Tumori Journal Abstract Book - October 2020 - 38

38	

Tumori Journal 106(2S)

Dipartimento di Medicina Specialistica, di Laboratorio e Sperimentale,
Università Alma Mater, Bologna; 6Dipartimento di Oncologia - Istituto Mario
Negri - IRCCS, Milano; 7Università della Campania "L. Vanvitelli", Napoli;
8
Precision Oncology, IFOM-FIRC Institute of Molecular Oncology, Milano

Background: Central nervous system (CNS) metastases
rarely occur in metastatic colorectal cancer (mCRC)
patients (1-4%). HER2 amplification can be detected in
5% of RAS WT mCRC and has been recognized as a therapeutic target for trastuzumab in combination with lapatinib or pertuzumab. We recently reported a high rate of
CNS recurrences (19%) among HER2-positive mCRC
treated with trastuzumab and lapatinib (Sartore-Bianchi
et al. JAMA Oncol 2020). Here we describe the prevalence, timing of onset and characteristics in a larger cohort
of patients.
Patients and Methods: Consecutive patients with HER2positive mCRC by immunohistochemistry and in-situ
hybridization, treated with both anti-HER2 regimens within

the multi-center HERACLES clinical program and per
institutional protocols at Niguarda Cancer Center were
included in the analysis.
Results: Between August 2012 and April 2020, 92 patients
have been treated with an anti-HER2 regimen: 42 patients
received trastuzumab and lapatinib, 31 patients pertuzumab and T-DM1 and 19 patients other treatments in
clinical trials. Progression in CNS was clinically evident in
10/92 (11%). Clinical characteristics are provided in Table
1. In one patient, who underwent surgical removal of a cerebellum metastases, maintenance of HER2-positivity in
CNS was demonstrated.
Conclusions: Present data indicate a high prevalence of
CNS recurrences in HER2 positive mCRC, suggesting that
the CNS may represent a sanctuary of relapse, and brain
imaging for staging and tumor assessment is warranted.
Further studies are needed to understand the mechanisms
underlying this observed tropism.

Table 1. 
Patient

Anti-Her2
Treatment

ORR to anti-HER2
treatment

Brain PFS
(months)§

Timing of CNS
progression*

Brain metastases
treatment

OS (months)§

1
2
3
4
5
6
7
8
9
10

T+L
T+L
T+L
T+L
T+L
T+L
T+L
P+T-D
P+T-D -> O
O -> T+L

SD
PR
SD
PR
PD
SD
PD
PD
SD; PD
PR; PD

59.8
51.0
32.9
57.8
33.9
13.7
26.3
38.7
18.6
84.9

Off-treatment
On-treatment
On-treatment
Off-treatment
On-treatment
On-treatment
Off-treatment
Off-treatment
On-treatment
Off-treatment

Surgery
None
None
SRS
SRS
SRS
SRS
None
Surgery

77.9
51.3
36.5
62.6
36.8
21.4
29.0
45.7
19.8
85.4+

§
=from diagnosis of stage IV.
*= 2 pre-existing and stable after SRS, 5 documented under and 3 after anti-HER2 treatment.
ORR=Objective Response Rate; PFS=Progression Free Survival; OS=Overall Survival; PD=Progressive Disease; PR=Partial Response; SD=Stable
Disease; T=trastuzumab; L=lapatinib; P=pertuzumab; T-D=T-DM1; O=other anti-Her2 in clinical trial; SRS=Stereotactic radiosurgery; +=ongoing.

B17
Preoperative chemoradiotherapy
of locally advanced rectal
cancer and tumor-infiltrating
lymphocyte response related: the
SMART-STAR study
Negri F.1, Bottarelli L.1, Gnetti L.1, Campanini N.1, Negru E.2,
Bergamo F.3, Siena S.4, Frisinghelli M.5, Petric M.6, Chiaulon G.7,
Mosconi S.8, Gelsomino F.9, Azzoni C.1, Silini E.M.1, Valentini S.10,
Gaiani F.1, De'Angelis G.L.1, Leonardi F.1, Pedrazzi G.11, Aschele C.2
1

Azienda Ospedaliero-Universitaria di Parma, Parma; 2ASL5, La Spezia;
Istituto Oncologico Veneto IOV - IRCCS, Padova; 4Ospedale Niguarda,
Milano; 5Ospedale Civile Santa Chiara, Trento; 6Azienda Sanitaria dell'Alto
Adige, Bolzano; 7Azienda Sanitaria Universitaria Integrata di Udine,
Udine; 8Ospedale Papa Giovanni XXIII, Bergamo; 9Azienda OspedalieroUniversitaria di Modena, Modena; 10Ospedale Borgomanero, Novara;
11
Università degli Studi di Parma, Parma
3

Background: Preoperative chemoradiotherapy can
enhance antitumor immunity through increasing T-cell
activation and tumor infiltration. These effects could
potentially sensitize tumors to immunotherapies, including checkpoint inhibitors. We explored whether preoperative therapy for locally advanced rectal cancer induces
immunologic changes.
Materials and Methods: We analyzed by immunohistochemistry 55 cases, of whom 25 paired pre- and postoperative specimens of locally advanced rectal cancer from the
STAR-01 cohort. The multicenter study enrolled patients
treated with preoperative chemoradiation with or without
oxaliplatin. The immunoistochemical analysis was performed with a panel of immune cells and associated factors
as CD3, CD20, CD4/CD8, PD1 and FoxP3. The pattern of
tumor infiltrating lymphocytes (TILs) and related infiltrating lymphocytes (RILs) was also evaluated.



Tumori Journal Abstract Book - October 2020

Table of Contents for the Digital Edition of Tumori Journal Abstract Book - October 2020

Contents
Tumori Journal Abstract Book - October 2020 - Cover1
Tumori Journal Abstract Book - October 2020 - Cover2
Tumori Journal Abstract Book - October 2020 - I
Tumori Journal Abstract Book - October 2020 - II
Tumori Journal Abstract Book - October 2020 - Contents
Tumori Journal Abstract Book - October 2020 - IV
Tumori Journal Abstract Book - October 2020 - V
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Tumori Journal Abstract Book - October 2020 - Cover3
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