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Ciscar M, Trinidad EM, Perez‐Chacon G, Alsaleem M, Jimenez M, Jimenez‐Santos MJ, Perez‐Montoyo H, Sanz‐Moreno A, Vethencourt A, Toss M, Petit A, Soler‐Monso MT, Lopez V, Gomez‐Miragaya J, Gomez‐Aleza C, Dobrolecki LE, Lewis MT, Bruna A, Mouron S, Quintela‐Fandino M, Al‐Shahrour F, Martinez‐Aranda A, Sierra A, Green AR, Rakha E, Gonzalez‐Suarez E. RANK is a poor prognosis marker and a therapeutic target in ER-negative postmenopausal breast cancer. EMBO Mol Med 2023; 15:e16715. [PMID: 36880458 PMCID: PMC10086586 DOI: 10.15252/emmm.202216715] [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: 08/08/2022] [Revised: 01/24/2023] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
Despite strong preclinical data, the therapeutic benefit of the RANKL inhibitor, denosumab, in breast cancer patients, beyond the bone, is unclear. Aiming to select patients who may benefit from denosumab, we hereby analyzed RANK and RANKL protein expression in more than 2,000 breast tumors (777 estrogen receptor-negative, ER- ) from four independent cohorts. RANK protein expression was more frequent in ER- tumors, where it associated with poor outcome and poor response to chemotherapy. In ER- breast cancer patient-derived orthoxenografts (PDXs), RANKL inhibition reduced tumor cell proliferation and stemness, regulated tumor immunity and metabolism, and improved response to chemotherapy. Intriguingly, tumor RANK protein expression associated with poor prognosis in postmenopausal breast cancer patients, activation of NFKB signaling, and modulation of immune and metabolic pathways, suggesting that RANK signaling increases after menopause. Our results demonstrate that RANK protein expression is an independent biomarker of poor prognosis in postmenopausal and ER- breast cancer patients and support the therapeutic benefit of RANK pathway inhibitors, such as denosumab, in breast cancer patients with RANK+ ER- tumors after menopause.
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Affiliation(s)
- Marina Ciscar
- Molecular Oncology, Spanish National Cancer Research Centre (CNIO)MadridSpain
- Oncobell, Bellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
| | - Eva M Trinidad
- Oncobell, Bellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
| | - Gema Perez‐Chacon
- Molecular Oncology, Spanish National Cancer Research Centre (CNIO)MadridSpain
| | - Mansour Alsaleem
- Nottingham Breast Cancer Research Centre, Academic Unit for Translational Medical Sciences, School of MedicineUniversity of Nottingham Biodiscovery Institute, University ParkNottinghamUK
- Present address:
Department of Applied Medical Science, Applied CollegeQassim UniversityUnayzahSaudi Arabia
| | - Maria Jimenez
- Molecular Oncology, Spanish National Cancer Research Centre (CNIO)MadridSpain
| | - Maria J Jimenez‐Santos
- Bioinformatics Unit, Structural Biology, Spanish National Cancer Research Centre (CNIO)MadridSpain
| | | | - Adrian Sanz‐Moreno
- Oncobell, Bellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
| | - Andrea Vethencourt
- Oncobell, Bellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
- Medical Oncology, Breast Unit, Catalan Institute of Oncology (ICO)University Hospital of BellvitgeBarcelonaSpain
| | - Michael Toss
- Nottingham Breast Cancer Research Centre, Academic Unit for Translational Medical Sciences, School of MedicineUniversity of Nottingham Biodiscovery Institute, University ParkNottinghamUK
| | - Anna Petit
- Pathology DepartmentUniversity Hospital of Bellvitge, IDIBELLBarcelonaSpain
| | | | - Victor Lopez
- Molecular Oncology, Spanish National Cancer Research Centre (CNIO)MadridSpain
| | | | - Clara Gomez‐Aleza
- Oncobell, Bellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
| | - Lacey E Dobrolecki
- Molecular and Cellular Biology and RadiologyThe Lester and Sue Smith Breast Center, Baylor College of MedicineHoustonTexasUSA
| | - Michael T Lewis
- Molecular and Cellular Biology and RadiologyThe Lester and Sue Smith Breast Center, Baylor College of MedicineHoustonTexasUSA
| | - Alejandra Bruna
- Cancer Research UK Cambridge CentreCambridgeUK
- Present address:
Molecular Pathology DivisionCentre for Paediatric Oncology Experimental MedicineCentre for Cancer EvolutionThe Institute of Cancer ResearchLondonUK
| | - Silvana Mouron
- Breast Cancer Clinical Research Unit, Clinical Research ProgramSpanish National Cancer Research Centre (CNIO)MadridSpain
| | - Miguel Quintela‐Fandino
- Breast Cancer Clinical Research Unit, Clinical Research ProgramSpanish National Cancer Research Centre (CNIO)MadridSpain
| | - Fatima Al‐Shahrour
- Bioinformatics Unit, Structural Biology, Spanish National Cancer Research Centre (CNIO)MadridSpain
| | - Antonio Martinez‐Aranda
- Oncobell, Bellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
- Medical Oncology, Breast Unit, Catalan Institute of Oncology (ICO)University Hospital of BellvitgeBarcelonaSpain
| | - Angels Sierra
- Oncobell, Bellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
- Present address:
Laboratory of Experimental Oncological Neurosurgery, Neurosurgery ServiceHospital Clinic de Barcelona‐FCRBBarcelonaSpain
| | - Andrew R Green
- Nottingham Breast Cancer Research Centre, Academic Unit for Translational Medical Sciences, School of MedicineUniversity of Nottingham Biodiscovery Institute, University ParkNottinghamUK
| | - Emad Rakha
- Nottingham Breast Cancer Research Centre, Academic Unit for Translational Medical Sciences, School of MedicineUniversity of Nottingham Biodiscovery Institute, University ParkNottinghamUK
| | - Eva Gonzalez‐Suarez
- Molecular Oncology, Spanish National Cancer Research Centre (CNIO)MadridSpain
- Oncobell, Bellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
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Gaudio A, Xourafa A, Rapisarda R, Castellino P. Therapeutic Options in the Management of Aromatase Inhibitor-Associated Bone Loss. Endocr Metab Immune Disord Drug Targets 2021; 22:259-273. [PMID: 34370654 DOI: 10.2174/1871530321666210809153152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Breast cancer is the most commonly occurring cancer in women worldwide. Early breast cancer is a kind of invasive neoplasm that has not proliferated beyond the breast or the axillary lymph nodes. Current therapeutic strategies for breast cancer mainly include local therapies such as surgery or radiotherapy and systemic therapies like chemotherapy, endocrine, and targeted therapy.Nowadays, the adjuvant treatment for hormone receptor-positive early breast cancer in postmenopausal women remains the main effective systemic therapy which can improve disease-free survival and overall survival; it involves several endocrine treatment regimens including selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), or a combination of them. AIs have been shown to be more effective in preventing recurrence in postmenopausal women with early breast cancer when compared with tamoxifen, thus representing the standard of care for adjuvant endocrine therapy. Although AIs are usually well-tolerated, they can have some side effects. Apart from the appearance of arthralgias or myalgias and cardiovascular events, AI therapies, reducing already low endogenous postmenopausal estradiol levels, cause increased bone loss and increase fracture risk in postmenopausal women. OBJECTIVES To evaluate the therapeutic options in the management of aromatase inhibitor-associated bone loss (AIBL). METHODS We reviewed the current literature dealing with different therapeutic options in the treatment of AIBL. RESULTS Clinical practice guidelines recommend a careful evaluation of skeletal health in all women with breast cancer before AI therapy initiation. Adequate calcium and vitamin D intake have also been suggested. Pharmacological attempts to minimize AI-related bone loss have focused on the use of antiresorptive agents, such as bisphosphonates and denosumab, to protect bone integrity and reduce the risk of fractures. Furthermore, clinical trials have shown that by making the bone microenvironment less susceptible to breast cancer metastasis, these drugs are able to increase disease-free survival. CONCLUSIONS AI, thatare the pillar of the systemic treatment for patients with hormone receptor-positive breast cancer, are associated with different side effects, and in particular osteoporosis and fractures. Both bisphosphonates and denosumab are able to prevent this negative effect.
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Affiliation(s)
- Agostino Gaudio
- Department of Clinical and Experimental Medicine, University of Catania , Italy
| | | | | | - Pietro Castellino
- Department of Clinical and Experimental Medicine, University of Catania , Italy
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Yeung M, Ho K, Fornier MN, Farooki A. Vertebral Fractures After Denosumab Discontinuation in Breast Cancer Survivors: A Single Institution Experience. HSS J 2021; 17:185-191. [PMID: 34421429 PMCID: PMC8361583 DOI: 10.1177/1556331621995846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022]
Abstract
Background: Denosumab is approved to prevent fragility fractures in patients with osteoporosis at high risk for fracture and to prevent bone loss in patients with breast and prostate cancer who receive endocrine therapy. The antiresorptive effect of denosumab rapidly dissipates when it is delayed or discontinued, but the risk for, and incidence of, multiple clinical vertebral fractures in patients with breast cancer after stopping denosumab is currently unclear. Question/Purposes: We sought to identify the incidence of clinical vertebral fractures in patients with breast cancer who received at least 2 doses of denosumab (60 mg) and then discontinued the medication. Methods: We conducted a retrospective chart review to identify patients with a history of breast cancer who were treated with denosumab between June 1, 2010, and July 18, 2018, at Memorial Sloan Kettering Cancer Center. We identified 335 postmenopausal women and 1 man with nonmetastatic breast cancer who received their final denosumab injection at least 6.5 months earlier. Data recorded included baseline bone density and the incidence of vertebral fractures after denosumab discontinuation. Results: The median age of patients was 62 years. Patients received between 2 and 13 denosumab doses before drug discontinuation. Most of the patients (310; 92.3%) were also treated with aromatase inhibitors. Of the 194 patients with baseline bone density data, 50 (25.8%) had normal bone density, 97 (50.0%) had osteopenia, and 47 (24.2%) had osteoporosis. The median follow-up duration from the last denosumab dose was 18.5 months. We identified 1 case of spontaneous vertebral fractures after denosumab stoppage. We found no cases of osteonecrosis of the jaw or atypical femur fracture. Most of the patients (88%) had a gap in denosumab dosing. Conclusions: Clinicians treating patients with breast cancer-especially those continuing to take aromatase inhibitors-should be aware of the possible risks of delaying doses of or discontinuing denosumab and should educate their patients accordingly. Prospective studies are needed to fully evaluate the risks of stopping or delaying denosumab.
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Affiliation(s)
- Michele Yeung
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kaylee Ho
- Division of Biostatistics, Weill Cornell Medical College, New York, NY, USA
| | - Monica N. Fornier
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Azeez Farooki
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Azeez Farooki, MD, Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065-6007, USA.
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Cazzaniga ME, Giordano M, Bandera M, Cassani C, Bounous V, Lania A, Biasi G, Destro M, Ricci S, Lucini D, Biglia N, Pagani O. Managing Menopausal Symptoms in Young Women With Breast Cancer: When Medicine Is Not All. The Take Care Project. Clin Breast Cancer 2021; 21:e547-e560. [PMID: 33685833 DOI: 10.1016/j.clbc.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/29/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
In the last decade, endocrine therapy strategies in perimenopausal women with hormone-responsive early breast cancer (BC) have changed and now ovarian function suppression (OFS) is recommended for the majority of patients. Side effects of OFS mimic menopausal symptoms, including hot flushes, sweats, weight gain, and sexual dysfunction, which may negatively impact quality of life (QoL). Aims of the Take Care Project are the education of physicians and patients to have all the information (medical and nonmedical) they need to manage menopausal symptoms by distributing educational materials useful to face menopause. Four different areas have been identified by surveys conducted among physicians and young patients: for each area, interventions and tools have been elaborated by a doctor and nonphysician professionals of these identified areas, to offer the widest information available. Clinical and practical suggestions have been provided. Based on the evidence given, we strongly suggest setting up a multidisciplinary team for the treatment planning of young patients with BC, which could help patients to face and manage their new menopause condition. The reduction of side effects and the improvement in QoL should be the best ally to treat young patients with BC.
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Affiliation(s)
- Marina Elena Cazzaniga
- Phase 1 Research Unit & Oncology Unit, Azienda Socio Sanitaria Territoriale Monza & Milano Bicocca School of Medicine and Surgery, Monza, Italy.
| | - Monica Giordano
- Oncology Unit, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - Mirko Bandera
- Farmacie Sant'Agata, Pharmacy Group, Bulgarograsso (Como), Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy
| | - Valentina Bounous
- Department of Obstetrics and Gynecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, Italy
| | - Andrea Lania
- Endocrinology, Diabetology and Andrology Unit, Biomedicine Department, Humanitas University, Milan, Italy
| | - Giovanna Biasi
- Prevention Department, Unità Operativa Complessa Medicine and Sport and Exercise, Treviso, Italy
| | - Maurizio Destro
- Medical Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio (BG) Italy
| | - Sauro Ricci
- Executive Chef, Joja Restaurant, Milan, Italy
| | - Daniela Lucini
- Exercise Medicine Unit, University of Milan BIOMETRA Department, Humanitas Clinical and Research Center, Milan, Italy
| | - Nicoletta Biglia
- Department of Obstetrics and Gynecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, Italy
| | - Olivia Pagani
- EOC Istituto Oncologico della Svizzera Italiana Ospedale Regionale Bellinzona e Valli 6500, Bellinzona, Switzerland
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Drake MT, Cremers S, Russell RG, Bilezikian JP. Drugs for the treatment of metabolic bone diseases. Br J Clin Pharmacol 2019; 85:1049-1051. [PMID: 30950086 DOI: 10.1111/bcp.13857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 12/17/2018] [Accepted: 12/28/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Matthew T Drake
- Department of Endocrinology and Kogod Center of Aging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Serge Cremers
- Division of Laboratory Medicine, Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City, New York.,Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City, New York
| | - R Graham Russell
- Mellanby Centre for Bone Research, Medical School, University of Sheffield, Sheffield, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Oxford University Institute of Musculoskeletal Sciences, The Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford, UK
| | - John P Bilezikian
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City, New York
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Cremers S, Drake MT, Ebetino FH, Bilezikian JP, Russell RGG. Pharmacology of bisphosphonates. Br J Clin Pharmacol 2019; 85:1052-1062. [PMID: 30650219 DOI: 10.1111/bcp.13867] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 12/27/2022] Open
Abstract
The biological effects of the bisphosphonates (BPs) as inhibitors of calcification and bone resorption were first described in the late 1960s. In the 50 years that have elapsed since then, the BPs have become the leading drugs for the treatment of skeletal disorders characterized by increased bone resorption, including Paget's disease of bone, bone metastases, multiple myeloma, osteoporosis and several childhood inherited disorders. The discovery and development of the BPs as a major class of drugs for the treatment of bone diseases is a paradigm for the successful journey from "bench to bedside and back again". Several of the leading BPs achieved "blockbuster" status as branded drugs. However, these BPs have now come to the end of their patent life, making them highly affordable. The opportunity for new clinical applications for BPs also exists in other areas of medicine such as ageing, cardiovascular disease and radiation protection. Their use as inexpensive generic medicines is therefore likely to continue for many years to come. Fifty years of research into the pharmacology of bisphosphonates have led to a fairly good understanding about how these drugs work and how they can be used safely in patients with metabolic bone diseases. However, while we seemingly know much about these drugs, a number of key aspects related to BP distribution and action remain incompletely understood. This review summarizes the existing knowledge of the (pre)clinical and translational pharmacology of BPs, and highlights areas in which understanding is lacking.
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Affiliation(s)
- Serge Cremers
- Division of Laboratory Medicine, Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.,Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew T Drake
- Department of Endocrinology and Kogod Center of Aging, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - F Hal Ebetino
- Department of Chemistry, University of Rochester, Rochester, NY, USA.,Mellanby Centre for Bone Research, Medical School, University of Sheffield, UK
| | - John P Bilezikian
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - R Graham G Russell
- Mellanby Centre for Bone Research, Medical School, University of Sheffield, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Oxford University Institute of Musculoskeletal Sciences, The Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford, UK
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Chukir T, Liu Y, Farooki A. Antiresorptive agents' bone-protective and adjuvant effects in postmenopausal women with early breast cancer. Br J Clin Pharmacol 2019; 85:1125-1135. [PMID: 30536446 DOI: 10.1111/bcp.13834] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/22/2018] [Accepted: 11/25/2018] [Indexed: 12/28/2022] Open
Abstract
Potent antiresorptive drugs (bisphosphonate and denosumab) are often used to protect bone health in postmenopausal breast cancer patients. In addition, clinical trials have shown that these drugs increase disease-free survival, though the mechanism of adjuvant benefit is largely unknown. Here we review the bone health and adjuvant data for both classes of antiresorptive drugs and highlight differences in their pharmacology. Inhibition of bone resorption is vitally important to protect against osteoporotic fractures, and may also contribute to adjuvant survival benefits by making the bone microenvironment less amenable to breast cancer metastasis. After a course of therapy, stoppage of bisphosphonates yields a persistent antiresorptive effect, whereas discontinuation of denosumab causes a rebound increase in bone resorption markers and a loss of bone mineral density to baseline levels. Whether the potential adjuvant benefits of denosumab are also rapidly lost after drug discontinuation deserves further investigation.
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Affiliation(s)
- Tariq Chukir
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yi Liu
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Azeez Farooki
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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