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Heregulin (HRG) assessment for clinical trial eligibility testing in a molecular registry (PRAEGNANT) in Germany

Hanna Huebner, Christian M Kurbacher, Geoffrey Kuesters, Andreas D Hartkopf, Michael P Lux, Jens Huober, Bernhard Volz, Florin-Andrei Taran, Friedrich Overkamp, Hans Tesch, Lothar Häberle, Diana Lüftner, Markus Wallwiener, Volkmar Müller, Matthias W Beckmann, Erik Belleville, Matthias Ruebner, Michael Untch, Peter A Fasching, Wolfgang Janni, Tanja N Fehm, Hans-Christian Kolberg, Diethelm Wallwiener, Sara Y Brucker, Andreas Schneeweiss & Johannes Ettl

abstract

BACKGROUND
Eligibility criteria are a critical part of clinical trials, as they define the patient population under investigation. Besides certain patient characteristics, clinical trials often include biomarker testing for eligibility. However, patient-identification mostly relies on the trial site itself and is often a time-consuming procedure, which could result in missing out on potentially eligible patients. Pre-selection of those patients using a registry could facilitate the process of eligibility testing and increase the number of identified patients. One aim with the PRAEGNANT registry (NCT02338167) is to identify patients for therapies based on clinical and molecular data. Here, we report eligibility testing for the SHERBOC trial using the German PRAEGNANT registry.

METHODS
Heregulin (HRG) has been reported to identify patients with better responses to therapy with the anti-HER3 monoclonal antibody seribantumab (MM-121). The SHERBOC trial investigated adding seribantumab (MM-121) to standard therapy in patients with advanced HER2-negative, hormone receptor-positive (HR-positive) breast cancer and HRG overexpression. The PRAEGNANT registry was used for identification and tumor testing, helping to link potential HRG positive patients to the trial. Patients enrolled in PRAEGNANT have invasive and metastatic or locally advanced, inoperable breast cancer. Patients eligible for SHERBOC were identified by using the registry. Study aims were to describe the HRG positivity rate, screening procedures, and patient characteristics associated with inclusion and exclusion criteria.

RESULTS
Among 2769 unselected advanced breast cancer patients, 650 were HER2-negative, HR-positive and currently receiving first- or second-line treatment, thus potentially eligible for SHERBOC at the end of current treatment; 125 patients also met further clinical eligibility criteria (e.g. menopausal status, ECOG). In the first/second treatment lines, patients selected for SHERBOC based on further eligibility criteria had a more favorable prognosis than those not selected. HRG status was tested in 38 patients, 14 of whom (36.8%) proved to be HRG-positive.

CONCLUSION
Using a real-world breast cancer registry allowed identification of potentially eligible patients for SHERBOC focusing on patients with HER3 overexpressing, HR-positive, HER2-negative metastatic breast cancer. This approach may provide insights into differences between patients eligible or non-eligible for clinical trials.

TRIAL REGISTRATION
Clinicaltrials, NCT02338167 , Registered 14 January 2015 - retrospectively registered.
   
citation Huebner H, Kurbacher C M, Kuesters G, Hartkopf A D, Lux M P, Huober J, Volz B, Taran F A, Overkamp F, Tesch H, Häberle L, Lüftner D, Wallwiener M, Müller V, Beckmann M W, Belleville E, Ruebner M, Untch M, Fasching P A, Janni W, Fehm T N, Kolberg H C, Wallwiener D, Brucker S Y, Schneeweiss A, Ettl J. Heregulin (HRG) assessment for clinical trial eligibility testing in a molecular registry (PRAEGNANT) in Germany. BMC Cancer 2020; 20:1091.
   
type journal paper/review (English)
date of publishing 11-11-2020
journal title BMC Cancer (20/1)
ISSN electronic 1471-2407
pages 1091
PubMed 33176725
DOI 10.1186/s12885-020-07546-1