Prognostic and predictive value of TP53 mutations in node-positive breast cancer patients treated with anthracycline- or anthracycline/taxane-based adjuvant therapy: results from the BIG 02-98 phase III trial

Lynnette Fernández-Cuesta, Catherine Oakman, Priscila Falagan-Lotsch, Ke-Seay Smoth, Emmanuel Quinaux, Marc Buyse, M Stella Dolci, Evandro De Azambuja, Pierre Hainaut, Patrizia Dell'orto, Denis Larsimont, Prudence A Francis, John Crown, Martine Piccart-Gebhart, Giuseppe Viale, Angelo Di Leo, Magali Olivier, Lynnette Fernández-Cuesta, Catherine Oakman, Priscila Falagan-Lotsch, Ke-Seay Smoth, Emmanuel Quinaux, Marc Buyse, M Stella Dolci, Evandro De Azambuja, Pierre Hainaut, Patrizia Dell'orto, Denis Larsimont, Prudence A Francis, John Crown, Martine Piccart-Gebhart, Giuseppe Viale, Angelo Di Leo, Magali Olivier

Abstract

Introduction: Pre-clinical data suggest p53-dependent anthracycline-induced apoptosis and p53-independent taxane activity. However, dedicated clinical research has not defined a predictive role for TP53 gene mutations. The aim of the current study was to retrospectively explore the prognosis and predictive values of TP53 somatic mutations in the BIG 02-98 randomized phase III trial in which women with node-positive breast cancer were treated with adjuvant doxorubicin-based chemotherapy with or without docetaxel.

Methods: The prognostic and predictive values of TP53 were analyzed in tumor samples by gene sequencing within exons 5 to 8. Patients were classified according to p53 protein status predicted from TP53 gene sequence, as wild-type (no TP53 variation or TP53 variations which are predicted not to modify p53 protein sequence) or mutant (p53 nonsynonymous mutations). Mutations were subcategorized according to missense or truncating mutations. Survival analyses were performed using the Kaplan-Meier method and log-rank test. Cox-regression analysis was used to identify independent predictors of outcome.

Results: TP53 gene status was determined for 18% (520 of 2887) of the women enrolled in BIG 02-98. TP53 gene variations were found in 17% (90 of 520). Nonsynonymous p53 mutations, found in 16.3% (85 of 520), were associated with older age, ductal morphology, higher grade and hormone-receptor negativity. Of the nonsynonymous mutations, 12.3% (64 of 520) were missense and 3.6% were truncating (19 of 520). Only truncating mutations showed significant independent prognostic value, with an increased recurrence risk compared to patients with non-modified p53 protein (hazard ratio = 3.21, 95% confidence interval = 1.740 to 5.935, P = 0.0002). p53 status had no significant predictive value for response to docetaxel.

Conclusions: p53 truncating mutations were uncommon but associated with poor prognosis. No significant predictive role for p53 status was detected.

Trial registration: ClinicalTrials.gov NCT00174655.

Figures

Figure 1
Figure 1
Prognostic value of p53 mutations. Survival in p53 wild-type versus p53 mutated cases, (a) DFS and (b) OS. Survival in p53 wild-type versus missense versus truncated mutations, (c) DFS and (d) OS. DFS, disease-free survival; OS, overall survival.
Figure 2
Figure 2
Value of p53 mutations in predicting DFS benefit from adding docetaxel to control anthracycline-based therapy. (a) Wild-type p53 versus mutant p53 protein. (b) p53 wild-type versus missense mutant versus truncated mutant. Treatment comparisons were made between (i) anthracycline control arms (A+AC) and sequential docetaxel (A-T); (ii) anthracycline control arms (A+AC) and concurrent docetaxel (AT); and (iii) anthracycline control arms (A+AC) and combined docetaxel arms (A-T+AT). A, doxorubicin; C, cyclophosphamide; DFS, disease-free survival; T, docetaxel.

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