801
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Collignon J, Lousberg L, Schroeder H, Jerusalem G. Triple-negative breast cancer: treatment challenges and solutions. BREAST CANCER (DOVE MEDICAL PRESS) 2016; 8:93-107. [PMID: 27284266 PMCID: PMC4881925 DOI: 10.2147/bctt.s69488] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Triple-negative breast cancers (TNBCs) are defined by the absence of estrogen and progesterone receptors and the absence of HER2 overexpression. These cancers represent a heterogeneous breast cancer subtype with a poor prognosis. Few systemic treatment options exist besides the use of chemotherapy (CT). The heterogeneity of the disease has limited the successful development of targeted therapy in unselected patient populations. Currently, there are no approved targeted therapies for TNBC. However, intense research is ongoing to identify specific targets and develop additional and better systemic treatment options. Standard adjuvant and neoadjuvant regimens include anthracyclines, cyclophosphamide, and taxanes. Platinum-based CT has been proposed as another CT option of interest in TNBC. We review the role of this therapy in general, and particularly in patients carrying BRCA germ-line mutations. Available data concerning the role of platinum-based CT in TNBC were acquired primarily in the neoadjuvant setting. The routine use of platinum-based CT is not yet recommended by available guidelines. Many studies have reported the molecular characterization of TNBCs. Several actionable targets have been identified. Novel therapeutic strategies are currently being tested in clinical trials based on promising results observed in preclinical studies. These targets include androgen receptor, EGFR, PARP, FGFR, and the angiogenic pathway. We review the recent data on experimental drugs in this field. We also discuss the recent data concerning immunologic checkpoint inhibitors.
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Affiliation(s)
- Joëlle Collignon
- Medical Oncology Department, CHU Sart Tilman Liege, Domaine Universitaire du Sart Tilman, Liege, Belgium
| | - Laurence Lousberg
- Medical Oncology Department, CHU Sart Tilman Liege, Domaine Universitaire du Sart Tilman, Liege, Belgium
| | - Hélène Schroeder
- Medical Oncology Department, CHU Sart Tilman Liege, Domaine Universitaire du Sart Tilman, Liege, Belgium
| | - Guy Jerusalem
- Medical Oncology Department, CHU Sart Tilman Liege, Domaine Universitaire du Sart Tilman, Liege, Belgium
- University of Liege, Liege, Belgium
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802
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Triple-negative breast cancer: challenges and opportunities of a heterogeneous disease. Nat Rev Clin Oncol 2016; 13:674-690. [PMID: 27184417 DOI: 10.1038/nrclinonc.2016.66] [Citation(s) in RCA: 1740] [Impact Index Per Article: 217.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chemotherapy is the primary established systemic treatment for patients with triple-negative breast cancer (TNBC) in both the early and advanced-stages of the disease. The lack of targeted therapies and the poor prognosis of patients with TNBC have fostered a major effort to discover actionable molecular targets to treat patients with these tumours. Massively parallel sequencing and other 'omics' technologies have revealed an unexpected level of heterogeneity of TNBCs and have led to the identification of potentially actionable molecular features in some TNBCs, such as germline BRCA1/2 mutations or 'BRCAness', the presence of the androgen receptor, and several rare genomic alterations. Whether these alterations are molecular 'drivers', however, has not been clearly established. A subgroup of TNBCs shows a high degree of tumour-infiltrating lymphocytes that also correlates with a lower risk of disease relapse and a higher likelihood of benefit from chemotherapy. Proof-of-principle studies with immune-checkpoint inhibitors in advanced-stage TNBC have yielded promising results, indicating the potential benefit of immunotherapy for patients with TNBC. In this Review, we discuss the most relevant molecular findings in TNBC from the past decade and the most promising therapeutic opportunities derived from these data.
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803
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Tumor-Infiltrating Lymphocytes: A Predictive and Prognostic Biomarker in Neoadjuvant-Treated HER2-Positive Breast Cancer. Clin Cancer Res 2016; 22:5747-5754. [DOI: 10.1158/1078-0432.ccr-15-2338] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 11/16/2022]
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804
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Park HS, Heo I, Kim JY, Kim S, Nam S, Park S, Kim SI. No effect of tumor-infiltrating lymphocytes (TILs) on prognosis in patients with early triple-negative breast cancer: Validation of recommendations by the International TILs Working Group 2014. J Surg Oncol 2016; 114:17-21. [PMID: 27157771 DOI: 10.1002/jso.24275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/15/2016] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of this study was to examine the International TILs Working Group 2014 (IWG) recommendations for evaluating the clinical utility of tumor-infiltrating lymphocytes (TILs) in patients with early triple-negative breast cancer (TNBC). METHODS Records for 133 patients with early TNBC who underwent surgery between 2008 and 2010 were reviewed. A total of 121 of 133 formalin-fixed, paraffin-embedded tumor samples were available and reviewed following IWG recommendations. RESULTS Most of the patients had node-negative T1-2 tumors and received adjuvant chemotherapy; T1-2 tumors accounted for 117 of 121 cases. Sixty-two percent (75/121) of all patients had >10% stromal TILs. Intratumoral TILs and lymphocyte-predominant breast cancer (LPBC) were observed in 72% and 19% of the patients, respectively. However, there were no significant differences according to the presence of stromal TILs, intratumoral TILs, TILs at the invasive edge, or LPBC in terms of recurrence-free and overall survival (all P > 0.05). A multivariate analysis adjusted for T and N stage, grade, and adjuvant chemotherapy revealed that no TILs parameters were associated with survival outcomes. CONCLUSIONS TILs evaluations following the IWG recommendations may not be useful for predicting survival outcomes in patients with early TNBC. J. Surg. Oncol. 2016;114:17-21. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ilyeong Heo
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sanghwa Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sanggeun Nam
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seho Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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805
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Immune infiltrates in the breast cancer microenvironment: detection, characterization and clinical implication. Breast Cancer 2016; 24:3-15. [PMID: 27138387 DOI: 10.1007/s12282-016-0698-z] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/10/2016] [Indexed: 12/24/2022]
Abstract
Although unlike melanoma, breast cancer is not generally viewed as a highly immunogenic cancer, recent studies have described a rich tumor immune microenvironment in a subset of breast cancers. These immune infiltrates, comprised cells from the innate and adaptive immune response, can be detected and characterized in biopsy specimens and have prognostic value. Tumor-infiltrating lymphocytes (TILs) represent the majority of mononuclear immune infiltrates in the breast tumor microenvironment and can be easily identified in formalin-fixed paraffin-embedded tissues after standard hematoxylin and eosin staining. High levels of TILs are most common in HER2+ and basal-like subtypes where they are associated with good prognosis and with response to certain therapies such as the anti-HER2 antibody trastuzumab. International collaborative efforts are underway to standardize the assessment of TILs so as to facilitate their implementation as a breast cancer biomarker. Using immunohistochemistry to further characterize TILs, recent reports describe the presence of important lymphocyte populations including CD8+ cytotoxic, FOXP3+ regulatory, and CD4+ helper and follicular T cells which have overlapping associations with prognosis and response to therapies. Moreover, recently identified immune checkpoint markers (PD-1, PD-L1) are present in some breast cancers, implying some cases might be especially amenable to immune checkpoint inhibitor treatment strategies which are being evaluated in a number of active clinical trials.
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806
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Yu X, Zhang Z, Wang Z, Wu P, Qiu F, Huang J. Prognostic and predictive value of tumor-infiltrating lymphocytes in breast cancer: a systematic review and meta-analysis. Clin Transl Oncol 2016; 18:497-506. [PMID: 26459255 PMCID: PMC4823351 DOI: 10.1007/s12094-015-1391-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/17/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Breast cancer is the most common invasive cancer to affect women in the world. Studies showed tumor-infiltrating lymphocytes can exhibit both beneficial and harmful effects on the biology and clinical outcome of breast cancer, the conclusion still remains incomplete. Here, we conducted a meta-analysis to evaluate the relationship between tumor-infiltrating lymphocytes and breast cancer. METHODS A comprehensive search strategy was used to search relevant literatures in PubMed and the ISI Web of Science. The correlation among TILs and breast cancer clinicopathological features and prognosis was analyzed by using Review Manager 5.3 and Stata 12.0. RESULT Seventeen eligible studies consisting of 12,968 participants were included. We found that higher value of tumor-infiltrating lymphocytes had no relationship with breast cancer clinicopathological variables. Interestingly, it was correlated with response to neoadjuvant chemotherapy in majority (pooled RR 2.43, 95% CI 1.99-2.97). Moreover, higher value of total tumor-infiltrating lymphocytes (both intraepithelial and stromal) was associated with better prognosis (pooled HR 0.88, 95% CI 0.83-0.94), whereas some subtypes predicted a worse prognosis. CONCLUSION This meta-analysis indicated that high value of total TILs is not associated with breast cancer clinicopathological features, but can predict a favorable outcome for neoadjuvant chemotherapy in majority except for hormone receptor (-) subtype. And higher total TILs (both intraepithelial TILs and stromal TILs) may be the potential better prognostic indicators, while some subtypes like PD-1(+) TILs and Foxp3(+) TILs show a worse prognosis.
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Affiliation(s)
- X. Yu
- />Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, National Ministry of Education, Provincial Key Laboratory of Molecular Biology in Medical Sciences), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China
- />Department of Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Z. Zhang
- />Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, National Ministry of Education, Provincial Key Laboratory of Molecular Biology in Medical Sciences), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China
- />Department of Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China
- />Department of Gynecology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Z. Wang
- />Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, National Ministry of Education, Provincial Key Laboratory of Molecular Biology in Medical Sciences), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - P. Wu
- />Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, National Ministry of Education, Provincial Key Laboratory of Molecular Biology in Medical Sciences), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - F. Qiu
- />Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, National Ministry of Education, Provincial Key Laboratory of Molecular Biology in Medical Sciences), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China
- />Department of Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - J. Huang
- />Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, National Ministry of Education, Provincial Key Laboratory of Molecular Biology in Medical Sciences), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China
- />Department of Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China
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807
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Duchnowska R, Pęksa R, Radecka B, Mandat T, Trojanowski T, Jarosz B, Czartoryska-Arłukowicz B, Olszewski WP, Och W, Kalinka-Warzocha E, Kozłowski W, Kowalczyk A, Loi S, Biernat W, Jassem J. Immune response in breast cancer brain metastases and their microenvironment: the role of the PD-1/PD-L axis. Breast Cancer Res 2016; 18:43. [PMID: 27117582 PMCID: PMC4847231 DOI: 10.1186/s13058-016-0702-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/04/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A better understanding of immune response in breast cancer brain metastases (BCBM) may prompt new preventive and therapeutic strategies. METHODS Immunohistochemical expression of stromal tumor-infiltrating lymphocytes (TILs: CD4, CD8, CTLA4), macrophage/microglial cells (CD68), programmed cell death protein 1 receptor (PD-1), programmed cell death protein 1 receptor ligand (PD-L)1, PD-L2 and glial fibrillary acid protein was assessed in 84 BCBM and their microenvironment. RESULTS Median survival after BCBM excision was 18.3 months (range 0-99). Median number of CD4+, CD8+ TILs and CD68+ was 49, 69 and 76 per 1 mm(2), respectively. PD-L1 and PD-L2 expression in BCBM was present in 53 % and 36 % of cases, and was not related to BCBM phenotype. PD-1 expression on TILs correlated positively with CD4+ and CD8+ TILs (r = 0.26 and 0.33), and so did CD68+ (r = 0.23 and 0.27, respectively). In the multivariate analysis, survival after BCBM excision positively correlated with PD-1 expression on TILs (hazard ratio (HR) = 0.3, P = 0.003), CD68+ infiltration (HR = 0.2, P < 0.001), brain radiotherapy (HR = 0.1, P < 0.001), endocrine therapy (HR = 0.1, P < 0.001), and negatively with hormone-receptor-negative/human epidermal growth factor receptor 2 (HER2)-positive phenotype of primary tumor (HR = 2.6, P = 0.01), HER2 expression in BCBM (HR = 4.9, P = 0.01). CONCLUSIONS PD-L1 and PD-L2 expression is a common occurrence in BCBM, irrespective of primary tumor and BCBM phenotype. Favorable prognostic impact of PD-1 expression on TILs suggests a beneficial effect of preexisting immunity and implies a potential therapeutic role of immune checkpoint inhibitors in BCBM.
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Affiliation(s)
- Renata Duchnowska
- />Department of Oncology, Military Institute of Medicine, Szaserów St 128, 04-141 Warsaw, Poland
| | - Rafał Pęksa
- />Department of Pathology, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
| | - Barbara Radecka
- />Department of Oncology, Regional Oncology Center, 66a Katowicka St, 45-060 Opole, Poland
| | - Tomasz Mandat
- />Department of Neurosurgery, Oncology Center-Institute, 5 Roentgena St, 02-781 Warsaw, Poland
| | - Tomasz Trojanowski
- />Department of Neurosurgery, Medical University of Lublin, 1 Al. Racławickie, 20-059 Lublin, Poland
| | - Bożena Jarosz
- />Department of Neurosurgery, Medical University of Lublin, 1 Al. Racławickie, 20-059 Lublin, Poland
| | | | - Wojciech P. Olszewski
- />Department of Pathology, Oncology Center-Institute, 5 Roentgena St, 02-781 Warsaw, Poland
| | - Waldemar Och
- />Department of Neurosurgery, Regional Hospital, 18 Żołnierska St, 10-561 Olsztyn, Poland
| | - Ewa Kalinka-Warzocha
- />Department of Oncology, Regional Oncology Center, 62 Pabianicka St, 93-513 Łódź, Poland
| | - Wojciech Kozłowski
- />Department of Pathology, Military Institute of Medicine, Szaserów St 128, 04-141 Warsaw, Poland
| | - Anna Kowalczyk
- />Department of Oncology and Radiotherapy, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
| | - Sherene Loi
- />Division of Cancer Medicine and Research, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, East Melbourne, VIC 8006 Australia
| | - Wojciech Biernat
- />Department of Pathology, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
| | - Jacek Jassem
- />Department of Oncology and Radiotherapy, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
| | - for the Polish Brain Metastasis Consortium
- />Department of Oncology, Military Institute of Medicine, Szaserów St 128, 04-141 Warsaw, Poland
- />Department of Pathology, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
- />Department of Oncology, Regional Oncology Center, 66a Katowicka St, 45-060 Opole, Poland
- />Department of Neurosurgery, Oncology Center-Institute, 5 Roentgena St, 02-781 Warsaw, Poland
- />Department of Neurosurgery, Medical University of Lublin, 1 Al. Racławickie, 20-059 Lublin, Poland
- />Department of Oncology, Regional Oncology Center, 12 Ogrodowa St, 15-027 Białystok, Poland
- />Department of Pathology, Oncology Center-Institute, 5 Roentgena St, 02-781 Warsaw, Poland
- />Department of Neurosurgery, Regional Hospital, 18 Żołnierska St, 10-561 Olsztyn, Poland
- />Department of Oncology, Regional Oncology Center, 62 Pabianicka St, 93-513 Łódź, Poland
- />Department of Pathology, Military Institute of Medicine, Szaserów St 128, 04-141 Warsaw, Poland
- />Department of Oncology and Radiotherapy, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
- />Division of Cancer Medicine and Research, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, East Melbourne, VIC 8006 Australia
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808
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Ingold Heppner B, Loibl S, Denkert C. Tumor-Infiltrating Lymphocytes: A Promising Biomarker in Breast Cancer. Breast Care (Basel) 2016; 11:96-100. [PMID: 27239170 DOI: 10.1159/000444357] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is clear evidence that the immune system plays an essential role in tumor defense. By determining tumor-infiltrating lymphocytes (TILs), the individual immunological response becomes more apparent and measurable. In breast cancer, high levels of TILs are associated with a more favorable clinical course. In this review, we describe how TILs are determined with emphasis on daily routine diagnostics. We further discuss their impact as a prognostic and predictive biomarker in the neoadjuvant and adjuvant therapy setting as well as in residual disease. We also discuss their potential future implications on further stratifying prognostic subgroups of breast cancer, thereby possibly influencing future therapy considerations.
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Affiliation(s)
| | - Sibylle Loibl
- German Breast Group (GBG) c/o Forschungs GmbH, Neu-Isenburg, Germany; Sana Klinikum Offenbach, Offenbach, Germany
| | - Carsten Denkert
- Institut für Pathologie, Charité Universitätsmedizin, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany
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809
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Bertucci F, Finetti P, Colpaert C, Mamessier E, Parizel M, Dirix L, Viens P, Birnbaum D, van Laere S. PDL1 expression in inflammatory breast cancer is frequent and predicts for the pathological response to chemotherapy. Oncotarget 2016; 6:13506-19. [PMID: 25940795 PMCID: PMC4537030 DOI: 10.18632/oncotarget.3642] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/23/2015] [Indexed: 12/31/2022] Open
Abstract
We retrospectively analyzed PDL1 mRNA expression in 306 breast cancer samples, including 112 samples of an aggressive form, inflammatory breast cancer (IBC). PDL1 expression was heterogeneous, but was higher in IBC than in non-IBC. Compared to normal breast samples, PDL1 was overexpressed in 38% of IBC. In IBC, PDL1 overexpression was associated with estrogen receptor-negative status, basal and ERBB2-enriched aggressive subtypes, and clinico-biological signs of anti-tumor T-cell cytotoxic response. PDL1 overexpression was associated with better pathological response to chemotherapy, independently of histo-clinical variables and predictive gene expression signatures. No correlation was found with metastasis-free and overall specific survivals. In conclusion, PDL1 overexpression in IBC correlated with better response to chemotherapy. This seemingly counterintuitive correlation between expression of an immunosuppressive molecule and improved therapeutic response may be resolved if PDL1 expression is viewed as a surrogate marker of a strong antitumor immune response among patients treated with immunogenic chemotherapy. In such patients, PDL1 inhibition could protect activated T-cells or reactivate inhibited T-cells and improve the therapeutic response, notably when associated with immunogenic chemotherapy.
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Affiliation(s)
- François Bertucci
- Département d'Oncologie Moléculaire, "Equipe Labellisée Ligue Contre le Cancer", Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Marseille, France.,Département d'Oncologie Médicale, CRCM, Institut Paoli-Calmettes, Marseille, France.,Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Pascal Finetti
- Département d'Oncologie Moléculaire, "Equipe Labellisée Ligue Contre le Cancer", Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Marseille, France
| | - Cécile Colpaert
- Department of Pathology, GZA Hospitals Sint-Augustinus, Antwerp, Belgium
| | - Emilie Mamessier
- Département d'Oncologie Moléculaire, "Equipe Labellisée Ligue Contre le Cancer", Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Marseille, France
| | - Maxime Parizel
- Department of Pathology, GZA Hospitals Sint-Augustinus, Antwerp, Belgium
| | - Luc Dirix
- Center for Oncological Research (CORE), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Patrice Viens
- Département d'Oncologie Moléculaire, "Equipe Labellisée Ligue Contre le Cancer", Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Marseille, France.,Département d'Oncologie Médicale, CRCM, Institut Paoli-Calmettes, Marseille, France.,Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Daniel Birnbaum
- Département d'Oncologie Moléculaire, "Equipe Labellisée Ligue Contre le Cancer", Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Marseille, France
| | - Steven van Laere
- Center for Oncological Research (CORE), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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810
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Brodsky AS, Xiong J, Yang D, Schorl C, Fenton MA, Graves TA, Sikov WM, Resnick MB, Wang Y. Identification of stromal ColXα1 and tumor-infiltrating lymphocytes as putative predictive markers of neoadjuvant therapy in estrogen receptor-positive/HER2-positive breast cancer. BMC Cancer 2016; 16:274. [PMID: 27090210 PMCID: PMC4835834 DOI: 10.1186/s12885-016-2302-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/07/2016] [Indexed: 12/15/2022] Open
Abstract
Background The influence of the tumor microenvironment and tumor-stromal interactions on the heterogeneity of response within breast cancer subtypes have just begun to be explored. This study focuses on patients with estrogen receptor-positive/human epidermal growth factor receptor 2-positive (ER+/HER2+) breast cancer receiving neoadjuvant chemotherapy and HER2-targeted therapy (NAC+H), and was designed to identify novel predictive biomarkers by combining gene expression analysis and immunohistochemistry with pathologic response. Methods We performed gene expression profiling on pre-NAC+H tumor samples from responding (no or minimal residual disease at surgery) and non-responding patients. Gene set enrichment analysis identified potentially relevant pathways, and immunohistochemical staining of pre-treatment biopsies was used to measure protein levels of those pathways, which were correlated with pathologic response in both univariate and multivariate analysis. Results Increased expression of genes encoding for stromal collagens, including Col10A1, and reduced expression of immune-associated genes, reflecting lower levels of total tumor-infiltrating lymphocytes (TILs), were strongly associated with poor pathologic response. Lower TILs in tumor biopsies correlated with reduced likelihood of achieving an optimal pathologic response, but increased expression of the Col10A1 gene product, colXα1, had greater predictive value than stromal abundance for poor response (OR = 18.9, p = 0.003), and the combination of increased colXα1 expression and low TILs was significantly associated with poor response in multivariate analysis. ROC analysis suggests strong specificity and sensitivity for this combination in predicting treatment response. Conclusions Increased expression of stromal colXα1 and low TILs correlate with poor pathologic response in ER+/HER2+ breast tumors. Further studies are needed to confirm their predictive value and impact on long-term outcomes, and to determine whether this collagen exerts a protective effect on the cancer cells or simply reflects other factors within the tumor microenvironment. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2302-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander S Brodsky
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, USA. .,Department of Pathology, Rhode Island Hospital and Lifespan Medical Center, Providence, RI, 02903, USA.
| | - Jinjun Xiong
- Department of Pathology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, USA
| | - Dongfang Yang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, USA
| | - Christoph Schorl
- Molecular Biology, Cell Biology, & Biochemistry, Brown University, Providence, USA
| | - Mary Anne Fenton
- Department of Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, USA
| | - Theresa A Graves
- Department of Surgery, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, USA
| | - William M Sikov
- Program in Women's Oncology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, USA
| | - Murray B Resnick
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, USA. .,Department of Pathology, Rhode Island Hospital and Lifespan Medical Center, Providence, RI, 02903, USA.
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811
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Purrington KS, Visscher DW, Wang C, Yannoukakos D, Hamann U, Nevanlinna H, Cox A, Giles GG, Eckel-Passow JE, Lakis S, Kotoula V, Fountzilas G, Kabisch M, Rüdiger T, Heikkilä P, Blomqvist C, Cross SS, Southey MC, Olson JE, Gilbert J, Deming-Halverson S, Kosma VM, Clarke C, Scott R, Jones JL, Zheng W, Mannermaa A, Eccles DM, Vachon CM, Couch FJ. Genes associated with histopathologic features of triple negative breast tumors predict molecular subtypes. Breast Cancer Res Treat 2016; 157:117-31. [PMID: 27083182 DOI: 10.1007/s10549-016-3775-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 03/30/2016] [Indexed: 01/07/2023]
Abstract
Distinct subtypes of triple negative (TN) breast cancer have been identified by tumor expression profiling. However, little is known about the relationship between histopathologic features of TN tumors, which reflect aspects of both tumor behavior and tumor microenvironment, and molecular TN subtypes. The histopathologic features of TN tumors were assessed by central review and 593 TN tumors were subjected to whole genome expression profiling using the Illumina Whole Genome DASL array. TN molecular subtypes were defined based on gene expression data associated with histopathologic features of TN tumors. Gene expression analysis yielded signatures for four TN subtypes (basal-like, androgen receptor positive, immune, and stromal) consistent with previous studies. Expression analysis also identified genes significantly associated with the 12 histological features of TN tumors. Development of signatures using these markers of histopathological features resulted in six distinct TN subtype signatures, including an additional basal-like and stromal signature. The additional basal-like subtype was distinguished by elevated expression of cell motility and glucose metabolism genes and reduced expression of immune signaling genes, whereas the additional stromal subtype was distinguished by elevated expression of immunomodulatory pathway genes. Histopathologic features that reflect heterogeneity in tumor architecture, cell structure, and tumor microenvironment are related to TN subtype. Accounting for histopathologic features in the development of gene expression signatures, six major subtypes of TN breast cancer were identified.
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Affiliation(s)
- Kristen S Purrington
- Department of Oncology, Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, USA.,Department of Health Sciences Research, Mayo Clinic, Stabile 2-42, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Daniel W Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Chen Wang
- Department of Health Sciences Research, Mayo Clinic, Stabile 2-42, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory INRASTES, National Centre for Scientific Research "Demokritos", Athens, Greece
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Angela Cox
- Department of Oncology, University of Sheffield, Sheffield, UK
| | - Graham G Giles
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
| | - Jeanette E Eckel-Passow
- Department of Health Sciences Research, Mayo Clinic, Stabile 2-42, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sotiris Lakis
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Vassiliki Kotoula
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Maria Kabisch
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Rüdiger
- Institute of Pathology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Päivi Heikkilä
- Department of Pathology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Carl Blomqvist
- Department of Oncology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Simon S Cross
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Melbourne, Australia
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Stabile 2-42, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Judy Gilbert
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Sandra Deming-Halverson
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - Veli-Matti Kosma
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Biocenter Kuopio, Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Christine Clarke
- Centre for Cancer Research, University of Sydney at the Westmead Millennium Institute, Westmead, Australia
| | - Rodney Scott
- Division of Genetics, Hunter Area Pathology Service and University of Newcastle, Newcastle, Australia
| | - J Louise Jones
- Barts Cancer Research Institute, Queen Mary University of London, London, UK
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - Arto Mannermaa
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Biocenter Kuopio, Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | | | - Diana M Eccles
- Faculty of Medicine and NIHR/CRUK Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Celine M Vachon
- Department of Health Sciences Research, Mayo Clinic, Stabile 2-42, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Fergus J Couch
- Department of Health Sciences Research, Mayo Clinic, Stabile 2-42, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
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812
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Mao Y, Qu Q, Chen X, Huang O, Wu J, Shen K. The Prognostic Value of Tumor-Infiltrating Lymphocytes in Breast Cancer: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0152500. [PMID: 27073890 PMCID: PMC4830515 DOI: 10.1371/journal.pone.0152500] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/15/2016] [Indexed: 11/19/2022] Open
Abstract
Background The prognostic values of tumor-infiltrating lymphocytes (TILs) and TILs subsets in breast cancer (BC) are uncertain. Methods A systematic literature search (MEDLINE, Web of Science, EMBASE, and the Cochrane Library to August 2014) was conducted for studies which met the eligibility criteria. The primary clinical outcome was defined as disease-free survival (DFS), overall survival (OS), and BC-specific survival (BCSS). Random or fixed-effects model was adopted to estimate the summary hazard ratio (HR). Results Twenty-five published studies comprising 22,964 patients were reviewed. Pooled analysis indicated that TILs were not prognostic markers for DFS and OS in overall population, but related to improved DFS (HR, 0.82; 95% CI, 0.76–0.88) and OS (HR, 0.79; 95% CI, 0.71–0.87) in triple negative breast cancer (TNBC) patients. For TILs subsets, CD8+ lymphocytes were associated with improved DFS (HR, 0.69; 95% CI, 0.56–0.84) and BCSS (HR, 0.78; 95% CI, 0.71–0.86) in overall population, while FOXP3+ lymphocytes were associated with reduced DFS (HR, 1.47; 95% CI, 1.01–2.05) and OS (HR, 1.50; 95% CI, 1.15–1.97). In estrogen receptor (ER) negative patients, CD8+ lymphocytes was also related to better BCSS. In addition, the high density of CD20+, CD3+ or low level of PD-1+ or γδ T lymphocytes indicated increased OS in limited studies. Conclusion TILs and TILs subsets are promising prognostic biomarkers in breast cancer, especially in TNBC.
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Affiliation(s)
- Yan Mao
- Breast Health Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Qu
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaosong Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ou Huang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail:
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813
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Brambilla E, Le Teuff G, Marguet S, Lantuejoul S, Dunant A, Graziano S, Pirker R, Douillard JY, Le Chevalier T, Filipits M, Rosell R, Kratzke R, Popper H, Soria JC, Shepherd FA, Seymour L, Tsao MS. Prognostic Effect of Tumor Lymphocytic Infiltration in Resectable Non-Small-Cell Lung Cancer. J Clin Oncol 2016; 34:1223-30. [PMID: 26834066 PMCID: PMC4872323 DOI: 10.1200/jco.2015.63.0970] [Citation(s) in RCA: 251] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Tumor lymphocytic infiltration (TLI) has differing prognostic value among various cancers. The objective of this study was to assess the effect of TLI in lung cancer. PATIENTS AND METHODS A discovery set (one trial, n = 824) and a validation set (three trials, n = 984) that evaluated the benefit of platinum-based adjuvant chemotherapy in non-small-cell lung cancer were used as part of the LACE-Bio (Lung Adjuvant Cisplatin Evaluation Biomarker) study. TLI was defined as intense versus nonintense. The main end point was overall survival (OS); secondary end points were disease-free survival (DFS) and specific DFS (SDFS). Hazard ratios (HRs) and 95% CIs associated with TLI were estimated through a multivariable Cox model in both sets. TLI-histology and TLI-treatment interactions were explored in the combined set. RESULTS Discovery and validation sets with complete data included 783 (409 deaths) and 763 (344 deaths) patients, respectively. Median follow-up was 4.8 and 6 years, respectively. TLI was intense in 11% of patients in the discovery set compared with 6% in the validation set (P < .001). The prognostic value of TLI in the discovery set (OS: HR, 0.56; 95% CI, 0.38 to 0.81; P = .002; DFS: HR, 0.59; 95% CI, 0.42 to 0.83; P = .002; SDFS: HR, 0.56; 95% CI, 0.38 to 0.82; P = .003) was confirmed in the validation set (OS: HR, 0.45; 95% CI, 0.23 to 0.85; P = .01; DFS: HR, 0.44; 95% CI, 0.24 to 0.78; P = .005; SDFS: HR, 0.42; 95% CI, 0.22 to 0.80; P = .008) with no heterogeneity across trials (P ≥ .38 for all end points). No significant predictive effect was observed for TLI (P ≥ .78 for all end points). CONCLUSION Intense lymphocytic infiltration, found in a minority of tumors, was validated as a favorable prognostic marker for survival in resected non-small-cell lung cancer.
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Affiliation(s)
- Elisabeth Brambilla
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada.
| | - Gwénaël Le Teuff
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Sophie Marguet
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Sylvie Lantuejoul
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Ariane Dunant
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Stephen Graziano
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Robert Pirker
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Jean-Yves Douillard
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Thierry Le Chevalier
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Martin Filipits
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Rafael Rosell
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Robert Kratzke
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Helmut Popper
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Jean-Charles Soria
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Frances A Shepherd
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Lesley Seymour
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
| | - Ming Sound Tsao
- Elisabeth Brambilla and Sylvie Lantuejoul, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale U823; and Centre Hospitalier Universitaire Albert Michallon, Grenoble; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Institut Gustave Roussy, Villejuif; Gwénaël Le Teuff, Sophie Marguet, Ariane Dunant, Thierry Le Chevalier, and Jean-Charles Soria, Université Paris-Sud, Orsay; Gwénaël Le Teuff, Université Paris-Saclay, Saint-Aubin; Jean-Yves Douillard, Centre René Gauducheau Institut de Cancerologie de l'Ouest, Saint-Herblain, France; Stephen Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Pirker and Martin Filipits, Medical University of Vienna, Vienna; Helmut Popper, Medical University of Graz, Graz, Austria; Rafael Rosell, Catalan Institute of Oncology, Barcelona, Spain; Robert Kratzke, University of Minnesota, Minneapolis, MN; Frances A. Shepherd and Ming Sound Tsao, Princess Margaret Cancer Centre; Frances A. Shepherd and Ming Sound Tsao, University of Toronto, Toronto; and Lesley Seymour, Queen's University, Kingston, Ontario, Canada
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814
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García-Teijido P, Cabal ML, Fernández IP, Pérez YF. Tumor-Infiltrating Lymphocytes in Triple Negative Breast Cancer: The Future of Immune Targeting. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2016; 10:31-9. [PMID: 27081325 PMCID: PMC4822722 DOI: 10.4137/cmo.s34540] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 12/13/2022]
Abstract
Triple negative breast cancer (TNBC) is a highly heterogeneous tumor. There is increasing evidence of the role of tumor lymphocytic immune infiltrates in this subtype of breast cancer. Robust levels of tumor infiltrating lymphocytes (TILs) have been associated with improved disease-free and overall survival rates in TNBC patients with and without any treatment. Recent efforts have been made to develop a standardized methodology for evaluating TILs. The presence of TILs in the breast tumor microenvironment can also predict responses not only to neoadjuvant but also to adjuvant chemotherapy treatments. High numbers of TILs correlate with increased pathological complete responses (pCR) in TNBC. TILs are prognostic and predictive of response to standard therapies; thus, the immune system appears to play an active role in a subgroup of breast cancer. There is an increasing interest in directly targeting the immune system as part of breast cancer therapy, mainly in patients with TNBC. New immune modulatory agents, including immune checkpoints inhibitors, have shown promising activity in a subgroup of metastatic TNBC. Increased programmed cell death protein 1 ligand (PD-L1) expression on the surface of TNBC provides the rationale for implementing therapeutic strategies targeting the PD-1/PD-L1 axis in TNBC. The programmed cell death protein 1 (PD-1) inhibitor pembrolizumab, and the PD-L1 inhibitor atezolizumab have shown promising results in clinical trials.
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Affiliation(s)
- Paula García-Teijido
- Department of Medical Oncology, Hospital San Agustín, C/Camino de Heros 6, Asturias, Spain
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815
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Razi A, Afghah F, Singh S, Varadan V. Network-Based Enriched Gene Subnetwork Identification: A Game-Theoretic Approach. Biomed Eng Comput Biol 2016; 7:1-14. [PMID: 27081328 PMCID: PMC4822726 DOI: 10.4137/becb.s38244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 01/25/2023] Open
Abstract
Identifying subsets of genes that jointly mediate cancer etiology, progression, or therapy response remains a challenging problem due to the complexity and heterogeneity in cancer biology, a problem further exacerbated by the relatively small number of cancer samples profiled as compared with the sheer number of potential molecular factors involved. Pure data-driven methods that merely rely on multiomics data have been successful in discovering potentially functional genes but suffer from high false-positive rates and tend to report subsets of genes whose biological interrelationships are unclear. Recently, integrative data-driven models have been developed to integrate multiomics data with signaling pathway networks in order to identify pathways associated with clinical or biological phenotypes. However, these approaches suffer from an important drawback of being restricted to previously discovered pathway structures and miss novel genomic interactions as well as potential crosstalk among the pathways. In this article, we propose a novel coalition-based game-theoretic approach to overcome the challenge of identifying biologically relevant gene subnetworks associated with disease phenotypes. The algorithm starts from a set of seed genes and traverses a protein–protein interaction network to identify modulated subnetworks. The optimal set of modulated subnetworks is identified using Shapley value that accounts for both individual and collective utility of the subnetwork of genes. The algorithm is applied to two illustrative applications, including the identification of subnetworks associated with (i) disease progression risk in response to platinum-based therapy in ovarian cancer and (ii) immune infiltration in triple-negative breast cancer. The results demonstrate an improved predictive power of the proposed method when compared with state-of-the-art feature selection methods, with the added advantage of identifying novel potentially functional gene subnetworks that may provide insights into the mechanisms underlying cancer progression.
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Affiliation(s)
- Abolfazl Razi
- Electrical Engineering and Computer Science, Northern Arizona University, Flagstaff, AZ, USA
| | - Fatemeh Afghah
- Electrical Engineering and Computer Science, Northern Arizona University, Flagstaff, AZ, USA
| | - Salendra Singh
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Vinay Varadan
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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816
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Salgado R, Denkert C, Campbell C, Savas P, Nuciforo P, Nucifero P, Aura C, de Azambuja E, Eidtmann H, Ellis CE, Baselga J, Piccart-Gebhart MJ, Michiels S, Bradbury I, Sotiriou C, Loi S. Tumor-Infiltrating Lymphocytes and Associations With Pathological Complete Response and Event-Free Survival in HER2-Positive Early-Stage Breast Cancer Treated With Lapatinib and Trastuzumab: A Secondary Analysis of the NeoALTTO Trial. JAMA Oncol 2016; 1:448-54. [PMID: 26181252 DOI: 10.1001/jamaoncol.2015.0830] [Citation(s) in RCA: 440] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE The presence of tumor-infiltrating lymphocytes (TILs) is associated with improved outcomes in human epidermal growth factor receptor 2 (HER2)-positive early breast cancer treated with adjuvant trastuzumab and chemotherapy. The prognostic associations in the neoadjuvant setting of other anti-HER2 agents and combinations are unknown. OBJECTIVE To determine associations between presence of TILs, pathological complete response (pCR), and event-free survival (EFS) end points in patients with early breast cancer treated with trastuzumab, lapatinib, or the combination. DESIGN, SETTING, AND PARTICIPANTS The NeoALTTO trial (Neoadjuvant Lapatinib and/or Trastuzumab Treatment Optimization) randomly assigned 455 women with HER2-positive early-stage breast cancer between January 5, 2008, and May 27, 2010, to 1 of 3 neoadjuvant treatment arms: trastuzumab, lapatinib, or the combination for 6 weeks followed by the addition of weekly paclitaxel for 12 weeks, followed by 3 cycles of fluorouracil, epirubicin, and cyclophosphamide after surgery. The primary end point used in this study was pCR in the breast and lymph nodes, with a secondary end point of EFS. We evaluated levels of percentage of TILs using hematoxylin-eosin-stained core biopsy sections taken at diagnosis (prior to treatment) in a prospectively defined retrospective analysis. MAIN OUTCOMES AND MEASURES Levels of TILs were examined for their associations with efficacy end points adjusted for prognostic clinicopathological factors including PIK3CA genotype. RESULTS Of the 455 patients, 387 (85.1%) tumor samples were used for the present analysis. The median (interquartile range [IQR]) level of TILs was 12.5% (5.0%-30.0%), with levels lower in hormone receptor-positive (10.0% [5.0%-22.5%]) vs hormone receptor-negative (12.5% [3.0%-35.0%]) samples (P = .02). For the pCR end point, levels of TILs greater than 5% were associated with higher pCR rates independent of treatment group (adjusted odds ratio, 2.60 [95% CI, 1.26-5.39]; P = .01). With a median (IQR) follow-up time of 3.77 (3.50-4.22) years, every 1% increase in TILs was associated with a 3% decrease in the rate of an event (adjusted hazard ratio, 0.97 [95% CI, 0.95-0.99]; P = .002) across all treatment groups. CONCLUSIONS AND RELEVANCE The presence of TILs at diagnosis is an independent, positive, prognostic marker in HER2-positive early breast cancer treated with neoadjuvant anti-HER2 agents and chemotherapy for both pCR and EFS end points. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00553358.
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Affiliation(s)
- Roberto Salgado
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium2Department of Pathology, Gasthuis Zusters Antwerpen Hospitals, Antwerp, Belgium
| | - Carsten Denkert
- Institute of Pathology, Charité-Universitätsmedizin, Berlin, Germany4German Cancer Consortium, Berlin, Germany
| | - Christine Campbell
- Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, United Kingdom
| | - Peter Savas
- Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Claudia Aura
- Val d'Hebron Institute of Oncology, Barcelona, Spain
| | - Evandro de Azambuja
- Breast European Adjuvant Study Team, Institut Jules Bordet, Brussels, Belgium
| | - Holger Eidtmann
- Department of Obstetrics and Gynecology, Campus Kiel, University Hospital Kiel, Kiel, Germany
| | | | - Jose Baselga
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Stefan Michiels
- Centre de Recherche en Epidémiologie et Santé des Populations, INSERM U1018, Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Sud, Villejuif, France
| | - Ian Bradbury
- Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, United Kingdom
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sherene Loi
- Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
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817
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Harris LN, Ismaila N, McShane LM, Andre F, Collyar DE, Gonzalez-Angulo AM, Hammond EH, Kuderer NM, Liu MC, Mennel RG, Van Poznak C, Bast RC, Hayes DF. Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34:1134-50. [PMID: 26858339 PMCID: PMC4933134 DOI: 10.1200/jco.2015.65.2289] [Citation(s) in RCA: 571] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To provide recommendations on appropriate use of breast tumor biomarker assay results to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer. METHODS A literature search and prospectively defined study selection sought systematic reviews, meta-analyses, randomized controlled trials, prospective-retrospective studies, and prospective comparative observational studies published from 2006 through 2014. Outcomes of interest included overall survival and disease-free or recurrence-free survival. Expert panel members used informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 50 relevant studies. One randomized clinical trial and 18 prospective-retrospective studies were found to have evaluated the clinical utility, as defined by the guideline, of specific biomarkers for guiding decisions on the need for adjuvant systemic therapy. No studies that met guideline criteria for clinical utility were found to guide choice of specific treatments or regimens. RECOMMENDATIONS In addition to estrogen and progesterone receptors and human epidermal growth factor receptor 2, the panel found sufficient evidence of clinical utility for the biomarker assays Oncotype DX, EndoPredict, PAM50, Breast Cancer Index, and urokinase plasminogen activator and plasminogen activator inhibitor type 1 in specific subgroups of breast cancer. No biomarker except for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was found to guide choices of specific treatment regimens. Treatment decisions should also consider disease stage, comorbidities, and patient preferences.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Hormonal/therapeutic use
- Biomarkers, Tumor/analysis
- Breast Neoplasms/chemistry
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/chemistry
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Chemotherapy, Adjuvant
- Clinical Decision-Making/methods
- Comorbidity
- Disease-Free Survival
- Evidence-Based Medicine
- Female
- Humans
- Neoplasm Staging
- Plasminogen Activator Inhibitor 1/analysis
- Predictive Value of Tests
- Randomized Controlled Trials as Topic
- Receptor, ErbB-2/analysis
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Reproducibility of Results
- Survival Analysis
- Urokinase-Type Plasminogen Activator/analysis
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Affiliation(s)
- Lyndsay N Harris
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Nofisat Ismaila
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI.
| | - Lisa M McShane
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Fabrice Andre
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Deborah E Collyar
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Ana M Gonzalez-Angulo
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Elizabeth H Hammond
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Nicole M Kuderer
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Minetta C Liu
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Robert G Mennel
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Catherine Van Poznak
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Robert C Bast
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Daniel F Hayes
- Lyndsay N. Harris, Case Western Reserve University, Cleveland, OH; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Lisa M. McShane, National Cancer Institute, Bethesda, MD; Fabrice Andre, Institute Gustave Roussy, Paris, France; Deborah E. Collyar, Patient Advocates in Research; Elizabeth H. Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Ana M. Gonzalez-Angulo and Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G.Mennel, Baylor University Medical Center and Texas Oncology PA, Dallas, TX; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; and Catherine Van Poznak and Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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818
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Les traitements adjuvants des cancers du sein : dernières avancées et perspectives pour des cancers très différents. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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819
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USING OF BINOMINAL METHOD FOR THE PURPOSE OF DETERMINATION OF CONFIDENCE INTERVALS FOR PREDICTION OF INVASIVE DUCTAL BREAST CARCINOMA METASTASES. EUREKA: HEALTH SCIENCES 2016. [DOI: 10.21303/2504-5679.2016.00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The study was performed using surgical and biopsy material based on histopathological study, which was conducted at the Chernivtsy Regional Clinical Oncology Centre. In the cases of verified diagnosis of ductal breast carcinoma was studied the size of the primary tumour node and metastasis in lymphogenous features of regional lymph node according to classification system TNM. All cases were divided by categories T and N. Using statistical data was conducted the analysis in patients of verified diagnosis of ductal breast carcinoma in Chernivtsy region. We determined the features of metastasis to regional lymph nodes under according to the classification pTNM and confidence intervals calculated according to percent binomial method with p=0.05. After receiving the results the data were compared to predict metastasis. Using statistical data were conducted the analysis in women of Chernivtsi region with verified diagnosis of ductal breast cancer. We determined the features of metastasis classification according pTNM and confidence intervals of percent according to binominal method with p=0.05. All observations of histopathological conclusions were conducted on the basis of Chernivtsy Regional Clinical Oncology Centre.
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820
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Dieci MV, Griguolo G, Miglietta F, Guarneri V. The immune system and hormone-receptor positive breast cancer: Is it really a dead end? Cancer Treat Rev 2016; 46:9-19. [PMID: 27055087 DOI: 10.1016/j.ctrv.2016.03.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/21/2016] [Indexed: 01/08/2023]
Abstract
Even if breast cancer has not been traditionally considered an immunogenic tumor, recent data suggest that immunity, and its interaction with tumor cells and tumor microenvironment, might play an important role in this malignancy, in particular in triple negative and HER2+ subtypes. As no consistent data on the potential clinical relevance of tumor infiltrating lymphocytes have been produced in hormone receptor positive (HR+) HER2- breast cancer, the interest in studying immune aspects in this subtype has become less appealing. Nevertheless, some scattered evidence indicates that immunity and inflammation may be implicated in the biology of this subtype as well. In HR+ breast cancer, the interaction between tumor cells and the immune milieu might rely on different mechanisms than in other BC subtypes, involving the modulation of the tumor microenvironment by mutual interplays of endocrine factors, pro-inflammatory status and immune cells. These subtle mechanisms may require more refined methods of evaluation, such as the assessment of tumor infiltrating lymphocytes subpopulations or gene signatures. In this paper we aim to perform a comprehensive review of pre-clinical and clinical data on the interplay between the immune system and breast cancer in the HR+ subtype, to guide further research in the field.
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Affiliation(s)
- Maria Vittoria Dieci
- Dept. of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.
| | - Gaia Griguolo
- Dept. of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Federica Miglietta
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Valentina Guarneri
- Dept. of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
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821
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Tran T, Diniz MO, Dransart E, Gey A, Merillon N, Lone YC, Godefroy S, Sibley C, Ferreira LC, Medioni J, Oudard S, Johannes L, Tartour E. A Therapeutic Her2/neu Vaccine Targeting Dendritic Cells Preferentially Inhibits the Growth of Low Her2/neu-Expressing Tumor in HLA-A2 Transgenic Mice. Clin Cancer Res 2016; 22:4133-44. [PMID: 27006496 DOI: 10.1158/1078-0432.ccr-16-0044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/06/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE E75, a peptide derived from the Her2/neu protein, is the most clinically advanced vaccine approach against breast cancer. In this study, we aimed to optimize the E75 vaccine using a delivery vector targeting dendritic cells, the B-subunit of Shiga toxin (STxB), and to assess the role of various parameters (Her2/neu expression, combination with trastuzumab) in the efficacy of this cancer vaccine in a relevant preclinical model. EXPERIMENTAL DESIGN We compared the differential ability of the free E75 peptide or the STxB-E75 vaccine to elicit CD8(+) T cells, and the impact of the vaccine on murine HLA-A2 tumors expressing low or high levels of Her2/neu. RESULTS STxB-E75 synergized with granulocyte macrophage colony-stimulating factors and CpG and proved to be more efficient than the free E75 peptide in the induction of multifunctional and high-avidity E75-specific anti-CD8(+) T cells resulting in a potent tumor protection in HLA-A2 transgenic mice. High expression of HER2/neu inhibited the expression of HLA-class I molecules, leading to a poor recognition of human or murine tumors by E75-specific cytotoxic CD8(+) T cells. In line with these results, STxB-E75 preferentially inhibited the growth of HLA-A2 tumors expressing low levels of Her2/neu. Coadministration of anti-Her2/neu mAb potentiated this effect. CONCLUSIONS STxB-E75 vaccine is a potent candidate to be tested in patients with low Her2/neu-expressing tumors. It could also be indicated in patients expressing high levels of Her2/neu and low intratumoral T-cell infiltration to boost the recruitment of T cells-a key parameter in the efficacy of anti-Her2/neu mAb therapy. Clin Cancer Res; 22(16); 4133-44. ©2016 AACR.
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Affiliation(s)
- Thi Tran
- INSERM U970, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France. Equipe Labellisée Ligue Contre le Cancer, Paris, France
| | - Mariana O Diniz
- INSERM U970, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France. Equipe Labellisée Ligue Contre le Cancer, Paris, France. Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Estelle Dransart
- Institut Curie, PSL Research University, Chemical Biology of Membranes and Therapeutic Delivery Unit. INSERM, U 1143. CNRS, UMR 3666, 26 rue d'Ulm, 75248 Paris Cedex 05, France
| | - Alain Gey
- Service d'Immunologie biologique, Hopital Européen Georges Pompidou-APHP, Paris, France
| | - Nathalie Merillon
- INSERM U970, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Yu Chun Lone
- Inserm U-1014, Université Paris XI, Groupe Hospitalier Paul-Brousse, France
| | | | | | - Luis Cs Ferreira
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Jacques Medioni
- Service d'Oncologie Médicale, Hopital Européen Georges Pompidou, Paris, France
| | - Stephane Oudard
- INSERM U970, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France. Equipe Labellisée Ligue Contre le Cancer, Paris, France. Service d'Oncologie Médicale, Hopital Européen Georges Pompidou, Paris, France
| | - Ludger Johannes
- Institut Curie, PSL Research University, Chemical Biology of Membranes and Therapeutic Delivery Unit. INSERM, U 1143. CNRS, UMR 3666, 26 rue d'Ulm, 75248 Paris Cedex 05, France
| | - Eric Tartour
- INSERM U970, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France. Equipe Labellisée Ligue Contre le Cancer, Paris, France. Service d'Immunologie biologique, Hopital Européen Georges Pompidou-APHP, Paris, France.
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822
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Loi S, Dushyanthen S, Beavis PA, Salgado R, Denkert C, Savas P, Combs S, Rimm DL, Giltnane JM, Estrada MV, Sánchez V, Sanders ME, Cook RS, Pilkinton MA, Mallal SA, Wang K, Miller VA, Stephens PJ, Yelensky R, Doimi FD, Gómez H, Ryzhov SV, Darcy PK, Arteaga CL, Balko JM. RAS/MAPK Activation Is Associated with Reduced Tumor-Infiltrating Lymphocytes in Triple-Negative Breast Cancer: Therapeutic Cooperation Between MEK and PD-1/PD-L1 Immune Checkpoint Inhibitors. Clin Cancer Res 2016; 22:1499-509. [PMID: 26515496 PMCID: PMC4794351 DOI: 10.1158/1078-0432.ccr-15-1125] [Citation(s) in RCA: 384] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/21/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Tumor-infiltrating lymphocytes (TIL) in the residual disease (RD) of triple-negative breast cancers (TNBC) after neoadjuvant chemotherapy (NAC) are associated with improved survival, but insight into tumor cell-autonomous molecular pathways affecting these features are lacking. EXPERIMENTAL DESIGN We analyzed TILs in the RD of clinically and molecularly characterized TNBCs after NAC and explored therapeutic strategies targeting combinations of MEK inhibitors with PD-1/PD-L1-targeted immunotherapy in mouse models of breast cancer. RESULTS Presence of TILs in the RD was significantly associated with improved prognosis. Genetic or transcriptomic alterations in Ras-MAPK signaling were significantly correlated with lower TILs. MEK inhibition upregulated cell surface MHC expression and PD-L1 in TNBC cells both in vivo and in vitro. Moreover, combined MEK and PD-L1/PD-1 inhibition enhanced antitumor immune responses in mouse models of breast cancer. CONCLUSIONS These data suggest the possibility that Ras-MAPK pathway activation promotes immune-evasion in TNBC, and support clinical trials combining MEK- and PD-L1-targeted therapies. Furthermore, Ras/MAPK activation and MHC expression may be predictive biomarkers of response to immune checkpoint inhibitors.
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Affiliation(s)
- Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
| | | | - Paul A Beavis
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory, Institute Jules Bordet, Brussels, Department of Pathology, GZA Antwerp, Belgium
| | - Carsten Denkert
- Charité University and German Cancer Consortium (DKTK), Berlin, Germany
| | - Peter Savas
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Susan Combs
- Departments of Pathology and Medicine, Yale University, New Haven, Connecticut
| | - David L Rimm
- Departments of Pathology and Medicine, Yale University, New Haven, Connecticut
| | - Jennifer M Giltnane
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee. Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Monica V Estrada
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Violeta Sánchez
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Melinda E Sanders
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee. Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Rebecca S Cook
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee. Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
| | - Mark A Pilkinton
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Simon A Mallal
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee. Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Kai Wang
- Foundation Medicine, Cambridge, Massachusetts
| | | | | | | | - Franco D Doimi
- Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú
| | - Henry Gómez
- Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú
| | | | - Phillip K Darcy
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Carlos L Arteaga
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee. Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee. Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Justin M Balko
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee. Department of Medicine, Vanderbilt University, Nashville, Tennessee.
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823
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Loi S, Dushyanthen S, Beavis PA, Salgado R, Denkert C, Savas P, Combs S, Rimm DL, Giltnane JM, Estrada MV, Sánchez V, Sanders ME, Cook RS, Pilkinton MA, Mallal SA, Wang K, Miller VA, Stephens PJ, Yelensky R, Doimi FD, Gómez H, Ryzhov SV, Darcy PK, Arteaga CL, Balko JM. RAS/MAPK Activation Is Associated with Reduced Tumor-Infiltrating Lymphocytes in Triple-Negative Breast Cancer: Therapeutic Cooperation Between MEK and PD-1/PD-L1 Immune Checkpoint Inhibitors. Clin Cancer Res 2016. [PMID: 26515496 DOI: 10.1158/1078-0432.ccr-15-1125.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Tumor-infiltrating lymphocytes (TIL) in the residual disease (RD) of triple-negative breast cancers (TNBC) after neoadjuvant chemotherapy (NAC) are associated with improved survival, but insight into tumor cell-autonomous molecular pathways affecting these features are lacking. EXPERIMENTAL DESIGN We analyzed TILs in the RD of clinically and molecularly characterized TNBCs after NAC and explored therapeutic strategies targeting combinations of MEK inhibitors with PD-1/PD-L1-targeted immunotherapy in mouse models of breast cancer. RESULTS Presence of TILs in the RD was significantly associated with improved prognosis. Genetic or transcriptomic alterations in Ras-MAPK signaling were significantly correlated with lower TILs. MEK inhibition upregulated cell surface MHC expression and PD-L1 in TNBC cells both in vivo and in vitro. Moreover, combined MEK and PD-L1/PD-1 inhibition enhanced antitumor immune responses in mouse models of breast cancer. CONCLUSIONS These data suggest the possibility that Ras-MAPK pathway activation promotes immune-evasion in TNBC, and support clinical trials combining MEK- and PD-L1-targeted therapies. Furthermore, Ras/MAPK activation and MHC expression may be predictive biomarkers of response to immune checkpoint inhibitors.
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Affiliation(s)
- Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
| | | | - Paul A Beavis
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory, Institute Jules Bordet, Brussels, Department of Pathology, GZA Antwerp, Belgium
| | - Carsten Denkert
- Charité University and German Cancer Consortium (DKTK), Berlin, Germany
| | - Peter Savas
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Susan Combs
- Departments of Pathology and Medicine, Yale University, New Haven, Connecticut
| | - David L Rimm
- Departments of Pathology and Medicine, Yale University, New Haven, Connecticut
| | - Jennifer M Giltnane
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee. Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Monica V Estrada
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Violeta Sánchez
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Melinda E Sanders
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee. Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Rebecca S Cook
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee. Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
| | - Mark A Pilkinton
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Simon A Mallal
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee. Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Kai Wang
- Foundation Medicine, Cambridge, Massachusetts
| | | | | | | | - Franco D Doimi
- Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú
| | - Henry Gómez
- Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú
| | | | - Phillip K Darcy
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Carlos L Arteaga
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee. Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee. Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Justin M Balko
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee. Department of Medicine, Vanderbilt University, Nashville, Tennessee.
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824
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Swisher SK, Wu Y, Castaneda CA, Lyons GR, Yang F, Tapia C, Wang X, Casavilca SAA, Bassett R, Castillo M, Sahin A, Mittendorf EA. Interobserver Agreement Between Pathologists Assessing Tumor-Infiltrating Lymphocytes (TILs) in Breast Cancer Using Methodology Proposed by the International TILs Working Group. Ann Surg Oncol 2016; 23:2242-8. [PMID: 26965699 DOI: 10.1245/s10434-016-5173-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND The presence of tumor-infiltrating lymphocytes (TILs) in breast tumors is prognostic and predictive, suggesting that TILs may be an important biomarker. Recently, an international TILs working group formulated consensus recommendations for TIL evaluation. The current study was performed to determine interobserver agreement using that methodology. METHODS Tumor-infiltrating lymphocytes were assessed on a single hematoxylin and eosin (H&E)-stained slide obtained from the core biopsy of 75 triple-negative breast cancers. Four pathologists independently reviewed each slide and evaluated stromal TILs (sTILs) and intratumoral TIL (iTILs). The kappa statistic was used to estimate interobserver agreement for identification of sTILs, and the intraclass correlation coefficient (ICC) was used to estimate the agreement among observers for iTILs. Cases with poor agreement were reviewed to identify pathologic factors that may contribute to the lack of agreement. RESULTS The kappa statistic for sTIL evaluation was 0.57 (standard error, 0.04). For iTILs, the ICC calculated to determine internal consistency within raters was 0.65 (95 % confidence interval [CI] 0.56-0.74; p < 0.0001), and the ICC calculated to determine agreement among raters was 0.62 (95 % CI 0.50-0.72; p < 0.0001). In 10 cases (13 %), there was not agreement between three of four pathologists. The pathologic features contributing to difficulty in TIL enumeration included marked individual tumor cell necrosis or apoptosis, the presence of reactive plasma cells mimicking tumor cells, plasmatoid tumor cells, and accurate quantification of TILs in specimens with focal areas of heavy immune infiltrate. CONCLUSION Acceptable agreement in TIL enumeration was observed, suggesting that the proposed methodology can be used to facilitate the use of TILs as a biomarker in research and clinical trial settings.
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Affiliation(s)
- Shannon K Swisher
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun Wu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos A Castaneda
- Department of Clinical Medicine, Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Genvieve R Lyons
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fei Yang
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Coya Tapia
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiuhong Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sandro A A Casavilca
- Department of Pathology, Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Miluska Castillo
- Department of Clinical Medicine, Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Aysegul Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth A Mittendorf
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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825
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Asano Y, Kashiwagi S, Goto W, Kurata K, Noda S, Takashima T, Onoda N, Tanaka S, Ohsawa M, Hirakawa K. Tumour-infiltrating CD8 to FOXP3 lymphocyte ratio in predicting treatment responses to neoadjuvant chemotherapy of aggressive breast cancer. Br J Surg 2016; 103:845-54. [PMID: 26953091 DOI: 10.1002/bjs.10127] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/22/2015] [Accepted: 01/08/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tumour-infiltrating lymphocytes (TILs) can be used to monitor the immune response, and are important in predicting treatment responses and outcomes for various types of cancer. Recently, specific TIL subsets have been reported to be clinically useful in predicting treatment responses. The CD8+/FOXP3+ TIL ratio (CFR) may be a more sensitive indicator for monitoring immune function. This study investigated the clinical significance and value of CFR as a biomarker to predict treatment responses to neoadjuvant chemotherapy for breast cancer. METHODS Patients with resectable early-stage breast cancer treated with neoadjuvant chemotherapy at Osaka City University Hospital, Japan, between 2007 and 2013 were included. Oestrogen receptor, progesterone receptor, human epidermal growth factor receptor (HER) 2, Ki-67, CD8 and FOXP3 status were assessed by immunohistochemistry, and correlated with pathological complete response (pCR). RESULTS A total of 177 patients were included, of whom 90 had a high CFR and 87 a low CFR. Triple-negative breast cancer (TNBC) was more common in the high-CFR group than in the low-CFR group (46 versus 23 per cent; P = 0·002), as was HER2-enriched breast cancer (HER2BC) (27 versus 14 per cent; P = 0·033). Among these patients, the pCR rate was significantly higher in the high-CFR group than in the low-CFR group (TNBC: P = 0·022; HER2BC: P < 0·001). In multivariable analysis high-CFR status was an independent predictor of a favourable prognosis: hazard ratio 0·24 (95 per cent c.i. 0·05 to 0·72; P = 0·015) for TNBC and 0·10 (0·10 to 0·90; P = 0·041) for HER2BC. CONCLUSION The CFR may be a useful biomarker to predict treatment response to neoadjuvant therapy in aggressive breast cancer subtypes, such as TNBC and HER2BC.
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Affiliation(s)
- Y Asano
- Departments of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - S Kashiwagi
- Departments of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - W Goto
- Departments of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - K Kurata
- Departments of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - S Noda
- Departments of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - T Takashima
- Departments of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - N Onoda
- Departments of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - S Tanaka
- Departments of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - M Ohsawa
- Departments of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - K Hirakawa
- Departments of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
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826
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Raphael J, Gong IY, Nofech-Mozes S, Bartlett JMS, Nafisi H, Verma S. Tumour infiltrating lymphocytes and stromal CD68 in early stage HER2 positive breast cancer. J Clin Pathol 2016; 69:552-5. [DOI: 10.1136/jclinpath-2015-203493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/15/2016] [Indexed: 11/03/2022]
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827
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Thompson E, Taube JM, Elwood H, Sharma R, Meeker A, Warzecha HN, Argani P, Cimino-Mathews A, Emens LA. The immune microenvironment of breast ductal carcinoma in situ. Mod Pathol 2016; 29:249-58. [PMID: 26769139 PMCID: PMC5484584 DOI: 10.1038/modpathol.2015.158] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 12/25/2022]
Abstract
The host immune response has a key role in breast cancer progression and response to therapy. However, relative to primary invasive breast cancers, the immune milieu of breast ductal carcinoma in situ (DCIS) is less understood. Here, we profile tumor infiltrating lymphocytes and expression of the immune checkpoint ligand programmed death ligand 1 (PD-L1) in 27 cases of DCIS with known estrogen receptor (ER), progesterone receptor, and human epidermal growth factor 2 (HER-2) expression using tissue microarrays. Twenty-four cases were pure DCIS and three had associated invasive ductal carcinoma. Tumors were stained by immunohistochemistry for PD-L1, as well as the lymphocyte markers CD3, CD4, CD8, FoxP3, and CD20. The expression of PD-L1 by DCIS carcinoma cells and tumor infiltrating lymphocytes was determined, and the average tumor infiltrating lymphocytes per high power field were manually scored. None of the DCIS cells expressed PD-L1, but 81% of DCIS lesions contained PD-L1+ tumor infiltrating lymphocytes. DCIS with moderate-diffuse tumor infiltrating lymphocytes was more likely to have PD-L1+ tumor infiltrating lymphocytes (P=0.004). Tumor infiltrating lymphocytes with high levels of PD-L1 expression (>50% cells) were seen only in triple-negative DCIS (P=0.0008), and PD-L1-tumor infiltrating lymphocytes were seen only in ER+/HER-2-DCIS (P=0.12). The presence of PD-L1+ tumor infiltrating lymphocytes was associated with a younger mean patient age (P=0.01). Further characterization of the DCIS immune microenvironment may identify useful targets for immune-based therapy and breast cancer prevention.
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Affiliation(s)
- Elizabeth Thompson
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, United States 21287
| | - Janis M. Taube
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, United States 21287,Department of Pathology and Dermatology, The Johns Hopkins Hospital, Baltimore, MD, United States, 21287
| | - Hillary Elwood
- Department of Pathology, University of New Mexico, Albuquerque, NM, United States, 87131
| | - Rajni Sharma
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, United States 21287
| | - Alan Meeker
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, United States 21287
| | | | - Pedram Argani
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, United States 21287,Department of Oncology, Sidney Kimmel Cancer Center, The Johns Hopkins Hospital, Baltimore, MD, United States, 21287
| | - Ashley Cimino-Mathews
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, United States 21287,Department of Oncology, Sidney Kimmel Cancer Center, The Johns Hopkins Hospital, Baltimore, MD, United States, 21287,Corresponding authors: Ashley Cimino-Mathews, MD, Departments of Pathology and Oncology, Johns Hopkins School of Medicine, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Weinberg Building 2242, 401 N. Broadway St, Baltimore MD 21287, , Leisha A. Emens, MD PhD, Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Bunting-Blaustein Cancer Research Building, 1650 Orleans Street, Room 409, Baltimore, MD 21231-1000,
| | - Leisha A. Emens
- Department of Oncology, Sidney Kimmel Cancer Center, The Johns Hopkins Hospital, Baltimore, MD, United States, 21287,Corresponding authors: Ashley Cimino-Mathews, MD, Departments of Pathology and Oncology, Johns Hopkins School of Medicine, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Weinberg Building 2242, 401 N. Broadway St, Baltimore MD 21287, , Leisha A. Emens, MD PhD, Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Bunting-Blaustein Cancer Research Building, 1650 Orleans Street, Room 409, Baltimore, MD 21231-1000,
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828
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Cheng SHC, Yu BL, Horng CF, Tsai SY, Chen CM, Chu NM, Tsou MH, Lin CK, Shih LS, Liu MC. Long-term survival and stage I breast cancer subtypes. JOURNAL OF CANCER RESEARCH AND PRACTICE 2016. [DOI: 10.1016/j.jcrpr.2015.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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829
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Loi S, Savas P. Looking Deep Into the Heterogeneity of Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer: Can We Understand It Better? J Clin Oncol 2016; 34:521-3. [DOI: 10.1200/jco.2015.64.7495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Sherene Loi
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Peter Savas
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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830
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Awada G, Gombos A, Aftimos P, Awada A. Emerging drugs targeting human epidermal growth factor receptor 2 (HER2) in the treatment of breast cancer. Expert Opin Emerg Drugs 2016; 21:91-101. [PMID: 26817602 DOI: 10.1517/14728214.2016.1146680] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Human epidermal growth factor 2 (HER2) overexpression is present in 20% of breast cancer patients. It is associated with more aggressive disease and worse clinical outcome. New drugs are thus needed. Approved and future treatments will be discussed in this review. AREAS COVERED The monoclonal antibodies trastuzumab and pertuzumab, the tyrosine kinase inhibitor lapatinib and the antibody-drug conjugate trastuzmab emtansine are approved for HER2 positive breast cancer. The combination of trastuzumab, pertuzumab and docetaxel is currently the first-line treatment in the metastatic setting. New therapies are still needed due to frequent relapse and resistance. These include mammalian target of rapamycin inhibitors, heat shock protein 90 inhibitors, pan-HER2 tyrosine kinase inhibitors, antibody-drug conjugates, immunotherapy agents (antibodies and vaccines), radioimmunotherapy and HER2 specific affinity proteins. Possible developmental issues are the complexity of the molecular biology of the HER2 positive cancer cell, the occurrence of resistance, toxicity and the high cost. EXPERT OPINION The determination of the right sequence of use of old and new therapies remains a challenging issue. The selection of patients who do or don't benefit from potentially toxic chemotherapy is also difficult. Central nervous system metastases are a common problem in HER2 positive breast cancer that needs to be addressed in future trials.
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Affiliation(s)
- Gil Awada
- a Internal Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Andrea Gombos
- b Medical Oncology Clinic , Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
| | - Philippe Aftimos
- b Medical Oncology Clinic , Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
| | - Ahmad Awada
- b Medical Oncology Clinic , Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
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831
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Pusztai L, Karn T, Safonov A, Abu-Khalaf MM, Bianchini G. New Strategies in Breast Cancer: Immunotherapy. Clin Cancer Res 2016; 22:2105-10. [PMID: 26867935 DOI: 10.1158/1078-0432.ccr-15-1315] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/26/2016] [Indexed: 11/16/2022]
Abstract
More than 70% of breast cancers contain lymphocytic infiltration in the stroma, and preclinical studies suggest that immunoediting and partial control of cancer progression by the local immune microenvironment operate in most breast cancers. Consistent with this hypothesis, a large number of studies demonstrated a favorable prognostic and chemotherapy response predictive role for immune infiltration in breast cancer. The evidence is particularly strong for triple-negative and HER2-positive cancers. The development of clinically effective immune checkpoint inhibitors now provides an opportunity to test the therapeutic potential of augmenting the local antitumor immune response. Several phase I clinical trials using single-agent anti-PD-1 and anti-PD-L1 antibodies demonstrated objective tumor response rates, with remarkably durable responses, in heavily pretreated, metastatic, triple-negative cancers and somewhat lower responses in estrogen receptor-positive cancers. Currently, close to 50 ongoing, or soon to open, clinical trials evaluate the role of this new treatment modality in breast cancer. Clin Cancer Res; 22(9); 2105-10. ©2016 AACR.
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Affiliation(s)
- Lajos Pusztai
- Breast Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut.
| | - Thomas Karn
- Department of Obstetrics and Gynecology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Anton Safonov
- Breast Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Maysa M Abu-Khalaf
- Breast Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
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832
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Carbognin L, Pilotto S, Nortilli R, Brunelli M, Nottegar A, Sperduti I, Giannarelli D, Bria E, Tortora G. Predictive and Prognostic Role of Tumor-Infiltrating Lymphocytes for Early Breast Cancer According to Disease Subtypes: Sensitivity Analysis of Randomized Trials in Adjuvant and Neoadjuvant Setting. Oncologist 2016; 21:283-91. [PMID: 26865589 DOI: 10.1634/theoncologist.2015-0307] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/16/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The role of tumor-infiltrating lymphocytes (TILs) in breast cancer (BC) is still an issue for clinical research. Toward this end, a sensitivity analysis of neoadjuvant and adjuvant randomized clinical trials was performed according to disease subtypes. METHODS Pathological complete responses (pCRs) after neoadjuvant treatment according to the presence or absence of lymphocyte-predominant BC (LPBC) were extracted and cumulated as odds ratios (ORs) by adopting a random-effects model by subtype. Overall survival hazard ratios as a function of 10% incremental values of stromal TILs (sTILs) in adjuvant trials were extracted. The interaction test was adopted to determine the differential effect according to the subtype. RESULTS Eight trials (5,514 patients) were identified. With regard to neoadjuvant setting (4 studies), a significant interaction (p < .0001) according to LPBC was found. The presence of LPBC was associated with a 29.5% increase in pCR rate compared with non-LPBC (p < .0001). The pCR rate was significantly higher in patients with LPBC in triple-negative BC (TNBC) and HER2-positive BC settings, with an absolute difference of 15.7% (95% confidence interval [CI], 4.9%-26.2%) and 33.3% (95% CI, 23.6%-42.7%), respectively. With respect to the adjuvant setting (4 studies), a significant interaction (p < .0001) according to sTILs was found. A survival benefit was more likely to be determined for HER2-positive BC (p = .025) and TNBC (p < .0001), with no statistically significant difference for estrogen receptor-positive/HER2-negative disease. CONCLUSION Despite the retrospective nature of this analysis, the presence of TILs may represent a robust predictive and prognostic marker for BC, particularly for TNBC and HER2-positive disease.
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Affiliation(s)
- Luisa Carbognin
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Pilotto
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rolando Nortilli
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessia Nottegar
- Department of Pathology and Diagnostics, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Emilio Bria
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giampaolo Tortora
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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833
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Biomarkers of residual disease after neoadjuvant therapy for breast cancer. Nat Rev Clin Oncol 2016; 13:487-503. [DOI: 10.1038/nrclinonc.2016.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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834
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Natrajan R, Sailem H, Mardakheh FK, Arias Garcia M, Tape CJ, Dowsett M, Bakal C, Yuan Y. Microenvironmental Heterogeneity Parallels Breast Cancer Progression: A Histology-Genomic Integration Analysis. PLoS Med 2016; 13:e1001961. [PMID: 26881778 PMCID: PMC4755617 DOI: 10.1371/journal.pmed.1001961] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 01/11/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The intra-tumor diversity of cancer cells is under intense investigation; however, little is known about the heterogeneity of the tumor microenvironment that is key to cancer progression and evolution. We aimed to assess the degree of microenvironmental heterogeneity in breast cancer and correlate this with genomic and clinical parameters. METHODS AND FINDINGS We developed a quantitative measure of microenvironmental heterogeneity along three spatial dimensions (3-D) in solid tumors, termed the tumor ecosystem diversity index (EDI), using fully automated histology image analysis coupled with statistical measures commonly used in ecology. This measure was compared with disease-specific survival, key mutations, genome-wide copy number, and expression profiling data in a retrospective study of 510 breast cancer patients as a test set and 516 breast cancer patients as an independent validation set. In high-grade (grade 3) breast cancers, we uncovered a striking link between high microenvironmental heterogeneity measured by EDI and a poor prognosis that cannot be explained by tumor size, genomics, or any other data types. However, this association was not observed in low-grade (grade 1 and 2) breast cancers. The prognostic value of EDI was superior to known prognostic factors and was enhanced with the addition of TP53 mutation status (multivariate analysis test set, p = 9 × 10-4, hazard ratio = 1.47, 95% CI 1.17-1.84; validation set, p = 0.0011, hazard ratio = 1.78, 95% CI 1.26-2.52). Integration with genome-wide profiling data identified losses of specific genes on 4p14 and 5q13 that were enriched in grade 3 tumors with high microenvironmental diversity that also substratified patients into poor prognostic groups. Limitations of this study include the number of cell types included in the model, that EDI has prognostic value only in grade 3 tumors, and that our spatial heterogeneity measure was dependent on spatial scale and tumor size. CONCLUSIONS To our knowledge, this is the first study to couple unbiased measures of microenvironmental heterogeneity with genomic alterations to predict breast cancer clinical outcome. We propose a clinically relevant role of microenvironmental heterogeneity for advanced breast tumors, and highlight that ecological statistics can be translated into medical advances for identifying a new type of biomarker and, furthermore, for understanding the synergistic interplay of microenvironmental heterogeneity with genomic alterations in cancer cells.
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Affiliation(s)
- Rachael Natrajan
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom.,Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Heba Sailem
- Division of Cancer Biology, The Institute of Cancer Research, London, United Kingdom
| | - Faraz K Mardakheh
- Division of Cancer Biology, The Institute of Cancer Research, London, United Kingdom
| | - Mar Arias Garcia
- Division of Cancer Biology, The Institute of Cancer Research, London, United Kingdom
| | - Christopher J Tape
- Division of Cancer Biology, The Institute of Cancer Research, London, United Kingdom
| | - Mitch Dowsett
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom.,Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom.,Centre for Molecular Pathology, Royal Marsden Hospital, London, United Kingdom.,Academic Department of Biochemistry, Royal Marsden Hospital, London, United Kingdom
| | - Chris Bakal
- Division of Cancer Biology, The Institute of Cancer Research, London, United Kingdom
| | - Yinyin Yuan
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom.,Centre for Molecular Pathology, Royal Marsden Hospital, London, United Kingdom.,Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
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835
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Wei H, Fu P, Yao M, Chen Y, Du L. Breast cancer stem cells phenotype and plasma cell-predominant breast cancer independently indicate poor survival. Pathol Res Pract 2016; 212:294-301. [PMID: 26857534 DOI: 10.1016/j.prp.2016.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/20/2015] [Accepted: 01/24/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE Cancer stem cell-tumor microenvironment ecosystem is proposed to drive tumor heterogeneity. Tumor-infiltrating lymphocytes (TILs) in breast cancer ecosystem were demonstrated to indicate better prognosis and benefit from chemotherapy. This study sought to detect the association between breast cancer stem cells and TILs. METHODS 92 patients with breast cancer were enrolled. Matched cancerous and paracancerous tissues were assembled in a tissue microarray and immunohistochemistry was employed to test expression of breast cancer stem cells (BCSCs) markers. TILs counts were estimated with global hematoxylin-eosin staining. The association between TILs and BCSCs phenotypes was analysed by multivariate analysis. RESULTS Although it was unable to find direct significant association between BCSCs phenotypes and TILs, the BCSCs phenotype with CD44(+)CD24(-)ALDH1A1(+)EpCAM(+)CD49f(+) was proved to be associated with worse DFS and OS (P=0.037 and 0.001). This result was confirmed by cox proportional-hazards regression model (for DFS and OS respectively, HR=2.438 and 3.383, P=0.019 [95%CI 1.418-3.457] and 0.025 [95%CI 1.162-9.843]). Additionally, in results of TILs, plasma cell-predominant breast cancer (PPBC) was unexpectedly found to indicate worse OS and HR was 2.686 (P=0.038 [95%CI 1.582-3.789]). CONCLUSIONS The BCSCs phenotype and PPBC may be helpful stratified factors in future clinical trials. The underlying mechanism needs further research.
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Affiliation(s)
- Haiyan Wei
- Breast Center, the Fist Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003 China.
| | - Peifen Fu
- Breast Center, the Fist Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003 China.
| | - Minya Yao
- Breast Center, the Fist Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003 China.
| | - Yaomin Chen
- Breast Center, the Fist Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003 China.
| | - Linlin Du
- Department of Intensive Care Unit, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310009 China.
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836
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Lessons from breast cancer trials of HER2-kinase inhibitors. Lancet Oncol 2016; 17:267-268. [PMID: 26822399 DOI: 10.1016/s1470-2045(16)00004-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 12/20/2015] [Accepted: 12/21/2015] [Indexed: 01/26/2023]
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837
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Finn OJ, Beatty PL. Cancer immunoprevention. Curr Opin Immunol 2016; 39:52-8. [PMID: 26799207 DOI: 10.1016/j.coi.2016.01.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 12/29/2015] [Accepted: 01/04/2016] [Indexed: 12/25/2022]
Abstract
Cancer immunotherapy is now a reality. The results are phenomenal but the cost is outrageous. Even if the cost eventually comes down and immunotherapy becomes more broadly available, using the knowledge derived from immunotherapy to apply to immunoprevention would be a good strategy. The most likely approach to cancer immunoprevention is cancer vaccines. To date, cancer vaccines have been tested mostly in the setting of advanced disease. Numerous immunosuppressive mechanisms have been identified in the tumor microenvironment as well as systemically that compromise the ability of cancer patients to respond to the vaccines. Multiple approaches are being tested to improve therapeutic cancer vaccine efficacy, including combinations with other immunotherapies. An alternative approach is to administer the vaccines to individuals without cancer but at high risk for cancer. Data in support of this approach and immunoprevention in general is accumulating and clinical testing has started.
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Affiliation(s)
- Olivera J Finn
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
| | - Pamela L Beatty
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
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838
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Kroemer G, Senovilla L, Galluzzi L, André F, Zitvogel L. Natural and therapy-induced immunosurveillance in breast cancer. Nat Med 2016; 21:1128-38. [PMID: 26444637 DOI: 10.1038/nm.3944] [Citation(s) in RCA: 230] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/17/2015] [Indexed: 02/07/2023]
Abstract
The immunosurveillance theory postulates that tumors evolve and progress in an uncontrolled fashion only when anticancer immune responses fail. Natural immunosurveillance clearly influences human breast cancer (BC) progression because the prognosis of BC patients is dictated by the density, composition and activity of the tumor immune infiltrate at diagnosis. Moreover, chemotherapeutic and radiotherapeutic regimens commonly employed for the treatment of BC affect the tumor immune infiltrate, and accumulating data suggest that the clinical efficacy of these treatments is largely determined by T cell-dependent tumor-specific immune responses. In addition, the mechanism of action of targeted anticancer therapeutics, such as the erb-b2 receptor tyrosine kinase 2 (ERBB2)-targeting agent trastuzumab, involves the innate and adaptive arms of the immune system. In this Review, we discuss these findings as well as preliminary evidence indicating that immunotherapy constitutes a promising option for the treatment of BC. Moreover, we point out that the successful implementation of immunotherapy to BC management requires the optimization of current immunotherapeutic regimens and the identification of immunological biomarkers that enable improved risk stratification and the design of personalized, dynamic treatment plans.
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Affiliation(s)
- Guido Kroemer
- Equipe 11 labellisée Ligue contre le Cancer, Centre de Recherche des Cordeliers, Paris, France.,INSERM, U1138, Paris, France.,Université Paris Descartes/Paris V, Sorbonne, Paris, France.,Université Pierre et Marie Curie/Paris VI, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Comprehensive Cancer Institute, Villejuif, France.,Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Laura Senovilla
- Equipe 11 labellisée Ligue contre le Cancer, Centre de Recherche des Cordeliers, Paris, France.,INSERM, U1138, Paris, France.,Université Paris Descartes/Paris V, Sorbonne, Paris, France.,Université Pierre et Marie Curie/Paris VI, Paris, France.,Gustave Roussy Comprehensive Cancer Institute, Villejuif, France
| | - Lorenzo Galluzzi
- Equipe 11 labellisée Ligue contre le Cancer, Centre de Recherche des Cordeliers, Paris, France.,INSERM, U1138, Paris, France.,Université Paris Descartes/Paris V, Sorbonne, Paris, France.,Université Pierre et Marie Curie/Paris VI, Paris, France.,Gustave Roussy Comprehensive Cancer Institute, Villejuif, France
| | - Fabrice André
- Gustave Roussy Comprehensive Cancer Institute, Villejuif, France.,University of Paris Sud/Paris XI, Le Kremlin-Bicêtre, France
| | - Laurence Zitvogel
- Gustave Roussy Comprehensive Cancer Institute, Villejuif, France.,University of Paris Sud/Paris XI, Le Kremlin-Bicêtre, France.,INSERM, U1015, Villejuif, France.,Center of Clinical Investigations in Biotherapies of Cancer 507 (CICBT 507), Villejuif, France
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839
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Kwa M, Adams S. Prognostic and Predictive Value of Tumor-Infiltrating Lymphocytes in Breast Cancer. CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0198-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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840
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Mittal D, Caramia F, Michiels S, Joensuu H, Kellokumpu-Lehtinen PL, Sotiriou C, Loi S, Smyth MJ. Improved Treatment of Breast Cancer with Anti-HER2 Therapy Requires Interleukin-21 Signaling in CD8+ T Cells. Cancer Res 2016; 76:264-74. [PMID: 26744522 DOI: 10.1158/0008-5472.can-15-1567] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
Abstract
The HER2/ErbB2 monoclonal antibody (mAb) trastuzumab is combined with chemotherapy as a standard-of-care for newly diagnosed HER2(+) breast cancer patients, but some patients treated with this combination therapy experience early relapse. Our analysis of data from a clinical trial evaluating the efficacy of chemotherapy plus/minus trastuzumab suggested that the magnitude of trastuzumab benefit on distant disease-free survival was higher for increasing expression of the IL21 receptor (IL21R). Therefore, we investigated a possible role for IL21 signaling in promoting HER2 mAb therapeutic efficacy. We found that IL21R-deficient mice and wild-type mice treated with a neutralizing anti-IL21 mAb were less susceptible to trastuzumab-like anti-ErbB2 therapy. Furthermore, IL21R expression on CD8(+) T cells, but not on natural killer cells, was required for optimal anti-ErbB2 mAb efficacy, and IL21 expression was enhanced in tumor-infiltrating CD4(+) T lymphocytes after anti-ErbB2 therapy. Finally, we found that administering recombinant IL21 in combination with anti-ErbB2 therapy was therapeutic against primary tumors and experimental metastases in mice. Collectively, our findings suggest that elevating IL21 signaling may enhance trastuzumab efficacy, thus constituting a novel candidate strategy to overcome trastuzumab resistance and improve patient survival. Cancer
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Affiliation(s)
- Deepak Mittal
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia. School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Franco Caramia
- Peter MacCallum Cancer Centre, University of Melbourne, East Melbourne, Victoria, Australia
| | - Stefan Michiels
- Service de Biostatistique et d'Epidemiologie, Gustave Roussy, Villejuif, France. INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Central Hospital and Helsinki University, Helsinki, Finland
| | | | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - Sherene Loi
- Peter MacCallum Cancer Centre, University of Melbourne, East Melbourne, Victoria, Australia
| | - Mark J Smyth
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia. School of Medicine, University of Queensland, Herston, Queensland, Australia.
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841
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Varadan V, Sandoval M, Harris LN. Biomarkers for Predicting Response to Anti-HER2 Agents. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 882:155-67. [PMID: 26987534 DOI: 10.1007/978-3-319-22909-6_6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The HER2 receptor is amplified or overexpressed in approximately 20% of all breast cancers, but despite significant efforts of the clinical research community and a growing number of anti-HER2 agents, a significant number of patients with HER2-positive breast cancer either progress or suffer disease relapse within 5-10 years. The development of robust biomarkers that predict response to anti-HER2 agents is therefore an important clinical need to prevent overtreatment and to enable earlier assignment of patients to more optimal therapies. Here we review some of the recent advances in the field by focusing on pathways mediating resistance to anti-HER2 therapies, and the role of the immune system and cancer stem cells in therapy response. We also review preoperative treatment strategies and research paradigms that show promise in identifying novel biomarkers of response while also enabling the delineation of the mechanisms underlying clinical benefit from anti-HER2 therapies.
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Affiliation(s)
- Vinay Varadan
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Maria Sandoval
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Lyndsay N Harris
- Seidman Cancer Center, Cleveland, OH, USA.
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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842
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Perez EA, Ballman KV, Tenner KS, Thompson EA, Badve SS, Bailey H, Baehner FL. Association of Stromal Tumor-Infiltrating Lymphocytes With Recurrence-Free Survival in the N9831 Adjuvant Trial in Patients With Early-Stage HER2-Positive Breast Cancer. JAMA Oncol 2016; 2:56-64. [PMID: 26469139 PMCID: PMC4713247 DOI: 10.1001/jamaoncol.2015.3239] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE The presence of tumor-infiltrating lymphocytes at diagnosis is reported to be prognostic in triple-negative breast cancer. OBJECTIVE To evaluate the association of stromal tumor-infiltrating lymphocytes (STILs) with recurrence-free survival (RFS) in women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer treated with chemotherapy or chemotherapy plus trastuzumab in the N9831 trial. DESIGN, SETTING, AND PARTICIPANTS Hematoxylin-eosin-stained tumor slides from patients with early-stage HER2-positive breast cancer in 2 of the 3 arms of the N9831 trial were assessed for STILs at an academic medical center. The amounts of STILs were quantitated in deciles, and a level of at least 60% STILs was used for the prespecified categorical cutoff. The association between STILs and RFS was evaluated with Cox models. EXPOSURE Standard chemotherapy consisting of doxorubicin-cyclophosphamide followed by weekly paclitaxel (arm A) or doxorubicin-cyclophosphamide followed by weekly paclitaxel plus trastuzumab followed by trastuzumab alone (arm C). MAIN OUTCOMES AND MEASURES Stromal tumor-infiltrating lymphocytes and their association with RFS. RESULTS A total of 489 patients from arm A and 456 patients from arm C were assessed with a median (range) follow-up of 4.4 (0-13.6) years. The 10-year Kaplan-Meier estimates for RFS in arm A were 90.9% and 64.5% for patients with high and low levels of STILs, respectively (hazard ratio [HR], 0.23 [95% CI, 0.07-0.73]; P = .01). The 10-year estimates for RFS in arm C were 80.0% and 80.1% for patients with high and low levels of STILs, respectively (HR, 1.26 [95% CI, 0.50-3.17]; P = .63). The test for interaction between trastuzumab treatment and STIL status was statistically significant (P = .03). In a multivariable analysis, STIL status remained significantly associated with RFS in arm A and not significantly associated in arm C (HR, 1.01 [95% CI, 0.89-1.15]; interaction P = .04). CONCLUSIONS AND RELEVANCE This analysis of participants in the N9831 trial found that the presence of STILs was prognostically associated with RFS in patients treated with chemotherapy alone but not in patients treated with chemotherapy plus trastuzumab. High levels of STILs were associated with lack of trastuzumab therapy benefit, in contrast to a previously reported association between increased levels of STILs and increased trastuzumab benefit in HER2-positive patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00005970.
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Affiliation(s)
| | | | | | | | | | | | - Frederick L. Baehner
- Genomic Health Inc., Redwood City, CA
- University of California, San Francisco, San Francisco, CA
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843
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Cimino-Mathews A, Thompson E, Taube JM, Ye X, Lu Y, Meeker A, Xu H, Sharma R, Lecksell K, Cornish TC, Cuka N, Argani P, Emens LA. PD-L1 (B7-H1) expression and the immune tumor microenvironment in primary and metastatic breast carcinomas. Hum Pathol 2016; 47:52-63. [PMID: 26527522 PMCID: PMC4778421 DOI: 10.1016/j.humpath.2015.09.003] [Citation(s) in RCA: 259] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/24/2015] [Accepted: 09/02/2015] [Indexed: 12/31/2022]
Abstract
Programmed death ligand 1 (PD-L1) expression by tumor-infiltrating lymphocytes (TILs) and tumor cells in breast cancer has been reported, but the relationships between PD-L1 expression by TIL, carcinoma cells, and other immunologic features of the breast tumor microenvironment remain unclear. We therefore evaluated the interrelationships between tumor cell surface and TIL PD-L1 expression, lymphocyte subpopulations, and patterns of immune cell infiltration in cohorts of treatment-naive, primary breast cancers (PBCs) (n = 45) and matched PBC and metastatic breast cancers (MBC) (n = 26). Seventy-eight percent of untreated PBCs contained PD-L1(+) TILs, but only 21% had PD-L1(+) carcinoma cells. Carcinoma PD-L1 expression localized to the tumor invasive front and was associated with high tumor grade (P = .04). Eighty-nine percent of PD-L1(+) carcinomas contained brisk TIL infiltrates, compared to only 24% of PD-L1(-) carcinomas; this included CD3(+) (P = .02), CD4(+) (P = .04), CD8(+) (P = .002), and FoxP3(+) T cells (P = .02). PD-L1(+) PBCs were more likely to contain PD-L1(+) TIL than PD-L1(-) PBCs (P = .04). Peripheral lymphoid aggregates were present in 100% of PD-L1(+) compared to 41% of PD-L1(-) PBC (P < .001). No patient with PD-L1(+) PBC developed distant recurrence, compared to 15% of patients with PD-L1(-) PBC. For the matched PBC and MBC cohort, 2 patients (8%) had PD-L1(+) tumors, with 1 case concordant and 1 case discordant for carcinoma PD-L1 expression in the PBC and MBC. Our data support PD-L1 expression by tumor cells as a biomarker of active breast tumor immunity and programmed death 1 blockade as a therapeutic strategy for breast cancer.
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Affiliation(s)
- Ashley Cimino-Mathews
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287; Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD 21287.
| | - Elizabeth Thompson
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Janis M Taube
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287; Department of Dermatology, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Xiaobu Ye
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Yao Lu
- Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Alan Meeker
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Haiying Xu
- Department of Dermatology, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Rajni Sharma
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Kristen Lecksell
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Toby C Cornish
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Nathan Cuka
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Pedram Argani
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287; Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD 21287
| | - Leisha A Emens
- Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD 21287.
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844
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Walsh EM, Keane MM, Wink DA, Callagy G, Glynn SA. Review of Triple Negative Breast Cancer and the Impact of Inducible Nitric Oxide Synthase on Tumor Biology and Patient Outcomes. Crit Rev Oncog 2016; 21:333-351. [PMID: 29431082 DOI: 10.1615/critrevoncog.2017021307] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Triple negative breast cancers (TNBCs), which are defined as estrogen-receptor, progesterone-receptor, and HER2-receptor negative, account for 10-20% of breast cancers, and they are associated with early metastasis, chemotherapeutic resistance, and poor survival rates. One aspect of TNBC that complicates its prognosis and the development of new molecular therapeutic targets is its clinical and molecular heterogeneity. Herein we compare TNBC and basal cytokeratin-positive breast cancers. We examine the different TNBC molecular subtypes, based on gene expression profiling, which include basal-like, mesenchymal, and luminal androgen receptors, in the context of their biology and impact on TNBC prognosis. We explore the potential role of inducible nitric oxide synthase (iNOS) in TNBC tumor biology and treatment responses. iNOS has been shown to induce p53 mutation accumulation, basal-like gene signature enrichment, and transactivation of the epidermal growth factor receptor (EGFR) via S-nitrosylation, all of which are key components of TNBC biology. Moreover, iNOS predicts poor outcome in TNBC, and iNOS inhibitors show efficacy against TNBC when used in combination with chemotherapy. We discuss molecular targeted approaches, including EGFR, PARP, and VEGF inhibitors and immunotherapeutics, that are under consideration for the treatment of TNBC and what role, if any, iNOS may play in their success.
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Affiliation(s)
- Elaine M Walsh
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland; Medical Oncology, Galway University Hospitals, Galway, Ireland
| | - Maccon M Keane
- Medical Oncology, Galway University Hospitals, Galway, Ireland
| | - David A Wink
- Cancer and Inflammation Program, National Cancer Institute-Frederick, Frederick, Maryland, USA
| | - Grace Callagy
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Sharon A Glynn
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
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845
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Tamkus D, Joginpally T. Therapeutic strategies to reverse immunosuppressive breast cancer microenvironment. ACTA ACUST UNITED AC 2016. [DOI: 10.7243/2052-6199-4-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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846
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Suppan C, Bjelic-Radisic V, La Garde M, Groselj-Strele A, Eberhard K, Samonigg H, Loibner H, Dandachi N, Balic M. Neutrophil/Lymphocyte ratio has no predictive or prognostic value in breast cancer patients undergoing preoperative systemic therapy. BMC Cancer 2015; 15:1027. [PMID: 26715527 PMCID: PMC4696229 DOI: 10.1186/s12885-015-2005-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/15/2015] [Indexed: 01/26/2023] Open
Abstract
Background The primary goal of preoperative systemic treatment (PST) in patients with breast cancer is downsizing of tumors to enhance the rate of breast conserving surgery. Additionally, preoperative systemic treatment offers the possibility to assess for chemosensitivity of early stage disease. In various cancers the prognostic value of neutrophil/lymphocyte ratio (NLR) was demonstrated, indicating that high NLR determines worse prognosis of the patients. The goal of our study was to evaluate the predictive and prognostic value of NLR in early stage breast cancer patients undergoing PST. Methods 247 female patients with histologically proven breast cancer were analysed in this retrospective analysis. The NLR before the initiation of PST was documented. Histopathological response in surgically removed specimens was evaluated using a modified Sinn regression score and the pCR defined as no invasive tumor in primary tumor and lymph nodes. NLR was correlated with response to PST and disease free survival. Results PST was categorized into five groups (anthracycline containing, anthracycline and taxane containing, taxane containing, hormone treatment and other chemotherapies). pCR rate was defined as no invasive rest of tumor either in primary tumor or (ypT0 = Sinn) or in primary tumor and in lymph nodes (ypT0isypN0). Median NLR in patients without any invasive tumor rest was significantly higher than in patients either with some invasive tumor rest or not responding to chemotherapy. Despite this primary difference, the results were not stable across the analysed treatment groups particularly in the group with highest pCR rates (taxane and anthracycline treatment). Further, no association with disease free survival could be observed. Conclusions Although there was a reverse trend with the higher NLR prior to systemic treatment in patients who achieved pCR, we could not demonstrate predictive or prognostic value of NLR in the cohort of early stage breast cancer patients treated with PST.
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Affiliation(s)
- Christoph Suppan
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Vesna Bjelic-Radisic
- Department of Gynaecology and Obstetrics, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
| | - Marlen La Garde
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. .,Department of Gynaecology and Obstetrics, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
| | - Andrea Groselj-Strele
- Research Facility for Biostatistics, Center for Medical Research, Medical University of Graz, Stiftingtalstraße 24, 8010, Graz, Austria.
| | - Katharina Eberhard
- Research Facility for Biostatistics, Center for Medical Research, Medical University of Graz, Stiftingtalstraße 24, 8010, Graz, Austria.
| | - Hellmut Samonigg
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Hans Loibner
- Apeiron Biologics AG, Campus-Vienna-Biocenter 5, 1030, Vienna, Austria.
| | - Nadia Dandachi
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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847
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Nabholtz J, Chalabi N, Radosevic-Robin N, Dauplat M, Mouret-Reynier M, Van Praagh I, Servent V, Jacquin JP, Benmammar K, Kullab S, Bahadoor M, Kwiatkowski F, Cayre A, Abrial C, Durando X, Bignon Y, Chollet P, Penault-Llorca F. Multicentric neoadjuvant pilot Phase II study of cetuximab combined with docetaxel in operable triple negative breast cancer. Int J Cancer 2015; 138:2274-80. [DOI: 10.1002/ijc.29952] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/11/2015] [Accepted: 11/13/2015] [Indexed: 02/02/2023]
Affiliation(s)
- J.M. Nabholtz
- ERTICA EA 4677, University of Auvergne; Clermont-Ferrand France
- Clinical and Translational Research Division; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
- CIC 501, UMR 766; Clermont-Ferrand France
- Medical Oncology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
| | - N. Chalabi
- ERTICA EA 4677, University of Auvergne; Clermont-Ferrand France
- Clinical and Translational Research Division; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
- CIC 501, UMR 766; Clermont-Ferrand France
| | - N. Radosevic-Robin
- ERTICA EA 4677, University of Auvergne; Clermont-Ferrand France
- Department of Biopathology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
| | - M.M. Dauplat
- ERTICA EA 4677, University of Auvergne; Clermont-Ferrand France
- Department of Biopathology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
| | - M.A. Mouret-Reynier
- ERTICA EA 4677, University of Auvergne; Clermont-Ferrand France
- Medical Oncology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
| | - I. Van Praagh
- Medical Oncology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
| | - V. Servent
- Oscar Lambret Comprehensive Cancer Centre; Lille France
| | - JP Jacquin
- Lucien Neuwirth Institute; Saint-Etienne France
| | - K.E. Benmammar
- Medical Oncology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
| | - S. Kullab
- Medical Oncology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
| | - M.R.K. Bahadoor
- Medical Oncology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
- Oncauvergne Regional Oncology Network, Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
| | - F. Kwiatkowski
- ERTICA EA 4677, University of Auvergne; Clermont-Ferrand France
- Clinical and Translational Research Division; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
- LMB GenAuvergne Oncogenetics Department; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
| | - A. Cayre
- ERTICA EA 4677, University of Auvergne; Clermont-Ferrand France
- Department of Biopathology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
| | - C. Abrial
- ERTICA EA 4677, University of Auvergne; Clermont-Ferrand France
- Clinical and Translational Research Division; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
- CIC 501, UMR 766; Clermont-Ferrand France
| | - X. Durando
- Clinical and Translational Research Division; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
- CIC 501, UMR 766; Clermont-Ferrand France
- Medical Oncology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
- EA 3846, University of Auvergne; Clermont-Ferrand France
| | - Y.J. Bignon
- ERTICA EA 4677, University of Auvergne; Clermont-Ferrand France
- LMB GenAuvergne Oncogenetics Department; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
| | - P. Chollet
- Clinical and Translational Research Division; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
- Inserm UMR 990; Clermont-Ferrand France
- University of Auvergne Clermont-Ferrand; Clermont-Ferrand France
| | - F. Penault-Llorca
- ERTICA EA 4677, University of Auvergne; Clermont-Ferrand France
- Department of Biopathology; Jean Perrin Comprehensive Cancer Centre; Clermont-Ferrand France
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848
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Abstract
INTRODUCTION Trabectedin is an anti-tumor compound registered in Europe and in several other countries, for the second-line treatment of soft tissue sarcoma (STS) and for ovarian cancer in combination with liposomal doxorubicin. Trabectedin inhibits cancer cell proliferation mainly affecting the transcription regulation. Trabectedin also acts as a modulator of tumor microenvironment by reducing the number of tumor associated macrophages (TAM). Because of its unique mechanism of action, trabectedin has the potential to act as antineoplastic agent also in several solid malignancies, including breast cancer (BC). AREAS COVERED This article reviews the preclinical and clinical data of trabectedin focusing on development in metastatic BC (mBC). Comments regarding the nature and the results of these trials are included. EXPERT OPINION Trabectedin is thought to have a crucial activity with defective DNA-repair machinery and also in modulating the tumor micro-environment and the immune-system of cancer patients. From the current available data, we recognize a potential activity of trabectedin in mBC and support the renewed efforts to better elucidate the value of trabectedin in this indication.
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Affiliation(s)
- Maurizio D'Incalci
- a Department of Oncology , IRCCS - Istituto di Ricerche Farmacologiche Mario Negri , Via La Masa 19, Milan 20156 , Italy
| | - Alberto Zambelli
- b Medical Oncology , Papa Giovanni XXIII Hospital , P.zza OMS 1, Bergamo 24127 , Italy
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849
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Abstract
The clinical relevance of the host immune system in breast cancer has long been unexplored. Studies developed over the past decade have highlighted the biological heterogeneity of breast cancer, prompting researchers to investigate whether the role of the immune system in this malignancy is similar across different molecular subtypes of the disease. The presence of high levels of lymphocytic infiltration has been consistently associated with a more-favourable prognosis in patients with early stage triple-negative and HER2-positive breast cancer. These infiltrates seem to reflect favourable host antitumour immune responses, suggesting that immune activation is important for improving survival outcomes. In this Review, we discuss the composition of the immune infiltrates observed in breast cancers, as well as data supporting the clinical relevance of host antitumour immunity, as represented by lymphocytic infiltration, and how this biomarker could be used in the clinical setting. We also discuss the rationale for enhancing immunity in breast cancer, including early data on the efficacy of T-cell checkpoint inhibition in this setting.
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850
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Optimizing the Management of Metastatic HER2-Positive Breast Cancer. CURRENT BREAST CANCER REPORTS 2015. [DOI: 10.1007/s12609-015-0191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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