Differential Benefit of Metronomic Chemotherapy Among Triple-Negative Breast Cancer Subtypes Treated in the IBCSG Trial 22-00.

Abstract

PURPOSE:

To explore whether specific triple-negative breast cancer (TNBC) molecular subtypes are predictive for a benefit from maintenance low-dose cyclophosphamide and methotrexate (CM) in the adjuvant IBCSG 22-00 phase III clinical trial.

EXPERIMENTAL DESIGN:

RNA sequencing was performed on a selection of 347 TNBC formalin-fixed paraffin-embedded (FFPE) tumor samples following a case-cohort-like sampling. TNBC subtypes were computed on gene expression data. The association between TNBC subtypes and treatment outcome was assessed using a Cox proportional-hazards interaction test.

RESULTS:

Immunomodulatory (IM) and basal-like/immune activated (BLIA) molecular subtypes showed a significant survival benefit when treated with low-dose CM [disease-free survival (DFS): HR, 0.5; 95% confidence interval (CI), 0.28-0.89; Pinteraction = 0.018 and HR, 0.49; 95% CI, 0.27-0.9; Pinteraction = 0.021]. Moreover, a high expression of regulatory T-cell immune signature was associated with a better prognosis in the CM arm, in line with a potential immunomodulating role of cyclophosphamide. In contrast, a worse outcome was observed in tumors with a mesenchymal (M) subtype treated with low-dose CM (DFS: HR, 1.9; 95% CI, 1.2-3; Pinteraction = 0.0044).

CONCLUSIONS:

Our results show a differential benefit of low-dose CM therapy across different TNBC subtypes. Low-dose CM therapy could be considered as a potential strategy for TNBC tumors with IM subtype in the early-disease setting.

• Authors: Andrea Joaquin Garcia, Mattia Rediti, David Venet, Samira Majjaj, Roswitha Kammler, Elisabetta Munzone, Lorenzo Gianni, Beat Thürlimann, István Laáng, Marco Colleoni, Sherene Loi, Giuseppe Viale, Meredith M Regan, Laurence Buisseret, Françoise Rothé, Christos Sotiriou
• Journal: Clinical cancer research : an official journal of the American Association for Cancer Research (Clin Cancer Res) Vol. 29 Issue 23 Pg. 4908-4919 (12 01 2023) ISSN: 1557-3265 [Electronic] United States
• PMID: 37733800 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: ©2023 American Association for Cancer Research.

Chemical References

• Cyclophosphamide

Topics

• Humans
• Triple Negative Breast Neoplasms (drug therapy, genetics, pathology)
• Treatment Outcome
• Disease-Free Survival
• Prognosis
• Chemotherapy, Adjuvant (methods)
• Cyclophosphamide