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Kwei KA, Kung Y, Salari K, Holcomb IN, Pollack JR. Genomic instability in breast cancer: pathogenesis and clinical implications. Mol Oncol 2010; 4:255-66. [PMID: 20434415 DOI: 10.1016/j.molonc.2010.04.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 03/27/2010] [Accepted: 04/02/2010] [Indexed: 10/19/2022] Open
Abstract
Breast cancer is a heterogeneous disease, appreciable by molecular markers, gene-expression profiles, and most recently, patterns of genomic alteration. In particular, genomic profiling has revealed three distinct patterns of DNA copy-number alteration: a "simple" type with few gains or losses of whole chromosome arms, an "amplifier" type with focal high-level DNA amplifications, and a "complex" type marked by numerous low-amplitude changes and copy-number transitions. The three patterns are associated with distinct gene-expression subtypes, and preferentially target different loci in the genome (implicating distinct cancer genes). Moreover, the different patterns of alteration imply distinct underlying mechanisms of genomic instability. The amplifier pattern may arise from transient telomere dysfunction, although new data suggest ongoing "amplifier" instability. The complex pattern shows similarity to breast cancers with germline BRCA1 mutation, which also exhibit "basal-like" expression profiles and complex-pattern genomes, implicating a possible defect in BRCA1-associated repair of DNA double-strand breaks. As such, targeting presumptive DNA repair defects represents a promising area of clinical investigation. Future studies should clarify the pathogenesis of breast cancers with amplifier and complex-pattern genomes, and will likely identify new therapeutic opportunities.
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Affiliation(s)
- Kevin A Kwei
- Department of Pathology, Stanford University School of Medicine, CCSR-3245A, 269 Campus Drive, Stanford, CA 94305-5176, USA
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102
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Perez EA, Moreno-Aspitia A, Aubrey Thompson E, Andorfer CA. Adjuvant therapy of triple negative breast cancer. Breast Cancer Res Treat 2010; 120:285-91. [PMID: 20094772 PMCID: PMC3918886 DOI: 10.1007/s10549-010-0736-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 01/06/2010] [Indexed: 12/28/2022]
Abstract
Patients with the triple negative subtype of breast cancer have an overall poor outcome, with earlier relapses, distinct patterns of metastases, and lack of specific targets for treatment selection. Classification of these tumors has begun to be modified by inclusion of immunohistochemistry for various markers, and gene profiling. Further characterization of this subtype of breast cancer may aid in the identification of new targeted therapies. Anthracyclines and taxanes remain the standard of care in the adjuvant setting. However, novel anti-angiogenesis, anti-tubulin, and DNA repair agents are already under evaluation in (neo) adjuvant trials. Molecular characterization is being included in trials to identify optimal adjuvant strategies. The aim of this manuscript is to review data concerning the molecular characterization of triple negative breast cancers as well as the clinical outcomes of treating patients with existing adjuvant treatments, and to highlight newer adjuvant research strategies in development.
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Affiliation(s)
- Edith A Perez
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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103
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Margeli M, Cirauqui B, Castella E, Tapia G, Costa C, Gimenez-Capitan A, Barnadas A, Ronco MS, Benlloch S, Taron M, Rosell R. The prognostic value of BRCA1 mRNA expression levels following neoadjuvant chemotherapy in breast cancer. PLoS One 2010; 5:e9499. [PMID: 20209131 PMCID: PMC2831058 DOI: 10.1371/journal.pone.0009499] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 02/03/2010] [Indexed: 01/21/2023] Open
Abstract
Background A fraction of sporadic breast cancers has low BRCA1 expression. BRCA1 mutation carriers are more likely to achieve a pathological complete response with DNA-damage-based chemotherapy compared to non-mutation carriers. Furthermore, sporadic ovarian cancer patients with low levels of BRCA1 mRNA have longer survival following platinum-based chemotherapy than patients with high levels of BRCA1 mRNA. Methodology/Principal Findings Tumor biopsies were obtained from 86 breast cancer patients who were candidates for neoadjuvant chemotherapy, treated with four cycles of neoadjuvant fluorouracil, epirubicin and cyclophosphamide. Estrogen receptor (ER), progesterone receptor (PR), HER2, cytokeratin 5/6 and vimentin were examined by tissue microarray. HER2 were also assessed by chromogenic in situ hybridization, and BRCA1 mRNA was analyzed in a subset of 41 patients for whom sufficient tumor tissue was available by real-time quantitative PCR. Median time to progression was 42 months and overall survival was 55 months. In the multivariate analysis for time to progression and overall survival for 41 patients in whom BRCA1 could be assessed, low levels of BRCA1 mRNA, positive PR and negative lymph node involvement predicted a significantly lower risk of relapse, low levels of BRCA1 mRNA and positive PR were the only variables associated with significantly longer survival. Conclusions/Significance We provide evidence for a major role for BRCA1 mRNA expression as a marker of time to progression and overall survival in sporadic breast cancers treated with anthracycline-based chemotherapy. These findings can be useful for customizing chemotherapy.
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Affiliation(s)
- Mireia Margeli
- Medical Oncology Service, Department of Medicine, Catalan Institute of Oncology, Hospital Germans Trias i Pujol and Autonomous University of Barcelona, Badalona, Spain
- * E-mail: (MM); (RR)
| | - Beatriz Cirauqui
- Medical Oncology Service, Department of Medicine, Catalan Institute of Oncology, Hospital Germans Trias i Pujol and Autonomous University of Barcelona, Badalona, Spain
| | - Eva Castella
- Pathology Service, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Gustavo Tapia
- Pathology Service, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carlota Costa
- Pangaea Biotech, SA, USP Dexeus University Institute, Barcelona, Spain
| | | | - Agusti Barnadas
- Medical Oncology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Susana Benlloch
- Pangaea Biotech, SA, USP Dexeus University Institute, Barcelona, Spain
| | - Miquel Taron
- Medical Oncology Service, Department of Medicine, Catalan Institute of Oncology, Hospital Germans Trias i Pujol and Autonomous University of Barcelona, Badalona, Spain
- Pangaea Biotech, SA, USP Dexeus University Institute, Barcelona, Spain
| | - Rafael Rosell
- Medical Oncology Service, Department of Medicine, Catalan Institute of Oncology, Hospital Germans Trias i Pujol and Autonomous University of Barcelona, Badalona, Spain
- Pangaea Biotech, SA, USP Dexeus University Institute, Barcelona, Spain
- * E-mail: (MM); (RR)
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104
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Tulchin N, Chambon M, Juan G, Dikman S, Strauchen J, Ornstein L, Billack B, Woods NT, Monteiro ANA. BRCA1 protein and nucleolin colocalize in breast carcinoma tissue and cancer cell lines. THE AMERICAN JOURNAL OF PATHOLOGY 2010; 176:1203-14. [PMID: 20075200 PMCID: PMC2832143 DOI: 10.2353/ajpath.2010.081063] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2009] [Indexed: 12/20/2022]
Abstract
The breast and ovarian cancer susceptibility gene BRCA1 encodes a tumor suppressor. BRCA1 protein, which is involved in DNA damage response, has been thought to be found primarily in cell nuclei. In the present investigation, immunohistological studies of BRCA1 protein in frozen breast cancer tissue and MCF7 and HeLa cell lines revealed BRCA1 expression in both nucleoli and nucleoplasmic foci. Immunoelectron microscopic studies of estrogen-stimulated MCF7 cells demonstrated BRCA1 protein localization in the granular components of the nucleolus. Moreover, immunofluorescence of BRCA1 and nucleolin double-labeling showed colocalization in both nucleoli and nucleoplasmic foci in breast tumor cells and asynchronously growing MCF7 and HeLa cells. Multiparameter analysis of BRCA1 and nucleolin in relation to cell cycle position (DNA content) showed expression during G1-S and persistence of BRCA1 during G2/M. After gamma-irradiation of MCF7 cells, BRCA1 protein dispersed from nucleoli and nucleoplasmic foci to other nucleoplasmic sites, which did not colocalize with nucleolin. Small interfering RNA-mediated knockdown of BRCA1 protein resulted in decreased immunofluorescence staining, which was confirmed by Western blotting. The observed colocalization of BRCA1 and nucleolin raises new possibilities for the nucleoplasm-nucleolus pathways of these proteins and their functional significance.
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Affiliation(s)
- Natalie Tulchin
- Department of Pathology, Box 1194, Mt. Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, USA.
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105
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Prasad CP, Rath G, Mathur S, Bhatnagar D, Ralhan R. Expression analysis of maspin in invasive ductal carcinoma of breast and modulation of its expression by curcumin in breast cancer cell lines. Chem Biol Interact 2009; 183:455-61. [PMID: 19944674 DOI: 10.1016/j.cbi.2009.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 11/19/2009] [Accepted: 11/19/2009] [Indexed: 01/05/2023]
Abstract
In breast cancer, maspin, a serine protease inhibitor, can suppress tumor growth and metastasis in vivo and tumor cell motility and invasion in vitro. The clinical significance of maspin expression in breast cancer, especially in the sequence of ductal carcinoma in situ (DCIS)-invasive cancer-lymph node metastasis is well known in the Western countries, but its status in the rapidly increasing breast cancers in India remains unknown. The present study was designed to determine the clinical significance of maspin expression in invasive ductal carcinomas of breast (IDCs) in North Indian population and modulation of its expression by curcumin. Immunohistochemical analysis of maspin showed loss or reduced cytoplasmic expression in 36 of 59 (61%) tumors. Furthermore, breast cancer cells (MCF-7 (wild type p53) and MDA-MB-231 (mutant p53)) were treated with curcumin and the effect on expression of maspin gene at transcription and translation levels was analyzed by RT-PCR, immunofluorescence and Western blotting. Maspin expression was also correlated with p53 and Bcl-2 levels. Curcumin inhibited cell growth, induced apoptosis and upregulated maspin gene expression in MCF-7 cells and these findings were further correlated with the upregulation of p53 protein and downregulation of Bcl-2, suggesting maspin mediated apoptosis in MCF-7 cells. To our knowledge this is the first report showing the upregulation of maspin expression by curcumin in breast cancer cells and taken together with the clinical data suggests a potential therapeutic role for curcumin in inducing maspin mediated inhibition of invasion of breast carcinoma cells.
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Affiliation(s)
- Chandra P Prasad
- Department of Anatomy, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India
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106
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Lin X, Afsari B, Marchionni L, Cope L, Parmigiani G, Naiman D, Geman D. The ordering of expression among a few genes can provide simple cancer biomarkers and signal BRCA1 mutations. BMC Bioinformatics 2009; 10:256. [PMID: 19695104 PMCID: PMC2745389 DOI: 10.1186/1471-2105-10-256] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 08/20/2009] [Indexed: 11/11/2022] Open
Abstract
Background A major challenge in computational biology is to extract knowledge about the genetic nature of disease from high-throughput data. However, an important obstacle to both biological understanding and clinical applications is the "black box" nature of the decision rules provided by most machine learning approaches, which usually involve many genes combined in a highly complex fashion. Achieving biologically relevant results argues for a different strategy. A promising alternative is to base prediction entirely upon the relative expression ordering of a small number of genes. Results We present a three-gene version of "relative expression analysis" (RXA), a rigorous and systematic comparison with earlier approaches in a variety of cancer studies, a clinically relevant application to predicting germline BRCA1 mutations in breast cancer and a cross-study validation for predicting ER status. In the BRCA1 study, RXA yields high accuracy with a simple decision rule: in tumors carrying mutations, the expression of a "reference gene" falls between the expression of two differentially expressed genes, PPP1CB and RNF14. An analysis of the protein-protein interactions among the triplet of genes and BRCA1 suggests that the classifier has a biological foundation. Conclusion RXA has the potential to identify genomic "marker interactions" with plausible biological interpretation and direct clinical applicability. It provides a general framework for understanding the roles of the genes involved in decision rules, as illustrated for the difficult and clinically relevant problem of identifying BRCA1 mutation carriers.
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Affiliation(s)
- Xue Lin
- Department of Applied Mathematics and Statistics, The Johns Hopkins University, Baltimore, Maryland, USA.
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107
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Rakha E, Reis-Filho JS. Basal-like breast carcinoma: from expression profiling to routine practice. Arch Pathol Lab Med 2009; 133:860-8. [PMID: 19492878 DOI: 10.5858/133.6.860] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Advances in the understanding of the molecular and genetic mechanisms of breast cancer have led to realization of the heterogeneity of the disease and the promise of a new era of individualized management for patients with breast cancer. The advent and use of high-throughput molecular methods for the study of breast cancer have brought to the forefront the existence of the so-called basal-like breast cancers, which have been shown to have distinct biologic and clinical characteristics. OBJECTIVE To critically assess the clinicopathologic features of basal-like breast cancer, discuss the morphologic and immunophenotypic features of basal-like cancer, and explore the criteria that can be used to identify these tumors in routine practice. DATA SOURCES A Medline/PubMed search was conducted using the terms "basal-like," "(basal OR basaloid OR basal-like) AND breast cancer." All articles in English language were retrieved and critically reviewed. CONCLUSIONS Basal-like breast cancers constitute a distinct, yet heterogeneous, class of neoplasms associated with specific histologic features and poor prognosis despite high response rates to neoadjuvant chemotherapy. Basal-like breast cancers have features that recapitulate those of tumors arising in BRCA1 mutation carriers, and the majority of patients with BRCA1 germline mutations develop basal-like breast cancers. At the molecular level, basal-like cancers harbor a transcriptome that is distinct from that of hormone-receptor-positive or HER2-amplified tumors, being characterized by the expression of genes usually found in basal/myoepithelial cells of the breast. However, translating the new concepts about basal-like cancer into clinical practice has proven a Herculean task, given the lack of an internationally accepted definition for these tumors and for the method of identification in routine practice.
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Affiliation(s)
- Emad Rakha
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
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108
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Rakha EA, Elsheikh SE, Aleskandarany MA, Habashi HO, Green AR, Powe DG, El-Sayed ME, Benhasouna A, Brunet JS, Akslen LA, Evans AJ, Blamey R, Reis-Filho JS, Foulkes WD, Ellis IO. Triple-negative breast cancer: distinguishing between basal and nonbasal subtypes. Clin Cancer Res 2009; 15:2302-10. [PMID: 19318481 DOI: 10.1158/1078-0432.ccr-08-2132] [Citation(s) in RCA: 353] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Triple-negative (TN; estrogen receptor, progesterone receptor, and HER-2 negative) cancer and basal-like breast cancer (BLBC) are associated with poor outcome and lack the benefit of targeted therapy. It is widely perceived that BLBC and TN tumors are synonymous and BLBC can be defined using a TN definition without the need for the expression of basal markers. EXPERIMENTAL DESIGN We have used two well-defined cohorts of breast cancers with a large panel of biomarkers, BRCA1 mutation status, and follow-up data to compare the clinicopathologic and immunohistochemical features of TN tumors expressing one or more of the specific basal markers (CK5/6, CK17, CK14, and epidermal growth factor receptor; BLBC) with those TN tumors that express none of these markers (TN3BKE-). RESULTS Here, we show that although the morphologic features of BLBC are not significantly different from that of TN3BKE- tumors, BLBC showed distinct clinical and immunophenotypic differences. BLBC showed a statistically significant association with the expression of the hypoxia-associated factor (CA9), neuroendocrine markers, and other markers of poor prognosis such as p53. A difference in the expression of cell cycle-associated proteins and biomarkers involved in the immunologic portrait of tumors was seen. Compared with TN3BKE- tumors, BLBC was positively associated with BRCA1 mutation status and showed a unique pattern of distant metastasis, better response to chemotherapy, and shorter survival. CONCLUSION TN breast cancers encompass a remarkably heterogeneous group of tumors. Expression of basal markers identifies a biologically and clinically distinct subgroup of TN tumors, justifying the use of basal markers (in TN tumors) to define BLBC.
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Affiliation(s)
- Emad A Rakha
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, United Kingdom.
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109
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Abstract
It has been proposed that gene expression profiles will revolutionize the classification of breast cancer, eventually replacing histopathology with a more reproducible technology. These new approaches, combined with a better understanding of the cellular origins of breast cancer, should enable us to identify patient subgroups for more effective therapy. However, in such a rapidly advancing field it is essential that initial and thought-provoking results do not become established as 'facts' without question. This Opinion addresses some of the negatives and positives generated by the term 'basal-like' breast cancer, and questions its existence as an entity.
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Affiliation(s)
- Barry Gusterson
- Division of Cancer Sciences and Molecular Pathology, University of Glasgow, Western Infirmary (Pathology), Dumbarton Road, Glasgow G11 6NT, Scotland, UK.
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110
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Meiser B, Tucker K, Friedlander M, Barlow-Stewart K, Lobb E, Saunders C, Mitchell G. Genetic counselling and testing for inherited gene mutations in newly diagnosed patients with breast cancer: a review of the existing literature and a proposed research agenda. Breast Cancer Res 2008; 10:216. [PMID: 19090970 PMCID: PMC2656887 DOI: 10.1186/bcr2194] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Many women newly diagnosed with breast cancer and with a strong family history of breast cancer are referred to a family cancer service for genetic counselling and for consideration of genetic testing for germline mutations in cancer predisposition genes following completion of their cancer treatment. However, there is growing evidence that mutation status may influence treatment recommendations, and that there may be benefits in having 'treatment-focused genetic counselling and testing' available shortly after cancer diagnosis. This article reviews the literature that could inform the development of treatment-focused genetic counselling and testing, including: the rationale for genetic testing to aid with treatment decisions; the potential benefits of using mutation or risk status to tailor management; the criteria that may be used to identify patients most likely to carry germline mutations; and the evidence regarding women's decision-making regarding treatment-focused genetic counselling and testing and the associated psychological impact.
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Affiliation(s)
- Bettina Meiser
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW 2031, Australia.
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111
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Loredo-Pozos G, Chiquete E, Oceguera-Villanueva A, Panduro A, Siller-López F, Ramos-Márquez ME. Expression profile of BRCA1 and BRCA2 genes in premenopausal Mexican women with breast cancer: clinical and immunohistochemical correlates. Med Oncol 2008; 26:269-75. [PMID: 19012002 DOI: 10.1007/s12032-008-9114-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Accepted: 10/15/2008] [Indexed: 11/25/2022]
Abstract
Low BRCA1 gene expression is associated with increased invasiveness and influences the response of breast carcinoma (BC) to chemotherapeutics. However, expression of BRCA1 and BRCA2 genes has not been completely characterized in premenopausal BC. We analyzed the clinical and immunohistochemical correlates of BRCA1 and BRCA2 expression in young BC women. We studied 62 women (mean age 38.8 years) who developed BC before the age of 45 years. BRCA1 and BRCA2 mRNA expression was assessed by reverse transcriptase-polymerase chain reaction (RT-PCR) and that of HER-2 and p53 proteins by immunohistochemistry. Body mass index (BMI) > or = 27 (52%) and a declared family history of BC (26%) were the main risk factors. Ductal infiltrative adenocarcinoma was found in 86% of the cases (tumor size >5 cm in 48%). Disease stages I-IV occurred in 2, 40, 55, and 3%, respectively (73% implicating lymph nodes). Women aged < or = 35 years (24%) had more family history of cervical cancer, stage III/IV disease, HER-2 positivity, and lower BRCA1 expression than older women (P < 0.05). BRCA1 and BRCA2 expression correlated in healthy, but not in tumor tissues (TT). Neither BRCA1 nor BRCA2 expression was associated with tumor histology, differentiation, nodal metastasis or p53 and HER-2 expression. After multivariate analysis, only disease stage explained BRCA1 mRNA levels in the lowest quartile. Premenopausal BC has aggressive clinical and molecular characteristics. Low BRCA1 mRNA expression is associated mainly with younger ages and advanced clinical stage of premenopausal BC. BRCA2 expression is not associated with disease severity in young BC women.
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Affiliation(s)
- Gloria Loredo-Pozos
- Instituto de Enfermedades Crónico-Degenerativas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada 950, Colonia Independencia, Guadalajara, Jalisco C.P. 44340, Mexico
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112
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Shiu KK, Tan DSP, Reis-Filho JS. Development of therapeutic approaches to 'triple negative' phenotype breast cancer. Expert Opin Ther Targets 2008; 12:1123-37. [PMID: 18694379 DOI: 10.1517/14728222.12.9.1123] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Triple negative phenotype (TNP) breast cancers are characterised by the lack of expression of oestrogen and progesterone receptors and of human EGF receptor 2 (HER2) overexpression/amplification. This subgroup of cancers has an aggressive clinical behaviour and is associated with poorer overall survival compared with other subtypes. Given the lack of targets for current tailored therapies in TNP tumours, chemotherapy is the only systemic treatment available; however, overall outcomes remain poor. Therefore, optimal treatment regimens and targeted therapies are urgently needed. OBJECTIVE We discuss characteristics of TNP cancers that underpin the rationale of current and novel therapeutic strategies, and an approach for finding and validating new therapeutic targets. RESULTS/CONCLUSION The results of large prospective randomised controlled trials are currently awaited. Efforts to unravel the heterogeneity and complexity of TNP cancers using the latest high-throughput molecular techniques and integrating these findings with biology-driven therapeutic strategies in clinical trials will be of paramount importance for the development of treatment approaches for this breast cancer subtype.
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Affiliation(s)
- Kai-Keen Shiu
- Institute of Cancer Research, The Breakthrough Breast Cancer Research Centre, 237 Fulham Road, London, SW3 6JB, UK
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113
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Tan DSP, Marchiò C, Reis-Filho JS. Hereditary breast cancer: from molecular pathology to tailored therapies. J Clin Pathol 2008; 61:1073-82. [PMID: 18682420 DOI: 10.1136/jcp.2008.057950] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Hereditary breast cancer accounts for up to 5-10% of all breast carcinomas. Recent studies have demonstrated that mutations in two high-penetrance genes, namely BRCA1 and BRCA2, are responsible for about 16% of the familial risk of breast cancer. Even though subsequent studies have failed to find another high-penetrance breast cancer susceptibility gene, several genes that confer a moderate to low risk of breast cancer development have been identified; moreover, hereditary breast cancer can be part of multiple cancer syndromes. In this review we will focus on the hereditary breast carcinomas caused by mutations in BRCA1, BRCA2, Fanconi anaemia (FANC) genes, CHK2 and ATM tumour suppressor genes. We describe the hallmark histological features of these carcinomas compared with non-hereditary breast cancers and show how an accurate histopathological diagnosis may help improve the identification of patients to be screened for mutations. Finally, novel therapeutic approaches to treat patients with BRCA1 and BRCA2 germ line mutations, including cross-linking agents and PARP inhibitors, are discussed.
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Affiliation(s)
- D S P Tan
- Molecular Pathology Laboratory, The Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK
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