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Fasching PA, Hu C, Hart SN, Ruebner M, Polley EC, Gnanaolivu RD, Hartkopf AD, Huebner H, Janni W, Hadji P, Tesch H, Uhrig S, Ettl J, Lux MP, Lüftner D, Wallwiener M, Wurmthaler LA, Goossens C, Müller V, Beckmann MW, Hein A, Anetsberger D, Belleville E, Wimberger P, Untch M, Ekici AB, Kolberg HC, Hartmann A, Taran FA, Fehm TN, Wallwiener D, Brucker SY, Schneeweiss A, Häberle L, Couch FJ. Susceptibility gene mutations in germline and tumors of patients with HER2-negative advanced breast cancer. NPJ Breast Cancer 2024; 10:57. [PMID: 39003306 PMCID: PMC11246424 DOI: 10.1038/s41523-024-00667-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
Germline mutations in BRCA1 and BRCA2 (gBRCA1/2) are required for a PARP inhibitor therapy in patients with HER2-negative (HER2-) advanced breast cancer (aBC). However, little is known about the prognostic impact of gBRCA1/2 mutations in aBC patients treated with chemotherapy. This study aimed to investigate the frequencies and prognosis of germline and somatic BRCA1/2 mutations in HER2- aBC patients receiving the first chemotherapy in the advanced setting. Patients receiving their first chemotherapy for HER2- aBC were retrospectively selected from the prospective PRAEGNANT registry (NCT02338167). Genotyping of 26 cancer predisposition genes was performed with germline DNA of 471 patients and somatic tumor DNA of 94 patients. Mutation frequencies, progression-free and overall survival (PFS, OS) according to germline mutation status were assessed. gBRCA1/2 mutations were present in 23 patients (4.9%), and 33 patients (7.0%) had mutations in other cancer risk genes. Patients with a gBRCA1/2 mutation had a better OS compared to non-mutation carriers (HR: 0.38; 95%CI: 0.17-0.86). PFS comparison was not statistically significant. Mutations in other risk genes did not affect prognosis. Two somatic BRCA2 mutations were found in 94 patients without gBRCA1/2 mutations. Most frequently somatic mutated genes were TP53 (44.7%), CDH1 (10.6%) and PTEN (6.4%). In conclusion, aBC patients with gBRCA1/2 mutations had a more favorable prognosis under chemotherapy compared to non-mutation carriers. The mutation frequency of ~5% with gBRCA1/2 mutations together with improved outcome indicates that germline genotyping of all metastatic patients for whom a PARP inhibitor therapy is indicated should be considered.
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Affiliation(s)
- Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Chunling Hu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Steven N Hart
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Eric C Polley
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Rohan D Gnanaolivu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Andreas D Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Hanna Huebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Peyman Hadji
- Frankfurt Center for Bone Health, Frankfurt am Main, Germany
| | - Hans Tesch
- Oncology Practice, Bethanien Hospital, Frankfurt am Main, Germany
| | - Sabrina Uhrig
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Germany; St. Vincenz Kliniken Salzkotten + Paderborn, Paderborn, Germany
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz & Medical University of Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Buckow, Germany
| | | | - Lena A Wurmthaler
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Chloë Goossens
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Anetsberger
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden Germany and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin-Buch, Berlin, Germany
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | | | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Florin-Andrei Taran
- Department of Gynecology and Obstetrics, University Hospital Freiburg, Freiburg, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
- Center for Integrated Oncology Aachen Bonn Köln Düsseldorf, Düsseldorf, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Andreas Schneeweiss
- Division of Gynecologic Oncology, National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Biostatistics Unit, Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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van den Ende NS, Nguyen AH, Jager A, Kok M, Debets R, van Deurzen CHM. Triple-Negative Breast Cancer and Predictive Markers of Response to Neoadjuvant Chemotherapy: A Systematic Review. Int J Mol Sci 2023; 24:ijms24032969. [PMID: 36769287 PMCID: PMC9918290 DOI: 10.3390/ijms24032969] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Around 40-50% of all triple-negative breast cancer (TNBC) patients achieve a pathological complete response (pCR) after treatment with neoadjuvant chemotherapy (NAC). The identification of biomarkers predicting the response to NAC could be helpful for personalized treatment. This systematic review provides an overview of putative biomarkers at baseline that are predictive for a pCR following NAC. Embase, Medline and Web of Science were searched for articles published between January 2010 and August 2022. The articles had to meet the following criteria: patients with primary invasive TNBC without distant metastases and patients must have received NAC. In total, 2045 articles were screened by two reviewers resulting in the inclusion of 92 articles. Overall, the most frequently reported biomarkers associated with a pCR were a high expression of Ki-67, an expression of PD-L1 and the abundance of tumor-infiltrating lymphocytes, particularly CD8+ T cells, and corresponding immune gene signatures. In addition, our review reveals proteomic, genomic and transcriptomic markers that relate to cancer cells, the tumor microenvironment and the peripheral blood, which also affect chemo-sensitivity. We conclude that a prediction model based on a combination of tumor and immune markers is likely to better stratify TNBC patients with respect to NAC response.
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Affiliation(s)
- Nadine S. van den Ende
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, 3015 GD Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-640213383
| | - Anh H. Nguyen
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, 3015 GD Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, 3015 GD Rotterdam, The Netherlands
| | - Marleen Kok
- Department of Medical Oncology, Tumor Biology & Immunology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Reno Debets
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, 3015 GD Rotterdam, The Netherlands
| | - Carolien H. M. van Deurzen
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, 3015 GD Rotterdam, The Netherlands
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Discrimination between Complete versus Non-Complete Pathologic Response to Neoadjuvant Therapy Using Ultrasensitive Mutation Analysis: A Proof-of-Concept Study in BRCA1-Driven Breast Cancer Patients. Int J Mol Sci 2023; 24:ijms24031870. [PMID: 36768191 PMCID: PMC9914941 DOI: 10.3390/ijms24031870] [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] [Received: 12/18/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Neoadjuvant chemotherapy (NACT) for breast cancer (BC) often results in pathologic complete response (pCR), i.e., the complete elimination of visible cancer cells. It is unclear whether the use of ultrasensitive genetic methods may still detect residual BC cells in complete responders. Breast carcinomas arising in BRCA1 mutation carriers almost always carry alterations of the TP53 gene thus providing an opportunity to address this question. The analysis of consecutive BC patients treated by NACT revealed a higher pCR rate in BRCA1-driven vs. BRCA1-wildtype BCs (13/24 (54%) vs. 29/192 (15%), p < 0.0001). Twelve pre-/post-NACT tissue pairs obtained from BRCA1 mutation carriers were available for the study. While TP53 mutation was identified in all chemonaive tumors, droplet digital PCR (ddPCR) analysis of the post-NACT tumor bed revealed the persistence of this alteration in all seven pCR-non-responders but in none of five pCR responders. Eleven patients provided to the study post-NACT tissue samples only; next-generation sequencing (NGS) analysis revealed mutated TP53 copies in all six cases without pCR but in none of five instances of pCR. In total, TP53 mutation was present in post-NACT tissues in all 13 cases without pCR, but in none of 10 patients with pCR (p < 0.000001). Therefore, the lack of visible tumor cells in the post-NACT tumor bed is indeed a reliable indicator of the complete elimination of transformed clones. Failure of ultrasensitive methods to identify patients with minimal residual disease among pCR responders suggests that the result of NACT is a categorical rather than continuous variable, where some patients are destined to be cured while others ultimately fail to experience tumor eradication.
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Mavragani A, Rodrigues PP, Nakazawa-Miklaševiča M, Pinto D, Miklaševičs E, Trofimovičs G, Gardovskis J, Cardoso F, Cardoso MJ. Effectiveness of Secondary Risk-Reducing Strategies in Patients With Unilateral Breast Cancer With Pathogenic Variants of BRCA1 and BRCA2 Subjected to Breast-Conserving Surgery: Evidence-Based Simulation Study. JMIR Form Res 2022; 6:e37144. [PMID: 36580360 PMCID: PMC9837710 DOI: 10.2196/37144] [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] [Received: 02/18/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Approximately 62% of patients with breast cancer with a pathogenic variant (BRCA1 or BRCA2) undergo primary breast-conserving therapy. OBJECTIVE The study aims to develop a personalized risk management decision support tool for carriers of a pathogenic variant (BRCA1 or BRCA2) who underwent breast-conserving therapy for unilateral early-stage breast cancer. METHODS We developed a Bayesian network model of a hypothetical cohort of carriers of BRCA1 or BRCA2 diagnosed with stage I/II unilateral breast cancer and treated with breast-conserving treatment who underwent subsequent second primary cancer risk-reducing strategies. Using event dependencies structured according to expert knowledge and conditional probabilities obtained from published evidence, we predicted the 40-year overall survival rate of different risk-reducing strategies for 144 cohorts of women defined by the type of pathogenic variants (BRCA1 or BRCA2), age at primary breast cancer diagnosis, breast cancer subtype, stage of primary breast cancer, and presence or absence of adjuvant chemotherapy. RESULTS Absence of adjuvant chemotherapy was the most powerful factor that was linked to a dramatic decline in survival. There was a negligible decline in the mortality in patients with triple-negative breast cancer, who received no chemotherapy and underwent any secondary risk-reducing strategy, compared with surveillance. The potential survival benefit from any risk-reducing strategy was more modest in patients with triple-negative breast cancer who received chemotherapy compared with patients with luminal breast cancer. However, most patients with triple-negative breast cancer in stage I benefited from bilateral risk-reducing mastectomy and risk-reducing salpingo-oophorectomy or just risk-reducing salpingo-oophorectomy. Most patients with luminal stage I/II unilateral breast cancer benefited from bilateral risk-reducing mastectomy and risk-reducing salpingo-oophorectomy. The impact of risk-reducing salpingo-oophorectomy in patients with luminal breast cancer in stage I/II increased with age. Most older patients with the BRCA1 and BRCA2 pathogenic variants in exons 12-24/25 with luminal breast cancer may gain a similar survival benefit from other risk-reducing strategies or surveillance. CONCLUSIONS Our study showed that it is mandatory to consider the complex interplay between the types of BRCA1 and BRCA2 pathogenic variants, age at primary breast cancer diagnosis, breast cancer subtype and stage, and received systemic treatment. As no prospective study results are available at the moment, our simulation model, which will integrate a decision support system in the near future, could facilitate the conversation between the health care provider and patient and help to weigh all the options for risk-reducing strategies leading to a more balanced decision.
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Affiliation(s)
| | - Pedro Pereira Rodrigues
- Information and Health Decision Sciences of the Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - David Pinto
- Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal
| | | | | | - Jānis Gardovskis
- Department of Surgery, Faculty of Medicine, Pauls Stradins Clinical University Hospital, Rīga Stradiņš University, Riga, Latvia
| | - Fatima Cardoso
- Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal
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Xu J, Su SM, Zhang X, Chan UI, Adhav R, Shu X, Liu J, Li J, Mo L, Wang Y, An T, Lei JH, Miao K, Deng CX, Xu X. ATP11B inhibits breast cancer metastasis in a mouse model by suppressing externalization of nonapoptotic phosphatidylserine. J Clin Invest 2022; 132:e149473. [PMID: 35025764 PMCID: PMC8884903 DOI: 10.1172/jci149473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
Cancer metastasis is the cause of the majority of cancer-related deaths. In this study, we demonstrated that no expression or low expression of ATP11B in conjunction with high expression of PTDSS2, which was negatively regulated by BRCA1, markedly accelerates tumor metastasis. Further analysis revealed that cells with low ATP11B expression and high PTDSS2 expression (ATP11BloPTDSS2hi cells) were associated with poor prognosis and enhanced metastasis in breast cancer patients in general. Mechanistically, an ATP11BloPTDSS2hi phenotype was associated with increased levels of nonapoptotic phosphatidylserine (PS) on the outer leaflet of the cell membrane. This PS increase serves as a global immunosuppressive signal to promote breast cancer metastasis through an enriched tumor microenvironment with the accumulation of myeloid-derived suppressor cells and reduced activity of cytotoxic T cells. The metastatic processes associated with ATP11BloPTDSS2hi cancer cells can be effectively overcome by changing the expression phenotype to ATP11BhiPTDSS2lo through a combination of anti-PS antibody with either paclitaxel or docetaxel. Thus, blocking the ATP11BloPTDSS2hi axis provides a new selective therapeutic strategy to prevent metastasis in breast cancer patients.
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Affiliation(s)
- Jun Xu
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Sek Man Su
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Xin Zhang
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Un In Chan
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Ragini Adhav
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Xiaodong Shu
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Jianlin Liu
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Jianjie Li
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Lihua Mo
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Yuqing Wang
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Tingting An
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Josh Haipeng Lei
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
| | - Kai Miao
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
- Ministry of Education Frontiers Science Center for Precision Oncology, University of Macau, Macau, China
| | - Chu-Xia Deng
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
- Ministry of Education Frontiers Science Center for Precision Oncology, University of Macau, Macau, China
| | - Xiaoling Xu
- Cancer Centre, Faculty of Health Sciences
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, and
- Ministry of Education Frontiers Science Center for Precision Oncology, University of Macau, Macau, China
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Ejaz S, Abbas Z, Nouroz F. Exceptional behavior of breast cancer-associated type 1 gene in breast invasive carcinoma. J Cancer Res Ther 2022; 18:1743-1753. [DOI: 10.4103/jcrt.jcrt_1310_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Liu H, Lv L, Gao H, Cheng M. Pathologic Complete Response and Its Impact on Breast Cancer Recurrence and Patient's Survival after Neoadjuvant Therapy: A Comprehensive Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:7545091. [PMID: 35003324 PMCID: PMC8741368 DOI: 10.1155/2021/7545091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Earlier research has illustrated prognostic significance of pathologic complete response (pCR) in neoadjuvant therapy (NAT) for breast cancer, whereas correlation between treatment after achieving pCR and survival improvement remains underexplored. We attempted to measure the relation between pCR achieved after NAT and breast cancer recurrence or patient's survival. METHODS We searched PubMed, EMBASE, Web of Science, and The Cochrane Library databases to find relevant articles from their inception to November 2020. According to eligibility criteria, studies were selected and basic data were extracted. The primary endpoint was the correlation between pCR achieved after NAT and event-free survival (EFS) or overall survival (OS). The results were obtained by directly extracting specific information from the literature or estimating individual data by survival curves on DigitizeIt software, presented with HR and 95% CI. All data were processed on Stata 14.0 software. RESULTS Among 4338 articles, there were 25 eligible articles involving 8767 patients. The EFS of patients achieved pCR after NAT improved obviously (HR = 0.27; 95% CI, 0.24-0.31), especially in triple negative (HR = 0.17; 95% CI, 0.12-0.24) and HER2 positive (HR = 0.24; 95% CI, 0.20-0.30) breast cancer patients. As such, pCR after NAT was implicated in significantly increased OS (HR = 0.32; 95% CI, 0.27-0.37). CONCLUSION Achieving pCR after NAT was notably related to the improvement of EFS and OS, especially for patients with triple-negative and HER2-positive breast cancer. pCR can be a surrogate indicator for outcome of breast cancer patients after NAT, as well as a predictor of treatment efficacy after NAT. Besides, well-designed studies are still warranted for confirmation.
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Affiliation(s)
- Hui Liu
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - Liqiong Lv
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - Hui Gao
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - Ming Cheng
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
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Imyanitov EN. Cytotoxic and targeted therapy for BRCA1/2-driven cancers. Hered Cancer Clin Pract 2021; 19:36. [PMID: 34454564 PMCID: PMC8399736 DOI: 10.1186/s13053-021-00193-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/17/2021] [Indexed: 12/24/2022] Open
Abstract
Tumors arising in BRCA1/2 germline mutation carriers usually demonstrate somatic loss of the remaining BRCA1/2 allele and increased sensitivity to platinum compounds, anthracyclines, mitomycin C and poly (ADP-ribose) polymerase inhibitors (PARPi). Exposure to conventional platinum-based therapy or PARPi results in the restoration of BRCA1/2 function and development of resistance to systemic therapy, therefore, there is a need for other treatment options. Some studies suggested that the use of specific drug combinations or administration of high-dose chemotherapy may result in pronounced tumor responses. BRCA1/2-driven tumors are characterized by increased immunogenicity; promising efficacy of immune therapy has been demonstrated in a number of preclinical and clinical investigations. There are outstanding issues, which require further consideration. Platinum compounds and PARPi have very similar mode of antitumor action and are likely to render cross-resistance to each other, so their optimal position in cancer treatment schemes may be a subject of additional studies. Sporadic tumors with somatically acquired inactivation of BRCA1/2 or related genes resemble hereditary neoplasms with regard to the spectrum of drug sensitivity; the development of user-friendly BRCAness tests presents a challenge. Many therapeutic decisions are now based on the BRCA1/2 status, so the significant reduction of the turn-around time for predictive laboratory assays is of particular importance.
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Affiliation(s)
- Evgeny N Imyanitov
- N.N. Petrov Institute of Oncology, Pesochny, Saint-Petersburg, 197758, Russia. .,St.-Petersburg Pediatric Medical University, Saint Petersburg, 194100, Russia. .,I.I. Mechnikov North-Western Medical University, St.-Petersburg, 191015, Russia.
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9
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Fehm TN, Stickeler E, Fasching PA, Janni W, Kolberg-Liedtke C, Kolberg HC, Lüftner D, Müller V, Schütz F, Thomssen C, Belleville E, Behrens A, Bader S, Untch M, Welslau M, Würstlein R, Thill M, Krug D, Hartkopf AD. Update Breast Cancer 2021 Part 3 - Current Developments in the Treatment of Early Breast Cancer: Review and Assessment of Specialised Treatment Scenarios by an International Expert Panel. Geburtshilfe Frauenheilkd 2021; 81:654-665. [PMID: 34168379 PMCID: PMC8216783 DOI: 10.1055/a-1487-7642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 12/13/2022] Open
Abstract
The continuous availability of findings from new studies repeatedly results in updated treatment recommendations and guidelines. In the case of breast carcinoma in particular, several studies have been published in the last few years that have transformed how early and advanced breast carcinoma is being treated. However, this by no means means implies that there is agreement among all experts on specific issues. It is precisely the diversity of interpretation of guidelines and study findings that reflects the constantly changing available data and its complexity, as well as the availability of new drugs. In recent years, new substances such as pertuzumab, T-DM1, neratinib and capecitabine have become available to treat patients with early stages of breast carcinoma. Furthermore, the first results on the use of CDK4/6 inhibitors for adjuvant treatment have now been published. Last but not least, the use of multigene tests to avoid the necessity of chemotherapy in certain
patients is still under discussion. This review summarises the state of the data and publishes the results of the survey completed by experts at the 2021 St. Gallen Breast Cancer Conference on early-stage breast cancer.
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Affiliation(s)
- Tanja N Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, RWTH University Hospital Aachen, Aachen, Germany
| | - Peter A Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Cornelia Kolberg-Liedtke
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany.,palleos healthcare, Wiesbaden, Germany.,Phaon Scientific, Wiesbaden, Germany
| | | | - Diana Lüftner
- Charité University Hospital, Department of Hematology, Oncology and Tumour Immunology, University Medicine Berlin, Berlin, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Florian Schütz
- Gynäkologie und Geburtshilfe, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Annika Behrens
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Simon Bader
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Untch
- Clinic for Gynecology and Obstetrics, Breast Cancer Center, Genecologic Oncology Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | | | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich LMU, LMU University Hospital, Munich, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Department of Gynecology and Gynecological Oncology, Frankfurt, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Andreas D Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
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10
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Huang M, O'Shaughnessy J, Zhao J, Haiderali A, Cortés J, Ramsey SD, Briggs A, Hu P, Karantza V, Aktan G, Qi CZ, Gu C, Xie J, Yuan M, Cook J, Untch M, Schmid P, Fasching PA. Association of Pathologic Complete Response with Long-Term Survival Outcomes in Triple-Negative Breast Cancer: A Meta-Analysis. Cancer Res 2020; 80:5427-5434. [DOI: 10.1158/0008-5472.can-20-1792] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/13/2020] [Accepted: 09/09/2020] [Indexed: 11/16/2022]
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11
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Wunderle M, Häberle L, Hein A, Jud SM, Lux MP, Hack CC, Emons J, Heindl F, Nabieva N, Loehberg CR, Schulz-Wendtland R, Hartmann A, Beckmann MW, Fasching PA, Gass P. Influence of Family History of Breast or Ovarian Cancer on Pathological Complete Response and Long-Term Prognosis in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy. Breast Care (Basel) 2020; 16:254-262. [PMID: 34248466 DOI: 10.1159/000507475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/24/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose In breast cancer, a pathological complete response (pCR) has been described as generally resulting in a favorable prognosis. However, there are subgroups, such as patients with a mutation in BRCA1 or BRCA2, in which the effect of pCR on the prognosis is suspected to be weaker. Patients with a family history of breast and/or ovarian cancer may therefore react differently in relation to pCR and prognosis, and this is investigated in this study. Patients and Methods Breast cancer patients were identified from a clinical breast cancer registry. The study subjects had been treated with neoadjuvant chemotherapy from 2001 to 2018 and their pathological and clinical information as well as medical family history were available. They were considered to have a positive family history if they had at least 1 first-degree relative with breast and/or ovarian cancer. Multivariate logistic regression analyses were performed to study the association between family history, pCR (ypT0; ypN0), and disease-free survival (DFS). Results Of 1,480 patients, 228 (15.4%) had a positive family history. The pCR rates were 24.9% in all patients, and 24.4% and 27.6% in those without/with a family history, respectively. Family history was not associated with a higher pCR rate (adjusted odds ratio [OR] 1.23; 95% confidence interval [CI] 0.85-1.76; p = 0.27) or a different disease-free survival (DFS; adjusted hazard ratio [HR] 1.15; 95% CI 0.88-1.52; p = 0.30). pCR did not affect the prognosis differently in relation to family history. Conclusions In this retrospective analysis, family history was not associated with pCR and DFS. pCR improved survival, independently of family history.
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Affiliation(s)
- Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Women's Hospital St. Louise Paderborn, Women's Hospital St. Josefs-Krankenhaus Salzkotten, Frauen- und Kinderklinik St. Louise, Paderborn, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Naiba Nabieva
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Christian R Loehberg
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Institute of Diagnostic Radiology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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12
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De Talhouet S, Peron J, Vuilleumier A, Friedlaender A, Viassolo V, Ayme A, Bodmer A, Treilleux I, Lang N, Tille JC, Chappuis PO, Buisson A, Giraud S, Lasset C, Bonadona V, Trédan O, Labidi-Galy SI. Clinical outcome of breast cancer in carriers of BRCA1 and BRCA2 mutations according to molecular subtypes. Sci Rep 2020; 10:7073. [PMID: 32341426 PMCID: PMC7184602 DOI: 10.1038/s41598-020-63759-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/01/2020] [Indexed: 12/13/2022] Open
Abstract
BRCA1/BRCA2 genes play a central role in DNA repair and their mutations increase sensitivity to DNA-damaging agents. There are conflicting data regarding the prognostic value of BRCA germline mutations in breast cancer (BC) patients. We collected clinical, pathological and genetic data of a cohort 925 BC patients preselected for genetic screening and treated with neoadjuvant or adjuvant chemotherapy, of whom 266 were BRCA carriers. Overall, 171 women carried a BRCA1 mutation, 95 carried a BRCA2 mutation, and 659 were non-carriers. In the entire cohort, there was a prolonged disease-free survival (DFS) for BRCA carriers (hazard ratio (HR) = 0.63; 95% confidence interval (CI), 0.44–0.90 for BRCA1; HR = 0.72; 95%CI, 0.47–1.1 for BRCA2; p = 0.020) and a trend toward prolonged disease-specific survival (DSS; HR = 0.65; 95%CI, 0.40–1.1 for BRCA1; HR = 0.78; 95%CI, 0.44–1.38 for BRCA2; p = 0.19) though not statistically significant. In the TNBC group, BRCA carriers had prolonged DFS (adjusted HR = 0.50; 95%CI, 0.28–0.89 for BRCA1; adjusted HR = 0.37; 95%CI, 0.11–1.25, for BRCA2; p = 0.034) and DSS (adjusted HR = 0.42; 95%CI, 0.21–0.82 for BRCA1; adjusted HR = 0.45; 95%CI, 0.11–1.9 for BRCA2; p = 0.023). In the non-TNBC group, the BRCA1 or BRCA2 mutations did not have any impact on survival. These results suggest that BRCA1/BRCA2 germline mutations are associated with prolonged survival only if women were diagnosed with TNBC.
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Affiliation(s)
| | - Julien Peron
- Department of Oncology, Hospices Civils de Lyon, Université Lyon 1, Lyon, France.,Department of Biostatistics, Hospices Civils de Lyon, CNRS, UMR 5558, Lyon, France.,Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | - Aurelie Vuilleumier
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alex Friedlaender
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Valeria Viassolo
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Aurélie Ayme
- Department of Genetic Medicine, Laboratory and Pathology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alexandre Bodmer
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Noemie Lang
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jean- Christophe Tille
- Department of Diagnostics, Division of pathology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pierre O Chappuis
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland.,Department of Genetic Medicine, Laboratory and Pathology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrien Buisson
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - Sophie Giraud
- Department of Genetics, Hospices Civils de Lyon, Lyon, France
| | - Christine Lasset
- Unit of Prevention and Genetic Epidemiology, UMR CNRS 5558, Centre Léon Bérard, Lyon, France
| | - Valerie Bonadona
- Unit of Prevention and Genetic Epidemiology, UMR CNRS 5558, Centre Léon Bérard, Lyon, France
| | - Olivier Trédan
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - S Intidhar Labidi-Galy
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland. .,Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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13
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Wang Y, Stear JH, Swain A, Xu X, Bryce NS, Carnell M, Alieva IB, Dugina VB, Cripe TP, Stehn J, Hardeman EC, Gunning PW. Drug Targeting the Actin Cytoskeleton Potentiates the Cytotoxicity of Low Dose Vincristine by Abrogating Actin-Mediated Repair of Spindle Defects. Mol Cancer Res 2020; 18:1074-1087. [PMID: 32269073 DOI: 10.1158/1541-7786.mcr-19-1122] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/09/2020] [Accepted: 04/03/2020] [Indexed: 11/16/2022]
Abstract
Antimicrotubule vinca alkaloids are widely used in the clinic but their toxicity is often dose limiting. Strategies that enhance their effectiveness at lower doses are needed. We show that combining vinca alkaloids with compounds that target a specific population of actin filaments containing the cancer-associated tropomyosin Tpm3.1 result in synergy against a broad range of tumor cell types. We discovered that low concentrations of vincristine alone induce supernumerary microtubule asters that form transient multi-polar spindles in early mitosis. Over time these asters can be reconstructed into functional bipolar spindles resulting in cell division and survival. These microtubule asters are organized by the nuclear mitotic apparatus protein (NuMA)-dynein-dynactin complex without involvement of centrosomes. However, anti-Tpm3.1 compounds at nontoxic concentrations inhibit this rescue mechanism resulting in delayed onset of anaphase, formation of multi-polar spindles, and apoptosis during mitosis. These findings indicate that drug targeting actin filaments containing Tpm3.1 potentiates the anticancer activity of low-dose vincristine treatment. IMPLICATIONS: Simultaneously inhibiting Tpm3.1-containing actin filaments and microtubules is a promising strategy to potentiate the anticancer activity of low-dose vincristine.
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Affiliation(s)
- Yao Wang
- Cellular and Genetic Medicine Unit, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Jeffrey H Stear
- Cellular and Genetic Medicine Unit, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Ashleigh Swain
- Cellular and Genetic Medicine Unit, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Xing Xu
- Cellular and Genetic Medicine Unit, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole S Bryce
- Cellular and Genetic Medicine Unit, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Carnell
- Biomedical Imaging Facility, Mark Wainwright Analytical Center, University of New South Wales, Sydney, New South Wales, Australia
| | - Irina B Alieva
- Department of Electron Microscopy, A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Vera B Dugina
- Department of Mathematical Methods in Biology, A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | | | - Justine Stehn
- Cellular and Genetic Medicine Unit, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Edna C Hardeman
- Cellular and Genetic Medicine Unit, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter W Gunning
- Cellular and Genetic Medicine Unit, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
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14
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Association of BRCA Mutations and BRCAness Status With Anticancer Drug Sensitivities in Triple-Negative Breast Cancer Cell Lines. J Surg Res 2020; 250:200-208. [PMID: 32092597 DOI: 10.1016/j.jss.2019.12.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/02/2019] [Accepted: 12/26/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many triple-negative breast cancers (TNBCs) show impaired breast cancer susceptibility gene I (BRCA1) function, called BRCAness. BRCAness tumors may show similar sensitivities to anticancer drugs as tumors with BRCA1 mutations. In this study, we investigated the association of BRCA mutations or BRCAness with drug sensitivities in TNBC. METHODS BRCAness was evaluated as BRCA1-like scores, using multiplex ligation-dependent probe amplification in 12 TNBC cell lines, including four with mutations. Sensitivities to docetaxel, cisplatin, and epirubicin were compared with BRCA mutations and BRCA1-like scores. Cisplatin sensitivity was examined in BRCA1 knockdown Michigan Cancer Foundation-7 cell lines. RESULTS Eight and four cell lines had characteristics of BRCAness and non-BRCAness, respectively. The 50% inhibitory concentration of docetaxel was higher in BRCA mutant and BRCAness cell lines than their counterparts. BRCA1-like scores showed a weak positive correlation with docetaxel sensitivity (r = 0.377; P = 0.039). Regarding cisplatin, scores were lower in BRCA mutants and BRCAness tumors than their counterparts. A negative correlation was found between BRCA1-like scores and cisplatin sensitivity (r = -0.407; P = 0.013). No differences were found for epirubicin. BRCA1 gene knockdown increased the cisplatin sensitivity of Michigan Cancer Foundation-7 cells. CONCLUSIONS BRCA1-like scores were associated with cisplatin sensitivity and docetaxel resistance. BRCA1-like score is hence a promising indicator for estimating drug sensitivities in TNBC.
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15
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Paluch-Shimon S, Evron E. Targeting DNA repair in breast cancer. Breast 2019; 47:33-42. [DOI: 10.1016/j.breast.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 12/16/2022] Open
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16
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Armstrong N, Ryder S, Forbes C, Ross J, Quek RGW. A systematic review of the international prevalence of BRCA mutation in breast cancer. Clin Epidemiol 2019; 11:543-561. [PMID: 31372057 PMCID: PMC6628947 DOI: 10.2147/clep.s206949] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
A systematic review was conducted, summarizing international BRCA 1 or 2 (BRCA1/2) mutation prevalence in breast cancer. Databases (eg, Medline and Embase; N=7) and conferences were searched (January 2012 to December 2017). From 17,872 records, 70 studies were included. In 58 large (N>100) studies, BRCA1/2 mutation prevalence varied widely from 1.8% (Spain) in sporadic breast cancer to 36.9% (United States) in estrogen receptor/progesterone receptor low+ (1-9% on immunohistochemistry/human epidermal growth factor receptor 2-negative [HER2-]) breast cancer. In 2 large studies unselected for family history, ethnicity, sex, or age and no/unclear selection by breast cancer stage or hormone receptor (HR) status, germline BRCA (gBRCA) mutation prevalence was 2.9% (Italy) to 3.0% (South Korea). In the 4 large unselected triple-negative breast cancer studies, gBRCA mutation prevalence varied from 9.3% (Australia) to 15.4% (United States). gBRCA mutation prevalence in 1 large unselected HR positive/HER2- early breast cancer study was 5% (United States). In 2 large unselected metastatic breast cancer studies, gBRCA mutation prevalence was 2.7% (France) and 4.3% (Germany). Locally advanced breast cancer studies were small and not in unselected populations. Poor reporting of gBRCA status and basis of selection implies a need for further large well-reported BRCA mutation prevalence studies in breast cancer.
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Affiliation(s)
- Nigel Armstrong
- Health Economics, Kleijnen Systematic Reviews Ltd., YorkYO19 6FD, UK
| | - Steve Ryder
- Health Economics, Kleijnen Systematic Reviews Ltd., YorkYO19 6FD, UK
| | - Carol Forbes
- Systematic Reviews, Kleijnen Systematic Reviews Ltd., YorkYO19 6FD, UK
| | - Janine Ross
- Information, Kleijnen Systematic Reviews Ltd
., YorkYO19 6FD, UK
| | - Ruben GW Quek
- Health Economics & Outcomes Research, Pfizer Inc., San Francisco, CA94105, USA
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17
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Schneeweiss A, Denkert C, Fasching PA, Fremd C, Gluz O, Kolberg-Liedtke C, Loibl S, Lück HJ. Diagnosis and Therapy of Triple-Negative Breast Cancer (TNBC) - Recommendations for Daily Routine Practice. Geburtshilfe Frauenheilkd 2019; 79:605-617. [PMID: 31217629 PMCID: PMC6570613 DOI: 10.1055/a-0887-0285] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 02/08/2023] Open
Abstract
The rapid increase in knowledge in tumour biology and tumour pathogenesis of triple-negative breast cancer (TNBC) has resulted in new therapeutic approaches and new therapeutic concepts for treatment. For years, TNBC has been considered to be a difficult-to-treat tumour due to its generally aggressive tumour biology and in view of limited therapeutic options. The risk of recurrence and metastasis is higher than in the case of other breast cancer subtypes of the same stage. In addition to surgery and radiation in the curative situation, systemic chemotherapy with anthracyclines and/or taxanes is still the therapy of choice. New therapeutic approaches are based on the knowledge that TNBC is a molecularly very heterogeneous disease. Research groups are working to classify TNBC better and better on a molecular level and use this molecular subtyping as the basis for new therapeutic strategies. The most promising new approaches and considerations regarding the therapy of TNBCs are shown below. In addition, the current therapeutic strategies are discussed using a fictitious case history, taking the current data and the resultant therapeutic consequence into account.
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Affiliation(s)
- Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum, Heidelberg, Germany.,Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Carsten Denkert
- Institut für Pathologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Peter A Fasching
- Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carlo Fremd
- Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum, Heidelberg, Germany
| | - Oleg Gluz
- Brustzentrum Niederrhein, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany.,Westdeutsche Studiengruppe, Mönchengladbach, Germany
| | | | - Sibylle Loibl
- German Breast Group c/o GBG Forschungs GmbH, Neu-Isenburg, Germany.,Zentrum für Hämatologie und Onkologie Bethanien, Goethe Universität Frankfurt, Frankfurt am Main, Germany
| | - Hans-Joachim Lück
- Gynäkologie Onkologie, Gynäkologisch-onkologische Praxis, Hannover, Germany
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18
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Platinum salts in the treatment of BRCA-associated breast cancer: A true targeted chemotherapy? Crit Rev Oncol Hematol 2019; 135:66-75. [DOI: 10.1016/j.critrevonc.2019.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 02/06/2023] Open
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19
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Nicolas E, Bertucci F, Sabatier R, Gonçalves A. Targeting BRCA Deficiency in Breast Cancer: What are the Clinical Evidences and the Next Perspectives? Cancers (Basel) 2018; 10:cancers10120506. [PMID: 30544963 PMCID: PMC6316565 DOI: 10.3390/cancers10120506] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 11/27/2018] [Accepted: 12/09/2018] [Indexed: 12/24/2022] Open
Abstract
Breast cancers (BC) associated with germline mutations of BRCA1/2 represent 3–5% of cases. BRCA1/2-associated BC have biological features leading to genomic instability and potential sensitivity to DNA damaging agents, including poly(ADP-ribose) polymerase (PARP) and platinum agents. In this review, we will summarize clinical trials of chemotherapy and PARP inhibitors (PARPi), alone or in combination, at the early or late stage of BRCA1/2-associated BC. We will also present the mechanisms of resistance to PARPi as well as the new therapeutic strategies of association with PARPi. Finally, we will discuss under which conditions the use of DNA damaging agents can be extended to the BRCA1/2-wild type population, the BRCAness concept.
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Affiliation(s)
- Emanuel Nicolas
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France.
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France.
- CRCM-Predictive Oncology laboratory, Institut Paoli-Calmettes, Inserm U1068, CNRS UMR7258, Aix-Marseille Univ, 13009 Marseille, France.
| | - Renaud Sabatier
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France.
- CRCM-Predictive Oncology laboratory, Institut Paoli-Calmettes, Inserm U1068, CNRS UMR7258, Aix-Marseille Univ, 13009 Marseille, France.
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France.
- CRCM-Predictive Oncology laboratory, Institut Paoli-Calmettes, Inserm U1068, CNRS UMR7258, Aix-Marseille Univ, 13009 Marseille, France.
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20
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Evans A, Whelehan P, Thompson A, Purdie C, Jordan L, Macaskill J, Henderson S, Vinnicombe S. Identification of pathological complete response after neoadjuvant chemotherapy for breast cancer: comparison of greyscale ultrasound, shear wave elastography, and MRI. Clin Radiol 2018; 73:910.e1-910.e6. [PMID: 29980324 DOI: 10.1016/j.crad.2018.05.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/12/2018] [Accepted: 05/29/2018] [Indexed: 12/16/2022]
Abstract
AIM To assess the value of post-treatment shear-wave elastography (SWE) parameters (maximum stiffness [Emax], mean stiffness [Emean], and standard deviation [SD]) compared to greyscale ultrasonography (US) and magnetic resonance imaging (MRI) in identifying pathological complete response (pCR) to neoadjuvant chemotherapy (NACT) in breast cancer. MATERIALS AND METHODS In a prospective cohort study, 80 patients receiving NACT for breast cancer underwent baseline and post-treatment US, SWE, and MRI examinations. Four SWE images in two orthogonal planes were obtained. Maximum greyscale US diameter and maximum diameter of lesion enhancement on MRI were measured. Percentage reductions between baseline and post-treatment scans were calculated for MRI and greyscale US diameter, and Emean, Emax, and SD. The percentage reduction in Emean and US diameter were also analysed as a combination. Analysis was undertaken using receiver operating characteristic (ROC) curves and the chi-squared test. RESULTS pCR occurred in 21 of 80 (26%) women. The area under the ROC curve (AUC) for pCR of percentage reductions in Emean, Emax, SD, and greyscale US diameter were 0.89, 0.85, 0.75, and 0.86, respectively. The combination of percentage reductions in Emean and greyscale ultrasound diameter yielded an AUC of 0.92, which is similar to the AUC for MRI of 0.96 (p=0.28). CONCLUSIONS SWE combined with greyscale US shows promise for end-of-treatment identification of response to NACT in women with breast cancer, with accuracies similar to breast MRI. This technique could be used to inform surgical decision-making after NACT.
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Affiliation(s)
- A Evans
- Ninewells Hospital and Medical School, Mailbox 4, Dundee DD1 9SY, UK.
| | - P Whelehan
- Ninewells Hospital and Medical School, Mailbox 4, Dundee DD1 9SY, UK
| | - A Thompson
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - C Purdie
- Pathology Department, Ninewells Hospital, Dundee DD1 9SY, UK
| | - L Jordan
- Pathology Department, Ninewells Hospital, Dundee DD1 9SY, UK
| | - J Macaskill
- Breast Surgery Department, Ninewells Hospital, Dundee DD1 9SY, UK
| | - S Henderson
- Medical Physics Department, Ninewells Hospital, Dundee DD1 9SY, UK
| | - S Vinnicombe
- Ninewells Hospital and Medical School, Mailbox 4, Dundee DD1 9SY, UK
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Sella T, Gal Yam EN, Levanon K, Rotenberg TS, Gadot M, Kuchuk I, Molho RB, Itai A, Modiano TM, Gold R, Kaufman B, Shimon SP. Evaluation of tolerability and efficacy of incorporating carboplatin in neoadjuvant anthracycline and taxane based therapy in a BRCA1 enriched triple-negative breast cancer cohort. Breast 2018; 40:141-146. [DOI: 10.1016/j.breast.2018.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/25/2018] [Accepted: 05/14/2018] [Indexed: 11/24/2022] Open
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Gass P, Untch M, Müller V, Möbus V, Thomssen C, Häberle L, Erber R, Hein A, Jud SM, Lux MP, Hack CC, Hartmann A, Kolberg HC, Ettl J, Lüftner D, Jackisch C, Beckmann MW, Janni W, Schneeweiss A, Fasching PA, Nabieva N. Using Probability for Pathological Complete Response (pCR) as a Decision Support Marker for Neoadjuvant Chemotherapy in HER2 Negative Breast Cancer Patients - a Survey Among Physicians. Geburtshilfe Frauenheilkd 2018; 78:707-714. [PMID: 30057427 PMCID: PMC6059863 DOI: 10.1055/a-0642-9462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In women with early breast cancer, a pathological complete response (pCR) after neoadjuvant chemotherapy is reported to be associated with an improvement of the survival. The aim of this survey among physicians was to investigate whether the probability of achieving pCR in patients with a hormone receptor-positive, HER2-negative disease encourages physicians to recommend neoadjuvant chemotherapy. METHODS The study was conducted via an online survey that was sent to 493 physicians, who were either known as members of national guideline committees, heads of breast cancer centers, being high recruiters in clinical trials or leading a private practice. Participants were asked about a specific case that should resemble patients for whom it is unclear, whether they should be treated with chemotherapy. RESULTS 113 (24.5%) physicians participated at the survey, out of which 96.5% had a work experience of more than 10 years and 94.7% were board certified in their specialty. A total of 84.1% would consider pCR for a decision concerning neoadjuvant chemotherapy. With regard to the pCR probability, 2.7 and 10.6% of the participants demanded at least a pCR rate of 5 and 10%, respectively, while 25.7% were satisfied with 20% probability, and another 25.7% with a pCR rate of 30%. CONCLUSIONS The vast majority of the long-term experienced physicians would embrace the implementation of a further method such as the prediction of pCR probability in clinical routine to support decision making regarding the necessity of neoadjuvant chemotherapy. The cut-off of around 30% pCR probability seems to be a realizable rate to distinguish patient groups.
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Affiliation(s)
- Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Untch
- Department of Obstetrics and Gynecology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Volker Möbus
- Department of Gynecology and Obstetrics, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Christoph Thomssen
- Department of Gynecology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
- Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ramona Erber
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Michael Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael P. Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carolin C. Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Diana Lüftner
- Charité University Hospital, Berlin, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumour Immunology, Berlin, Germany
| | | | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Naiba Nabieva
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Fasching PA, Loibl S, Hu C, Hart SN, Shimelis H, Moore R, Schem C, Tesch H, Untch M, Hilfrich J, Rezai M, Gerber B, Costa SD, Blohmer JU, Fehm T, Huober J, Liedtke C, Weinshilboum RM, Wang L, Ingle JN, Müller V, Nekljudova V, Weber KE, Rack B, Rübner M, von Minckwitz G, Couch FJ. BRCA1/2 Mutations and Bevacizumab in the Neoadjuvant Treatment of Breast Cancer: Response and Prognosis Results in Patients With Triple-Negative Breast Cancer From the GeparQuinto Study. J Clin Oncol 2018; 36:2281-2287. [PMID: 29791287 DOI: 10.1200/jco.2017.77.2285] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose BRCA1/2 mutations are frequent in patients with triple-negative breast cancer (TNBC). These patients are often treated with primary systemic chemotherapy. The aim of this study was to analyze the effects of BRCA1/2 mutations on pathologic complete response (pCR) and disease-free survival (DFS) in a cohort of patients with TNBC treated with anthracycline and taxane-containing chemotherapy, with or without bevacizumab. Patients and Methods Germline DNA was sequenced to identify mutations in BRCA1 and BRCA2 in 493 patients with TNBC from the GeparQuinto study. The pCR rates were compared in patients with and without mutation, as well as in patients treated with and without bevacizumab. In addition, the influence of BRCA1/2 mutation status and pCR status on DFS was evaluated relative to treatment. Results BRCA1/2 mutations were detected in 18.3% of patients with TNBC. Overall, patients with mutations had a pCR rate of 50%, compared with 31.5% in patients without a mutation (odds ratio [OR], 2.17; 95% CI, 1.37 to 3.46; P = .001). The pCR rate among patients treated with bevacizumab was 61.5% for BRCA1/2 mutation carriers and 35.6% for those without mutations (OR, 2.90; 95% CI, 1.43 to 5.89; P = .004). pCR was a strong predictor of DFS for patients without BRCA1/2 mutations (hazard ratio, 0.18; 95% CI, 0.11 to 0.31) but not for patients with BRCA1/2 mutations (hazard ratio, 0.74; 95% CI, 0.32 to 1.69). Conclusion The addition of bevacizumab may increase the pCR after standard neoadjuvant chemotherapy for patients with TNBC with BRCA1/2 mutations. In patients treated with anthracycline and taxane-based chemotherapy (with or without bevacizumab), pCR was a weaker predictor of DFS for BRCA1/2 mutation carriers than for patients without mutations.
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Affiliation(s)
- Peter A Fasching
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Sibylle Loibl
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Chunling Hu
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Steven N Hart
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Hermela Shimelis
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Raymond Moore
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Christian Schem
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Hans Tesch
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Michael Untch
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Jörn Hilfrich
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Mahdi Rezai
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Bernd Gerber
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Serban Dan Costa
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Jens-Uwe Blohmer
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Tanja Fehm
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Jens Huober
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Cornelia Liedtke
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Richard M Weinshilboum
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Liewei Wang
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - James N Ingle
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Volkmar Müller
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Valentina Nekljudova
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Karsten E Weber
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Brigitte Rack
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Matthias Rübner
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Gunter von Minckwitz
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
| | - Fergus J Couch
- Peter A. Fasching and Matthias Rübner, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen; Sibylle Loibl, Valentina Nekljudova, Karsten E. Weber, and Gunter von Minckwitz, German Breast Group Forschungs, Neu-Isenburg; Christian Schem, University Medical Center Schleswig-Holstein, Kiel; Hans Tesch, Centrum für Hämatologie und Onkologie Bethanien, Frankfurt; Michael Untch, Helios-Klinikum, Berlin-Buch; Jörn Hilfrich, Eilenriede-Klinik, Hannover; Mahdi Rezai, Luisenkrankenhaus; Tanja Fehm, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, Düsseldorf; Bernd Gerber, University of Rostock, Rostock; Serban Dan Costa, Magdeburg University Hospital, Magdeburg; Jens-Uwe Blohmer and Cornelia Liedtke, Charité University Hospital Campus Charité-Mitte, Berlin; Jens Huober, University of Ulm; Brigitte Rack, University Hospital Ulm, Ulm; Volkmar Müller, Hamburg University Hospital, Hamburg, Germany; Chunling Hu, Steven N. Hart, Hermela Shimelis, Raymond Moore, James N. Ingle, and Fergus J. Couch, Mayo Clinic; and Richard M. Weinshilboum and Liewei Wang, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN
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Wunderle M, Gass P, Häberle L, Flesch VM, Rauh C, Bani MR, Hack CC, Schrauder MG, Jud SM, Emons J, Erber R, Ekici AB, Hoyer J, Vasileiou G, Kraus C, Reis A, Hartmann A, Lux MP, Beckmann MW, Fasching PA, Hein A. BRCA mutations and their influence on pathological complete response and prognosis in a clinical cohort of neoadjuvantly treated breast cancer patients. Breast Cancer Res Treat 2018; 171:85-94. [PMID: 29725888 DOI: 10.1007/s10549-018-4797-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE BRCA1/2 mutations influence the molecular characteristics and the effects of systemic treatment of breast cancer. This study investigates the impact of germline BRCA1/2 mutations on pathological complete response and prognosis in patients receiving neoadjuvant systemic chemotherapy. METHODS Breast cancer patients were tested for a BRCA1/2 mutation in clinical routine work and were treated with anthracycline-based or platinum-based neoadjuvant chemotherapy between 1997 and 2015. These patients were identified in the tumor registry of the Breast Center of the University of Erlangen (Germany). Logistic regression and Cox regression analyses were performed to investigate the associations between BRCA1/2 mutation status, pathological complete response, disease-free survival, and overall survival. RESULTS Among 355 patients, 59 had a mutation in BRCA1 or in BRCA2 (16.6%), 43 in BRCA1 (12.1%), and 16 in BRCA2 (4.5%). Pathological complete response defined as "ypT0; ypN0" was observed in 54.3% of BRCA1/2 mutation carriers, but only in 22.6% of non-carriers. The adjusted odds ratio was 2.48 (95% CI 1.26-4.91) for BRCA1/2 carriers versus non-carriers. Patients who achieved a pathological complete response had better disease-free survival and overall survival rates compared with those who did not achieve a pathological complete response, regardless of BRCA1/2 mutation status. CONCLUSIONS BRCA1/2 mutation status leads to better responses to neoadjuvant chemotherapy in breast cancer. Pathological complete response is the main predictor of disease-free survival and overall survival, independently of BRCA1/2 mutation status.
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Affiliation(s)
- Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Vivien M Flesch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Mayada R Bani
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael G Schrauder
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ramona Erber
- Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Juliane Hoyer
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Georgia Vasileiou
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Cornelia Kraus
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Andre Reis
- Institute of Human Genetics, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany. .,Department of Medicine, Division of Hematology and Oncology, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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25
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Telli ML, Hellyer J, Audeh W, Jensen KC, Bose S, Timms KM, Gutin A, Abkevich V, Peterson RN, Neff C, Hughes E, Sangale Z, Jones J, Hartman AR, Chang PJ, Vinayak S, Wenstrup R, Ford JM. Homologous recombination deficiency (HRD) status predicts response to standard neoadjuvant chemotherapy in patients with triple-negative or BRCA1/2 mutation-associated breast cancer. Breast Cancer Res Treat 2017; 168:625-630. [DOI: 10.1007/s10549-017-4624-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
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Lux MP, Janni W, Hartkopf AD, Nabieva N, Taran FA, Overkamp F, Kolberg HC, Hadji P, Tesch H, Ettl J, Huober JB, Lüftner D, Wallwiener M, Müller V, Beckmann MW, Belleville E, Fehm TN, Wallwiener D, Brucker SY, Schneeweiss A, Fasching PA. Update Breast Cancer 2017 - Implementation of Novel Therapies. Geburtshilfe Frauenheilkd 2017; 77:1281-1290. [PMID: 29269955 PMCID: PMC5734938 DOI: 10.1055/s-0043-122885] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 12/19/2022] Open
Abstract
In recent years, numerous new therapy options for patients with breast cancer have been developed in clinical studies, with some options already approved for routine treatment. As the speed at which innovations are introduced increases, the importance of conferences also increases, as conferences are where the data underpinning new therapies are usually presented for the first time. This review looks at publications of the ASCO (American Society of Clinical Oncology) and ESMO (European Society of Medical Oncology) conferences in 2017, summarizes them and evaluates them in the context of existing data. The focus is on new insights for neoadjuvant therapy and new treatment options in the metastatic setting, such as the use of CDK4/6 inhibitors or PARP inhibitors. The first results of treatments with checkpoint inhibitors are presented. With the patent expiry of trastuzumab, a number of study results for trastuzumab biosimilars have also been published. The digitization of patient care provides the first results on quality of life and prognosis of patients with advanced cancer. Digital communications between patients and physicians are being evaluated in several studies in Germany. As the discussion about patient-relevant endpoints for patients in the metastatic setting continues, overall survival rates from studies of big endocrine-based therapies are urgently needed. Preliminary analyses of small study cohorts offer initial insights. In the context of improving patient care, in the coming years, questions will center on which patients particularly benefit from certain therapies and which patients need particular protection from specific side effects. Questions about these predictors are raised in many scientific projects as attention increasingly focuses on this topic.
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Affiliation(s)
- Michael P. Lux
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Andreas D. Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Naiba Nabieva
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | | | - Peyman Hadji
- Department of Bone Oncology, Nordwest Hospital, Frankfurt, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jens B. Huober
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Diana Lüftner
- Charité University Hospital, Berlin, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumour Immunology, Berlin, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Matthias W. Beckmann
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Sara Y. Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Andreas Schneeweiss
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases, Division Gynecologic Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter A. Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Brianese RC, Nakamura KDDM, Almeida FGDSR, Ramalho RF, Barros BDDF, Ferreira ENE, Formiga MNDC, de Andrade VP, de Lima VCC, Carraro DM. BRCA1 deficiency is a recurrent event in early-onset triple-negative breast cancer: a comprehensive analysis of germline mutations and somatic promoter methylation. Breast Cancer Res Treat 2017; 167:803-814. [DOI: 10.1007/s10549-017-4552-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 10/24/2017] [Indexed: 01/01/2023]
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28
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Bignon L, Fricker JP, Nogues C, Mouret-Fourme E, Stoppa-Lyonnet D, Caron O, Lortholary A, Faivre L, Lasset C, Mari V, Gesta P, Gladieff L, Hamimi A, Petit T, Velten M. Efficacy of anthracycline/taxane-based neo-adjuvant chemotherapy on triple-negative breast cancer in BRCA1/BRCA2 mutation carriers. Breast J 2017; 24:269-277. [PMID: 28929593 DOI: 10.1111/tbj.12887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022]
Abstract
This study aims to estimate the pathologic complete response (pCR) rate after neo-adjuvant chemotherapy and to compare disease-free survival (DFS) and overall survival (OS) between pCR and non-pCR groups of patients with triple-negative breast cancer (TNBC) and deleterious BRCA1 or BRCA2 mutation. We carried out a retrospective analysis of 53 patients including 46 BRCA1, 6 BRCA2, and 1 combined BRCA1 and BRCA2 mutation. All patients had been diagnosed with triple-negative breast cancer (TNBC) between 1997 and 2014. Neo-adjuvant therapy consisted of regimens that were based on anthracycline or an anthracycline-taxane doublet. DFS included any relapse or second cancer. The Kaplan-Meier method and the log-rank test were used to compare pCR and non-pCR groups. A pCR was observed in 23 (42.6% [95% CI, 29.2%-56.8%]) of the TNBC included. The pCR rate was 38.3% [95% CI, 26%-55%] among BRCA1 mutation carriers, and 66% among the 6 BRCA2 mutation carriers. Median follow-up was 4.4 years (range 0.62-16.2 years) and did not differ between the groups (P = .25). Fifteen relapses and six second cancers were recorded during the follow-up period. Eleven deaths occurred, all of which were in the non-pCR group. DFS (P < .01) and OS (P < .01) were significantly better in the pCR group than the non-pCR group. This study shows a high pCR rate after neo-adjuvant therapy in BRCA-mutated triple-negative breast cancer, and the survival results confirm the prognostic value of pCR in this group. These outcomes should be considered as a basis of comparison to be used by future studies about new therapies in this domain.
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Affiliation(s)
- Lucie Bignon
- Medical Oncology Department, Paul Strauss Cancer Center, Strasbourg Cedex, France
| | - Jean-Pierre Fricker
- Medical Oncology Department, Paul Strauss Cancer Center, Strasbourg Cedex, France
| | - Catherine Nogues
- Service d'Oncogénétique Clinique, Hôpital René Huguenin/Institut Curie, Saint-Cloud, France
| | | | - Dominique Stoppa-Lyonnet
- Department of Tumour Biology, Institut Curie, Paris, France.,Institut Curie, INSERM U830, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Olivier Caron
- Consultation d'Oncogénétique, Département de Médecine Oncologique, Institut Gustave Roussy, Villejuif, France
| | - Alain Lortholary
- Service d'Oncologie Médicale, Centre Catherine de Sienne, Nantes, France
| | - Laurence Faivre
- Centre Georges François Leclerc, Oncogénétique, Dijon, France.,Centre de Génétique, CHU, Dijon, France
| | - Christine Lasset
- Centre Léon Bérard, Unité de Prévention et Epidémiologie Génétique, Lyon, France
| | - Veronique Mari
- Centre Antoine Lacassagne, Unité d'Oncogénétique, Nice, France
| | - Paul Gesta
- Centre Hospitalier Georges Renon, Pôle Oncologie pour la consultation oncogénétique régionale Poitou-Charentes, Niort, France
| | - Laurence Gladieff
- Service d'Oncologie Médicale, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Akila Hamimi
- Service d'Oncogénétique Clinique, Hôpital René Huguenin/Institut Curie, Saint-Cloud, France
| | - Thierry Petit
- Medical Oncology Department, Paul Strauss Cancer Center, Strasbourg Cedex, France
| | - Michel Velten
- Department of Epidemiology and Biostatistics, Paul Strauss Cancer Center, Strasbourg, France.,Cancer Registry of Bas-Rhin, EA3430, Faculty of medicine, University of Strasbourg, Strasbourg, France
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29
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The role of BRCA status on prognosis in patients with triple-negative breast cancer. Oncotarget 2017; 8:87151-87162. [PMID: 29152070 PMCID: PMC5675622 DOI: 10.18632/oncotarget.19895] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 07/18/2017] [Indexed: 02/05/2023] Open
Abstract
Studies have showed that dysfunction in the breast cancer susceptibility gene (BRCA) is associated with triple-negative breast cancer (TNBC); however, its effect on patient survival remains controversial. We investigated the distribution of BRCA1/2 mutations in unselected Chinese patients with TNBC and explored their roles in prognosis. Then a systematic review and meta-analysis were performed to evaluate the prognostic role of BRCA dysfunction, including BRCA1/2 germline/somatic mutations, BRCA1 promoter methylation, and low BRCA1 protein expression in TNBC patients. Pooled hazard ratios with 95% confidence intervals were estimated to determine the association between BRCA dysfunction and survival. Our results showed a high frequency of BRCA1/2 mutations, especially germline BRCA1 variants, were associated with bilateral breast cancer. Although no correlations were found between BRCA1/2 mutations and recurrence-free survival (RFS) or overall survival (OS). In the meta-analysis, patients with BRCA1 promoter methylation showed poor OS. However, there was a favorable impact on disease free survival (DFS) for TNBC patients with BRCA1 promoter methylation when received adjuvant-chemotherapy. In conclusion, BRCA1/2 mutations were associated with bilateral breast cancer and BRCA1 promoter methylation may have a prognostic effect on TNBC.
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30
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Halpern N, Sonnenblick A, Uziely B, Divinsky L, Goldberg Y, Hamburger T, Peretz T, Kadouri L. Oncotype Dx recurrence score among BRCA1/2 germline mutation carriers with hormone receptors positive breast cancer. Int J Cancer 2017; 140:2145-2149. [PMID: 28120435 DOI: 10.1002/ijc.30616] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/02/2017] [Accepted: 01/12/2017] [Indexed: 11/10/2022]
Abstract
Gene expression assays are widely used to predict risk of recurrence in early breast cancer (BC). We report the 21-gene expression assay (Oncotype Dx) recurrence score (RS) distribution of 27 BRCA carriers with estrogen receptor (ER) positive BCs, identified at Hadassah Medical Center, combined with 2 previous studies. Treatment decision and outcomes of the 27 BRCA carriers were compared with an Israeli cohort of 1594 patients published recently. We found Oncotype Dx RS low (<18), intermediate (18-30) and high (>30) among 12 (21.4%), 23 (41.1%) and 21 (37.5%) of 56 BRCA1 carriers compared with 15 (17.2%), 49 (56.3%) and 23 (26.4%) of 87 BRCA2 carriers (p = 0.2). The corresponding distribution in a population of 82,434 women published by Genomic Health was 53.4%, 36.3% and 10.3% for low, intermediate and high RS (p < 0.001 for BRCA1 and BRCA2). Treatment decision regarding chemotherapy according to RS was similar in BRCA1, BRCA2 and the control group. Two of 27 carriers had distant recurrence: a BRCA1 carrier with RS of 18 and a BRCA2 carrier with RS of 22; both have an excellent response to chemotherapy. We found an approximately ∼3 fold increased rate of high RS among BRCA1 and 2 carriers with ER positive BC compared with the general BC population. These data might indicate that hormone positive BC in BRCA carriers are molecularly unique. The surprisingly good response to chemotherapy in the metastatic setting in 2 patients may suggest that the predictive value of low-intermediate RS in carriers merits further studies.
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Affiliation(s)
- Naama Halpern
- Institute of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Amir Sonnenblick
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Beatrice Uziely
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Luba Divinsky
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yael Goldberg
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Tamar Hamburger
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Luna Kadouri
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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31
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32
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Fasching PA, Gaß P, Hein A. Neoadjuvant Treatment of Breast Cancer - Advances and Limitations. Breast Care (Basel) 2016; 11:313-314. [PMID: 27920622 DOI: 10.1159/000452463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gaß
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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