1
|
Padevit L, Vasella F, Friedman J, Mutschler V, Jenkins F, Held U, Rushing EJ, Wirsching HG, Weller M, Regli L, Neidert MC. A prognostic model for tumor recurrence and progression after meningioma surgery: preselection for further molecular work-up. Front Oncol 2023; 13:1279933. [PMID: 38023177 PMCID: PMC10646388 DOI: 10.3389/fonc.2023.1279933] [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: 08/18/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The selection of patients for further therapy after meningioma surgery remains a challenge. Progress has been made in this setting in selecting patients that are more likely to have an aggressive disease course by using molecular tests such as gene panel sequencing and DNA methylation profiling. The aim of this study was to create a preselection tool warranting further molecular work-up. Methods All patients undergoing surgery for resection or biopsy of a cranial meningioma from January 2013 until December 2018 at the University Hospital Zurich with available tumor histology were included. Various prospectively collected clinical, radiological, histological and immunohistochemical variables were analyzed and used to train a logistic regression model to predict tumor recurrence or progression. Regression coefficients were used to generate a scoring system grading every patient into low, intermediate, and high-risk group for tumor progression or recurrence. Results Out of a total of 13 variables preselected for this study, previous meningioma surgery, Simpson grade, progesterone receptor staining as well as presence of necrosis and patternless growth on histopathological analysis of 378 patients were included into the final model. Discrimination showed an AUC of 0.81 (95% CI 0.73 - 0.88), the model was well-calibrated. Recurrence-free survival was significantly decreased in patients in intermediate and high-risk score groups (p-value < 0.001). Conclusion The proposed prediction model showed good discrimination and calibration. This prediction model is based on easily obtainable information and can be used as an adjunct for patient selection for further molecular work-up in a tertiary hospital setting.
Collapse
Affiliation(s)
- Luis Padevit
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Flavio Vasella
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jason Friedman
- Department of Informatics, Eidgenössische Technische Hochschule (ETH) Zürich, Zurich, Switzerland
| | - Valentino Mutschler
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Freya Jenkins
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Elisabeth Jane Rushing
- Department of Neuropathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hans-Georg Wirsching
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marian Christoph Neidert
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
2
|
Hurvitz SA, Bardia A, Quiroga V, Park YH, Blancas I, Alonso-Romero JL, Vasiliev A, Adamchuk H, Salgado M, Yardley DA, Berzoy O, Zamora-Auñón P, Chan D, Spera G, Xue C, Ferreira E, Badovinac Crnjevic T, Pérez-Moreno PD, López-Valverde V, Steinseifer J, Fernando TM, Moore HM, Fasching PA. Neoadjuvant palbociclib plus either giredestrant or anastrozole in oestrogen receptor-positive, HER2-negative, early breast cancer (coopERA Breast Cancer): an open-label, randomised, controlled, phase 2 study. Lancet Oncol 2023; 24:1029-1041. [PMID: 37657462 DOI: 10.1016/s1470-2045(23)00268-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/10/2023] [Accepted: 05/24/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND The development of more potent selective oestrogen receptor antagonists and degraders (SERDs) that can be orally administered could help to address the limitations of current endocrine therapies. We report the primary and final analyses of the coopERA Breast Cancer study, designed to test whether giredestrant, a highly potent, non-steroidal, oral SERD, would show a stronger anti-proliferative effect than anastrozole after 2 weeks for oestrogen receptor-positive, HER2-negative, untreated early breast cancer. METHODS In this open-label, randomised, controlled, phase 2 study, postmenopausal women were eligible if they were aged 18 years or older; had clinical T stage (cT)1c to cT4a-c (≥1·5 cm within cT1c) oestrogen receptor-positive, HER2-negative, untreated early breast cancer; an Eastern Cooperative Oncology Group performance status of 0-1; and baseline Ki67 score of at least 5%. The study was conducted at 59 hospital or clinic sites in 11 countries globally. Participants were randomly assigned (1:1) to giredestrant 30 mg oral daily or anastrozole 1 mg oral daily on days 1-14 (window-of-opportunity phase) via an interactive web-based system with permuted-block randomisation with block size of four. Randomisation was stratified by cT stage, baseline Ki67 score, and progesterone receptor status. A 16-week neoadjuvant phase comprised the same regimen plus palbociclib 125 mg oral daily on days 1-21 of a 28-day cycle, for four cycles. The primary endpoint was geometric mean relative Ki67 score change from baseline to week 2 in patients with complete central Ki67 scores at baseline and week 2 (window-of-opportunity phase). Safety was assessed in all patients who received at least one dose of study drug. The study is registered with ClinicalTrials.gov (NCT04436744) and is complete. FINDINGS Between Sept 4, 2020, and June 22, 2021, 221 patients were enrolled and randomly assigned to the giredestrant plus palbociclib group (n=112; median age 62·0 years [IQR 57·0-68·5]) or anastrozole plus palbociclib group (n=109; median age 62·0 [57·0-67·0] years). 15 (7%) of 221 patients were Asian, three (1%) were Black or African American, 194 (88%) were White, and nine (4%) were unknown races. At data cutoff for the primary analysis (July 19, 2021), the geometric mean relative reduction of Ki67 from baseline to week 2 was -75% (95% CI -80 to -70) with giredestrant and -67% (-73 to -59) with anastrozole (p=0·043), meeting the primary endpoint. At the final analysis (data cutoff Nov 24, 2021), the most common grade 3-4 adverse events were neutropenia (29 [26%] of 112 in the giredestrant plus palbociclib group vs 29 [27%] of 109 in the anastrozole plus palbociclib group) and decreased neutrophil count (17 [15%] vs 16 [15%]). Serious adverse events occurred in five (4%) patients in the giredestrant plus palbociclib group and in two (2%) patients in the anastrozole plus palbociclib group. There were no treatment-related deaths. One patient died due to an adverse event in the giredestrant plus palbociclib group (myocardial infarction). INTERPRETATION Giredestrant offers encouraging anti-proliferative and anti-tumour activity and was well tolerated, both as a single agent and in combination with palbociclib. Results justify further investigation in ongoing trials. FUNDING F Hoffmann-La Roche.
Collapse
Affiliation(s)
- Sara A Hurvitz
- Breast Cancer Clinical Trials Program, Division of Hematology-Oncology, David Geffen School of Medicine, Clinical Research Unit, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Aditya Bardia
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vanesa Quiroga
- GEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain; Catalan Institute of Oncology Badalona, Barcelona, Spain
| | | | - Isabel Blancas
- GEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain; Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada, Granada, Spain; Medicine Department, Granada University, Granada, Spain
| | - José Luis Alonso-Romero
- GEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain; Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Aleksandr Vasiliev
- NSHI Road Clinical Hospital of JSC Russian Railways, Saint Petersburg, Russia
| | - Hryhoriy Adamchuk
- Communal Enterprise Kryvyi Rih Oncology Dispensary, Kryvyi Rih, Ukraine
| | | | - Denise A Yardley
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN, USA
| | - Oleksandr Berzoy
- Communal Non-profit Enterprise Odesa Regional Clinical Hospital of Odesa Regional Council, Odesa, Ukraine
| | - Pilar Zamora-Auñón
- GEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain; Hospital Universitario La Paz, Madrid, Spain
| | - David Chan
- Torrance Memorial Hunt Cancer Center, Torrance, CA, USA
| | - Gonzalo Spera
- Translational Research in Oncology (TRIO), Montevideo, Uruguay
| | - Cloris Xue
- F Hoffmann-La Roche, Toronto, ON, Canada
| | | | | | | | | | | | | | | | - Peter A Fasching
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
3
|
Bliss JM, Tovey H, Evans A, Holcombe C, Horgan K, Mallon E, Vidya R, Skene A, Dodson A, Hills M, Detre S, Zabaglo L, Banerji J, Kilburn L, Morden JP, Robertson JFR, Smith I, Dowsett M. Clinico-pathologic relationships with Ki67 and its change with short-term aromatase inhibitor treatment in primary ER + breast cancer: further results from the POETIC trial (CRUK/07/015). Breast Cancer Res 2023; 25:39. [PMID: 37046348 PMCID: PMC10099675 DOI: 10.1186/s13058-023-01626-3] [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: 12/02/2022] [Accepted: 02/27/2023] [Indexed: 04/14/2023] Open
Abstract
PURPOSE Ki67 assessed at diagnosis (Ki67baseline) is an important prognostic factor in primary oestrogen receptor-positive (ER +) breast cancer. Proportional change in Ki67 after 2 weeks (∆Ki672week) is associated with clinical benefit from endocrine therapies and residual Ki67 (Ki672week) with recurrence-free survival. The aim was to define the association between Ki67baseline and after aromatase inhibitor (AI) exposure ∆Ki672week and Ki672week with key prognostic and biologic factors utilising data from the POETIC study. PATIENTS AND METHODS In POETIC 4480 postmenopausal patients with primary ER and/or PgR + breast cancer were randomised 2:1 to 2 weeks' presurgical AI (anastrozole or letrozole) or no presurgical treatment (control). Ki67 was measured centrally in core-cut biopsies taken prior to AI and in core-cuts or the excision biopsy at surgery. Relationships between the Ki67 and biologic factors were explored using linear regression. RESULTS Established associations of Ki67baseline with biologic factors including PgR status, tumour grade, tumour size, histological subtype, nodal status, and vascular invasion were confirmed in the HER2- subpopulation. In the HER2 + subpopulation only grade and tumour size were significantly associated with Ki67baseline. In control group Ki672week was 18% lower than Ki67baseline (p < 0.001) when Ki672week was measured in excision biopsies but not when measured in core-cuts. Median suppression by AIs (∆Ki672week) was 79.3% (IQR: -89.9 to -54.6) and 53.7% (IQR: -78.9 to -21.1) for HER2-negative and HER2-positive cases, respectively. Significantly less suppression occurred in PgR- vs PgR + and HER2 + vs HER2- tumours which remained apparent after adjustment for 2-week sample type. CONCLUSIONS The magnitude of this study allowed characterisation of relationships between Ki67baseline, ∆Ki672week and Ki672week with high degrees of confidence providing a reference source for other studies. Lower values of Ki67 occur when measured on excision biopsies and could lead to apparent but artefactual decreases in Ki67: this should be considered when either ∆Ki672week or Ki672week is used in routine clinical practice to aid treatment decisions or in clinical trials assessing new drug therapies.
Collapse
Affiliation(s)
- Judith M Bliss
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK.
| | - Holly Tovey
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | | | | | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | | | | | | | - Andrew Dodson
- UK NEQAS for Immunocytochemistry and In-Situ Hybridisation, London, UK
| | - Margaret Hills
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, and Breast Cancer Now Centre, The Institute of Cancer Research, London, UK
| | - Simone Detre
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, and Breast Cancer Now Centre, The Institute of Cancer Research, London, UK
| | - Lila Zabaglo
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, and Breast Cancer Now Centre, The Institute of Cancer Research, London, UK
| | - Jane Banerji
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Lucy Kilburn
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - James P Morden
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | | | - Ian Smith
- Breast Unit, Royal Marsden Hospital, London, UK
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, and Breast Cancer Now Centre, The Institute of Cancer Research, London, UK
| |
Collapse
|
4
|
Alataki A, Zabaglo L, Tovey H, Dodson A, Dowsett M. A simple digital image analysis system for automated Ki67 assessment in primary breast cancer. Histopathology 2021; 79:200-209. [PMID: 33590538 DOI: 10.1111/his.14355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/16/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
AIMS Ki67 is a well-established immunohistochemical marker associated with cell proliferation that has prognostic and predictive value in breast cancer. Quantitative evaluation of Ki67 is traditionally performed by assessing stained tissue slides with light microscopy. Automated image analysis systems have become available and, if validated, could provide greater standardisation and improved precision of Ki67 scoring. Here, we aimed to evaluate the use of the Cognition Master Professional Suite (CogM) image analysis software, which is a simple system for scoring Ki67 in primary breast cancer samples. METHODS AND RESULTS Sections from 94 core-cut biopsies, 20 excision specimens and 29 pairs of core-cut biopsies and excision specimens were stained for Ki67 with MIB1 antibody and the Dako EnVision FLEX Detection System. Stained slides were scanned to convert them to digital data. Computer-based Ki67 scoring was performed with CogM. Manual Ki67 scoring assessment was conducted on previously stained sections from the same biopsies with a clinically validated system that had been calibrated against the risk of recurrence. A high correlation between manual and digital scores was observed [rCores = 0.92, 95% confidence interval (CI) 0.87-0.94, P < 0.0001; rExcisions = 0.95, 95% CI 0.86-0.98, P < 0.0001] and there was no significant bias between them (P = 0.45). There was also a high correlation of Ki67 scores between paired core-cut biopsies and excision specimens when CogM was used (r = 0.78, 95% CI 0.59-0.89, P < 0.0001). CONCLUSIONS CogM image analysis allows for standardised automated Ki67 scoring that accurately replicates previously clinically validated and calibrated manual scores.
Collapse
Affiliation(s)
- Anastasia Alataki
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital and The Institute of Cancer Research, London, UK.,The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Lila Zabaglo
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital and The Institute of Cancer Research, London, UK.,The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Andrew Dodson
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital and The Institute of Cancer Research, London, UK.,The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| |
Collapse
|
5
|
Nitz U, Gluz O, Kreipe HH, Christgen M, Kuemmel S, Baehner FL, Shak S, Aktas B, Braun M, Lüdtke-Heckenkamp K, Forstbauer H, Grischke EM, Nuding B, Darsow M, Schumacher C, Krauss K, Malter W, Thill M, Warm M, Wuerstlein R, Kates RE, Harbeck N. The run-in phase of the prospective WSG-ADAPT HR+/HER2- trial demonstrates the feasibility of a study design combining static and dynamic biomarker assessments for individualized therapy in early breast cancer. Ther Adv Med Oncol 2020; 12:1758835920973130. [PMID: 33281950 PMCID: PMC7692353 DOI: 10.1177/1758835920973130] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/23/2020] [Indexed: 01/30/2023] Open
Abstract
Background: Endocrine sensitivity, as determined by response of the proliferation marker Ki-67 to short-term preoperative endocrine therapy (ET), is currently not included in adjuvant treatment decisions in hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)− breast cancer (BC). Methods: The prospective WSG-ADAPT HR+/HER2− trial included patients with N0/N1 early BC who were candidates for adjuvant chemotherapy based on clinical–pathological criteria alone. The trial utilized a genomic assessment [the Recurrence Score (RS)] plus endocrine sensitivity testing to guide treatment. All patients received 3 (±1) weeks of preoperative induction ET. According to protocol, patients with RS 0–11 or RS 12–25 plus endocrine proliferation response (EPR, post-induction Ki-67 ⩽ 10%) were to be spared adjuvant chemotherapy. Results: The ADAPT HR+/HER2− trial run-in phase included 407 patients with baseline RS, of whom 386 (median age: 54 years) had complete data for Ki-67 at both baseline and post-induction. RS distribution: 23.1% RS 0–11, 58.3% RS 12–25, and 18.7% RS 26–100. EPR occurred in 84.3%, 76.0%, and 36.1% of these RS groups, respectively. Differences in EPR proportions (RS 26–100 versus others, RS 0–11 versus others) were significant (both p < 0.001); Ki-67 quotients were higher for RS 26–100 (p = 0.02, Mann–Whitney). In premenopausal women (n = 146, mostly tamoxifen-treated), median quotient of Ki-67 level (post/pre) was significantly higher than in postmenopausal women (n = 222, mostly aromatase-inhibitor treated; 0.67 versus 0.25, p < 0.001). EPR was significantly associated with baseline estrogen-receptor status as determined by immunohistochemistry (p = 0.002) or real-time polymerase chain reaction (p < 0.001). Also, a strong correlation was observed between RS measured pre- and post-ET (RS = 0.7, n = 181). Conclusions: This phase of the WSG-ADAPT HR+/HER2− trial confirms trial design estimates of RS and EPR. It indicates that the ADAPT concept of combining static and dynamic biomarker assessment for individualized therapy decisions in early BC is feasible using the EPR criterion post-induction Ki-67 ⩽ 10%. Clinicaltrials.gov identifier: NCT01779206.
Collapse
Affiliation(s)
- Ulrike Nitz
- West German Study Group, Moenchengladbach, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany
| | - Hans H Kreipe
- Medical College of Hannover, Institute for Pathology, Hannover, Germany
| | | | | | | | | | - Bahriye Aktas
- University Clinics Essen, Women's Clinic, Essen, Germany University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | | | | | | | - Benno Nuding
- Ev. Hospital Bergisch Gladbach, Bergisch Gladbach, Germany
| | - Maren Darsow
- Luisenhospital Duesseldorf, Practice for Senologic Oncology, Duessedorf, Germany
| | | | - Katja Krauss
- University Clinics Aachen, Women's Clinic, Aachen, Germany
| | - Wolfram Malter
- University Clinics Cologne, Women's Clinic and Breast Center, Cologne, Germany
| | - Marc Thill
- Markus Hospital, Breast Center, Frankfurt, Germany
| | - Mathias Warm
- City Hospital Holweide, Breast Center, Cologne, Germany
| | | | | | - Nadia Harbeck
- Breast Center, Department OB&GYN and CCCLMU, LMU University Hospital, Marchioninistrasse 15, Munich DE-81377, Germany
| |
Collapse
|
6
|
Dowsett M, Ellis MJ, Dixon JM, Gluz O, Robertson J, Kates R, Suman VJ, Turnbull AK, Nitz U, Christgen M, Kreipe H, Kuemmel S, Bliss JM, Barry P, Johnston SR, Jacobs SA, Ma CX, Smith IE, Harbeck N. Evidence-based guidelines for managing patients with primary ER+ HER2- breast cancer deferred from surgery due to the COVID-19 pandemic. NPJ Breast Cancer 2020; 6:21. [PMID: 32550266 PMCID: PMC7280290 DOI: 10.1038/s41523-020-0168-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/21/2020] [Indexed: 12/24/2022] Open
Abstract
Many patients with ER+ HER2- primary breast cancer are being deferred from surgery to neoadjuvant endocrine therapy (NeoET) during the COVID-19 pandemic. We have collated data from multiple international trials of presurgical endocrine therapy in order to provide guidance on the identification of patients who may have insufficiently endocrine-sensitive tumors and should be prioritised for early surgery or neoadjuvant chemotherapy rather than NeoET during or in the aftermath of the COVID-19 pandemic for safety or when surgical activity needs to be prioritized. For postmenopausal patients, our data provide strong support for the use of ER and PgR status at diagnosis for triaging of patients into three groups in which (taking into account clinical factors): (i) NeoET is likely to be inappropriate (Allred ER <6 or ER 6 and PgR <6) (ii) a biopsy for Ki67 analysis (on-treatment Ki67) could be considered after 2-4 weeks of NeoET (a: ER 7 or 8 and PgR <6 or b: ER 6 or 7 and PgR ≥6) or (iii) NeoET is an acceptable course of action (ER 8 and PgR ≥6). Cut-offs for percentage of cells positive are also given. For group (ii), a high early on-treatment level of Ki67 (>10%) indicates a higher priority for early surgery. Too few data were available for premenopausal patients to provide a similar treatment algorithm. These guidelines should be helpful for managing patients with early ER+ HER2- breast cancer during and in the aftermath of the COVID-19 crisis.
Collapse
Affiliation(s)
- Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
- Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK
| | - Matthew J. Ellis
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX USA
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX USA
- Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | | | - Oleg Gluz
- Bethesda Hospital, Breast Center Niederrhein, Mönchengladbach, Germany
- Westdeutsche Studiengruppe, Mönchengladbach, Germany
- Uniklinik Köln, Köln, Germany
| | - John Robertson
- University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, UK
| | - Ronald Kates
- West German Study Group, Mönchengladbach, Germany
| | - Vera J. Suman
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | - Arran K. Turnbull
- CRUK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Ulrike Nitz
- Bethesda Hospital, Breast Center Niederrhein, Mönchengladbach, Germany
| | | | - Hans Kreipe
- Medical School Hannover, Institute of Pathology, Hannover, Germany
| | | | - Judith M. Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Peter Barry
- Breast Unit, Royal Marsden Hospital, London, UK
| | | | - Samuel A. Jacobs
- National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA USA
| | - Cynthia X. Ma
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110 USA
| | | | - Nadia Harbeck
- West German Study Group, Mönchengladbach, Germany
- Breast Center, Department of Obstetrics and Gynecology, and CCCLMU, LMU University Hospital, Munich, Germany
| |
Collapse
|
7
|
Barchiesi G, Mazzotta M, Krasniqi E, Pizzuti L, Marinelli D, Capomolla E, Sergi D, Amodio A, Natoli C, Gamucci T, Vizza E, Marchetti P, Botti C, Sanguineti G, Ciliberto G, Barba M, Vici P. Neoadjuvant Endocrine Therapy in Breast Cancer: Current Knowledge and Future Perspectives. Int J Mol Sci 2020; 21:E3528. [PMID: 32429381 PMCID: PMC7278946 DOI: 10.3390/ijms21103528] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022] Open
Abstract
In locally advanced (LA) breast cancer (BC), neoadjuvant treatments have led to major achievements, which hold particular relevance in HER2-positive and triple-negative BC. Conversely, their role in hormone receptor positive (HR+), hormone epidermal growth factor 2 negative (HER2-) BC is still under debate, mainly due to the generally low rates of pathological complete response (pCR) and lower accuracy of pCR as predictors of long-term outcomes in this patient subset. While administration of neoadjuvant chemotherapy (NCT) in LA, HR+, HER2- BC patients is widely used in clinical practice, neoadjuvant endocrine therapy (NET) still retains an unfulfilled potential in the management of these subgroups, particularly in elderly and unfit patients. In addition, NET has gained a central role as a platform to test new drugs and predictive biomarkers in previously untreated patients. We herein present historical data regarding Tamoxifen and/or Aromatase Inhibitors and a debate on recent evidence regarding agents such as CDK4/6 and PI3K/mTOR inhibitors in the neoadjuvant setting. We also discuss key issues concerning the optimal treatment length, appropriate comparisons with NCT efficacy and use of NET in premenopausal patients.
Collapse
Affiliation(s)
| | - Marco Mazzotta
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.K.); (L.P.); (E.C.); (D.S.); (A.A.); (P.V.)
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.K.); (L.P.); (E.C.); (D.S.); (A.A.); (P.V.)
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.K.); (L.P.); (E.C.); (D.S.); (A.A.); (P.V.)
| | - Daniele Marinelli
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University; Medical Oncology Unit, 00189 Rome, Italy; (D.M.); (P.M.)
| | - Elisabetta Capomolla
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.K.); (L.P.); (E.C.); (D.S.); (A.A.); (P.V.)
| | - Domenico Sergi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.K.); (L.P.); (E.C.); (D.S.); (A.A.); (P.V.)
| | - Antonella Amodio
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.K.); (L.P.); (E.C.); (D.S.); (A.A.); (P.V.)
| | - Clara Natoli
- Department of Medical, Oral & Biotechnological Sciences, University G. D’Annunzio, 66100 Chieti-Pescara, Italy;
| | - Teresa Gamucci
- Medical Oncology, Sandro Pertini Hospital, 00157 Rome, Italy;
| | - Enrico Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, “Regina Elena” National Cancer Institute, 00144 Rome, Italy;
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University; Medical Oncology Unit, 00189 Rome, Italy; (D.M.); (P.M.)
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.K.); (L.P.); (E.C.); (D.S.); (A.A.); (P.V.)
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.K.); (L.P.); (E.C.); (D.S.); (A.A.); (P.V.)
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW Window of Opportunity (WOO) studies have gain their place in current clinical and translational research in breast cancer patients. This review provides current information and future applications of this specific type of research. RECENT FINDINGS So far, WOO trials in breast cancer patients have demonstrated their utility in breast cancer research as: first they allow administering a treatment for a short period of time to treatment-naïve patients whose tumors have not developed mechanisms of resistance or heterogeneity because of previous therapies. Second, it brings a unique opportunity for translational research providing easy access to tumor tissue in order to evaluate antitumor effect from initial biopsy and from surgical resection specimen. They provide the perfect scenario for biomarker discovery and validation in an efficient and timely manner and valuable information about drug pharmacodynamics. Several issues need to be contemplated when designing and performing this type of trials including choice of a biological surrogate endpoint of efficacy as standard clinical activity endpoints are not feasible. SUMMARY Despite some limitations like the absence of information about secondary mechanisms of resistance, WOO trials represent an important support for drug development and biomarker discovery in breast cancer patients.
Collapse
|
9
|
Wang Y, He L, Song Y, Wu Q, Wang H, Zhang B, Ma X. The tumour response of postmenopausal hormone receptor-positive breast cancers undergoing different types of neoadjuvant therapy: a meta-analysis. BMC WOMENS HEALTH 2020; 20:17. [PMID: 32005117 PMCID: PMC6993383 DOI: 10.1186/s12905-020-0879-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/07/2020] [Indexed: 12/17/2022]
Abstract
Background To investigate the efficacy of neoadjuvant chemotherapy (NCT), neoadjuvant endocrine therapy (NET) and neoadjuvant chemoendocrine therapy (NCET) on the tumour response, including pathological complete response (pCR) rate and overall response rate (ORR), in postmenopausal women with hormone receptor (HR)-positive breast cancer. Methods Based on a PRISMA-IPD statement, the PubMed, Embase and Cochrane Library databases were used to identify eligible trials published from inception to 7 May 2019. Pooled odds ratio (OR) with 95% confidential interval (CI) was calculated to assess the pCR rate and ORR of tumours among those three treatments via fixed- or random-effect Mantel-Haenszel models in terms of a Heterogeneity Chi2 test with a significant level of p < 0.1. All statistical tests were performed by the software of StataSE, version 12.0. Results The analysed data consisted of 10 eligible clinical trials with 971 unique HR-positive breast cancer patients. The pooled results indicated that the pCR rate of those patients undergoing NET was significantly lower than those undergoing NCT (pooled OR, 0.48; 95% CI, 0.26–0.90), whereas the difference of ORR between both therapies was not statistically significant (pooled OR, 1.05; 95% CI, 0.73–1.52). The combined paradigm of NCET compared with the monotherapy of NET or NCT did not present a significantly improved pCR rate or ORR (pooled OR, 2.61; 95% CI, 0.94–7.25; and 2.25; 95% CI, 0.39–13.05; respectively). Conclusion Postmenopausal HR-positive breast cancer patients after NCT may have better tumour response than those after NET, while those undergoing NCET may not manifest the apparently improved clinical efficacies compared to those receiving monotherapy.
Collapse
Affiliation(s)
- Yaling Wang
- Department of Oncology, The Second Affiliated Hospital of Medical College of Qingdao University, No. 127 Siliunan Road, City North District, Qingdao, Shandong Province, China
| | - Lin He
- Breast Center B ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yuhua Song
- Breast Center B ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Qian Wu
- Breast Center B ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Haiji Wang
- Department of Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Biyuan Zhang
- Department of Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xuezhen Ma
- Department of Oncology, The Second Affiliated Hospital of Medical College of Qingdao University, No. 127 Siliunan Road, City North District, Qingdao, Shandong Province, China. .,Department of Oncology, Qingdao Central Hospital, No. 127 Siliunan Road, City North District, Qingdao, Shandong Province, China.
| |
Collapse
|
10
|
Gao Q, López-Knowles E, Cheang MCU, Morden J, Ribas R, Sidhu K, Evans D, Martins V, Dodson A, Skene A, Holcombe C, Mallon E, Evans A, Bliss JM, Robertson J, Smith I, Martin LA, Dowsett M. Impact of aromatase inhibitor treatment on global gene expression and its association with antiproliferative response in ER+ breast cancer in postmenopausal patients. Breast Cancer Res 2019; 22:2. [PMID: 31892336 PMCID: PMC6938628 DOI: 10.1186/s13058-019-1223-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/04/2019] [Indexed: 12/31/2022] Open
Abstract
Background Endocrine therapy reduces breast cancer mortality by 40%, but resistance remains a major clinical problem. In this study, we sought to investigate the impact of aromatase inhibitor (AI) therapy on gene expression and identify gene modules representing key biological pathways that relate to early AI therapy resistance. Methods Global gene expression was measured on pairs of core-cut biopsies taken at baseline and at surgery from 254 patients with ER-positive primary breast cancer randomised to receive 2-week presurgical AI (n = 198) or no presurgical treatment (control n = 56) from the POETIC trial. Data from the AI group was adjusted to eliminate artefactual process-related changes identified in the control group. The response was assessed by changes in the proliferation marker, Ki67. Results High baseline ESR1 expression associated with better AI response in HER2+ tumours but not HER2− tumours. In HER2− tumours, baseline expression of 48 genes associated with poor antiproliferative response (p < 0.005) including PERP and YWHAQ, the two most significant, and the transcription co-regulators (SAP130, HDAC4, and NCOA7) which were among the top 16 most significant. Baseline gene signature scores measuring cell proliferation, growth factor signalling (ERBB2-GS, RET/GDNF-GS, and IGF-1-GS), and immune activity (STAT1-GS) were significantly higher in poor AI responders. Two weeks of AI caused downregulation of genes involved in cell proliferation and ER signalling, as expected. Signature scores of E2F activation and TP53 dysfunction after 2-week AI were associated with poor AI response in both HER2− and HER2+ patients. Conclusions There is a high degree of heterogeneity in adaptive mechanisms after as little as 2-week AI therapy; however, all appear to converge on cell cycle regulation. Our data support the evaluation of whether an E2F signatures after short-term exposure to AI may identify those patients most likely to benefit from the early addition of CDK4/6 inhibitors. Trial registration ISRCTN, ISRCTN63882543, registered on 18 December 2007.
Collapse
Affiliation(s)
- Qiong Gao
- Breast Cancer Now Research Centre, ICR, London, UK
| | - Elena López-Knowles
- Breast Cancer Now Research Centre, ICR, London, UK.,Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Maggie Chon U Cheang
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - James Morden
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - Kally Sidhu
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - David Evans
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Vera Martins
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Andrew Dodson
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Anthony Skene
- Royal Bournemouth Hospital, Castle Lane East, Bournemouth, UK
| | - Chris Holcombe
- Royal Liverpool University Hospital, 200 London Road, Liverpool, UK
| | | | | | - Judith M Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - Ian Smith
- Breast Unit, Royal Marsden Hospital, London, UK
| | | | - Mitch Dowsett
- Breast Cancer Now Research Centre, ICR, London, UK. .,Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK.
| | | |
Collapse
|
11
|
Di Benedetto A, Ercolani C, Pizzuti L, Angelucci D, Sergi D, Marinelli C, Iezzi L, Sperati F, Terrenato I, Mazzotta M, Mariani L, Vizza E, Paoletti G, Tomao S, Maugeri-Saccà M, Barba M, Tinari N, Natoli C, Ciliberto G, Grassadonia A, Vici P. Prognostic relevance of DNA damage and repair biomarkers in elderly patients with hormone-receptor-positive breast cancer treated with neoadjuvant hormone therapy: evidence from the real-world setting. Ther Adv Med Oncol 2019; 11:1758835919853192. [PMID: 31452691 PMCID: PMC6700857 DOI: 10.1177/1758835919853192] [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: 10/16/2018] [Accepted: 04/10/2019] [Indexed: 01/06/2023] Open
Abstract
Background: The logic behind the outcome of endocrine therapy in breast cancer has long remained poorly understood. The prognostic role of DNA damage and repair biomarkers (DDR) was explored in postmenopausal, hormone-receptor-positive breast cancer patients treated with neoadjuvant hormone therapy (NAHT). Methods: Data on 55 patients were included. The phosphorylated ataxia-teleangectasia and Rad3-related protein (pATR), phosphorylated ataxia-telangiectasia mutated (ATM) kinase, and phosphorylated H2A Histone Family Member X (γ-H2AX) were evaluated by immunohistochemistry in paired tissues collected at baseline and following NAHT. Biomarkers were considered both singularly and within signatures. Ki-67 percentage change was the primary biomarker endpoint. Classical endpoints were also considered. Results: The most favorable Ki-67 outcome was associated with the γ-H2AX/pATM signature (p = 0.011). In models of Ki-67 reduction, ‘luminal B’ subtype, higher grade of anaplasia, and the γ-H2AX/pATM signature tested as significant (p < 0.05 for all). Results were confirmed in multivariate analysis. No association was observed with pathologic response. An increase of ∆γ-H2AX in paired breast tissues was associated with longer event-free survival (p = 0.027) and overall survival (p = 0.042). In Cox models, both survival outcomes were solely affected by grade of anaplasia, with less favorable prognosis in the highest grades (p < 0.05 for both). Conclusions: We report novel evidence of the prognostic role of DDR biomarkers on important patient outcomes in postmenopausal hormone-receptor-positive breast cancer patients treated with NAHT. If confirmed in future and adequately sized trials, our results may help inform therapeutic decisions and clarify underlying biological mechanisms.
Collapse
Affiliation(s)
- Anna Di Benedetto
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Cristiana Ercolani
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Domenico Sergi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Laura Iezzi
- Department of Medical and Oral Science and Biotechnologies, University G. D'Annunzio, Chieti, Italy
| | - Francesca Sperati
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Mazzotta
- Department of Clinical and Molecular Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - Luciano Mariani
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Vizza
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giancarlo Paoletti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Silverio Tomao
- Medical Oncology Unit A, Policlinico Umberto I, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Nicola Tinari
- Department of Medical and Oral Science and Biotechnologies, University G. D'Annunzio, Chieti, Italy
| | - Clara Natoli
- Department of Medical and Oral Science and Biotechnologies, University G. D'Annunzio, Chieti, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonino Grassadonia
- Department of Medical and Oral Science and Biotechnologies, University G. D'Annunzio, Chieti, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| |
Collapse
|
12
|
Yao LT, Wang MZ, Wang MS, Yu XT, Guo JY, Sun T, Li XY, Xu YY. Neoadjuvant endocrine therapy: A potential strategy for ER-positive breast cancer. World J Clin Cases 2019; 7:1937-1953. [PMID: 31423426 PMCID: PMC6695538 DOI: 10.12998/wjcc.v7.i15.1937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/21/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023] Open
Abstract
A potential strategy for patients with estrogen receptor (ER)-positive breast cancer is necessary to replace neoadjuvant chemotherapy which has limited benefit. Neoadjuvant endocrine therapy (NAE) has been indicated to be a favorable alternate approach to downstage large or locally advanced breast cancer in ER-positive, human epidermal growth factor receptor 2 (HER2)-negative (ER+/HER2-) patients, especially postmenopausal women. Previous studies have demonstrated the efficacy of various endocrine agents in NAE. Aromatase inhibitors (AIs) have proven superiority over tamoxifen as a suitable choice to optimize treatment efficacy. Fulvestrant was recently reported as an effective agent, similar to AIs. Furthermore, the addition of targeted agents exerts synergistic antiproliferative effects with endocrine agents and rapidly improves response rates in both endocrine sensitive and resistant tumors. The neoadjuvant platform provides a unique opportunity to define the appropriate strategy and address the mechanisms of endocrine resistance. In addition, the predictive value of biomarkers and genomic assays in NAE is under investigation to evaluate individual effects and validate biomarker-based strategies. In this review, we discuss the most relevant evidence on the potential of NAE for ER+ breast cancer. The current understanding also offers new insights into the identification of the optimal settings and valuable predictive tools of NAE to guide clinical treatment decisions and achieve beneficial therapeutic effects.
Collapse
Affiliation(s)
- Li-Tong Yao
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Mo-Zhi Wang
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Meng-Shen Wang
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xue-Ting Yu
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jing-Yi Guo
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Tie Sun
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xin-Yan Li
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Ying-Ying Xu
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| |
Collapse
|
13
|
Leal MF, Haynes BP, MacNeill FA, Dodson A, Dowsett M. Comparison of protein expression between formalin-fixed core-cut biopsies and surgical excision specimens using a novel multiplex approach. Breast Cancer Res Treat 2019; 175:317-326. [PMID: 30796652 PMCID: PMC6533418 DOI: 10.1007/s10549-019-05163-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE We evaluated whether multiplex protein quantification using antibody bar-coding with photocleavable oligonucleotides (NanoString) can be applied to evaluate protein expression in breast cancer FFPE specimens. We also assessed whether diagnostic core-cuts fixed immediately at time of procedures and surgical excision sections from routinely fixed breast cancers are affected by the same fixation related differences noted using immunohistochemistry (IHC). METHODS The expression of 26 proteins was analysed using NanoString technology in 16 pairs of FFPE breast cancer core-cuts and surgical excisions. The measurements yielded were compared with those by IHC on Ki67, PgR and HER2 biomarkers and pAKT and pERK1/2 phosphorylated proteins. RESULTS When considered irrespective of sample type, expression measured by the two methods was strongly correlated for all markers (p < 0.001; ρ = 0.69-0.88). When core-cuts and excisions were evaluated separately, the correlations between NanoString and IHC were weaker but significant except for pAKT in excisions. Surgical excisions showed lower levels of 8/12 phosphoproteins and higher levels of 4/13 non-phosphorylated proteins in comparison to core-cuts (p < 0.01). Reduced p4EBP1, pAMPKa, pRPS6 and pRAF1 immunogenicity in excisions was correlated with tumour size and mastectomy specimens showed lower p4EBP1 and pRPS6 expression than lumpectomy (p < 0.05). CONCLUSIONS Our study supports the validity of the new multiplex approach to protein analysis but indicates that, as with IHC, caution is necessary for the analysis in excisions particularly of phosphoproteins. The specimen type, tumour size and surgery type may lead to biases in the quantitative analysis of many proteins of biologic and clinical interest in excision specimens.
Collapse
Affiliation(s)
- Mariana Ferreira Leal
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK.
- Breast Cancer Now Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK.
| | - Ben P Haynes
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK
| | - Fiona A MacNeill
- Breast Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Andrew Dodson
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK
- Breast Cancer Now Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
| |
Collapse
|
14
|
Schuster EF, Gellert P, Segal CV, López-Knowles E, Buus R, Cheang MCU, Morden J, Robertson J, Bliss JM, Smith I, Dowsett M. Genomic Instability and TP53 Genomic Alterations Associate With Poor Antiproliferative Response and Intrinsic Resistance to Aromatase Inhibitor Treatment. JCO Precis Oncol 2019; 3:1800286. [PMID: 32914010 PMCID: PMC7446335 DOI: 10.1200/po.18.00286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although aromatase inhibitor (AI) treatment is effective in estrogen receptor-positive postmenopausal breast cancer, resistance is common and incompletely explained. Genomic instability, as measured by somatic copy number alterations (SCNAs), is important in breast cancer development and prognosis. SCNAs to specific genes may drive intrinsic resistance, or high genomic instability may drive tumor heterogeneity, which allows differential response across tumors and surviving cells to evolve resistance to treatment rapidly. We therefore evaluated the relationship between SCNAs and intrinsic resistance to treatment as measured by a poor antiproliferative response. PATIENTS AND METHODS SCNAs were determined by single nucleotide polymorphism array in baseline and surgery core-cuts from 73 postmenopausal patients randomly assigned to receive 2 weeks of preoperative AI or no AI in the Perioperative Endocrine Therapy-Individualizing Care (POETIC) trial. Fifty-six samples from the AI group included 28 poor responders (PrRs, less than 60% reduction in protein encoded by the MKI67 gene [Ki-67]) and 28 good responders (GdRs, greater than 75% reduction in Ki-67). Exome sequencing was available for 72 pairs of samples. RESULTS Genomic instability correlated with Ki-67 expression at both baseline (P < .001) and surgery (P < .001) and was higher in PrRs (P = .048). The SCNA with the largest difference between GdRs and PrRs was loss of heterozygosity observed at 17p (false discovery rate, 0.08), which includes TP53. Nine of 28 PrRs had loss of wild-type TP53 as a result of mutations and loss of heterozygosity compared with three of 28 GdRs. In PrRs, somatic alterations of TP53 were associated with higher genomic instability, higher baseline Ki-67, and greater resistance to AI treatment compared with wild-type TP53. CONCLUSION We observed that primary tumors with high genomic instability have an intrinsic resistance to AI treatment and do not require additional evolution to develop resistance to estrogen deprivation therapy.
Collapse
Affiliation(s)
- Eugene F. Schuster
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
- Eugene F. Schuster, PhD, The Institute of Cancer Research, 237 Fulham Rd, London SW3 6JB, United Kingdom; e-mail:
| | - Pascal Gellert
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
| | - Corrinne V. Segal
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
| | - Elena López-Knowles
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
| | - Richard Buus
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
| | | | - James Morden
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Ian Smith
- Royal Marsden Hospital, London, United Kingdom
| | - Mitch Dowsett
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
| | | |
Collapse
|
15
|
Cochran JM, Busch DR, Leproux A, Zhang Z, O’Sullivan TD, Cerussi AE, Carpenter PM, Mehta RS, Roblyer D, Yang W, Paulsen KD, Pogue B, Jiang S, Kaufman PA, Chung SH, Schnall M, Snyder BS, Hylton N, Carp SA, Isakoff SJ, Mankoff D, Tromberg BJ, Yodh AG. Tissue oxygen saturation predicts response to breast cancer neoadjuvant chemotherapy within 10 days of treatment. JOURNAL OF BIOMEDICAL OPTICS 2018; 24:1-11. [PMID: 30338678 PMCID: PMC6194199 DOI: 10.1117/1.jbo.24.2.021202] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/30/2018] [Indexed: 05/20/2023]
Abstract
Ideally, neoadjuvant chemotherapy (NAC) assessment should predict pathologic complete response (pCR), a surrogate clinical endpoint for 5-year survival, as early as possible during typical 3- to 6-month breast cancer treatments. We introduce and demonstrate an approach for predicting pCR within 10 days of initiating NAC. The method uses a bedside diffuse optical spectroscopic imaging (DOSI) technology and logistic regression modeling. Tumor and normal tissue physiological properties were measured longitudinally throughout the course of NAC in 33 patients enrolled in the American College of Radiology Imaging Network multicenter breast cancer DOSI trial (ACRIN-6691). An image analysis scheme, employing z-score normalization to healthy tissue, produced models with robust predictions. Notably, logistic regression based on z-score normalization using only tissue oxygen saturation (StO2) measured within 10 days of the initial therapy dose was found to be a significant predictor of pCR (AUC = 0.92; 95% CI: 0.82 to 1). This observation suggests that patients who show rapid convergence of tumor tissue StO2 to surrounding tissue StO2 are more likely to achieve pCR. This early predictor of pCR occurs prior to reductions in tumor size and could enable dynamic feedback for optimization of chemotherapy strategies in breast cancer.
Collapse
Affiliation(s)
- Jeffrey M. Cochran
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
- Address all correspondence to: Jeffrey M. Cochran, E-mail:
| | - David R. Busch
- University of Texas Southwestern, Department of Anesthesiology and Pain Management, Dallas, Texas, United States
| | - Anaïs Leproux
- University of California, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Zheng Zhang
- Brown University School of Public Health, Department of Biostatistics and Center for Statistical Sciences, Providence, Rhode Island, United States
| | - Thomas D. O’Sullivan
- University of California, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Albert E. Cerussi
- University of California, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Philip M. Carpenter
- University of Southern California, Keck School of Medicine, Department of Pathology, Los Angeles, California, United States
| | - Rita S. Mehta
- University of California Irvine, Department of Medicine, Irvine, California, United States
| | - Darren Roblyer
- Boston University, Department of Biomedical Engineering, Boston, Massachusetts, United States
| | - Wei Yang
- University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, Texas, United States
| | - Keith D. Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, United States
| | - Brian Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, United States
| | - Shudong Jiang
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, United States
| | - Peter A. Kaufman
- Dartmouth-Hitchcock Medical Center, Department of Hematology and Oncology, Lebanon, New Hampshire, United States
| | - So Hyun Chung
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - Mitchell Schnall
- University of Pennsylvania, Department of Radiology, Philadelphia, Pennsylvania, United States
| | - Bradley S. Snyder
- Brown University School of Public Health, Center for Statistical Sciences, Providence, Rhode Island, United States
| | - Nola Hylton
- University of California, Department of Radiology, San Francisco, California, United States
| | - Stefan A. Carp
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Boston, Massachusetts, United States
| | - Steven J. Isakoff
- Massachusetts General Hospital, Department of Hematology and Oncology, Boston, Massachusetts, United States
| | - David Mankoff
- University of Pennsylvania, Division of Nuclear Medicine, Department of Radiology, Philadelphia, Pennsylvania, United States
| | - Bruce J. Tromberg
- University of California, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Arjun G. Yodh
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| |
Collapse
|
16
|
Therapeutic predictors of neoadjuvant endocrine therapy response in estrogen receptor-positive breast cancer with reference to optimal gene expression profiling. Breast Cancer Res Treat 2018; 172:353-362. [PMID: 30151737 DOI: 10.1007/s10549-018-4933-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/21/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Neoadjuvant endocrine therapy (NAET) for estrogen receptor-positive primary breast cancer causes adequate tumor shrinkage, and is expected to be helpful for breast-conserving surgery, but the adaptation criteria, especially in regard to treatment duration, have never been elucidated. Re-visiting past gene expression profiles, we explored the data for specialized pre-therapeutic predictors and validated the results using our in-house clinical cohorts. METHODS We sorted the genes related to a > 30% tumor volume reduction through NAET from a cDNA microarray data-set of GSE20181, then selected the top 40 genes. We validated these gene expression levels using pre-therapeutic biopsy samples obtained from patients treated with long-term NAET (over 4 months; N = 40). A short-term (2-8 weeks; N = 37) NAET cohort was also validated to clarify whether expression of these genes is also related to a rapid response of Ki67 and PEPI score. RESULTS In the long-term group, higher expression of KRAS, CUL2, FAM13A, ADCK2, and LILRA2 was significantly associated with tumor shrinkage, and KRAS, MMS19, and IVD were related to lower PEPI score (≤ 3). Meanwhile in the short-term group, none of these genes except CUL2 showed a direct correlation with Ki67 reduction or PEPI score. This suggested that tumor shrinkage by NAET might be induced by response to the hypoxic environment (CUL2, FAM13A, KRAS) and activation of tumor immune system (LILRA2), without involving inhibition of proliferation. CONCLUSION Expression of specific genes may allow selection of the most responsive patients for maximum tumor shrinkage with NAET.
Collapse
|
17
|
Gao Q, López-Knowles E, U Cheang MC, Morden J, Ribas R, Sidhu K, Evans D, Martins V, Dodson A, Skene A, Holcombe C, Mallon E, Evans A, Bliss JM, Robertson J, Smith I, Martin LA, Dowsett M. Major Impact of Sampling Methodology on Gene Expression in Estrogen Receptor-Positive Breast Cancer. JNCI Cancer Spectr 2018; 2:pky005. [PMID: 31360844 PMCID: PMC6649758 DOI: 10.1093/jncics/pky005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/16/2018] [Indexed: 12/05/2022] Open
Abstract
To investigate the impact of sampling methodology on gene expression data from primary estrogen receptor–positive (ER+) breast cancer biopsies, global gene expression was measured in core-cut biopsies at baseline and surgery from patients randomly assigned to receive either two weeks of presurgical aromatase inhibitor (AI; n = 157) or no presurgical treatment (n = 56). Those genes most markedly altered in the AI group (eg, FOS, DUSP1, RGS1, FOSB) were similarly altered in the no treatment group; some widely investigated genes that were apparently unaffected in the AI group (eg, MYC) were counter-altered in the control group, masking actual AI-dependent changes. In the absence of a control group, these artefactual changes would likely lead to the most affected genes being the erroneous focus of research. The findings are likely relevant to all archival collections of ER+ breast cancer.
Collapse
Affiliation(s)
- Qiong Gao
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - Elena López-Knowles
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK.,Ralph Lauren Centre for Breast Cancer Research
| | - Maggie Chon U Cheang
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - James Morden
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Ricardo Ribas
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - Kally Sidhu
- Ralph Lauren Centre for Breast Cancer Research
| | - David Evans
- Ralph Lauren Centre for Breast Cancer Research
| | | | | | | | | | | | | | - Judith M Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - Ian Smith
- Breast Unit, Royal Marsden Hospital, London, UK
| | - Lesley-Ann Martin
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - Mitch Dowsett
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK.,Ralph Lauren Centre for Breast Cancer Research
| | | |
Collapse
|
18
|
Haibe-Kains B, Cescon DW. Gene Expression Analyses in Breast Cancer: Sample Matters. JNCI Cancer Spectr 2018; 2:pky019. [PMID: 31360851 PMCID: PMC6649719 DOI: 10.1093/jncics/pky019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Benjamin Haibe-Kains
- Campbell Family Institute for Breast Cancer Research, Department of Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Medical Biophysics, Department of Computer Science, and Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - David W Cescon
- Campbell Family Institute for Breast Cancer Research, Department of Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Medical Biophysics, Department of Computer Science, and Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
19
|
Iwamoto T, Katagiri T, Niikura N, Miyoshi Y, Kochi M, Nogami T, Shien T, Motoki T, Taira N, Omori M, Tokuda Y, Fujiwara T, Doihara H, Gyorffy B, Matsuoka J. Immunohistochemical Ki67 after short-term hormone therapy identifies low-risk breast cancers as reliably as genomic markers. Oncotarget 2018; 8:26122-26128. [PMID: 28412725 PMCID: PMC5432244 DOI: 10.18632/oncotarget.15385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 01/31/2017] [Indexed: 01/10/2023] Open
Abstract
Background The purpose of this study was to test whether immunohistochemical (IHC) Ki67 levels after short-term preoperative hormone therapy (post-Ki67) predict similar numbers of patients with favorable prognoses as genomic markers. Results Thirty paired cases (60 samples) were enrolled in this study. Post-Ki67 levels were significantly lower than pre-treatment Ki67 levels (P < 0.001). Post-Ki67 predicted more low-risk cases (83.3%, 25/30) than pre-genomic surrogate signature(GSS) (66.7%: 20/30), but the difference in predictive power was not significant (P = 0.233). Proliferation (MKI67, STK15, Survivin, CCNB1, and MYBL2) and estrogen (ER, PGR, BCL2, and SCUBE2) related signatures were significantly downregulated after therapy (P < 0.001 and 0.041, respectively). Materials and Methods Core needle biopsy specimens of primary breast cancer were collected at Okayama University Hospital from hormone receptor-positive and human epidermal growth factor 2-negative patients that subsequently received two weeks of neoadjuvant hormone therapy. Paired post-treatment specimens from surgical samples were also collected. IHC Ki67 levels and GSS were compared between pre- and post-hormone treatment samples. Changes of gene expression pattern in short-term hormone therapy were also assessed. Conclusions IHC based post-Ki67 levels may have distinct predictive power compared with the naïve IHC Ki67. Future studies with larger cohorts and longer follow-up periods may be needed to validate our results.
Collapse
Affiliation(s)
- Takayuki Iwamoto
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.,Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan
| | - Toyomasa Katagiri
- Division of Genome Medicine, Institute for Genome Research, Tokushima University, Tokushima, Japan
| | - Naoki Niikura
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Yuichiro Miyoshi
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Mariko Kochi
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.,Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan
| | - Tomohiro Nogami
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Takayuki Motoki
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.,Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan
| | - Naruto Taira
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Masako Omori
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Yutaka Tokuda
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroyoshi Doihara
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Balazs Gyorffy
- MTA TTK Lendület Cancer Biomarker Research Group, Budapest, Hungary.,nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Junji Matsuoka
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.,Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan.,Department of Palliative and Supportive Medicine, Okayama University Hospital, Okayama, Japan
| |
Collapse
|
20
|
Gianni L, Bisagni G, Colleoni M, Del Mastro L, Zamagni C, Mansutti M, Zambetti M, Frassoldati A, De Fato R, Valagussa P, Viale G. Neoadjuvant treatment with trastuzumab and pertuzumab plus palbociclib and fulvestrant in HER2-positive, ER-positive breast cancer (NA-PHER2): an exploratory, open-label, phase 2 study. Lancet Oncol 2018; 19:249-256. [DOI: 10.1016/s1470-2045(18)30001-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/05/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022]
|
21
|
Heindl A, Sestak I, Naidoo K, Cuzick J, Dowsett M, Yuan Y. Relevance of Spatial Heterogeneity of Immune Infiltration for Predicting Risk of Recurrence After Endocrine Therapy of ER+ Breast Cancer. J Natl Cancer Inst 2018; 110:4064177. [PMID: 28859291 PMCID: PMC6298573 DOI: 10.1093/jnci/djx137] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022] Open
Abstract
Background Despite increasing evidence supporting the clinical utility of immune infiltration in the estrogen receptor-negative (ER-) subtype, the prognostic value of immune infiltration for ER+ disease is not well defined. Methods Quantitative immune scores of cell abundance and spatial heterogeneity were computed using a fully automated hematoxylin and eosin-stained image analysis algorithm and spatial statistics for 1178 postmenopausal patients with ER+ breast cancer treated with five years' tamoxifen or anastrozole. The prognostic significance of immune scores was compared with Oncotype DX 21-gene recurrence score (RS), PAM50 risk of recurrence (ROR) score, IHC4, and clinical treatment score, available for 963 patients. Statistical tests were two-sided. Results Scores of immune cell abundance were not associated with recurrence-free survival. In contrast, high immune spatial scores indicating increased cell spatial clustering were associated with poor 10-year, early (0-5 years), and late (5-10 years) recurrence-free survival (Immune Hotspot: LR-χ2 = 14.06, P < .001, for 0-10 years; LR-χ2 = 6.24, P = .01, for 0-5 years; LR-χ2 = 7.89, P = .005, for 5-10 years). The prognostic value of spatial scores for late recurrence was similar to that of IHC4 and RS in both populations, but was not as strong as other tests in comparison for recurrence across 10 years. Conclusions These results provide a missing link between tumor immunity and disease outcome in ER+ disease by examining tumor spatial architecture. The association between spatial scores and late recurrence suggests a lasting memory of protumor immunity that may impact disease progression and evolution of endocrine treatment resistance, which may be exploited for therapeutic advances.
Collapse
Affiliation(s)
- Andreas Heindl
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK; Centre for Molecular Pathology, Royal Marsden Hospital, London, UK; Division of Molecular Pathology, The Institute of Cancer Research, London, UK; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK; The Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK; Cellular Pathology, Guy's and St Thomas' NHS Trust, Westminster Bridge Rd, London, UK; Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Ivana Sestak
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK; Centre for Molecular Pathology, Royal Marsden Hospital, London, UK; Division of Molecular Pathology, The Institute of Cancer Research, London, UK; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK; The Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK; Cellular Pathology, Guy's and St Thomas' NHS Trust, Westminster Bridge Rd, London, UK; Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Kalnisha Naidoo
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK; Centre for Molecular Pathology, Royal Marsden Hospital, London, UK; Division of Molecular Pathology, The Institute of Cancer Research, London, UK; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK; The Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK; Cellular Pathology, Guy's and St Thomas' NHS Trust, Westminster Bridge Rd, London, UK; Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Jack Cuzick
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK; Centre for Molecular Pathology, Royal Marsden Hospital, London, UK; Division of Molecular Pathology, The Institute of Cancer Research, London, UK; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK; The Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK; Cellular Pathology, Guy's and St Thomas' NHS Trust, Westminster Bridge Rd, London, UK; Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Mitchell Dowsett
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK; Centre for Molecular Pathology, Royal Marsden Hospital, London, UK; Division of Molecular Pathology, The Institute of Cancer Research, London, UK; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK; The Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK; Cellular Pathology, Guy's and St Thomas' NHS Trust, Westminster Bridge Rd, London, UK; Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Yinyin Yuan
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK; Centre for Molecular Pathology, Royal Marsden Hospital, London, UK; Division of Molecular Pathology, The Institute of Cancer Research, London, UK; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK; The Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK; Cellular Pathology, Guy's and St Thomas' NHS Trust, Westminster Bridge Rd, London, UK; Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| |
Collapse
|
22
|
Abstract
Neoadjuvant endocrine therapy (NET) can be effective at downstaging patients with estrogen receptor-positive tumors and identifying those tumors that are endocrine sensitive and resistant. The optimal prognostic markers for stratification are under investigation. Use of NET will allow the identification of patients with estrogen receptor-positive tumors who might benefit from additional treatment and allow better understanding of endocrine resistance.
Collapse
Affiliation(s)
- Julie Grossman
- Department of Medicine, Washington University, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Cynthia Ma
- Department of Medicine, Washington University, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Rebecca Aft
- Department of Surgery, Washington University, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| |
Collapse
|
23
|
Palmieri C, Szydlo R, Miller M, Barker L, Patel NH, Sasano H, Barwick T, Tam H, Hadjiminas D, Lee J, Shaaban A, Nicholas H, Coombes RC, Kenny LM. IPET study: an FLT-PET window study to assess the activity of the steroid sulfatase inhibitor irosustat in early breast cancer. Breast Cancer Res Treat 2017; 166:527-539. [PMID: 28795252 PMCID: PMC5668341 DOI: 10.1007/s10549-017-4427-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/26/2017] [Indexed: 10/24/2022]
Abstract
BACKGROUND Steroid sulfatase (STS) is involved in oestrogen biosynthesis and irosustat is a first generation, irreversible steroid sulfatase inhibitor. A pre-surgical window-of-opportunity study with irosustat was undertaken in estrogen receptor-positive (ER+) breast cancer to assess the effect of irosustat on tumour cell proliferation as measured by 3'-deoxy-3'-[18F] fluorothymidine uptake measured by PET scanning (FLT-PET) and Ki67. METHODS Postmenopausal women with untreated ER+ early breast cancer were recruited, and imaged with FLT-PET at baseline and after at least 2 weeks treatment with irosustat, 40 mg once daily orally. The primary endpoint was changed in FLT uptake; secondary endpoints included safety and tolerability of irosustat, changes in tumoral Ki67 and steroidogenic enzymes expression and circulating steroid hormone levels. RESULTS Thirteen women were recruited, and ten started irosustat for 2 weeks, followed by repeat FLT-PET scans in eight. Defining response as decreases of ≥20% in standardized uptake value (SUV) or ≥30% in Ki, 1 (12.5% (95% CI 2-47%, p = 0.001)) and 3 (43% (95% CI 16-75%, p = <0.001) patients, respectively, responded. 6 out of 7 patients had a Ki67 reduction (range = -19.3 to 76.4%), and median percentage difference in Ki67 was 52.3% (p = 0.028). In one patient with a low baseline STS expression, a 19.7% increase in Ki67 was recorded. STS decreases were seen in tumours with high basal STS expression, significant decreases were also noted in aromatase, and 17β-hydroxysteroid dehydrogenase type 1 and 2. Irosustat was generally well tolerated with all adverse event CTCAE Grade ≤2. CONCLUSIONS Irosustat resulted in a significant reduction in FLT uptake and Ki67, and is well tolerated. These data are the first demonstrating clinical activity of irosustat in early breast cancer. Baseline expression of STS may be a biomarker of sensitivity to irosustat.
Collapse
Affiliation(s)
- Carlo Palmieri
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, L69 3BX, UK.
- Liverpool & Merseyside Breast Academic Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK.
- Academic Department of Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK.
| | - Richard Szydlo
- Centre for Haematology, Imperial College London, London, W12 0NN, UK
| | - Marie Miller
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - Laura Barker
- Department of Medical Oncology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Neva H Patel
- Radiological Sciences Unit and Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
- Department of Nuclear Medicine, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
| | - Hironobu Sasano
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Tara Barwick
- Department of Radiology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Henry Tam
- Department of Radiology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Dimitri Hadjiminas
- Department of Surgery, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Jasmin Lee
- Department of Pathology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Abeer Shaaban
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Hanna Nicholas
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - R Charles Coombes
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
- Department of Medical Oncology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Laura M Kenny
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
- Department of Medical Oncology, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| |
Collapse
|
24
|
Abstract
Purpose of Review Pre-operative endocrine therapy can be used to down-stage large or locally advanced breast cancers in ER+ disease. In the last four decades, it has evolved from a treatment perceived as an alternative to surgery for those too unfit to undergo surgery or chemotherapy, to the present day where it is a valuable and valid option in the treatment of postmenopausal women with ER-rich (Allred score 7–8, or > 50% staining for ER) breast cancer. Recent Findings Emerging data from the metastatic setting is translating into neoadjuvant trials, utilising dual endocrine targeting or combinations of endocrine agents and other targeted drugs, including those acting against components of the PI3K pathway and the cell cycle. The routine use of peri-operative endocrine therapy in all ER+ tumours may help to yield important long-term prognostic information, and guide adjuvant endocrine therapy. Summary Pre-operative endocrine therapy is an exciting and evolving area with emerging new approaches. In this review, established evidence and emerging data on its applications are discussed.
Collapse
|
25
|
Hierro C, Azaro A, Argilés G, Elez E, Gómez P, Carles J, Rodon J. Unveiling changes in the landscape of patient populations in cancer early drug development. Oncotarget 2017; 8:14158-14172. [PMID: 27835915 PMCID: PMC5355170 DOI: 10.18632/oncotarget.13258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/26/2016] [Indexed: 01/25/2023] Open
Abstract
The introduction of new Molecularly Targeted Agents (MTA) has changed the landscape in Early Drug Development (EDD) over the last two decades, leading to an improvement in clinical trial design. Previous Phase 1 (Ph1) studies with cytotoxics focused on safety objectives, only recruiting heavily pre-treated cancer patients, have been left behind. In this review, we will illustrate the slow although unstoppable change that has increasingly been observed in those populations candidate to participate in EDD trials with the advent of MTA. As more evidence regarding oncogene addiction becomes available, molecular-biomarker driven selection has been implemented among Molecularly-Selected Population (MSP) studies. New Window-Of-Opportunity (WOO) and Phase 0 (Ph0) studies have been developed in order to assess whether a MTA produces the hypothetical proposed biological effect. The rising need of getting early pharmacokinetics and pharmacodynamics data has led to the conduction of Healthy Volunteer (HV) studies, in part favoured for the particular and different toxicity profile of these MTA. However, several challenges will need to be addressed in order to boost the implementation of these new clinical trial designs in the forthcoming years. Among the problems to overcome, we would highlight a better coordination effort between centers for ensuring adequate patient accrual among small patient populations and a deepening into the ethics implied in enrolling patients in studies with no therapeutic intent. However, these tribulations will be certainly compensated by the possibility of opening a new horizon of treatment for diseases with dismal prognosis.
Collapse
Affiliation(s)
- Cinta Hierro
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Analía Azaro
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Guillem Argilés
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Elena Elez
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Patricia Gómez
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Joan Carles
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Jordi Rodon
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| |
Collapse
|
26
|
Cohen AL, Factor RE, Mooney K, Salama ME, Wade M, Serpico V, Ostrander E, Nelson E, Porretta J, Matsen C, Bernard P, Boucher K, Neumayer L. POWERPIINC (PreOperative Window of Endocrine TheRapy Provides Information to Increase Compliance) trial: Changes in tumor proliferation index and quality of life with 7 days of preoperative tamoxifen. Breast 2016; 31:219-223. [PMID: 27915204 DOI: 10.1016/j.breast.2016.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/31/2016] [Accepted: 11/18/2016] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES A decrease in Ki67 during neoadjuvant therapy predicts response to tamoxifen. Previous trials have shown a decreased Ki67 in breast tumors with as little as two or more weeks of preoperative tamoxifen. Shortening the preoperative treatment time in window of opportunity clinical trials makes these trials more attractive to women. POWERPIINC examined the effect of 7 days of preoperative tamoxifen on breast tumor proliferation and patient symptoms. METHODS Women with untreated stage I/II, ER-positive, invasive breast cancer with no contraindications to tamoxifen were enrolled. Women received 20 mg of tamoxifen for 7 days up to the day of surgery. Proliferation was assessed by Ki67 immunohistochemistry before and after 7 days of tamoxifen. Symptoms and QOL were assessed by the FACT-ES and MENQOL. Adherence was measured by pill counts. RESULTS 52 women were enrolled, and 44 were evaluable for Ki67. The median age was 58.5 years, and the median tumor diameter was 1.2 cm. Most women (73%) were post-menopausal. Most tumors were PR positive (88%) and HER2-negative (92%). The Ki67 decreased by a geometric mean of 40% (95% CI 29%-63%), and 73% (95% CI 57%-85%) of women had tumors with decreased proliferation (p = 0.0001 by paired t-test). Adherence to taking tamoxifen during the preoperative period was 100%. Women reported minimal bother from psychosocial or physical symptoms at baseline or on the day of surgery. CONCLUSION Seven days of tamoxifen showed a similar relative decrease in Ki67 as that reported for longer courses, was acceptable to women, and could be considered for window of opportunity studies.
Collapse
Affiliation(s)
- Adam L Cohen
- Department of Internal Medicine, College of Medicine, University of Utah, USA; Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84124, USA.
| | - Rachel E Factor
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84124, USA; Department of Pathology, University of Utah, School of Medicine, ARUP Laboratories, 15 North Medical Drive East, Ste #1100, Salt Lake City, UT 84112, USA
| | - Kathi Mooney
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84124, USA; College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA
| | - Mohamed E Salama
- Department of Pathology, University of Utah, School of Medicine, ARUP Laboratories, 15 North Medical Drive East, Ste #1100, Salt Lake City, UT 84112, USA
| | - Mark Wade
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84124, USA
| | - Victoria Serpico
- Department of Internal Medicine, College of Medicine, University of Utah, USA; Department of Surgery, College of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84124, USA
| | - Emily Ostrander
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84124, USA
| | - Edward Nelson
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84124, USA; Department of Surgery, College of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84124, USA
| | - Jane Porretta
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84124, USA; Department of Surgery, College of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84124, USA
| | - Cindy Matsen
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84124, USA; Department of Surgery, College of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84124, USA
| | - Philip Bernard
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84124, USA; Department of Pathology, University of Utah, School of Medicine, ARUP Laboratories, 15 North Medical Drive East, Ste #1100, Salt Lake City, UT 84112, USA
| | - Ken Boucher
- Department of Internal Medicine, College of Medicine, University of Utah, USA; Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84124, USA
| | - Leigh Neumayer
- Department of Surgery, College of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84124, USA
| |
Collapse
|
27
|
Lim E, Tarulli G, Portman N, Hickey TE, Tilley WD, Palmieri C. Pushing estrogen receptor around in breast cancer. Endocr Relat Cancer 2016; 23:T227-T241. [PMID: 27729416 DOI: 10.1530/erc-16-0427] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 12/21/2022]
Abstract
The estrogen receptor-α (herein called ER) is a nuclear sex steroid receptor (SSR) that is expressed in approximately 75% of breast cancers. Therapies that modulate ER action have substantially improved the survival of patients with ER-positive breast cancer, but resistance to treatment still remains a major clinical problem. Treating resistant breast cancer requires co-targeting of ER and alternate signalling pathways that contribute to resistance to improve the efficacy and benefit of currently available treatments. Emerging data have shown that other SSRs may regulate the sites at which ER binds to DNA in ways that can powerfully suppress the oncogenic activity of ER in breast cancer. This includes the progesterone receptor (PR) that was recently shown to reprogram the ER DNA binding landscape towards genes associated with a favourable outcome. Another attractive candidate is the androgen receptor (AR), which is expressed in the majority of breast cancers and inhibits growth of the normal breast and ER-positive tumours when activated by ligand. These findings have led to the initiation of breast cancer clinical trials evaluating therapies that selectively harness the ability of SSRs to 'push' ER towards anti-tumorigenic activity. Our review will focus on the established and emerging clinical evidence for activating PR or AR in ER-positive breast cancer to inhibit the tumour growth-promoting functions of ER.
Collapse
Affiliation(s)
- Elgene Lim
- Garvan Institute of Medical Research and St Vincent's HospitalUniversity of New South Wales, Sydney, New South Wales, Australia
| | - Gerard Tarulli
- Dame Roma Mitchell Cancer Research Laboratories and Adelaide Prostate Cancer Research CentreUniversity of Adelaide, Adelaide, South Australia, Australia
| | - Neil Portman
- Garvan Institute of Medical Research and St Vincent's HospitalUniversity of New South Wales, Sydney, New South Wales, Australia
| | - Theresa E Hickey
- Dame Roma Mitchell Cancer Research Laboratories and Adelaide Prostate Cancer Research CentreUniversity of Adelaide, Adelaide, South Australia, Australia
| | - Wayne D Tilley
- Dame Roma Mitchell Cancer Research Laboratories and Adelaide Prostate Cancer Research CentreUniversity of Adelaide, Adelaide, South Australia, Australia
| | - Carlo Palmieri
- Institute of Translational MedicineUniversity of Liverpool, Clatterbridge Cancer Centre, NHS Foundation Trust, and Royal Liverpool University Hospital, Liverpool, Merseyside, UK
| |
Collapse
|
28
|
Impact of mutational profiles on response of primary oestrogen receptor-positive breast cancers to oestrogen deprivation. Nat Commun 2016; 7:13294. [PMID: 27827358 PMCID: PMC5105193 DOI: 10.1038/ncomms13294] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 09/19/2016] [Indexed: 12/19/2022] Open
Abstract
Pre-surgical studies allow study of the relationship between mutations and response of oestrogen receptor-positive (ER+) breast cancer to aromatase inhibitors (AIs) but have been limited to small biopsies. Here in phase I of this study, we perform exome sequencing on baseline, surgical core-cuts and blood from 60 patients (40 AI treated, 20 controls). In poor responders (based on Ki67 change), we find significantly more somatic mutations than good responders. Subclones exclusive to baseline or surgical cores occur in ∼30% of tumours. In phase II, we combine targeted sequencing on another 28 treated patients with phase I. We find six genes frequently mutated: PIK3CA, TP53, CDH1, MLL3, ABCA13 and FLG with 71% concordance between paired cores. TP53 mutations are associated with poor response. We conclude that multiple biopsies are essential for confident mutational profiling of ER+ breast cancer and TP53 mutations are associated with resistance to oestrogen deprivation therapy.
Collapse
|
29
|
Maugeri-Saccà M, Barba M, Vici P, Pizzuti L, Sergi D, Catenaro T, Di Lauro L, Mottolese M, Santini D, Milella M, De Maria R. Presurgical window of opportunity trial design as a platform for testing anticancer drugs: Pros, cons and a focus on breast cancer. Crit Rev Oncol Hematol 2016; 106:132-42. [PMID: 27637358 DOI: 10.1016/j.critrevonc.2016.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 06/17/2016] [Accepted: 08/16/2016] [Indexed: 12/24/2022] Open
Abstract
The high attrition rate is a major issue in anticancer drug development. Among the alternative trial designs, presurgical window of opportunity trials envision a short course treatment in the time window between diagnostic biopsy and surgery in a moderately-sized patient population. This approach allows testing therapeutics when pre- and post-treatment tumor tissues are available for comprehensive molecular analyses. The emerging evidence may help define the ability of a given agent to modulate its target(s) and help obtain a broader picture of the molecular changes operated by the treatment. The resulting gain may outweigh the potential harms for patients in the early disease setting. Window of opportunity trials have been extensively applied to breast cancer. Overall, a wider use of these trial designs might lead to the identification of potential responders, ineffective drugs or combinations, and ultimately contribute to enhance the efficiency of the clinical developmental process.
Collapse
Affiliation(s)
- Marcello Maugeri-Saccà
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - Maddalena Barba
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - Patrizia Vici
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Teresa Catenaro
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Luigi Di Lauro
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Marcella Mottolese
- Department of Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico, University of Rome, 00128 Rome, Italy
| | - Michele Milella
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Ruggero De Maria
- Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| |
Collapse
|
30
|
López-Knowles E, Gao Q, Cheang MCU, Morden J, Parker J, Martin LA, Pinhel I, McNeill F, Hills M, Detre S, Afentakis M, Zabaglo L, Dodson A, Skene A, Holcombe C, Robertson J, Smith I, Bliss JM, Dowsett M. Heterogeneity in global gene expression profiles between biopsy specimens taken peri-surgically from primary ER-positive breast carcinomas. Breast Cancer Res 2016; 18:39. [PMID: 27036195 PMCID: PMC4818440 DOI: 10.1186/s13058-016-0696-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/10/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Gene expression is widely used for the characterisation of breast cancers. Variability due to tissue heterogeneity or measurement error or systematic change due to peri-surgical procedures can affect measurements but is poorly documented. We studied the variability of global gene expression between core-cuts of primary ER+ breast cancers and the impact of delays to tissue stabilisation due to sample X-ray and of diagnostic core cutting. METHODS Twenty-six paired core-cuts were taken immediately after tumour excision and up to 90 minutes delay due to sample X-ray; 57 paired core-cuts were taken at diagnosis and 2 weeks later at surgical excision. Whole genome expression analysis was conducted on extracted RNA. Correlations and differences were assessed between the expression of individual genes, gene sets/signatures and intrinsic subtypes. RESULTS Twenty-three and 56 sample pairs, respectively, were suitable for analysis. The range of correlations for both sample sets were similar with the majority being >0.97 in both. Correlations between pairs for 18 commonly studied genes were also similar between the studies and mainly with Pearson correlation coefficients >0.6 except for a small number of genes, which had a narrow-dynamic range (e.g. MKI67, SNAI2). There was no systematic difference in intrinsic subtyping between the first and second sample of either set but there was c.15 % discordance between the subtype assignments between the pairs, mainly where the subtyping of individual samples was less certain. Increases in the expression of several stress/early-response genes (e.g. FOS, FOSB, JUN) were found in both studies and confirmed findings in earlier smaller studies. Increased expression of IL6, IGFBP2 and MYC (by 17 %, 14 % and 44 %, respectively) occurred between the samples taken 2 weeks apart and again confirmed findings from an earlier study. CONCLUSIONS There is generally good correlation in gene expression between pairs of core-cuts except where genes have a narrow dynamic range. Similar correlation coefficients to the average gene expression profiles of intrinsic subtype, particularly LumA and LumB, can lead to discordances between assigned subtypes. Substantial changes in expression of early-response genes occur within an hour after surgery and in IL6, IGFB2 and MYC as a result of diagnostic core-cut biopsy. TRIAL REGISTRATION Trial number CRUK/07/015 . Study start date September 2008.
Collapse
Affiliation(s)
- Elena López-Knowles
- Royal Marsden Hospital, London, UK. .,Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK.
| | - Qiong Gao
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - Maggie Chon U Cheang
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - James Morden
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Joel Parker
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Lesley-Ann Martin
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - Isabel Pinhel
- Royal Marsden Hospital, London, UK.,Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK.,Present address: Kingston University, London, UK
| | | | | | | | | | | | | | | | | | - John Robertson
- Faculty of Medicine & Health Sciences, Queen's Medical Centre, Nottingham, UK
| | | | - Judith M Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Mitch Dowsett
- Royal Marsden Hospital, London, UK.,Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | | |
Collapse
|
31
|
Klintman M, Dowsett M. Early Surrogate Markers of Treatment Activity: Where Are We Now? J Natl Cancer Inst Monogr 2016; 2015:24-8. [PMID: 26063881 DOI: 10.1093/jncimonographs/lgv002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The assessment of new therapies in the adjuvant setting in early breast cancer requires large numbers of patients and many years of follow-up for results to be presented. Therefore, the neoadjuvant study setting, which allows for early prediction of treatment response in smaller patient sets, has become increasingly popular. Ki67 is the most commonly used and extensively studied intermediate biomarker of treatment activity and residual risk in neoadjuvant trials on endocrine therapy, new biological therapies, and chemotherapy. It is increasingly being used as a primary endpoint for new therapies particularly those added to endocrine therapy. The PeriOperative Endocrine Therapy for Individualizing Care (POETIC) trial, including more than 4000 postmenopausal, estrogen receptor (ER)-positive patients randomly assigned to receive 2 weeks of presurgical treatment with an aromatase inhibitor or no further treatment, is the largest window-of-opportunity trial conducted and is assessing the clinical utility of on-treatment Ki67 as a predictor of long-term outcome. For generalizability, Ki67 measurements in the POETIC and other trials need to use standard methodology. The International Working Group on Ki67 in Breast Cancer is conducting a series of studies to bring this to reality.
Collapse
Affiliation(s)
- Marie Klintman
- Academic Department of Biochemistry, Royal Marsden Hospital, London, UK (MK, MD).
| | - Mitchell Dowsett
- Academic Department of Biochemistry, Royal Marsden Hospital, London, UK (MK, MD)
| |
Collapse
|
32
|
Demark-Wahnefried W, Nix JW, Hunter GR, Rais-Bahrami S, Desmond RA, Chacko B, Morrow CD, Azrad M, Frugé AD, Tsuruta Y, Ptacek T, Tully SA, Segal R, Grizzle WE. Feasibility outcomes of a presurgical randomized controlled trial exploring the impact of caloric restriction and increased physical activity versus a wait-list control on tumor characteristics and circulating biomarkers in men electing prostatectomy for prostate cancer. BMC Cancer 2016; 16:61. [PMID: 26850040 PMCID: PMC4743419 DOI: 10.1186/s12885-016-2075-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/19/2016] [Indexed: 01/10/2023] Open
Abstract
Background Obesity is associated with tumor aggressiveness and disease-specific mortality for more than 15 defined malignancies, including prostate cancer. Preclinical studies suggest that weight loss from caloric restriction and increased physical activity may suppress hormonal, energy-sensing, and inflammatory factors that drive neoplastic progression; however, exact mechanisms are yet to be determined, and experiments in humans are limited. Methods We conducted a randomized controlled trial among 40 overweight or obese, newly-diagnosed prostate cancer patients who elected prostatectomy to explore feasibility of a presurgical weight loss intervention that promoted a weight loss of roughly one kg. week−1 via caloric restriction and physical activity, as well as to assess effects on tumor biology and circulating biomarkers. Measures of feasibility (accrual, retention, adherence, and safety) were primary endpoints. Exploratory aims were directed at the intervention’s effect on tumor proliferation (Ki-67) and other tumor markers (activated caspase-3, insulin and androgen receptors, VEGF, TNFβ, NFκB, and 4E-BP1), circulating biomarkers (PSA, insulin, glucose, VEGF, TNFβ, leptin, SHBG, and testosterone), lymphocytic gene expression of corresponding factors and cellular bioenergetics in neutrophils, and effects on the gut microbiome. Consenting patients were randomized in a 1:1 ratio to either: 1) weight loss via a healthful, guidelines-based diet and exercise regimen; or 2) a wait-list control. While biological testing is currently ongoing, this paper details our methods and feasibility outcomes. Results The accrual target was met after screening 101 cases (enrollment rate: 39.6 %). Other outcomes included a retention rate of 85 %, excellent adherence (95 %), and no serious reported adverse events. No significant differences by age, race, or weight status were noted between enrollees vs. non-enrollees. The most common reasons for non-participation were “too busy” (30 %), medical exclusions (21 %), and “distance” (16 %). Conclusions Presurgical trials offer a means to study the impact of diet and exercise interventions directly on tumor tissue, and other host factors that are feasible and safe, though modifications are needed to conduct trials within an abbreviated period of time and via distance medicine-based approaches. Pre-surgical trials are critical to elucidate the impact of lifestyle interventions on specific mechanisms that mediate carcinogenesis and which can be used subsequently as therapeutic targets. Trial registration NCT01886677
Collapse
Affiliation(s)
- Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), 346 Webb Nutrition Sciences Bldg., 1675 University Blvd, Birmingham, AL, USA.
| | | | - Gary R Hunter
- Department of Human Studies, UAB, Birmingham, AL, USA
| | | | | | - Balu Chacko
- Department of Molecular & Cellular Pathology, UAB, Birmingham, AL, USA
| | - Casey D Morrow
- Department of Cell, Developmental & Integrative Biology, UAB, Birmingham, AL, USA
| | - Maria Azrad
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), 346 Webb Nutrition Sciences Bldg., 1675 University Blvd, Birmingham, AL, USA
| | - Andrew D Frugé
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), 346 Webb Nutrition Sciences Bldg., 1675 University Blvd, Birmingham, AL, USA
| | - Yuko Tsuruta
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), 346 Webb Nutrition Sciences Bldg., 1675 University Blvd, Birmingham, AL, USA
| | - Travis Ptacek
- Department of Microbiology, UAB, Birmingham, AL, USA
| | | | - Roanne Segal
- Department of Medicine, University of Ottawa, Ontario, Canada
| | | |
Collapse
|
33
|
Window of opportunity studies: Do they fulfil our expectations? Cancer Treat Rev 2016; 43:50-7. [DOI: 10.1016/j.ctrv.2015.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/21/2022]
|
34
|
Zoghi B, Elledge R. Endocrine Therapy for Leptomeningeal Metastases from ER-Positive Breast Cancer: Case Report and a Review of the Literature. Breast J 2016; 22:218-23. [PMID: 26748605 DOI: 10.1111/tbj.12554] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leptomeningeal disease is an uncommon complication of estrogen receptor positive breast cancer. While there is little consensus on the standard of care, recommendations from current clinical practice guidelines are to treat with intrathecal chemotherapy, necessitating invasive procedures and potentially resulting in a substantial incidence of serious complications and side effects. Here, we review all published evidence of the effectiveness of systemic hormonal therapy alone in treating this condition, with the advantage of requiring no invasive procedures and having virtually no serious complications or side effects. Evidence indicates that most hormonal therapies can penetrate the central nervous system and can be an effective treatment of endocrine sensitive breast cancer that is widely metastatic to the leptomeninges.
Collapse
Affiliation(s)
- Behyar Zoghi
- University of Texas Health Science Center, Cancer Therapy and Research Center at San Antonio, San Antonio, Texas
| | - Richard Elledge
- University of Texas Health Science Center, Cancer Therapy and Research Center at San Antonio, San Antonio, Texas
| |
Collapse
|
35
|
Barroso-Sousa R, Silva DDAFR, Alessi JVM, Mano MS. Neoadjuvant endocrine therapy in breast cancer: current role and future perspectives. Ecancermedicalscience 2016; 10:609. [PMID: 26823678 PMCID: PMC4720494 DOI: 10.3332/ecancer.2016.609] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Indexed: 12/18/2022] Open
Abstract
Luminal breast cancer, as defined by oestrogen and/or progesterone expression by immunohistochemistry, accounts for up to 75% of all breast cancers. In this population, endocrine therapy is likely to account for most of the gains obtained with the administration of adjuvant systemic treatment. The role of adjuvant chemotherapy in these patients remains debatable since it is known that only a small fraction of patients will derive meaningful benefit from this treatment whilst the majority will be exposed to significant and unnecessary chemotherapy-related toxicities, in particular the elderly and frail. Therefore, neoadjuvant endocrine therapy (NET) becomes an attractive option for selected patients with hormonal-receptor positive locally advanced breast cancer. In this review, we discuss the current role of NET and future perspectives in the field.
Collapse
Affiliation(s)
- Romualdo Barroso-Sousa
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 251, 5o andar, 01246-000 São Paulo, SP, Brazil
| | - Danilo D A Fonseca Reis Silva
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 251, 5o andar, 01246-000 São Paulo, SP, Brazil
| | - Joao Victor Machado Alessi
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 251, 5o andar, 01246-000 São Paulo, SP, Brazil
| | - Max Senna Mano
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 251, 5o andar, 01246-000 São Paulo, SP, Brazil
| |
Collapse
|
36
|
Kos Z, Dabbs DJ. Biomarker assessment and molecular testing for prognostication in breast cancer. Histopathology 2015; 68:70-85. [DOI: 10.1111/his.12795] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Zuzana Kos
- University of Ottawa and The Ottawa Hospital; Ottawa ON Canada
| | | |
Collapse
|
37
|
Marous M, Bièche I, Paoletti X, Alt M, Razak A, Stathis A, Kamal M, Le Tourneau C. Designs of preoperative biomarkers trials in oncology: a systematic review of the literature. Ann Oncol 2015; 26:2419-28. [DOI: 10.1093/annonc/mdv378] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 08/19/2015] [Indexed: 01/06/2023] Open
|
38
|
Szabo E. Biomarkers in phase I-II chemoprevention trials: lessons from the NCI experience. Ecancermedicalscience 2015; 9:599. [PMID: 26635903 PMCID: PMC4664504 DOI: 10.3332/ecancer.2015.599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Indexed: 12/13/2022] Open
Abstract
Early phase clinical trials are an essential component of chemopreventive drug development to identify signals of drug efficacy that can subsequently be explored definitively in phase III trials. Whereas phase I trials focus on safety and identification of optimal dose and schedule for cancer prevention, phase II trials focus on intermediate endpoints that are variably related to cancer development. The United States National Cancer Institute supports a programme devoted to early phase cancer prevention clinical trials. The experience, along with the benefits and limitations of the range of biomarker endpoints used in these studies, are reviewed here.
Collapse
Affiliation(s)
- Eva Szabo
- Lung and Upper Aerodigestive Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, 9609 Medical Centre Drive, Room 5E-102, Bethesda, MD 20892, USA
| |
Collapse
|
39
|
Chen X, Zhu S, Fei X, Garfield DH, Wu J, Huang O, Li Y, Zhu L, He J, Chen W, Jin X, Shen K. Surgery time interval and molecular subtype may influence Ki67 change after core needle biopsy in breast cancer patients. BMC Cancer 2015; 15:822. [PMID: 26514283 PMCID: PMC4627413 DOI: 10.1186/s12885-015-1853-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 10/27/2015] [Indexed: 12/22/2022] Open
Abstract
Background To investigate the accuracy of core needle biopsy (CNB) in evaluating breast cancer estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki67 status and to identify factors which might be associated with Ki67 value change after CNB. Methods A retrospective study was carried out on 276 patients with paired CNB and surgically removed samples (SRS). Clinico-pathological factors as well as the surgery time interval (STI) between CNB and surgery were analyzed to determine whether there were factors associated with Ki67 value change after CNB. Five tumor subtypes were classified as follows: Luminal A, Luminal B-HER2-, Luminal B-HER2+, Triple Negative (TN), and HER2+. Ki67 value change was calculated as SRS minus CNB. Results Mean STI after CNB was 4.5 (1-37) days. Good agreement was achieved for ER, PR, and HER2 evaluation between CNB and SRS. However, Ki67 expression level was significantly higher in SRS compared with CNB samples: 29.1 % vs. 26.2 % (P < 0.001). Both univariate and multivariate analysis demonstrated that STI and molecular subtype were associated with a Ki67 change after CNB. Luminal A tumors experienced more Ki67 elevation than Luminal B-HER2- diseases (6.2 % vs -0.1 %, P = 0.014). Patients with longer STI after CNB had a higher Ki67 increase: -1.1 % within 1-2 days, 2.1 % with 3-4 days, and 5.6 % more than 4 days, respectively (P = 0.007). For TN and HER2+ tumors, the Ki67 change was apt to be 0 with STI ≤ 4 days, while a >7 % Ki67 increase was noticed in patients with STI ≥ 5 days. Conclusion CNB was accurate in evaluating ER, PR, HER2, and molecular subtype status. Ki67 value significantly increased after CNB, which was associated with STI and molecular subtype. Further translational research needs to consider Ki67 changes following CNB among different breast cancer molecular subtypes. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1853-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Xiaosong Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 20025, China.
| | - Siji Zhu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 20025, China.
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - David H Garfield
- University of Colorado Comprehensive Cancer Center, Aurora, CO, 80045, USA.
| | - Jiayi Wu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 20025, China.
| | - Ou Huang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 20025, China.
| | - Yafen Li
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 20025, China.
| | - Li Zhu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 20025, China.
| | - Jianrong He
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 20025, China.
| | - Weiguo Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 20025, China.
| | - Xiaolong Jin
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Kunwei Shen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 20025, China.
| |
Collapse
|
40
|
Yeo B, Dowsett M. Neoadjuvant endocrine therapy: Patient selection, treatment duration and surrogate endpoints. Breast 2015; 24 Suppl 2:S78-83. [PMID: 26255746 DOI: 10.1016/j.breast.2015.07.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Neoadjuvant endocrine treatment has become of increasing interest for downstaging primary ER+ breast cancers as it has become clear that the pathologic complete response rate of luminal tumours to chemotherapy is much lower than that of non-luminal and differs little from that to endocrine therapy. There is much more experience in postmenopausal than premenopausal women. Aromatase inhibitors are generally the agent of choice. Responses are lower in those with the low levels of ER. While duration of endocrine treatment in clinical trials has usually been standardized at around three to four months it is clear that volume reductions continue to occur beyond that time in a large proportion of cases and routine clinical practice is often to treat to maximum response. This relatively slow emergence of downstaging relates to the absence of any increase in apoptosis with endocrine therapy and dependence of responses on the antiproliferative effects of oestrogen withdrawal: apoptosis occurs but at a slightly lower rate such that cell loss is attritional. The dependence of responses on the reduced proliferation underpins the value of Ki67 as an intermediate end-point for treatment benefit with multiple studies having found that relative effects on proliferation by different drugs in neoadjuvant trials match their relative impact on recurrence. While change in Ki67 is now accepted as a validated endpoint for comparing endocrine agents in the neoadjuvant scenario, on-treatment levels of Ki67 are related to long-term prognosis more closely than pretreatment Ki67. The Preoperative Endocrine Prognostic Index (PEPI) that combines residual Ki67 score with measures of on-treatment ER and other clinicopathologic factors has also found application in clinical trials. The potential to make longitudinal assessments of both clinical and biomarker responses has encouraged the development of novel clinical trial designs for assessing the impact of agents that aim to enhance response beyond that of endocrine agents alone. Such strategies include the early measurement of residual Ki67 levels after challenge with an endocrine agent alone and evaluation of the impact of the added agent on Ki67 or other agent-specific end-points.
Collapse
Affiliation(s)
- Belinda Yeo
- Department of Medicine, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK; Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK; Institute of Cancer Research, Fulham Road, London SW3 6JB, UK.
| | - Mitch Dowsett
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK; Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
| |
Collapse
|
41
|
Sonnenblick A, Piccart M. Adjuvant systemic therapy in breast cancer: quo vadis? Ann Oncol 2015; 26:1629-34. [DOI: 10.1093/annonc/mdv108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/16/2015] [Indexed: 11/13/2022] Open
|
42
|
López-Knowles E, Wilkerson PM, Ribas R, Anderson H, Mackay A, Ghazoui Z, Rani A, Osin P, Nerurkar A, Renshaw L, Larionov A, Miller WR, Dixon JM, Reis-Filho JS, Dunbier AK, Martin LA, Dowsett M. Integrative analyses identify modulators of response to neoadjuvant aromatase inhibitors in patients with early breast cancer. Breast Cancer Res 2015; 17:35. [PMID: 25888249 PMCID: PMC4406016 DOI: 10.1186/s13058-015-0532-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 02/05/2015] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Aromatase inhibitors (AIs) are a vital component of estrogen receptor positive (ER+) breast cancer treatment. De novo and acquired resistance, however, is common. The aims of this study were to relate patterns of copy number aberrations to molecular and proliferative response to AIs, to study differences in the patterns of copy number aberrations between breast cancer samples pre- and post-AI neoadjuvant therapy, and to identify putative biomarkers for resistance to neoadjuvant AI therapy using an integrative analysis approach. METHODS Samples from 84 patients derived from two neoadjuvant AI therapy trials were subjected to copy number profiling by microarray-based comparative genomic hybridisation (aCGH, n=84), gene expression profiling (n=47), matched pre- and post-AI aCGH (n=19 pairs) and Ki67-based AI-response analysis (n=39). RESULTS Integrative analysis of these datasets identified a set of nine genes that, when amplified, were associated with a poor response to AIs, and were significantly overexpressed when amplified, including CHKA, LRP5 and SAPS3. Functional validation in vitro, using cell lines with and without amplification of these genes (SUM44, MDA-MB134-VI, T47D and MCF7) and a model of acquired AI-resistance (MCF7-LTED) identified CHKA as a gene that when amplified modulates estrogen receptor (ER)-driven proliferation, ER/estrogen response element (ERE) transactivation, expression of ER-regulated genes and phosphorylation of V-AKT murine thymoma viral oncogene homolog 1 (AKT1). CONCLUSIONS These data provide a rationale for investigation of the role of CHKA in further models of de novo and acquired resistance to AIs, and provide proof of concept that integrative genomic analyses can identify biologically relevant modulators of AI response.
Collapse
Affiliation(s)
- Elena López-Knowles
- Royal Marsden Hospital, London, UK.
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
| | - Paul M Wilkerson
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
| | - Ricardo Ribas
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
| | - Helen Anderson
- Royal Marsden Hospital, London, UK.
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
| | - Alan Mackay
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
| | - Zara Ghazoui
- Royal Marsden Hospital, London, UK.
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
- Current affiliation: AstraZeneca, Alderley Park, Macclesfield, SK10 4TG, UK.
| | - Aradhana Rani
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
| | | | | | | | - Alexey Larionov
- University of Edinburgh, Edinburgh, UK.
- Current affiliation: Academic Laboratory of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | | | | | - Jorge S Reis-Filho
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
- Current affiliation: Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA.
| | - Anita K Dunbier
- Royal Marsden Hospital, London, UK.
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
- Current affiliation: Department of Biochemistry, University of Otago, Dunedin, New Zealand.
| | - Lesley-Ann Martin
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
| | - Mitch Dowsett
- Royal Marsden Hospital, London, UK.
- Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
| |
Collapse
|
43
|
Rapid response of breast cancer to neoadjuvant intramammary testosterone-anastrozole therapy: neoadjuvant hormone therapy in breast cancer. Menopause 2015; 21:673-8. [PMID: 24149917 PMCID: PMC4033664 DOI: 10.1097/gme.0000000000000096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective Experimental and clinical data support the inhibitory effect of testosterone on breast tissue and breast cancer. However, testosterone is aromatized to estradiol, which exerts the opposite effect. The aim of this study was to determine the effect of testosterone, combined with the aromatase inhibitor anastrozole, on a hormone receptor positive, infiltrating ductal carcinoma in the neoadjuvant setting. Methods To determine clinical response, we obtained serial ultrasonic measurements and mammograms before and after therapy. Three combination implants—each containing 60 mg of testosterone and 4 mg of anastrozole—were placed anterior, superior, and inferior to a 2.4-cm tumor in the left breast. Three additional testosterone-anastrozole implants were again placed peritumorally 48 days later. Results By day 46, there was a sevenfold reduction in tumor volume, as measured on ultrasound. By week 13, we documented a 12-fold reduction in tumor volume, demonstrating a rapid logarithmic response to intramammary testosterone-anastrozole implant therapy, equating to a daily response rate of 2.78% and a tumor half-life of 23 days. Therapeutic systemic levels of testosterone were achieved without elevation of estradiol, further demonstrating the efficacy of anastrozole combined with testosterone. Conclusions This novel therapy, delivered in the neoadjuvant setting, has the potential to identify early responders and to evaluate the effectiveness of therapy in vivo. This may prove to be a new approach to both local and systemic therapies for breast cancer in subgroups of patients. In addition, it can be used to reduce tumor volume, allowing for less surgical intervention and better cosmetic oncoplastic results.
Collapse
|
44
|
Johnstone CN, Smith YE, Cao Y, Burrows AD, Cross RSN, Ling X, Redvers RP, Doherty JP, Eckhardt BL, Natoli AL, Restall CM, Lucas E, Pearson HB, Deb S, Britt KL, Rizzitelli A, Li J, Harmey JH, Pouliot N, Anderson RL. Functional and molecular characterisation of EO771.LMB tumours, a new C57BL/6-mouse-derived model of spontaneously metastatic mammary cancer. Dis Model Mech 2015; 8:237-51. [PMID: 25633981 PMCID: PMC4348562 DOI: 10.1242/dmm.017830] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The translation of basic research into improved therapies for breast cancer patients requires relevant preclinical models that incorporate spontaneous metastasis. We have completed a functional and molecular characterisation of a new isogenic C57BL/6 mouse model of breast cancer metastasis, comparing and contrasting it with the established BALB/c 4T1 model. Metastatic EO771.LMB tumours were derived from poorly metastatic parental EO771 mammary tumours. Functional differences were evaluated using both in vitro assays and spontaneous metastasis assays in mice. Results were compared to non-metastatic 67NR and metastatic 4T1.2 tumours of the 4T1 model. Protein and transcript levels of markers of human breast cancer molecular subtypes were measured in the four tumour lines, as well as p53 (Tp53) tumour-suppressor gene status and responses to tamoxifen in vivo and in vitro. Array-based expression profiling of whole tumours identified genes and pathways that were deregulated in metastatic tumours. EO771.LMB cells metastasised spontaneously to lung in C57BL/6 mice and displayed increased invasive capacity compared with parental EO771. By immunohistochemical assessment, EO771 and EO771.LMB were basal-like, as was the 4T1.2 tumour, whereas 67NR had a luminal phenotype. Primary tumours from all lines were negative for progesterone receptor, Erb-b2/Neu and cytokeratin 5/6, but positive for epidermal growth factor receptor (EGFR). Only 67NR displayed nuclear estrogen receptor alpha (ERα) positivity. EO771 and EO771.LMB expressed mutant p53, whereas 67NR and 4T1.2 were p53-null. Integrated molecular analysis of both the EO771/EO771.LMB and 67NR/4T1.2 pairs indicated that upregulation of matrix metalloproteinase-3 (MMP-3), parathyroid hormone-like hormone (Pthlh) and S100 calcium binding protein A8 (S100a8) and downregulation of the thrombospondin receptor (Cd36) might be causally involved in metastatic dissemination of breast cancer.
Collapse
Affiliation(s)
- Cameron N Johnstone
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia Department of Pathology, University of Melbourne, Parkville, VIC 3010, Australia Department of Pharmacology & Therapeutics, University of Melbourne, Parkville, VIC 3010, Australia
| | - Yvonne E Smith
- Angiogenesis and Metastasis Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Yuan Cao
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Allan D Burrows
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Ryan S N Cross
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Xiawei Ling
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Richard P Redvers
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Judy P Doherty
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Bedrich L Eckhardt
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia Morgan Welch Inflammatory Breast Cancer Research and Clinic, Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Anthony L Natoli
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Christina M Restall
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Erin Lucas
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Helen B Pearson
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Siddhartha Deb
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, VIC 2010, Australia
| | - Kara L Britt
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Alexandra Rizzitelli
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Jason Li
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia
| | - Judith H Harmey
- Angiogenesis and Metastasis Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Normand Pouliot
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia Department of Pathology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Robin L Anderson
- Research Division, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC 3002, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia Department of Pathology, University of Melbourne, Parkville, VIC 3010, Australia
| |
Collapse
|
45
|
Evaluating the feasibility of performing window of opportunity trials in breast cancer. Int J Surg Oncol 2015; 2015:785793. [PMID: 25685551 PMCID: PMC4320871 DOI: 10.1155/2015/785793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 12/26/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The waiting period to surgery represents a valuable "window of opportunity" to evaluate novel therapeutic strategies. Interventional studies performed during this period require significant multidisciplinary collaboration to overcome logistical hurdles. We undertook a one-year prospective window of opportunity study to assess feasibility. METHODS Eligible newly diagnosed postmenopausal, estrogen receptor positive breast cancer patients awaiting primary surgery received anastrozole daily until surgery. Feasibility was assessed by (a) the proportion of patients who consented and (b) completed the study. Comparison of pre- and poststudy Ki67 labelling index and cleaved caspase 3 scores (CC3) was performed. RESULTS 22/131 (16.8%) patients were confirmed eligible and 20/22 (91%) patients completed the study. 19/20 (95%) patients agreed to undergo optional additional tissue biopsies. The mean duration of anastrozole use was 24.7 (15-44) days. There were a statistically significant decline in mean Ki67 indices of 48.8% (p < 0.001) and a trend towards significance in the decline of CC3 (p = 0.17) when comparing pre- with posttreatment values. CONCLUSION window of opportunity trials in breast cancer are a feasible way of assessing the biologic efficacy of different therapies in the presurgical setting. The majority of eligible women were willing to participate including undergoing additional tissue biopsies.
Collapse
|
46
|
Ingram DR, Dillon LM, Lev DC, Lazar A, Demicco EG, Eisenberg BL, Miller TW. Estrogen receptor alpha and androgen receptor are commonly expressed in well-differentiated liposarcoma. BMC Clin Pathol 2014; 14:42. [PMID: 25349530 PMCID: PMC4209467 DOI: 10.1186/1472-6890-14-42] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/13/2014] [Indexed: 12/19/2022] Open
Abstract
Background Liposarcoma (LS) is the second-most common type of soft-tissue sarcoma. Despite advances in knowledge and treatment of this disease, there remains a need for more effective LS therapy. Steroid hormone receptors regulate metabolism in adipocytes. Estrogen receptor alpha (ER), progesterone receptor (PR), and androgen receptor (AR) have been implicated in the pathophysiology of other cancer types. We sought to comprehensively determine temporal expression patterns of these receptors in LS. Methods We analyzed 561 histologically subtyped LS specimens from 354 patients for expression of ER, PR, and AR by immunohistochemistry (IHC) using diagnostic-grade reagents and protocols. The fractions of positively stained tumor cells were scored within each specimen. IHC scores were compared across LS subtypes using the Kruskal-Wallis test, and subtypes were compared using Dunn’s post-hoc test. Ages of patients with receptor-positive vs. -negative LS were compared by t-test. Genders and races were compared for hormone receptor positivity using Fisher’s exact test and Chi-square analysis, respectively. Recurrence-free survival was compared between receptor-positive and negative patients by log-rank test. p< 0.05 was considered significant. Results ER and AR were frequently expressed in LS, while few tumors expressed PR. Most of the ER + and AR + samples were of the well-differentiated LS subtype. A smaller fraction of de-differentiated LS expressed ER or AR, but expression was common within well-differentiated regions of tumors histologically classified as de-differentiated LS. In LS specimens from patients who underwent multiple surgeries over time, receptor expression frequently changed over time, which may be attributable in part to intratumor heterogeneity, varying degrees of de-differentiation, and biopsy bias. ER and AR were frequently co-expressed. Receptor status was not significantly associated with gender or race, but AR and PR expression were associated with earlier age at diagnosis. Receptor expression was not associated with altered recurrence-free survival. Conclusions ER and AR are commonly expressed in LS, particularly in well-differentiated tumors. These data warrant further functional study to determine receptor function in LS, and the potential efficacy of anti-hormone therapies for the treatment of patients with LS.
Collapse
Affiliation(s)
- Davis R Ingram
- Departments of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd, Houston, TX, USA
| | - Lloye M Dillon
- Departments of Pharmacology & Toxicology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, HB-7936, Lebanon, NH 03756, USA
| | - Dina Chelouche Lev
- Departments of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd, Houston, TX, USA
| | - Alexander Lazar
- Departments of Surgical Pathology, M.D. Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd, Houston, TX, USA
| | - Elizabeth G Demicco
- Department of Pathology, Mount Sinai Medical Center, One Gustave L. Levy Pl, New York, NY, USA
| | - Burton L Eisenberg
- Departments of Surgery, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH, USA
| | - Todd W Miller
- Departments of Pharmacology & Toxicology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, HB-7936, Lebanon, NH 03756, USA
| |
Collapse
|
47
|
Ki67 as a Biomarker of Prognosis and Prediction: Is it Ready for Use in Routine Pathology Practice? CURRENT BREAST CANCER REPORTS 2014. [DOI: 10.1007/s12609-014-0163-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
48
|
Stathopoulos GP, Malamos NA, Markopoulos C, Polychronis A, Armakolas A, Rigatos S, Yannopoulou A, Kaparelou M, Antoniou P. The role of Ki-67 in the proliferation and prognosis of breast cancer molecular classification subtypes. Anticancer Drugs 2014; 25:950-7. [PMID: 24949917 PMCID: PMC4162382 DOI: 10.1097/cad.0000000000000123] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 03/26/2014] [Indexed: 01/18/2023]
Abstract
The Ki-67 antigen was identified in the early steps of polymerase I-dependent ribosomal RNA synthesis. Although it seems that this protein has an important function in cell division, its exact role is still unclear and there is little published work on its overall function. The aim of the present study was to evaluate the contribution of the level of Ki-67 with respect to tumor recurrence in molecularly classified groups of breast cancer patients. Ki-67 was divided into the percentage levels up to and including 20% and over 20%. Immunohistochemistry and fluorescence in-situ hybridization are described for the results of estrogen receptor, progesterone receptor, c-erb-B2, and Ki-67 biomarkers. Formaldehyde-fixed breast samples were paraffin wax embedded and processed for paraffin sections. The protocol of the present study started in 1995 and finished in 2010. Nine hundred and sixteen patients with breast cancer were examined: 291 were grouped as luminal A, 228 as luminal B, 221 as the Her-2 subtype, and 107 as basal cell (triple negative). Follow-up ranged from 3 to 15 years following diagnosis. It was found that in luminal A patients, only one had a Ki-67 level higher than 20%. In luminal B, the Ki-67 was higher than 20% in 51.16% of the patients and recurrence occurred in 23.68%. In the Her-2 subtype, the Ki-67 level was more than 20% in 48.63%. In basal cell triple-negative patients, Ki-67 was more than 20% in 63.86%. The data presented here indicate that the level of Ki-67 may be considered one of the valuable biomarkers in breast cancer patients with respect to process and recurrence.
Collapse
|
49
|
Lee O, Page K, Ivancic D, Helenowski I, Parini V, Sullivan ME, Margenthaler JA, Chatterton RT, Jovanovic B, Dunn BK, Heckman-Stoddard BM, Foster K, Muzzio M, Shklovskaya J, Skripkauskas S, Kulesza P, Green D, Hansen NM, Bethke KP, Jeruss JS, Bergan R, Khan SA. A randomized phase II presurgical trial of transdermal 4-hydroxytamoxifen gel versus oral tamoxifen in women with ductal carcinoma in situ of the breast. Clin Cancer Res 2014; 20:3672-82. [PMID: 25028506 PMCID: PMC4101910 DOI: 10.1158/1078-0432.ccr-13-3045] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Local transdermal therapy to the breast may achieve effective target-organ drug delivery, while diminishing systemic effects. We conducted a randomized, double-blind, placebo-controlled phase II trial comparing transdermal 4-hydroxytamoxifen gel (4-OHT) to oral tamoxifen (oral-T) in women with ductal carcinoma in situ (DCIS). METHODS Twenty-seven pre- and postmenopausal women were randomized to 4-OHT (4 mg/day) or oral-T (20 mg/day) for 6 to 10 weeks before surgery. Plasma, nipple aspirate fluid, and breast adipose tissue concentrations of tamoxifen and its major metabolites were determined by liquid chromatography/tandem mass spectrometry. The primary endpoint was Ki67 labeling in DCIS lesions, measured by immunohistochemistry. In plasma, insulin-like growth factor-1 (IGFI), sex hormone-binding globulin (SHBG), and coagulation protein concentrations were determined. RESULTS Posttherapy Ki67 decreased by 3.4% in the 4-OHT and 5.1% in the oral-T group (P ≤ 0.03 in both, between-group P = 0. 99). Mean plasma 4-OHT was 0.2 and 1.1 ng/mL in 4-OHT and oral groups, respectively (P = 0.0003), whereas mean breast adipose tissue concentrations of 4-OHT were 5.8 ng/g in the 4-OHT group and 5.4 ng/g in the oral group (P = 0.88). There were significant increases in plasma SHBG, factor VIII, and von Willebrand factor and a significant decrease in plasma IGFI with oral-T, but not with 4-OHT. The incidence of hot flashes was similar in both groups. CONCLUSIONS The antiproliferative effect of 4-OHT gel applied to breast skin was similar to that of oral-T, but effects on endocrine and coagulation parameters were reduced. These findings support the further evaluation of local transdermal therapy for DCIS and breast cancer prevention.
Collapse
Affiliation(s)
- Oukseub Lee
- Authors' Affiliations: Departments of Surgery
| | - Katherine Page
- The Robert H. Lurie Cancer Center of Northwestern University
| | | | | | | | | | - Julie A Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Barbara K Dunn
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland; and
| | | | - Kathleen Foster
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland; and
| | | | | | | | | | | | - Nora M Hansen
- Authors' Affiliations: Departments of Surgery, The Robert H. Lurie Cancer Center of Northwestern University
| | - Kevin P Bethke
- Authors' Affiliations: Departments of Surgery, The Robert H. Lurie Cancer Center of Northwestern University
| | - Jacqueline S Jeruss
- Authors' Affiliations: Departments of Surgery, The Robert H. Lurie Cancer Center of Northwestern University
| | - Raymond Bergan
- Medicine, Division of Hematology/Oncology; The Robert H. Lurie Cancer Center of Northwestern University
| | - Seema A Khan
- Authors' Affiliations: Departments of Surgery, The Robert H. Lurie Cancer Center of Northwestern University;
| |
Collapse
|
50
|
Gonzalez-Cortijo L. Neoadjuvant endocrine therapy in breast cancer. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.13.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Preoperative therapy in breast cancer was initially considered a therapeutic tool to downstage large tumors. In the last few years, neoadjuvant endocrine therapy has emerged as an active approach for the treatment of locally advanced estrogen receptor-positive breast cancer. Moreover, the parallel results obtained with neoadjuvant and adjuvant endocrine trials suggest that rationale for future adjuvant designs should be based on previously confirmed positive outcomes obtained in neoadjuvant studies. Ki-67, a proliferation-associated antigen determined by serial biopsies during therapy, has been validated as a biomarker and can provide useful information to define prognosis and establish therapeutic decisions. This review focuses on the classical indications of neoadjuvant endocrine therapy, the parallelism between adjuvant and neoadjuvant studies and the potential role of this approach to predict outcomes based on short-term molecular markers in estrogen receptor-positive breast cancer.
Collapse
|