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Herzog SK, Fuqua SAW. ESR1 mutations and therapeutic resistance in metastatic breast cancer: progress and remaining challenges. Br J Cancer 2022; 126:174-186. [PMID: 34621045 PMCID: PMC8770568 DOI: 10.1038/s41416-021-01564-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/27/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022] Open
Abstract
Breast cancer accounts for 25% of the cancers in women worldwide. The most common subtype of breast cancer diagnosed is hormone receptor positive, which expresses the oestrogen receptor (ER). Targeting of the ER with endocrine therapy (ET) is the current standard of care for ER-positive (ER+) breast cancer, reducing the mortality by up to 40%. Resistance to ET, however, remains a major issue for ER + breast cancer, leading to recurrence and metastasis. One major driver of ET resistance is mutations in the ER gene (ESR1) leading to constitutive transcriptional activity and reduced ET sensitivity. These mutations are particularly detrimental in metastatic breast cancer (MBC) as they are present in as high as 36% of the patients. This review summarises the pre-clinical characterisation of ESR1 mutations and their association with clinical outcomes in MBC and primary disease. The clinically approved and investigational therapeutic options for ESR1 mutant breast cancer and the current clinical trials evaluating ESR1 mutations and ET resistance are also discussed. Finally, this review addresses pre-clinical models and multi-'omics' approaches for developing the next generation of therapeutics for ESR1 mutant and ET-resistant breast cancer.
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Affiliation(s)
- Sarah K Herzog
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
- Program in Integrative Molecular and Biomedical Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Suzanne A W Fuqua
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA.
- Program in Integrative Molecular and Biomedical Sciences, Baylor College of Medicine, Houston, TX, USA.
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA.
- Dan L Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA.
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Pepermans RA, Sharma G, Prossnitz ER. G Protein-Coupled Estrogen Receptor in Cancer and Stromal Cells: Functions and Novel Therapeutic Perspectives. Cells 2021; 10:cells10030672. [PMID: 33802978 PMCID: PMC8002620 DOI: 10.3390/cells10030672] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
Estrogen is involved in numerous physiological and pathophysiological systems. Its role in driving estrogen receptor-expressing breast cancers is well established, but it also has important roles in a number of other cancers, acting both on tumor cells directly as well as in the function of multiple cells of the tumor microenvironment, including fibroblasts, immune cells, and adipocytes, which can greatly impact carcinogenesis. One of its receptors, the G protein-coupled estrogen receptor (GPER), has gained much interest over the last decade in both health and disease. Increasing evidence shows that GPER contributes to clinically observed endocrine therapy resistance in breast cancer while also playing a complex role in a number of other cancers. Recent discoveries regarding the targeting of GPER in combination with immune checkpoint inhibition, particularly in melanoma, have led to the initiation of the first Phase I clinical trial for the GPER-selective agonist G-1. Furthermore, its functions in metabolism and corresponding pathophysiological states, such as obesity and diabetes, are becoming more evident and suggest additional therapeutic value in targeting GPER for both cancer and other diseases. Here, we highlight the roles of GPER in several cancers, as well as in metabolism and immune regulation, and discuss the therapeutic value of targeting this estrogen receptor as a potential treatment for cancer as well as contributing metabolic and inflammatory diseases and conditions.
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Affiliation(s)
- Richard A. Pepermans
- Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (R.A.P.); (G.S.)
| | - Geetanjali Sharma
- Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (R.A.P.); (G.S.)
- Center of Biomedical Research Excellence in Autophagy, Inflammation and Metabolism, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Eric R. Prossnitz
- Division of Molecular Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (R.A.P.); (G.S.)
- Center of Biomedical Research Excellence in Autophagy, Inflammation and Metabolism, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
- Correspondence: ; Tel.: +1-505-272-5647
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Besret L, d'Heilly S, Aubert C, Bluet G, Gruss-Leleu F, Le-Gall F, Caron A, Andrieu L, Vincent S, Shomali M, Bouaboula M, Voland C, Ming J, Roy S, Rao S, Carrez C, Jouannot E. Translational strategy using multiple nuclear imaging biomarkers to evaluate target engagement and early therapeutic efficacy of SAR439859, a novel selective estrogen receptor degrader. EJNMMI Res 2020; 10:70. [PMID: 32601772 PMCID: PMC7324464 DOI: 10.1186/s13550-020-00646-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/13/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Preclinical in vivo nuclear imaging of mice offers an enabling perspective to evaluate drug efficacy at optimal dose and schedule. In this study, we interrogated sufficient estrogen receptor occupancy and degradation for the selective estrogen receptor degrader (SERD) compound SAR439859 using molecular imaging and histological techniques. MATERIAL AND METHODS [18F]FluoroEstradiol positron emission tomography (FES-PET), [18F]FluoroDeoxyGlucose (FDG) PET, and [18F]FluoroThymidine (FLT) PET were investigated as early pharmacodynamic, tumor metabolism, and tumor proliferation imaging biomarkers, respectively, in mice bearing subcutaneous MCF7-Y537S mutant ERα+ breast cancer model treated with the SERD agent SAR439859. ER expression and proliferation index Ki-67 were assessed by immunohistochemistry (IHC). The combination of palbociclib CDK 4/6 inhibitor with SAR439859 was tested for its potential synergistic effect on anti-tumor activity. RESULTS After repeated SAR439859 oral administration over 4 days, FES tumoral uptake (SUVmean) decreases compared to baseline by 35, 57, and 55% for the 25 mg/kg qd, 12.5 mg/kg bid and 5 mg/kg bid treatment groups, respectively. FES tumor uptake following SAR439859 treatment at different doses correlates with immunohistochemical scoring for ERα expression. No significant difference in FDG uptake is observed after SAR439859 treatments over 3 days. FLT accumulation in tumor is significantly decreased when palbociclib is combined to SAR439859 (- 64%) but not different from the group dosed with palbociclib alone (- 46%). The impact on proliferation is corroborated by Ki-67 IHC data for both groups of treatment. CONCLUSIONS In our preclinical studies, dose-dependent inhibition of FES tumoral uptake confirmed target engagement of SAR439859 to ERα. FES-PET thus appears as a relevant imaging biomarker for measuring non-invasively the impact of SAR439859 on tumor estrogen receptor occupancy. This study further validates the use of FLT-PET to directly visualize the anti-proliferative tumor effect of the palbociclib CDK 4/6 inhibitor alone and in combination with SAR439859.
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Affiliation(s)
- Laurent Besret
- Sanofi Research and Development France, 13 quai Jules Guesde, 94403, Vitry-sur-Seine, France.
| | - Sébastien d'Heilly
- Sanofi Research and Development France, 13 quai Jules Guesde, 94403, Vitry-sur-Seine, France
| | - Cathy Aubert
- Sanofi Research and Development France, 13 quai Jules Guesde, 94403, Vitry-sur-Seine, France
| | - Guillaume Bluet
- Sanofi Research and Development France, 13 quai Jules Guesde, 94403, Vitry-sur-Seine, France
| | - Florence Gruss-Leleu
- Sanofi Research and Development France, 13 quai Jules Guesde, 94403, Vitry-sur-Seine, France
| | - Françoise Le-Gall
- Sanofi Research and Development France, 13 quai Jules Guesde, 94403, Vitry-sur-Seine, France
| | - Anne Caron
- Sanofi Research and Development France, 13 quai Jules Guesde, 94403, Vitry-sur-Seine, France
| | - Laurent Andrieu
- Sanofi Research and Development France, 13 quai Jules Guesde, 94403, Vitry-sur-Seine, France
| | - Sylvie Vincent
- Present address: Takeda Pharmaceuticals, 35 Landsdowne St, Cambridge, MA, 02139, USA
| | - Maysoun Shomali
- Sanofi Research and Development USA, 640 Memorial Drive, Cambridge, MA, 02139, USA
| | - Monsif Bouaboula
- Sanofi Research and Development USA, 640 Memorial Drive, Cambridge, MA, 02139, USA
| | - Carole Voland
- Sanofi Research and Development France, 371, rue du Pr Blayac, 34184, Montpellier Cedex 4, France
| | - Jeffrey Ming
- Sanofi Research and Development USA, 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Sébastien Roy
- Sanofi Research and Development France, 13 quai Jules Guesde, 94403, Vitry-sur-Seine, France
| | - Srinivas Rao
- Sanofi Research and Development USA, 640 Memorial Drive, Cambridge, MA, 02139, USA
| | - Chantal Carrez
- Sanofi Research and Development France, 13 quai Jules Guesde, 94403, Vitry-sur-Seine, France
| | - Erwan Jouannot
- Sanofi Research and Development France, 13 quai Jules Guesde, 94403, Vitry-sur-Seine, France
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Fanning SW, Jeselsohn R, Dharmarajan V, Mayne CG, Karimi M, Buchwalter G, Houtman R, Toy W, Fowler CE, Han R, Lainé M, Carlson KE, Martin TA, Nowak J, Nwachukwu JC, Hosfield DJ, Chandarlapaty S, Tajkhorshid E, Nettles KW, Griffin PR, Shen Y, Katzenellenbogen JA, Brown M, Greene GL. The SERM/SERD bazedoxifene disrupts ESR1 helix 12 to overcome acquired hormone resistance in breast cancer cells. eLife 2018; 7:37161. [PMID: 30489256 PMCID: PMC6335054 DOI: 10.7554/elife.37161] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 11/28/2018] [Indexed: 12/15/2022] Open
Abstract
Acquired resistance to endocrine therapy remains a significant clinical burden for breast cancer patients. Somatic mutations in the ESR1 (estrogen receptor alpha (ERα)) gene ligand-binding domain (LBD) represent a recognized mechanism of acquired resistance. Antiestrogens with improved efficacy versus tamoxifen might overcome the resistant phenotype in ER +breast cancers. Bazedoxifene (BZA) is a potent antiestrogen that is clinically approved for use in hormone replacement therapies. We found that BZA possesses improved inhibitory potency against the Y537S and D538G ERα mutants compared to tamoxifen and has additional inhibitory activity in combination with the CDK4/6 inhibitor palbociclib. In addition, comprehensive biophysical and structural biology studies show BZA’s selective estrogen receptor degrading (SERD) properties that override the stabilizing effects of the Y537S and D538G ERα mutations.
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Affiliation(s)
- Sean W Fanning
- Ben May Department for Cancer Research, University of Chicago, Chicago, United States
| | - Rinath Jeselsohn
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, United States.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States
| | | | - Christopher G Mayne
- Department of Biochemistry, College of Medicine, Center for Biophysics and Computational Biology, University of Illinois at Urbana-Champaign, Urbana, United States
| | - Mostafa Karimi
- Department of Electrical and Computer Engineering, TEES-AgriLife Center for Bioinformatics and Genomic Systems Engineering, Texas A&M University, Texas, United States
| | - Gilles Buchwalter
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, United States
| | - René Houtman
- PamGene International BV, 's-Hertogenbosch, The Netherlands
| | - Weiyi Toy
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Colin E Fowler
- Ben May Department for Cancer Research, University of Chicago, Chicago, United States
| | - Ross Han
- Ben May Department for Cancer Research, University of Chicago, Chicago, United States
| | - Muriel Lainé
- Ben May Department for Cancer Research, University of Chicago, Chicago, United States
| | - Kathryn E Carlson
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, United States
| | - Teresa A Martin
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, United States
| | - Jason Nowak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States
| | - Jerome C Nwachukwu
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, Jupiter, United States
| | - David J Hosfield
- Ben May Department for Cancer Research, University of Chicago, Chicago, United States
| | - Sarat Chandarlapaty
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Emad Tajkhorshid
- Department of Biochemistry, College of Medicine, Center for Biophysics and Computational Biology, University of Illinois at Urbana-Champaign, Urbana, United States
| | - Kendall W Nettles
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, United States
| | - Patrick R Griffin
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, United States
| | - Yang Shen
- Department of Electrical and Computer Engineering, TEES-AgriLife Center for Bioinformatics and Genomic Systems Engineering, Texas A&M University, Texas, United States
| | | | - Myles Brown
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, United States.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States
| | - Geoffrey L Greene
- Ben May Department for Cancer Research, University of Chicago, Chicago, United States
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