1. Immuno-priming durvalumab with bevacizumab in HER2-negative advanced breast cancer : a pilot clinical trial
- Author
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Quintela-Fandino, Miguel, Holgado, Esther, Manso, Luis, Morales, Serafin, Bermejo, Begoña, Colomer, Ramon, Apala, Juan V., Blanco, Raquel, Muñoz, Manuel, Caleiras, Eduardo, Iranzo, Vega, Martínez López, Mario, Dominguez, Orlando, Hornedo, Javier, Gonzalez-Cortijo, Lucia, Cortés, Javier, Gasol Cudos, Ariadna, Malon, Diego, Lopez-Alonso, Antonio, Moreno-Ortíz, María C., Mouron, Silvana, Mañes, Santos, Universitat Autònoma de Barcelona, Quintela-Fandino, Miguel, Holgado, Esther, Manso, Luis, Morales, Serafin, Bermejo, Begoña, Colomer, Ramon, Apala, Juan V., Blanco, Raquel, Muñoz, Manuel, Caleiras, Eduardo, Iranzo, Vega, Martínez López, Mario, Dominguez, Orlando, Hornedo, Javier, Gonzalez-Cortijo, Lucia, Cortés, Javier, Gasol Cudos, Ariadna, Malon, Diego, Lopez-Alonso, Antonio, Moreno-Ortíz, María C., Mouron, Silvana, Mañes, Santos, and Universitat Autònoma de Barcelona
- Abstract
Preclinical research suggests that the efficacy of immune checkpoint inhibitors in breast cancer can be enhanced by combining them with antiangiogenics, particularly in a sequential fashion. We sought to explore the efficacy and biomarkers of combining the anti-PD-L1 durvalumab plus the antiangiogenic bevacizumab after bevacizumab monotherapy for advanced HER2-negative breast cancer. Patients had advanced HER2-negative disease that progressed while receiving single-agent bevacizumab maintenance as a part of a previous chemotherapy plus bevacizumab regimen. Treatment consisted of bi-weekly durvalumab plus bevacizumab (10 mg/kg each i.v.). Peripheral-blood mononuclear cells (PBMCs) were obtained before the first durvalumab dose and every 4 weeks and immunophenotyped by flow-cytometry. A fresh pre-durvalumab tumor biopsy was obtained; gene-expression studies and immunohistochemical staining to assess vascular normalization and characterize the immune infiltrate were conducted. Patients were classified as "non-progressors" if they had clinical benefit (SD/PR/CR) at 4 months. The co-primary endpoints were the changes in the percentage T cell subpopulations in PBMCs in progressors versus non-progressors, and PFS/OS time. Twenty-six patients were accrued. Median PFS and OS were 3.5 and 11 months; a trend for a longer OS was detected for the hormone-positive subset (19.8 versus 7.4 months in triple-negatives; P = 0.11). Clinical benefit rate at 2 and 4 months was 60% and 44%, respectively, without significant differences between hormone-positive and triple-negative (P = 0.73). Non-progressors' tumors displayed vascular normalization features as a result of previous bevacizumab, compared with generally abnormal patterns observed in progressors. Non-progressors also showed increased T-effector and T-memory signatures and decreased T signatures in gene expression studies in baseline-post-bevacizumab-tumors compared with progressors. Notably, analysis of PBMC populations before
- Published
- 2020