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Hinić S, Cybulski C, Van der Post RS, Vos JR, Schuurs-Hoeijmakers J, Brugnoletti F, Koene S, Vreede L, van Zelst-Stams WAG, Kets CM, Haadsma M, Spruijt L, Wevers MR, Evans DG, Wimmer K, Schnaiter S, Volk AE, Möllring A, de Putter R, Soikkonen L, Kahre T, Tooming M, de Jong MM, Vaz F, Mensenkamp AR, Genuardi M, Lubinski J, Ligtenberg M, Hoogerbrugge N, de Voer RM. The heterogeneous cancer phenotype of individuals with biallelic germline pathogenic variants in CHEK2. Genet Med 2024; 26:101101. [PMID: 38362852 DOI: 10.1016/j.gim.2024.101101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Females with biallelic CHEK2 germline pathogenic variants (gPVs) more often develop multiple breast cancers than individuals with monoallelic CHEK2 gPVs. This study is aimed at expanding the knowledge on the occurrence of other malignancies. METHODS Exome sequencing of individuals who developed multiple primary malignancies identified 3 individuals with the CHEK2 (NM_007194.4) c.1100del p.(Thr367MetfsTer15) loss-of-function gPV in a biallelic state. We collected the phenotypes of an additional cohort of individuals with CHEK2 biallelic gPVs (n = 291). RESULTS In total, 157 individuals (53.4%; 157/294 individuals) developed ≥1 (pre)malignancy. The most common (pre)malignancies next to breast cancer were colorectal- (n = 19), thyroid- (n = 19), and prostate (pre)malignancies (n = 12). Females with biallelic CHEK2 loss-of-function gPVs more frequently developed ≥2 (pre)malignancies and at an earlier age compared with females biallelic for the CHEK2 c.470T>C p.(Ile157Thr) missense variant. Furthermore, 26 males (31%; 26/84 males) with CHEK2 biallelic gPVs developed ≥1 (pre)malignancies of 15 origins. CONCLUSION Our study suggests that CHEK2 biallelic gPVs likely increase the susceptibility to develop multiple malignancies in various tissues, both in females and males. However, it is possible that a substantial proportion of individuals with CHEK2 biallelic gPVs is missed as diagnostic testing for CHEK2 often is limited to individuals who developed breast cancer.
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Affiliation(s)
- Snežana Hinić
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands
| | - Cezary Cybulski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland; European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands
| | - Rachel S Van der Post
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Radboud University Medical Center, Research Institute for Medical Innovation, Department of Pathology, Nijmegen, The Netherlands
| | - Janet R Vos
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands; European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands
| | - Janneke Schuurs-Hoeijmakers
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands
| | - Fulvia Brugnoletti
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands; Genomic Medicine, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Saskia Koene
- Leiden University Medical Center, Department of Clinical Genetics, Leiden, The Netherlands
| | - Lilian Vreede
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands
| | - Wendy A G van Zelst-Stams
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands
| | - C Marleen Kets
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands
| | - Maaike Haadsma
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands
| | - Liesbeth Spruijt
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands
| | - Marijke R Wevers
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands
| | - D Gareth Evans
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; The University of Manchester, Genomic Medicine, Division of Evolution, Infection and Genomic Sciences, Manchester, United Kingdom
| | - Katharina Wimmer
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Simon Schnaiter
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander E Volk
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Möllring
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robin de Putter
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Center for Medical Genetics, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Leila Soikkonen
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Oulu University Hospital, Department of Clinical Genetics, Oulu, Finland
| | - Tiina Kahre
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Genetics and Personalized Medicine Clinic, Department of Laboratory Genetics, Tartu University Hospital, Tartu, Estonia; Department of Clinical Genetics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Mikk Tooming
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Genetics and Personalized Medicine Clinic, Department of Laboratory Genetics, Tartu University Hospital, Tartu, Estonia; Department of Clinical Genetics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Mirjam M de Jong
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Fátima Vaz
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Instituto Português Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Arjen R Mensenkamp
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands
| | - Maurizio Genuardi
- European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Genomic Medicine, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy; Medical Genetics Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland; European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands
| | - Marjolijn Ligtenberg
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands; European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands; Radboud University Medical Center, Research Institute for Medical Innovation, Department of Pathology, Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands; European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands
| | - Richarda M de Voer
- Radboud University Medical Center, Research Institute for Medical Innovation, Department of Human Genetics, Nijmegen, The Netherlands; European Reference Network for Genetic Tumour Risk Syndromes (ERN GENTURIS), Nijmegen, The Netherlands.
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Schwartz CJ, Khorsandi N, Blanco A, Mukhtar RA, Chen YY, Krings G. Clinicopathologic and genetic analysis of invasive breast carcinomas in women with germline CHEK2 variants. Breast Cancer Res Treat 2024; 204:171-179. [PMID: 38091153 PMCID: PMC10806021 DOI: 10.1007/s10549-023-07176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/02/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Germline pathogenic variants in checkpoint kinase 2 (CHEK2) are associated with a moderately increased risk of breast cancer (BC). The spectrum of clinicopathologic features and genetics of these tumors has not been fully established. METHODS We characterized the histopathologic and clinicopathologic features of 44 CHEK2-associated BCs from 35 women, and assessed responses to neoadjuvant chemotherapy. A subset of cases (n = 23) was additionally analyzed using targeted next-generation DNA sequencing (NGS). RESULTS Most (94%, 33/35) patients were heterozygous carriers for germline CHEK2 variants, and 40% had the c.1100delC allele. Two patients were homozygous, and five had additional germline pathogenic variants in ATM (2), PALB2 (1), RAD50 (1), or MUTYH (1). CHEK2-associated BCs occurred in younger women (median age 45 years, range 25-75) and were often multifocal (20%) or bilateral (11%). Most (86%, 38/44) were invasive ductal carcinomas of no special type (IDC-NST). Almost all (95%, 41/43) BCs were ER + (79% ER + HER2-, 16% ER + HER2 + , 5% ER-HER2 +), and most (69%) were luminal B. Nottingham grade, proliferation index, and results of multiparametric molecular testing were heterogeneous. Biallelic CHEK2 alteration with loss of heterozygosity was identified in most BCs (57%, 13/23) by NGS. Additional recurrent alterations included GATA3 (26%), PIK3CA (226%), CCND1 (22%), FGFR1 (22%), ERBB2 (17%), ZNF703 (17%), TP53 (9%), and PPM1D (9%), among others. Responses to neoadjuvant chemotherapy were variable, but few patients (21%, 3/14) achieved pathologic complete response. Most patients (85%) were without evidence of disease at time of study (n = 34). Five patients (15%) developed distant metastasis, and one (3%) died (mean follow-up 50 months). CONCLUSION Almost all CHEK2-associated BCs were ER + IDC-NST, with most classified as luminal B with or without HER2 overexpression. NGS supported the luminal-like phenotype and confirmed CHEK2 as an oncogenic driver in the majority of cases. Responses to neoadjuvant chemotherapy were variable but mostly incomplete.
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Affiliation(s)
- Christopher J Schwartz
- Department of Pathology, University of California San Francisco (UCSF), 1825 4th Street, San Francisco, CA, 94143, USA.
| | - Nikka Khorsandi
- Department of Pathology, University of California San Francisco (UCSF), 1825 4th Street, San Francisco, CA, 94143, USA
| | - Amie Blanco
- Department of Cancer Genetics and Prevention Program, UCSF, San Francisco, CA, USA
| | | | - Yunn-Yi Chen
- Department of Pathology, University of California San Francisco (UCSF), 1825 4th Street, San Francisco, CA, 94143, USA
| | - Gregor Krings
- Department of Pathology, University of California San Francisco (UCSF), 1825 4th Street, San Francisco, CA, 94143, USA
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Ekram SN, Al Shanbari N, Bin Laswad BM, Alharthi A, Tayeb W, Bahha A. Checkpoint Kinase 2 (CHEK2) Gene Mutation in a Patient With Breast and Prostate Cancer: A Unique Presentation of a Rare Disease. Cureus 2023; 15:e49710. [PMID: 38161833 PMCID: PMC10757464 DOI: 10.7759/cureus.49710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Breast cancer is one of the rarest malignancies in males, with a low incidence rate compared to all breast cancers. Gene mutation plays a significant role in the pathologic process of cancer. Mutations in breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) have been associated with male breast cancer (MBC), as well as prostate cancer (PCa). Despite the etiopathogenetic similarity, combined MBC and PCa is a rare entity. This report presents the case of a 57-year-old male with a history of breast cancer who underwent modified radical mastectomy (MRM) with lymph node dissection followed by adjuvant chemoradiotherapy four years ago. The patient presented with recurrent episodes of voiding dysfunction for three months, followed by urine retention. His family history was positive for breast and lung cancer. High prostate-specific antigen (PSA) and Prostate Imaging-Reporting and Data System 5 (PI-RADS5) necessitate transrectal ultrasound-guided biopsy, which confirmed the diagnosis of PCa. Molecular genetics testing and next-generation sequencing (NGS) analysis identified heterozygous variant c.636T>G, p.(Tyr212*) in the checkpoint kinase 2 (CHEK2) gene. The patient is planned for neoadjuvant luteinizing hormone-releasing hormone (LHRH) for 3-6 months, to be followed by transurethral tunneling of the prostate (TUTP) with adjuvant LHRH. The allele frequency of this patient mutation was documented for the first time among the general population, and it has not been described in the literature. This unique and rare case was presented with clinical, morphological, and immunohistochemical features together with a review of the current literature.
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Affiliation(s)
- Samar N Ekram
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Nasser Al Shanbari
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Bassam M Bin Laswad
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Abdulrahman Alharthi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Waseem Tayeb
- Department of Surgery, Division of Urology, King Abdullah Medical City, Makkah, SAU
| | - Abdulbari Bahha
- Department of Surgery, Division of Urology, King Abdullah Medical City, Makkah, SAU
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Szczepanek J, Skorupa M, Jarkiewicz-Tretyn J, Cybulski C, Tretyn A. Harnessing Epigenetics for Breast Cancer Therapy: The Role of DNA Methylation, Histone Modifications, and MicroRNA. Int J Mol Sci 2023; 24:ijms24087235. [PMID: 37108398 PMCID: PMC10138995 DOI: 10.3390/ijms24087235] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/24/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Breast cancer exhibits various epigenetic abnormalities that regulate gene expression and contribute to tumor characteristics. Epigenetic alterations play a significant role in cancer development and progression, and epigenetic-targeting drugs such as DNA methyltransferase inhibitors, histone-modifying enzymes, and mRNA regulators (such as miRNA mimics and antagomiRs) can reverse these alterations. Therefore, these epigenetic-targeting drugs are promising candidates for cancer treatment. However, there is currently no effective epi-drug monotherapy for breast cancer. Combining epigenetic drugs with conventional therapies has yielded positive outcomes and may be a promising strategy for breast cancer therapy. DNA methyltransferase inhibitors, such as azacitidine, and histone deacetylase inhibitors, such as vorinostat, have been used in combination with chemotherapy to treat breast cancer. miRNA regulators, such as miRNA mimics and antagomiRs, can alter the expression of specific genes involved in cancer development. miRNA mimics, such as miR-34, have been used to inhibit tumor growth, while antagomiRs, such as anti-miR-10b, have been used to inhibit metastasis. The development of epi-drugs that target specific epigenetic changes may lead to more effective monotherapy options in the future.
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Affiliation(s)
- Joanna Szczepanek
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, 87-100 Torun, Poland
| | - Monika Skorupa
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, 87-100 Torun, Poland
- Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, 87-100 Torun, Poland
| | | | - Cezary Cybulski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Andrzej Tretyn
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, 87-100 Torun, Poland
- Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, 87-100 Torun, Poland
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