1
|
Arqueros C, Salazar J, Gallardo A, Andrés M, Tibau A, Lidia Bell O, Artigas A, Lasa A, Ramón y Cajal T, Lerma E, Barnadas A. Secreted Protein Acidic and Rich in Cysteine ( SPARC) Polymorphisms in Response to Neoadjuvant Chemotherapy in HER2-Negative Breast Cancer Patients. Biomedicines 2023; 11:3231. [PMID: 38137452 PMCID: PMC10741005 DOI: 10.3390/biomedicines11123231] [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: 10/23/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Secreted protein acidic and rich in cysteine (SPARC) expression has been proposed as a prognostic and predictive biomarker for some cancer types, but knowledge about the predictive value of SPARC polymorphisms in the context of neoadjuvant therapy for breast cancer (BC) is lacking. In 132 HER2-negative BC patients treated with neoadjuvant chemotherapy, we determined polymorphisms in the SPARC gene and analyzed their association with outcome. We also determined SPARC protein expression in tumor tissue. SPARC rs19789707 was significantly associated with response to treatment according to the Miller and Payne system in the breast (multivariate: odds ratio (OR), 3.81; p = 0.028). This association was significant in the subgroup of patients with luminal tumors (univariate: p = 0.047). Regarding survival, two SPARC variants showed significant associations with event-free survival: the rs19789707 variant in the subgroup of luminal A tumors (univariate: p = 0.006), and the rs4958487 variant in the subgroup of luminal B tumors (univariate: p = 0.022). In addition, SPARC rs4958487, rs10065756, and rs12153644 were significantly correlated with SPARC protein expression. Our findings suggest that SPARC polymorphisms could be good predictors of treatment response and survival in BC patients treated with neoadjuvant chemotherapy, especially those with luminal tumors.
Collapse
Affiliation(s)
- Cristina Arqueros
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.A.); (M.A.)
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Juliana Salazar
- Translational Medical Oncology Laboratory, Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), Institut de Recerca Sant Pau—CERCA Center, 08041 Barcelona, Spain
| | - Alberto Gallardo
- Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), Institut de Recerca Sant Pau—CERCA Center, 08041 Barcelona, Spain; (A.G.)
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Morphological Sciences, Faculty of Medicine Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Marta Andrés
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.A.); (M.A.)
| | - Ariadna Tibau
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.A.); (M.A.)
| | - Olga Lidia Bell
- Translational Medical Oncology Laboratory, Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), Institut de Recerca Sant Pau—CERCA Center, 08041 Barcelona, Spain
| | - Alícia Artigas
- Genetics Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain (A.L.)
| | - Adriana Lasa
- Genetics Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain (A.L.)
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Teresa Ramón y Cajal
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.A.); (M.A.)
| | - Enrique Lerma
- Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau), Institut de Recerca Sant Pau—CERCA Center, 08041 Barcelona, Spain; (A.G.)
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Morphological Sciences, Faculty of Medicine Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Agustí Barnadas
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.A.); (M.A.)
- Centro de Investigación Biomédica en Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
2
|
Sejben A, Hegedűs F, Almási S, Berta M, Oláh-Németh O, Zombori T. Good practice: The experiences with the utilization of residual cancer burden-A single institution study. Thorac Cancer 2023; 14:963-968. [PMID: 36866777 PMCID: PMC10101829 DOI: 10.1111/1759-7714.14826] [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: 12/13/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION The use of neoadjuvant therapy (NAT) has been showing an incraesing tendency in the treatment of locally advanced breast cancer. The evaluation of residual cancer could be performed by Residual Cancer Burden (RCB) calculator. The prognostic system takes the two largest diameters of the tumor, the cellularity, the amount of in situ carcinoma, the number of metastatic lymph nodes, and the size of the largest metastatic deposit into account. The aim of our study was to examine the reproducibility of RCB in NAT treated patients. METHODS Patients who were treated with NAT and had resection specimens between 2018 and 2021 were selected. Histological examination was performed by five pathologists. After assessment of the examined variables, RCB points and RCB classes were defined. For statistical analysis, interclass correlation was used (SPSS Statistics V.22.0 software). RESULTS Altogether 100 patients were included in our retrospective, cohort study (average age: 57 years). In two-thirds of the cases, third generation chemotherapy was used, and mastectomy was performed. Significant concordance was found in the two largest diameters of the tumor (coefficients, 0.984 and 0.973), the cellularity (coefficient, 0.970), and the largest metastatic deposit (coefficient, 0.998). Although the amount of in situ carcinoma proved to be the least reproducible factor, it resulted in almost 90% of agreement (coefficient, 0.873). Regarding RCB points and classes, similar results were observed (coefficients, 0.989 and 0.960). CONCLUSIONS Significant agreement was observed between examiners based on almost all RCB parameters, points, and classes, reflecting the optimal reproducibility of RCB. Therefore, we recommend the use of the calculator in routine histopathological reports in NAT cases.
Collapse
Affiliation(s)
- Anita Sejben
- Department of Pathology, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Fanni Hegedűs
- Department of Pathology, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Szintia Almási
- Department of Pathology, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Márton Berta
- Department of Pathology, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Orsolya Oláh-Németh
- Department of Pathology, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Faculty of Medicine, Szeged, Hungary
| |
Collapse
|
3
|
Bo J, Yu B, Bi R, Xu X, Cheng Y, Tu X, Bai Q, Yang W, Shui R. Conversion of ER and HER2 status after neoadjuvant therapy in Chinese breast cancer patients. Clin Breast Cancer 2023; 23:436-446. [PMID: 36990841 DOI: 10.1016/j.clbc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/21/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Few studies have focused on converting ER-low-positive and HER2-low status following neoadjuvant therapy (NAT). We aimed to assess the evolution in ER and HER2 status after NAT in breast cancer patients. PATIENTS AND METHODS Our study included 481 patients with residual invasive breast cancer after NAT. ER and HER2 status were assessed in the primary tumor and residual disease, and associations between ER and HER2 conversion and clinicopathological factors were explored. RESULTS In primary tumors, 305 (63.4%) cases were ER-positive (including 36 cases of ER-low-positive), 176 (36.6%) were ER-negative. In residual disease, ER status changed in 76 (15.8%) cases, of which 69 cases switched from positive to negative. ER-low-positive tumors (31/36) were the most likely to change. In primary tumors, 140 (29.1%) tumors were HER2-positive, and 341 (70.9%) were HER2-negative (including 209 cases of HER2-low and 132 cases of HER2-zero). In residual disease, 25 (5.2%) cases had HER2 conversion between positive and negative. Considering HER2-low status, 113 (23.5%) cases had HER2 conversion, mostly driven by cases switching either to or from HER2-low. ER conversion had a positive correlation with pretreatment ER status (r = 0.25; P = .00). There was a positive correlation between HER2 conversion and HER2-targeted therapy (r = 0.18; P = .00). CONCLUSION Conversion of ER and HER2 status was observed in some breast cancer patients after NAT. Both ER-low-positive and HER2-low tumors showed high instability from the primary tumor to residual disease. ER and HER2 status should be retested in residual disease for further treatment decisions, especially in ER-low-positive and HER2-low breast cancer.
Collapse
|
4
|
Next Generation Sequencing of Reactive Stroma and Residual Breast Cancer Cells in Tumor Bed after Neoadjuvant Chemotherapy. Cancers (Basel) 2022; 14:cancers14225609. [PMID: 36428702 PMCID: PMC9688915 DOI: 10.3390/cancers14225609] [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: 09/23/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022] Open
Abstract
Primary systemic or neoadjuvant chemotherapy of breast cancer has become a standard therapy option in locally advanced or predefined intrinsic subtypes such as triple negative or Her2 positive breast cancer. Neoadjuvant chemotherapy can result in complete pathological response without residual tumor cells (tumor bed) or partial response and non-response with different amounts of reactive stroma and residual tumor cells. The interaction between therapy regimens and tumoral driver mutations have been extensively studied, although the reactive stroma of the tumor bed received less attention. In this study, we characterized the mutational status of residual breast cancer cells and reactive tumor stroma devoid of residual tumor cells in partial or non-responders using next generation sequencing. Twenty-one post-therapeutic breast surgical specimens after neoadjuvant chemotherapy underwent pathogenic driver-mutation screening using microdissected residual breast cancer cells and in reactive stroma adjacent to tumor bed areas. In reactive stroma, no mutations could be validated. In residual breast cancer cells, mutations were detected in sixteen of twenty-one cases (76%). In nine of these twenty-one cases (43%), pathogenic driver mutations (PIK3CA, PTEN, TP53, FN1, PLAG1) were identified. Pathogenic driver-mutations are exclusively restricted to residual carcinoma cells and are absent in reactive stroma independently from intrinsic breast cancer subtypes or tumor stage. These data suggest that the absence of pathogenic mutations in a tumor bed without residual tumor cells may have prognostic implications after neoadjuvant chemotherapy.
Collapse
|
5
|
Agostinetto E, Jacobs F, Debien V, De Caluwé A, Pop CF, Catteau X, Aftimos P, de Azambuja E, Buisseret L. Post-Neoadjuvant Treatment Strategies for Patients with Early Breast Cancer. Cancers (Basel) 2022; 14:cancers14215467. [PMID: 36358886 PMCID: PMC9654353 DOI: 10.3390/cancers14215467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/14/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
Simple Summary Treatment strategies for early breast cancer have significantly improved in the last decades. Several new effective agents have proved clinical benefit and have entered the clinics, changing the treatment landscape for this disease and inducing significant prolongation of patient survival. Alongside, there has been an evolution in the design of clinical trials for early breast cancer, with an increasing interest in the pre-surgical treatment approach, which allows a direct evaluation of treatment effect on tumor size and a post-therapy risk stratification. Consequently, the post-neoadjuvant setting has been gaining increasing attention, thanks to the possibility to provide additional treatment for selected patients at higher risk of relapse, namely those who did not respond to neoadjuvant therapy and had residual disease at surgery. Abstract Pre-surgical treatments in patients with early breast cancer allows a direct estimation of treatment efficacy, by comparing the tumor and the treatment. Patients who achieve a pathological complete response at surgery have a better prognosis, with lower risk of disease recurrence and death. Hence, clinical research efforts have been focusing on high-risk patients with residual disease at surgery, who may be “salvaged” through additional treatments administered in the post-neoadjuvant setting. In the present review, we aim to illustrate the development and advantages of the post-neoadjuvant setting, and to discuss the available strategies for patients with early breast cancer, either approved or under investigation. This review was written after literature search on main scientific databases (e.g., PubMed) and conference proceedings from major oncology conferences up to 1 August 2022. T-DM1 and capecitabine are currently approved as post-neoadjuvant treatments for patients with HER2-positive and triple-negative breast cancer, respectively, with residual disease at surgery. More recently, other treatment strategies have been approved for patients with high-risk early breast cancer, including the immune checkpoint inhibitor pembrolizumab, the PARP inhibitor olaparib and the CDK 4/6 inhibitor abemaciclib. Novel agents and treatment combinations are currently under investigation as promising post-neoadjuvant treatment strategies.
Collapse
Affiliation(s)
- Elisa Agostinetto
- Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B.),1070 Bruxelles, Belgium
| | - Flavia Jacobs
- Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B.),1070 Bruxelles, Belgium
| | - Véronique Debien
- Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B.),1070 Bruxelles, Belgium
| | - Alex De Caluwé
- Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B.),1070 Bruxelles, Belgium
| | - Catalin-Florin Pop
- Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B.),1070 Bruxelles, Belgium
| | - Xavier Catteau
- Curepath Laboratory (CHU Tivoli, CHIREC), Rue de Borfilet 12A, 6040 Jumet, Belgium
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, 1070 Brussels, Belgium
| | - Philippe Aftimos
- Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B.),1070 Bruxelles, Belgium
| | - Evandro de Azambuja
- Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B.),1070 Bruxelles, Belgium
| | - Laurence Buisseret
- Institut Jules Bordet, L’Université Libre de Bruxelles (U.L.B.),1070 Bruxelles, Belgium
- Correspondence:
| |
Collapse
|
6
|
Lin Y, Lin E, Li Y, Chen X, Chen M, Huang J, Guo W, Chen L, Wu L, Zhang X, Zhang W, Jin X, Zhang J, Fu F, Wang C. Thrombospondin 2 is a Functional Predictive and Prognostic Biomarker for Triple-Negative Breast Cancer Patients With Neoadjuvant Chemotherapy. Pathol Oncol Res 2022; 28:1610559. [DOI: 10.3389/pore.2022.1610559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022]
Abstract
Background: Triple-negative breast cancer (TNBC) is characterized by a more aggressive biological behavior and unfavorable outcome. Circulating and histological expression of THBS2 has been demonstrated to be a novel diagnostic and prognostic biomarker in patients with various types of tumors. However, few studies have evaluated the predictive and prognostic value of THBS2 in TNBC specifically.Methods: In total, 185 triple-negative breast cancer patients (TNBC) with preoperative neoadjuvant chemotherapy were enrolled in this study. Serum THBS2 (sTHBS2) level was measured both prior to the start of NAC and at surgery by enzyme-linked immunosorbent assay (ELISA). Histological THBS2 (hTHBS2) expression in patients with residual tumors was evaluated by immunohistochemistry (IHC) staining method. Correlations between variables and treatment response were studied. Kaplan-Meier plots and Cox proportional hazard regression model were applied for survival analysis. Functional activities of THBS2 in TNBC cells were determined by CCK-8 assay, colony formation, wound healing, and transwell assay.Results: Of the 185 patients, 48 (25.9%) achieved pathological complete response (pCR) after completion of NAC. Elevated pCR rates were observed in patients with a lower level of sTHBS2 at surgery and higher level of sTHBS2 change (OR = 0.88, 95%CI: 0.79–0.98, p = 0.020 and OR = 1.12, 95%CI: 1.02–1.23, p = 0.015, respectively). In survival analysis, hTHBS2 expression in residual tumor was of independent prognostic value for both disease-free survival (HR = 2.21, 95%CI = 1.24–3.94, p = 0.007) and overall survival (HR = 2.07, 95%CI = 1.09–3.92, p = 0.026). For functional studies, THBS2 was indicated to inhibit proliferation, migration, and invasion abilities of TNBC cells in vitro.Conclusion: Our findings confirmed the value of serum THBS2 level to predict pCR for TNBC patients and the prognostic performance of histological THBS2 expression in non-pCR responders after NAC. THBS2 might serve as a promising functional biomarker for patients with triple-negative breast cancer.
Collapse
|
7
|
Grigoryeva ES, Tashireva LA, Alifanov VV, Savelieva OE, Vtorushin SV, Zavyalova MV, Cherdyntseva NV, Perelmuter VM. The Novel Association of Early Apoptotic Circulating Tumor Cells with Treatment Outcomes in Breast Cancer Patients. Int J Mol Sci 2022; 23:ijms23169475. [PMID: 36012742 PMCID: PMC9408919 DOI: 10.3390/ijms23169475] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Stemness and epithelial-mesenchymal plasticity are widely studied in the circulating tumor cells of breast cancer patients because the roles of both processes in tumor progression are well established. An important property that should be taken into account is the ability of CTCs to disseminate, particularly the viability and apoptotic states of circulating tumor cells (CTCs). Recent data demonstrate that apoptosis reversal promotes the formation of stem-like tumor cells with pronounced potential for dissemination. Our study focused on the association between different apoptotic states of CTCs with short- and long-term treatment outcomes. We evaluated the association of viable CTCs, CTCs with early features of apoptosis, and end-stage apoptosis/necrosis CTCs with clinicopathological parameters of breast cancer patients. We found that the proportion of circulating tumor cells with features of early apoptosis is a perspective prognosticator of metastasis-free survival, which also correlates with the neoadjuvant chemotherapy response in breast cancer patients. Moreover, we establish that apoptotic CTCs are associated with the poor response to neoadjuvant chemotherapy, and metastasis-free survival expressed at least two stemness markers, CD44 and CD133.
Collapse
Affiliation(s)
- Evgeniya S. Grigoryeva
- The Laboratory of Molecular Oncology and Immunology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634050 Tomsk, Russia
- Correspondence:
| | - Liubov A. Tashireva
- The Department of General and Molecular Pathology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634050 Tomsk, Russia
| | - Vladimir V. Alifanov
- The Department of General and Molecular Pathology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634050 Tomsk, Russia
| | - Olga E. Savelieva
- The Department of General and Molecular Pathology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634050 Tomsk, Russia
| | - Sergey V. Vtorushin
- The Department of General and Molecular Pathology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634050 Tomsk, Russia
| | - Marina V. Zavyalova
- The Department of General and Molecular Pathology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634050 Tomsk, Russia
| | - Nadezhda V. Cherdyntseva
- The Laboratory of Molecular Oncology and Immunology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634050 Tomsk, Russia
| | - Vladimir M. Perelmuter
- The Department of General and Molecular Pathology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634050 Tomsk, Russia
| |
Collapse
|
8
|
Troxell ML, Gupta T. Neoadjuvant Therapy in Breast Cancer: Histologic Changes and Clinical Implications. Surg Pathol Clin 2022; 15:57-75. [PMID: 35236634 DOI: 10.1016/j.path.2021.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cytotoxic or endocrine therapy before surgery (neoadjuvant) for breast cancer has become standard of care, affording the opportunity to assess and quantify response in the subsequent resection specimen. Correlation with radiology, cassette mapping, and histologic review with a semi-quantitative reporting system such as residual cancer burden (RCB) provides important prognostic data that may guide further therapy. The tumor bed should be identified histologically, often as a collagenized zone devoid of normal breast epithelium, with increased vasculature. Identification of residual treated carcinoma may require careful high power examination, as residual tumor cells may be small and dyscohesive; features are widely variable and include hyperchromatic small, large, or multiple nuclei with clear, foamy, or eosinophilic cytoplasm. Calculation of RCB requires residual carcinoma span in 2 dimensions, estimated carcinoma cellularity (% area), number of involved lymph nodes, and span of largest nodal carcinoma. These RCB parameters may differ from AJCC staging measurements, which depend on only contiguous carcinoma in breast and lymph nodes.
Collapse
Affiliation(s)
- Megan L Troxell
- Department of Pathology, Stanford University School of Medicine, Stanford Pathology, 300 Pasteur Drive, H2110, Stanford, CA 94305, USA.
| | - Tanya Gupta
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, 900 Blake Wilbur Drive, Palo Alto, CA 94304 USA
| |
Collapse
|
9
|
Priskin K, Pólya S, Pintér L, Jaksa G, Csányi B, Enyedi MZ, Sági-Zsigmond E, Sükösd F, Oláh-Németh O, Kelemen G, Nikolényi A, Uhercsák G, Sántha D, Dobi Á, Szilágyi É, Valicsek E, Tordai L, Tóth R, Kahán Z, Haracska L. BC-Monitor: Towards a Routinely Accessible Circulating Tumor DNA-Based Tool for Real-Time Monitoring Breast Cancer Progression and Treatment Effectiveness. Cancers (Basel) 2021; 13:3489. [PMID: 34298704 PMCID: PMC8305126 DOI: 10.3390/cancers13143489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022] Open
Abstract
Circulating tumor DNA (ctDNA) is increasingly employed in the screening, follow-up, and monitoring of the continuously evolving tumor; however, most ctDNA assays validated for clinical use cannot maintain the right balance between sensitivity, coverage, sample requirements, time, and cost. Here, we report our BC-monitor, a simple, well-balanced ctDNA diagnostic approach using a gene panel significant in breast cancer and an optimized multiplex PCR-based NGS protocol capable of identifying allele variant frequencies below 1% in cell-free plasma DNA. We monitored a cohort of 45 breast cancer patients prospectively enrolled into our study receiving neoadjuvant chemotherapy or endocrine therapy or palliative therapy for metastatic diseases. Their tumor mutation status was examined in the archived tumor samples and plasma samples collected before and continuously during therapy. Traceable mutations of the used 38-plex NGS assay were found in approximately two-thirds of the patients. Importantly, we detected new pathogenic variants in follow-up plasma samples that were not detected in the primary tumor and baseline plasma samples. We proved that the BC-monitor can pre-indicate disease progression four-six months earlier than conventional methods. Our study highlights the need for well-designed ctDNA monitoring during treatment and follow-up, integrated into a real-time treatment assessment, which could provide information on the active tumor DNA released into the blood.
Collapse
Affiliation(s)
- Katalin Priskin
- Delta Bio 2000 Ltd., 6726 Szeged, Hungary; (K.P.); (L.P.); (G.J.); (M.Z.E.); (E.S.-Z.)
| | - Sára Pólya
- Visal Plus Ltd., 6726 Szeged, Hungary; (S.P.); (B.C.)
| | - Lajos Pintér
- Delta Bio 2000 Ltd., 6726 Szeged, Hungary; (K.P.); (L.P.); (G.J.); (M.Z.E.); (E.S.-Z.)
| | - Gábor Jaksa
- Delta Bio 2000 Ltd., 6726 Szeged, Hungary; (K.P.); (L.P.); (G.J.); (M.Z.E.); (E.S.-Z.)
| | | | - Márton Zsolt Enyedi
- Delta Bio 2000 Ltd., 6726 Szeged, Hungary; (K.P.); (L.P.); (G.J.); (M.Z.E.); (E.S.-Z.)
| | - Eszter Sági-Zsigmond
- Delta Bio 2000 Ltd., 6726 Szeged, Hungary; (K.P.); (L.P.); (G.J.); (M.Z.E.); (E.S.-Z.)
| | - Farkas Sükösd
- Department of Pathology, University of Szeged, 6701 Szeged, Hungary;
| | - Orsolya Oláh-Németh
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Gyöngyi Kelemen
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Alíz Nikolényi
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Gabriella Uhercsák
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Dóra Sántha
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Ágnes Dobi
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Éva Szilágyi
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Erzsébet Valicsek
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - László Tordai
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Rozália Tóth
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Lajos Haracska
- HCEMM-BRC Mutagenesis and Carcinogenesis Research Group, Biological Research Centre, Institute of Genetics, 6726 Szeged, Hungary
| |
Collapse
|
10
|
Zhu Q, Ademuyiwa FO, Young C, Appleton C, Covington MF, Ma C, Sanati S, Hagemann IS, Mostafa A, Uddin KMS, Grigsby I, Frith AE, Hernandez-Aya LF, Poplack SS. Early Assessment Window for Predicting Breast Cancer Neoadjuvant Therapy using Biomarkers, Ultrasound, and Diffuse Optical Tomography. Breast Cancer Res Treat 2021; 188:615-630. [PMID: 33970392 DOI: 10.1007/s10549-021-06239-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of the study was to assess the utility of tumor biomarkers, ultrasound (US) and US-guided diffuse optical tomography (DOT) in early prediction of breast cancer response to neoadjuvant therapy (NAT). METHODS This prospective HIPAA compliant study was approved by the institutional review board. Forty one patients were imaged with US and US-guided DOT prior to NAT, at completion of the first three treatment cycles, and prior to definitive surgery from February 2017 to January 2020. Miller-Payne grading was used to assess pathologic response. Receiver operating characteristic curves (ROCs) were derived from logistic regression using independent variables, including: tumor biomarkers, US maximum diameter, percentage reduction of the diameter (%US), pretreatment maximum total hemoglobin concentration (HbT) and percentage reduction in HbT (%HbT) at different treatment time points. Resulting ROCs were compared using area under the curve (AUC). Statistical significance was tested using two-sided two-sample student t-test with P < 0.05 considered statistically significant. Logistic regression was used for ROC analysis. RESULTS Thirty-eight patients (mean age = 47, range 24-71 years) successfully completed the study, including 15 HER2 + of which 11 were ER + ; 12 ER + or PR + /HER2-, and 11 triple negative. The combination of HER2 and ER biomarkers, %HbT at the end of cycle 1 (EOC1) and %US (EOC1) provided the best early prediction, AUC = 0.941 (95% CI 0.869-1.0). Similarly an AUC of 0.910 (95% CI 0.810-1.0) with %US (EOC1) and %HbT (EOC1) can be achieved independent of HER2 and ER status. The most accurate prediction, AUC = 0.974 (95% CI 0.933-1.0), was achieved with %US at EOC1 and %HbT (EOC3) independent of biomarker status. CONCLUSION The combined use of tumor HER2 and ER status, US, and US-guided DOT may provide accurate prediction of NAT response as early as the completion of the first treatment cycle. CLINICAL TRIAL REGISTRATION NUMBER NCT02891681. https://clinicaltrials.gov/ct2/show/NCT02891681 , Registration time: September 7, 2016.
Collapse
Affiliation(s)
- Quing Zhu
- Biomedical Engineering and Radiology, Washington University in St Louis, One Brookings Drive, Mail Box 1097, Whitaker Hall 200F, St. Louis, MO, 63130, USA. .,Washington University School of Medicine in St Louis, St. Louis, USA.
| | - Foluso O Ademuyiwa
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | - Catherine Young
- Washington Baylor Scott & White Health, Medical Center, Texas, Dallas, USA
| | - Catherine Appleton
- Diagnostic Imaging Associates, Ltd. St. Luke's Hospital, Chesterfield, USA
| | - Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, USA
| | - Cynthia Ma
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | - Souzan Sanati
- Pathology, Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Ian S Hagemann
- Washington University School of Medicine in St Louis, St. Louis, USA
| | - Atahar Mostafa
- Biomedical Engineering and Radiology, Washington University in St Louis, One Brookings Drive, Mail Box 1097, Whitaker Hall 200F, St. Louis, MO, 63130, USA
| | - K M Shihab Uddin
- Biomedical Engineering and Radiology, Washington University in St Louis, One Brookings Drive, Mail Box 1097, Whitaker Hall 200F, St. Louis, MO, 63130, USA
| | - Isabella Grigsby
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | - Ashley E Frith
- Medical Oncology, Washington University School of Medicine in St Louis, St. Louis, USA
| | | | - Steven S Poplack
- Washington University School of Medicine in St Louis, St. Louis, USA.,Radiology, Stanford University, Stanford, USA
| |
Collapse
|