51
|
Quicker, deeper and stronger imaging: A review of tumor-targeted, near-infrared fluorescent dyes for fluorescence guided surgery in the preclinical and clinical stages. Eur J Pharm Biopharm 2020; 152:123-143. [PMID: 32437752 DOI: 10.1016/j.ejpb.2020.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
Cancer is a public health problem and the main cause of human mortality and morbidity worldwide. Complete removal of tumors and metastatic lymph nodes in surgery is significantly beneficial for the prognosis of patients. Tumor-targeted, near-infrared fluorescent (NIRF) imaging is an emerging field of real-time intraoperative cancer imaging based on tumor-targeted NIRF dyes. Targeted NIRF dyes contain NIRF fluorophores and specific binding ligands such as antibodies, peptides and small molecules. The present article reviews recently updated tumor-targeted NIRF dyes for the molecular imaging of malignant tumors in the preclinical stage and clinical trials. The strengths and challenges of NIRF agents with tumor-targeting ability are also summarized. Smaller ligands, near infrared II dyes, dual-modality dyes and activatable dyes may contribute to quicker, deeper, stronger imaging in the nearest future. In this review, we highlighted tumor-targeted NIRF dyes for fluorescence-guided surgery and their potential clinical translation.
Collapse
|
52
|
Zhang H, Moisini I, Ajabnoor RM, Turner BM, Hicks DG. Applying the New Guidelines of HER2 Testing in Breast Cancer. Curr Oncol Rep 2020; 22:51. [PMID: 32346807 DOI: 10.1007/s11912-020-0901-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The human epidermal growth factor receptor 2 (HER2) is an important prognostic and predictive biomarker in the breast cancer. The American Society of Clinical Oncology/College of American Pathology (ASCO/CAP) has published HER2 testing guidelines in breast cancer. We herein reviewed the HER2 testing guidelines in breast cancer with a focus on the application of the current guidelines. RECENT FINDINGS The continual investigation of HER2 testing in breast cancer has resulted in updates in the HER2 testing guidelines. The current guidelines focus on the uncommon clinical scenarios and emphasize the coordination between immunohistochemistry and in situ hybridization results, in an effort to improve clarity and accuracy. The ASCO/CAP guidelines provide valuable recommendations to ensure the accurate evaluation of HER2 status in breast cancer patients through standardization. Additional studies, particularly those with long-term outcome data are still needed to validate the guideline recommendations, especially the uncommon cases.
Collapse
Affiliation(s)
- Huina Zhang
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Ioana Moisini
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Rana M Ajabnoor
- Department of Pathology, Faculty of medicine, King Abdulaziz University, Jeddah, 21589, Kingdom of Saudi Arabia
| | - Bradley M Turner
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - David G Hicks
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 626, Rochester, NY, 14642, USA.
| |
Collapse
|
53
|
Rakha EA, Pareja FG. New Advances in Molecular Breast Cancer Pathology. Semin Cancer Biol 2020; 72:102-113. [PMID: 32259641 DOI: 10.1016/j.semcancer.2020.03.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Abstract
Breast cancer (BC) comprises a diverse spectrum of diseases featuring distinct presentation, morphological, biological, and clinical phenotypes. BC behaviour and response to therapy also vary widely. Current evidence indicates that traditional prognostic and predictive classification systems are insufficient to reflect the biological and clinical heterogeneity of BC. Advancements in high-throughput molecular techniques and bioinformatics have contributed to the improved understanding of BC biology, refinement of molecular taxonomies and the development of novel prognostic and predictive molecular assays. Molecular testing has also become increasingly important in the diagnosis and treatment of BC in the era of precision medicine. Despite the enormous amount of research work to develop and refine BC molecular prognostic and predictive assays, it is still in evolution and proper incorporation of these molecular tests into clinical practice to guide patient's management remains a challenge. With the increasing use of more sophisticated high throughput molecular techniques, large amounts of data will continue to emerge, which could potentially lead to identification of novel therapeutic targets and allow more precise classification systems that can accurately predict outcome and response to therapy. In this review, we provide an update on the molecular classification of BC and molecular prognostic assays. Companion diagnostics, contribution of massive parallel sequencing and the use of liquid biopsy are also highlighted.
Collapse
Affiliation(s)
- Emad A Rakha
- Department of Histopathology, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, NG5 1PB, UK.
| | - Fresia G Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| |
Collapse
|
54
|
Goutsouliak K, Veeraraghavan J, Sethunath V, De Angelis C, Osborne CK, Rimawi MF, Schiff R. Towards personalized treatment for early stage HER2-positive breast cancer. Nat Rev Clin Oncol 2020; 17:233-250. [PMID: 31836877 PMCID: PMC8023395 DOI: 10.1038/s41571-019-0299-9] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2019] [Indexed: 12/13/2022]
Abstract
Advances in HER2-targeted therapies have improved the survival of patients with HER2-positive breast cancer. The standard-of-care treatment for localized disease has been chemotherapy and 1 year of adjuvant HER2-targeted therapy, typically with the anti-HER2 antibody trastuzumab. Despite the effectiveness of this treatment, disease relapse occurs in a subset of patients; thus, focus has been placed on escalating treatment by either combining different HER2-targeted agents or extending the duration of HER2-targeted therapy. Indeed, dual HER2-targeted therapies and extended-duration anti-HER2 therapy, as well as adjuvant therapy with the anti-HER2 antibody-drug conjugate T-DM1, have all been approved for clinical use. Emerging evidence suggests, however, that some patients do not derive sufficient benefit from these additional therapies to offset the associated toxicities and/or costs. Similarly, the universal use of chemotherapy might not benefit all patients, and treatment de-escalation through omission of chemotherapy has shown promise in clinical trials and is currently being explored further. The future of precision medicine should therefore involve tailoring of therapy based on the genetics and biology of each tumour and the clinical characteristics of each patient. Predictive biomarkers that enable the identification of patients who will benefit from either escalated or de-escalated treatment will be crucial to this approach. In this Review, we summarize the available HER2-targeted agents and associated mechanisms of resistance, and describe the current therapeutic landscape of early stage HER2-positive breast cancer, focusing on strategies for treatment escalation or de-escalation.
Collapse
Affiliation(s)
- Kristina Goutsouliak
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jamunarani Veeraraghavan
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Vidyalakshmi Sethunath
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Carmine De Angelis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - C Kent Osborne
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Mothaffar F Rimawi
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA.
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Rachel Schiff
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA.
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
55
|
Stroes CI, Schokker S, Creemers A, Molenaar RJ, Hulshof MC, van der Woude SO, Bennink RJ, Mathôt RA, Krishnadath KK, Punt CJ, Verhoeven RH, van Oijen MG, Creemers GJ, Nieuwenhuijzen GA, van der Sangen MJ, Beerepoot LV, Heisterkamp J, Los M, Slingerland M, Cats A, Hospers GA, Bijlsma MF, van Berge Henegouwen MI, Meijer SL, van Laarhoven HW. Phase II Feasibility and Biomarker Study of Neoadjuvant Trastuzumab and Pertuzumab With Chemoradiotherapy for Resectable Human Epidermal Growth Factor Receptor 2-Positive Esophageal Adenocarcinoma: TRAP Study. J Clin Oncol 2020; 38:462-471. [PMID: 31809243 PMCID: PMC7007286 DOI: 10.1200/jco.19.01814] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Approximately 15% to 43% of esophageal adenocarcinomas (EACs) are human epidermal growth factor receptor 2 (HER2) positive. Because dual-agent HER2 blockade demonstrated a survival benefit in breast cancer, we conducted a phase II feasibility study of trastuzumab and pertuzumab added to neoadjuvant chemoradiotherapy (nCRT) in patients with EAC. PATIENTS AND METHODS Patients with resectable HER2-positive EAC received standard nCRT with carboplatin and paclitaxel and 41.4 Gy of radiotherapy, with 4 mg/kg of trastuzumab on day 1, 2 mg/kg per week during weeks 2 to 6, and 6 mg/kg per week during weeks 7, 10, and 13 and 840 mg of pertuzumab every 3 weeks. The primary end point was feasibility, defined as ≥ 80% completion of treatment with both trastuzumab and pertuzumab. An exploratory comparison of survival with a propensity score-matched cohort receiving standard nCRT was performed, as were exploratory pharmacokinetic and biomarker analyses. RESULTS Of the 40 enrolled patients (78% men; median age, 63 years), 33 (83%) completed treatment with trastuzumab and pertuzumab. No unexpected safety events were observed. R0 resection was achieved in all patients undergoing surgery, with pathologic complete response in 13 patients (34%). Three-year progression-free and overall survival (OS) were 57% and 71%, respectively (median follow-up, 32.1 months). Compared with the propensity score-matched cohort, a significantly longer OS was observed with HER2 blockade (hazard ratio, 0.58; 95% CI, 0.34 to 0.97). Results of pharmacokinetic analysis and activity on [18F]fluorodeoxyglucose positron emission tomography scans did not correlate with survival or pathologic response. Patients with HER2 3+ overexpression or growth factor receptor-bound protein 7 (Grb7) -positive tumors at baseline demonstrated significantly better survival (P = .007) or treatment response (P = .016), respectively. CONCLUSION Addition of trastuzumab and pertuzumab to nCRT in patients with HER2-positive EAC is feasible and demonstrates potentially promising activity compared with historical controls. HER2 3+ overexpression and Grb7 positivity are potentially predictive for survival and treatment response, respectively.
Collapse
Affiliation(s)
- Charlotte I. Stroes
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Sandor Schokker
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Aafke Creemers
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Remco J. Molenaar
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Maarten C.C.M. Hulshof
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Stephanie O. van der Woude
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Roel J. Bennink
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Ron A.A. Mathôt
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Kausilia K. Krishnadath
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Cornelis J.A. Punt
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Martijn G.H. van Oijen
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | | | - Maartje Los
- Sint Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Annemieke Cats
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Maarten F. Bijlsma
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Oncode Institute, Amsterdam, the Netherlands
| | - Mark I. van Berge Henegouwen
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Sybren L. Meijer
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Hanneke W.M. van Laarhoven
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
56
|
Prat A, Pascual T, De Angelis C, Gutierrez C, Llombart-Cussac A, Wang T, Cortés J, Rexer B, Paré L, Forero A, Wolff AC, Morales S, Adamo B, Brasó-Maristany F, Vidal M, Veeraraghavan J, Krop I, Galván P, Pavlick AC, Bermejo B, Izquierdo M, Rodrik-Outmezguine V, Reis-Filho JS, Hilsenbeck SG, Oliveira M, Dieci MV, Griguolo G, Fasani R, Nuciforo P, Parker JS, Conte P, Schiff R, Guarneri V, Osborne CK, Rimawi MF. HER2-Enriched Subtype and ERBB2 Expression in HER2-Positive Breast Cancer Treated with Dual HER2 Blockade. J Natl Cancer Inst 2020; 112:46-54. [PMID: 31037288 PMCID: PMC7850037 DOI: 10.1093/jnci/djz042] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/06/2019] [Accepted: 03/26/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Identification of HER2-positive breast cancers with high anti-HER2 sensitivity could help de-escalate chemotherapy. Here, we tested a clinically applicable RNA-based assay that combines ERBB2 and the HER2-enriched (HER2-E) intrinsic subtype in HER2-positive disease treated with dual HER2-blockade without chemotherapy. METHODS A research-based PAM50 assay was applied in 422 HER2-positive tumors from five II-III clinical trials (SOLTI-PAMELA, TBCRC023, TBCRC006, PER-ELISA, EGF104090). In SOLTI-PAMELA, TBCRC023, TBCRC006, and PER-ELISA, all patients had early disease and were treated with neoadjuvant lapatinib or pertuzumab plus trastuzumab for 12-24 weeks. Primary outcome was pathological complete response (pCR). In EGF104900, 296 women with advanced disease were randomized to receive either lapatinib alone or lapatinib plus trastuzumab. Progression-free survival (PFS), overall response rate (ORR), and overall survival (OS) were evaluated. RESULTS A total of 305 patients with early and 117 patients with advanced HER2-positive disease were analyzed. In early disease, HER2-E represented 83.8% and 44.7% of ERBB2-high and ERBB2-low tumors, respectively. Following lapatinib and trastuzumab, the HER2-E and ERBB2 (HER2-E/ERBB2)-high group showed a higher pCR rate compared to the rest (44.5%, 95% confidence interval [CI] = 35.4% to 53.9% vs 11.6%, 95% CI = 6.9% to 18.0%; adjusted odds ratio [OR] = 6.05, 95% CI = 3.10 to 11.80, P < .001). Similar findings were observed with neoadjuvant trastuzumab and pertuzumab (pCR rate of 66.7% in HER2-E/ERBB2-high, 95% CI = 22.3% to 95.7% vs 14.7% in others, 95% CI = 4.9% to 31.1%; adjusted OR = 11.60, 95% CI = 1.66 to 81.10, P = .01). In the advanced setting, the HER2-E/ERBB2-high group was independently associated with longer PFS (hazard ratio [HR] = 0.52, 95% CI = 0.35 to 0.79, P < .001); higher ORR (16.3%, 95% CI = 8.9% to 26.2% vs 3.7%, 95% CI = 0.8% to 10.3%, P = .02); and longer OS (HR = 0.66, 95% CI = 0.44 to 0.97, P = .01). CONCLUSIONS Combining HER2-E subtype and ERBB2 mRNA into a single assay identifies tumors with high responsiveness to HER2-targeted therapy. This biomarker could help de-escalate chemotherapy in approximately 40% of patients with HER2-positive breast cancer.
Collapse
Affiliation(s)
- Aleix Prat
- Department of Medical Oncology, Hospital Clínic de Barcelona, Spain
- Translational Genomics and Targeted Therapeutics in Solid Tumors Laboratory, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Scientific Department, SOLTI Breast Cancer Cooperative Group, Barcelona, Spain
| | - Tomás Pascual
- Department of Medical Oncology, Hospital Clínic de Barcelona, Spain
- Translational Genomics and Targeted Therapeutics in Solid Tumors Laboratory, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Scientific Department, SOLTI Breast Cancer Cooperative Group, Barcelona, Spain
| | - Carmine De Angelis
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX
| | - Carolina Gutierrez
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX
| | | | - Tao Wang
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | - Javier Cortés
- IOB Institute of Oncology, Quironsalud Group, Madrid & Barcelona, Spain
- Breast Cancer Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Brent Rexer
- Department of Medicine, Vanderbilt University, Nashville, TN
| | - Laia Paré
- Department of Medical Oncology, Hospital Clínic de Barcelona, Spain
- Translational Genomics and Targeted Therapeutics in Solid Tumors Laboratory, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Scientific Department, SOLTI Breast Cancer Cooperative Group, Barcelona, Spain
| | - Andres Forero
- Department of Medicine, University of Alabama-Birmingham, Birmingham, AL
| | | | - Serafín Morales
- Department of Medical Oncology, Hospital Universitari Arnau Vilanova, Lleida, Spain
| | - Barbara Adamo
- Department of Medical Oncology, Hospital Clínic de Barcelona, Spain
- Translational Genomics and Targeted Therapeutics in Solid Tumors Laboratory, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Fara Brasó-Maristany
- Department of Medical Oncology, Hospital Clínic de Barcelona, Spain
- Translational Genomics and Targeted Therapeutics in Solid Tumors Laboratory, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Maria Vidal
- Department of Medical Oncology, Hospital Clínic de Barcelona, Spain
- Translational Genomics and Targeted Therapeutics in Solid Tumors Laboratory, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Jamunarani Veeraraghavan
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX
| | - Ian Krop
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Patricia Galván
- Department of Medical Oncology, Hospital Clínic de Barcelona, Spain
- Translational Genomics and Targeted Therapeutics in Solid Tumors Laboratory, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Anne C Pavlick
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | - Begoña Bermejo
- Department of Medical Oncology, Hospital Clínico de Valencia, Valencia, Spain
| | | | | | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Susan G Hilsenbeck
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX
| | - Mafalda Oliveira
- Breast Cancer Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medical Oncology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Maria Vittoria Dieci
- Department of Genetics, University of North Carolina, Chapel Hill, NC
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Gaia Griguolo
- Department of Genetics, University of North Carolina, Chapel Hill, NC
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Roberta Fasani
- Breast Cancer Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Paolo Nuciforo
- Breast Cancer Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Joel S Parker
- Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Rachel Schiff
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - C Kent Osborne
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX
| | - Mothaffar F Rimawi
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX
- Department of Medicine, Baylor College of Medicine, Houston, TX
| |
Collapse
|
57
|
De Angelis C, Nagi C, Hoyt CC, Liu L, Roman K, Wang C, Zheng Y, Veeraraghavan J, Sethunath V, Nuciforo P, Wang T, Tsimelzon A, Mao S, Hilsenbeck SG, Trivedi MV, Cataldo ML, Pavlick A, Wolff AC, Weigelt B, Reis-Filho JS, Prat A, Gutierrez C, Osborne CK, Rimawi MF, Schiff R. Evaluation of the Predictive Role of Tumor Immune Infiltrate in Patients with HER2-Positive Breast Cancer Treated with Neoadjuvant Anti-HER2 Therapy without Chemotherapy. Clin Cancer Res 2019; 26:738-745. [PMID: 31653641 DOI: 10.1158/1078-0432.ccr-19-1402] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/17/2019] [Accepted: 10/21/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Tumor-infiltrating lymphocytes (TIL) are associated with benefit to trastuzumab and chemotherapy in patients with early-stage HER2+ breast cancer. The predictive value of TILs, TIL subsets, and other immune cells in patients receiving chemotherapy-sparing lapatinib plus trastuzumab treatment is unclear.Experimental Design: Hematoxylin and eosin-stained slides (n = 59) were used to score stromal (s-)TILs from pretreatment biopsies of patients enrolled in the neoadjuvant TBCRC006 trial of 12-week lapatinib plus trastuzumab therapy (plus endocrine therapy for ER+ tumors). A 60% threshold was used to define lymphocyte-predominant breast cancer (LPBC). Multiplexed immunofluorescence (m-IF) staining (CD4, CD8, CD20, CD68, and FoxP3) and multispectral imaging were performed to characterize immune infiltrates in single formalin-fixed paraffin-embedded slides (n = 33). RESULTS The pathologic complete response (pCR) rate was numerically higher in patients with LPBC compared with patients with non-LPBC (50% vs. 19%, P = 0.057). Unsupervised hierarchical clustering of the five immune markers identified two patient clusters with different responses to lapatinib plus trastuzumab treatment (pCR = 7% vs. 50%, for cluster 1 vs. 2 respectively; P = 0.01). In multivariable analysis, cluster 2, characterized by high CD4+, CD8+, CD20+ s-TILs, and high CD20+ intratumoral TILs, was independently associated with a higher pCR rate (P = 0.03). Analysis of single immune subpopulations revealed a significant association of pCR with higher baseline infiltration by s-CD4, intratumoral (i-) CD4, and i-CD20+ TILs. CONCLUSIONS LPBC was marginally associated with higher pCR rate than non-LPBC in patients with lapatinib plus trastuzumab treated HER2+ breast cancer. Quantitative assessment of the immune infiltrate by m-IF is feasible and may help correlate individual immune cell subpopulations and immune cell profiles with treatment response.
Collapse
Affiliation(s)
- Carmine De Angelis
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Chandandeep Nagi
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | | | | | | | | | - Yi Zheng
- Akoya Biosciences, Hopkinton, Massachusetts
| | - Jamunarani Veeraraghavan
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Vidyalakshmi Sethunath
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Paolo Nuciforo
- Breast Cancer Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Tao Wang
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Anna Tsimelzon
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Sufeng Mao
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Susan G Hilsenbeck
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Meghana V Trivedi
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
| | - Maria Letizia Cataldo
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Anne Pavlick
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Antonio C Wolff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Carolina Gutierrez
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Charles Kent Osborne
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mothaffar F Rimawi
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Rachel Schiff
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. .,Department of Medicine, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
58
|
Carbognin L, Miglietta F, Paris I, Dieci MV. Prognostic and Predictive Implications of PTEN in Breast Cancer: Unfulfilled Promises but Intriguing Perspectives. Cancers (Basel) 2019; 11:E1401. [PMID: 31546901 PMCID: PMC6769721 DOI: 10.3390/cancers11091401] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 12/31/2022] Open
Abstract
The characterization of tumor biology and consequently the identification of prognostic and predictive biomarkers represent key issues for the translational research in breast cancer (BC). Phosphatase and tensin homolog deleted on chromosome ten (PTEN), the negative regulator of the proto-oncogenic phosphatidylinositol-3-kinase (PI3K)/protein kinase B (Akt) pathway, constitutes one of the most intriguing tumor suppressor genes involved in a series of biological processes, such as cell growth and survival, cellular migration and genomic stability. Loss of PTEN activity, due to protein, genetic or epigenetic alterations, was reported in up to almost half of BC cases. Recently, besides the role of PTEN in the pathogenesis of BC, investigated for over 20 years after the PTEN discovery, several retrospective and prospective translational studies, in the early and advanced setting, reported controversial results regarding the association between PTEN functional status and both clinical outcome and response to various BC treatments. This review explores the pre-clinical and clinical role of PTEN in BC with regard to the potential association of PTEN with prognosis and treatment response or resistance, underlying the complexity of the interpretation of available results and suggesting potential future perspectives.
Collapse
Affiliation(s)
- Luisa Carbognin
- Department of Medicine, University of Verona, 37126 Verona, Italy.
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
| | - Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy.
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, 35128 Padova, Italy.
| | - Ida Paris
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy.
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, 35128 Padova, Italy.
| |
Collapse
|
59
|
Moore HM, Savage HM, O'Brien C, Zhou W, Sokol ES, Goldberg ME, Metcalfe C, Friedman LS, Lackner MR, Wilson TR. Predictive and Pharmacodynamic Biomarkers of Response to the Phosphatidylinositol 3-Kinase Inhibitor Taselisib in Breast Cancer Preclinical Models. Mol Cancer Ther 2019; 19:292-303. [PMID: 31534012 DOI: 10.1158/1535-7163.mct-19-0284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/31/2019] [Accepted: 09/12/2019] [Indexed: 11/16/2022]
Abstract
The PI3K signaling pathway serves as a central node in regulating cell survival, proliferation, and metabolism. PIK3CA, the gene encoding the PI3K catalytic subunit p110-alpha, is commonly altered in breast cancer resulting in the constitutive activation of the PI3K pathway. Using an unbiased cell line screening approach, we tested the sensitivity of breast cancer cell lines to taselisib, a potent PI3K inhibitor, and correlated sensitivity with key biomarkers (PIK3CA, HER2, PTEN, and ESR1). We further assessed how taselisib modulates downstream signaling in the different genomic backgrounds that occur within breast cancer. We found that sensitivity to taselisib correlated with the presence of PIK3CA mutations, but was independent of HER2 status. We further showed that HER2-amplified/PIK3CA wild-type cell lines are not as sensitive to taselisib when compared with HER2-amplified/PIK3CA-mutant cell lines. In a PIK3CA-mutant/PTEN null background, PI3K downstream signaling rebounded in the presence of taselisib correlating with decreased sensitivity at later time points. Finally, we observed that PIK3CA mutations cooccurred with mutations in the estrogen receptor (ER; ESR1) in metastatic tumors from patients with ER+ breast cancer. However, the cooccurrence of an ESR1 mutation with a PIK3CA mutation did not affect response to taselisib in a single agent setting or in combination with fulvestrant. In summary, these data suggest that development of taselisib in breast cancer should occur in a PIK3CA-mutant setting with cotreatments determined by the specific subtypes under investigation.
Collapse
Affiliation(s)
- Heather M Moore
- Oncology Biomarker Development, Genentech Inc., South San Francisco, California
| | - Heidi M Savage
- Oncology Biomarker Development, Genentech Inc., South San Francisco, California
| | | | - Wei Zhou
- Translational Oncology, Genentech Inc., South San Francisco, California
| | - Ethan S Sokol
- Cancer Genomics Research, Foundation Medicine Inc., Cambridge, Massachusetts
| | - Michael E Goldberg
- Cancer Genomics Research, Foundation Medicine Inc., Cambridge, Massachusetts
| | - Ciara Metcalfe
- Translational Oncology, Genentech Inc., South San Francisco, California
| | | | | | - Timothy R Wilson
- Oncology Biomarker Development, Genentech Inc., South San Francisco, California.
| |
Collapse
|
60
|
Lazaridis G, Kotoula V, Vrettou E, Kostopoulos I, Manousou K, Papadopoulou K, Giannoulatou E, Bobos M, Sotiropoulou M, Pentheroudakis G, Efstratiou I, Papoudou-Bai A, Psyrri A, Christodoulou C, Gogas H, Koutras A, Timotheadou E, Pectasides D, Zagouri F, Fountzilas G. Opposite Prognostic Impact of Single PTEN-loss and PIK3CA Mutations in Early High-risk Breast Cancer. Cancer Genomics Proteomics 2019; 16:195-206. [PMID: 31018950 DOI: 10.21873/cgp.20125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/AIM PTEN-loss and PIK3CA mutations have been addressed as markers of PI3K activation in breast cancer. We evaluated these markers in early high-risk breast cancer (EBC) focusing on PTEN immunohistochemistry (IHC) issues, particularly in HER2-positive disease. MATERIALS AND METHODS We examined PTEN-loss and PIK3CA mutations in 1265 EBC patients treated with adjuvant chemotherapy within two clinical trials. Two different methods for the evaluation of PTEN IHC were used, one upfront binary (loss; no-loss) and the other initially multi-scale allowing for the classification of "grey zone" tumors with low and very low PTEN protein expression. RESULTS PTEN-loss (33.4% and 22.1%, depending on the IHC method) and PIK3CA mutations (29.6%) were associated with ER/PgR/HER2-negative and ER/PgR-positive disease, respectively. Concordance of the two IHC methods was moderate (Cohen's kappa 0.624). PTEN-loss discrepancy and intra-tumor heterogeneity concerned "grey zone" tumors that were prevalent among HER2-positive cancers. PTEN-loss independently conferred higher risk for relapse and death. Compared to single PIK3CA mutations,single PTEN-loss was independently associated with increased risk for relapse and death. Depending on the evaluation method, in HER2-positive cancer, PTEN-loss was without- or of marginal unfavorable prognostic significance. CONCLUSION In EBC, PTEN-loss is an independent predictor of poor outcome. When occurring singly, PTEN-loss and PIK3CA mutations have opposite prognostic impact. In HER2-positive disease, assessment of PTEN-loss by IHC appears unreliable and the marker is without clear prognostic significance.
Collapse
Affiliation(s)
- Georgios Lazaridis
- Department of Medical Oncology, Faculty of Medicine Papageorgiou Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Thessaloniki, Greece
| | - Vassiliki Kotoula
- Department of Pathology, School of Health Sciences, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Vrettou
- Department of Pathology, School of Health Sciences, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kostopoulos
- Department of Pathology, School of Health Sciences, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriaki Manousou
- Section of Biostatistics, Hellenic Cooperative Oncology Group, Data Office, Athens, Greece
| | - Kyriaki Papadopoulou
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia.,The University of New South Wales, Kensington, NSW, Australia
| | - Mattheos Bobos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Ioannis Efstratiou
- Department of Pathology, School of Health Sciences, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Amanda Psyrri
- Division of Oncology, Second Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | | | - Helen Gogas
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Angelos Koutras
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece
| | - Eleni Timotheadou
- Department of Medical Oncology, Faculty of Medicine Papageorgiou Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Thessaloniki, Greece
| | - Dimitrios Pectasides
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, Athens, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
61
|
Liu YC, Ma Y, An N, Sun P, Wang Y, Sun C. Clinical efficacy of combination of pertuzumab, trastuzumab, and docetaxel for treatment of patients with HER2-positive breast cancer. Medicine (Baltimore) 2019; 98:e17262. [PMID: 31568001 PMCID: PMC6756723 DOI: 10.1097/md.0000000000017262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study will systematically investigate the efficacy and safety of the combination of pertuzumab, trastuzumab, and docetaxel (PTD) for treatment of patients with HER2-positive breast cancer (HER2-PBC). METHODS A comprehensive literature search for this study will consist of 2 parts: electronic database records and gray literature. The electronic database literatures are searched from PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All databases will be searched from inception up to the present. In addition, gray literatures, such as dissertations, ongoing trials, and so on, will also be searched. Two authors will independently read the records, extract data collection, and evaluate the risk of bias. RevMan V.5.3 software will be applied for statistical analysis. RESULTS This study will summarize up-to-date evidence of PTD for patients with HER2-PBC via overall survival, complete response, cancer-specific survival, recurrence-free survival, disease-free survival, quality of life, and toxicities. CONCLUSION This study will provide efficacy and safety of PTD for HER2-PBC.
Collapse
Affiliation(s)
| | - Ying Ma
- Department of Library, Mudanjiang Medical University
| | - Ning An
- Second Ward of Neurology Department, Affiliated Hongqi Hospital of Mudanjiang Medical University
| | | | - Ying Wang
- Institute of Neuro Tissue Engineering, Mudanjiang Medical University, Mudanjiang, China
| | | |
Collapse
|
62
|
The 41-gene classifier TRAR predicts response of HER2 positive breast cancer patients in the NeoALTTO study. Eur J Cancer 2019; 118:1-9. [DOI: 10.1016/j.ejca.2019.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/29/2022]
|
63
|
Pondé NF, Zardavas D, Piccart M. Progress in adjuvant systemic therapy for breast cancer. Nat Rev Clin Oncol 2019; 16:27-44. [PMID: 30206303 DOI: 10.1038/s41571-018-0089-9] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The prognosis of patients with early stage breast cancer has greatly improved in the past three decades. Following the first adjuvant endocrine therapy and chemotherapy trials, continuous improvements of clinical outcomes have been achieved through intense therapeutic escalation, albeit with increased health-care costs and treatment-related toxicities. In contrast to the advances achieved in surgery or radiotherapy, the identification of the patient subgroups that will derive clinical benefit from therapeutic escalation has proved to be a daunting process hindered by a lack of collaboration between scientific groups and by the pace of drug development. In the past few decades, initiatives towards de-escalation of systemic adjuvant treatment have achieved success. Herein, we summarize attempts to escalate and de-escalate adjuvant systemic treatment for patients with breast cancer and argue that new, creative trial designs focused on patients' actual needs rather than on maximizing drug market size are needed. Ultimately, the adoption of effective treatments that do not needlessly expose patients and health-care systems to harm demands extensive international collaboration between academic groups, governments, and pharmaceutical companies.
Collapse
Affiliation(s)
- Noam F Pondé
- Research Department, Institut Jules Bordet, Academic Promoting Team, Brussels, Belgium
| | | | - Martine Piccart
- Research Department, Institut Jules Bordet, Brussels, Belgium.
| |
Collapse
|
64
|
Choi JDW, Hughes TMD, Marx G, Rutovitz J, Hasovits C, Ngui NK. Pathological outcomes of HER2‐positive non‐metastatic breast cancer patients treated with neoadjuvant dual anti‐HER2 therapy and taxane: An Australian experience. Asia Pac J Clin Oncol 2019; 16:103-107. [DOI: 10.1111/ajco.13178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/27/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Joseph Do Woong Choi
- Division of SurgerySydney Adventist Hospital Sydney New South Wales Australia
- Sydney Adventist Hospital Clinical SchoolThe University of Sydney Sydney New South Wales Australia
| | - Thomas Michael D. Hughes
- Division of SurgerySydney Adventist Hospital Sydney New South Wales Australia
- Sydney Adventist Hospital Clinical SchoolThe University of Sydney Sydney New South Wales Australia
- Breast Multidisciplinary TeamSydney Adventist Hospital Sydney New South Wales Australia
| | - Gavin Marx
- Sydney Adventist Hospital Clinical SchoolThe University of Sydney Sydney New South Wales Australia
- Department of Medical OncologySydney Adventist Hospital Sydney New South Wales Australia
- Breast Multidisciplinary TeamSydney Adventist Hospital Sydney New South Wales Australia
| | - Josie Rutovitz
- Department of Medical OncologySydney Adventist Hospital Sydney New South Wales Australia
- Breast Multidisciplinary TeamSydney Adventist Hospital Sydney New South Wales Australia
| | - Csilla Hasovits
- Department of Medical OncologySydney Adventist Hospital Sydney New South Wales Australia
- Breast Multidisciplinary TeamSydney Adventist Hospital Sydney New South Wales Australia
| | - Nicholas K. Ngui
- Division of SurgerySydney Adventist Hospital Sydney New South Wales Australia
- Sydney Adventist Hospital Clinical SchoolThe University of Sydney Sydney New South Wales Australia
- Breast Multidisciplinary TeamSydney Adventist Hospital Sydney New South Wales Australia
| |
Collapse
|
65
|
Leal MF, Haynes BP, MacNeill FA, Dodson A, Dowsett M. Comparison of protein expression between formalin-fixed core-cut biopsies and surgical excision specimens using a novel multiplex approach. Breast Cancer Res Treat 2019; 175:317-326. [PMID: 30796652 PMCID: PMC6533418 DOI: 10.1007/s10549-019-05163-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE We evaluated whether multiplex protein quantification using antibody bar-coding with photocleavable oligonucleotides (NanoString) can be applied to evaluate protein expression in breast cancer FFPE specimens. We also assessed whether diagnostic core-cuts fixed immediately at time of procedures and surgical excision sections from routinely fixed breast cancers are affected by the same fixation related differences noted using immunohistochemistry (IHC). METHODS The expression of 26 proteins was analysed using NanoString technology in 16 pairs of FFPE breast cancer core-cuts and surgical excisions. The measurements yielded were compared with those by IHC on Ki67, PgR and HER2 biomarkers and pAKT and pERK1/2 phosphorylated proteins. RESULTS When considered irrespective of sample type, expression measured by the two methods was strongly correlated for all markers (p < 0.001; ρ = 0.69-0.88). When core-cuts and excisions were evaluated separately, the correlations between NanoString and IHC were weaker but significant except for pAKT in excisions. Surgical excisions showed lower levels of 8/12 phosphoproteins and higher levels of 4/13 non-phosphorylated proteins in comparison to core-cuts (p < 0.01). Reduced p4EBP1, pAMPKa, pRPS6 and pRAF1 immunogenicity in excisions was correlated with tumour size and mastectomy specimens showed lower p4EBP1 and pRPS6 expression than lumpectomy (p < 0.05). CONCLUSIONS Our study supports the validity of the new multiplex approach to protein analysis but indicates that, as with IHC, caution is necessary for the analysis in excisions particularly of phosphoproteins. The specimen type, tumour size and surgery type may lead to biases in the quantitative analysis of many proteins of biologic and clinical interest in excision specimens.
Collapse
Affiliation(s)
- Mariana Ferreira Leal
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK.
- Breast Cancer Now Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK.
| | - Ben P Haynes
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK
| | - Fiona A MacNeill
- Breast Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Andrew Dodson
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK
- Breast Cancer Now Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
| |
Collapse
|
66
|
Mulero-Sánchez A, Pogacar Z, Vecchione L. Importance of genetic screens in precision oncology. ESMO Open 2019; 4:e000505. [PMID: 31231569 PMCID: PMC6555615 DOI: 10.1136/esmoopen-2019-000505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 01/05/2023] Open
Abstract
Precision oncology aims to distinguish which patients are eligible for a specific treatment in order to achieve the best possible outcome. In the last few years, genetic screens have shown their potential to find the new targets and drug combinations as well as predictive biomarkers for response and/or resistance to cancer treatment. In this review, we outline how precision oncology is changing over time and describe the different applications of genetic screens. Finally, we present some practical examples that describe the utility and the limitations of genetic screens in precision oncology.
Collapse
Affiliation(s)
- Antonio Mulero-Sánchez
- Division of Molecular Carcinogenesis, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ziva Pogacar
- Division of Molecular Carcinogenesis, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Loredana Vecchione
- Charite Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
67
|
Loibl S, Treue D, Budczies J, Weber K, Stenzinger A, Schmitt WD, Weichert W, Jank P, Furlanetto J, Klauschen F, Karn T, Pfarr N, von Minckwitz G, Möbs M, Jackisch C, Sers C, Schneeweiss A, Fasching PA, Schem C, Hummel M, van Mackelenbergh M, Nekljudova V, Untch M, Denkert C. Mutational Diversity and Therapy Response in Breast Cancer: A Sequencing Analysis in the Neoadjuvant GeparSepto Trial. Clin Cancer Res 2019; 25:3986-3995. [PMID: 30979740 DOI: 10.1158/1078-0432.ccr-18-3258] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/18/2019] [Accepted: 04/02/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Next-generation sequencing (NGS) can be used for comprehensive investigation of molecular events in breast cancer. We evaluated the relevance of genomic alterations for response to neoadjuvant chemotherapy (NACT) in the GeparSepto trial. EXPERIMENTAL DESIGN Eight hundred fifty-one pretherapeutic formalin-fixed paraffin-embedded (FFPE) core biopsies from GeparSepto study were sequenced. The panel included 16 genes for mutational (AKT1, BRAF, CDH1, EGFR, ERBB2, ESR1, FBXW7, FGFR2, HRAS, KRAS, NRAS, SF3B1, TP53, HNF1A, PIK3CA, and PTEN) and 8 genes for copy-number alteration analysis (CCND1, ERBB2, FGFR1, PAK1, PIK3CA, TOP2A, TP53, and ZNF703). RESULTS The most common genomic alterations were mutations of TP53 (38.4%) and PIK3CA (21.5%), and 8 different amplifications (TOP2A 34.9%; ERBB2 30.6%; ZNF703 30.1%; TP53 21.9%; PIK3CA 24.1%; CCND1 17.7%; PAK1 14.9%; FGFR 12.6%). All other alterations had a prevalence of less than 5%. The genetic heterogeneity in different breast cancer subtypes [lum/HER2neg vs. HER2pos vs. triple-negative breast cancer (TNBC)] was significantly linked to differences in NACT response. A significantly reduced pathologic complete response rate was observed in PIK3CA-mutated breast cancer [PIK3CAmut: 23.0% vs. wild-type (wt) 38.8%, P < 0.0001] in particular in the HER2pos subcohort [multivariate OR = 0.43 (95% CI, 0.24-0.79), P = 0.006]. An increased response to nab-paclitaxel was observed only in PIK3CAwt breast cancer, with univariate significance for the complete cohort (P = 0.009) and the TNBC (P = 0.013) and multivariate significance in the HER2pos subcohort (test for interaction P = 0.0074). CONCLUSIONS High genetic heterogeneity was observed in different breast cancer subtypes. Our study shows that FFPE-based NGS can be used to identify markers of therapy resistance in clinical study cohorts. PIK3CA mutations could be a major mediator of therapy resistance in breast cancer.
Collapse
Affiliation(s)
| | - Denise Treue
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - Jan Budczies
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Sites Berlin and Munich, Germany.,Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Albrecht Stenzinger
- German Cancer Consortium (DKTK), Partner Sites Berlin and Munich, Germany.,Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang D Schmitt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - Wilko Weichert
- German Cancer Consortium (DKTK), Partner Sites Berlin and Munich, Germany.,Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Paul Jank
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | | | - Frederick Klauschen
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Sites Berlin and Munich, Germany
| | - Thomas Karn
- Department of Gynecology and Obstetrics, University of Frankfurt, Frankfurt am Main, Germany
| | - Nicole Pfarr
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | | | - Markus Möbs
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | - Christian Jackisch
- Department of Obstetrics and Gynecology and Breast Cancer Center, Sana Klinikum Offenbach, Offenbach, Germany
| | - Christine Sers
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Sites Berlin and Munich, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Christian Schem
- Mammazentrum Hamburg - Brustklinik am Krankenhaus Jerusalem, Hamburg, Germany
| | - Michael Hummel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany
| | | | | | | | - Carsten Denkert
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Sites Berlin and Munich, Germany.,Institute of Pathology, Philipps-University Marburg and University Hospital Marburg, Marburg, Germany
| |
Collapse
|
68
|
Eiger D, Pondé NF, de Azambuja E. Pertuzumab in HER2-positive early breast cancer: current use and perspectives. Future Oncol 2019; 15:1823-1843. [PMID: 30938542 DOI: 10.2217/fon-2018-0896] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Although the prognosis of HER2-positive breast cancer patients has dramatically improved with modern chemotherapy and the monoclonal antibody trastuzumab, up to 31% of them will experience a recurrence in the long term. After the unprecedented benefit in overall survival with the addition of the second monoclonal antibody pertuzumab for patients with metastatic disease, the drug was tested with various degrees of success in the preoperative and postoperative settings. In this review, we will focus on the pharmacologic aspects of the drug, including mechanism of action and toxicities, and discuss clinical data regarding its use in advanced and early stage HER2-positive breast cancer, placing in perspective the pros and cons regarding other available drugs and biomarkers.
Collapse
Affiliation(s)
- Daniel Eiger
- Institut Jules Bordet - Université Libre de Bruxelles (ULB); Medical Oncology Department, Academic Promoting Team at Boulevard de Waterloo, 121, 1000, Brussels, Belgium
| | - Noam Falbel Pondé
- Institut Jules Bordet - Université Libre de Bruxelles (ULB); Medical Oncology Department, Academic Promoting Team at Boulevard de Waterloo, 121, 1000, Brussels, Belgium
| | - Evandro de Azambuja
- Institut Jules Bordet - Université Libre de Bruxelles (ULB); Medical Oncology Department, Academic Promoting Team at Boulevard de Waterloo, 121, 1000, Brussels, Belgium
| |
Collapse
|
69
|
Kennedy SP, Han JZR, Portman N, Nobis M, Hastings JF, Murphy KJ, Latham SL, Cadell AL, Miladinovic D, Marriott GR, O'Donnell YEI, Shearer RF, Williams JT, Munoz AG, Cox TR, Watkins DN, Saunders DN, Timpson P, Lim E, Kolch W, Croucher DR. Targeting promiscuous heterodimerization overcomes innate resistance to ERBB2 dimerization inhibitors in breast cancer. Breast Cancer Res 2019; 21:43. [PMID: 30898150 PMCID: PMC6429830 DOI: 10.1186/s13058-019-1127-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background The oncogenic receptor tyrosine kinase (RTK) ERBB2 is known to dimerize with other EGFR family members, particularly ERBB3, through which it potently activates PI3K signalling. Antibody-mediated inhibition of this ERBB2/ERBB3/PI3K axis has been a cornerstone of treatment for ERBB2-amplified breast cancer patients for two decades. However, the lack of response and the rapid onset of relapse in many patients now question the assumption that the ERBB2/ERBB3 heterodimer is the sole relevant effector target of these therapies. Methods Through a systematic protein-protein interaction screen, we have identified and validated alternative RTKs that interact with ERBB2. Using quantitative readouts of signalling pathway activation and cell proliferation, we have examined their influence upon the mechanism of trastuzumab- and pertuzumab-mediated inhibition of cell growth in ERBB2-amplified breast cancer cell lines and a patient-derived xenograft model. Results We now demonstrate that inactivation of ERBB3/PI3K by these therapeutic antibodies is insufficient to inhibit the growth of ERBB2-amplified breast cancer cells. Instead, we show extensive promiscuity between ERBB2 and an array of RTKs from outside of the EGFR family. Paradoxically, pertuzumab also acts as an artificial ligand to promote ERBB2 activation and ERK signalling, through allosteric activation by a subset of these non-canonical RTKs. However, this unexpected activation mechanism also increases the sensitivity of the receptor network to the ERBB2 kinase inhibitor lapatinib, which in combination with pertuzumab, displays a synergistic effect in single-agent resistant cell lines and PDX models. Conclusions The interaction of ERBB2 with a number of non-canonical RTKs activates a compensatory signalling response following treatment with pertuzumab, although a counter-intuitive combination of ERBB2 antibody therapy and a kinase inhibitor can overcome this innate therapeutic resistance. Electronic supplementary material The online version of this article (10.1186/s13058-019-1127-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sean P Kennedy
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.,Systems Biology Ireland, University College Dublin, Belfield, Dublin 4, Ireland
| | - Jeremy Z R Han
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Neil Portman
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.,St Vincent's Hospital Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Max Nobis
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Jordan F Hastings
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Kendelle J Murphy
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Sharissa L Latham
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Antonia L Cadell
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Dushan Miladinovic
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Gabriella R Marriott
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Yolande E I O'Donnell
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Robert F Shearer
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - James T Williams
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.,School of Medicine, University of Notre Dame, Sydney, NSW, 2011, Australia
| | - Amaya Garcia Munoz
- Systems Biology Ireland, University College Dublin, Belfield, Dublin 4, Ireland
| | - Thomas R Cox
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.,St Vincent's Hospital Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia
| | - D Neil Watkins
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.,St Vincent's Hospital Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Darren N Saunders
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, 2025, Australia
| | - Paul Timpson
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.,St Vincent's Hospital Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Elgene Lim
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.,St Vincent's Hospital Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Walter Kolch
- Systems Biology Ireland, University College Dublin, Belfield, Dublin 4, Ireland.,Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.,School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - David R Croucher
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia. .,St Vincent's Hospital Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia. .,School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland.
| |
Collapse
|
70
|
Chia SKL, Martin M, Holmes FA, Ejlertsen B, Delaloge S, Moy B, Iwata H, von Minckwitz G, Mansi J, Barrios CH, Gnant M, Tomašević Z, Denduluri N, Šeparović R, Kim SB, Jakobsen EH, Harvey V, Robert N, Smith J, Harker G, Zhang B, Eli LD, Ye Y, Lalani AS, Buyse M, Chan A. PIK3CA alterations and benefit with neratinib: analysis from the randomized, double-blind, placebo-controlled, phase III ExteNET trial. Breast Cancer Res 2019; 21:39. [PMID: 30867034 PMCID: PMC6417207 DOI: 10.1186/s13058-019-1115-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Neratinib is an irreversible pan-HER tyrosine kinase inhibitor that inhibits PI3K/Akt and MAPK signaling pathways after HER2 receptor activation. The ExteNET study showed that neratinib significantly improved 5-year invasive disease-free survival (iDFS) in women who completed trastuzumab-based adjuvant therapy for early breast cancer (EBC). We assessed the prognostic and predictive significance of PIK3CA alterations in patients in ExteNET. METHODS Participants were women aged ≥ 18 years (≥ 20 years in Japan) with stage 1-3c (modified to stage 2-3c in February 2010) operable breast cancer, who had completed (neo)adjuvant chemotherapy plus trastuzumab ≤ 2 years before randomization, with no evidence of disease recurrence or metastatic disease at study entry. Patients were randomized to oral neratinib 240 mg/day or placebo for 1 year. Formalin-fixed, paraffin-embedded primary tumor specimens underwent polymerase chain reaction (PCR) PIK3CA testing for two hotspot mutations in exon 9, one hot-spot mutation in exon 20, and fluorescence in situ hybridization (FISH) analysis for PIK3CA amplification. The primary endpoint (iDFS) was tested with log-rank test and hazard ratios (HRs) estimated using Cox proportional-hazards models. RESULTS Among the intent-to-treat population (n = 2840), tumor specimens were available for PCR testing (991 patients) and PIK3CA FISH (702 patients). Overall, 262 samples were PIK3CA altered: 201 were mutated (77%), 52 (20%) were amplified, and 9 (3%) were mutated and amplified. iDFS was non-significantly worse in placebo-treated patients with altered vs wild-type PIK3CA (HR 1.34; 95% CI 0.72-2.50; P = 0.357). Neratinib's effect over placebo was significant in patients with PIK3CA-altered tumors (HR 0.41; 95% CI 0.17-0.90, P = 0.028) but not PIK3CA wild-type tumors (HR 0.72; 95% CI 0.36-1.41; P = 0.34). The interaction test was non-significant (P = 0.309). CONCLUSIONS Although there was a greater absolute risk reduction associated with neratinib treatment of patients with PIK3CA-altered tumors in ExteNET, current data do not support PIK3CA alteration as a predictive biomarker of response to neratinib in HER2-positive EBC. TRIAL REGISTRATION ClinicalTrials.gov , NCT00878709 . Trial registered April 9, 2009.
Collapse
Affiliation(s)
- Stephen K L Chia
- British Columbia Cancer Agency, University of British Columbia, 600 West 10th Avenue, Vancouver, British Columbia, V5Z4E6, Canada.
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Gunter von Minckwitz
- Luisenkrankenhaus, German Breast Group Forschungs GmbH, Düsseldorf, Neu-isenburg, Germany
| | - Janine Mansi
- Biomedical Research Centre, Guy's Hospital, King's College London, London, UK
| | - Carlos H Barrios
- Pontifical Catholic University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Zorica Tomašević
- Daily Chemotherapy Hospital, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | | | - Robert Šeparović
- University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Sung-Bae Kim
- Asan Medical Center, University of Ulsan, Seoul, Korea
| | | | - Vernon Harvey
- Auckland City Hospital, Grafton, Auckland, New Zealand
| | - Nicholas Robert
- McKesson Specialty Health and The US Oncology Network, The Woodlands, TX, USA
| | | | | | - Bo Zhang
- Puma Biotechnology, Inc., Los Angeles, CA, USA
| | - Lisa D Eli
- Puma Biotechnology, Inc., Los Angeles, CA, USA
| | - Yining Ye
- Puma Biotechnology, Inc., Los Angeles, CA, USA
| | | | - Marc Buyse
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - Arlene Chan
- Breast Cancer Research Centre-WA, Perth & Curtin University, Nedlands, Australia
| |
Collapse
|
71
|
Kim JY, Lee E, Park K, Jung HH, Park WY, Lee KH, Sohn J, Lee KS, Jung KH, Kim JH, Lee KH, Im SA, Park YH. Molecular alterations and poziotinib efficacy, a pan-HER inhibitor, in human epidermal growth factor receptor 2 (HER2)-positive breast cancers: Combined exploratory biomarker analysis from a phase II clinical trial of poziotinib for refractory HER2-positive breast cancer patients. Int J Cancer 2019; 145:1669-1678. [PMID: 30720867 DOI: 10.1002/ijc.32188] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/19/2018] [Accepted: 11/28/2018] [Indexed: 12/29/2022]
Abstract
We aimed to investigate the impact of genetic alterations on the efficacy of poziotinib in a phase II clinical trial of patients with heavily treated HER2-positive metastatic breast cancer (BC). We performed targeted ultra-deep sequencing with a customized cancer gene panel and RNA expression assay using BC specimens. Of 106 patients, biomarker data were available for 85. Copy number (CN) amplifications of HER2 were observed in 72 patients (85%), and CN >8 in 50 (59%). Single nucleotide variants (SNVs) of HER2 were found in 16 patients (19%). Genetic alterations of PIK3CA pathway were found in 40 patients (47%). Median progression free survival (PFS) of the biomarker analysis group was 3.61 months. In terms of PFS, HER2 with CN >8 prolonged (hazard ratio (HR) 0.61, 95% CI: 0.38, 0.97, p = 0.037) and alteration of PIK3CA pathway shortened the duration of survival (HR 2.25, 95% CI: 1.39, 3.63, p = 0.001). SNVs of HER2 increased survival duration, but the effect was not significant (HR: 0.58, 95% CI: 0.31, 1.08, p = 0.085). In addition, SNVs in the ERBB3 cytoplasmic domain decreased poziotinib response (HR: 4.58, 95% CI: 2.02, 10.37, p < 0.001). In multigene analysis, BC with HER2 CN >8 and intact PIK3CA pathway had significantly longer PFS compared to others (HR: 0.37, 95% CI: 0.21, 0.66, p = 0.001), while SNVs in the ERBB3 cytoplasmic domain predicted poor prognosis (HR: 4.28, 95% CI: 1.71, 10.71, p < 0.001). In conclusion, HER2 CN amplification, PIK3CA pathway alteration, and ERBB3 cytoplasmic mutation showed predictive roles on clinical outcomes of HER2-positive MBC treated with poziotinib.
Collapse
Affiliation(s)
- Ji-Yeon Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eunjin Lee
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyunghee Park
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hae Hyun Jung
- Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung-Hun Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, South Korea
| | - Joohyuk Sohn
- Department of Internal Medicine, Yonsei Cancer Center, Seoul, South Korea
| | - Keun Seok Lee
- Center for Breast Cancer, National Cancer Center Hospital, Goyang, South Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ki Hyeong Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Seock-Ah Im
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, South Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
72
|
Hicks DG, Buscaglia B, Goda H, McMahon L, Natori T, Turner B, Soukiazian A, Okada H, Nakano Y. A novel detection methodology for HER2 protein quantitation in formalin-fixed, paraffin embedded clinical samples using fluorescent nanoparticles: an analytical and clinical validation study. BMC Cancer 2018; 18:1266. [PMID: 30563489 PMCID: PMC6299600 DOI: 10.1186/s12885-018-5172-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/03/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Clinical assays for the assessment of the human epidermal growth factor receptor-2 (HER2) status in breast cancer include immunohistochemistry (IHC) and in situ hybridization (ISH), both of which have limitations. Recent studies have suggested that a more quantitative approach to the measurement of HER2 protein expression may improve specificity in selecting patients for HER-2 targeted therapy. In the current study, we have used HER2 expression in breast cancer cell lines and clinical samples as a model to explore the potential utility of a novel immunodetection technique, using streptavidin coated Phosphor Integrated Dot fluorescent nanoparticles (PID), which can be quantitatively measured using computer analysis. METHODS The expression of HER2 protein in cell lines was evaluated with antibody-binding capacity using fluorescence-activated cell sorting (FACS) for comparison with PID measurements to test for correlations with existing quantitative protein analysis methodologies. Various other analytic validation tests were also performed, including accuracy, precision, sensitivity, robustness and reproducibility. A methods comparison study investigated correlations between PID versus IHC and ISH in clinical samples. Lastly, we measured HER2 protein expression using PID in the pretreatment biopsies from 34 HER2-positive carcinomas that had undergone neoadjuvant trastuzumab-based chemotherapy. RESULTS In the analytic validation, PID HER2 measurements showed a strong linear correlation with FACS analysis in breast cell lines, and demonstrated significant correlations with all aspects of precision, sensitivity, robustness and reproducibility. PID also showed strong correlations with conventional HER2 testing methodologies (IHC and ISH). In the neoadjuvant study, patients with a pathologic complete response (pCR) had a significantly higher PID score compared with patients who did not achieve a pCR (p = 0.011), and was significantly correlated to residual cancer burden (RCB) class (p = 0.026, R2 = 0.9975). CONCLUSIONS Analytic testing of PID showed that it may be a viable testing methodology that could offer advantages over other experimental or conventional biomarker diagnostic methodologies. Our data also suggests that PID quantitation of HER2 protein may offer an improvement over conventional HER2 testing in the selection of patients who will be the most likely to benefit from HER2-targeted therapy. Further studies with a larger cohort are warranted.
Collapse
Affiliation(s)
- David G Hicks
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Brandon Buscaglia
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hideki Goda
- Konica Minolta INC., Bio Health Care Business Development Division, Corporate R&D Headquarters, No. 1 Sakura-machi, Hino-shi Tokyo, 191-8511, Japan
| | - Loralee McMahon
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Takako Natori
- Konica Minolta INC., Bio Health Care Business Development Division, Corporate R&D Headquarters, No. 1 Sakura-machi, Hino-shi Tokyo, 191-8511, Japan
| | - Bradley Turner
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Armen Soukiazian
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hisatake Okada
- Konica Minolta INC., Bio Health Care Business Development Division, Corporate R&D Headquarters, No. 1 Sakura-machi, Hino-shi Tokyo, 191-8511, Japan
| | - Yasushi Nakano
- Konica Minolta INC., Bio Health Care Business Development Division, Corporate R&D Headquarters, No. 1 Sakura-machi, Hino-shi Tokyo, 191-8511, Japan
| |
Collapse
|
73
|
Escrivá-de-Romaní S, Arumí M, Zamora E, Bellet M. Neoadjuvant Model as a Platform for Research in Breast Cancer and Novel Targets under Development in this Field. Breast Care (Basel) 2018; 13:251-262. [PMID: 30319327 DOI: 10.1159/000492122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
For decades, the neoadjuvant setting has provided a useful scenario for research in breast cancer. Historically, neoadjuvant clinical trials, either hormone therapy-based or chemotherapy-based, have tried to recapitulate the results of their counterpart adjuvant studies, but with smaller patient numbers, more rapid outcomes (clinical response and/or pathologic complete response (pCR)), together with additional biologic information. As for neoadjuvant chemotherapy trials, the increase in pCR rates has been recently accepted as an appropriate surrogate marker to accelerate drug approval in high-risk breast cancer patients. In this setting, with the exception of luminal A tumors, pCR has been associated with improved long-term outcomes, particularly when the analysis is based on specific trials for each breast cancer subtype. For luminal tumors receiving neoadjuvant endocrine therapy, Ki67 at 2-4 weeks and the preoperative endocrine prognostic index score are the most accepted intermediate markers of efficacy, which will be validated in ongoing larger trials. In this review, we describe the different neoadjuvant designs: from the classical randomized trials in which treatment is delivered for 6 or more months to short non-therapeutic presurgical studies lasting just 2 or 3 weeks. We also review the main neoadjuvant trials, either ongoing or completed, for luminal, triple-negative, and HER2-positive breast cancer. The translational effort and research of biomarkers conducted in these studies will be particularly addressed.
Collapse
Affiliation(s)
- Santiago Escrivá-de-Romaní
- Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Miriam Arumí
- Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Esther Zamora
- Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Meritxell Bellet
- Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| |
Collapse
|
74
|
Pernas S, Barroso-Sousa R, Tolaney SM. Optimal treatment of early stage HER2-positive breast cancer. Cancer 2018; 124:4455-4466. [PMID: 30291791 DOI: 10.1002/cncr.31657] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/16/2018] [Accepted: 07/15/2018] [Indexed: 01/20/2023]
Abstract
Significant advances have occurred in the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer that have changed its natural history. The addition of trastuzumab to standard therapy has dramatically improved the prognosis for patients with early stage, HER2-positive breast cancer to unprecedented survival outcomes. Yet, long-term follow-up data from adjuvant pivotal trials indicate that 15-24% of patients still develop recurrent disease. Most of the research has focused on the addition of novel anti-HER2 drugs to standard therapy, including studies evaluating the monoclonal antibody pertuzumab; the antibody-drug conjugate trastuzumab-emtansine (T-DM1); the selective, reversible HER2/epidermal growth factor receptor kinase inhibitor lapatinib; or the irreversible pan-HER2 inhibitor neratinib. Dual HER2 blockade has improved overall survival remarkably in metastatic breast cancer; however, in patients with early stage disease, it has led to small benefits in progression-free survival. Moreover, biologic heterogeneity within HER2-positive disease may determine response to treatment and prognosis. Different subgroups of patients with HER2-positive breast cancer may benefit from different therapeutic approaches. Thus, there is ongoing work to optimize and de-escalate treatment in patients who may do just as well with less therapy and can avoid unnecessary treatments and their related toxicities. The objective of this review is to summarize the background and latest evidence on the current management of early stage, HER2-positive breast cancer and to present novel perspectives on its management.
Collapse
Affiliation(s)
- Sonia Pernas
- Department of Medical Oncology, Institut Catala d'Oncologia-H.U.Bellvitge-IDIBELL, L´Hospitalet-Barcelona, Spain.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
75
|
Nicolini A, Ferrari P, Duffy MJ. Prognostic and predictive biomarkers in breast cancer: Past, present and future. Semin Cancer Biol 2018; 52:56-73. [DOI: 10.1016/j.semcancer.2017.08.010] [Citation(s) in RCA: 209] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/14/2017] [Accepted: 08/24/2017] [Indexed: 12/19/2022]
|
76
|
Li H, Xu Y, Zhao F, Song G, Rugo HS, Zhang Y, Yang L, Liu X, Shao B, Yang L, Liu Y, Ran R, Zhang R, Guan Y, Chang L, Yi X. Plasma PIK3CA ctDNA specific mutation detected by next generation sequencing is associated with clinical outcome in advanced breast cancer. Am J Cancer Res 2018; 8:1873-1886. [PMID: 30323979 PMCID: PMC6176180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023] Open
Abstract
Through next generation sequencing, this study evaluated the circulating tumor DNA (ctDNA) of advanced breast cancer patients to prospectively explore the relationship between specific DNA mutations and prognosis as well as therapeutic decision making. The target region covered 1021 gene totally. Clinical characteristics, treatment and outcome data were collected. We analyzed progression-free survival (PFS) from first-line therapy and overall survival (OS), and found that their endpoints were correlated with observed gene mutations. We enrolled 54 patients, with a median follow-up time of 8 years. Mutations were found in TP53, PIK3CA, and ERBB family, at 40.7%, 35.2%, and 25.9%, respectively. PIK3CA more frequently occurred in the site of 3140 A>G (p.H1047R) for 20.4% and HER2+ diseases, and it was associated with shorter median PFS and worse OS among HER2+ patients [mutant vs. wild type: 4 (range 2-9) vs. 8 (range 2-22) months, P=0.006], and [mutant vs. wild type: 29 (range 12-74) vs. 64 (range 20-96) months, P=0.043], respectively. The patients with mutations in TP53 had shorter OS (median 64 vs. 121 months, P=0.006). Multivariate analysis for HER2+ disease demonstrated that the PIK3CA p.H1047R mutation was the only factor associated with shorter PFS (P=0.025); while the receiver operating characteristic (ROC) analysis produces an area under the curve (AUC) of 0.789. The ctDNA analysis, found PIK3CA p.H1047R mutation was more frequent in HER2+ disease and associated with worse OS. It was also the only mutation associated with shorter PFS through a multivariate analysis of HER2+ patients who were treated with trastuzumab, suggesting trastuzumab had lower activity in these patients. The presence of a TP53 mutation was associated with worse OS.
Collapse
Affiliation(s)
- Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute52 Fucheng Rd, Beijing 100142, China
| | - Yaping Xu
- Geneplus-BeijingBeijing 102206, China
| | - Fangyuan Zhao
- University of Chicago, Division of The Social Sciences1130E, 59th Street, Chicago 60637, IL, USA
| | - Guohong Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute52 Fucheng Rd, Beijing 100142, China
| | - Hope S Rugo
- Department of Medicine, University of California at San Francisco, Helen Diller Family Comprehensive Cancer CenterSan Francisco, USA
| | - Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Branch of Medical Statistics, Peking University Cancer Hospital and Institute52 Fucheng Rd, Beijing 100142, China
| | - Ling Yang
- Geneplus-BeijingBeijing 102206, China
| | - Xiaoran Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute52 Fucheng Rd, Beijing 100142, China
| | - Bin Shao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute52 Fucheng Rd, Beijing 100142, China
| | | | - Yaxin Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute52 Fucheng Rd, Beijing 100142, China
| | - Ran Ran
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute52 Fucheng Rd, Beijing 100142, China
| | - Ruyan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute52 Fucheng Rd, Beijing 100142, China
| | | | | | - Xin Yi
- Geneplus-BeijingBeijing 102206, China
| |
Collapse
|
77
|
Wulfkuhle JD, Yau C, Wolf DM, Vis DJ, Gallagher RI, Brown-Swigart L, Hirst G, Voest EE, DeMichele A, Hylton N, Symmans F, Yee D, Esserman L, Berry D, Liu M, Park JW, Wessels LF, van’t Veer L, Petricoin EF. Evaluation of the HER/PI3K/AKT Family Signaling Network as a Predictive Biomarker of Pathologic Complete Response for Patients With Breast Cancer Treated With Neratinib in the I-SPY 2 TRIAL. JCO Precis Oncol 2018; 2:PO.18.00024. [PMID: 32914002 PMCID: PMC7446527 DOI: 10.1200/po.18.00024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE In the I-SPY 2 TRIAL (Investigation of Serial Studies to Predict Your Therapeutic Response With Imaging and Molecular Analysis 2), the pan-erythroblastic oncogene B inhibitor neratinib was available to all hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) subtypes and graduated in the HR-negative/HER2-positive signature. We hypothesized that neratinib response may be predicted by baseline HER2 epidermal growth factor receptor (EGFR) signaling activation/phosphorylation levels independent of total levels of HER2 or EGFR proteins. MATERIALS AND METHODS Complete experimental and response data were available for between 130 and 193 patients. In qualifying analyses, which used logistic regression and treatment interaction analysis, 18 protein/phosphoprotein, 10 mRNA, and 12 DNA biomarkers that related to HER family signaling were evaluated. Exploratory analyses used Wilcoxon rank sum and t tests without multiple comparison correction. RESULTS HER pathway DNA biomarkers were either low prevalence or nonpredictive. In expression biomarker analysis, only one gene (STMN1) was specifically associated with response to neratinib in the HER2-negative subset. In qualifying protein/phosphoprotein analyses that used reverse phase protein microarrays, six HER family markers were associated with neratinib response. After analysis was adjusted for HR/HER2 status, EGFR Y1173 (pEGFR) showed a significant biomarker-by-treatment interaction (P = .049). Exploratory analysis of HER family signaling in patients with triple-negative (TN) disease found that activation of EGFR Y1173 (P = .005) and HER2 Y1248 (pHER2) (P = .019) were positively associated with pathologic complete response. Exploratory analysis in this pEGFR/pHER2-activated TN subgroup identified elevated levels of estrogen receptor α (P < .006) in these patients. CONCLUSION Activation of HER family phosphoproteins associates with response to neratinib, but only EGFR Y1173 and STMN1 appear to add value to the graduating signature. Activation of HER2 and EGFR in TN tumors may identify patients whose diseases respond to neratinib and implies that there is a subset of patients with TN disease who paradoxically exhibit HER family signaling activation and may achieve clinical benefit with neratinib; this concept must be validated in future studies.
Collapse
Affiliation(s)
- Julia D. Wulfkuhle
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Christina Yau
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Denise M. Wolf
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Daniel J. Vis
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Rosa I. Gallagher
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Lamorna Brown-Swigart
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Gillian Hirst
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Emile E. Voest
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Angela DeMichele
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Nola Hylton
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Fraser Symmans
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Douglas Yee
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Laura Esserman
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Donald Berry
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Minetta Liu
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - John W. Park
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Lodewyk F.A. Wessels
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Laura van’t Veer
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| | - Emanuel F. Petricoin
- Julia D. Wulfkuhle, Rosa I. Gallagher, and Emanuel F. Petricoin III, George Mason University, Manassas, VA; Christina Yau, Denise M. Wolf, Lamorna Brown-Swigart, Gillian Hirst, Nola Hylton, Laura Esserman, John W. Park, and Laura van’t Veer, University of California, San Francisco, San Francisco, CA; Daniel J. Vis, Emile E. Voest, and Lodewyk F.A. Wessels, Netherlands Cancer Institute, Amsterdam, the Netherlands; Angela DeMichele, University of Pennsylvania, Philadelphia, PA; Fraser Symmans, University of Texas MD Anderson Cancer Center, Houston; Donald Berry, Berry Consultants, Austin, TX; Douglas Yee, University of Minnesota, Minneapolis; and Minetta Liu, Mayo Clinic, Rochester, MN
| |
Collapse
|
78
|
Liang X, Vacher S, Boulai A, Bernard V, Baulande S, Bohec M, Bièche I, Lerebours F, Callens C. Targeted next-generation sequencing identifies clinically relevant somatic mutations in a large cohort of inflammatory breast cancer. Breast Cancer Res 2018; 20:88. [PMID: 30086764 PMCID: PMC6081877 DOI: 10.1186/s13058-018-1007-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background Inflammatory breast cancer (IBC) is the most aggressive form of primary breast cancer. Using a custom-made breast cancer gene sequencing panel, we investigated somatic mutations in IBC to better understand the genomic differences compared with non-IBC and to consider new targeted therapy in IBC patients. Methods Targeted next-generation sequencing (NGS) of 91 candidate breast cancer-associated genes was performed on 156 fresh-frozen breast tumor tissues from IBC patients. Mutational profiles from 197 primary breast tumors from The Cancer Genome Atlas (TCGA) were used as non-IBC controls for comparison analysis. The mutational landscape of IBC was correlated with clinicopathological data and outcomes. Results After genotype calling and algorithmic annotations, we identified 392 deleterious variants in IBC and 320 variants in non-IBC cohorts, respectively. IBC tumors harbored more mutations than non-IBC (2.5 per sample vs. 1.6 per sample, p < 0.0001). Eighteen mutated genes were significantly different between the two cohorts, namely TP53, CDH1, NOTCH2, MYH9, BRCA2, ERBB4, POLE, FGFR3, ROS1, NOTCH4, LAMA2, EGFR, BRCA1, TP53BP1, ESR1, THBS1, CASP8, and NOTCH1. In IBC, the most frequently mutated genes were TP53 (43.0%), PIK3CA (29.5%), MYH9 (8.3%), NOTCH2 (8.3%), BRCA2 (7.7%), ERBB4 (7.1%), FGFR3 (6.4%), POLE (6.4%), LAMA2 (5.8%), ARID1A (5.1%), NOTCH4 (5.1%), and ROS1 (5.1%). After grouping 91 genes on 10 signaling pathways, we found that the DNA repair pathway for the triple-negative breast cancer (TNBC) subgroup, the RTK/RAS/MAPK and cell cycle pathways for the HR–/HER2+ subgroup, the DNA repair, RTK/RAS/MAPK, and NOTCH pathways for the HR+/HER2– subgroup, and the DNA repair, epigenome, and diverse pathways for the HR+/HER2+ subgroup were all significantly differently altered between IBC and non-IBC. PIK3CA mutation was independently associated with worse metastasis-free survival (MFS) in IBC since the median MFS for the PIK3CA mutant type was 26.0 months and for the PIK3CA wild type was 101.1 months (p = 0.002). This association was observed in TNBC (p = 0.04) and the HR–/HER2+ subgroups (p = 0.0003), but not in the HR+/HER2– subgroup of IBC. Conclusions Breast cancer-specific targeted NGS uncovered a high frequency of deleterious somatic mutations in IBC, some of which may be relevant for clinical management. Electronic supplementary material The online version of this article (10.1186/s13058-018-1007-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Xu Liang
- Department of Breast Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.,Pharmacogenomic Unit, Department of Genetics, Curie Institute, PSL Research University, 26 rue d'Ulm, 75005, Paris, France
| | - Sophie Vacher
- Pharmacogenomic Unit, Department of Genetics, Curie Institute, PSL Research University, 26 rue d'Ulm, 75005, Paris, France
| | - Anais Boulai
- Pharmacogenomic Unit, Department of Genetics, Curie Institute, PSL Research University, 26 rue d'Ulm, 75005, Paris, France
| | - Virginie Bernard
- Clinic bioinformatic Unit, Department of Biopathology, Curie Institute, PSL Research University, Paris, France
| | - Sylvain Baulande
- Institut Curie Genomics of Excellence (ICGex) Platform, Curie Institute, PSL Research University, Paris, France
| | - Mylene Bohec
- Institut Curie Genomics of Excellence (ICGex) Platform, Curie Institute, PSL Research University, Paris, France
| | - Ivan Bièche
- Pharmacogenomic Unit, Department of Genetics, Curie Institute, PSL Research University, 26 rue d'Ulm, 75005, Paris, France.,EA7331, Paris Descartes University, Sorbonne Paris Cité, Faculty of Pharmaceutical and Biological Sciences, Paris, France
| | - Florence Lerebours
- Department of Medical Oncology, Curie Institute, René Huguenin Hospital, Saint-Cloud, France
| | - Céline Callens
- Pharmacogenomic Unit, Department of Genetics, Curie Institute, PSL Research University, 26 rue d'Ulm, 75005, Paris, France.
| |
Collapse
|
79
|
Bulbul A, Araujo-Mino E, Dayao ZR. The Conundrum of Adjuvant HER2 Treatment Options. Front Oncol 2018; 8:177. [PMID: 29900124 PMCID: PMC5989731 DOI: 10.3389/fonc.2018.00177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/08/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ajaz Bulbul
- Division of Internal Medicine, Department of Hematology/Oncology, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, United States.,Hematology and Oncology, Kymera Cancer Center, Carlsbad, NM, United States
| | - Emilio Araujo-Mino
- Hematology and Oncology, Kymera Cancer Center, Carlsbad, NM, United States.,Division of Hematology Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| | - Zoneddy Ruiz Dayao
- Division of Hematology Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| |
Collapse
|
80
|
Zhao B, Zhao Y, Sun Y, Niu H, Sheng L, Huang D, Li L. Alterations in mRNA profiles of trastuzumab‑resistant Her‑2‑positive breast cancer. Mol Med Rep 2018; 18:139-146. [PMID: 29750305 PMCID: PMC6059662 DOI: 10.3892/mmr.2018.8981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 04/05/2018] [Indexed: 12/16/2022] Open
Abstract
Breast cancer is one of the most common malignancies in women. Neoadjuvant trastuzumab therapy improves the prognosis of certain Her-2-positive breast cancer patients, however around two-thirds of patients with Her-2-positive breast cancer do not benefit from Her-2-targeted therapy. To investigate the key mechanisms in trastuzumab resistance, potential biomarkers for neoadjuvant trastuzumab sensitivity were investigated using the gene expression omnibus (GEO) database for mRNA microarray data of Her-2-positive breast cancer patients who received neoadjuvant trastuzumab therapy. GEO profiles of 22 patients with a complete response and 48 patients with a partial response were identified in the GSE22358, GSE62327 and GSE66305 datasets. A total of 2,376, 1,000 and 1,152 differentially expressed genes in GSE22358, GSE62327 and GSE66305 datasets were demonstrated, respectively, utilizing GEO2R software. Furthermore, enriched gene ontology terms and Kyoto Encyclopedia of Genes and Genomes pathways were analyzed using the Database for Annotation, Visualization and Integrated Discovery software. Subsequently, a protein-protein interaction network was established using STRING software. The results demonstrated that low sex-determining region Y-box 11 and high Bcl-2 expression may be employed as markers for neoadjuvant trastuzumab therapy for Her-2-positive breast cancer. More importantly, phosphoinositide 3-kinase/Akt and angiogenesis pathways, which are known to be the key targets of trastuzumab, were activated at a lower level in the partial response patients, while the Wnt and estrogen receptor signaling pathways were activated in these patients. Therefore, combination therapy of trastuzumab and anti-Wnt or hormone therapy may be a promising treatment modality and should be tested in further studies.
Collapse
Affiliation(s)
- Bin Zhao
- Department of Ultrasonography, Qilu Hospital, Shandong University, Qingdao, Shandong 266035, P.R. China
| | - Yang Zhao
- Department of Transplantation, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Yan Sun
- Department of Ultrasonography, Qilu Hospital, Shandong University, Qingdao, Shandong 266035, P.R. China
| | - Haitao Niu
- Department of Transplantation, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Long Sheng
- Department of Transplantation, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Dongfang Huang
- Department of Transplantation, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Li Li
- Department of Ultrasonography, Qilu Hospital, Shandong University, Qingdao, Shandong 266035, P.R. China
| |
Collapse
|
81
|
Fan H, Li C, Xiang Q, Xu L, Zhang Z, Liu Q, Zhang T, Zhou Y, Zhao X, Cui Y. PIK3CA mutations and their response to neoadjuvant treatment in early breast cancer: A systematic review and meta-analysis. Thorac Cancer 2018; 9:571-579. [PMID: 29575819 PMCID: PMC5928352 DOI: 10.1111/1759-7714.12618] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND PIK3CA mutations frequently occur in breast cancer patients. This study was conducted to evaluate the relationship between PIK3CA mutations and neoadjuvant treatment response and to analyze the clinical implications. METHODS PubMed, Embase, and the Cochrane database were searched for relevant studies in September 2017. The pooled risk ratio (RR) was estimated using fixed effects or random effects models according to heterogeneity among studies. RESULTS This meta-analysis included 20 studies with 4392 patients. The pooled RR showed that PIK3CA mutation is correlated to lower pathological complete response (pCR) in unselected HER2+ patients (RR = 0.73; 95% confidence interval [CI] 0.66-0.81), thus the predictive value of PIK3CA status may be stronger in HER2+/HR+ patients (RR = 0.50; 95% CI 0.27-0.93) and those administered dual-targeting treatment (RR = 0.55; 95% CI 0.39-0.78). In contrast with wild type, either exon 9 (RR = 0.55; 95% CI 0.39-0.78) or exon 20 (RR = 0.71; 95% CI 0.58-0.89) mutations were significantly associated with lower pCR. The predictive value of exon 9 mutations was not significantly greater than exon 20 mutations (RR = 0.76; 95% CI 0.51-1.13). CONCLUSION In early breast cancer, PIK3CA mutations seem to identify HER2+ patients who are less likely to reach pCR. The clinical implications of PIK3CA mutations tend to vary between exon 9 and exon 20. This mechanism should be explored in further studies.
Collapse
Affiliation(s)
- Hongwei Fan
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Chao Li
- Department of PharmacyPeking University First HospitalBeijingChina
- National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Qian Xiang
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Ling Xu
- Breast Disease CenterPeking University First HospitalBeijingChina
| | - Zhuo Zhang
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Qianxin Liu
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Tonttong Zhang
- National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Ying Zhou
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Xia Zhao
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Yimin Cui
- Department of PharmacyPeking University First HospitalBeijingChina
| |
Collapse
|
82
|
Predicting the Efficacy of HER2-Targeted Therapies: A Look at the Host. DISEASE MARKERS 2017; 2017:7849108. [PMID: 29403144 PMCID: PMC5748305 DOI: 10.1155/2017/7849108] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/21/2017] [Indexed: 12/29/2022]
Abstract
HER2 is overexpressed in 20% of invasive breast cancers (BCs) and correlates with a more aggressive disease. Until the advent of targeted agents, HER2 was associated with worse outcomes. Rationally designed HER2-targeted agents have been developed and introduced into clinical practice for women with HER2-amplified BC, improving disease-free and overall survival for primary and metastatic tumors. Trastuzumab, a recombinant humanized anti-HER2 monoclonal antibody, combined with chemotherapy, remains the standard of care for patients with HER2-positive BCs. However, many patients do not respond to this agent, whereas newer drugs have proven to be efficacious in clinical trials. The identification of biomarkers that select sensitive tumors and patients who will benefit from these new agents would help the incorporation of these therapies, limiting the risk of side effects and overtreatment and improving the outcomes of all patients with early-stage HER2-positive BC. We review the mechanisms of action of HER2-targeting agents, focusing on the involvement of the immune system and related predictive biomarkers.
Collapse
|
83
|
Rimawi MF, De Angelis C, Contreras A, Pareja F, Geyer FC, Burke KA, Herrera S, Wang T, Mayer IA, Forero A, Nanda R, Goetz MP, Chang JC, Krop IE, Wolff AC, Pavlick AC, Fuqua SAW, Gutierrez C, Hilsenbeck SG, Li MM, Weigelt B, Reis-Filho JS, Kent Osborne C, Schiff R. Low PTEN levels and PIK3CA mutations predict resistance to neoadjuvant lapatinib and trastuzumab without chemotherapy in patients with HER2 over-expressing breast cancer. Breast Cancer Res Treat 2017; 167:731-740. [PMID: 29110152 DOI: 10.1007/s10549-017-4533-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/04/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Aberrant activation of the PI3K pathway has been implicated in resistance to HER2-targeted therapy, but results of clinical trials are confounded by the co-administration of chemotherapy. We investigated the effect of perturbations of this pathway in breast cancers from patients treated with neoadjuvant anti-HER2-targeted therapy without chemotherapy. PATIENTS AND METHODS Baseline tumor samples from patients with HER2-positive breast cancer enrolled in TBCRC006 (NCT00548184), a 12-week neoadjuvant clinical trial with lapatinib plus trastuzumab [plus endocrine therapy for estrogen receptor (ER)-positive tumors], were assessed for PTEN status by immunohistochemistry and PIK3CA mutations by sequencing. Results were correlated with pathologic complete response (pCR). RESULTS Of 64 evaluable patients, PTEN immunohistochemistry and PIK3CA mutation analysis were performed for 59 and 46 patients, respectively. PTEN status (dichotomized by H-score median) was correlated with pCR (32% in high PTEN vs. 9% in low PTEN, p = 0.04). PIK3CA mutations were identified in 14/46 tumors at baseline (30%) and did not correlate with ER or PTEN status. One patient whose tumor harbored a PIK3CA mutation achieved pCR (p = 0.14). When considered together (43 cases), 1/25 cases (4%) with a PIK3CA mutation and/or low PTEN expression levels had a pCR compared to 7/18 cases (39%) with wild-type PI3KCA and high PTEN expression levels (p = 0.006). CONCLUSION PI3K pathway activation is associated with resistance to lapatinib and trastuzumab in breast cancers, without chemotherapy. Further studies are warranted to investigate how to use these biomarkers to identify upfront patients who may respond to anti-HER2 alone, without chemotherapy.
Collapse
Affiliation(s)
- Mothaffar F Rimawi
- Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine and Baylor St. Luke's Medical Center, BCM 600, One Baylor Plaza, Houston, TX, 77030, USA.
| | - Carmine De Angelis
- Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine and Baylor St. Luke's Medical Center, BCM 600, One Baylor Plaza, Houston, TX, 77030, USA
| | - Alejandro Contreras
- Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine and Baylor St. Luke's Medical Center, BCM 600, One Baylor Plaza, Houston, TX, 77030, USA
| | - Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Felipe C Geyer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathleen A Burke
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sabrina Herrera
- Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine and Baylor St. Luke's Medical Center, BCM 600, One Baylor Plaza, Houston, TX, 77030, USA
| | - Tao Wang
- Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine and Baylor St. Luke's Medical Center, BCM 600, One Baylor Plaza, Houston, TX, 77030, USA
| | | | - Andres Forero
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Ian E Krop
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Antonio C Wolff
- Johns Hopkins Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Anne C Pavlick
- Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine and Baylor St. Luke's Medical Center, BCM 600, One Baylor Plaza, Houston, TX, 77030, USA
| | - Suzanne A W Fuqua
- Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine and Baylor St. Luke's Medical Center, BCM 600, One Baylor Plaza, Houston, TX, 77030, USA
| | - Carolina Gutierrez
- Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine and Baylor St. Luke's Medical Center, BCM 600, One Baylor Plaza, Houston, TX, 77030, USA
| | - Susan G Hilsenbeck
- Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine and Baylor St. Luke's Medical Center, BCM 600, One Baylor Plaza, Houston, TX, 77030, USA
| | - Marilyn M Li
- University of Pennsylvania, Philadelphia, PA, USA
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C Kent Osborne
- Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine and Baylor St. Luke's Medical Center, BCM 600, One Baylor Plaza, Houston, TX, 77030, USA
| | - Rachel Schiff
- Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine and Baylor St. Luke's Medical Center, BCM 600, One Baylor Plaza, Houston, TX, 77030, USA
| |
Collapse
|
84
|
Mittendorf EA, Chavez-MacGregor M. All HER2-Positive Tumors are not Created Equal. Ann Surg Oncol 2017; 24:3471-3474. [DOI: 10.1245/s10434-017-6053-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 12/11/2022]
|
85
|
Smith IE, Okines AFC. De-escalating and escalating systemic therapy of early breast cancer. Breast 2017; 34 Suppl 1:S5-S9. [PMID: 28694014 DOI: 10.1016/j.breast.2017.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ian E Smith
- Royal Marsden Hospital and Institute of Cancer Research, London, UK.
| | | |
Collapse
|