Molecular correlates of response to eribulin and pembrolizumab in hormone receptor-positive metastatic breast cancer.

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA. Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. Breast Tumor Immunology Laboratory, Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA. Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. Ludwig Center for Cancer Research at Harvard, Harvard Medical School, Boston, MA, USA. Oncology Center, Hospital Sírio-Libanês, Brasília, Brazil. Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA. Medical Oncology Department, INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Institut Gustave Roussy, Villejuif, France. Harvard Graduate Program in Biophysics, Boston, MA, USA. Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA. Breast Cancer, Cancer Center, Massachusetts General Hospital, Boston, MA, USA. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. eliezerm_vanallen@dfci.harvard.edu. Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA. eliezerm_vanallen@dfci.harvard.edu. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. sara_tolaney@dfci.harvard.edu. Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. sara_tolaney@dfci.harvard.edu.

Nature communications. 2021;(1):5563

Abstract

Immune checkpoint inhibitors (ICIs) have minimal therapeutic effect in hormone receptor-positive (HR+ ) breast cancer. We present final overall survival (OS) results (n = 88) from a randomized phase 2 trial of eribulin ± pembrolizumab for patients with metastatic HR+ breast cancer, computationally dissect genomic and/or transcriptomic data from pre-treatment tumors (n = 52) for molecular associations with efficacy, and identify cytokine changes differentiating response and ICI-related toxicity (n = 58). Despite no improvement in OS with combination therapy (hazard ratio 0.95, 95% CI 0.59-1.55, p = 0.84), immune infiltration and antigen presentation distinguished responding tumors, while tumor heterogeneity and estrogen signaling independently associated with resistance. Moreover, patients with ICI-related toxicity had lower levels of immunoregulatory cytokines. Broadly, we establish a framework for ICI response in HR+ breast cancer that warrants diagnostic and therapeutic validation. ClinicalTrials.gov Registration: NCT03051659.

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