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Generali D, Berruti A, Cappelletti MR, Zanotti L, Brugnoli G, Forti M, Bedussi F, Vailati ME, Milani M, Strina C, Ardine M, Aguggini S, Allevi G, Ferrero G, Bertoni R, Bottini A, Harris AL, Fox SB. Effect of Primary Letrozole Treatment on Tumor Expression of mTOR and HIF-1α and Relation to Clinical Response. J Natl Cancer Inst Monogr 2015; 2015:64-6. [PMID: 26063890 DOI: 10.1093/jncimonographs/lgv018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024] Open
Abstract
INTRODUCTION Recently the combination of the mammalian target of rapamycin (mTOR) inhibitor everolimus and the aromatase inhibitor exemestane has been shown to double the progression-free survival rate in advanced breast cancer. However, the effect of the interrelated pathways of hypoxia-inducible factor-1α (HIF-1α) and mTOR signaling, both of which are associated with a more aggressive breast cancer phenotype and endocrine resistance, on response in the neoadjuvant setting is unknown. We, therefore, have investigated the influence of these pathways with the aim of better defining those patients most likely to benefit from an endocrine-based therapy associated with/without mTOR inhibitors. PATIENTS AND METHODS A total of 107 women with T2-4 N0-1 and estrogen receptor-positive breast cancer were randomly assigned to 6 months of primary letrozole (2.5 mg/daily) (LET) or LET plus oral "metronomic" cyclophosphamide (50mg/daily) (LET-CYC). Phospo-mTOR and HIF-1α were evaluated in tumor specimens collected before and after treatment using a tissue microarray format. RESULTS LET-based therapy induced a downregulation of phospho-mTOR and HIF-1α expression (P = .0001 and P < .004, respectively). The reduction of HIF-1α expression observed was positively correlated with phospho-mTOR reduction (P < .03); however, no treatment interaction between the two proteins was detected. HIF-1α expression was significantly modulated by the treatment (P < .004) with a reduction both in the LET arm (45%, n = 36/80) (P = .05) and LET-CYC arm (55%, n = 44/80) (P = .04). HIF-1α reduction showed a relationship with clinical response confined in LET arm only (P < .03). CONCLUSIONS In this neoadjuvant population, LET was able to modulate the phospho-mTOR and HIF-1α pathways and may define a subpopulation of nonresponders who may be most likely to benefit from mTOR inhibitors.
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Affiliation(s)
- Daniele Generali
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF).
| | - Alfredo Berruti
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Maria Rosa Cappelletti
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Laura Zanotti
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Giulia Brugnoli
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Michela Forti
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Francesca Bedussi
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Maria Elena Vailati
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Manuela Milani
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Carla Strina
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Mara Ardine
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Sergio Aguggini
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Giovanni Allevi
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Giuseppina Ferrero
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Ramona Bertoni
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Alberto Bottini
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Adrian L Harris
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
| | - Stephen B Fox
- U.O. Multidisciplinare di Patologia Mammaria/ US Terapia Molecolare (DG, MRC, LZ, GB, MF, FB, MEV, MM, CS, MA, SA, GA, ABo), and Anatomia Patologica (GF, RB), Azienda Istituti Ospitalieri di Cremona, Cremona, Italy; Oncologia Medica, Università di Brescia, Spedali Civili di Brescia, Brescia, Italy (ABe, GB); Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK (ALH); Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Australia (SBF)
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