Emerging targeted therapies for breast cancer

A polydopamine-based platform for anti-cancer drug delivery

Cancer is the second leading cause of death in the world with around 9.6 million deaths in 2018, approximately 70% of which occurred in the middle- and low-income countries; moreover, the economic impact of cancer is significant and escalating day by day. The total annual economic cost of cancer treatment in 2010 was estimated at approximately US$ 1.16 trillion. Researchers have explored cancer mitigation therapies such as chemo-thermal therapy, chemo-photothermal therapy and photodynamic-photothermal therapy. These combinational therapies facilitate better control on the tunability of the carrier for effectively diminishing cancer cells than individual therapies such as chemotherapy, photothermal therapy and targeted therapy. All these therapies come under novel drug delivery systems in which anti-cancer drugs attack the cancerous cells due to various stimuli (e.g. pH, thermal, UV, IR, acoustic and magnetic)-responsive properties of the anti-cancer drug carriers. Compared to conventional drug delivery systems, the novel drug delivery systems have several advantages such as targeted drug release, sustained and consistent blood levels within the therapeutic window, and decreased dosing frequency. Among the numerous polymeric carriers developed for drug delivery, polydopamine has been found to be more suitable as a carrier for these drug delivery functions due to its easy and cost-effective fabrication, excellent biocompatibility, multi-drug carrier capacity and stimuli sensitivity. Therefore, in this review, we have explored polydopamine-based carriers for anti-cancer drug delivery systems to mitigate cancer and simultaneously discussed basic synthesis routes for polydopamine.

The expression of TRMT2A, a novel cell cycle regulated protein, identifies a subset of breast cancer patients with HER2 over-expression that are at an increased risk of recurrence

Background

Over-expression of HER2 in a subset of breast cancers (HER2+) is associated with high histological grade and aggressive clinical course. Despite these distinctive features, the differences in response of HER2+ patients to both adjuvant cytotoxic chemotherapy and targeted therapy (e.g. trastuzumab) suggests that unrecognized biologic and clinical diversity is confounding treatment strategies. Furthermore, the small but established risk of cardiac morbidity with trastuzumab therapy compels efforts towards the identification of biomarkers that might help stratify patients.

Methods

A single institution tissue array cohort assembled at the Clearview Cancer Institute of Huntsville (CCIH) was screened by immunohistochemistry staining using a large number of novel and commercially available antibodies to identify those with a univariate association with clinical outcome in HER2+ patients. Staining with antibody directed at TRMT2A was found to be strongly associated with outcome in HER2+ patients. This association with outcome was tested in two independent validation cohorts; an existing staining dataset derived from tissue assembled at the Cleveland Clinic Foundation (CCF), and in a new retrospective study performed by staining archived paraffin blocks available at the Roswell Park Cancer Institute (RPCI).

Results

TRMT2A staining showed a strong correlation with likelihood of recurrence at five years in 67 HER2+ patients from the CCIH discovery cohort (HR 7.0; 95% CI 2.4 to 20.1, p < 0.0004). This association with outcome was confirmed using 75 HER2+ patients from the CCF cohort (HR 3.6; 95% CI 1.3 to 10.2, p < 0.02) and 64 patients from the RPCI cohort (HR 3.4; 95% CI 1.3-8.9, p < 0.02). In bivariable analysis the association with outcome was independent of grade, tumor size, nodal status and the administration of conventional adjuvant chemotherapy in the CCIH and RPCI cohorts.

Conclusions

Studies from three independent single institution cohorts support TRMT2A protein expression as a biomarker of increased risk of recurrence in HER2+ breast cancer patients. These results suggest that TRMT2A expression should be further studied in the clinical trial setting to explore its predictive power for response to adjuvant cytotoxic chemotherapy in combination with HER2 targeted therapy.