Optimizing HER2-targeting using RNA- and DNA-based predictive algorithms

摘要 HER 2阳性疾病占所有乳腺癌的20%，是最具侵袭性的疾病之一， 可治疗的形式。HER 2阳性患者的结局已经通过几种治疗方法的发展而改变。 广泛用于I-IV期HER 2+乳腺癌的高效HER 2靶向药物， 单一药剂或双重HER 2靶向。这些药物使这种疾病的死亡率降低了近 然而，40%的药物成本很高-所有HER 2靶向药物的成本至少为100，000美元。 年我们也明显过度治疗了大约40，000名被诊断为患有癌症的非转移性患者中的许多人。 HER 2阳性乳腺癌在美国每年。大多数用于I-III期HER 2- 阳性乳腺癌包括给予2-3种细胞毒性药物加1-2种HER 2靶向药物的综合化疗 1年。 来自大型随机试验的基因组研究提供了改进的机会。几项研究 发现肿瘤和微环境影响是反应变异性的主要贡献者， 结果。来自CALGB 40601和其他HER 2靶向新辅助治疗试验的基于RNA和DNA的研究 药物提示肿瘤内在分子亚型和免疫细胞活化至少与 治疗类型在确定结果中的作用，并且可以识别对单一或双重HER 2- 面向.这些研究提出了一种更深思熟虑、更理性地治疗HER 2阳性乳腺癌的方法 患者，但我们必须全面合作。 我们建议将临床、基因表达、基因畸变、对 治疗，以及来自1500多名参与多项随机新辅助化疗的女性的结局数据。 HER 2靶向治疗的临床试验。我们将研究肿瘤和微环境因素在 确定对HER 2靶向的应答，病理完全应答与结果的关系，以及 HER 2阳性乳腺癌中双重或单一HER 2靶向治疗后残留疾病的生物学。

ABSTRACT HER2-positive disease, which comprises 20% of all breast cancers, is among the most aggressive but treatable forms. Outcomes for HER2-positive patients have been transformed by the development of several highly effective HER2-targeting agents that are given broadly for stages I-IV HER2+ breast cancer either as single agents or as dual HER2-targeting. These drugs have reduced death rates from this disease by nearly 40%, however come at a high financial cost – all HER2-targeted drugs individually cost at least $100,000 per year. We also clearly overtreat many of the approximately 40,000 non-metastatic patients diagnosed with HER2-positive breast cancers in the U.S. each year. Most of the treatment regimens used in stages I-III HER2- positive breast cancer include polychemotherapy with 2-3 cytotoxic drugs plus 1-2 HER2-targeted drugs given for 1 year. Genomic studies from large randomized trials provide opportunities for improvement. Several studies have found that tumor and microenvironmental influences are major contributors to variability in response and outcome. RNA- and DNA-based studies from CALGB 40601 and other neoadjuvant trials of HER2-targeting agents suggest that tumor intrinsic molecular subtype and immune cell activation are at least as important as treatment type in determining outcome and can identify tumors that respond best to single or dual HER2- targeting. These studies suggest a way to more thoughtfully and rationally treat HER2-positive breast cancer patients, but we must do this collaboratively and comprehensively. We propose to collectively integrate and analyze the clinical, gene expression, gene aberration, response to therapy, and outcomes data from more than 1500 women participating in multiple randomized neoadjuvant clinical trials of HER2-targeted therapy. We will examine the role of tumor and microenvironmental factors in determining response to HER2-targeting, relationship of pathologic complete response to outcome, and the biology of residual disease after dual or single HER2-targeting in HER2-positive breast cancer.