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William J. Gradishar, MD, FACP, FASCO
William J. Gradishar, MD, FACP, FASCO
Posted: Monday, March 4, 2024
Optimizing first-line subtyping-based therapy may improve clinical outcomes for patients with triple-negative breast cancer, according to Zhi-Ming Shao, MD, PhD, of Fudan University Shanghai Cancer Center, and colleagues. In fact, categorizing patients based upon molecular subtype and genetic biomarker status increased progression-free survival compared with the nonsubtyped group. The findings of this multicohort, randomized, phase II trial, FUTURE-SUPER, were published in The Lancet Oncology.
“The subtyping-based precision treatment concept will be iteratively updated following advances in drug development. The simplicity of this subtyping method and comprehensive coverage of the metastatic triple-negative breast cancer population makes it highly promising for transforming treatment approaches,” stated the study investigators. “Phase III randomized clinical trials assessing the efficacy of subtyping-based regimens are now underway.”
Women with untreated metastatic or recurrent triple-negative breast cancer were enrolled and randomly assigned to the subtyping-based group (n = 69) or the control group (n = 70). Patients were categorized into five subgroups based upon molecular subtype and genetic biomarkers. All groups received nab-paclitaxel, alone (control group) or in combination with an additional treatment specific to each subtype.
Those with luminal androgen receptor breast cancer with mutations in HER2 or PI3K/AKT mutations received the kinase inhibitor pyrotinib or the mTOR inhibitor everolimus, respectively. The mesenchymal-like and basal-like immune-suppressed PI3K/AKT-mutant groups and immunomodulatory group received the PD-1 inhibitor camrelizumab, the kinase inhibitor famitinib, and the angiogenesis inhibitor bevacizumab, respectively.
At the median follow-up of 22.5 months, median progression-free survival was longer in the pooled subtyping-based group (11.3 months) than in the control group (5.8 months, P < .0001). Neutropenia, anemia, and increased alanine aminotransferase levels were the most common grade 3 or 4 treatment-related adverse events, with serious events reported for seven (10%) patients in the subtyping-based group and none in the control group. No treatment-related deaths were reported.
Disclosure: Dr. Shao reported no conflicts of interest. However, two coauthors are employees of Jiangsu Hengrui Pharmaceuticals.
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