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This study evaluated the HER2DX variables in patients with advanced HER2+ metastatic breast cancer (MBC) treated with trastuzumab emtansine (T-DM1). The results demonstrated that ERBB2 mRNA expression, as measured using the standardized HER2DX assay, was associated with response to T-DM1. The overall response rate was higher in the ERBB2-high groups compared with the ERBB2-medium or ERBB2-low groups. ERBB2 mRNA expression was significantly associated with better progression-free survival and overall survival (OS) outcomes.
HER2DX risk and immunoglobulin signature scores were significantly associated with OS from the time of diagnosis. The standardized HER2DX genomic assay has potential predictive and prognostic utility in patients with advanced HER2+ MBC treated with T-DM1.
In advanced HER2-positive (HER2+) breast cancer (BC), the new antibody-drug conjugate trastuzumab deruxtecan (T-DXd) is more effective compared to trastuzumab emtansine (T-DM1). However, T-DXd can have significant toxicities, and the right treatment sequence is unknown. Biomarkers to guide the use of anti-HER2 therapies beyond HER2 status are needed. Here, we evaluated if pre-established levels of ERBB2 mRNA expression according to the HER2DX standardized assay are associated with response and survival following T-DM1. In ERBB2 low, medium, and high groups, the overall response rate was 0%, 29% and 56%, respectively (P<.001). ERBB2 mRNA was significantly associated with better progression-free survival (p = 0.002) and overall survival (OS; P = 0.02). These findings were independent of HER2 IHC levels, hormone receptor, age, brain metastasis and line of therapy. The HER2DX risk-score (P=.04) and the immunoglobulin (IGG) signature (P=.04) were significantly associated with OS since diagnosis. HER2DX provides prognostic and predictive information following T-DM1 in advanced HER2+ BC.
HER2DX ERBB2 mRNA expression in advanced HER2-positive breast cancer treated with T-DM1
J. Natl. Cancer Inst 2022 Dec 28;[EPub Ahead of Print], F Brasó-Maristany, G Griguolo, N Chic, T Pascual, L Paré, J Maues, P Galván, MV Dieci, F Miglietta, T Giarratano, O Martínez-Sáez, M Marín-Aguilera, F Schettini, B Conte, L Angelats, M Vidal, B Adamo, M Muñoz, E Sanfeliu, B González, A Vivancos, P Villagrasa, JS Parker, CM Perou, P Conte, A Prat, V Guarneri