- Wolf, Denise M;
- Yau, Christina;
- Wulfkuhle, Julia;
- Brown-Swigart, Lamorna;
- Gallagher, Rosa I;
- Lee, Pei Rong Evelyn;
- Zhu, Zelos;
- Magbanua, Mark J;
- Sayaman, Rosalyn;
- O’Grady, Nicholas;
- Basu, Amrita;
- Delson, Amy;
- Coppé, Jean Philippe;
- Lu, Ruixiao;
- Braun, Jerome;
- Investigators, I-SPY2;
- Asare, Smita M;
- Sit, Laura;
- Matthews, Jeffrey B;
- Perlmutter, Jane;
- Hylton, Nola;
- Liu, Minetta C;
- Pohlmann, Paula;
- Symmans, W Fraser;
- Rugo, Hope S;
- Isaacs, Claudine;
- DeMichele, Angela M;
- Yee, Douglas;
- Berry, Donald A;
- Pusztai, Lajos;
- Petricoin, Emanuel F;
- Hirst, Gillian L;
- Esserman, Laura J;
- van 't Veer, Laura J
Using pre-treatment gene expression, protein/phosphoprotein, and clinical data from the I-SPY2 neoadjuvant platform trial (NCT01042379), we create alternative breast cancer subtypes incorporating tumor biology beyond clinical hormone receptor (HR) and human epidermal growth factor receptor-2 (HER2) status to better predict drug responses. We assess the predictive performance of mechanism-of-action biomarkers from ∼990 patients treated with 10 regimens targeting diverse biology. We explore >11 subtyping schemas and identify treatment-subtype pairs maximizing the pathologic complete response (pCR) rate over the population. The best performing schemas incorporate Immune, DNA repair, and HER2/Luminal phenotypes. Subsequent treatment allocation increases the overall pCR rate to 63% from 51% using HR/HER2-based treatment selection. pCR gains from reclassification and improved patient selection are highest in HR+ subsets (>15%). As new treatments are introduced, the subtyping schema determines the minimum response needed to show efficacy. This data platform provides an unprecedented resource and supports the usage of response-based subtypes to guide future treatment prioritization.