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Kuilman MM, Ellappalayam A, Barcaru A, Haan JC, Bhaskaran R, Wehkamp D, Menicucci AR, Audeh WM, Mittempergher L, Glas AM. BluePrint breast cancer molecular subtyping recognizes single and dual subtype tumors with implications for therapeutic guidance. Breast Cancer Res Treat 2022; 195:263-274. [PMID: 35984580 PMCID: PMC9464757 DOI: 10.1007/s10549-022-06698-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/27/2022] [Indexed: 12/05/2022]
Abstract
Purpose BluePrint (BP) is an 80-gene molecular subtyping test that classifies early-stage breast cancer (EBC) into Basal, Luminal, and HER2 subtypes. In most cases, breast tumors have one dominant subtype, representative of a single activated pathway. However, some tumors show a statistically equal representation of more than one subtype, referred to as dual subtype. This study aims to identify and examine dual subtype tumors by BP to understand their biology and possible implications for treatment guidance. Methods The BP scores of over 15,000 tumor samples from EBC patients were analyzed, and the differences between the highest and the lowest scoring subtypes were calculated. Based upon the distribution of the differences between BP scores, a threshold was determined for each subtype to identify dual versus single subtypes. Results Approximately 97% of samples had one single activated BluePrint molecular subtype, whereas ~ 3% of samples were classified as BP dual subtype. The most frequently occurring dual subtypes were the Luminal-Basal-type and Luminal-HER2-type. Luminal-Basal-type displays a distinct biology from the Luminal single type and Basal single type. Burstein’s classification of the single and dual Basal samples showed that the Luminal-Basal-type is mostly classified as ‘luminal androgen receptor’ and ‘mesenchymal’ subtypes, supporting molecular evidence of AR activation in the Luminal-Basal-type tumors. Tumors classified as Luminal-HER2-type resemble features of both Luminal-single-type and HER2-single-type. However, patients with dual Luminal-HER2-type have a lower pathological complete response after receiving HER2-targeted therapies in addition to chemotherapy in comparison with patients with a HER2-single-type. Conclusion This study demonstrates that BP identifies tumors with two active functional pathways (dual subtype) with specific transcriptional characteristics and highlights the added value of distinguishing BP dual from single subtypes as evidenced by distinct treatment response rates. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06698-x.
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Affiliation(s)
- Midas M Kuilman
- Department of Research and Development, Agendia N.V, Radarweg 60, 1043 NT, Amsterdam, The Netherlands
| | - Architha Ellappalayam
- Department of Research and Development, Agendia N.V, Radarweg 60, 1043 NT, Amsterdam, The Netherlands
| | - Andrei Barcaru
- Department of Research and Development, Agendia N.V, Radarweg 60, 1043 NT, Amsterdam, The Netherlands
| | - Josien C Haan
- Department of Research and Development, Agendia N.V, Radarweg 60, 1043 NT, Amsterdam, The Netherlands
| | - Rajith Bhaskaran
- Department of Research and Development, Agendia N.V, Radarweg 60, 1043 NT, Amsterdam, The Netherlands
| | - Diederik Wehkamp
- Department of Research and Development, Agendia N.V, Radarweg 60, 1043 NT, Amsterdam, The Netherlands
| | - Andrea R Menicucci
- Department of Medical Affairs, Agendia Inc, 22 Morgan, Irvine, CA, 92618, USA
| | - William M Audeh
- Department of Medical Affairs, Agendia Inc, 22 Morgan, Irvine, CA, 92618, USA
| | - Lorenza Mittempergher
- Department of Research and Development, Agendia N.V, Radarweg 60, 1043 NT, Amsterdam, The Netherlands.
| | - Annuska M Glas
- Department of Research and Development, Agendia N.V, Radarweg 60, 1043 NT, Amsterdam, The Netherlands.
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Kurdziel KA, Mena E, McKinney Y, Wong K, Adler S, Sissung T, Lee J, Lipkowitz S, Lindenberg L, Turkbey B, Kummar S, Milenic DE, Doroshow JH, Figg WD, Merino MJ, Paik CH, Brechbiel MW, Choyke PL. First-in-human phase 0 study of 111In-CHX-A"-DTPA trastuzumab for HER2 tumor imaging. ACTA ACUST UNITED AC 2018; 5. [PMID: 30906574 PMCID: PMC6425962 DOI: 10.15761/jts.1000269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Introduction: Tumors over-expressing the human epithelial receptor 2 (HER2) or exhibiting amplification or mutation of its proto-oncogene have a poorer prognosis. Using trastuzumab and/or other HER2 targeted therapies can increase overall survival in patients with HER2(+) tumors making it critical to accurately identify patients who may benefit. We report on a Phase 0 study of the imaging agent, 111In-CHX-A”-DTPA trastuzumab, in patients with known HER2 status to evaluate its safety and biodistribution and to obtain preliminary data regarding its ability to provide an accurate, whole-body, non-invasive means to determine HER2 status. Methods: 111In-CHX-A”-DTPA trastuzumab was radiolabeled on-site and slowly infused into 11 patients who underwent single (n=5) or multiple (n=6) ɣ-camera (n=6) and/or SPECT (n=8) imaging sessions. Results: No safety issues were identified. Visual and semi-quantitative imaging data were concordant with tissue HER2 expression profiling in all but 1 patient. The biodistribution showed intense peak liver activity at the initial imaging timepoint (3.3h) and a single-phase clearance fit of the average time-activity curve (TAC) estimated t1/2=46.9h (R2=0.97; 95%CI 41.8 to 53h). This was followed by high gastrointestinal (GI) tract activity peaking by 52h. Linear regression predicted GI clearance by 201.2h (R2 =0.96; 95%CI 188.5 to 216.9h). Blood pool had lower activity with its maximum on the initial images. Non-linear regression fit projected a t1/2=34.2h (R2 =0.96; 95%CI 25.3 to 46.3h). Assuming linear whole-body clearance, linear regression projected complete elimination (x-intercept) at 256.5hr (R2=0.96; 95%CI 186.1 to 489.2h). Conclusion: 111In-CHX-A”-DTPA trastuzumab can be safely imaged in humans. The biodistribution allowed for visual and semiquantitative analysis with results concordant with tissue expression profiling in 10 of 11 patients. Advances in Knowledge and Implications for Patient Care Using readily available components and on-site radiolabeling 111In-CHX-A”-DTPA trastuzumab SPECT imaging may provide an economical, non-invasive means to detect HER2 over-expression.
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Affiliation(s)
- K A Kurdziel
- Molecular Imaging Program (MIP), Center for Cancer Research (CCR)/National Cancer Institute (NCI), National Institutes of Health (NIH), USA
| | - E Mena
- Molecular Imaging Program (MIP), Center for Cancer Research (CCR)/National Cancer Institute (NCI), National Institutes of Health (NIH), USA
| | - Y McKinney
- Molecular Imaging Program (MIP), Center for Cancer Research (CCR)/National Cancer Institute (NCI), National Institutes of Health (NIH), USA
| | - K Wong
- Molecular Imaging Program (MIP), Center for Cancer Research (CCR)/National Cancer Institute (NCI), National Institutes of Health (NIH), USA
| | - S Adler
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, USA
| | - T Sissung
- Genitourinary Malignancies Branch, CCR/NCI, NIH, USA
| | - J Lee
- Division of Nuclear Medicine, Radiology and Imaging Sciences, Clinical Center(CC), NIH, USA
| | - S Lipkowitz
- Women's Malignancies Branch, CCR/NCI, NIH, USA
| | - L Lindenberg
- Molecular Imaging Program (MIP), Center for Cancer Research (CCR)/National Cancer Institute (NCI), National Institutes of Health (NIH), USA
| | - B Turkbey
- Molecular Imaging Program (MIP), Center for Cancer Research (CCR)/National Cancer Institute (NCI), National Institutes of Health (NIH), USA
| | - S Kummar
- Women's Malignancies Branch, CCR/NCI, NIH, USA
| | - D E Milenic
- Radiation Oncology Branch, CCR/NCI, NIH, USA
| | - J H Doroshow
- Division of Cancer Treatment and Diagnosis and CCR/NCI, NIH, USA
| | - W D Figg
- Genitourinary Malignancies Branch, CCR/NCI, NIH, USA
| | - M J Merino
- Laboratory of Pathology, CCR/NCI, NIH, USA
| | - C H Paik
- Division of Nuclear Medicine, Radiology and Imaging Sciences, Clinical Center(CC), NIH, USA
| | | | - P L Choyke
- Molecular Imaging Program (MIP), Center for Cancer Research (CCR)/National Cancer Institute (NCI), National Institutes of Health (NIH), USA
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Desai NV, Torous V, Parker J, Auman JT, Rosson GB, Cruz C, Perou CM, Schnitt SJ, Tung N. Intrinsic molecular subtypes of breast cancers categorized as HER2-positive using an alternative chromosome 17 probe assay. Breast Cancer Res 2018; 20:75. [PMID: 29996866 PMCID: PMC6042281 DOI: 10.1186/s13058-018-1005-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The 2013 update of the American Society of Clinical Oncology-College of American Pathologists (ASCO-CAP) human epidermal growth factor receptor 2 (HER2) testing guidelines recommend using an alternative chromosome 17 probe assay to resolve HER2 results determined to be equivocal by immunohistochemistry (IHC) or fluorescence in-situ hybridization (FISH). However, it is unclear if cases considered HER2-positive (HER2+) by the alternative probe method are similar to those classified as HER2+ by traditional IHC and FISH criteria and benefit the same from HER2-targeted therapies. We studied the clinical and pathologic features of all 31 breast cancers classified as HER2+ by the alternative probe method at our institution since 2013 and determined their PAM50 intrinsic molecular subtypes. For comparison, we analyzed 19 consecutive cases that were classified as HER2+ by traditional FISH criteria during the same time period. Thirty (97%) cancers in the alternative probe cohort were estrogen receptor (ER)-positive (ER+), while only 9/19 (47%) of traditional HER2 controls were ER+ (p = 0.0002). Sufficient tissue for intrinsic subtype analysis was available for 20/31 cancers in the alternative probe cohort and 9/19 in the traditional HER2+ group. None (0%) of the 20 alternative probe-positive cases were of the HER2-enriched intrinsic subtype, while 8/9 (89%) of those HER2+ by traditional FISH criteria were HER2-enriched (p = 0.0001). These findings suggest that breast cancers classified as HER2+ only by the alternative probe method are biologically distinct from those classified as HER2+ by traditional criteria, and raises questions as to whether or not they derive the same benefit from HER2-targeted therapies.
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Affiliation(s)
- Neelam V Desai
- Department of Hematology-Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Shapiro 9, Boston, MA, 02215, USA.
| | - Vanda Torous
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Joel Parker
- Department of Genetics and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James T Auman
- Department of Pathology and Laboratory Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gary B Rosson
- Department of Pathology and Laboratory Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cassandra Cruz
- Department of Hematology-Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Shapiro 9, Boston, MA, 02215, USA
| | - Charles M Perou
- Department of Genetics and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stuart J Schnitt
- Department of Pathology, Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Nadine Tung
- Department of Hematology-Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Shapiro 9, Boston, MA, 02215, USA
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Siegfried JM, Lin Y, Diergaarde B, Lin HM, Dacic S, Pennathur A, Weissfeld JL, Romkes M, Nukui T, Stabile LP. Expression of PAM50 Genes in Lung Cancer: Evidence that Interactions between Hormone Receptors and HER2/HER3 Contribute to Poor Outcome. Neoplasia 2016; 17:817-25. [PMID: 26678909 PMCID: PMC4681883 DOI: 10.1016/j.neo.2015.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/04/2015] [Accepted: 11/08/2015] [Indexed: 01/16/2023] Open
Abstract
Non–small cell lung cancers (NSCLCs) frequently express estrogen receptor (ER) β, and estrogen signaling is active in many lung tumors. We investigated the ability of genes contained in the prediction analysis of microarray 50 (PAM50) breast cancer risk predictor gene signature to provide prognostic information in NSCLC. Supervised principal component analysis of mRNA expression data was used to evaluate the ability of the PAM50 panel to provide prognostic information in a stage I NSCLC cohort, in an all-stage NSCLC cohort, and in The Cancer Genome Atlas data. Immunohistochemistry was used to determine status of ERβ and other proteins in lung tumor tissue. Associations with prognosis were observed in the stage I cohort. Cross-validation identified seven genes that, when analyzed together, consistently showed survival associations. In pathway analysis, the seven-gene panel described one network containing the ER and progesterone receptor, as well as human epidermal growth factor receptor (HER)2/HER3 and neuregulin-1. NSCLC cases also showed a significant association between ERβ and HER2 protein expression. Cases positive for HER2 expression were more likely to express HER3, and ERβ-positive cases were less likely to be both HER2 and HER3 negative. Prognostic ability of genes in the PAM50 panel was verified in an ERβ-positive cohort representing all NSCLC stages. In The Cancer Genome Atlas data sets, the PAM50 gene set was prognostic in both adenocarcinoma and squamous cell carcinoma, whereas the seven-gene panel was prognostic only in squamous cell carcinoma. Genes in the PAM50 panel, including those linking ER and HER2, identify lung cancer patients at risk for poor outcome, especially among ERβ-positive cases and squamous cell carcinoma.
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Affiliation(s)
- Jill M Siegfried
- Department of Pharmacology, University of Minnesota, Minneapolis, MN 55455; Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA 15213
| | - Yan Lin
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA 15213; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA 15213
| | - Brenda Diergaarde
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA 15213; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213
| | - Hui-Min Lin
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA 15213
| | - Sanja Dacic
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA 15213; Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213
| | - Arjun Pennathur
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA 15213; Department of Thoracic Surgery, University of Pittsburgh, Pittsburgh, PA 15213
| | - Joel L Weissfeld
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA 15213; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213
| | - Marjorie Romkes
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA 15213; Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213
| | - Tomoko Nukui
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213
| | - Laura P Stabile
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA 15213; University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA 15213.
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