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Bertucci F, Finetti P, Roche H, Le Doussal J, Marisa L, Martin A, Lacroix-Triki M, Blanc-Fournier C, Jacquemier J, Peyro-Saint-Paul H, Viens P, Sotiriou C, Birnbaum D, Penault-Llorca F. Comparison of the prognostic value of genomic grade index, Ki67 expression and mitotic activity index in early node-positive breast cancer patients. Ann Oncol 2013; 24:625-32. [DOI: 10.1093/annonc/mds510] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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302
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Martín M, Prat A, Rodríguez-Lescure A, Caballero R, Ebbert MTW, Munárriz B, Ruiz-Borrego M, Bastien RRL, Crespo C, Davis C, Rodríguez CA, López-Vega JM, Furió V, García AM, Casas M, Ellis MJ, Berry DA, Pitcher BN, Harris L, Ruiz A, Winer E, Hudis C, Stijleman IJ, Tuck DP, Carrasco E, Perou CM, Bernard PS. PAM50 proliferation score as a predictor of weekly paclitaxel benefit in breast cancer. Breast Cancer Res Treat 2013; 138:457-66. [PMID: 23423445 PMCID: PMC3608881 DOI: 10.1007/s10549-013-2416-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 01/11/2013] [Indexed: 12/20/2022]
Abstract
To identify a group of patients who might benefit from the addition of weekly paclitaxel to conventional anthracycline-containing chemotherapy as adjuvant therapy of node-positive operable breast cancer. The predictive value of PAM50 subtypes and the 11-gene proliferation score contained within the PAM50 assay were evaluated in 820 patients from the GEICAM/9906 randomized phase III trial comparing adjuvant FEC to FEC followed by weekly paclitaxel (FEC-P). Multivariable Cox regression analyses of the secondary endpoint of overall survival (OS) were performed to determine the significance of the interaction between treatment and the (1) PAM50 subtypes, (2) PAM50 proliferation score, and (3) clinical and pathological variables. Similar OS analyses were performed in 222 patients treated with weekly paclitaxel versus paclitaxel every 3 weeks in the CALGB/9342 and 9840 metastatic clinical trials. In GEICAM/9906, with a median follow up of 8.7 years, OS of the FEC-P arm was significantly superior compared to the FEC arm (unadjusted HR = 0.693, p = 0.013). A benefit from paclitaxel was only observed in the group of patients with a low PAM50 proliferation score (unadjusted HR = 0.23, p < 0.001; and interaction test, p = 0.006). No significant interactions between treatment and the PAM50 subtypes or the various clinical–pathological variables, including Ki-67 and histologic grade, were identified. Finally, similar OS results were obtained in the CALGB data set, although the interaction test did not reach statistical significance (p = 0.109). The PAM50 proliferation score identifies a subset of patients with a low proliferation status that may derive a larger benefit from weekly paclitaxel.
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Affiliation(s)
- Miguel Martín
- Department of Medical Oncology, Instituto de Investigación Sanitaria Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
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303
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Phillips TA, Fabian CJ, Kimler BF, Petroff BK. Assessment of RNA in human breast tissue sampled by random periareolar fine needle aspiration and ductal lavage and processed as fixed or frozen specimens. Reprod Biol 2013; 13:75-81. [PMID: 23522074 DOI: 10.1016/j.repbio.2013.01.179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
Abstract
Ductal lavage (DL) and random periareolar fine needle aspiration (RPFNA) have both been proposed as minimally invasive techniques to sample breast tissue during breast cancer prevention trials. Laser capture microdissection (LCM), linear RNA amplification and quantitative real-time polymerase chain reaction (qPCR) theoretically overcome the limitations of small specimen size obtained with DL and RPFNA. In order to test the yield, relative stability and amplifiability of RNA from fixed and archived RPFNA and DL specimens, breast tissue was sampled from individual high risk women (n=9) by both DL and RPFNA. RPFNA samples showed good RNA/cDNA yield and amplification while only 2 of 9 of the paired DL specimens had cDNA of adequate quality for subsequent PCR. One and two rounds of linear amplification provided approximately a 200- and 20,000-fold enrichment of RNA, respectively. PCR analysis consistently detected ER and COX-1 mRNA in the majority of RPFNA samples examined while pS2, PCNA, VEGF and survivin expression varied with subject. RNA yield and/or stability was greater for fixed and archived RPFNA than DL specimens of breast tissue. In a subsequent study examining an expanded biomarker gene panel in fixed vs. frozen RPFNA samples, mRNA profiles and ranked relative mRNA abundance were similar (r=0.89) for frozen and fixed RPFNA specimens. In summary, frozen RPFNA samples may be optimal for RNA endpoints in human breast cancer prevention trials but fixed RPFNA specimens allow similar analyses with greater convenience.
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Affiliation(s)
- Teresa A Phillips
- Breast Cancer Prevention Center, University of Kansas Medical Center, Kansas City, KS 66160, United States
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304
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Cheng J, Lei L, Xu J, Sun Y, Zhang Y, Wang X, Pan L, Shao Z, Zhang Y, Liu G. 18F-fluoromisonidazole PET/CT: a potential tool for predicting primary endocrine therapy resistance in breast cancer. J Nucl Med 2013; 54:333-40. [PMID: 23401605 DOI: 10.2967/jnumed.112.111963] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED Although endocrine therapy is an effective method to treat estrogen receptor (ER)-positive breast cancer, approximately 30%-40% of all hormone receptor-positive tumors display de novo resistance. The aim of our current study was to analyze whether (18)F-labeled fluoromisonidazole (1-(2-nitro-1-imidazolyl)-2-hydroxy-3-fluoropropane [(18)F-FMISO]) PET/CT could predict primary resistance to hormonal therapy in ER-positive breast cancer. METHODS Postmenopausal women who had ER-α-positive breast cancer, stages II-IV, and had never received prior endocrine therapy were prospectively enrolled in this study. Patients underwent both (18)F-FDG and (18)F-FMISO PET/CT scans before and after treatment. The hottest (18)F-FDG standardized uptake value (SUV) in the tumor foci, the SUVs at 2 and 4 h, and the TBR2 h and TBR4 h for the target lesions were calculated (TBR2 h = SUV2 hT/SUV2 hB and TBR4 h = SUV4 hT/SUV4 hB [TBR is the tumor-to-background ratio]). Clinical outcomes of primary endocrine therapy with letrozole were evaluated according to the criteria of the World Health Organization after at least 3 mo of treatment. Immunohistochemistry for markers of proliferation (Ki67) and hypoxia-induced factor 1α was performed on a subset of tumors that had undergone biopsy or surgery. Pearson and Spearman analysis was used to determine the correlation between the parameters of (18)F-FDG and (18)F-FMISO uptake and clinical or immunohistochemistry outcomes with a 0.01 threshold for statistical significance. RESULTS A total of 45 lesions (13 primary, 32 metastatic) from 20 patients met the inclusion criteria in this study. Baseline (18)F-FDG and (18)F-FMISO PET/CT scans were obtained for 33 lesions from 16 patients. The correlation between baseline (18)F-FDG uptake and clinical outcome was weak and did not reach statistical significance (r = 0.37, P = 0.031). However, there was a significantly positive correlation between baseline (18)F-FMISO uptake (SUV2 hT, TBR2 h, SUV4 hT, and TBR4 h) and clinical outcomes after ≥3 mo of primary endocrine therapy with letrozole (r = 0.77, 0.76, 0.71, and 0.78, respectively; P < 0.0001). The application of a TBR4 h cutoff of ≥1.2 allowed the prediction of 88% of the cases of progressive disease (15/17). Despite poor correlation between (18)F-FMISO uptake and hypoxia-induced factor 1α expression, a marginal positive correlation between TBR4 h and Ki67 expression was measured (r = 0.51, P = 0.011) in a subset of malignant lesions acquired by biopsy or surgery. CONCLUSION (18)F-FMISO PET/CT can be used to predict primary endocrine resistance in ER-positive breast cancer.
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Affiliation(s)
- Jingyi Cheng
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China
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305
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Haynes BP, Viale G, Galimberti V, Rotmensz N, Gibelli B, A'Hern R, Smith IE, Dowsett M. Expression of key oestrogen-regulated genes differs substantially across the menstrual cycle in oestrogen receptor-positive primary breast cancer. Breast Cancer Res Treat 2013; 138:157-65. [PMID: 23378065 DOI: 10.1007/s10549-013-2426-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/21/2013] [Indexed: 01/15/2023]
Abstract
Plasma estradiol (E2) and progesterone vary markedly through the menstrual cycle. Data on whether these differences in hormone levels affect gene expression in oestrogen receptor-positive (ER+) tumours are inconsistent. We wished to determine whether there are substantial changes in the expression of oestrogen-regulated genes (ERGs) in ER+ breast cancer through the menstrual cycle. One hundred and seventy five paraffin-embedded ER+ breast carcinomas from premenopausal patients were analysed. Timing of the ovarian cycle was confirmed using serum progesterone levels. Patients were ascribed to one of three pre-defined menstrual cycle windows: 1 (days 27-35 + 1-6), 2 (days 7-16) and 3 (days 17-26). The RNA expression of ESR1, four ERGs (PGR, GREB1, TFF1 and PDZK1), and three proliferation genes (MKI67, TOP2A and CDC20) were compared between the windows. Gene expression of the four ERGs was 53-129 % higher in window 2 than window 1 (p = 0.0013, 0.0006, 0.022 and 0.066 for PGR, GREB1, TFF1 and PDZK1, respectively) and lower (9-41 %) in window 3 compared to window 2 (p = 0.079, 0.31, 0.031 and 0.065 for PGR, GREB1, TFF1 and PDZK1, respectively). Their average expression (AvERG) was 64 % higher in window 2 than window 1 (p < 0.0001) and 21 % lower in window 3 than window 2 (p = 0.0043). There were no significant differences between the windows for ESR1 and proliferation genes. In agreement with the gene expression data, progesterone receptor protein levels measured by immunohistochemistry (IHC) were 164 and 227 % higher in windows 2 and 3, respectively, compared to window 1 (30.7 and 37.9 % cells positive vs. 11.6 %; p = 0.0003 and 0.0004, respectively), while no difference in ER IHC score was observed. In conclusion, we observed significant differences in the expression of ERGs in ER+ breast tumours across the menstrual cycle. This variability may affect the interpretation of gene expression profiles incorporating ERGs and may be exploitable as an endogenous test of endocrine responsiveness.
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Affiliation(s)
- Ben P Haynes
- Department of Academic Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
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306
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Montemurro F, Rossi V, Geuna E, Valabrega G, Martinello R, Milani A, Aglietta M. Current status and future perspectives in the endocrine treatment of postmenopausal, hormone receptor-positive metastatic breast cancer. Expert Opin Pharmacother 2013; 13:2143-56. [PMID: 22984936 DOI: 10.1517/14656566.2012.725723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Endocrine therapy is a fundamental component of the therapeutic repertoire for treatment of metastatic, hormone receptor-positive breast cancer. Inevitably, however, tumors develop resistance to these compounds, and overcoming this phenomenon is a key motivator of research in this field. AREAS COVERED This review summarizes the current status of endocrine therapy for the treatment of metastatic disease, with a main focus on postmenopausal patients. Furthermore, strategies that could potentially sustain endocrine resistance and future perspectives in this direction are also to be described. Relevant references were identified by PubMed searches and from the abstract books of the annual meetings of The European Society of Clinical Oncology (ESMO), The American Society of Clinical Oncology (ASCO) and from the San Antonio Breast Cancer Symposia. EXPERT OPINION Combinations of endocrine therapy with HER2 targeting agents, as well as with compounds that can interfere with PI3K/Akt/mTOR signaling, are two promising strategies for delaying or overcoming endocrine resistance, mediated by these relevant biological pathways. Due to increased costs and the burden of toxicity associated with these combination therapies, compared to endocrine therapy alone, it is imperative to concentrate efforts on establishing biomarkers that can predict efficacy.
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Affiliation(s)
- Filippo Montemurro
- Institute for Cancer Research, Unit of Investigative Clinical Oncology (INCO), Candiolo, Italy.
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307
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PIK3CA genotype and a PIK3CA mutation-related gene signature and response to everolimus and letrozole in estrogen receptor positive breast cancer. PLoS One 2013; 8:e53292. [PMID: 23301057 PMCID: PMC3534682 DOI: 10.1371/journal.pone.0053292] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 11/27/2012] [Indexed: 11/19/2022] Open
Abstract
The phosphatidylinositol 3′ kinase (PI3K) pathway is commonly activated in breast cancer and aberrations such as PI3K mutations are common. Recent exciting clinical trial results in advanced estrogen receptor-positive (ER) breast cancer support mTOR activation is a major means of estrogen-independent tumor growth. Hence the means to identify a responsive breast cancer population that would most benefit from these compounds in the adjuvant or earlier stage setting is of high interest. Here we study PIK3CA genotype as well as a previously reported PI3K/mTOR-pathway gene signature (PIK3CA-GS) and their ability to estimate the level of PI3K pathway activation in two clinical trials of newly diagnosed ER-positive breast cancer patients- a total of 81 patients- one of which was randomized between letrozole and placebo vs letrozole and everolimus. The main objectives were to correlate the baseline PIK3CA genotype and GS with the relative change from baseline to day 15 in Ki67 (which has been shown to be prognostic in breast cancer) and phosphorylated S6 (S240) immunohistochemistry (a substrate of mTOR). In the randomized dataset, the PIK3CA-GS could identify those patients with the largest relative decreases in Ki67 to letrozole/everolimus (R = −0.43, p = 0.008) compared with letrozole/placebo (R = 0.07, p = 0.58; interaction test p = 0.02). In a second dataset of pre-surgical everolimus alone, the PIK3CA-GS was not significantly correlated with relative change in Ki67 (R = −0.11, p = 0.37) but with relative change in phosphorlyated S6 (S240) (R = −0.46, p = 0.028). PIK3CA genotype was not significantly associated with any endpoint in either datasets. Our results suggest that the PIK3CA-GS has potential to identify those ER-positive BCs who may benefit from the addition of everolimus to letrozole. Further evaluation of the PIK3CA-GS as a predictive biomarker is warranted as it may facilitate better selection of responsive patient populations for mTOR inhibition in combination with letrozole.
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308
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Shimizu D, Ishikawa T, Tanabe M, Sasaki T, Ichikawa Y, Chishima T, Endo I. Preoperative endocrine therapy with goserelin acetate and tamoxifen in hormone receptor-positive premenopausal breast cancer patients. Breast Cancer 2012. [PMID: 23184499 DOI: 10.1007/s12282-012-0429-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The use of preoperative endocrine therapy for breast cancer has increased during the last decade. Although several studies have reported favorable response rates in postmenopausal women, its effectiveness in premenopausal women remains unknown. This study therefore aimed to evaluate the potential benefits of preoperative endocrine therapy in premenopausal women. METHODS Fifty-three patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative invasive breast cancer were included in this study. Preoperative endocrine therapy with goserelin acetate and tamoxifen was administered for 3 months. Clinical evaluations were performed by ultrasonography before and after endocrine therapy. Pathological evaluations were performed using core biopsy and surgical specimens. Immunohistochemical evaluations of ER, progesterone receptor (PgR), HER2, and Ki-67 were performed before and after endocrine therapy. RESULTS Partial response (PR) was observed in 23 % (12/53) and progressive disease (PD) in 2 % (2/53) of patients. Significant suppression of Ki-67 was observed following endocrine therapy in 90 % (47/52) of patients (P < 0.0001). Significant downregulation of PgR was observed after endocrine therapy (P = 0.0002), which tended to be correlated with clinical response (P = 0.058). CONCLUSIONS Three months of preoperative endocrine therapy with goserelin acetate and tamoxifen was safe and effective in premenopausal patients with invasive breast cancer, with a 23 % PR rate. Changes in PgR and Ki-67 expression might be promising markers for endocrine responsiveness.
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Affiliation(s)
- Daisuke Shimizu
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan,
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309
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Different prognostic significance of Ki-67 change between pre- and post-neoadjuvant chemotherapy in various subtypes of breast cancer. Breast Cancer Res Treat 2012. [PMID: 23184081 DOI: 10.1007/s10549-012-2344-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In a neoadjuvant setting, three parameters for Ki-67 could be obtained: pre-treatment Ki-67, post-treatment Ki-67 and Ki-67 change between pre- and post-treatments. It is uncertain which of the three parameters has the greatest prognostic significance, and whether this parameter has significance in each subtype of breast cancer. A total of 385 patients who received neoadjuvant anthracycline followed by taxane chemotherapy and subsequent surgery for breast cancer were analyzed retrospectively. By immunohistochemistry (IHC), patients were divided into four subtypes (Luminal A, Luminal B, Triple negative, and HER2). Ki-67 was examined by IHC in pre-treatment core needle samples and post-treatment surgical excision specimens. The relapse-free survival (RFS) rate was compared among each subtype. The median follow-up period was 56 months. The rate of pathological complete response was higher for HER2 (34.8 %) and Triple negative (24.3 %) subtypes than for Luminal B (8.3 %) and Luminal A (3.8 %) subtypes (p < 0.0001). A reduction in Ki-67 was observed in 58.5, 83.4, 70.2, and 74.2 % of patients in the Luminal A, Luminal B, Triple negative, and HER2 subtypes, respectively. Ki-67 change between pre- and post-treatments was an independent prognostic factor, but pre-treatment Ki-67 and post-treatment Ki-67 were not independent prognostic factors in a multivariate analysis. The RFS was significantly different between patients whose Ki-67 was reduced and those not reduced for Luminal B (81.4 vs. 50.0 %, p = 0.006), Triple negative (74.8 vs. 43.5 %, p = 0.006) and HER2 (82.7 vs. 59.0 %, p = 0.009). However, for Luminal A, the difference in RFS was not associated with changes of Ki-67 (78.8 vs. 75.3 %, p = 0.193). Ki-67 change between pre- and post-neoadjuvant chemotherapy is an independent prognostic factor in patients of Luminal B, Triple negative, and HER2 subtypes. Pre-treatment Ki-67 and post-treatment Ki-67 were not independent prognostic factors in a multivariate analysis.
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Dragnev K, You M, Wang Y, Lubet R. Lung cancer chemoprevention: difficulties, promise and potential agents? Expert Opin Investig Drugs 2012; 22:35-47. [PMID: 23167766 DOI: 10.1517/13543784.2013.731392] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION In a variety of cancers there is evidence that specific regimens can prevent or significantly delay the development of cancer. Thus, for breast cancer (ER+) use of SERMs or aromatase inhibitors can substantially decrease tumor incidence. For cervical cancer, HPV vaccination will inhibit long term cancer incidence. For colon cancer, the second greatest cancer killer, administration of aspirin and other NSAIDs decreases advanced colon adenomas in Phase II trials and epidemiologic data support their ability to prevent colon cancer. To date prevention trials in the area of lung cancer have shown minimal efficacy. AREAS COVERED The paper examines and discusses in greater detail certain promising agents which the authors have tested either preclinically and or in early phase clinical trials. These agents include RXR agonists, EGFr inhibitors, NSAIDs and Triterpenoids. Other agents including glucocorticoids, pioglitazone and iloprost are briefly mentioned. In addition, the paper presents various types of potential Phase II lung cancer prevention trials and describes their strengths and weaknesses. The potential use of various biomarkers as endpoints in trials e.g. histopathology, non-specific biomarkers (e.g., Ki67, cyclin D expression, apoptosis) and molecular biomarkers (e.g. specific phosphorylated proteins, gene expression etc.) is presented. Finally, we examine at least one approach, the use of aerosols, which may diminish the systemic toxicity associated with certain of these agents. EXPERT OPINION The manuscript presents: a) a number of promising agents which appear applicable to further Phase II prevention trials; b) approaches to defining potential preventive agents as well; c) approaches which might mitigate the side effects associated with potential agents most specifically the use of aerosols. Finally, we discuss biomarker studies both preclinical and clinical which might help support potential Phase II trials. The particular appeal to the preclinical studies is that they can be followed to a tumor endpoint. We hope that this will give the reader further background and allow one to appreciate the potential and some of the hurdles associated with lung cancer chemoprevention.
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311
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Yamaguchi T, Mukai H. Ki-67 index guided selection of preoperative chemotherapy for HER2-positive breast cancer: a randomized phase II trial. Jpn J Clin Oncol 2012; 42:1211-4. [PMID: 23129778 DOI: 10.1093/jjco/hys161] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Changes in Ki-67 may be a useful predictor of efficacy for preoperative therapy in breast cancer. This randomized Phase II trial will compare standard preoperative chemotherapy comprising paclitaxel and trastuzumab with Ki-67 index guided preoperative chemotherapy in patients with human epidermal growth factor receptor 2-positive operable breast cancer. In the Ki-67 index guided therapy, paclitaxel and trastuzumab were administered initially and the Ki-67 index is evaluated from biopsied specimens after 2 weeks of preoperative chemotherapy. The subsequent chemotherapy regimen is modified according to changes in the Ki-67 index from the start of therapy. If the Ki-67 index is reduced as expected, paclitaxel and trastuzumab are continued. If the Ki-67 index is not reduced as expected, the chemotherapy regimen is changed to epirubicin, cyclophosphamide and trastuzumab. The primary endpoint is the rate of pathological complete response. The secondary endpoints are the objective response rate, disease-free survival and overall survival. Two hundred patients were planned to be accrued.
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312
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Lazzeroni M, Serrano D, Dunn BK, Heckman-Stoddard BM, Lee O, Khan S, Decensi A. Oral low dose and topical tamoxifen for breast cancer prevention: modern approaches for an old drug. Breast Cancer Res 2012; 14:214. [PMID: 23106852 PMCID: PMC4053098 DOI: 10.1186/bcr3233] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Tamoxifen is a drug that has been in worldwide use for the treatment of estrogen receptor (ER)-positive breast cancer for over 30 years; it has been used in both the metastatic and adjuvant settings. Tamoxifen's approval for breast cancer risk reduction dates back to 1998, after results from the Breast Cancer Prevention Trial, co-sponsored by the National Cancer Institute and the National Surgical Adjuvant Breast and Bowel Project, showed a 49% reduction in the incidence of invasive, ER-positive breast cancer in high-risk women. Despite these positive findings, however, the public's attitude toward breast cancer chemoprevention remains ambivalent, and the toxicities associated with tamoxifen, particularly endometrial cancer and thromboembolic events, have hampered the drug's uptake by high-risk women who should benefit from its preventive effects. Among the strategies to overcome such obstacles to preventive tamoxifen, two novel and potentially safer modes of delivery of this agent are discussed in this paper. Low-dose tamoxifen, expected to confer fewer adverse events, is being investigated in both clinical biomarker-based trials and observational studies. A series of systemic biomarkers (including lipid and insulin-like growth factor levels) and tissue biomarkers (including Ki-67) are known to be favorably affected by conventional tamoxifen dosing and have been shown to be modulated in a direction consistent with a putative anti-cancer effect. These findings suggest possible beneficial clinical preventive effects by low-dose tamoxifen regimens and they are supported by observational studies. An alternative approach is topical administration of active tamoxifen metabolites directly onto the breast, the site where the cancer is to be prevented. Avoidance of systemic administration is expected to reduce the distribution of drug to tissues susceptible to tamoxifen-induced toxicity. Clinical trials of topical tamoxifen with biological endpoints are still ongoing whereas pharmacokinetic studies have already shown that appropriate formulations of drug successfully penetrate the skin to reach breast tissue, where a preventive effect is sought.
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Cavazzoni A, Bonelli MA, Fumarola C, La Monica S, Airoud K, Bertoni R, Alfieri RR, Galetti M, Tramonti S, Galvani E, Harris AL, Martin LA, Andreis D, Bottini A, Generali D, Petronini PG. Overcoming acquired resistance to letrozole by targeting the PI3K/AKT/mTOR pathway in breast cancer cell clones. Cancer Lett 2012; 323:77-87. [DOI: 10.1016/j.canlet.2012.03.034] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 03/29/2012] [Accepted: 03/29/2012] [Indexed: 02/07/2023]
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Fuksa L, Micuda S, Grim J, Ryska A, Hornychova H. Predictive Biomarkers in Breast Cancer: Their Value in Neoadjuvant Chemotherapy. Cancer Invest 2012; 30:663-78. [DOI: 10.3109/07357907.2012.725441] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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315
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Balko JM, Cook RS, Vaught DB, Kuba MG, Miller TW, Bhola NE, Sanders ME, Granja-Ingram NM, Smith JJ, Meszoely IM, Salter J, Dowsett M, Stemke-Hale K, González-Angulo AM, Mills GB, Pinto JA, Gómez HL, Arteaga CL. Profiling of residual breast cancers after neoadjuvant chemotherapy identifies DUSP4 deficiency as a mechanism of drug resistance. Nat Med 2012; 18:1052-9. [PMID: 22683778 DOI: 10.1038/nm.2795] [Citation(s) in RCA: 191] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/18/2012] [Indexed: 12/14/2022]
Abstract
Neoadjuvant chemotherapy (NAC) induces a pathological complete response (pCR) in ~30% of patients with breast cancer. However, many patients have residual cancer after chemotherapy, which correlates with a higher risk of metastatic recurrence and poorer outcome than those who achieve a pCR. We hypothesized that molecular profiling of tumors after NAC would identify genes associated with drug resistance. Digital transcript counting was used to profile surgically resected breast cancers after NAC. Low concentrations of dual specificity protein phosphatase 4 (DUSP4), an ERK phosphatase, correlated with high post-NAC tumor cell proliferation and with basal-like breast cancer (BLBC) status. BLBC had higher DUSP4 promoter methylation and gene expression patterns of Ras-ERK pathway activation relative to other breast cancer subtypes. DUSP4 overexpression increased chemotherapy-induced apoptosis, whereas DUSP4 depletion dampened the response to chemotherapy. Reduced DUSP4 expression in primary tumors after NAC was associated with treatment-refractory high Ki-67 scores and shorter recurrence-free survival. Finally, inhibition of mitogen-activated protein kinase kinase (MEK) synergized with docetaxel treatment in BLBC xenografts. Thus, DUSP4 downregulation activates the Ras-ERK pathway in BLBC, resulting in an attenuated response to anti-cancer chemotherapy.
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Affiliation(s)
- Justin M Balko
- Department of Medicine, Vanderbilt-Ingram Comprehensive Cancer Center, Vanderbilt University, Nashville, Tennessee, USA
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Iwata H, Masuda N, Sagara Y, Kinoshita T, Nakamura S, Yanagita Y, Nishimura R, Iwase H, Kamigaki S, Takei H, Tsuda H, Hayashi N, Noguchi S. Analysis of Ki-67 expression with neoadjuvant anastrozole or tamoxifen in patients receiving goserelin for premenopausal breast cancer. Cancer 2012; 119:704-13. [PMID: 22972694 DOI: 10.1002/cncr.27818] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/09/2012] [Accepted: 08/13/2012] [Indexed: 01/15/2023]
Abstract
BACKGROUND The increasing costs associated with large-scale adjuvant trials mean that the prognostic value of biologic markers is increasingly important. The expression of nuclear antigen Ki-67, a marker of cell proliferation, has been correlated with treatment efficacy and is being investigated for its value as a predictive marker of therapeutic response. In the current study, the authors explored correlations between Ki-67 expression and tumor response, estrogen receptor (ER) status, progesterone receptor (PgR) status, and histopathologic response from the STAGE study (S_tudy of T_amoxifen or A_rimidex, combined with G_oserelin acetate to compare E_fficacy and safety). METHODS In a phase 3, double-blind, randomized trial (National Clinical Trials identifier NCT00605267), premenopausal women with ER-positive, early stage breast cancer received either anastrozole plus goserelin or tamoxifen plus goserelin for 24 weeks before surgery. The Ki-67 index, hormone receptor (ER and PgR) status, and histopathologic responses were determined from histopathologic samples that were obtained from core-needle biopsies at baseline and at surgery. Tumor response was determined by using magnetic resonance imaging or computed tomography. RESULTS In total, 197 patients were randomized to receive either anastrozole plus goserelin (n = 98) or tamoxifen plus goserelin (n = 99). The best overall tumor response was better for the anastrozole group compared with the tamoxifen group both among patients who had a baseline Ki-67 index ≥20% and among those who had a baseline Ki-67 index <20%. There was no apparent correlation between baseline ER status and the Ki-67 index in either group. Positive PgR status was reduced from baseline to week 24 in the anastrozole group. CONCLUSIONS In premenopausal women with ER-positive breast cancer, anastrozole produced a greater best overall tumor response compared with tamoxifen regardless of the baseline Ki-67 index.
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Affiliation(s)
- Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Aichi, Japan
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317
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Sheri A, Dowsett M. Developments in Ki67 and other biomarkers for treatment decision making in breast cancer. Ann Oncol 2012; 23 Suppl 10:x219-27. [DOI: 10.1093/annonc/mds307] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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318
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Delpech Y, Wu Y, Hess KR, Hsu L, Ayers M, Natowicz R, Coutant C, Rouzier R, Barranger E, Hortobagyi GN, Mauro D, Pusztai L. Ki67 expression in the primary tumor predicts for clinical benefit and time to progression on first-line endocrine therapy in estrogen receptor-positive metastatic breast cancer. Breast Cancer Res Treat 2012; 135:619-27. [PMID: 22890751 DOI: 10.1007/s10549-012-2194-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 07/31/2012] [Indexed: 02/03/2023]
Abstract
We examined whether baseline Ki67 expression in estrogen receptor-positive (ER+) primary breast cancer correlates with clinical benefit and time to progression on first-line endocrine therapy and survival in metastatic disease. Ki67 values and outcome information were retrieved from a prospectively maintained clinical database and validated against the medical records; 241 patients with metastatic breast cancer were included--who had ER+ primary cancer with known Ki67 expression level--and received first-line endocrine therapy for metastatic disease. Patients were assigned to low (<10 %), intermediate (10-25 %), or high (>25 %) Ki67 expression groups. Kaplan-Meier survival curves were plotted and multivariate analysis was performed to assess association between clinical and immunohistochemical variables and outcome. The clinical benefit rates were 81, 65, and 55 % in the low (n = 32), intermediate (n = 103), and high (n = 106) Ki67 expression groups (P = 0.001). The median times to progression on first-line endocrine therapy were 20.3 (95 % CI, 17.5-38.5), 10.8 (95 % CI, 8.9-18.8), and 8 (95 % CI, 6.1-11.1) months, respectively (P = 0.0002). The median survival times after diagnosis of metastatic disease were also longer for the low/intermediate compared to the high Ki67 group, 52 versus 30 months (P < 0.0001). In multivariate analysis, high Ki67 expression in the primary tumor remained an independent adverse prognostic factor in metastatic disease (P = 0.001). Low Ki67 expression in the primary tumor is associated with higher clinical benefit and longer time to progression on first-line endocrine therapy and longer survival after metastatic recurrence.
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Affiliation(s)
- Y Delpech
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, PO Box 301439, Houston, TX 77230-1439, USA
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319
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Colleoni M, Montagna E. Neoadjuvant therapy for ER-positive breast cancers. Ann Oncol 2012; 23 Suppl 10:x243-8. [DOI: 10.1093/annonc/mds305] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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320
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Paul AK, Schwab RB. Efficacy and pharmacogenomic biomarkers in breast cancer. Biomark Med 2012; 6:211-21. [PMID: 22448796 DOI: 10.2217/bmm.12.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In patients with breast cancer, a number of biomarkers, such as estrogen receptor, progesterone receptor and HER2, are part of routine work-up and used to guide endocrine, cytotoxic and HER2-targeted treatment. Interaction among these markers may also impact on treatment response and is being investigated. Multigene assays have reached varying levels of validation and clinical use as predictive biomarkers of cytotoxic therapy in specific clinical situations. A number of pharmacogenomic biomarkers based on germline polymorphisms have reached some degree of validation for predicting variation in treatment response and treatment-associated adverse effects. The challenge of validating biomarkers will be exacerbated as the cost of nucleic acid sequencing rapidly declines and more potential biomarkers emerge. New, carefully designed approaches will be needed to address this issue and realize the potential of biomarkers in breast cancer.
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Affiliation(s)
- Asit K Paul
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
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321
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Lønning PE. Poor-prognosis estrogen receptor- positive disease: present and future clinical solutions. Ther Adv Med Oncol 2012; 4:127-37. [PMID: 22590486 DOI: 10.1177/1758834012439338] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Use of chemotherapy for patients with estrogen receptor (ER)-positive breast cancer has been a conflicting issue. Recent studies have identified predictive markers allowing identification of poor-prognosis ER-positive breast cancers in need of more aggressive therapy. In general, tumours belonging to the so-called luminal B class, tumours expressing a high Ki67, human epidermal growth factor receptor 2 (HER-2) overexpression or a high score on the Oncotype DX gene expression profile reveal a poor prognosis compared with ER-rich tumours of the luminal A class. In contrast, recent studies have shown these tumours, contrasting tumours of the luminal A class, to benefit from more aggressive anthracycline-containing chemotherapy including a taxane. In the case of metastatic disease, patients with HER-2-positive, ER-positive tumours may benefit from having endocrine therapy and an anti-HER-2 agent administered in combination.
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Affiliation(s)
- Per E Lønning
- Professor and Consultant Oncologist, Section of Oncology, Institute of Medicine, University of Bergen; Department of Oncology, Haukeland University Hospital, N-5021, Bergen, Norway
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Abstract
Luminal breast cancers are traditionally considered to comprise of tumors expressing estrogen receptor (ER) and represent the majority of breast cancers. These tumors are characterized by significant heterogeneity in phenotype, molecular signature, relapse patterns and therapeutic response to endocrine and chemotherapy. Whilst adjuvant endocrine therapy is standard of care in patients with tumors that express either ER and/or progesterone receptor (PR), the indication for adjuvant chemotherapy is less clear-cut. On average, ER-positive breast tumors derive less benefit from chemotherapy compared to ER-negative tumors, however there is still clearly a subset of patients with ER-positive tumors that are chemosensitive. The basis for the addition of chemotherapy to adjuvant endocrine therapy is usually guided by the clinician's estimation of prognosis and assessment of the endocrine sensitivity of the tumor. The use of chemotherapy in this setting, however, is highly variable. There is tremendous value in identifying subgroups of patients who can expect favorable outcomes with endocrine therapy and who may not require any additional therapy. Similarly, it is equally important, if not more important, to characterize patients with ER-positive disease who will derive a substantial benefit from cytotoxic chemotherapy. In this article, we aim to discuss the utility of current biomarkers used to guide decisions regarding chemotherapy in ER-positive, HER2-negative breast cancers.
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Affiliation(s)
- Elgene Lim
- Dana-Farher Cancer Institute, Division of Women's Cancers. 450 Brookline Ave, Boston, MA 02115, USA.
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Balko JM, Mayer IA, Sanders ME, Miller TW, Kuba MG, Meszoely IM, Wagle N, Garraway LA, Arteaga CL. Discordant cellular response to presurgical letrozole in bilateral synchronous ER+ breast cancers with a KRAS mutation or FGFR1 gene amplification. Mol Cancer Ther 2012; 11:2301-5. [PMID: 22879364 DOI: 10.1158/1535-7163.mct-12-0511] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We describe herein a patient presenting with bilateral estrogen-receptor-positive (ER+) breast tumors who was enrolled in a clinical trial exploring molecular aberrations associated with hormone-refractory tumor cell proliferation. Short-term (two week) hormonal therapy with the aromatase inhibitor letrozole substantially reduced proliferation as measured by Ki67 immunohistochemistry in one tumor, whereas the second was essentially unchanged. Extensive molecular and genetic work-up of the two tumors yielded divergent lesions in the two tumors: an activating KRAS mutation in the responsive tumor and an amplification of the fibroblast growth factor receptor-1 (FGFR1) locus in the treatment-refractory tumor. These findings provide an insight to possible mechanisms of resistance to antiestrogen therapy in ER+ breast cancers. First, they illustrate the necessity of clinically approved assays to identify FGFR1 gene amplification, which occur in approximately 5% of breast tumors and have been linked to antiestrogen resistance. It is quite possible that the addition of FGFR inhibitors to ER-targeted therapy will yield a superior antitumor effect and improved patient outcome. Second, they suggest that the role of activating mutations in RAS, although rare in breast cancer, may need to be explored in the context of ER+ breast tumors.
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Affiliation(s)
- Justin M Balko
- Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN 37232-6307, USA
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Bonanni B, Puntoni M, Cazzaniga M, Pruneri G, Serrano D, Guerrieri-Gonzaga A, Gennari A, Trabacca MS, Galimberti V, Veronesi P, Johansson H, Aristarco V, Bassi F, Luini A, Lazzeroni M, Varricchio C, Viale G, Bruzzi P, DeCensi A. Dual Effect of Metformin on Breast Cancer Proliferation in a Randomized Presurgical Trial. J Clin Oncol 2012; 30:2593-600. [DOI: 10.1200/jco.2011.39.3769] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose Metformin is associated with reduced breast cancer risk in observational studies in patients with diabetes, but clinical evidence for antitumor activity is unclear. The change in Ki-67 between pretreatment biopsy and post-treatment surgical specimen has prognostic value and may predict antitumor activity in breast cancer. Patients and Methods After tumor biopsy, we randomly allocated 200 nondiabetic women with operable breast cancer to either metformin 850 mg/twice per day (n = 100) or placebo (n = 100). The primary outcome measure was the difference between arms in Ki-67 after 4 weeks adjusted for baseline values. Results Overall, the metformin effect on Ki-67 change relative to placebo was not statistically significant, with a mean proportional increase of 4.0% (95% CI, −5.6% to 14.4%) 4 weeks apart. However, there was a different drug effect depending on insulin resistance (homeostasis model assessment [HOMA] index > 2.8, fasting glucose [mmol/L] × insulin [mU/L]/22.5; Pinteraction = .045), with a nonsignificant mean proportional decrease in Ki-67 of 10.5% (95% CI, −26.1% to 8.4%) in women with HOMA more than 2.8 and a nonsignificant increase of 11.1% (95% CI, −0.6% to 24.2%) with HOMA less than or equal to 2.8. A different effect of metformin according to HOMA index was noted also in luminal B tumors (Pinteraction = .05). Similar trends to drug effect modifications were observed according to body mass index (P = .143), waist/hip girth-ratio (P = .058), moderate alcohol consumption (P = .005), and C-reactive protein (P = .080). Conclusion Metformin before surgery did not significantly affect Ki-67 overall, but showed significantly different effects according to insulin resistance, particularly in luminal B tumors. Our findings warrant further studies of metformin in breast cancer with careful consideration to the metabolic characteristics of the study population.
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Affiliation(s)
- Bernardo Bonanni
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Matteo Puntoni
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Massimiliano Cazzaniga
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Giancarlo Pruneri
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Davide Serrano
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Aliana Guerrieri-Gonzaga
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Alessandra Gennari
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Maria Stella Trabacca
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Viviana Galimberti
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Paolo Veronesi
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Harriet Johansson
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Valentina Aristarco
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Fabio Bassi
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Alberto Luini
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Matteo Lazzeroni
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Clara Varricchio
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Giuseppe Viale
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Paolo Bruzzi
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
| | - Andrea DeCensi
- Bernardo Bonanni, Massimiliano Cazzaniga, Giancarlo Pruneri, Davide Serrano, Aliana Guerrieri-Gonzaga, Viviana Galimberti, Paolo Veronesi, Harriet Johansson, Valentina Aristarco, Fabio Bassi, Alberto Luini, Matteo Lazzeroni, Clara Varricchio, Giuseppe Viale, and Andrea DeCensi, European Institute of Oncology; Giancarlo Pruneri, Paolo Veronesi, and Giuseppe Viale, University of Milan, Milan; Matteo Puntoni, Alessandra Gennari, Maria Stella Trabacca, and Andrea DeCensi, E.O. Ospedali Galliera; and Paolo
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Tamaki K, Ishida T, Tamaki N, Kamada Y, Uehara K, Miyashita M, Amari M, Tadano-Sato A, Takahashi Y, Watanabe M, McNamara K, Ohuchi N, Sasano H. Analysis of clinically relevant values of Ki-67 labeling index in Japanese breast cancer patients. Breast Cancer 2012; 21:325-33. [PMID: 22782361 DOI: 10.1007/s12282-012-0387-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 06/13/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND It has become important to standardize the methods of Ki-67 evaluation in breast cancer patients, especially those used in the interpretation and scoring of immunoreactivity. Therefore, in this study, we examined the Ki-67 immunoreactivity of breast cancer surgical specimens processed and stained in the same manner in one single Japanese institution by counting nuclear immunoreactivity in the same fashion. METHODS We examined 408 Japanese breast cancers with invasive ductal carcinoma and studied the correlation between Ki-67 labeling index and ER/HER2 status and histological grade of breast cancer. We also analyzed overall survival (OS) and disease-free survival (DFS) of these patients according to individual Ki-67 labeling index. RESULTS There were statistically significant differences of Ki-67 labeling index between ER positive/HER2 negative and ER positive/HER2 positive, ER negative/HER2 positive or ER negative/HER2 negative, and ER positive/HER2 positive and ER negative/HER2 negative groups (all P < 0.001). There were also statistically significant differences of Ki-67 labeling index among each histological grade (P < 0.001, respectively). As for multivariate analyses, Ki-67 labeling index was strongly associated with OS (HR 39.12, P = 0.031) and DFS (HR 10.85, P = 0.011) in ER positive and HER2 negative breast cancer patients. In addition, a statistically significant difference was noted between classical luminal A group and "20 % luminal A" in DFS (P = 0.039) but not between classical luminal A group and "25 % luminal A" (P = 0.105). CONCLUSIONS A significant positive correlation was detected between Ki-67 labeling index and ER/HER2 status and histological grades of the cases examined in our study. The suggested optimal cutoff point of Ki-67 labeling index is between 20 and 25 % in ER positive and HER2 negative breast cancer patients.
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Affiliation(s)
- Kentaro Tamaki
- Department of Breast Surgery, Nahanishi Clinic, 2-1-9 Akamine, Naha, Okinawa, 901-0154, Japan,
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Kurland BF, Gadi VK, Specht JM, Allison KH, Livingston RB, Rodler ET, Peterson LM, Schubert EK, Chai X, Mankoff DA, Linden HM. Feasibility study of FDG PET as an indicator of early response to aromatase inhibitors and trastuzumab in a heterogeneous group of breast cancer patients. EJNMMI Res 2012; 2:34. [PMID: 22731662 PMCID: PMC3444390 DOI: 10.1186/2191-219x-2-34] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 06/25/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In breast cancer endocrine therapy, post-therapy Ki-67 assay of biopsy material predicts recurrence-free survival but is invasive and prone to sampling error. [18F]Fluorodeoxyglucose (FDG) positron emission tomography (PET) has shown an early agonist or 'flare' response to tamoxifen and estradiol, but has not been tested in response to estrogen-lowering aromatase inhibitors (AIs). We hypothesized that decreased agonistic response to AIs would result in early FDG uptake decline. We also measured early response to trastuzumab (T), another targeted agent for breast cancer with differing mechanisms of action. Our study was designed to test for an early decline in FDG uptake in response to AI or T and to examine association with Ki-67 measures of early response. METHODS Patients with any stage of newly diagnosed or recurrent breast cancer were eligible and enrolled prior to initiation (or resumption) of AI or T therapy. FDG PET and tissue biopsy were planned before and after 2 weeks of AI or T therapy, with pretreatment archival tissue permitted. Cutoffs of ≥20% decline in standardized uptake value (SUV) as FDG PET early response and ≤5% post-treatment expression as Ki-67 early response were defined prior to analysis. RESULTS Forty-two patients enrolled, and 40 (28 AI, 12 T) completed serial FDG-PET imaging. Twenty-two patients (17 AI, 5 T) had newly diagnosed disease, and 23 (14 AI, 9 T) had metastatic disease (5 newly diagnosed). Post-treatment biopsy was performed in 25 patients (63%) and was either refused or not feasible in 15. Post-treatment biopsy yielded tumor in only 17/25 cases (14 AI, 3 T). Eleven of 14 AI patients with post-therapy tissue showed FDG PET early response, and there was 100% concordance of PET and post-therapy Ki-67 early response. For the T group, 6/12 showed an FDG PET early response, including 2/3 patients with post-therapy biopsy, all with Ki-67 >5%. CONCLUSIONS Substantial changes in FDG PET SUV occurred over 2 weeks of AI therapy and were associated with low post-therapy proliferation. SUV decline was seen in response to T, but few tissue samples were available to test association with Ki-67. Our results support further investigation of FDG PET as a biomarker for early response to AI therapy.
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Affiliation(s)
- Brenda F Kurland
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
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Beaver JA, Park BH. The BOLERO-2 trial: the addition of everolimus to exemestane in the treatment of postmenopausal hormone receptor-positive advanced breast cancer. Future Oncol 2012; 8:651-7. [PMID: 22764762 PMCID: PMC3466807 DOI: 10.2217/fon.12.49] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The combination of the mTOR inhibitor everolimus with the aromatase inhibitor exemestane was evaluated in the randomized Phase III BOLERO-2 trial. Research has indicated that aberrant signaling through the mTOR pathway is associated with resistance to endocrine therapies. The BOLERO-2 trial examined the effects on progression-free survival of the addition of everolimus to exemestane in a patient population of postmenopausal, hormone receptor-positive, advanced breast cancer. At the interim analysis, the median progression-free survival assessed by local investigators was 6.9 months for everolimus plus exemestane versus 2.8 months for placebo plus exemestane (hazard ratio: 0.43; p < 0.001), and by central assessment was 10.6 versus 4.1 months, respectively (hazard ratio: 0.36; p < 0.001). The everolimus plus exemestane arm showed greater number of grade 3 and 4 adverse events. This study suggests that the addition of everolimus to exemestane is a potential viable treatment option for this patient population.
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Affiliation(s)
- Julia A Beaver
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans St, Room 151, Baltimore, MD 21287, USA
| | - Ben H Park
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans St, Room 151, Baltimore, MD 21287, USA
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Fumagalli D, Bedard PL, Nahleh Z, Michiels S, Sotiriou C, Loi S, Sparano JA, Ellis M, Hylton N, Zujewski JA, Hudis C, Esserman L, Piccart M. A common language in neoadjuvant breast cancer clinical trials: proposals for standard definitions and endpoints. Lancet Oncol 2012; 13:e240-8. [PMID: 22652232 DOI: 10.1016/s1470-2045(11)70378-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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The Current Role of Endocrine Therapy in Locally Advanced Breast Cancer to Improve Breast Conservation Rates. CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0077-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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How reliable is Ki-67 immunohistochemistry in grade 2 breast carcinomas? A QA study of the Swiss Working Group of Breast- and Gynecopathologists. PLoS One 2012; 7:e37379. [PMID: 22662150 PMCID: PMC3360682 DOI: 10.1371/journal.pone.0037379] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/18/2012] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Adjuvant chemotherapy decisions in breast cancer are increasingly based on the pathologist's assessment of tumor proliferation. The Swiss Working Group of Gyneco- and Breast Pathologists has surveyed inter- and intraobserver consistency of Ki-67-based proliferative fraction in breast carcinomas. METHODS Five pathologists evaluated MIB-1-labeling index (LI) in ten breast carcinomas (G1, G2, G3) by counting and eyeballing. In the same way, 15 pathologists all over Switzerland then assessed MIB-1-LI on three G2 carcinomas, in self-selected or pre-defined areas of the tumors, comparing centrally immunostained slides with slides immunostained in the different laboratoires. To study intra-observer variability, the same tumors were re-examined 4 months later. RESULTS The Kappa values for the first series of ten carcinomas of various degrees of differentiation showed good to very good agreement for MIB-1-LI (Kappa 0.56-0.72). However, we found very high inter-observer variabilities (Kappa 0.04-0.14) in the read-outs of the G2 carcinomas. It was not possible to explain the inconsistencies exclusively by any of the following factors: (i) pathologists' divergent definitions of what counts as a positive nucleus (ii) the mode of assessment (counting vs. eyeballing), (iii) immunostaining technique, and (iv) the selection of the tumor area in which to count. Despite intensive confrontation of all participating pathologists with the problem, inter-observer agreement did not improve when the same slides were re-examined 4 months later (Kappa 0.01-0.04) and intra-observer agreement was likewise poor (Kappa 0.00-0.35). CONCLUSION Assessment of mid-range Ki-67-LI suffers from high inter- and intra-observer variability. Oncologists should be aware of this caveat when using Ki-67-LI as a basis for treatment decisions in moderately differentiated breast carcinomas.
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Abstract
Recent advances in tumor genetics and drug development have led to the generation of a wealth of anticancer targeted therapies. A few recent examples indicate that these drugs are mainly, if not exclusively, active against tumors of a particular genotype that can be identified by a diagnostic test, usually by detecting a somatic alteration in the tumor DNA. However, for the majority of targeted therapies in development, there are still no clinical tools to determine which patients are most likely to benefit or, alternatively, be resistant de novo to these novel agents or drug combinations.
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Affiliation(s)
- Carlos L Arteaga
- Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-6307, USA.
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Moreno-Aspitia A. Neoadjuvant therapy in early-stage breast cancer. Crit Rev Oncol Hematol 2012; 82:187-99. [DOI: 10.1016/j.critrevonc.2011.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/28/2011] [Accepted: 04/29/2011] [Indexed: 11/30/2022] Open
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Berruti A, Generali D, Bertaglia V, Brizzi MP, Mele T, Dogliotti L, Bruzzi P, Bottini A. Intermediate endpoints of primary systemic therapy in breast cancer patients. J Natl Cancer Inst Monogr 2012; 2011:142-6. [PMID: 22043062 DOI: 10.1093/jncimonographs/lgr036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Primary systemic therapy (PST) in breast cancer offers the opportunity to explore interactions between tumor biology and administered treatment. Changes in clinical, tissue-based, or imaging markers can provide information on the mechanisms of PST activity (activity endpoints) or predict treatment efficacy (surrogate endpoints). The most frequently used intermediate endpoint for PST is pathological complete response, but its role as a surrogate parameter of efficacy has not yet been demonstrated. Changes in tumor biology after PST may occur already a few days after treatment start; this implies that new potential surrogates occurring much earlier than pathological complete response (ie, the proliferation marker Ki67) can be identified and that short-term preoperative trials (window-of-opportunity trials) can be designed using a biological parameter as a primary endpoint. From these small trials, crucial information can be gleaned about the activity of new drugs for the design of large clinical trials.
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Affiliation(s)
- Alfredo Berruti
- Oncologia Medica, Azienda Ospedaliero Universitaria San Luigi, 10043 Orbassano, Italy.
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Generali D, Symmans WF, Berruti A, Fox SB. Predictive immunohistochemical biomarkers in the context of neoadjuvant therapy for breast cancer. J Natl Cancer Inst Monogr 2012; 2011:99-102. [PMID: 22043052 DOI: 10.1093/jncimonographs/lgr030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The adoption of personalized medicine has led to the search for prognostic and predictive markers that can be applied to individual patients to give optimal information for their clinical management. We have used samples from randomized clinical trials of hormonal and chemotherapy to identify relevant markers of sensitivity and resistance using a neoadjuvant approach by linking expression of a panel of proteins involved in growth factor receptor signaling, angiogenesis, estrogen receptor signaling, and hypoxia to individual patient response. We evaluated samples from randomized clinical trials of epirubicin with or without tamoxifen, and letrozole with or without metronomic cyclophosphamide, to study chemotherapy, hormonal therapy, and antiangiogenic effects. We present a proof of principle of this approach in identifying several key pathways that are associated with clinical and pathological response. Thus, we have shown that the hypoxia-inducible factor (HIF) pathway, mitogen activated protein kinase, and phosphorylated estrogen receptor-α can identify patients who are likely to respond to hormonal therapy and that HIF signaling is also a marker of resistance for anthracycline-based chemotherapy. To redress the role of HIF, we then evaluated samples from a randomized control trial of an anthracycline chemotherapy with and without erythropoietin. These studies demonstrate that the approach of using primary systemic therapy in breast can identify markers of response and potentially targets for rationale design of new therapies.
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Affiliation(s)
- Daniele Generali
- Unità di Patologia Mammaria-Breast Cancer Unit, Azienda Instituti Ospitalieri di Cremona, Cremona, Italy
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Specht JM, Mankoff DA. Advances in molecular imaging for breast cancer detection and characterization. Breast Cancer Res 2012; 14:206. [PMID: 22423895 PMCID: PMC3446362 DOI: 10.1186/bcr3094] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Advances in our ability to assay molecular processes, including gene expression, protein expression, and molecular and cellular biochemistry, have fueled advances in our understanding of breast cancer biology and have led to the identification of new treatments for patients with breast cancer. The ability to measure biologic processes without perturbing them in vivo allows the opportunity to better characterize tumor biology and to assess how biologic and cytotoxic therapies alter critical pathways of tumor response and resistance. By accurately characterizing tumor properties and biologic processes, molecular imaging plays an increasing role in breast cancer science, clinical care in diagnosis and staging, assessment of therapeutic targets, and evaluation of responses to therapies. This review describes the current role and potential of molecular imaging modalities for detection and characterization of breast cancer and focuses primarily on radionuclide-based methods.
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Affiliation(s)
- Jennifer M Specht
- Division of Medical Oncology, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G3-630, Seattle, WA 98109, USA.
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Goncalves R, Ma C, Luo J, Suman V, Ellis MJ. Use of neoadjuvant data to design adjuvant endocrine therapy trials for breast cancer. Nat Rev Clin Oncol 2012; 9:223-9. [PMID: 22371132 PMCID: PMC3518447 DOI: 10.1038/nrclinonc.2012.21] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mature outcomes from adjuvant endocrine therapy trials in estrogen receptor-positive breast cancer have enabled comparisons with neoadjuvant clinical trials that have parallel randomizations of treatment in terms of the response of disseminated disease versus the local response within the breast. Imprecise end points, such as 'clinical response', have produced inconsistent results regarding the relationship between neoadjuvant and adjuvant endocrine therapy outcomes. However, the proliferation marker Ki-67, measured during neoadjuvant treatment, has predicted accurately and consistently the results of much larger studies in the adjuvant setting. In this Review, we summarize these trials and discuss the implications for the design of future adjuvant endocrine therapy trials. We conclude that there is sufficient evidence supporting the view that the degree of Ki-67 suppression is a reliable short-term surrogate for the adjuvant potential of endocrine drugs, at least in postmenopausal women. We propose that adjuvant endocrine therapy trials should only be conducted once adequately-powered neoadjuvant studies have indicated superior Ki-67 suppression in patients receiving experimental endocrine treatment versus the standard treatment.
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Affiliation(s)
- Rodrigo Goncalves
- Breast Oncology Section, Washington University in St Louis, Campus Box 8056, 660 South Euclid Avenue, St Louis, MO 63110, USA
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Yamamoto S, Ibusuki M, Yamamoto Y, Fu P, Fujiwara S, Murakami K, Iwase H. Clinical relevance of Ki67 gene expression analysis using formalin-fixed paraffin-embedded breast cancer specimens. Breast Cancer 2012; 20:262-70. [PMID: 22362219 DOI: 10.1007/s12282-012-0332-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/03/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ki67 is a protein associated with cell cycle activity and shows a good correlation with the growth fraction, which has been proposed as a prognostic or predictive marker in breast cancer. In this study, we aimed to analyze the expression levels of Ki67 (MKI67) messenger RNA (mRNA) derived from formalin-fixed paraffin-embedded (FFPE) tissues for comparison with the immunohistochemical Ki67 labeling index, and investigate the correlation coefficients with clinical outcomes. METHODS We analyzed the data of Ki67 mRNA from FFPE and matched fresh-frozen (FF) tissues based on a real-time quantitative reverse-transcription polymerase chain reaction (RT-qPCR) assay system in 203 cases of primary invasive breast cancer. RESULTS The correlation between Ki67 mRNA expression of either FFPE or FF specimens and Ki67 labeling index was positive, as was the correlation between the FFPE and FF results (P < 0.0001). Ki67 mRNA expression of FFPE specimens was significantly associated with clinicopathological characteristics: tumor size, lymph node status, nuclear grade, hormone receptors, human epidermal growth factor receptor 2 (Her2) status, and tumor subtype. In prognostic results, Ki67 gene expression in the FFPE specimens revealed almost similar patterns of significance in Kaplan-Meier curves and univariate and multivariate relapse-free survival results as the Ki67 labeling index. CONCLUSIONS Gene expression analysis of Ki67 of FFPE specimens could be successfully performed using RT-qPCR, closely resembling the significant clinical characteristics of Ki67 labeling index. These results confirm that Ki67 gene expression of FFPE specimens has potential for evaluation of cell cycle activity of breast cancer specimens.
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Affiliation(s)
- Satoko Yamamoto
- Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo Kumamoto, Kumamoto, Japan
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Serrero G, Hawkins DM, Yue B, Ioffe O, Bejarano P, Phillips JT, Head JF, Elliott RL, Tkaczuk KR, Godwin AK, Weaver J, Kim WE. Progranulin (GP88) tumor tissue expression is associated with increased risk of recurrence in breast cancer patients diagnosed with estrogen receptor positive invasive ductal carcinoma. Breast Cancer Res 2012; 14:R26. [PMID: 22316048 PMCID: PMC3496144 DOI: 10.1186/bcr3111] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 01/16/2012] [Accepted: 02/08/2012] [Indexed: 01/10/2023] Open
Abstract
Introduction GP88 (progranulin) has been implicated in tumorigenesis and resistance to anti-estrogen therapies for estrogen receptor positive (ER+) breast cancer. Previous pathological studies showed that GP88 is expressed in invasive ductal carcinoma (IDC), but not in normal mammary epithelial tissue, benign lesions or lobular carcinoma. Based on these results, the present study examines GP88 prognostic significance in association with recurrence and death risks for ER+ IDC patients. Methods Two retrospective multi-site clinical studies examined GP88 expression by immunohistochemistry (IHC) analysis of paraffin-embedded breast tumor tissue sections from ER+ IDC patients (lymph node positive and negative, stage 1 to 3) in correlation with patients' survival outcomes. The training study established a GP88 cut-off value associated with decreased disease-free (DFS) and overall (OS) survivals. The validation study verified the GP88 cut-off value and compared GP88 prognostic information with other prognostic factors, particularly tumor size, grade, disease stage and lymph node status in multivariate analysis. Results GP88 expression is associated with a statistically significant increase in recurrence risk for ER+ IDC patients. The training study established that GP88 3+ score was associated with decreased DFS (P = 0.0004) and OS (P = 0.0036). The independent validation study verified that GP88 3+ score was associated with a 5.9-fold higher hazard of disease recurrence and a 2.5-fold higher mortality hazard compared to patients with tumor GP88 < 3+. GP88 remained an independent risk predictor after considering age, ethnicity, nodal status, tumor size, tumor grade, disease stage, progesterone receptor expression and treatments. Conclusions The survival factor GP88 is a novel prognostic biomarker, predictive of recurrence risk and increased mortality for non-metastatic ER+ IDC patients. Of importance, our data show that GP88 continues to be a prognostic factor even after five years. These results also provide evidence that GP88 provides prognostic information independent of tumor and clinical characteristics and would support prospective study to examine whether GP88 expression could help stratify patients with ER+ tumors for adjuvant therapy.
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Affiliation(s)
- Ginette Serrero
- A&G Pharmaceutical Inc,, 9130 Red Branch Rd,, Columbia, MD 21045, USA.
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Abstract
Estrogen receptor (ER)-positive breast cancer is the most prevalent subtype of invasive breast cancers. Patients with ER-positive breast cancers have variable clinical outcomes and responses to endocrine therapy and chemotherapy. With the advent of microarray-based gene expression profiling, unsupervised analysis methods have resulted in a classification of ER-positive disease into subtypes with different outcomes (ie, luminal A and luminal B); subsequent studies have demonstrated that these subtypes have different patterns of genetic aberrations and outcome. Studies based on supervised methods of microarray analysis have led to the development of prognostic gene signatures that identify a subgroup of ER-positive breast cancer patients with excellent outcome, who could forego chemotherapy. Despite the excitement with these approaches, several lines of evidence have demonstrated that the subclassification of ER-positive cancers and the prognostic value of gene signatures is largely driven by the expression levels of proliferation-related genes and that proliferation markers, such as Ki67, may provide equivalent prognostic information to that provided by gene signatures. In this review, we discuss the contribution of gene expression profiling to the classification of ER-positive breast cancer, the role of prognostic and predictive signatures, and the potential stratification of ER-positive disease according to their dependency on the phosphatidylinositol 3-kinase pathway.
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Loi S, Symmans WF, Bartlett JMS, Fumagalli D, Van't Veer L, Forbes JF, Bedard P, Denkert C, Zujewski J, Viale G, Pusztai L, Esserman LJ, Leyland-Jones BR. Proposals for uniform collection of biospecimens from neoadjuvant breast cancer clinical trials: timing and specimen types. Lancet Oncol 2011; 12:1162-8. [PMID: 21684810 DOI: 10.1016/s1470-2045(11)70117-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this Personal View, we outline proposals for uniform collection of biospecimens obtained in neoadjuvant breast cancer trials undertaken by the Breast International Group (BIG) and the National Cancer Institute-sponsored North American Breast Cancer Group (NABCG). These proposals aim to standardise collection of high-quality specimens, with respect to both type and timing, to enhance and allow integration of results obtained from neoadjuvant trials done by several groups. They should be considered in parallel with recommendations for tissue-specimen collection and handling previously developed by BIG and NABCG. We propose that tumour tissue (formalin-fixed, paraffin-embedded and samples dedicated for molecular studies) should be taken at baseline, 1-3 weeks after the start of treatment, and at definitive surgery, with clear prioritisation in the study protocol of number, order, and preservation of samples to be gathered. This step should be accompanied by blood collection (plasma, serum, and whole blood) whenever possible. We advocate strongly a move towards one diagnostic and research biopsy procedure in all women with breast cancers potentially suitable for neoadjuvant treatment. If possible, patients should be referred at the outset to specialised centres to give them the opportunity to participate in neoadjuvant clinical trials, thereby avoiding several biopsy procedures.
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Affiliation(s)
- Sherene Loi
- Breast International Group, and Breast Cancer Translational Research Laboratory, Institute Jules Bordet, Brussels, Belgium
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Mortazavi-Jehanno N, Giraudet AL, Champion L, Lerebours F, Le Stanc E, Edeline V, Madar O, Bellet D, Pecking AP, Alberini JL. Assessment of response to endocrine therapy using FDG PET/CT in metastatic breast cancer: a pilot study. Eur J Nucl Med Mol Imaging 2011; 39:450-60. [DOI: 10.1007/s00259-011-1981-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 10/17/2011] [Indexed: 11/30/2022]
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Preoperative Endocrine Therapy: Preferred Therapy for Whom? CURRENT BREAST CANCER REPORTS 2011. [DOI: 10.1007/s12609-011-0060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Chimge NO, Baniwal SK, Luo J, Coetzee S, Khalid O, Berman BP, Tripathy D, Ellis MJ, Frenkel B. Opposing effects of Runx2 and estradiol on breast cancer cell proliferation: in vitro identification of reciprocally regulated gene signature related to clinical letrozole responsiveness. Clin Cancer Res 2011; 18:901-11. [PMID: 22147940 DOI: 10.1158/1078-0432.ccr-11-1530] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess the clinical significance of the interaction between estrogen and Runx2 signaling, previously shown in vitro. EXPERIMENTAL DESIGN MCF7/Rx2(dox) breast cancer cells were treated with estradiol and/or doxycycline to induce Runx2, and global gene expression was profiled to define genes regulated by estradiol, Runx2, or both. Anchorage-independent growth was assessed by soft-agar colony formation assays. Expression of gene sets defined using the MCF7/Rx2(dox) system was analyzed in pre- and on-treatment biopsies from hormone receptor-positive patients undergoing neoadjuvant letrozole treatment in two independent studies, and short-term changes in gene expression were correlated with tumor size reduction or Ki67 index at surgery. RESULTS Reflecting its oncogenic property, estradiol strongly promoted soft-agar colony formation, whereas Runx2 blocked this process suggesting tumor suppressor property. Transcriptome analysis of MCF7/Rx2(dox) cells treated with estradiol and/or doxycycline showed reciprocal attenuation of Runx2 and estrogen signaling. Correspondingly in breast cancer tumors, expression of estradiol- and Runx2-regulated genes was inversely correlated, and letrozole increased expression of Runx2-stimulated genes, as defined in the MCF7/Rx2(dox) model. Of particular interest was a gene set upregulated by estradiol and downregulated by Runx2 in vitro; its short-term response to letrozole treatment associated with tumor size reduction and Ki67 index at surgery better than other estradiol-regulated gene sets. CONCLUSION This work provides clinical evidence for the importance of antagonism between Runx2 and E2 signaling in breast cancer. Likely sensing the tension between them, letrozole responsiveness of a genomic node, positively regulated by estradiol and negatively regulated by Runx2 in vitro, best correlated with the clinical efficacy of letrozole treatment.
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Affiliation(s)
- Nyam-Osor Chimge
- Department of Biochemistry, Institute for Genetic Medicine, USC Epigenome Center, Keck School of Medicine of the University of Southern California, Los Angeles, California 90033, USA
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Bedard PL, Singhal SK, Ignatiadis M, Bradbury I, Haibe-Kains B, Desmedt C, Loi S, Evans DB, Michiels S, Dixon JM, Miller WR, Piccart MJ, Sotiriou C. Low residual proliferation after short-term letrozole therapy is an early predictive marker of response in high proliferative ER-positive breast cancer. Endocr Relat Cancer 2011; 18:721-30. [PMID: 21984694 DOI: 10.1530/erc-11-0180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The gene expression grade index (GGI) is a 97-gene algorithm that measures proliferation and divides intermediate histological grade tumors into two distinct groups. We investigated the association between early changes in GGI and clinical response to neoadjuvant letrozole and compared this to Ki67 values. The paired gene expression data at the beginning and after 10-14 days of neoadjuvant letrozole treatment were available for 52 post-menopausal patients with estrogen receptor (ER)-positive breast cancer. Baseline values and changes in GGI, Ki67, and RNA expression modules representing oncogenic signaling pathways were compared to sonographic tumor volume changes after 3 months of treatment in the subsets of patients defined by high and low baseline GGI. The clinical response was observed in 80% genomic low-grade (24/30) and 59% genomic high-grade (13/22) tumors (P=0.10). Low residual proliferation after 10-14 days of neoadjuvant letrozole therapy, measured by either GGI or Ki67, was associated with sonographic response in genomic high-grade (GGI, P=0.003; Ki67, P=0.017) but not genomic low-grade (GGI, P=0.25; Ki67, P=1.0) tumors. The analysis of expression modules suggested that sonographic response to letrozole in genomic high-grade tumors was associated with an early reduction in IGF1 signaling (unadjusted P=0.018). The major conclusion of this study is that the early assessment of proliferation after short-term endocrine therapy may be useful to evaluate endocrine responsiveness, particularly in genomic high-grade ER-positive breast cancer.
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Affiliation(s)
- Philippe L Bedard
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Hospital, University of Toronto, Ontario, Canada
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Endocrine Therapy in the Preoperative Setting and Strategies to Overcome Resistance. CURRENT BREAST CANCER REPORTS 2011. [DOI: 10.1007/s12609-011-0056-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Currin E, Linden HM, Mankoff DA. Predicting Breast Cancer Endocrine Responsiveness Using Molecular Imaging. CURRENT BREAST CANCER REPORTS 2011; 3:205-211. [PMID: 23105956 PMCID: PMC3480214 DOI: 10.1007/s12609-011-0053-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The estrogen receptor (ER) is expressed on the vast majority of newly diagnosed breast cancers, yet not all ER-positive tumors will respond to endocrine therapy. Selecting patients for endocrine therapy can be considered as a series of predictive tests: does the tumor express the ER and if so, will the endocrine therapy interact with the target to produce a response? These are both challenges to which molecular imaging is functionally suited. Imaging of the ER has been most successful using 16-α[18F]-flouro-17β-estradiol (FES) positron emission tomography (PET). Functional imaging of the ER using FES-PET has been shown to be a predictive tool in determining response to endocrine therapy, and PET imaging of the ER can be used to measure the pharmacodynamic effect of ER-directed endocrine therapy. This article reviews the literature on FES-PET as a functional tool in predicting response to endocrine therapy in breast cancer and discusses future directions.
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Affiliation(s)
- Erin Currin
- Department of Medicine Box 354760 University of Washington 1959 N.E. Pacific St. Seattle, WA 98195 206-598-8750 (ph)
| | - Hannah M. Linden
- Department of Oncology University of Washington and Seattle Cancer Care Alliance G3-210, 825 Eastlake Avenue East Seattle WA, 98109 206 288-6710 (ph) 206 288-2054 (fax)
| | - David A. Mankoff
- Department of Radiology University of Washington and Seattle Cancer Care Alliance G2-600, 825 Eastlake Avenue East Seattle, WA 98109 206-288-2173 (ph) 206-288-6556 (fax)
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