Steroid hormones and cancer: (II) Lessons from experimental systems

Long-term treatment with the pure anti-estrogen fulvestrant durably remodels estrogen signaling in BG-1 ovarian cancer cells

Most ovarian cancers are estrogen-positive and hormonal treatments using anti-estrogens or aromatase inhibitors are under investigation for treating the tumors that are resistant to conventional therapies. In this study, the long-term effects of two anti-estrogens, namely 4-hydroxytamoxifen and fulvestrant (or ICI182,780), were investigated in ERα-positive BG1 epithelial ovarian cancer cells. To this aim, cells were grown in the presence of anti-estrogen concentrations that were sufficient to saturate the estrogen receptors, but were neither cytotoxic nor cytostatic as indicated by the absence of inhibition of cell proliferation. In these conditions and despite the lack of cytostatic effect of the drugs, long-term treatment (3 months) with the pure anti-estrogen fulvestrant induced a specific, reproducible and irreversible inhibition of ERα expression. This inhibition was accompanied by loss of estrogen-induced cell proliferation and gene expression as indicated by the analysis of several estrogen-responsive genes. ERα down-regulation was not linked to deregulated expression of transcription factors which drive ERα transcription and did not involve DNA methylation or histone deacetylation. Altogether, these results demonstrate that non-cytotoxic concentrations of pure anti-estrogens affect estrogen signaling and might be relevant for the treatment for ovarian cancers.

Aurora-A expression, hormone receptor status and clinical outcome in hormone related cancers

AIMS

We investigated the correlation between protein expression of Aurora-A with hormone receptor expression and clinicopathological parameters in ovarian, breast and prostate cancer.

METHODS

Subcellular expression of Aurora-A, and androgen receptor (AR), oestrogen receptor (ER) and progesterone receptor (PR) expression, were examined by immunohistochemistry in human tissue microarrays of the three cancer types and by Western blot in cancer cell lines and selected patient tissues.

RESULTS

Subgroups of all three cancer types exhibited both nuclear and cytoplasmic expression of Aurora-A. Nuclear presence of Aurora-A was observed in ER positive and negative breast cancer cell lines and tissues. Eighteen of the 126 (14%) tumour tissues that showed nuclear expression of Aurora-A were strongly associated with ER and PR positive breast tumours (p = 0.001). Cytoplasmic expression of AR and Aurora-A was strongly associated in prostate cancer tissues (45% versus 0, p = 0.015). Ovarian tumours (n = 45) with Aurora-A nuclear expression had decreased patient survival (mean survival, 29.5 versus 106.7 months; p < 0.0005) and showed a significant association with recurrence-free survival (mean survival 19.7 versus 95.9 months; p = 0.002).

CONCLUSION

Association between nuclear Aurora-A with hormone receptors in breast cancer and with poor clinical outcome in ovarian cancer suggests the significance of active Aurora-A in disease initiation and progression.

Breast response to menopausal hormone therapy--aspects on proliferation, apoptosis and mammographic density

Breast cancer is the major malignancy among women in the Western world. The breast is clearly a target organ for sex steroid hormones and hormonal treatments have been associated with an increased risk of breast cancer. The balance between proliferation and apoptosis is important for breast cell homeostasis. Mammographic breast density has been identified as a strong and independent risk factor for breast cancer. It seems clear that there is a difference between various hormonal treatments with regard to their effects on breast density and cell proliferation. Also, not all women respond similarly to the same treatment. Combined estrogen and progestogen therapy generally will enhance density and proliferation more than treatment with estrogen alone. Certain constitutional and hormonal factors appear to be predictive of breast reactivity. Older women with a low body mass index respond more strongly to treatment. Estrogen levels have a positive and androgens a negative association to increase in density and proliferation. A combination of increased proliferation and decreased apoptosis could be one mechanism to explain the excess risk of breast cancer during combined estrogen/progestogen treatment. Tibolone seems to have less impact on breast response than conventional hormone therapy. Efforts should be made to identify those women with an adverse response to treatment as well as therapeutic principles with the least possible influence on the breast.

Mammographic breast density, hormones, and growth factors during continuous combined hormone therapy

OBJECTIVE

To study the effect on mammographic breast density of two different continuous combined regimens for hormone therapy.

DESIGN

Randomized clinical study.

SETTING

University hospital.

PATIENT(S)

Postmenopausal women without any previous history of breast disorder.

INTERVENTION(S)

The women received either estradiol valerate/dienogest or estradiol/norethisterone acetate. Mammograms and venous blood samples were obtained at baseline and after 6 months.

MAIN OUTCOME MEASURE(S)

Change in mammographic breast density. Correlations with levels of hormones, growth factors, and binding proteins.

RESULT(S)

An increase in mammographic density was recorded in approximately 50% of the women, and there were no differences between treatments. Increased density showed a positive correlation with estradiol, estrone, and sex hormone-binding globulin and showed a negative association to free T. Among hormonal factors, levels of free T were the most important for predicting increased density.

CONCLUSION(S)

Continuous combined hormone therapy with different progestogens has a marked impact on the breast.

Hormonal interactions in ovarian cancer

According to the epidemiologic literature and the laboratory characterization of receptor content and molecular interactions, there is a relationship between the microenvironment of ovarian cancer and steroid hormones. Advances in our knowledge of the molecular-hormonal nature of ovarian cancer will help in designing a rationale for clinical trials in appropriate subsets of patients. However, currently, development of successful therapies and prevention strategies for women at risk remains a true challenge.