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Covington MF, O'Brien SR, Lawhn-Heath C, Pantel AR, Ulaner GA, Linden HM, Dehdashti F. 18F-Labeled Fluoroestradiol PET/CT: Current Status, Gaps in Knowledge, and Controversies- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024; 223:e2330330. [PMID: 38117098 DOI: 10.2214/ajr.23.30330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PET/CT using 16α-[18F]-fluoro-17β-estradiol (FES) noninvasively images tissues expressing estrogen receptors (ERs). FES has undergone extensive clinicopathologic validation for ER-positive breast cancer and in 2020 received FDA approval for clinical use as an adjunct to biopsy in patients with recurrent or metastatic ER-positive breast cancer. Clinical use of FES PET/CT is increasing but is not widespread in the United States. This AJR Expert Panel Narrative Review explores the present status and future directions of FES PET/CT, including image interpretation, existing and emerging uses, knowledge gaps, and current controversies. Specific controversies discussed include whether both FES PET/CT and FDG PET/CT are warranted in certain scenarios, whether further workup is required after negative FES PET/CT results, whether FES PET/CT findings should inform endocrine therapy selection, and whether immunohistochemistry should remain the stand-alone reference standard for determining ER status for all breast cancers. Consensus opinions from the panel include agreement with the appropriate clinical uses of FES PET/CT published by a multidisciplinary expert work group in 2023, anticipated expanded clinical use of FES PET/CT for staging ER-positive invasive lobular carcinomas and low-grade invasive ductal carcinomas pending ongoing clinical trial results, and the need for further research regarding the use of FES PET/CT for nonbreast malignancies expressing ER.
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Affiliation(s)
- Matthew F Covington
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
| | - Sophia R O'Brien
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Courtney Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Austin R Pantel
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA
- Radiology and Translational Genomics, University of Southern California, Los Angeles, CA
| | - Hannah M Linden
- Department of Medicine, Division of Hematology and Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
| | - Farrokh Dehdashti
- Mallinckrodt Institute of Radiology, Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO
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Wang J, Tian C, Zheng BJ, Zhang J, Jiao DC, Qu JR, Liu ZZ. The use of longitudinal CT-based radiomics and clinicopathological features predicts the pathological complete response of metastasized axillary lymph nodes in breast cancer. BMC Cancer 2024; 24:549. [PMID: 38693523 PMCID: PMC11062000 DOI: 10.1186/s12885-024-12257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/12/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Accurate assessment of axillary status after neoadjuvant therapy for breast cancer patients with axillary lymph node metastasis is important for the selection of appropriate subsequent axillary treatment decisions. Our objectives were to accurately predict whether the breast cancer patients with axillary lymph node metastases could achieve axillary pathological complete response (pCR). METHODS We collected imaging data to extract longitudinal CT image features before and after neoadjuvant chemotherapy (NAC), analyzed the correlation between radiomics and clinicopathological features, and developed models to predict whether patients with axillary lymph node metastasis can achieve axillary pCR after NAC. The clinical utility of the models was determined via decision curve analysis (DCA). Subgroup analyses were also performed. Then, a nomogram was developed based on the model with the best predictive efficiency and clinical utility and was validated using the calibration plots. RESULTS A total of 549 breast cancer patients with metastasized axillary lymph nodes were enrolled in this study. 42 independent radiomics features were selected from LASSO regression to construct a logistic regression model with clinicopathological features (LR radiomics-clinical combined model). The AUC of the LR radiomics-clinical combined model prediction performance was 0.861 in the training set and 0.891 in the testing set. For the HR + /HER2 - , HER2 + , and Triple negative subtype, the LR radiomics-clinical combined model yields the best prediction AUCs of 0.756, 0.812, and 0.928 in training sets, and AUCs of 0.757, 0.777 and 0.838 in testing sets, respectively. CONCLUSIONS The combination of radiomics features and clinicopathological characteristics can effectively predict axillary pCR status in NAC breast cancer patients.
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Affiliation(s)
- Jia Wang
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, Henan, 450008, China
| | - Cong Tian
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, Henan, 450008, China
| | - Bing-Jie Zheng
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, Henan, 450008, China
| | - Jiao Zhang
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, Henan, 450008, China
| | - De-Chuang Jiao
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, Henan, 450008, China
| | - Jin-Rong Qu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, Henan, 450008, China.
| | - Zhen-Zhen Liu
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, Henan, 450008, China.
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Marletta S, Giorlandino A, Cavallo E, Dello Spedale Venti M, Leone G, Tranchina MG, Gullotti L, Bonanno CL, Spoto G, Falzone G, Tornabene I, Trovato C, Baron MM, Di Mauro G, Falsaperna L, Angelico G, Pafumi S, Rizzo A. Discordance of Biomarker Expression Profile between Primary Breast Cancer and Synchronous Axillary Lymph Node Metastasis in Preoperative Core Needle Biopsy. Diagnostics (Basel) 2024; 14:259. [PMID: 38337775 PMCID: PMC10854870 DOI: 10.3390/diagnostics14030259] [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: 11/23/2023] [Revised: 01/12/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Breast cancer (BC) is a heterogeneous disease made up of clones with different metastatic potential. Intratumoral heterogeneity may cause metastases to show divergent biomarker expression, potentially affecting chemotherapy response. Methods: We investigated the immunohistochemical (IHC) and FISH profile of estrogen receptors (ER), progesterone (PR) receptors, Ki67, and HER2 in a series of BC-matched primary tumors (PTs) and axillary lymph node (ALN) metastases in pre-operative core needle biopsies (CNBs). Phenotypical findings were correlated to morphological features and their clinical implications. Results: Divergent expression between PTs and ALNs was found in 10% of the tumors, often involving multiple biomarkers (12/31, 39%). Most (52%) displayed significant differences in ER and PR staining. HER2 divergences were observed in almost three-quarters of the cases (23/31, 74%), with five (16%) switching from negativity to overexpression/amplification in ALNs. Roughly 90% of disparities reflected significant morphological differences between PTs and ALN metastases. Less than half of the discrepancies (12/31, 39%) modified pre/post-operative treatment options. Conclusions: We observed relevant discrepancies in biomarker expression between PTs and metastatic ALNs in a noteworthy proportion (10%) of preoperative BC CNBs, which were often able to influence therapies. Hence, our data suggest routine preoperative assessment of biomarkers in both PTs and ALNs in cases showing significant morphological differences.
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Affiliation(s)
- Stefano Marletta
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy
| | | | - Enrico Cavallo
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Michele Dello Spedale Venti
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giorgia Leone
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Maria Grazia Tranchina
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Lucia Gullotti
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Claudia Lucia Bonanno
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Graziana Spoto
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giusi Falzone
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Irene Tornabene
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Carmelina Trovato
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Marco Maria Baron
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giuseppe Di Mauro
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Lucia Falsaperna
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giuseppe Angelico
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, Anatomic Pathology, University of Catania, 95125 Catania, Italy;
| | - Sarah Pafumi
- Medical Oncology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy;
- Section of Oncology, Department of Medicine, University of Verona, Verona University Hospital Trust (AUOI), 37124 Verona, Italy
| | - Antonio Rizzo
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
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Chen J, Li J, Sun X, Lu H, Liu K, Li Z, Guan J, Song H, Wei W, Ge Y, Fan Q, Bao W, Ma B, Du Z. Precision Therapy of Recurrent Breast Cancer through Targeting Different Malignant Tumor Cells with a HER2/CD44-Targeted Hydrogel Nanobot. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2301043. [PMID: 37154208 DOI: 10.1002/smll.202301043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/20/2023] [Indexed: 05/10/2023]
Abstract
Heterogeneity and drug resistance of tumor cells are the leading causes of incurability and poor survival for patients with recurrent breast cancer. In order to accurately deliver the biological anticancer drugs to different subtypes of malignant tumor cells for omnidirectional targeted treatment of recurrent breast cancer, a distinct design is demonstrated by embedding liposome-based nanocomplexes containing pro-apoptotic peptide and survivin siRNA drugs (LPR) into Herceptin/hyaluronic acid cross-linked nanohydrogels (Herceptin-HA) to fabricate a HER2/CD44-targeted hydrogel nanobot (named as ALPR). ALPR delivered cargoes to the cells overexpressing CD44 and HER2, followed by Herceptin-HA biodegradation, subsequently, the exposed lipid component containing DOPE fused with the endosomal membrane and released peptide and siRNA into the cytoplasm. These experiments indicated that ALPR can specifically deliver Herceptin, peptide, and siRNA drugs to HER2-positive SKBR-3, triple-negative MDA-MB-231, and HER2-negative drug-resistant MCF-7 human breast cancer cells. ALPR completely inhibited the growth of heterogeneous breast tumors via multichannel synergistic effects: disrupting mitochondria, downregulating the survivin gene, and blocking HER2 receptors on the surface of HER2-positive cells. The present design overcomes the chemical drug resistance and opens a feasible route for the combinative treatment of recurrent breast cancer, even other solid tumors, utilizing different kinds of biological drugs.
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Affiliation(s)
- Juan Chen
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yi-Shan Road, Shanghai, 200233, China
| | - Jinjin Li
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Xiaolu Sun
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Huixia Lu
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Kuai Liu
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Zhenbo Li
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Jianyue Guan
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Huiling Song
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Wei Wei
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Yanhong Ge
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Qiong Fan
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China
| | - Wei Bao
- Department of Obstetrics and Gynecology, Shanghai General Hospital affiliated with Shanghai Jiao Tong University, 100 Haining Road, Shanghai, 200080, China
| | - Buyong Ma
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Zixiu Du
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, and School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
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Fourman MS, Siraj L, Duvall J, Ramsey DC, De La Garza Ramos R, Hadzipasic M, Connolly I, Williamson T, Shankar GM, Schoenfeld A, Yassari R, Massaad E, Shin JH. Can We Use Artificial Intelligence Cluster Analysis to Identify Patients with Metastatic Breast Cancer to the Spine at Highest Risk of Postoperative Adverse Events? World Neurosurg 2023; 174:e26-e34. [PMID: 36805503 DOI: 10.1016/j.wneu.2023.02.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Group patients who required open surgery for metastatic breast cancer to the spine by functional level and metastatic disease characteristics to identify factors that predispose to poor outcomes. METHODS A retrospective analysis included patients managed at 2 tertiary referral centers from 2008 to 2020. The primary outcome was a 90-day adverse event. A 2-step unsupervised cluster analysis stratified patients into cohorts using function at presentation, preoperative spine radiation, structural instability, epidural spinal cord compression (ESCC), neural deficits, and tumor location/hormone status. Comparisons were performed using χ2 test and one-way analysis of variance. RESULTS Five patient "clusters" were identified. High function (HIGH) had thoracic metastases and an Eastern Cooperative Oncology Group (ECOG) score of 1.0 ± 0.8. Low function/irradiated (LOW + RADS) had preoperative radiation and the lowest Karnofsky scores (56.0 ± 10.6). Estrogen receptor or progesterone receptor (ER/PR) positive patients had >90% estrogen/progesterone positivity and moderate Karnofsky scores (74.0 ± 11.5). Lumbar/noncompressive (NON-COMP) had the fewest patients with ESCC grade 2 or 3 epidural disease (42.1%, P < 0.001). Low function/neurologic deficits (LOW + NEURO) had ESCC grade 2 or 3 disease and neurologic deficits. Adverse event rates were 25.0% in the HIGH group, 73.3% in LOW + RADS, 24.0% in ER/PR, 31.6% in NON-COMP, and 60.0% in LOW + NEURO (P = 0.003). CONCLUSIONS Function at presentation, tumor hormone signature, radiation history, and epidural compression delineated postoperative trajectory. We believe our results can aid in expectation management and the identification of at-risk patients who may merit closer surveillance following surgical intervention.
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Affiliation(s)
- Mitchell S Fourman
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Layla Siraj
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Duvall
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Duncan C Ramsey
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Muhamed Hadzipasic
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian Connolly
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Theresa Williamson
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ganesh M Shankar
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Elie Massaad
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John H Shin
- Departments of Orthopaedic Surgery and Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Fan Y, Zhong X, Wang Y, Wang Z, Luo T, Wang Y, Zheng H. A prospective cohort study of clinical characteristics and outcomes in Chinese patients with estrogen receptor-negative/progesterone receptor-positive early breast cancer. Breast Cancer Res Treat 2023:10.1007/s10549-023-06964-6. [PMID: 37199804 DOI: 10.1007/s10549-023-06964-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/19/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE This study aimed to examine the clinical characteristics and outcomes of patients with estrogen receptor-negative (ER-)/progesterone receptor-positive (PR+) early breast cancer. We also aimed to investigate the benefits of adjuvant endocrine therapy (ET) in this patient population. METHODS Patients with early breast cancer diagnosed at West China Hospital were divided into the ER-/PR+, ER+, and ER-/PR- groups. The chi-square test was used to analyze differences in clinical and pathological features among the groups. Multivariable Cox and Fine-Gray regression models were used to compare mortality and locoregional recurrence (LRR)/distant recurrence (DR), respectively. We performed a subgroup analysis to determine which ER-/PR+ patients can benefit more from ET. RESULTS From 2008 to 2020, we enrolled 443, 7104, and 2892 patients into the ER-/PR+, ER+, and ER-/PR- groups, respectively. The ER-/PR+ group showed more unfavorable clinical features and aggressive pathological characteristics than the ER+ group. The mortality, LRR, and DR rates were higher in the ER-/PR+ than in the ER+ group. Most clinical features and pathological characteristics were similar between the ER-/PR+ and ER-/PR- group and their outcomes were comparable. In the ER-/PR+ group, patients who received ET showed significantly lower LRR and mortality rates than those who did not; however, no difference was observed in DR. Subgroup analysis suggested that ER-/PR+ patients age ≥ 55 years, and postmenopausal status can benefit from ET. CONCLUSION ER-/PR+ tumors have more aggressive pathological characteristics and more unfavorable clinical features than ER+ tumors. ET can reduce the LRR and mortality rates in ER-/PR+ patients. Postmenopausal and age ≥ 55 years ER-/PR+ patients can benefit from ET.
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Affiliation(s)
- Yu Fan
- Breast Center and Multi-omics Laboratory of Breast Diseases, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xiaorong Zhong
- Breast Center and Multi-omics Laboratory of Breast Diseases, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yu Wang
- Breast Center and Multi-omics Laboratory of Breast Diseases, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhu Wang
- Breast Center and Multi-omics Laboratory of Breast Diseases, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Ting Luo
- Breast Center and Multi-omics Laboratory of Breast Diseases, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yanping Wang
- Breast Center and Multi-omics Laboratory of Breast Diseases, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Hong Zheng
- Breast Center and Multi-omics Laboratory of Breast Diseases, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
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Hendrikse CSE, van der Ploeg P, van de Kruis NMA, Wilting JHC, Oosterkamp F, Theelen PMM, Lok CAR, de Hullu JA, Smedts HPM, Vos MC, Pijlman BM, Kooreman LFS, Bulten J, Lentjes-Beer MHFM, Bosch SL, van de Stolpe A, Lambrechts S, Bekkers RLM, Piek JMJ. Functional estrogen receptor signal transduction pathway activity and antihormonal therapy response in low-grade ovarian carcinoma. Cancer 2023; 129:1361-1371. [PMID: 36867576 DOI: 10.1002/cncr.34661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND Advanced low-grade ovarian carcinoma (LGOC) is difficult to treat. In several studies, high estrogen receptor (ER) protein expression was observed in patients with LGOC, which suggests that antihormonal therapy (AHT) is a treatment option. However, only a subgroup of patients respond to AHT, and this response cannot be adequately predicted by currently used immunohistochemistry (IHC). A possible explanation is that IHC only takes the ligand, but not the activity, of the whole signal transduction pathway (STP) into account. Therefore, in this study, the authors assessed whether functional STP activity can be an alternative tool to predict response to AHT in LGOC. METHODS Tumor tissue samples were obtained from patients with primary or recurrent LGOC who subsequently received AHT. Histoscores of ER and progesterone receptor (PR) were determined. In addition, STP activity of the ER STP and of six other STPs known to play a role in ovarian cancer was assessed and compared with the STP activity of healthy postmenopausal fallopian tube epithelium. RESULTS Patients who had normal ER STP activity had a progression-free survival (PFS) of 16.1 months. This was significantly shorter in patients who had low and very high ER STP activity, with a median PFS of 6.0 and 2.1 months, respectively (p < .001). Unlike ER histoscores, PR histoscores were strongly correlated to the ER STP activity and thus to PFS. CONCLUSIONS Aberrant low and very high functional ER STP activity and low PR histoscores in patients with LGOC indicate decreased response to AHT. ER IHC is not representative of functional ER STP activity and is not related to PFS.
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Affiliation(s)
- Cynthia S E Hendrikse
- Department of Gynecology and Obstetrics and Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Phyllis van der Ploeg
- Department of Gynecology and Obstetrics and Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Nienke M A van de Kruis
- Department of Gynecology and Obstetrics and Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands
| | - Jody H C Wilting
- Department of Gynecology and Obstetrics and Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands
| | - Floor Oosterkamp
- Department of Gynecology and Obstetrics and Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands
| | - Pauline M M Theelen
- Department of Gynecology and Obstetrics and Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands
| | - Christianne A R Lok
- Department of Gynecology and Obstetrics, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Joanne A de Hullu
- Department of Gynecology and Obstetrics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Huberdina P M Smedts
- Department of Gynecology and Obstetrics, Amphia Hospital, Breda, the Netherlands
| | - M Caroline Vos
- Department of Gynecology and Obstetrics, Elisabeth-Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - Brenda M Pijlman
- Department of Gynecology and Obstetrics, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
| | - Loes F S Kooreman
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Steven L Bosch
- Department of Pathology, Eurofins PAMM, Eindhoven, the Netherlands
| | - Anja van de Stolpe
- Philips Molecular Pathway Dx, Philips Research, Eindhoven, the Netherlands
| | - Sandrina Lambrechts
- Department of Gynecology and Obstetrics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ruud L M Bekkers
- Department of Gynecology and Obstetrics and Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Jurgen M J Piek
- Department of Gynecology and Obstetrics and Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands
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8
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Thyroglobulin expression, Ki-67 index, and lymph node ratio in the prognostic assessment of papillary thyroid cancer. Sci Rep 2023; 13:1070. [PMID: 36658256 PMCID: PMC9852547 DOI: 10.1038/s41598-023-27684-3] [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: 07/15/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
The clinical significance of thyroglobulin (Tg) expression in papillary thyroid cancer (PTC) has not been systematically explored in relation to the Ki-67 index, lymph node ratio (LNR), or other conventional prognostic predictors. In this retrospective study of 327 patients with PTC, we investigated the immunohistochemical expression of Tg in both primary tumors and their matching lymph node metastases in relation to the Ki-67 index, LNR, and clinical data. Tumoral Tg immunoreactivity was inversely correlated to the Ki-67 index and tumor recurrence. The Ki-67 index was higher in lymph node metastases (mean 4%) than in the primary tumors (mean 3%). Reduced Tg expression, estimated as 0-25% Tg positive tumor cells, was more common in lymph node metastases compared to primary tumors. In addition to advanced metastatic burden (defined as N1b stage and LNR ≥ 21%), low Tg expression (0-25% positive tumor cells) in lymph node metastases had a significant prognostic impact with shorter recurrence-free survival. These findings support the potential value of histopathological assessment of Tg expression and Ki-67 index in lymph node metastases as complementary predictors to anticipate the prognosis of PTC patients better.
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9
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Weydandt L, Nel I, Kreklau A, Horn LC, Aktas B. Heterogeneity between Core Needle Biopsy and Synchronous Axillary Lymph Node Metastases in Early Breast Cancer Patients-A Comparison of HER2, Estrogen and Progesterone Receptor Expression Profiles during Primary Treatment Regime. Cancers (Basel) 2022; 14:cancers14081863. [PMID: 35454772 PMCID: PMC9024720 DOI: 10.3390/cancers14081863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary All initial therapeutic decisions in early breast cancer are commonly based on the intrinsic subtype consisting of estrogen (ER), progesterone (PR), the human epidermal growth factor 2 (HER2) receptors and the proliferation marker Ki67. However, breast cancer is a very heterogeneous disease, and receptor expression is reported to change during progression. Little is known about receptor changes at the primary site. In a German single center study, we retrospectively analyzed a mostly therapy naive cohort of 215 primary breast cancer patients with axillary synchronous lymph node metastases (LNM). We compared core needle biopsy tissue of the primary tumor (t-CNB) to axillary LNM and detected receptor discordance for all three receptors at the primary site. Abstract In breast cancer therapeutic decisions are based on the expression of estrogen (ER), progesterone (PR), the human epidermal growth factor 2 (HER2) receptors and the proliferation marker Ki67. However, only little is known concerning heterogeneity between the primary tumor and axillary lymph node metastases (LNM) in the primary site. We retrospectively analyzed receptor profiles of 215 early breast cancer patients with axillary synchronous LNM. Of our cohort, 69% were therapy naive and did not receive neoadjuvant treatment. Using immunohistochemistry, receptor status and Ki67 were compared between core needle biopsy of the tumor (t-CNB) and axillary LNM obtained during surgery. The discordance rates between t-CNB and axillary LNM were 12% for HER2, 6% for ER and 20% for PR. Receptor discordance appears to already occur at the primary site. Receptor losses might play a role concerning overtreatment concomitant with adverse drug effects, while receptor gains might be an option for additional targeted or endocrine therapy. Hence, not only receptor profiles of the tumor tissue but also of the synchronous axillary LNM should be considered in the choice of treatment.
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Affiliation(s)
- Laura Weydandt
- Department of Gynecology, Medical Center, University of Leipzig, 04103 Leipzig, Germany; (I.N.); (A.K.); (B.A.)
- Correspondence: ; Tel.: +49-341-9723924
| | - Ivonne Nel
- Department of Gynecology, Medical Center, University of Leipzig, 04103 Leipzig, Germany; (I.N.); (A.K.); (B.A.)
| | - Anne Kreklau
- Department of Gynecology, Medical Center, University of Leipzig, 04103 Leipzig, Germany; (I.N.); (A.K.); (B.A.)
| | - Lars-Christian Horn
- Department of Pathology, Medical Center, University of Leipzig, 04103 Leipzig, Germany;
| | - Bahriye Aktas
- Department of Gynecology, Medical Center, University of Leipzig, 04103 Leipzig, Germany; (I.N.); (A.K.); (B.A.)
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10
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Gastrin-Releasing Peptide Receptor Antagonist [ 68Ga]RM2 PET/CT for Staging of Pre-Treated, Metastasized Breast Cancer. Cancers (Basel) 2021; 13:cancers13236106. [PMID: 34885214 PMCID: PMC8656859 DOI: 10.3390/cancers13236106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET)/computed tomography (CT) using the gastrin-releasing peptide receptor antagonist [68Ga]RM2 has shown to be a promising imaging method for primary breast cancer (BC) with positive estrogen receptor (ER) status. This study assessed tumor visualization by [68Ga]RM2 PET/CT in patients with pre-treated ER-positive BC and suspected metastases. METHODS This retrospective pilot study included eight female patients with initial ER-positive, pre-treated BC who underwent [68Ga]RM2 PET/CT. Most of these patients (seven out of eight; 88%) were still being treated with or had received endocrine therapy. [68Ga]RM2 PET/CTs were visually analyzed by two nuclear medicine specialists in consensus. Tumor manifestations were rated qualitatively (i.e., RM2-positive or RM2-negative) and quantitatively using the maximum standardized uptake value (SUVmax). SUVmax values were compared between the two subgroups (RM2-positive vs. RM2-negative). RESULTS Strong RM2 binding was found in all metastatic lesions of six patients (75%), whereas tracer uptake in all metastases of two patients (25%) was rated negative. Mean SUVmax of RM2-positive metastases with the highest SUVmax per patient (in lymph node and bone metastases; 15.8 ± 15.1 range: 3.7-47.8) was higher than mean SUVmax of the RM2-negative metastases with the highest SUVmax per patient (in bone metastases; 1.6 ± 0.1, range 1.5-1.7). CONCLUSIONS Our data suggest that RM2 binding is maintained in the majority of patients with advanced disease stage of pre-treated ER-positive BC. Thus, [68Ga]RM2 PET/CT could support treatment decision in these patients, radiotherapy planning in oligometastatic patients or selection of patients for RM2 radioligand therapy. Further studies with larger patient cohorts are warranted to confirm these findings.
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11
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Shen T, Wei L, Li X, Parwani AV, Li Z. Prognostic value of androgen receptor expression and molecular alterations in metastatic triple-negative or low hormone receptor breast carcinomas. Hum Pathol 2021; 116:73-81. [PMID: 34310983 DOI: 10.1016/j.humpath.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/06/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Metastatic breast carcinomas (BCs) with phenotype of triple-negative (TNBC) or low hormonal receptor levels [estrogen receptor (ER)/progesterone receptor (PR) < 10% and HER2-] are mainly treated with cytotoxic chemotherapy. Targeting androgen receptor (AR) pathway may represent a potential new therapeutic strategy in such group of BCs. We evaluated AR expression by immunohistochemistry and genetic alterations by next-generation sequencing. Among 114 metastatic BCs, 37 (32.5%) cases showed AR expression and 77 (67.5%) lacked AR expression. Statistical analysis revealed that AR expression is associated with older age, lobular carcinoma, positive ER and positive PR in primary tumors, and lymph node metastasis. Patients with AR-positive tumors had significantly longer metastatic intervals and overall survivals. In addition, AR-positive tumors had significantly higher rate of PI3CA mutation. Our results demonstrated that AR expression has prognostic value in this subgroup of metastatic BCs and tumors with AR expression had different molecular alterations compared with those without AR expression.
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Affiliation(s)
- Tiansheng Shen
- Department of Pathology, Wexner Medical Center at the Ohio State University, 410 W. 10th Ave, Columbus, OH 43210, USA
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA
| | - Xiaoxian Li
- Department of Pathology, Emory University, Atlanta, GA 30322, USA
| | - Anil V Parwani
- Department of Pathology, Wexner Medical Center at the Ohio State University, 410 W. 10th Ave, Columbus, OH 43210, USA
| | - Zaibo Li
- Department of Pathology, Wexner Medical Center at the Ohio State University, 410 W. 10th Ave, Columbus, OH 43210, USA.
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12
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Brazee RL, Nugent BD, Sereika SM, Rosenzweig M. The Quality of End-of-Life Care for Women Deceased From Metastatic Breast Cancer. J Hosp Palliat Nurs 2021; 23:238-247. [PMID: 33782263 DOI: 10.1097/njh.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metastatic breast cancer (MBC) carries unique disease burdens with potential for poor-quality end-of-life (EOL) care. It is the purpose of this article to explore the association of poor-quality EOL care indicators according to key tumor, demographic, social, and clinical factors. End-of-life quality indicators were based on Emanuel and Emanuel's good death model in conjunction with Earle et al (2003). A single-institution retrospective chart review of women deceased from MBC between November 2016 and November 2019 with double-verification chart review was completed. Data were analyzed with descriptive, correlative, and comparative statistics. Total sample was N = 167 women, with 14.4% (n = 24) Black and 85.6% (n = 143) White. Mean (SD) age was 55.3 (11.73) years. Overall, MBC survival was 3.12 years (SD, 3.31): White women, 41.2 months (3.4 years), and Black women, 19 months (1.6 years). A total of 64.1% (n = 107) experienced 1 or more indicators of poor-quality EOL care. Patients more likely to experience poor-quality EOL care were older (P = .03), estrogen negative (P = .08), human epidermal growth factor receptor 2 negative (P = .07), from more deprived neighborhoods (P = .02), married (P = .05), and with physical (P = .001) and mental (P = .002) comorbidities. Understanding sociodemographic and clinical factors associated with poor EOL MBC care may be useful for proactive patient navigation.
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13
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Peng L, Zhang Z, Zhao D, Zhao J, Mao F, Sun Q. Discordance in ER, PR, HER2, and Ki-67 Expression Between Primary and Recurrent/Metastatic Lesions in Patients with Primary Early Stage Breast Cancer and the Clinical Significance: Retrospective Analysis of 75 Cases. Pathol Oncol Res 2021; 27:599894. [PMID: 34257555 PMCID: PMC8262146 DOI: 10.3389/pore.2021.599894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/02/2021] [Indexed: 12/23/2022]
Abstract
Background: The objective was to explore the discordance in the expression of the estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 between primary and recurrent/metastatic lesions in patients with early stage breast cancer as well as the prognostic impact. Method: Patients with early-stage primary breast cancer and confirmed recurrence/metastasis at Peking Union Medical College Hospital between January 2005 and August 2018 were screened. The details of discordance in each parameter between primary and recurrent/metastatic lesions and progression were recorded. Regression and survival analysis were applied to determine the association and clinical impact of the discordance. Results: We evaluated 75 patients. The discordance rate of ER, PR, HER2, and Ki-67 expression was 9.3, 14.7, 14.7, and 21.5%, respectively. Additionally, 66.7, 11.8, 14.3, and 0% of patients with Luminal A, Luminal B, HER2, and triple-negative primary tumors presented with a different subtype for the recurrent/metastatic tumors, respectively. No statistical difference in progression-free survival was observed according to the subtype of the recurrent or metastatic breast cancer (p > 0.05). Among 69 patients for whom treatment was adjusted after recurrence or metastasis, 66 patients remained recurrence-free during the follow-up period. Conclusion: For patients with early-stage breast cancer, the ER, PR, HER2, and Ki-67 expression profile for recurrent/metastatic tumors does not always match that of the primary tumor. After adjusting treatment according to the receptor expression in recurrent/metastatic lesions, most patients remained progression-free during the follow-up period.
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Affiliation(s)
- Li Peng
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Zhen Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Dachun Zhao
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
| | - Jialin Zhao
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, China
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14
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Facca VJ, Al-Saden N, Ku A, Reilly RM. Imaging of HER2-Positive Tumors in NOD/SCID Mice with Pertuzumab Fab-Hexahistidine Peptide Immunoconjugates Labeled with [ 99mTc]-(I)-Tricarbonyl Complex. Mol Imaging Biol 2021; 23:495-504. [PMID: 33479914 DOI: 10.1007/s11307-020-01571-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Molecular imaging of tumor HER2 expression may allow patient selection for HER2-targeted therapies. Our aim was to introduce hexahistidine (His6) peptides into pertuzumab Fab to enable labeling with the [99mTc(CO)3(H2O)3]+ complex and study these radioimmunoconjugates for microSPECT/CT imaging of HER2-positive tumor xenografts in mice. PROCEDURES Fab were produced by papain digestion of pertuzumab and reacted with sulfo-SMCC for conjugation to His6-containing peptides (CGYGGHHHHHH). His6-peptide conjugation was measured by a radiometric assay. His6-pertuzumab Fab were labeled at 0.4-1.0 MBq/μg with [99mTc(CO)3(H2O)3]+ for 1 h at 37 °C. HER2 immunoreactivity was assessed in a direct (saturation) binding assay using HER2-overexpressing SK-BR-3 human breast cancer (BC) cells. MicroSPECT/CT and biodistribution studies were performed in NOD/SCID mice with HER2-positive s.c. SK-OV-3 human ovarian cancer, or MDA-MB-361 or MDA-MB-231 human BC xenografts at 4 or 24 h post i.v. injection of [99mTc]His6-pertuzumab Fab (29-49 MBq, 70 μg). The specificity of tumor uptake was assessed by comparison to irrelevant [99mTc]Fab 3913 in SK-OV-3 tumor-bearing mice. RESULTS SDS-PAGE analysis demonstrated cleavage of pertuzumab to produce Fab, which eluted as a single peak with a retention time of 13.8 min on SE-HPLC. Fab were conjugated to 2.1 ± 0.5 His6 peptides and labeled with [99mTc(CO)3(H2O)3]+ to a radiochemical purity of 92-97 % at 0.4-0.8 MBq/μg. [99mTc]His6-pertuzumab Fab exhibited saturable and specific binding to SK-BR-3 cells with a KD = 51.3 ± 5.2 × 10-9 M and Bmax = 3.5 ± 0.1 × 106 receptors/cell. SK-OV-3 tumors were imaged at 4 and 24 h p.i [99mTc]His6-pertuzumab Fab. Tumor uptake at 24 h p.i. was 4.1 ± 0.6 %ID/g, which was 13-fold significantly greater than [99mTc]Fab 3913 (0.3 ± 0.0 %ID/g; P < 0.01). MicroSPECT/CT imaged HER2-overexpressing MDA-MB-361 tumors but not MDA-MB-231 tumors with low HER2 expression. Tumor uptake was 5.2-fold significantly greater at 24 h p.i. in MDA-MB-361 than MDA-MB-231 tumors (3.2 ± 0.1 %ID/g vs. 0.8 ± 0.1 %ID/g; P < 0.05). CONCLUSIONS MicroSPECT/CT with [99mTc]His6-pertuzumab Fab imaged tumors in NOD/SCID mice that exhibited intermediate or high HER2 expression, but not tumors with low HER2. [99mTc]His6-pertuzumab Fab is promising for SPECT imaging of tumor HER2 expression.
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Affiliation(s)
- Valerie J Facca
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada
| | - Noor Al-Saden
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada
| | - Anthony Ku
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada
| | - Raymond M Reilly
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. .,Princess Margaret Cancer Centre and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
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15
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Association of circulating Progesterone Receptor Membrane Component-1 (PGRMC1) with breast tumor characteristics and comparison with known tumor markers. ACTA ACUST UNITED AC 2020; 27:183-193. [PMID: 31876619 DOI: 10.1097/gme.0000000000001436] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Progesterone receptor membrane component-1 (PGRMC1) expressed in breast cancer tissue has been suggested to predict a worse prognosis. The aim of this study was to assess for the first time if blood concentrations of PGRMC1 are also associated with receptor status, tumor diameter, grading, and lymphatic status. The second aim was comparison with known tumor markers. METHODS A total of 372 women, including 278 patients with invasive breast cancer, 65 with benign breast disease, and 29 healthy women (control), were recruited. PGRMC1 blood concentrations were measured by a recently developed enzyme-linked immunosorbant assay, and were correlated to predictive tumor characteristics and compared with serum carcinoembryonic antigen (CEA), CA125, and CA153. RESULTS PGRMC1 levels in the cancer group were significantly higher than in the control and benign group and increased with higher cancer stages (P < 0.05). PGRMC1 concentrations in the estrogen receptor (ER)+/progesterone receptor (PR)+ group were higher than in the ER-/PR- group, related to larger tumor diameter and the presence of lymph node metastasis (P < 0.05). Multivariable linear regression analysis was used to control the confounding factors. Tumor diameter, lymphatic metastasis, and ER (but not PR) were positively associated with PGRMC1 (P < 0.05). The receiver-operating characteristic curve (ROC) analysis was used to assess area under the curve (AUC). AUC was 87.9% for stages III+IV and 80.8% for stages I+II (P < 0.01). ROC did not find significant effects on AUC for CA125, only significant for CEA and CA153 for stages III+IV. CONCLUSION As PGRMC1 levels are positively associated with breast tumor characteristics known to predict a worse diagnosis, PGRMC1 may be valuable as a new tumor marker, and superior to CEA, C125, and CA153. Because of the positive association with ER-expression, PGRMC1 may interact with this receptor.
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16
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Sujarittanakarn S, Himakhun W, Worasawate W, Prasert W. The Case to Case Comparison of Hormone Receptors and HER2 Status between Primary Breast Cancer and Synchronous Axillary Lymph Node Metastasis. Asian Pac J Cancer Prev 2020; 21:1559-1565. [PMID: 32592349 PMCID: PMC7568873 DOI: 10.31557/apjcp.2020.21.6.1559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 12/04/2022] Open
Abstract
Background: Nowadays, the adjuvant treatment for breast cancer patients chosen depends on immunohistochemical pattern of Estrogen receptor(ER), Progesterone receptor(PR) and HER2 status of primary breast tumor. Several retrospective studies showed significant discordance in receptor expression between primary and metastatic tumors. The objective of this research was to determine discordant rate of ER, PR and HER2 status between primary breast cancer and synchronous axillary lymph node metastasis of individual breast cancer patients in Thammasat University Hospital. Methods: A prospective observational study of all breast cancer patients who have axillary metastasis and underwent surgery at Thammasat Hospital between January 2011 to December 2015. Tumor staging, ER, PR, and HER2 status on primary breast tumor were recorded. Synchronous axillary lymph node metastasis was evaluated with immunohistochemistry for ER, PR, and HER2. Results: The ER-positive rate from primary tumor to synchronous axillary lymph node metastasis decreased from 74.7% to 71.7%; the HER2 overexpression rate was decreased from 26% to 24%. In contrast, PR positive rate were 71% in both primary tumor and synchronous axillary lymph node metastasis. In case to case comparison, discordance rate of ER, PR and HER2 status between primary breast cancer and synchronous axillary lymph node metastasis were 11.1%, 20.2% and 10.1%, respectively. Furthermore, the tumor staging was not significant associated with discordance of ER, PR and HER2. Conclusion: ER, PR and HER 2 biomarkers showed significant concordance between primary tumor and synchronous axillary lymph node metastasis. Hence, if we cannot assess the ER, PR and HER2 status in primary tumor, then synchronous axillary lymph node metastasis can be studied instead. However, the repeat of biomarker testing in node-positive breast cancer patients may be beneficial for tailored adjuvant therapy, especially for patients with negative hormone receptor and/or HER2 profile on primary tumor.
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Affiliation(s)
| | - Wanwisa Himakhun
- Department of Pathology and Forensic science, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | - Wilairat Prasert
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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17
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Hampsch RA, Wells JD, Traphagen NA, McCleery CF, Fields JL, Shee K, Dillon LM, Pooler DB, Lewis LD, Demidenko E, Huang YH, Marotti JD, Goen AE, Kinlaw WB, Miller TW. AMPK Activation by Metformin Promotes Survival of Dormant ER + Breast Cancer Cells. Clin Cancer Res 2020; 26:3707-3719. [PMID: 32321715 DOI: 10.1158/1078-0432.ccr-20-0269] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Despite adjuvant endocrine therapy for patients with estrogen receptor alpha (ER)-positive breast cancer, dormant residual disease can persist for years and eventually cause tumor recurrence. We sought to deduce mechanisms underlying the persistence of dormant cancer cells to identify therapeutic strategies. EXPERIMENTAL DESIGN Mimicking the aromatase inhibitor-induced depletion of estrogen levels used to treat patients, we developed preclinical models of dormancy in ER+ breast cancer induced by estrogen withdrawal in mice. We analyzed tumor xenografts and cultured cancer cells for molecular and cellular responses to estrogen withdrawal and drug treatments. Publicly available clinical breast tumor gene expression datasets were analyzed for responses to neoadjuvant endocrine therapy. RESULTS Dormant breast cancer cells exhibited upregulated 5' adenosine monophosphate-activated protein kinase (AMPK) levels and activity, and upregulated fatty acid oxidation. While the antidiabetes AMPK-activating drug metformin slowed the estrogen-driven growth of cells and tumors, metformin promoted the persistence of estrogen-deprived cells and tumors through increased mitochondrial respiration driven by fatty acid oxidation. Pharmacologic or genetic inhibition of AMPK or fatty acid oxidation promoted clearance of dormant residual disease, while dietary fat increased tumor cell survival. CONCLUSIONS AMPK has context-dependent effects in cancer, cautioning against the widespread use of an AMPK activator across disease settings. The development of therapeutics targeting fat metabolism is warranted in ER+ breast cancer.
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Affiliation(s)
- Riley A Hampsch
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jason D Wells
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Nicole A Traphagen
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Charlotte F McCleery
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jennifer L Fields
- Department of Microbiology & Immunology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Kevin Shee
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Lloye M Dillon
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Darcy B Pooler
- Department of Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Lionel D Lewis
- Department of Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Eugene Demidenko
- Department of Community & Family Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Yina H Huang
- Department of Microbiology & Immunology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jonathan D Marotti
- Department of Pathology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Comprehensive Breast Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Abigail E Goen
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - William B Kinlaw
- Department of Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Todd W Miller
- Department of Molecular & Systems Biology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. .,Department of Comprehensive Breast Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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18
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Ponnusamy S, Asemota S, Schwartzberg LS, Guestini F, McNamara KM, Pierobon M, Font-Tello A, Qiu X, Xie Y, Rao PK, Thiyagarajan T, Grimes B, Johnson DL, Fleming MD, Pritchard FE, Berry MP, Oswaks R, Fine RE, Brown M, Sasano H, Petricoin EF, Long HW, Narayanan R. Androgen Receptor Is a Non-canonical Inhibitor of Wild-Type and Mutant Estrogen Receptors in Hormone Receptor-Positive Breast Cancers. iScience 2019; 21:341-358. [PMID: 31698248 PMCID: PMC6889594 DOI: 10.1016/j.isci.2019.10.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/08/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023] Open
Abstract
Sustained treatment of estrogen receptor (ER)-positive breast cancer with ER-targeting drugs results in ER mutations and refractory unresponsive cancers. Androgen receptor (AR), which is expressed in 80%-95% of ER-positive breast cancers, could serve as an alternate therapeutic target. Although AR agonists were used in the past to treat breast cancer, their use is currently infrequent due to virilizing side effects. Discovery of tissue-selective AR modulators (SARMs) has renewed interest in using AR agonists to treat breast cancer. Using translational models, we show that AR agonist and SARM, but not antagonist, inhibit the proliferation and growth of ER-positive breast cancer cells, patient-derived tissues, and patient-derived xenografts (PDX). Ligand-activated AR inhibits wild-type and mutant ER activity by reprogramming the ER and FOXA1 cistrome and rendering tumor growth inhibition. These findings suggest that ligand-activated AR may function as a non-canonical inhibitor of ER and that AR agonists may offer a safe and effective treatment for ER-positive breast cancer.
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Affiliation(s)
- Suriyan Ponnusamy
- Department of Medicine, College of Medicine, University of Tennessee Health Science Center, 19, S. Manassas, Room 120, Memphis, TN 38103, USA
| | - Sarah Asemota
- Department of Medicine, College of Medicine, University of Tennessee Health Science Center, 19, S. Manassas, Room 120, Memphis, TN 38103, USA
| | | | - Fouzia Guestini
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keely M McNamara
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mariaelena Pierobon
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, USA
| | - Alba Font-Tello
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Xintao Qiu
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yingtian Xie
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Prakash K Rao
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Thirumagal Thiyagarajan
- Department of Medicine, College of Medicine, University of Tennessee Health Science Center, 19, S. Manassas, Room 120, Memphis, TN 38103, USA
| | | | - Daniel L Johnson
- Molecular Informatics Core, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Martin D Fleming
- Department of Medicine, College of Medicine, University of Tennessee Health Science Center, 19, S. Manassas, Room 120, Memphis, TN 38103, USA
| | - Frances E Pritchard
- Department of Medicine, College of Medicine, University of Tennessee Health Science Center, 19, S. Manassas, Room 120, Memphis, TN 38103, USA
| | | | | | | | - Myles Brown
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Emanuel F Petricoin
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, USA
| | - Henry W Long
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ramesh Narayanan
- Department of Medicine, College of Medicine, University of Tennessee Health Science Center, 19, S. Manassas, Room 120, Memphis, TN 38103, USA; West Cancer Center, Memphis, TN, USA.
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19
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Steenbruggen TG, Bouwer NI, Smorenburg CH, Rier HN, Jager A, Beelen K, Ten Tije AJ, de Jong PC, Drooger JC, Holterhues C, Kitzen JJEM, Levin MD, Sonke GS. Radiological complete remission in HER2-positive metastatic breast cancer patients: what to do with trastuzumab? Breast Cancer Res Treat 2019; 178:597-605. [PMID: 31493033 DOI: 10.1007/s10549-019-05427-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Patients with HER2-positive metastatic breast cancer (MBC) treated with trastuzumab may experience durable tumor response for many years. It is unknown if patients with durable radiological complete remission (rCR) can discontinue trastuzumab. We analyzed clinical characteristics associated with rCR and overall survival (OS) in a historic cohort of patients with HER2-positive MBC and studied the effect of stopping trastuzumab in case of rCR. METHODS We included patients with HER2-positive MBC treated with first or second-line trastuzumab-based therapy in eight Dutch hospitals between 2000 and 2014. Data were collected from medical records. We used multivariable regression models to identify independent prognostic factors for rCR and OS. Time-to-progression after achieving rCR for patients who continued and stopped trastuzumab, and breast cancer-specific survival were also evaluated. RESULTS We identified 717 patients with a median age of 53 years at MBC diagnosis. The median follow-up was 109 months (IQR 72-148). The strongest factor associated with OS was achievement of rCR, adjusted hazard ratio 0.27 (95% CI 0.18-0.40). RCR was observed in 72 patients (10%). The ten-year OS estimate for patients who achieved rCR was 52 versus 7% for patients who did not achieve rCR. Thirty patients with rCR discontinued trastuzumab, of whom 20 (67%) are alive in ongoing remission after 78 months of median follow-up since rCR. Of forty patients (58%) who continued trastuzumab since rCR, 13 (33%) are in ongoing remission after 68 months of median follow-up. Median time-to-progression in the latter group was 14 months. CONCLUSIONS Achieving rCR is the strongest predictor for improved survival in patients with HER2-positive MBC. Trastuzumab may be discontinued in selected patients with ongoing rCR. Further research is required to identify patients who have achieved rCR and in whom trastuzumab may safely be discontinued.
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Affiliation(s)
- T G Steenbruggen
- Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - N I Bouwer
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - C H Smorenburg
- Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - H N Rier
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - A Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - K Beelen
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - A J Ten Tije
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | - P C de Jong
- Department of Medical Oncology, Sint Antonius Hospital, Utrecht, Utrecht, The Netherlands
| | - J C Drooger
- Department of Medical Oncology, Ikazia Hospital, Rotterdam, The Netherlands
| | - C Holterhues
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - J J E M Kitzen
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - M -D Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - G S Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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20
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Case report: recurrent metastatic breast cancer in internal mammary dissection bed discovered at the time of coronary bypass. J Cardiothorac Surg 2019; 14:158. [PMID: 31488186 PMCID: PMC6728940 DOI: 10.1186/s13019-019-0980-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/22/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Many patients who undergo coronary artery bypass surgery have a prior history of cancer and potentially chest radiation which is a known risk factor for coronary atherosclerosis. Prior radiation increases fibrosis and can make the dissection of the left internal mammary artery (LIMA) more challenging. Case report A 72-year-old woman with a history of stage IIA pT2N0M0 left breast intraductal carcinoma treated with lumpectomy, adjuvant chemotherapy and radiation therapy 11 years prior presented to the emergency room with a non-ST elevation myocardial infarction and was taken for cardiac catheterization followed by three-vessel coronary artery bypass grafting. The LIMA was found to be encased in scar tissue and was deemed unsuitable as a conduit, and a saphenous vein graft was bypassed to the left anterior descending artery in its place. Pathologic review of the LIMA showed nests of tumor cells infiltrating within dense fibrous tissue with areas of necrosis and calcifications consistent with recurrent breast cancer. Interestingly the patients original breast cancer was positive for estrogen receptors (ER) and progesterone receptors (PR) ER and PR and negative for HER2 and she had therefore been treated with 5 years of hormonal therapy. The recurrent cancer found in the LIMA dissection bed at the time of bypass surgery was ER, PR, and HER2 negative, suggesting hormonal therapy driven clonal selection of these metastatic tumor cells. Discussion and conclusions Scarring in the LIMA dissection bed in patients with a history of cancer and prior chest radiation should be carefully evaluated for the possibility of recurrent cancer. The gross appearance of tissue can be misleading and sending a biopsy for a formal frozen section histologic evaluation should be considered if there is any question of recurrent malignancy.
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21
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Mohammed SI, Torres‐Luquis O, Walls E, Lloyd F. Lymph-circulating tumor cells show distinct properties to blood-circulating tumor cells and are efficient metastatic precursors. Mol Oncol 2019; 13:1400-1418. [PMID: 31026363 PMCID: PMC6547792 DOI: 10.1002/1878-0261.12494] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/11/2019] [Accepted: 04/25/2019] [Indexed: 01/09/2023] Open
Abstract
The leading cause of breast cancer-associated death is metastasis. In 80% of solid tumors, metastasis via the lymphatic system precedes metastasis via the vascular system. However, the molecular properties of tumor cells as they exit the primary tumor into the afferent lymphatics en route to the sentinel lymph nodes (SLNs) are not yet known. Here, we developed an innovative technique that enables the collection of lymph and lymph-circulating tumor cells (LCTCs) en route to the SLN in an immunocompetent animal model of breast cancer metastasis. We found that the gene and protein expression profiles of LCTCs and blood-circulating tumor cells (BCTCs) as they exit the primary tumor are similar, but distinct from those of primary tumors and lymph node metastases (LNMs). LCTCs, but not BCTCs, exist in clusters, display a hybrid epithelial/mesenchymal phenotype and cancer stem cell-like properties, and are efficient metastatic precursors. These results demonstrate that tumor cells that metastasize through the lymphatic system are different from those spread by blood circulation. Understanding the relative contribution of these cells to overall peripheral blood-circulating tumor cells is important for cancer therapy. Whether these two types of cell occur in cancer patients remains to be determined.
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Affiliation(s)
- Sulma I. Mohammed
- Department of Comparative Pathobiology and Purdue University Center for Cancer ResearchPurdue UniversityWest LafayetteINUSA
| | - Odalys Torres‐Luquis
- Department of Comparative Pathobiology and Purdue University Center for Cancer ResearchPurdue UniversityWest LafayetteINUSA
| | - Elwood Walls
- Department of Basic Medical SciencesPurdue UniversityWest LafayetteINUSA
| | - Frank Lloyd
- Department of Biomedical EngineeringPurdue UniversityWest LafayetteINUSA
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22
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Pillappa R, Kraft AO. Immunohistochemical validation studies in effusion cytology: A cautionary tale. Cancer Cytopathol 2019; 127:680-683. [DOI: 10.1002/cncy.22149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Raghavendra Pillappa
- Department of Pathology Virginia Commonwealth University School of Medicine Richmond Virginia
| | - Adele O. Kraft
- Department of Pathology Virginia Commonwealth University School of Medicine Richmond Virginia
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23
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Francis IM, Altemaimi RA, Al-Ayadhy B, Alath P, Jaragh M, Mothafar FJ, Kapila K. Hormone Receptors and Human Epidermal Growth Factor (HER2) Expression in Fine-Needle Aspirates from Metastatic Breast Carcinoma - Role in Patient Management. J Cytol 2019; 36:94-100. [PMID: 30992644 PMCID: PMC6425780 DOI: 10.4103/joc.joc_117_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction: Estrogen receptors (ER), progesterone receptors (PR), and epidermal growth factor (HER2) are prognostic and predictive factors for breast carcinoma. We determined them by immunohistochemistry (IHC) on cell blocks from fine-needle aspirates (FNA) of metastatic breast carcinoma to axillary lymphnodes and compared them with that reported in the primary breast carcinoma (PBC) to document any change in their expression for future management. Materials and Methods: ER, PR, and HER2 by IHC and HER2 oncogene by fluorescent in-situ hybridization (FISH) were studied on cell blocks of FNA of axillary lymphnodes in 53 of 94 PBC cases from 2012 to 2016. Results: In 25 of 38 (65.8%) ER, PR negative PBC the metastasis on FNA was ER, PR+, whereas the 15 (28.3%) ER, PRPBC remained negative. In 10 of 11 (91%) of HER2-IHC+, PBC the metastatic tumor was HER2-IHC+. 7 of 32 (21.9%) HER2-IHC negative PBC were HER2-IHC+ in metastatic tumor. HER2-FISH was performed in 37 cases on FNA. Six of 37 were HER2 amplified/positive, whereas 9 and 19 remained equivocal and negative for HER2 copy number, and 3 were not interpretable. All the 6 HER2-FISH+ cases were positive by IHC. In our study, 34.2% of ER, PR+ cases of PBC became ER, PR– in the metastatic tumor and 21.9% of HER2-IHC negative PBC became HER2-IHC+ in the metastatic aspirate. Conclusion: ER, PR, and HER2 by IHC in cell blocks of metastatic lymphnodes are reliable. Change in receptor (34.2%) and HER2 status (21.9%) was documented, which is of clinical significance as these patients warrant a change of management.
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Affiliation(s)
- Issam M Francis
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
| | | | - Bushra Al-Ayadhy
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
| | - Preeta Alath
- Laboratory Department - Cytology Unit, Kuwait Cancer Control Centre, Kuwait
| | - Mohammed Jaragh
- Laboratory Department - Cytology Unit, Kuwait Cancer Control Centre, Kuwait
| | | | - Kusum Kapila
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
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24
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Al-Saden N, Cai Z, Reilly RM. Tumor uptake and tumor/blood ratios for [ 89Zr]Zr-DFO-trastuzumab-DM1 on microPET/CT images in NOD/SCID mice with human breast cancer xenografts are directly correlated with HER2 expression and response to trastuzumab-DM1. Nucl Med Biol 2018; 67:43-51. [PMID: 30390575 DOI: 10.1016/j.nucmedbio.2018.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/15/2018] [Accepted: 10/09/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Our objective was to determine correlations between the tumor uptake and T/B ratios for 89Zr-labeled T-DM1 (89Zr-DFO-T-DM1) in mice with human BC xenografts by microPET/CT and biodistribution studies with HER2 expression and response to treatment with trastuzumab-DM1 (T-DM1). METHODS The tumor and normal tissue uptake and T/B ratios for 89Zr-DFO-T-DM1 (10 μg; 7.0 MBq) incorporated into a therapeutic dose (60 μg) were determined by microPET/CT and biodistribution studies at 96 h p.i. in NOD/SCID mice with s.c. MDA-MB-231 (5 × 104 HER2/cell), MDA-MB-361 (5 × 105 HER2/cell) and BT-474 (2 × 106 HER2/cell) human BC xenografts. Mice bearing these tumors were treated with T-DM1 (3.6 mg/kg every 3 weeks) and the tumor doubling time estimated by fitting of tumor volume vs. time curves. A tumor doubling time ratio (TDR) was calculated by dividing the doubling time for T-DM1 and normal saline treated control mice. The clonogenic survival (CS) of BC cells with increasing HER2 expression treated for 72 h in vitro with T-DM1 or trastuzumab (0-100 μg/mL) was compared. Correlations were determined between the T/B ratios for 89Zr-DFO-T-DM1 and HER2 expression, TDR and CS, and between CS and TDR. RESULTS Uptake of 89Zr-DFO-T-DM1 in MDA-MB-231, MDA-MB-361 and BT-474 tumors was 2.4 ± 0.4%ID/g, 6.9 ± 2.2%ID/g and 9.8 ± 1.1%ID/g, respectively. There was a non-linear but direct correlation between the T/B ratios for 89Zr-DFO-T-DM1 and HER2 expression with the T/B ratio ranging from 4.5 ± 0.7 for MDA-MB-231 to 18.2 ± 1.8 for MDA-MB-361 and 35.9 ± 5.1 for BT-474 xenografts. Tumor intensity on microPET/CT images was proportional to HER2 expression. The standard uptake value (SUV) for the tumors on the images was strongly correlated with the T/B ratio in biodistribution studies. There was a direct linear correlation between the T/B ratio for 89Zr-DFO-T-DM1 and TDR, with TDR ranging from 0.9 for MDA-MB-231 to 1.6 for MDA-MB-361 and 2.1 for BT-474 tumors. The cytotoxicity of T-DM1 in vitro on BC cells was dependent on HER2 expression but T-DM1 was more potent than trastuzumab. There was an inverse correlation between the TDR for mice treated with T-DM1 and CS of BC cells exposed in vitro to T-DM1. CONCLUSIONS Based on the direct correlations between the T/B ratio for 89Zr-DFO-T-DM1 by PET and HER2 expression and response to T-DM1, our results suggest that PET with 89Zr-DFO-T-DM1 may predict response of HER2-positive BC to treatment with T-DM1. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE Our results suggest that PET with 89Zr-DFO-T-DM1 may predict response to treatment with T-DM1 in HER-positive BC.
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Affiliation(s)
- Noor Al-Saden
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada
| | - Zhongli Cai
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada
| | - Raymond M Reilly
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; Toronto General Research Institute and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
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25
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Voutsadakis IA. HER2 in stemness and epithelial-mesenchymal plasticity of breast cancer. Clin Transl Oncol 2018; 21:539-555. [PMID: 30306401 DOI: 10.1007/s12094-018-1961-x] [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: 08/19/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023]
Abstract
Breast cancer had been the first non-hematologic malignancy where sub-types based on molecular characterization had entered clinical practice. HER2 over-expression, due to either gene amplification or protein up-regulation, defines one of these sub-types and is clinically exploited by addition of HER2-targeted treatments to the regimens of treatment. Nevertheless, in many occasions HER2-positive cancers are resistant or become refractory to these therapies. Several mechanisms, such as activation of alternative pathways or loss of expression of the receptor in cancer cells, have been proposed as the cause of these therapeutic failures. Cancer stem cells (CSCs, alternatively called tumor-initiating cells) comprise a small percentage of the tumor cells, but are capable of reconstituting and propagating tumors due to their superior intrinsic capacity for regeneration, survival and resistance to therapies. CSCs possess circuits enabling epigenetic plasticity which endow them with the ability to alternate between epithelial and mesenchymal states. This paper will discuss the expression and regulation of HER2 in CSCs of the different sub-types of breast cancer and relationships of the receptor with both the circuits of stemness and epithelial-mesenchymal plasticity. Therapeutic repercussions of the relationship of HER2-initiated signaling with stemness networks will also be proposed.
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Affiliation(s)
- I A Voutsadakis
- Algoma District Cancer Program, Sault Area Hospital, 750 Great Northern Road, Sault Ste. Marie, ON, P6B 0A8, Canada. .,Section of Internal Medicine, Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, ON, Canada.
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26
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Abstract
Effusion cytology plays multiple roles in the management of benign and malignant disease, from primary diagnosis to tissue allocation for ancillary diagnostic studies and biomarker testing of therapeutic targets. This article summarizes recent advances in pleural effusion cytology, with a focus on the practical application of immunohistochemical markers, cytogenetic techniques, flow cytometry, and molecular techniques for the diagnosis and management of primary and secondary neoplasms of the pleura.
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Affiliation(s)
- Christin M Lepus
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Marina Vivero
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Traditional Chinese Medicine Extract from Huaier Increases the Expression of Duffy Antigen Receptor for Chemokines and Reduces the Expression of Its Ligands. Anal Cell Pathol (Amst) 2018; 2018:6756092. [PMID: 30140603 PMCID: PMC6081536 DOI: 10.1155/2018/6756092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/10/2018] [Accepted: 06/12/2018] [Indexed: 12/31/2022] Open
Abstract
Aims The aim of the present study is to investigate whether the aqueous extract from Huaier, a traditional Chinese medicine (TCM), can affect the expression of Duffy antigen receptor for chemokines (DARC) and its ligands. Moreover, we compare the status of DARC in primary and metastatic breast cancer tissues from the same patient. Methods Immunohistochemistry was used to detect the expression of DARC in primary and metastatic focuses in 30 patients with breast cancer. The effect of Huaier aqueous extract on the expression of DARC and its ligands was investigated by quantitative real-time polymerase chain reaction, Western blotting, and enzyme-linked immunosorbent assay. Results The expression score of DARC in primary focuses was significantly higher than that in metastatic focuses, while changes of ER, PR, and HER2 receptors were not significantly different between primary and metastatic focuses. Huaier aqueous extract promoted the expression of DARC and reduced the secretion of CC chemokine ligand 2 (CCL-2), CXC chemokine ligand 8 (CXCL-8, IL-8), matrix metalloproteinase 2 (MMP-2), and CXC chemokine ligand 1 (CXCL-1). Conclusion The present study demonstrates that difference in expression level of DARC between primary and metastatic focuses of breast cancer was significant, while differences in expression of ER, PR, and HER2 between primary and metastatic focuses were not significant. DARC may play a negative role in the metastasis of breast cancer. Traditional Chinese medicine extract from Huaier can increase DARC expression and reduce the expression of its ligands such as CCL-2, IL-8, MMP-2, and CXCL-1.
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28
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Al-saden N, Lam K, Chan C, Reilly RM. Positron-Emission Tomography of HER2-Positive Breast Cancer Xenografts in Mice with 89Zr-Labeled Trastuzumab-DM1: A Comparison with 89Zr-Labeled Trastuzumab. Mol Pharm 2018; 15:3383-3393. [DOI: 10.1021/acs.molpharmaceut.8b00392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Noor Al-saden
- Department of Pharmaceutical Sciences, University of Toronto, 144 College Street, Toronto ON M5S 3M2, Canada
| | - Karen Lam
- Department of Pharmaceutical Sciences, University of Toronto, 144 College Street, Toronto ON M5S 3M2, Canada
| | - Conrad Chan
- Department of Pharmaceutical Sciences, University of Toronto, 144 College Street, Toronto ON M5S 3M2, Canada
| | - Raymond M. Reilly
- Department of Pharmaceutical Sciences, University of Toronto, 144 College Street, Toronto ON M5S 3M2, Canada
- Department of Medical Imaging, University of Toronto, 263 McCaul Street, Toronto ON M5T 1W7, Canada
- Toronto General Research Institute and Joint Department of Medical Imaging, University Health Network, 200 Elizabeth Street, Toronto ON M5G 2C4, Canada
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29
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Comparative clinicopathological and cytomorphological analyses of peritoneal carcinomatosis associated with metastatic breast carcinoma and primary peritoneal/ovarian carcinoma in patients with a history of breast carcinoma. Virchows Arch 2018; 473:165-175. [DOI: 10.1007/s00428-018-2390-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/27/2018] [Accepted: 06/11/2018] [Indexed: 12/12/2022]
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30
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18F-Fluoroestradiol PET/CT Correctly Diagnosed 18F-FDG–Avid Inflammatory Lymph Nodes in a Patient With Estrogen Receptor–Positive Breast Cancer. Clin Nucl Med 2018; 43:379-380. [DOI: 10.1097/rlu.0000000000002041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ercolani G. A Positive Conversion of Hormone Receptor Status Might Improve Survival after Liver Resection for Breast Metastases: Reply to Dr. Altundag. Dig Surg 2018; 36:90. [PMID: 29597207 DOI: 10.1159/000488218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 12/10/2022]
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Dehdashti F, Wu N, Bose R, Naughton MJ, Ma CX, Marquez-Nostra BV, Diebolder P, Mpoy C, Rogers BE, Lapi SE, Laforest R, Siegel BA. Evaluation of [ 89Zr]trastuzumab-PET/CT in differentiating HER2-positive from HER2-negative breast cancer. Breast Cancer Res Treat 2018; 169:523-530. [PMID: 29442264 DOI: 10.1007/s10549-018-4696-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/29/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate whether tumor uptake of [89Zr]trastuzumab can distinguish HER2-positive from HER2-negative breast cancer. METHODS Women with HER2-positive (n = 34) and HER2-negative (n = 16) breast cancer underwent PET/CT 5 ± 2 days following [89Zr]trastuzumab administration. HER2 status was determined based on immunohistochemistry and/or fluorescence in situ hybridization of primary or metastatic/recurrent tumor. Tumor [89Zr]trastuzumab uptake was assessed qualitatively and semiquantitatively as maximum standardized uptake value (SUVmax), and correlated with HER2 status. Additionally, intrapatient heterogeneity of [89Zr]trastuzumab uptake was evaluated. RESULTS On a per-patient basis, [89Zr]trastuzumab-PET/CT was positive in 30/34 (88.2%) HER2-positive and negative in 15/16 (93.7%) HER2-negative patients. Considering all lesions, the SUVmax was not significantly different in patients with HER2-positive versus HER2-negative disease (p = 0.06). The same was true of when only hepatic lesions were evaluated (p = 0.42). However, after excluding hepatic lesions, tumor SUVmax was significantly higher in HER2-positive compared to HER2-negative patients (p = 0.003). A cutoff SUVmax of 3.2, determined by ROC analysis, demonstrated positive-predictive value of 83.3% (95% CI 65.3%, 94.4%), sensitivity of 75.8% (57.7%, 88.9%), negative-predictive value of 50% (24.7%, 75.3%), and specificity of 61.5% (95% 31.6%, 86.1%) for differentiating HER2-positive from HER2-negative lesions. There was intrapatient heterogeneity of [89Zr]trastuzumab uptake in 20% of patients with multiple lesions. CONCLUSIONS [89Zr]trastuzumab has the potential to characterize the HER2 status of the complete tumor burden in patients with breast cancer, thus obviating repeat or multiple tissue sampling to assess intrapatient heterogeneity of HER2 status.
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Affiliation(s)
- Farrokh Dehdashti
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA. .,Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA. .,Mallinckrodt Institute of Radiology, Campus Box 8223, 510 South Kingshighway Blvd., St. Louis, MO, 63110, USA.
| | - Ningying Wu
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ron Bose
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.,Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael J Naughton
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.,Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Cynthia X Ma
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.,Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Philipp Diebolder
- Department of Radiaton Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Cedric Mpoy
- Department of Radiaton Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Buck E Rogers
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Radiaton Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Suzanne E Lapi
- Departments of Radiology and Chemistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard Laforest
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.,Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Barry A Siegel
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.,Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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Wibmer AG, Hricak H, Ulaner GA, Weber W. Trends in oncologic hybrid imaging. Eur J Hybrid Imaging 2018; 2:1. [PMID: 29782605 PMCID: PMC5954767 DOI: 10.1186/s41824-017-0019-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/07/2017] [Indexed: 11/10/2022] Open
Abstract
Hybrid imaging plays a central role in the diagnosis and management of a wide range of malignancies at all stages. In this article, we review the most pertinent historical developments, emerging clinical applications of novel radiotracers and imaging technologies, and potential implications for training and practice. This includes an overview of novel tracers for prostate, breast, and neuroendocrine tumors, assessment of tumor heterogeneity, the concept of image-guided ‘biologically relevant dosing’, and theranostic applications. Recent technological advancements, including time-of-flight PET, PET/MRI, and ‘one-minute whole-body PET’, are also covered. Finally, we discuss how these rapidly evolving applications might affect current training curricula and how imaging-derived big data could be harnessed to the benefit of our patients.
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Affiliation(s)
- Andreas G Wibmer
- 1Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA.,2Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Hedvig Hricak
- 1Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Gary A Ulaner
- 1Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA.,2Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Wolfgang Weber
- 1Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA.,2Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
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Mortimer JE, Bading JR, Park JM, Frankel PH, Carroll MI, Tran TT, Poku EK, Rockne RC, Raubitschek AA, Shively JE, Colcher DM. Tumor Uptake of 64Cu-DOTA-Trastuzumab in Patients with Metastatic Breast Cancer. J Nucl Med 2018; 59:38-43. [PMID: 28637802 PMCID: PMC5750523 DOI: 10.2967/jnumed.117.193888] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/31/2017] [Indexed: 01/18/2023] Open
Abstract
The goal of this study was to characterize the relationship between tumor uptake of 64Cu-DOTA-trastuzumab as measured by PET/CT and standard, immunohistochemistry (IHC)-based, histopathologic classification of human epidermal growth factor receptor 2 (HER2) status in women with metastatic breast cancer (MBC). Methods: Women with biopsy-confirmed MBC and not given trastuzumab for 2 mo or more underwent complete staging, including 18F-FDG PET/CT. Patients were classified as HER2-positive (HER2+) or -negative (HER2-) based on fluorescence in situ hybridization (FISH)-supplemented immunohistochemistry of biopsied tumor tissue. Eighteen patients underwent 64Cu-DOTA-trastuzumab injection, preceded in 16 cases by trastuzumab infusion (45 mg). PET/CT was performed 21-25 (day 1) and 47-49 (day 2) h after 64Cu-DOTA-trastuzumab injection. Radiolabel uptake in prominent lesions was measured as SUVmax Average intrapatient SUVmax (pt) was compared between HER2+ and HER2- patients. Results: Eleven women were HER2+ (8 immunohistochemistry 3+; 3 immunohistochemistry 2+/FISH amplified), whereas 7 were HER2- (3 immunohistochemistry 2+/FISH nonamplified; 4 immunohistochemistry 1+). Median pt for day 1 and day 2 was 6.6 and 6.8 g/mL for HER 2+ and 3.7 and 4.3 g/mL for HER2- patients (P < 0.005 either day). The distributions of pt overlapped between the 2 groups, and interpatient variability was greater for HER2+ than HER2- disease (P < 0.005 and 0.001, respectively, on days 1 and 2). Conclusion: By 1 d after injection, uptake of 64Cu-DOTA-trastuzumab in MBC is strongly associated with patient HER2 status and is indicative of binding to HER2. The variability within and among HER2+ patients, as well as the overlap between the HER2+ and HER2- groups, suggests a role for 64Cu-DOTA-trastuzumab PET/CT in optimizing treatments that include trastuzumab.
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Affiliation(s)
- Joanne E Mortimer
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - James R Bading
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - Jinha M Park
- Department of Radiology, City of Hope, Duarte, California
| | - Paul H Frankel
- Department of Information Sciences, City of Hope, Duarte, California
| | - Mary I Carroll
- Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, California
| | - Tri T Tran
- Department of Radiology, City of Hope, Duarte, California
| | - Erasmus K Poku
- Department of Cancer Immunotherapy and Tumor Immunology, Beckman Research Institute of the City of Hope, Duarte, California; and
| | - Russell C Rockne
- Department of Information Sciences, City of Hope, Duarte, California
| | - Andrew A Raubitschek
- Department of Cancer Immunotherapy and Tumor Immunology, Beckman Research Institute of the City of Hope, Duarte, California; and
| | - John E Shively
- Department of Immunology, Beckman Research Institute of the City of Hope, Duarte, California
| | - David M Colcher
- Department of Cancer Immunotherapy and Tumor Immunology, Beckman Research Institute of the City of Hope, Duarte, California; and
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Malmgren JA, Mayer M, Atwood MK, Kaplan HG. Differential presentation and survival of de novo and recurrent metastatic breast cancer over time: 1990-2010. Breast Cancer Res Treat 2017; 167:579-590. [PMID: 29039120 PMCID: PMC5790843 DOI: 10.1007/s10549-017-4529-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/27/2017] [Indexed: 01/08/2023]
Abstract
Background
Differences in de novo (dnMBC) and recurrent metastatic breast cancer (rMBC) presentation and survival over time have not been adequately described. Methods A retrospective cohort study, 1990–2010, with follow up through 2015 of dnMBC patients (stage IV at diagnosis) and rMBC patients with subsequent distant metastatic recurrence (stage I–III initial diagnosis) [dnMBC = 247, rMBC = 911)]. Analysis included Chi squared tests of categorical variables, Kaplan–Meier survival estimates, and Cox proportional adjusted hazard ratios (HzR) and 95% confidence intervals (CI). Disease specific survival (DSS) was time from diagnosis or distant recurrence to BC death. Results Over time, 1990–1998, 1999–2004, and 2005–2010, dnMBC incidence was constant (3%) and rMBC incidence decreased [18% to 7% (p < 0.001)] with no change in dnMBC hormone receptor (HR) or her2-neu (HER2) status but a decrease in rMBC HER2-positive cases and increase in triple negative breast cancer (HR-negative/HER2-negative) (p = 0.049). Five-year dnMBC DSS was 44% vs. 21% for rMBC (p < 0.001). Five-year dnMBC DSS improved over time [28% to 55% (p = 0.008)] and rMBC worsened [23% to 13%, p = 0.065)]. Worse DSS was associated with HR-negative status (HzR = 1.63; 1.41, 1.89), rMBC (HzR = 1.88; 1.58, 2.23), older age (70 +) (HzR = 1.88; 1.58, 2.24), > 1 distant metastases (HzR 1.39; 1.20, 1.62), and visceral dominant disease (HzR 1.22; 1.05, 1.43). After 1998, HER2-positive disease was associated with better DSS (HzR = 0.72, 95% CI 0.56, 0.93). Conclusions Factors associated with the widening survival gap and non-equivalence between dnMBC and rMBC and decreased rMBC incidence warrant further study.
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Affiliation(s)
- Judith A Malmgren
- HealthStat Consulting, Inc, 12025 9th Ave NW, Seattle, WA, 98177, USA. .,School of Public Health, University of Washington, Seattle, WA, USA.
| | - Musa Mayer
- Metastatic Breast Cancer Alliance, New York, NY, USA
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Adachi Y, Yoshimura M, Nishida K, Usuki H, Shibata K, Hattori M, Kondo N, Yatabe Y, Iwata H, Kikumori T, Kodera Y, Nakanishi H. Acute phase dynamics of circulating tumor cells after paclitaxel and doxorubicin chemotherapy in breast cancer mouse models. Breast Cancer Res Treat 2017; 167:439-450. [DOI: 10.1007/s10549-017-4532-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/04/2017] [Indexed: 12/11/2022]
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Hou Y, Shen R, Chaudhary S, Tonkovich D, Li Z. Utility of different immunostains for diagnosis of metastatic breast carcinomas in both surgical and cytological specimens. Ann Diagn Pathol 2017; 30:21-27. [DOI: 10.1016/j.anndiagpath.2017.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
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Trastuzumab emtansine versus treatment of physician's choice in patients with previously treated HER2-positive metastatic breast cancer (TH3RESA): final overall survival results from a randomised open-label phase 3 trial. Lancet Oncol 2017; 18:743-754. [DOI: 10.1016/s1470-2045(17)30313-3] [Citation(s) in RCA: 283] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 11/19/2022]
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Charalampoudis P, Agrogiannis G, Kontzoglou K, Kouraklis G, Sotiropoulos GC. Thyroid hormone receptor alpha (TRa) tissue expression in ductal invasive breast cancer: A study combining quantitative immunohistochemistry with digital slide image analysis. Eur J Surg Oncol 2017; 43:1428-1432. [PMID: 28583788 DOI: 10.1016/j.ejso.2017.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/02/2017] [Accepted: 05/11/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In breast cancer, hormonal receptors hold promise for developing novel targeted therapies. The thyroid exerts its actions via the thyroid hormone receptors alpha and beta. The clinical significance of the expression of thyroid hormone receptors in breast cancer is unclear. MATERIAL AND METHODS We studied thyroid hormone receptor alpha (TRa) expression in 82 samples from 41 women with ductal invasive breast cancer and no thyroid disease. We performed quantitative immunohistochemistry with digital image analysis and correlated TRa expression with clinicopathological parameters. RESULTS TRa was expressed in both normal breast epithelium and breast cancer, but expression in breast cancer was significantly lower. TRa was expressed significantly less in larger and grade III tumors. Conversely, breast cancers with lymphovascular invasion showed increased TRa expression compared to cancers without lymphovascular invasion. TRa expression was not significantly different between node-positive and node-negative breast cancers, or among different hormonal profiles and intrinsic subtypes. DISCUSSION This is the first-in-human study to combine quantitative immunohistochemistry with image analysis to study TRa expression in women with ductal invasive breast cancer and no clinical or biochemical evidence of thyroid dysfunction. We confirm that TRa is expressed in both normal and malignant breast epithelium and suggest that TRa expression is downregulated during breast carcinogenesis. Larger and higher grade breast cancers demonstrate partial loss in TRa expression. Alterations in TRa expression take place even in the absence of clinical or biochemical thyroid disease. The underlying mechanism of these findings and their potential significance in survival and relapse mandate further research.
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Affiliation(s)
- P Charalampoudis
- Breast Unit, Second Propedeutic Department of Surgery, Laiko Hospital, Athens University School of Medicine, Athens, Greece; Breast Unit, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom; Division of Cancer Studies, King's College London, United Kingdom. petros.charalampoudis.@gmail.com
| | - G Agrogiannis
- First Department of Pathology, Athens University School of Medicine, Athens, Greece
| | - K Kontzoglou
- Breast Unit, Second Propedeutic Department of Surgery, Laiko Hospital, Athens University School of Medicine, Athens, Greece
| | - G Kouraklis
- Breast Unit, Second Propedeutic Department of Surgery, Laiko Hospital, Athens University School of Medicine, Athens, Greece
| | - G C Sotiropoulos
- Breast Unit, Second Propedeutic Department of Surgery, Laiko Hospital, Athens University School of Medicine, Athens, Greece
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P-cadherin: a useful biomarker for axillary-based breast cancer decisions in the clinical practice. Mod Pathol 2017; 30:698-709. [PMID: 28084338 DOI: 10.1038/modpathol.2016.232] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023]
Abstract
Axillary lymph node metastases represent the most powerful breast cancer prognostic factor, dictating disease staging and clinical therapeutic decisions. Nonetheless, breast cancer patients with positive lymph nodes still exhibit a heterogeneous behavior regarding disease progression. Stem-like subpopulations of cancer cells show high migratory and metastatic capacity, thus we hypothesize that breast cancer stem cell markers evaluation in metastasized lymph nodes could provide a more accurate prediction of patient's prognosis. Therefore, the expression profile of P-cadherin, CD44, and CD49f, which have been already associated to stem cell properties in breast cancer, has been evaluated by immunohistochemistry in a series of 135 primary tumors and matched axillary lymph node metastases from 135 breast cancer patients. Taking in consideration the expression of the stem cell markers only in axillary nodes, P-cadherin was the only biomarker significantly associated with poor disease-free and overall patient's survival. Moreover, although a concordant expression between primary tumors and matched lymph nodes has been found in the majority of the cases, a small but significant percentage displayed divergent expression (18.2-26.2%). Remarkably, although CD44 and CD49f changes between primary tumors and lymph node metastasis did not impact survival, the cases that were positive for P-cadherin in lymph node metastases being negative in the primary tumor, presented the worst disease-free and overall survival of the whole series. Accordingly, negative cases for this marker in the lymph nodes with positive expression in the matched breast carcinoma demonstrated a better prognosis, which overlapped with tumors that were negative in both sites. P-cadherin and CD49f gain of expression was mainly found in triple-negative carcinomas. Our results indicate for the first time that the evaluation of P-cadherin expression in lymph node metastases is an important predictor of disease outcome, being a putative valuable marker for axillary-based breast cancer decisions in the clinical practice.
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Snell CE, Gough M, Middleton K, Hsieh M, Furnas L, Seidl B, Gibbons K, Pyke C, Shannon C, Woodward N, Armes JE. Absent progesterone receptor expression in the lymph node metastases of ER-positive, HER2-negative breast cancer is associated with relapse on tamoxifen. J Clin Pathol 2017; 70:954-960. [PMID: 28416639 DOI: 10.1136/jclinpath-2016-204304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/14/2017] [Accepted: 03/29/2017] [Indexed: 02/01/2023]
Abstract
AIMS Progesterone receptor (PR) expression is prognostic in early stage breast cancer. There are several reports of discordant expression between primary tumour and axillary lymph node (ALN) metastasis expression of oestrogen receptor (ER) and PR. We sought to determine whether expression of these biomarkers in the synchronous ALN metastases of ER positive (+), HER2 negative (-) breast cancer could provide more accurate prognostic information. METHODS The retrospective cohort included 229 patients from a single institution with ER+, HER2- breast cancer who had synchronous ALN metastatic disease (2005-2014). PR expression was correlated with relapse-free survival, and subset analysis was performed for patients who received adjuvant tamoxifen or an aromatase inhibitor. RESULTS One patient had an ER+ primary tumour, which was ER- in the ALN metastasis. 27 (11.3%) were PR- in the primary tumour and 56 (23.6%) in the ALN metastasis. The predominant change was from PR+ in the primary tumour to PR- in the lymph node. Absence of PR expression in the ALN was significantly associated with relapse; however, this was not the case in the primary tumour. In a subset analysis of patients taking adjuvant endocrine therapy, poorer prognosis was limited to those with PR- metastases on tamoxifen (HR=5.203, 95% CI 1.649 to 16.416, p=0.005). No significant prognostic effect of PR- metastases in patients taking aromatase inhibitors was seen (HR=1.519, 95% CI 0.675 to 3.418, p=0.312). CONCLUSIONS Evaluation of PR expression in ALN metastasis may enable prediction of patients who are less likely to benefit from adjuvant tamoxifen. This study should be replicated in other cohorts.
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Affiliation(s)
- Cameron E Snell
- Breast Cancer Research Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia.,The Department of Anatomical Pathology, Mater Pathology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Madeline Gough
- Breast Cancer Research Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia.,The Department of Anatomical Pathology, Mater Pathology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Kathryn Middleton
- The Department of Medical Oncology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Michael Hsieh
- The Department of Anatomical Pathology, Mater Pathology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Lauren Furnas
- The Department of Anatomical Pathology, Mater Pathology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Brenton Seidl
- The Department of Medical Oncology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Kristen Gibbons
- Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia
| | - Christopher Pyke
- Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia.,The Department of Breast and Endocrine Surgery, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Catherine Shannon
- The Department of Medical Oncology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Natasha Woodward
- The Department of Medical Oncology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Jane E Armes
- The Department of Anatomical Pathology, Mater Pathology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia.,Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia
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Shien T, Tanaka T, Tanabe M, Okumura Y, Masuda N, Yoshida A, Arima N, Komoike Y, Tanaka S, Iwase T, Taguchi T, Nakatsukasa K, Inaji H, Ishitobi M. Evaluation of ALDH1 expression in ipsilateral breast cancer recurrence. Oncol Lett 2016; 13:1071-1077. [PMID: 28454215 PMCID: PMC5403634 DOI: 10.3892/ol.2016.5538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/11/2016] [Indexed: 12/27/2022] Open
Abstract
Aldehyde dehydrogenase 1 (ALDH1) is a cancer stem cell (CSC) marker that is easily evaluable. The expression and clinical significance of ALDH1 in ipsilateral breast tumor recurrence (IBTR) has yet to be investigated. In the present study, the expression profile of ALDH1 and its correlation with prognosis in IBTR tissues was examined. Patients with IBTR from eight institutions were retrospectively enrolled in the study. Immunohistochemistry was used to examine ALDH1 expression patterns in the tissue specimens of primary cancers and IBTRs. ALDH1 expression levels were investigated in 182 IBTR tumors, which included cases of invasive carcinoma selected from 271 consecutive patients with IBTR. ALDH1 was expressed in 23% of the IBTR tissue samples. The rate of concordant expression between primary cancer and IBTR tissues was 68%. There was no significant association between disease-free survival (DFS) and ALDH1 expression levels in IBTR. IBTRs that expressed ALDH1 and Ki-67 had a poorer prognosis and this expression pattern was significantly associated with DFS (P=0.0073). The percentages of ALDH1 positive expression in each tissue subtype were as follows: Luminal A, 20%; luminal B, 24%; human epidermal growth factor 2 (HER2), 35%; triple-negative, 21%. There was a significant correlation between DFS and ALDH1 expression levels in HER2-type IBTR tissue specimens (P=0.034). In conclusion, it is possible that ALDH1 and Ki-67 expression levels may be useful for predicting prognosis in patients with HER2-type tumors.
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Affiliation(s)
- Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama 700-8558, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Masahiko Tanabe
- Division of Breast Oncology, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Yasuhiro Okumura
- Department of Breast and Endocrine Surgery, Kumamoto City Hospital, Kumamoto 862-8505, Japan.,Department of Breast Oncology, Department of Pathology, Kumamoto Shinto General Hospital, Kumamoto 862-8655, Japan
| | - Norikazu Masuda
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka 540-0006, Japan
| | - Atsushi Yoshida
- Department of Breast Surgery, St. Luke's International Hospital, Tokyo 104-8560, Japan
| | - Nobuyuki Arima
- Department of Breast Oncology, Department of Pathology, Kumamoto Shinto General Hospital, Kumamoto 862-8655, Japan.,Department of Pathology, Kumamoto City Hospital, Kumamoto 862-8505, Japan
| | - Yoshifumi Komoike
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Satoru Tanaka
- Section of Breast and Endocrine Surgery, Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka 569-8686, Japan
| | - Takuji Iwase
- Division of Breast Oncology, The Cancer Institute Hospital of The Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Tetsuya Taguchi
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan
| | - Katsuhiko Nakatsukasa
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan
| | - Hideo Inaji
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Makoto Ishitobi
- Department of Breast and Endocrine Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
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Jeselsohn R, Barry WT, Migliaccio I, Biagioni C, Zhao J, De Tribolet-Hardy J, Guarducci C, Bonechi M, Laing N, Winer EP, Brown M, Di Leo A, Malorni L. TransCONFIRM: Identification of a Genetic Signature of Response to Fulvestrant in Advanced Hormone Receptor-Positive Breast Cancer. Clin Cancer Res 2016; 22:5755-5764. [PMID: 27185372 PMCID: PMC5124409 DOI: 10.1158/1078-0432.ccr-16-0148] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/25/2016] [Accepted: 04/16/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Fulvestrant is an estrogen receptor (ER) antagonist and an approved treatment for metastatic estrogen receptor-positive (ER+) breast cancer. With the exception of ER levels, there are no established predictive biomarkers of response to single-agent fulvestrant. We attempted to identify a gene signature of response to fulvestrant in advanced breast cancer. EXPERIMENTAL DESIGN Primary tumor samples from 134 patients enrolled in the phase III CONFIRM study of patients with metastatic ER+ breast cancer comparing treatment with either 250 mg or 500 mg fulvestrant were collected for genome-wide transcriptomic analysis. Gene expression profiling was performed using Affymetrix microarrays. An exploratory analysis was performed to identify biologic pathways and new signatures associated with response to fulvestrant. RESULTS Pathway analysis demonstrated that increased EGF pathway and FOXA1 transcriptional signaling is associated with decreased response to fulvestrant. Using a multivariate Cox model, we identified a novel set of 37 genes with an expression that is independently associated with progression-free survival (PFS). TFAP2C, a known regulator of ER activity, was ranked second in this gene set, and high expression was associated with a decreased response to fulvestrant. The negative predictive value of TFAP2C expression at the protein level was confirmed by IHC. CONCLUSIONS We identified biologic pathways and a novel gene signature in primary ER+ breast cancers that predicts for response to treatment in the CONFIRM study. These results suggest potential new therapeutic targets and warrant further validation as predictive biomarkers of fulvestrant treatment in metastatic breast cancer. Clin Cancer Res; 22(23); 5755-64. ©2016 AACR.
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Affiliation(s)
- Rinath Jeselsohn
- Susan F. Smith Center for Women’s Cancers, Dana Farber Cancer Institute, Boston, MA
- Center for Functional Caner Epigenetics, Dana Farber Cancer Institute, Boston, MA
| | - William T. Barry
- Susan F. Smith Center for Women’s Cancers, Dana Farber Cancer Institute, Boston, MA
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute
| | - Ilenia Migliaccio
- Translational Research Unit, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
| | - Chiara Biagioni
- Translational Research Unit, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
- "Sandro Pitigliani" Medica Oncology Unit, Istituto Toscano Tumori, Prato, Italy
| | - Jin Zhao
- Center for Functional Caner Epigenetics, Dana Farber Cancer Institute, Boston, MA
| | | | - Cristina Guarducci
- Translational Research Unit, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
| | - Martina Bonechi
- Translational Research Unit, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
| | - Naomi Laing
- Astra Zeneca Pharmaceuticals, Macclesfield, United Kingdom
| | - Eric P. Winer
- Susan F. Smith Center for Women’s Cancers, Dana Farber Cancer Institute, Boston, MA
| | - Myles Brown
- Susan F. Smith Center for Women’s Cancers, Dana Farber Cancer Institute, Boston, MA
- Center for Functional Caner Epigenetics, Dana Farber Cancer Institute, Boston, MA
| | - Angelo Di Leo
- Translational Research Unit, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
- "Sandro Pitigliani" Medica Oncology Unit, Istituto Toscano Tumori, Prato, Italy
| | - Luca Malorni
- Translational Research Unit, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
- "Sandro Pitigliani" Medica Oncology Unit, Istituto Toscano Tumori, Prato, Italy
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Comparison of immunophenotypes of primary breast carcinomas and multiple corresponding distant metastases: an autopsy study of 25 patients. Clin Exp Metastasis 2016; 34:103-113. [DOI: 10.1007/s10585-016-9830-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 11/07/2016] [Indexed: 02/07/2023]
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Hou Y, Shen R, Chaudhary S, Gao F, Li Z. Correlation of Expression of Breast Biomarkers in Primary and Metastatic Breast Carcinomas: A Single-Institution Experience. Acta Cytol 2016; 60:481-489. [PMID: 27681712 DOI: 10.1159/000449400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/24/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Changes in the status of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) in metastatic breast carcinomas are frequently reported. We examined the change in the status of biomarkers in metastatic breast carcinomas. STUDY DESIGN This study cohort was composed of 137 metastatic breast carcinomas (58 surgical and 79 cytological specimens) with existing primary tumors during a study period from 2013 to 2015. RESULTS The overall change rates in metastases were 9, 21 and 6% for ER, PR and HER2, respectively. All changes were from positive in the primary tumor to negative in the metastases. The ER change rate was significantly higher in the cytological than in the surgical metastases. Six of 14 cytological metastases with positive HER2 in primary tumors showed a change in HER2 status, including 5 fluid specimens and 1 fine-needle aspiration (FNA); the other 8 had no change in HER2 status, and included 7 FNAs and 1 fluid specimen. CONCLUSION The significant percentage of cases with a change in biomarker status supports the recommendation by the College of American Pathologists to test breast biomarkers in metastases. HER2 status change was mostly identified in fluid specimens; however, the small sample size in our cohort and the fact that HER2 fluorescence in situ hybridization was not performed may warrant further studies.
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Affiliation(s)
- Yanjun Hou
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Francis IM, Alath P, George SS, Jaragh M, Al Jassar A, Kapila K. Metastatic breast carcinoma in pleural fluid: Correlation of receptor and HER2 status with the primary carcinoma-a pilot study. Diagn Cytopathol 2016; 44:980-986. [DOI: 10.1002/dc.23607] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/24/2016] [Accepted: 08/30/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Issam M. Francis
- Department of Pathology; Faculty of Medicine, Kuwait University; Kuwait
| | - Preeta Alath
- Faculty of Medicine; Kuwait University and Laboratory Department, Cytology Unit, Kuwait Cancer Control Centre; Kuwait
| | - Sara S. George
- Department of Pathology; Faculty of Medicine, Kuwait University; Kuwait
| | - Mohammed Jaragh
- Faculty of Medicine; Kuwait University and Laboratory Department, Cytology Unit, Kuwait Cancer Control Centre; Kuwait
| | - Ayesha Al Jassar
- Faculty of Medicine; Kuwait University and Laboratory Department, Cytology Unit, Kuwait Cancer Control Centre; Kuwait
| | - Kusum Kapila
- Department of Pathology; Faculty of Medicine, Kuwait University; Kuwait
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Shin HC, Han W, Moon HG, Park IA, Noh DY. Patients with Concordant Triple-Negative Phenotype between Primary Breast Cancers and Corresponding Metastases Have Poor Prognosis. J Breast Cancer 2016; 19:268-274. [PMID: 27721876 PMCID: PMC5053311 DOI: 10.4048/jbc.2016.19.3.268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/31/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose We investigated the prognostic impact of discordance between the receptor status of primary breast cancers and corresponding metastases. Methods A total 144 patients with breast cancer and distant metastasis were investigated. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status of primary tumor and corresponding metastases were assessed. Tumor phenotype according to receptor status was classified as triple-negative phenotype (TNP) or non-TNP. Concordance and discordance was determined by whether there was a change in receptor status or phenotype between primary and metastatic lesions. Results The rates of discordance between primary breast cancer and metastatic lesions were 18.1%, 25.0%, and 10.3% for ER, PR, and HER2, respectively. The rates of concordant non-TNP, concordant TNP and discordant TNP were 65.9%, 20.9%, and 13.2%, respectively. Patients with concordant ER/PR-negative status had worse postrecurrence survival (PRS) than patients with concordant ER/PR-positive and discordant ER/PR status (p=0.001 and p=0.021, respectively). Patients who converted from HER2-positive to negative after distant metastasis had worst PRS (p=0.040). Multivariate analysis showed that concordant TNP was statistically significant factor for worse PRS (p<0.001). Conclusion Discordance in receptor status and tumor phenotype between primary breast cancer and corresponding metastatic lesions was observed. Patients with concordant TNP had worse long-term outcomes than patients with concordant non-TNP and discordant TNP between primary and metastatic breast cancer. Identifying the receptor status of metastatic lesions may lead to improvements in patient management and survival.
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Affiliation(s)
- Hee-Chul Shin
- Department of Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - In-Ae Park
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Zhang C, Guan Y, Sun Y, Ai D, Guo Q. Tumor heterogeneity and circulating tumor cells. Cancer Lett 2016; 374:216-23. [DOI: 10.1016/j.canlet.2016.02.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 12/15/2022]
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Aziz S, Wik E, Knutsvik G, Klingen TA, Chen Y, Davidsen B, Aas H, Aas T, Akslen LA. Evaluation of Tumor Cell Proliferation by Ki-67 Expression and Mitotic Count in Lymph Node Metastases from Breast Cancer. PLoS One 2016; 11:e0150979. [PMID: 26954367 PMCID: PMC4783103 DOI: 10.1371/journal.pone.0150979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/22/2016] [Indexed: 01/16/2023] Open
Abstract
Few studies have addressed the risk of recurrence by assessing proliferation markers in lymph node metastasis from breast cancer. Here, we aimed to examine Ki-67 expression and mitotic count in lymph nodes in comparison with primary tumors. A cohort of node positive breast cancer (n = 168) was studied as a part of the prospective Norwegian Breast Cancer Screening Program (1996-2009). The percentage of Ki-67 positivity was counted per 500 tumor cells in hot-spot areas (x630). Mitotic count was conducted in the most cellular and mitotic active areas in 10 high power fields (x400). Our results showed that Ki-67 and mitotic count were significantly correlated between primary tumor and lymph nodes (Spearman`s correlation 0. 56 and 0.46, respectively) and were associated with most of the histologic features of the primary tumor. Univariate survival analysis (log-rank test) showed that high Ki-67 and mitotic count in the primary tumor and lymph node metastasis significantly predicted risk of recurrence. In multivariate analysis, mitotic count in the lymph node metastasis was an independent predictor of tumor recurrence. In conclusion, proliferation markers in lymph node metastases significantly predicted disease free survival in node positive breast cancer.
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Affiliation(s)
- Sura Aziz
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Elisabeth Wik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Gøril Knutsvik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Tor Audun Klingen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ying Chen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Akerhus University Hospital, Lørenskog, Norway
| | | | - Hans Aas
- Department of Surgery, Vestfold Hospital Trust, Tønsberg, Norway
| | - Turid Aas
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - Lars A. Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
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Inno A, Bogina G, Turazza M, Bortesi L, Duranti S, Massocco A, Zamboni G, Carbognin G, Alongi F, Salgarello M, Gori S. Neuroendocrine Carcinoma of the Breast: Current Evidence and Future Perspectives. Oncologist 2015; 21:28-32. [PMID: 26659223 DOI: 10.1634/theoncologist.2015-0309] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/27/2015] [Indexed: 01/30/2023] Open
Abstract
UNLABELLED : Neuroendocrine carcinoma of the breast is considered a rare entity, and for this reason there are no data from prospective clinical trials on its optimal management. Early stage tumors are usually treated with the same strategy used for the other types of invasive breast cancer. Anthracycline- and taxane-based regimens represent the most frequently administered chemotherapy in neoadjuvant and adjuvant setting, as well as for metastatic disease, although combinations of platinum compounds and etoposide have been widely used, in particular for small-cell histology and tumors with a high proliferation index. For metastatic disease, a multimodality therapeutic strategy can be considered on an individual basis, with chemotherapy, endocrine therapy, peptide receptor radionuclide therapy, radiation therapy, surgery, or a combination of the above. In the near future, a better knowledge of the biology of these tumors will hopefully provide new therapeutic targets for personalized treatment. In this review, we discuss the current evidence and the future perspectives on diagnosis and treatment of neuroendocrine carcinoma of the breast. IMPLICATIONS FOR PRACTICE Neuroendocrine carcinoma of the breast (NECB) is a distinct entity of breast cancer. Clinical features and morphology are not helpful to distinguish NECB from other subtypes of breast cancer; therefore, immunohistochemistry markers for neuroendocrine differentiation, mainly chromogranin and synaptophysin, should be routinely used to confirm the diagnosis, especially in cases of mucinous or solid papillary carcinoma in which the suspicion of NECB may be relevant. Adjuvant treatment should be offered according to the same recommendations given for the other types of invasive breast cancer. An accurate diagnosis of NECB is also important in the metastatic setting, in which a multimodality approach including specific therapies such as peptide receptor radionuclide therapy can be considered.
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Affiliation(s)
- Alessandro Inno
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Giuseppe Bogina
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Monica Turazza
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Laura Bortesi
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Simona Duranti
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Alberto Massocco
- Department of Surgery, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Giuseppe Zamboni
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Giovanni Carbognin
- Department of Radiology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Filippo Alongi
- Department of Radiotherapy, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Matteo Salgarello
- Department of Nuclear Medicine, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Stefania Gori
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
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