 United States oncology centers throughout the Translational Research in Oncology network. Participants were randomized to receive trastuzumab (T; N = 34), lapatinib (L; N = 36), or both (TL; N = 58) as HER2-targeted therapy, with each participant given one cycle of this designated anti-HER2 therapy alone followed by six cycles of standard combination chemotherapy with the same anti-HER2 therapy. The primary objective was to estimate the rate of pathologic complete response (pCR) at the time of surgery in each of the three arms. In the intent-to-treat population, we observed similar pCR rates between T (47%, 95% confidence interval [CI] 30–65%) and TL (52%, 95% CI 38–65%), and a lower pCR rate with L (25%, 95% CI 13–43%). In the T arm, 100% of participants completed all protocol-specified treatment prior to surgery, as compared to 69% in the L arm and 74% in the TL arm. Tumor or tumor bed tissue was collected whenever possible pre-treatment (N = 110), after one cycle of HER2-targeted therapy alone (N = 89), and at time of surgery (N = 59). Higher-level amplification of HER2 and hormone receptor (HR)-negative status were associated with a higher pCR rate. Large shifts in the tumor, immune, and stromal gene expression occurred after one cycle of HER2-targeted therapy. In contrast to pCR rates, the L-containing arms exhibited greater proliferation reduction than T at this timepoint. Immune expression signatures increased in all arms after one cycle of HER2-targeted therapy, decreasing again by the time of surgery. Our results inform approaches to early assessment of sensitivity to anti-HER2 therapy and shed light on the role of the immune microenvironment in response to HER2-targeted agents.

Date: 2020
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DOI: 10.1038/s41467-020-19494-2

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