1
|
Saleh T, Alhesa A, Al-Balas M, Abuelaish O, Mansour A, Awad H, El-Sadoni M, Carpenter V, Azab B. Expression of therapy-induced senescence markers in breast cancer samples upon incomplete response to neoadjuvant chemotherapy. Biosci Rep 2021; 41:BSR20210079. [PMID: 33948615 PMCID: PMC8725197 DOI: 10.1042/bsr20210079] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 11/22/2022] Open
Abstract
Senescence is a cell stress response induced by replicative, oxidative, oncogenic, and genotoxic stresses. Tumor cells undergo senescence in response to several cancer therapeutics in vitro (Therapy-Induced Senescence, TIS), including agents utilized as neoadjuvant chemotherapy (NAC) in the treatment of invasive breast cancer. TIS has been proposed to contribute to adverse therapy outcomes including relapse. However, there is limited evidence on the induction of senescence in response to NAC in clinical cancer and its contribution to disease outcomes. In this work, the expression of three senescence-associated markers (p21CIP1, H3K9Me3 (histone H3 lysine 9 trimethylation), and Lamin B1) was investigated in breast cancer samples that developed partial or incomplete pathological response to NAC (n=37). Accordingly, 40.54% of all samples showed marker expression consistent with a senescence-like phenotype, while the remainders were either negative or inconclusive for senescence (2.70 and 56.8%, respectively). Moreover, analysis of core-needle biopsies revealed minimal changes in p21CIP1 and H3K9Me3, but significant changes in Lamin B1 expression levels following NAC, highlighting a more predictive role of Lamin B1 in senescence detection. However, our analysis did not establish an association between TIS and cancer relapse as only three patients (8.1%) with a senescence-like profile developed short-term recurrent disease. Our analysis indicates that identification of TIS in tumor samples requires large-scale transcriptomic and protein marker analyses and extended clinical follow-up. Better understanding of in vivo senescence should elucidate its contribution to therapy outcomes and pave the way for the utilization of senolytic approaches as potential adjuvant cancer therapy.
Collapse
Affiliation(s)
- Tareq Saleh
- Department of Basic Medical Sciences, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan
| | - Ahmad Alhesa
- Department of Pathology, Microbiology, and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Mahmoud Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan
| | - Omar Abuelaish
- Department of General Surgery, Royal Medical Services, Amman, Jordan
| | - Ahmad Mansour
- Department of Pathology, Microbiology, and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45219, U.S.A
| | - Heyam Awad
- Department of Pathology, Microbiology, and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Mohammed El-Sadoni
- Department of Pathology, Microbiology, and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Valerie J. Carpenter
- Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, U.S.A
| | - Bilal Azab
- Department of Pathology, Microbiology, and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| |
Collapse
|
2
|
Impact of Pathologic Complete Response following Neoadjuvant Chemotherapy ± Trastuzumab in Locally Advanced Breast Cancer. JOURNAL OF ONCOLOGY 2021; 2021:6639763. [PMID: 33628241 PMCID: PMC7895557 DOI: 10.1155/2021/6639763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/06/2021] [Accepted: 01/15/2021] [Indexed: 12/03/2022]
Abstract
Purpose This study was designed to examine the relationship between breast cancer molecular subtypes and pathological response to neoadjuvant chemotherapy (NAC) ± trastuzumab, in locally advanced breast cancer (LABC). Methods Female patients with LABC (T2–T4, N0–N2, and M0) who received neoadjuvant chemotherapy + trastuzumab if HER2+ subtype, followed by surgery and radiotherapy ± hormonal therapy, were identified. The primary endpoint was pathologic complete response (pCR) in the breast and axilla (ypT0/ypN0), with final analysis on disease-free survival (DFS) and overall survival (OS). Results Six hundred eighty-one patients with a median age of 44 years, premenopausal: 70%, median tumour size: 7.0 cm (range 4–11 cm), stage II B: 27% and III A/III B: 73%, ER+/HER2−: 40.8%, ER−/HER2−: 23%, ER+/HER2+: 17.7%, and ER−/HER2+: 18.5%. Overall pCR (ypT0/ypN0) was 23%. The pCR rates based on molecular subtypes were ER+/HER2−: 9%; ER+/HER2+: 29%; ER−/HER2−: 31%; and ER−/HER2+: 37%. At median follow-up of 61 months, ER+/HER2+ and ER+/HER2− subtypes had the best 5-year DFS and OS; meanwhile, ER−/HER2+ and ER−/HER2− subtypes had the worst. Conclusion Women with ER+/HER2− disease are the least likely to achieve pCR, with the highest rates in HER2+ and triple-negative subgroups. Degree of response is associated with OS; despite the comparatively higher likelihood of achieving pCR in ER−/HER2+ and triple-negative, these subgroups experience a survival detriment. We are consistent with the published data that patients who attain the pathological complete response defined as ypT0/ypN0 have improved outcomes.
Collapse
|
3
|
Consensus of the Spanish society of laboratory medicine and the Spanish society of medical oncology on the methodology and criteria for evaluation of circulating tumour markers in breast cancer. Clin Transl Oncol 2021; 23:1272-1280. [PMID: 33550504 PMCID: PMC8192375 DOI: 10.1007/s12094-020-02529-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
The measurement of circulating tumour markers (TMs) for the diagnosis or monitoring of breast cancer has sometimes been considered of limited utility. In addition to the overinterpretation of irrelevant changes in marker levels, the characteristics of the patient, the disease or other pathologies that can modify them are often not considered in their evaluation. On the other hand, there are recent data on the relationship of TMs with molecular subtypes and on their prognostic value, the knowledge of which may improve their clinical utility. This consensus article arises from a collaboration between the Spanish Society of Laboratory Medicine (SEQCML) and the Spanish Society of Medical Oncology (SEOM). It aims to improve the use and interpretation of circulating TMs in breast cancer. The text summarizes the current knowledge and available evidence on the subject and proposes a series of recommendations mainly focussed on the indication, the frequency of testing and the factors that should be considered for correctly interpreting changes in the levels of TMs.
Collapse
|
4
|
Al-Saleh K, Aldiab A, Salah T, Arafah M, Husain S, Al-Rikabi A, El-Aziz NA. Prognostic Significance of HER2 Expression Changes Following Neoadjuvant Chemotherapy in Saudi Patients With Locally Advanced Breast Cancer. Clin Breast Cancer 2020; 21:e362-e367. [PMID: 33419688 DOI: 10.1016/j.clbc.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/09/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Progesterone receptor (PR), estrogen receptor (ER), and human epidermal growth factor receptor 2 (HER2) significantly influence disease prognosis and therapeutic response in patients with breast cancer. Neoadjuvant chemotherapy (NACT) can change the receptor status, affecting the disease characteristics. PATIENTS AND METHODS A retrospective chart review was carried out at a single tertiary care hospital in Riyadh, Kingdom of Saudi Arabia, from December 2008 to December 2014, where 91 adult female patients diagnosed with locally advanced breast cancer planning to receive NACT were included. Original pathology and surgical histopathology reports were assessed, and patients were followed up to recurrence, death, or until December 2019. An expression for the ER, PR, and HER2 was carried out in pre and post NACT specimens by an experienced pathologist, and all HER2 with 2+ immunohistochemistry was sent for fluorescence in situ hybridization as per American Society of Clinical Oncology guidelines. RESULTS ER pre- and postoperatively changed from positive to negative in 17.6% of patients and from negative to positive in 1.1% of patients (P < .001). ER status remained stable in 81.3% of patients. PR changed from positive to negative in 13.2% of patients, and from negative to positive in 3.3% of patients (P < .001), whereas it remained stable in 83.5% of patients. HER2 changed from positive to negative in 11% of patients, and from negative to positive in 5.5% of patients (P < .001), and it remained stable in 83.5% of patients. No significant association was found between overall survival and disease-free-survival with HER2 expression change. CONCLUSION NACT can induce changes in the ER, PR, and HER2 status, which should be evaluated post-NACT to choose the optimal treatment regimens.
Collapse
Affiliation(s)
- Khalid Al-Saleh
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdurrahman Aldiab
- Division of Hematology-Oncology, Oncology Center, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Tareq Salah
- Division of Radiation Oncology, Oncology Center, King Saud University, Riyadh, Kingdom of Saudi Arabia; Clinical Oncology, Nuclear Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Maria Arafah
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sufia Husain
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ammar Al-Rikabi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nashwa Abd El-Aziz
- Division of Hematology-Oncology, Oncology Center, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia; Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
| |
Collapse
|
5
|
Wang L, Hong Y, Ma J, Han M, Zhang S, Shan B, Liu Y. Combination of pegylated liposomal doxorubicin and docetaxel as neoadjuvant therapy for breast cancer with axillary lymph node metastasis. J Int Med Res 2020; 48:300060520944310. [PMID: 32776809 PMCID: PMC7418263 DOI: 10.1177/0300060520944310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the efficacy and safety of the combination of pegylated liposomal doxorubicin and docetaxel as neoadjuvant therapy for breast cancer (BC) in patients with axillary lymph node metastasis. Methods In this single-arm study, 91 patients with clinical stage IIA–IIIc breast cancer received six cycles of pegylated liposomal doxorubicin plus docetaxel as neoadjuvant chemotherapy (NAC). Trastuzumab was allowed for patients with human epidermal growth factor receptor 2-positive tumors. The primary endpoint was pathologic complete response (pCR) in the breast after surgery. The overall response rate (ORR), Miller–Payne (MP) score of the primary tumors, and incidence of adverse events were also evaluated. Results In total, 88 patients completed all cycles of NAC. Fourteen patients (15.4%, 95% confidence interval [CI] = 7.8–22.9) achieved pCR. The ORR was 89% (95% CI = 82.5–95.6), and 72 lesions (79.1%) were rated as MP grade 3 or higher. The left ventricular ejection fraction (LVEF) was within the normal range, although four (4.4%) patients experienced an LVEF decline exceeding 10%. No symptomatic cardiac events were reported. Conclusion Preoperative NAC with pegylated liposomal doxorubicin and docetaxel appears effective and safe for treating BC with axillary lymph node metastasis.
Collapse
Affiliation(s)
- Li Wang
- Department of Breast Surgery, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Yang Hong
- Department of Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jie Ma
- Department of Breast Surgery, Tangshan People's Hospital, Tangshan, Hebei, China
| | - Meng Han
- Department of Breast Surgery, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Shuo Zhang
- Department of Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Baoen Shan
- Department of Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yunjiang Liu
- Department of Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| |
Collapse
|
6
|
Ki-67 Expression is a Significant Prognostic Factor Only When Progesterone Receptor Expression is Low in Estrogen Receptor-Positive and HER2-Negative Early Breast Cancer. JOURNAL OF ONCOLOGY 2019; 2019:7386734. [PMID: 31975992 PMCID: PMC6949686 DOI: 10.1155/2019/7386734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/05/2019] [Indexed: 01/18/2023]
Abstract
Objective While the value of Ki-67 has been recognized in breast cancer, controversy also exists. The goal of this study is to show the prognostic value of Ki-67 according to progesterone receptor (PgR) expression in patients who have estrogen receptor- (ER-) positive, human epidermal growth factor receptor 2- (HER2-) negative early breast cancer. Methods The records of nonmetastatic invasive breast cancer patients who underwent surgery at a single institution between 2009 and 2012 were reviewed. Primary end point was recurrence-free survival (RFS), and secondary end point was overall survival (OS). Ki-67 and PgR were assessed with immunohistochemistry for the tumor after surgery. Results A total of 1848 patients were enrolled in this study. 223 (12%) patients had high (≥10%) Ki-67, and 1625 (88%) had low Ki-67 expression. Significantly worse RFS and OS were observed in the high vs. low Ki-67 expression only when the PgR was low (<20%) (p < 0.001 and 0.005, respectively, for RFS and OS). There was no significant difference in RFS and OS according to Ki-67 when the PgR was high (p=0.120 and 0.076). RFS of four groups according to high/low Ki-67 and PgR expression was compared. The low PgR and high Ki-67 expression group showed worst outcome among them (p < 0.001). In a multivariate analysis, high Ki-67 was an independent prognostic factor when the PgR was low (HR 3.05; 95% CI 1.50–6.19; p=0.002). Conclusions Ki-67 had a value as a prognostic factor only under low PgR expression level in early breast cancer. PgR should be considered in evaluating the prognosis of breast cancer patients using Ki-67.
Collapse
|
7
|
Peng JH, Zhang X, Song JL, Ran L, Luo R, Li HY, Wang YH. Neoadjuvant chemotherapy reduces the expression rates of ER, PR, HER2, Ki67, and P53 of invasive ductal carcinoma. Medicine (Baltimore) 2019; 98:e13554. [PMID: 30633152 PMCID: PMC6336639 DOI: 10.1097/md.0000000000013554] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To analyze whether neoadjuvant chemotherapy (NAC) changes the expression rates of invasive ductal carcinoma (IDC) markers: estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki67, and P53.This was a retrospective study of 112 IDC patients who underwent NAC (docetaxel+epirubicin/pirarubicin+cyclophosphamide) but without pathological complete response (pCR) in 2012 to 2013 at the First Affiliated Hospital of Chongqing Medical University. The IDC subtypes and tumor protein markers were analyzed by immunohistochemistry (IHC). Specific changes in tumor protein markers before/after NAC were compared.The decrease in the positive rate of Ki-67 was the most significant, from 75.9% before NAC to 41.1% after NAC (P < .001). The positive rate of HER2 decreased from 42.0% before NAC to 32.1% after NAC (P = .04). The positive rate of ER decreased from 66.1% before NAC to 56.2% after NAC (P = .04). Increased number of metastatic lymph nodes (P = .006) and body mass index (BMI) (P = .028) seemed to be related to conversion of PR (positive to negative). There was statistical association between the Ki-67 (positive to negative) with the age greater or equal to 50 (P = .015). The BMI greater or equal to 24 (P = .021), age greater or equal to 50 (P = .047), and blood type A (P = .038) were independently associated with conversion of P53 (positive to negative). The BMI greater or equal to 24 (P = .004), number of metastatic lymph nodes greater or equal to 1 (P = .029) and TNM stages I-II (P = .008) were statistically associated with change of HER2 (positive to negative).In patients without pCR, NAC leads to changes in Ki-67, HER2, and hormone receptor (HR) expression. Age, BMI, number of metastatic lymph nodes, and TNM stage are associated with some changes of markers.
Collapse
MESH Headings
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/drug therapy
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Drug Therapy, Combination
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Ki-67 Antigen/metabolism
- Middle Aged
- Neoadjuvant Therapy
- Neoplasm Invasiveness
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Tumor Suppressor Protein p53/metabolism
Collapse
Affiliation(s)
- Jian-Heng Peng
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University
| | - Xiang Zhang
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Jun-Long Song
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Liang Ran
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University
| | - Rong Luo
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University
| | - Hong-Yuan Li
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Yong-Hong Wang
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University
| |
Collapse
|
8
|
Ma G, Huang H, Li M, Li L, Kong P, Zhu Y, Xia T, Wang S. Plasma CCL5 promotes EMT-medicated epirubicin-resistance in locally advanced breast cancer. Cancer Biomark 2018; 22:405-415. [PMID: 29758926 DOI: 10.3233/cbm-170986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neoadjuvant chemotherapy (NCT) is the standard treatment for locally advanced breast cancer (LABC). Pathological complete response (pCR) is commonly used as a valid predictor of NCT long-term outcomes. Blood-based tumor biomarkers have the potential to predict response to NCT at early stage non-invasively. We believed plasma CCL5 could be a potential marker to predict NCT of LABC. Its efficiency and possible mechanism was studied in this work. Human Cytokine Antibody Microarray was applied to screen different cytokine concentration in plasma between low histological regression (Low-R) and high histological regression (High-R) patients. LABC patients were divided into two groups according to pathological reactivity. The concentration of plasma CCL5 in different groups was determined by ELISA analysis. CCK8 assay was performed to analyze epirubicin susceptibility of breast cancer cells. Transwell assay was performed to determine the effect of CCL5 on breast cancer cells' migration and invasion. qRT-PCR and western blot were used to verify the EMT (epithelial-mesenchymal transition) markers in CCL5-treated and epirubicin-treated breast cancer cells. The concentration of plasma CCL5 of Low-R group was higher than High-R group before NCT. The plasma levels of CCL5 were significantly reduced after NCT in the group of high histological regression (High-R). Epirubicin susceptibility decreased in the breast cancer cells treated by recombinant CCL5. Migration and invasion were significantly enhanced in breast cancer cells treated by recombinant CCL5. E-cadherin expression was decreased whereas vimentin increased significantly in CCL5-treated breast cancer cells. The phosphorylation of ezrin in Y-567 and its downstream protein cortactin increased significantly in CCL5-treated breast cancer cells. Plasma CCL5 level could be a promised candidate to predict chemotherapy response of breast cancer. Plasma CCL5 plays an important role in EMT process of breast cancer.
Collapse
Affiliation(s)
- Ge Ma
- Breast Disease Center, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China.,Breast Disease Center, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China
| | - Huaxing Huang
- The First Clinical Medical College, Nanjing Medical University, 210029 Nanjing, Jiangsu, China.,Breast Disease Center, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China
| | - Minghui Li
- Breast Disease Center, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China.,Breast Disease Center, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China
| | - Li Li
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Peng Kong
- Breast Disease Center, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China
| | - Yichao Zhu
- Department of Physiology, Nanjing Medical University, Nanjing 211166, Jiangsu, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing 211166, Jiangsu, China
| | - Tiansong Xia
- Breast Disease Center, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China
| | - Shui Wang
- Breast Disease Center, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China
| |
Collapse
|
9
|
Guarneri V, Barbieri E, Piacentini F, Giovannelli S, Ficarra G, Frassoldati A, Maiorana A, D'Amico R, Conte P. Predictive and Prognostic Role of P53 According to Tumor Phenotype in Breast Cancer Patients Treated with Preoperative Chemotherapy: A Single-Institution Analysis. Int J Biol Markers 2018; 25:104-11. [DOI: 10.1177/172460081002500208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction and aims The p53 protein is a mediator of the cellular response to DNA damage. The aim of this study was to evaluate the predictive and/or prognostic value of p53 expression in relation to the molecular subtypes of breast cancer in patients treated with preoperative chemotherapy. Patients and methods Patients with stage II-III breast cancer were included in the study. The expression of p53 was evaluated by immunohistochemistry on the diagnostic core biopsy specimen. Patients received 4–6 courses of preoperative chemotherapy. Pathological complete response (pCR) was defined as complete disappearance of invasive tumor in the breast and axillary lymph nodes. Results 154 patients were included in the study and the molecular subtypes of their tumors were classified as follows: triple negative 18.2%, hormone receptor positive 60.4%, and HER2 positive 21.4%. p53 was expressed in 43.5% of the patients. A significant association between p53 expression and breast cancer molecular subtypes, tumor differentiation, and proliferation was observed. pCR was achieved in 8 patients (5.2%). p53 expression, molecular subtype, and nuclear grading were significant predictors of pCR (odds ratio for pCR in patients with p53-expressing tumors 10.03, p=0.0077). In univariate analysis, the expression of p53 as well as high proliferation and lymph node involvement after preoperative chemotherapy were predictors of a worse disease-free survival. Patients with p53 positivity also had a worse overall survival. In multivariate analysis, both p53 expression and nodal status after preoperative chemotherapy were significantly associated with disease-free and overall survival: the hazard ratios for relapse and death in patients with p53-expressing versus non-p53-expressing tumors were 2.29 (p=0.015) and 7.74 (p=0.002), respectively. The hazard ratios for relapse and death in node-positive versus node-negative patients were 3.63 (p=0.003) and 3.64 (p=0.041), respectively. Conclusions In this series of patients, p53 expression was significantly associated with markers of aggressive tumor biology, and with a higher likelihood of attaining pCR. p53 expression was a negative prognostic parameter for disease-free and overall survival in univariate and multivariate analysis.
Collapse
Affiliation(s)
- Valentina Guarneri
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | - Elena Barbieri
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | - Federico Piacentini
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | - Simona Giovannelli
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | - Guido Ficarra
- Department of Pathology, Modena University Hospital, Modena - Italy
| | - Antonio Frassoldati
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | | | - Roberto D'Amico
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | - PierFranco Conte
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| |
Collapse
|
10
|
Abstract
BACKGROUND Accuracy in predicting pathologic response to neoadjuvant chemotherapy (NACT) in breast cancer is essential for the determination of therapeutic efficacy and surgical planning. This study aimed to assess the precision of ultrasound (US) for predicting pathologic complete response (pCR = ypT0) after NACT. METHODS This retrospective mono-center study included 124 invasive breast cancer patients treated with NACT. Patients received US before and after NACT with documentation of clinical partial response (cPR) and clinical complete response (cCR). Post-operatively, the pathologic response was defined as absence of tumor cells (ypT0), presence of non-invasive tumor cells (ypTis) or invasive tumor cells (ypTinv). Sensitivity and specificity of US as well as false negative rate (FNR), negative predictive value (NPV) and positive predictive value (PPV) were analysed for receptor subtypes. A multivariable logistic regression model assessed the influence of patient- and tumor-associated covariates as predictors for pCR. RESULTS 50 patients (40.3%) achieved pCR, 39 (78.0%) had a corresponding cCR. Overall sensitivity was 60.8% and specificity 78.0% for US-predicted remission. NPV and FNR differed substantially between subtypes. NPV was highest (75.0%) in triple negative (TN) subtype, while FNR was low (37.5%). Therefore, pathological response was most accurately predicted for TN cancers. NPV for human-epidermal-growth-factor-receptor-2-positive/hormone-receptor-positive (HER2+/HR+) was 55.6%, for HER2+/HR- 64.3% and for HER2-/HR+ 16.7%, FNRs were 40.0%, 71.4% and 32.3%, respectively. Receptor subtypes impacted pCR significantly (p-value: 0.0033), cCR correlated positively with pCR (p-value: 0.0026). CONCLUSION US imaging is insufficient to predict pCR with adequate accuracy. Receptor subtypes, however, affect diagnostic precision of US and pathologic outcome.
Collapse
|
11
|
Alonso-González C, Menéndez-Menéndez J, González-González A, González A, Cos S, Martínez-Campa C. Melatonin enhances the apoptotic effects and modulates the changes in gene expression induced by docetaxel in MCF‑7 human breast cancer cells. Int J Oncol 2018; 52:560-570. [PMID: 29207126 DOI: 10.3892/ijo.2017.4213] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/15/2017] [Indexed: 02/07/2023] Open
Abstract
Results from clinical trials and multiple in vivo and in vitro studies point to melatonin as a promising adjuvant molecule with many beneficial effects when concomitantly administered with chemotherapy. Melatonin palliates side‑effects and enhances the efficacy of chemotherapeutic agents. However, the mechanisms through which melatonin regulates molecular changes induced by chemotherapeutic agents remain largely unknown. In this study, we demonstrated that melatonin enhanced the anti-proliferative and apoptotic responses to low doses of docetaxel in breast cancer cells. Importantly, these effects were more potent when melatonin was added prior to docetaxel. Treatment with 1 µM docetaxel (equivalent to the therapeutic dosage) induced changes in gene expression profiles and melatonin modulated these changes. Specifically, docetaxel downregulated TP53, cyclin-dependent kinase inhibitor 1A (CDKN1A) and cadherin 13 (CDH13), and upregulated mucin 1 (MUC1), GATA binding protein 3 (GATA3) and c-MYC, whereas melatonin counteracted these effects. Melatonin further stimulated the expression of the pro-apoptotic BAD and BAX genes, and enhanced the inhibition of the anti-apoptotic gene BCL-2 induced by docetaxel. The findings of this study suggest that melatonin is a molecule with potential for use as an adjuvant in cancer chemotherapy, which may have implications for designing clinical trials using chemotherapeutic drugs in combination with melatonin.
Collapse
Affiliation(s)
- Carolina Alonso-González
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria and Valdecilla Research Institute (IDIVAL), ES-39011 Santander, Spain
| | - Javier Menéndez-Menéndez
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria and Valdecilla Research Institute (IDIVAL), ES-39011 Santander, Spain
| | - Alicia González-González
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria and Valdecilla Research Institute (IDIVAL), ES-39011 Santander, Spain
| | - Alicia González
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria and Valdecilla Research Institute (IDIVAL), ES-39011 Santander, Spain
| | - Samuel Cos
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria and Valdecilla Research Institute (IDIVAL), ES-39011 Santander, Spain
| | - Carlos Martínez-Campa
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria and Valdecilla Research Institute (IDIVAL), ES-39011 Santander, Spain
| |
Collapse
|
12
|
Heil J, Schaefgen B, Sinn P, Richter H, Harcos A, Gomez C, Stieber A, Hennigs A, Rauch G, Schuetz F, Sohn C, Schneeweiss A, Golatta M. Can a pathological complete response of breast cancer after neoadjuvant chemotherapy be diagnosed by minimal invasive biopsy? Eur J Cancer 2016; 69:142-150. [DOI: 10.1016/j.ejca.2016.09.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/23/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
|
13
|
Maynadier M, Basile I, Gallud A, Gary-Bobo M, Garcia M. Combination treatment with proteasome inhibitors and antiestrogens has a synergistic effect mediated by p21WAF1 in estrogen receptor-positive breast cancer. Oncol Rep 2016; 36:1127-34. [PMID: 27373750 DOI: 10.3892/or.2016.4873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/11/2015] [Indexed: 11/06/2022] Open
Abstract
Although antiestrogens significantly improve the survival of patients with ER-positive breast cancer, therapeutic resistance remains a major limitation. The combinatorial use of antiestrogen with other therapies was proposed to increase their efficiency and more importantly, to prevent or delay the resistance phenomenon. In the present study, we addressed their combined effects with proteasome inhibitors (PIs). The effects of antiestrogens (hydroxyl-tamoxifen, raloxifen and fulvestrant) currently used in endocrine therapy were tested in combination with PIs, bortezomib or MG132, on the growth of three ER-positive breast cancer cell lines and in two cellular models of acquired antiestrogen resistance. When compared to single treatments, these combined treatments were significantly more effective in preventing the growth of the cell lines. The regulation of key cell cycle proteins, the cyclin-dependent kinase inhibitors, p21WAF1 and p27KIP1, were also studied. Bortezomib and MG132 drastically increased p21WAF1 expression through elevation of its mRNA concentration. Notably, p27KIP1 regulation was quite different from that of p21WAF1. Furthermore, the effect of bortezomib in combination with antiestrogen was evaluated on antiestrogen-resistant cell lines. The growth of two antiestrogen-resistant cell lines appeared responsive to proteasome inhibition and was strongly decreased by a combined therapy with an antiestrogen. Collectively, these findings provide new perspectives for the use of PIs in combination with endocrine therapies for breast cancer and possibly to overcome acquired hormonal resistance.
Collapse
Affiliation(s)
- Marie Maynadier
- Institut des Biomolécules Max Mousseron (IBMM), CNRS, Université Montpellier, ENSCM, Faculté de Montpellier, 34093 Montpellier Cedex 5, France
| | - Ilaria Basile
- Institut des Biomolécules Max Mousseron (IBMM), CNRS, Université Montpellier, ENSCM, Faculté de Montpellier, 34093 Montpellier Cedex 5, France
| | - Audrey Gallud
- Institut des Biomolécules Max Mousseron (IBMM), CNRS, Université Montpellier, ENSCM, Faculté de Montpellier, 34093 Montpellier Cedex 5, France
| | - Magali Gary-Bobo
- Institut des Biomolécules Max Mousseron (IBMM), CNRS, Université Montpellier, ENSCM, Faculté de Montpellier, 34093 Montpellier Cedex 5, France
| | - Marcel Garcia
- Institut des Biomolécules Max Mousseron (IBMM), CNRS, Université Montpellier, ENSCM, Faculté de Montpellier, 34093 Montpellier Cedex 5, France
| |
Collapse
|
14
|
Pare R, Shin JS, Lee CS. Increased expression of senescence markers p14(ARF) and p16(INK4a) in breast cancer is associated with an increased risk of disease recurrence and poor survival outcome. Histopathology 2016; 69:479-91. [PMID: 26843058 DOI: 10.1111/his.12948] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/31/2016] [Indexed: 11/28/2022]
Abstract
AIMS Breast cancer is a hormonally driven disease. Cellular senescence is an age-related irreversible cell cycle arrest at the G1 phase upon induction. The aim of this study was to characterize the expression patterns of the senescence markers p14(ARF) , p16(INK4a) and p21(WAF1/Cip1) during breast cancer progression in a large patient cohort. METHODS AND RESULTS We conducted a retrospective study of 1080 patients with invasive ductal carcinoma, no special type, over an 11-year period. We performed immunohistochemical staining on tissue microarrays that included normal, benign hyperplasia, ductal carcinoma in situ and invasive ductal carcinoma tissue from each patient. Invasive ductal carcinomas showed higher expression of p14(ARF) and p16(INK4a) but lower expression of p21(WAF1/Cip1) than non-malignant tissues. There were significant correlations of normal, benign, preinvasive and malignant tissues with p14(ARF) , p16(INK4a) and p21(WAF1/Cip1) expression (P < 0.05). Univariate comparison showed a correlation between high p16(INK4a) expression and poor survival (P = 0.000) and an increased risk of relapse (P = 0.000), whereas high p14(ARF) expression correlated only with an increased risk of relapse (P = 0.038). Multivariate analysis showed p16(INK4a) to be an important prognostic factor for overall survival (P = 0.011) and disease-free survival (P = 0.004), with p14(ARF) also being a significant prognostic factor for disease-free survival (P = 0.043). Moreover, patients showing both high p16(INK4a) expression and and high p14(ARF) expression had an adjusted three-fold increased risk of disease recurrence (P < 0.05) and a two-fold increased risk of all-cause-related death (P < 0.05). CONCLUSIONS These finding suggest p16(INK4a) expression and p14(ARF) expression may play an important role in the progression of proliferative breast tissue to invasive cancer, and may be useful as prognostic factors.
Collapse
Affiliation(s)
- Rahmawati Pare
- Discipline of Pathology, School of Medicine, Western Sydney University, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Joo-Shik Shin
- Discipline of Pathology, School of Medicine, Western Sydney University, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Department of Anatomical Pathology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Cheok Soon Lee
- Discipline of Pathology, School of Medicine, Western Sydney University, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Department of Anatomical Pathology, Liverpool Hospital, Liverpool, NSW, Australia.,Cancer Pathology, Bosch Institute, University of Sydney, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
15
|
A multicenter prospective phase II trial of neoadjuvant epirubicin, cyclophosphamide, and 5-fluorouracil (FEC100) followed by cisplatin-docetaxel with or without trastuzumab in locally advanced breast cancer. Cancer Chemother Pharmacol 2015; 77:147-53. [PMID: 26563257 DOI: 10.1007/s00280-015-2906-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the efficacy and safety profile of the (FEC100) followed by cisplatin/docetaxel with and without trastuzumab as primary chemotherapy for patients with locally advanced breast cancer (LABC). METHODS Eighty patients with LABC (T2-T4, N0-N2, M0) were enrolled to receive 24 weeks of neoadjuvant chemotherapy using epirubicin, cyclophosphamide, and 5-fluorouracil (FEC100) followed by cisplatin and docetaxel, plus trastuzumab if HER2 positive. The primary endpoint was pathologic complete response (pCR) in breast and axilla in separate HER2-negative and HER2-positive cohort. RESULTS Eighty patients were evaluable for analysis of which 51 were HER2 negative and 29 HER2 positive: median age: 43 years, premenopausal: 82%, median tumor size: 7.0 cm (4-10), stage IIB: 25% and IIIA/IIIB: 75%, both ER/PR positive: 56%, HER2 positive (3+) by IHC staining: 36%. Clinical complete response was seen in 48%, and clinical partial response was seen in 52%. Overall the pathologic complete response (pCR) was 36% in breast, 64 % in axilla, and 32% in both breast and axilla. Analysis of pCR in breast and axilla, as a function of the hormonal receptor (HR) and HER2, was as follows: HR(+)/HER2(-): 11%; HR(+)/HER(+): 56 %; HR(-)/HER2(-): 36%; HR(-)/HER2(+): 62%. CONCLUSION In this series of locally advanced breast cancer, the combination of (FEC100) followed by cisplatin/docetaxel with and without trastuzumab was very active obtaining an impressive rate of pCR, particularly in HER2-positive and triple negative disease, which merits further investigation.
Collapse
|
16
|
Heil J, Kümmel S, Schaefgen B, Paepke S, Thomssen C, Rauch G, Ataseven B, Große R, Dreesmann V, Kühn T, Loibl S, Blohmer JU, von Minckwitz G. Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques. Br J Cancer 2015; 113:1565-70. [PMID: 26554654 PMCID: PMC4705891 DOI: 10.1038/bjc.2015.381] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/23/2015] [Accepted: 10/10/2015] [Indexed: 11/25/2022] Open
Abstract
Background: Neoadjuvant chemotherapy (NACT) is widely used as an efficient breast cancer treatment. Ideally, a pathological complete response (pCR) can be achieved. Up to date, there is no reliable way of predicting a pCR. For the first time, we explore the ability of minimal invasive biopsy (MIB) techniques to diagnose pCR in patients with clinical complete response (cCR) to NACT in this study. This question is of high clinical relevance because a reliable pCR prediction could have direct implications for clinical practice. Methods: In all, 164 patients were included in this review-board approved, multicenter pooled analysis of prospectively assembled data. Core-cut (CC)-MIB or vacuum-assisted (VAB)-MIB were performed after NACT and before surgery. Negative predictive values (NPV) and false-negative rates (FNR) to predict a pCR in surgical specimen (diagnose pCR through MIB) were the main outcome measures. Results: Pathological complete response in surgical specimen was diagnosed in 93 (56.7%) cases of the whole cohort. The NPV of the MIB diagnosis of pCR was 71.3% (95% CI: (63.3% 79.3%)). The FNR was 49.3% (95% CI: (40.4% 58.2%)). Existence of a clip marker tended to improve the NPV (odds ratio 1.98; 95% CI: (0.81; 4.85)). None of the mammographically guided VABs (n=16) was false-negative (FNR 0%, NPV 100%). Conclusions: Overall accuracy of MIB diagnosis of pCR was insufficient to suggest changing clinical practice. However, subgroup analyses (mammographically guided VABs) suggest a potential capacity of MIB techniques to precisely diagnose pCR after NACT. Representativity of MIB could be a crucial factor to be focused on in further analyses.
Collapse
Affiliation(s)
- Joerg Heil
- Department of Gynecology, University Breast Unit, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Sherko Kümmel
- Kliniken Essen Mitte, Klinik für Senologie, Henricistraße 92, 45136 Essen, Germany
| | - Benedikt Schaefgen
- Department of Gynecology, University Breast Unit, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Stefan Paepke
- Department of Gynecology and Obstetrics, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Christoph Thomssen
- Department of Gynecology, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle an der Saale, Germany
| | - Geraldine Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - Beyhan Ataseven
- Kliniken Essen Mitte, Klinik für Senologie, Henricistraße 92, 45136 Essen, Germany
| | - Regina Große
- Department of Gynecology, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle an der Saale, Germany
| | - Volker Dreesmann
- Kliniken Essen Mitte, Klinik für Senologie, Henricistraße 92, 45136 Essen, Germany
| | - Thorsten Kühn
- Department of Gynaecology and Obstetrics, Interdisciplinary Breast Centre, Klinikum Esslingen, Hirschlandstraße 97, 73730 Esslingen, Germany
| | - Sibylle Loibl
- German Breast Group c/o GBG Forschungs GmbH, Schleussnerstrasse 42, 63263 Neu-Isenburg, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology, Charité, Chariteplatz 1, 10117 Berlin, Germany
| | - Gunter von Minckwitz
- German Breast Group c/o GBG Forschungs GmbH, Schleussnerstrasse 42, 63263 Neu-Isenburg, Germany
| |
Collapse
|
17
|
Schaefgen B, Mati M, Sinn HP, Golatta M, Stieber A, Rauch G, Hennigs A, Richter H, Domschke C, Schuetz F, Sohn C, Schneeweiss A, Heil J. Can Routine Imaging After Neoadjuvant Chemotherapy in Breast Cancer Predict Pathologic Complete Response? Ann Surg Oncol 2015; 23:789-95. [PMID: 26467456 DOI: 10.1245/s10434-015-4918-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study evaluated breast imaging procedures for predicting pathologic complete response (pCR = ypT0) after neoadjuvant chemotherapy (NACT) for breast cancer to challenge surgery as a diagnostic procedure after NACT. METHODS This retrospective, exploratory, monocenter study included 150 invasive breast cancers treated by NACT. The patients received magnetic resonance imaging (MRI), mammography (MGR), and ultrasound (US). The results were classified in three response subgroups according to response evaluation criteria in solid tumors. To incorporate specific features of MRI and MGR, an additional category [clinical near complete response (near-cCR)] was defined. Residual cancer in imaging and pathology was defined as a positive result. Negative predictive values (NPVs), false-negative rates (FNRs), and false-positive rates (FPRs) of all imaging procedures were analyzed for the whole cohort and for triple-negative (TN), HER2-positive (HER2+), and HER2-negative/hormone-receptor-positive (HER2-/HR+) cancers, respectively. RESULTS In 46 cases (31%), pCR (ypT0) was achieved. Clinical complete response (cCR) and near-cCR showed nearly the same NPVs and FNRs. The NPV was highest with 61% for near-cCR in MRI and lowest with 44% for near-cCR in MGR for the whole cohort. The FNRs ranged from 4 to 25% according to different imaging methods. The MRI performance seemed to be superior, especially in TN cancers (NPV 94%; FNR 5%). The lowest FPR was 10 % in MRI, and the highest FPR was 44% in US. CONCLUSION Neither MRI nor MGR or US can diagnose a pCR (ypT0) with sufficient accuracy to replace pathologic diagnosis of the surgical excision specimen.
Collapse
Affiliation(s)
- B Schaefgen
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - M Mati
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - H P Sinn
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - A Stieber
- Department of Diagnostic and Interventional Radiology, University Breast Unit, Heidelberg, Germany
| | - G Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - A Hennigs
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - H Richter
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - C Domschke
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology, University Breast Unit, Heidelberg, Germany
| | - A Schneeweiss
- Department of Gynecology, University Breast Unit, Heidelberg, Germany.,National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology, University Breast Unit, Heidelberg, Germany.
| |
Collapse
|
18
|
Kim T, Han W, Kim MK, Lee JW, Kim J, Ahn SK, Lee HB, Moon HG, Lee KH, Kim TY, Han SW, Im SA, Park IA, Kim JY, Noh DY. Predictive Significance of p53, Ki-67, and Bcl-2 Expression for Pathologic Complete Response after Neoadjuvant Chemotherapy for Triple-Negative Breast Cancer. J Breast Cancer 2015; 18:16-21. [PMID: 25834606 PMCID: PMC4381118 DOI: 10.4048/jbc.2015.18.1.16] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/05/2015] [Indexed: 12/31/2022] Open
Abstract
Purpose Patients with triple-negative breast cancer (TNBC) with pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) have superior survival outcomes compared to those with residual disease after NAC. This study investigated the value of three biomarkers, p53, Ki-67, and Bcl-2 for predicting pCR in NAC-treated patients with TNBC. Methods Between 2003 and 2012, 198 patients with pathologically confirmed primary TNBC were treated with two different taxane-based chemotherapeutic regimens prior to surgery. Before NAC, expression of p53 (cutoff 25%), Ki-67 (cutoff 10%), and Bcl-2 (cutoff 10%) was assessed immunohistochemically in core biopsy specimens. The incidence of pCR was correlated with the expression of these biomarkers. Results Overall, pCR occurred in 37 of the 198 patients (18.7%). A significant association was observed between the pCR rate and overexpression of the p53 and Ki-67 biomarkers. Multivariate analysis showed that only p53 expression was independently associated with pCR to NAC (odds ratio, 3.961; p=0.003). The sensitivity, specificity, positive predictive value, and negative predictive value of p53 expression for predicting pCR were 77.8%, 50.3%, 26.2%, and 90.9%, respectively. The pCR rate was the lowest (5.2%) in patients with low expression of both p53 and Ki-67, and it was the highest (25.8%) when both biomarkers showed high expression. Conclusion Expression of p53 was significantly associated with pCR after NAC in patients with TNBC, suggesting that this biomarker might be particularly valuable in identifying TNBC patients prone to have residual disease after NAC.
Collapse
Affiliation(s)
- Taeryung Kim
- Department of Surgery, Breast Cancer Center, Gachon University Gil Hospital, Incheon, Korea
| | - Wonshik Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyoon Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Woo Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jisun Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Kyung Ahn
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Byoel Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sae-Won Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - In Ae Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong-Young Noh
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
19
|
Dong MJ, Wang LB, Jiang ZN, Jin M, Hu WX, Shen JG. The transcription factor KLF4 as an independent predictive marker for pathologic complete remission in breast cancer neoadjuvant chemotherapy: a case-control study. Onco Targets Ther 2014; 7:1963-9. [PMID: 25368523 PMCID: PMC4216037 DOI: 10.2147/ott.s68340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To identify whether a stem cell biomarker, KLF4, may predict the pathologic tumor response to neoadjuvant chemotherapy for patients with locally advanced breast cancer. Methods Twelve locally advanced breast cancer patients who achieved pathologic complete remission (pCR) after neoadjuvant chemotherapy were identified and for each, three non-pCR breast cancer patients – matched for age, clinical tumor–node–metastasis stage, and neoadjuvant chemotherapy cycles – were selected. The relationship between KLF4 expression in the core needle biopsied cancer tissue and patient pCR rate was assessed using univariate and multivariate analysis. Results Receiver operating characteristic curve analysis showed that the patients with a histoscore of KLF4 expression >0.18 had a lower pCR rate. Multivariable analysis showed that higher KLF4 expression (odds ratio 0.013; 95% confidence interval 0.013–0.444; P=0.004) was independently correlated with a lower pCR rate after neoadjuvant chemotherapy. Conclusion KLF4 overexpression was associated with lower pCR in locally advanced breast cancer patients undergoing neoadjuvant chemotherapy. This study suggests that KLF4 may serve as a predictor for pCR in patients with breast cancer after neoadjuvant chemotherapy.
Collapse
Affiliation(s)
- Min Jun Dong
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Lin Bo Wang
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Zhi Nong Jiang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Mei Jin
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Wen Xian Hu
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Jian Guo Shen
- Department of Surgical Oncology, Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| |
Collapse
|
20
|
Tuxen MK, Cold S, Tange UB, Balslev E, Nielsen DL. Phase II study of neoadjuvant pegylated liposomal doxorubicin and cyclophosphamide ± trastuzumab followed by docetaxel in locally advanced breast cancer. Acta Oncol 2014; 53:1440-5. [PMID: 24991893 DOI: 10.3109/0284186x.2014.921727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
21
|
Fei F, Du Y, Di G, Wu J, Shao Z. Are changes in circulating tumor cell (CTC) count associated with the response to neoadjuvant chemotherapy in local advanced breast cancer? A meta-analysis. Oncol Res Treat 2014; 37:250-4. [PMID: 24853784 DOI: 10.1159/000362378] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/07/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Circulating tumor cells (CTCs) represent a biomarker for tumor progression and monitoring therapeutic effects. We evaluated the association between the changes in CTC count and the pathological response to neoadjuvant chemotherapy (NCT) for local advanced breast cancer (LABC) patients. METHODS PubMed, EBSCO, Web of Science, conference proceedings and key trials for the period 1998-2012 were searched. We used the hazard ratio (HR) to evaluate the variation in the number of CTCs to predict the response to NCT in LABC patients. All data from each study were investigated using either fixed- or random-effect models and were analyzed using Stata software. RESULTS There was no between-study heterogeneity in pathological complete response (pCR) (heterogeneity chi-squared = 0.02 (df = 1), I(2) = 0.0%, p = 0.877). Our meta-analysis showed that the change (decrease or increase) in CTC number in LABC patients during NCT was not correlated with pCR (HR = 0.918, 95% confidence interval 0.650-1.295; p = 0.877). CONCLUSION The results of the current meta-analysis indicate that there is no association between the decrease of CTC number and pCR after NCT. According to our results, a decrease in the CTC count after NCT in LABC patients did not indicate that they had an improved response to NCT. However, more randomized clinical trials are needed to confirm this conclusion.
Collapse
Affiliation(s)
- Fei Fei
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | | | | | | | | |
Collapse
|
22
|
Chen X, Liu X, Zhang L, Li S, Shi Y, Tong Z. Poorer survival of male breast cancer compared with female breast cancer patients may be due to biological differences. Jpn J Clin Oncol 2013; 43:954-63. [PMID: 23935206 DOI: 10.1093/jjco/hyt116] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The objective of the study was to compare disease-free survival and overall survival in a group of matched males and females with breast cancer, and to analyze possible treatment- and gender-related differences. METHODS We retrospectively analyzed the data of 150 operable male breast cancer patients treated in our hospital from December 1980 to June 2012. Each male breast cancer patient recorded in the database was matched with two female breast cancer patients of equal stage. Prognosis in terms of disease-free survival and overall survival was evaluated. RESULTS The mean age at diagnosis was 58.6 ± 9.7 years for males and 57.2 ± 10.3 years for females. The median follow-up was 69 months for males and 81 months for females. Significant differences were identified for tumor location, hormone receptor status, molecular subtypes and hormone therapy between the two groups. Monofactorial analysis demonstrated that tumor size, lymph node state, American Joint Committee on Cancer stage, molecular subtypes and adjuvant chemotherapy treatment were prognostic factors in male breast cancer patients. The 5- and 10-year disease-free survival rates were 65.6 and 40.1% for males, and 74.9 and 51.5% for females, respectively. The 5- and 10-year overall survival rates were 72.9 and 53.9% for males, and 83.2 and 68.5% for females, respectively. There was significantly difference in disease-free survival and overall survival between the two matched groups (P = 0.002). CONCLUSIONS Male breast cancer patients had inferior outcome despite of equal stage in comparison with matched female breast cancer patients, which demonstrates that biological differences may contribute to the worse prognosis.
Collapse
Affiliation(s)
- Xingyu Chen
- *Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin 300060, China.
| | | | | | | | | | | |
Collapse
|
23
|
Xu CC, Yue L, Wei HJ, Zhao WW, Sui AH, Wang XM, Qiu WS. Significance of TFF3 protein and Her-2/neu status in patients with gastric adenocarcinoma. Pathol Res Pract 2013; 209:479-85. [DOI: 10.1016/j.prp.2013.04.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 12/16/2022]
|
24
|
Li ZH, Xiong QY, Tu JH, Gong Y, Qiu W, Zhang HQ, Wei WS, Hou YF, Cui WQ. Tau proteins expressions in advanced breast cancer and its significance in taxane-containing neoadjuvant chemotherapy. Med Oncol 2013; 30:591. [PMID: 23681778 DOI: 10.1007/s12032-013-0591-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/23/2013] [Indexed: 12/11/2022]
Abstract
Tau is a microtubule-associated protein and expressed in normal breast epithelial cells and breast cancer. Tau expression in breast cancer may be important for chemotherapy optimization. This study is to investigate the expression of Tau in advanced breast cancer and its significance in taxane-containing neoadjuvant chemotherapy. Levels of Tau protein in advanced breast cancer were detected immunohistochemically. The chemotherapeutic efficacy indexes in Tau(-) group, which includes the remission rate, Miller-Payne pathological reactive grade, and pathologic complete response rate, were improved compared with that in Tau(+) group. There was difference in the efficacy indexes among ER+ subgroups but not among ER- patients. In addition, Tau expression was positively correlated (r = 0.32, P < 0.00). In multivariate analysis, when age, clinical stage, postoperative lymph node metastasis, ER, PR, HER2, Ki-67, TP53, or Tau status were included, postoperative lymph node metastasis and Tau-negative status were identified as independent predictors of pathologic complete response. In conclusion, negative Tau protein expression may be an effective predictor for taxane-containing neoadjuvant chemotherapy, especially in ER+ subgroups. Further study on the molecular mechanism and utility of Tau for individualizing adjuvant chemotherapy is warranted.
Collapse
Affiliation(s)
- Zhi-Hua Li
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang 330009, JiangXi, People's Republic of China.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
El-Sayed MI, Maximous DW, Zakhary MM, Mikhail NNH. Biological markers and response to neoadjuvant taxane-based chemotherapy in patients with locally advanced breast cancer. ISRN ONCOLOGY 2013; 2012:245891. [PMID: 23316390 PMCID: PMC3536061 DOI: 10.5402/2012/245891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/24/2012] [Indexed: 01/25/2023]
Abstract
Introduction. Biological markers as Her2/neu, p53, and hormonal receptors (HmRs) may be reliable parameters for prognostic assessment of patients of locally advanced breast cancer (LABC). This work aims at assessing the potential value of these biological markers for the prediction of disease outcome after neoadjuvant taxane-based chemotherapy and its implication on the surgical role. Patients and Methods. From March 2006 to September 2011, 95 patients with LABC were treated by neoadjuvant taxane-based chemotherapy given at intervals of 3 weeks. Expression of Her2/neu and p53 was examined in the initial tissue biopsy by using ELISA technique. Status of HmRs was determined using a commercial enzyme immunoassay. Three weeks after the third cycle, patients underwent surgical resection followed by 3 more cycles of taxane-based chemotherapy and radiotherapy as an adjuvant therapy. Relations of Her2/neu overexpression to p53, HmRs, and conventional prognostic factors were analyzed. Results. Median followup was 61 months. The 5-year DFS and OAS rates were significantly higher in patients with positive HmRs than in those with negative HmRs, patients with Her2- than those with Her2+ breast cancer, and patients with intact p53 breast cancer than those with inactive p53. HER-2 overexpression was statistically significant associated with loss of HmR positive immunostaining (P < 0.0001), grade III breast cancer (P < 0.0001), advanced nodal status (P = 0.0039), and younger (<50 years) age (P = 0.0108). Conclusion. Her2/neu overexpression was associated with poor DFS and OAS rates, as it was significantly associated with negative HmR and high grade.
Collapse
Affiliation(s)
- Mohamed I El-Sayed
- Department of Radiation Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | | | | | | |
Collapse
|
26
|
Wenners AS, Mehta K, Loibl S, Park H, Mueller B, Arnold N, Hamann S, Weimer J, Ataseven B, Darb-Esfahani S, Schem C, Mundhenke C, Khandan F, Thomssen C, Jonat W, Holzhausen HJ, von Minckwitz G, Denkert C, Bauer M. Neutrophil gelatinase-associated lipocalin (NGAL) predicts response to neoadjuvant chemotherapy and clinical outcome in primary human breast cancer. PLoS One 2012; 7:e45826. [PMID: 23056218 PMCID: PMC3467272 DOI: 10.1371/journal.pone.0045826] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 08/24/2012] [Indexed: 01/24/2023] Open
Abstract
In our previous work we showed that NGAL, a protein involved in the regulation of proliferation and differentiation, is overexpressed in human breast cancer (BC) and predicts poor prognosis. In neoadjuvant chemotherapy (NACT) pathological complete response (pCR) is a predictor for outcome. The aim of this study was to evaluate NGAL as a predictor of response to NACT and to validate NGAL as a prognostic factor for clinical outcome in patients with primary BC. Immunohistochemistry was performed on tissue microarrays from 652 core biopsies from BC patients, who underwent NACT in the GeparTrio trial. NGAL expression and intensity was evaluated separately. NGAL was detected in 42.2% of the breast carcinomas in the cytoplasm. NGAL expression correlated with negative hormone receptor (HR) status, but not with other baseline parameters. NGAL expression did not correlate with pCR in the full population, however, NGAL expression and staining intensity were significantly associated with higher pCR rates in patients with positive HR status. In addition, strong NGAL expression correlated with higher pCR rates in node negative patients, patients with histological grade 1 or 2 tumors and a tumor size <40 mm. In univariate survival analysis, positive NGAL expression and strong staining intensity correlated with decreased disease-free survival (DFS) in the entire cohort and different subgroups, including HR positive patients. Similar correlations were found for intense staining and decreased overall survival (OS). In multivariate analysis, NGAL expression remained an independent prognostic factor for DFS. The results show that in low-risk subgroups, NGAL was found to be a predictive marker for pCR after NACT. Furthermore, NGAL could be validated as an independent prognostic factor for decreased DFS in primary human BC.
Collapse
Affiliation(s)
- Antonia Sophie Wenners
- Department of Gynecology and Obstetrics, University Medical Center Schleswig-Holstein, Kiel, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Szkandera J, Absenger G, Dandachi N, Regitnig P, Lax S, Stotz M, Samonigg H, Renner W, Gerger A. Analysis of functional germline polymorphisms for prediction of response to anthracycline-based neoadjuvant chemotherapy in breast cancer. Mol Genet Genomics 2012; 287:755-64. [PMID: 22903472 DOI: 10.1007/s00438-012-0715-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 08/02/2012] [Indexed: 12/20/2022]
Abstract
To elucidate the role of predictive factors on individual's drug response, based on genetic variation, we examined the association between eight germline polymorphisms in genes involved in protection against oxidative stress, apoptosis, oncogenic transformation, proliferation, immune response and DNA repair (TP53, NQO1, IL6, TLR4 and XRCC1) and the pathological response to anthracycline-based neoadjuvant chemotherapy in 70 patients with breast cancer. The DNA was genotyped for eight polymorphisms in five genes (TP53, NQO1, IL6, TLR4 and XRCC1) by 5'-exonuclease (TaqMan™) technology. Fisher's exact test was used to evaluate the association between genotype, clinicopathological parameters and pathological response. A good pathological response, defined as a pathological complete response or residual isolated invasive tumor cells, was found significantly more frequently for estrogen (ER) and progesterone receptor (PR) negative breast carcinomas compared to ER and PR positive and ER or PR positive carcinomas, respectively (43.5 vs. 37.5 and 10.3 %, p = 0.006), and was significantly associated with high tumor grade (G3) (p = 0.002). A non-significant trend towards a good pathological response was shown in patients carrying the Arg/Arg or Arg/Pro TP53 codon 72 gene variant compared to those harboring the Pro/Pro variant (17.6 or 37.9 % vs. 0; p = 0.071). No association was found between NQO1 Pro187Ser, IL6 -174G>C, TLR4 Asp299Gly and Thr399Ile, and XRCC1 Arg194Trp, Arg399Gln and Arg280His and pathological response. The present study shows hormone receptor status and tumor grade as predictors for pathological response to neoadjuvant anthracycline-based chemotherapy. Among various functional germline polymorphisms, a potential predictive value was only found for the TP53 Arg72Pro gene variant.
Collapse
Affiliation(s)
- Joanna Szkandera
- Research Unit, Genetic Epidemiology and Pharmacogenetics in Oncology, Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Male breast cancer is a rare disease. The aim of this study was to compare overall survival (OS) and disease-free survival (DFS) in a group of matched males and females with breast cancer. The clinical data and survival status of 42 operable male breast cancer (MBC) cases treated at the Central Hospital of Tai'an from 1982 to 2006 were collected. Each MBC patient recorded in the database was matched with two female breast cancer (FBC) patients. Matching was conducted based on age, year of diagnosis, stage and pathology. SPSS 16.0 software was used for statistical analysis. The Chi-square test was used for the categorical data, the Kaplan-Meier method was applied to analyze survival and the log-rank test was used to compare curves between the groups. P<0.05 was considered to indicate a statistically significant difference. The 42 MBC patients were matched with 84 FBC patients. The mean age at diagnosis was 58.0±11.3 years for males and 57.1±10.6 years for females, and the median follow-up time was 64 months (range, 5-262 months) for males and 71 months (range, 29-283 months) for females. Significant differences were identified for tumor location, hormone receptor status, adjuvant chemotherapy and hormone therapy between the two groups. Monofactorial analysis demonstrated that tumor size, lymph node status and AJCC stage were prognostic factors in MBC patients. The 5- and 10-year DFS rates were 61.2 and 40.7% for males, and 68.7 and 43.0% for females, respectively. The 5-and 10-year OS rates were 75.3 and 52.3% for males, and 82.9 and 63.2% for females, respectively. In our study, male breast carcinoma patients had a worse prognosis compared to female breast carcinoma patients which may be due to the deficiency of adjuvant chemotherapy and endocrine therapy.
Collapse
|
29
|
Chen MB, Zhu YQ, Xu JY, Wang LQ, Liu CY, Ji ZY, Lu PH. Value of TP53 status for predicting response to neoadjuvant chemotherapy in breast cancer: a meta-analysis. PLoS One 2012; 7:e39655. [PMID: 22768103 PMCID: PMC3387248 DOI: 10.1371/journal.pone.0039655] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 05/24/2012] [Indexed: 12/31/2022] Open
Abstract
Background Numerous studies have yielded inconclusive results regarding the relationship between tumor suppressor protein TP53 overexpression and/or TP53 gene mutations and the response to neoadjuvant chemotherapy in patients with breast cancer. The purpose of the current study was therefore to evaluate the relationship between TP53 status and response to chemotherapy in breast cancer. Methods and Findings A total of 26 previously published eligible studies including 3,476 cases were identified and included in this meta-analysis. TP53 status (over expression of TP53 protein and/or TP53 gene mutations) was associated with good response in breast cancer patients who received neoadjuvant chemotherapy (total objective response: risk ratio [RR] = 1.20, 95% confidence interval [CI] = 1.09–1.33, p<0.001; pathological objective response: RR = 1.37, 95% CI = 1.20–1.57, p<0.01; total complete response: RR = 1.33, 95% CI = 1.15–1.53, p<0.001; pathological complete response: RR = 1.45, 95% CI = 1.25–1.68, p<0.001). In further stratified analyses, this association also existed among the studies using anthracycline-based neoadjuvant chemotherapy, and the association between response and the presence of gene alterations was stronger than that between response and immunohistochemistry positivity. Conclusion The results of the present meta-analysis suggest that TP53 status is a predictive factor for response in breast cancer patients undergoing neoadjuvant chemotherapy. Further larger and well-designed prospective studies are required to evaluate the predictive role of TP53 status in clinical practice.
Collapse
Affiliation(s)
- Min-Bin Chen
- Department of Medical Oncology, Kunshan First People’s Hospital Affiliated to Jiangsu University, Kunshan, People’s Republic of China
| | - Ya-Qun Zhu
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Jun-Ying Xu
- Department of Medical Oncology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi City, People’s Republic of China
| | - Li-Qiang Wang
- Department of Medical Oncology, Kunshan First People’s Hospital Affiliated to Jiangsu University, Kunshan, People’s Republic of China
| | - Chao-Ying Liu
- Department of Medical Oncology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi City, People’s Republic of China
| | - Zhang-Yi Ji
- Department of Medical Oncology, Kunshan First People’s Hospital Affiliated to Jiangsu University, Kunshan, People’s Republic of China
| | - Pei-Hua Lu
- Department of General Surgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi City, People’s Republic of China
- * E-mail:
| |
Collapse
|
30
|
Lee JS, Son BH, Ahn SH. The Predictive Value of Serum HER2/neu for Response to Anthracycline-Based and Trastuzumab-Based Neoadjuvant Chemotherapy. J Breast Cancer 2012; 15:189-96. [PMID: 22807936 PMCID: PMC3395742 DOI: 10.4048/jbc.2012.15.2.189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 04/13/2012] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Little information exists about the possible influence of serum HER2/neu on response to chemotherapy. We propose that the assessment of serum HER2/neu in a pretreatment serum sample may be useful in predicting response to neoadjuvant chemotherapy. METHODS All breast cancer patients were tested by immunohistochemical stain and fluorescent in situ hybridization for HER2/neu before treatment. Serum HER2/neu was twice measured by chemiluminescence immunoassay (ADVIA Centaur System) before neoadjuvant chemotherapy and before operation. The cut-off value was 10.2 mg/mL, according to the previous study. Pathologic complete response (pCR) was considered as no residual tumor or remnant ductal carcinoma in situ; partial response (PR) was a less than 50% decrease in maximal diameter in pathologic tumor size. The measurements for the changes of serum HER2/neu were defined as pretreatment HER2/neu-preoperation HER2/neu. We compared the change of serum HER2/neu between that from before chemotherapy and that after chemotherapy, the pathologic complete response and partial response, and the trastuzumab group and anthracycline group. RESULTS Serum HER2/neu was decreased after neoadjuvant chemotherapy. The mean of serum HER2/neu in prechemotherapy was 15.4±9.0 ng/mL, and that of postchemotherapy was 10.5±2.0 ng/mL (p=0.04). Pathologic response was correlated with the change of serum HER2/neu (PR, 11.7±2.2 ng/mL vs. pCR, 23.7±13.1 ng/mL; p=0.01). In the trastuzumab group, pCR was marginally correlated with the change of serum HER2/neu (PR, 0.8±0.84 ng/mL vs. pCR, 21.1±13.2 ng/mL; p=0.08). CONCLUSION Serum HER2/neu levels during treatment were associated with pathologic response in patients receiving neoadjuvant chemotherapy, particularly, in a trastuzumab-based regimen. The change of serum HER2/neu levels may serve in monitoring neoadjuvant therapy in HER2/neu-overexpressed breast cancer.
Collapse
Affiliation(s)
- Jung Sun Lee
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | | | | |
Collapse
|
31
|
Huang ZH, Tian XS, Li R, Wang XM, Wen W, Guan H, Yang YJ. Elevated thymidine kinase 1 in serum following neoadjuvant chemotherapy predicts poor outcome for patients with locally advanced breast cancer. Exp Ther Med 2011; 3:331-335. [PMID: 22969891 DOI: 10.3892/etm.2011.395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 11/22/2011] [Indexed: 11/06/2022] Open
Abstract
Patients with locally advanced breast cancer (LABC) commonly have an unfavorable prognosis. A molecular predictor for the identification of at-risk patients is urgently required. Thymidine kinase 1 in serum (S-TK1) is an enzyme involved in the synthesis of DNA precursors. In studies using immunohistochemistry, it was reported to be a more useful proliferation marker than Ki-67 in breast, lung and colorectal carcinoma. In the present study, we extended the research of prior breast carcinoma studies by postulating that in patients with LABC, overexpression of S-TK1 following neoadjuvant chemotherapy predicts cancer outcome. An experimental design consisting of 48 patients with LABC was prospectively constructed and analyzed. All patients received neoadjuvant chemotherapy and definitive surgical therapy. Study homogeneity was maintained by standardized treatment, surveillance and compliance protocols. The S-TK1 concentration was detected using the anti-TK1 chicken IgY antibody, using a dot-blot immuno-assay. After a median follow-up of 30 months, the results indicated a statistically significant trend (unadjusted). Patients with high S-TK1 overexpression had a significantly higher incidence of recurrence (P=0.006) and cancer death (P= 0.0128) than those with low S-TK1 overexpression. A multivariate analysis provided identical results. The hazards ratio for developing recurrence in patients with higher S-TK1 expression was 6-7 times higher than the hazards ratio in patients with lower expression. In conclusion, our results indicate that a high S-TK1 concentration in sera from LABC patients receiving neoadjuvant chemotherapy is predictive of cancer outcome.
Collapse
Affiliation(s)
- Zhi-Heng Huang
- Department of Breast Surgery, Shandong Province Hospital, Shandong University, Jinan 250012
| | | | | | | | | | | | | |
Collapse
|
32
|
Taft RJ, Hawkins PG, Mattick JS, Morris KV. The relationship between transcription initiation RNAs and CCCTC-binding factor (CTCF) localization. Epigenetics Chromatin 2011; 4:13. [PMID: 21813016 PMCID: PMC3170176 DOI: 10.1186/1756-8935-4-13] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 08/03/2011] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Transcription initiation RNAs (tiRNAs) are nuclear localized 18 nucleotide RNAs derived from sequences immediately downstream of RNA polymerase II (RNAPII) transcription start sites. Previous reports have shown that tiRNAs are intimately correlated with gene expression, RNA polymerase II binding and behaviors, and epigenetic marks associated with transcription initiation, but not elongation. RESULTS In the present work, we show that tiRNAs are commonly found at genomic CCCTC-binding factor (CTCF) binding sites in human and mouse, and that CTCF sites that colocalize with RNAPII are highly enriched for tiRNAs. To directly investigate the relationship between tiRNAs and CTCF we examined tiRNAs originating near the intronic CTCF binding site in the human tumor suppressor gene, p21 (cyclin-dependent kinase inhibitor 1A gene, also known as CDKN1A). Inhibition of CTCF-proximal tiRNAs resulted in increased CTCF localization and increased p21 expression, while overexpression of CTCF-proximal tiRNA mimics decreased CTCF localization and p21 expression. We also found that tiRNA-regulated CTCF binding influences the levels of trimethylated H3K27 at the alternate upstream p21 promoter, and affects the levels of alternate p21 (p21alt) transcripts. Extending these studies to another randomly selected locus with conserved CTCF binding we found that depletion of tiRNA alters nucleosome density proximal to sites of tiRNA biogenesis. CONCLUSIONS Taken together, these data suggest that tiRNAs modulate local epigenetic structure, which in turn regulates CTCF localization.
Collapse
Affiliation(s)
- Ryan J Taft
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland 4072, Australia
| | - Peter G Hawkins
- Department of Molecular and Experimental Medicine, The Kellogg School of Science and Technology, The Scripps Research Institute, La Jolla, CA 92037, USA
- The Kellogg School of Science and Technology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - John S Mattick
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland 4072, Australia
| | - Kevin V Morris
- Department of Molecular and Experimental Medicine, The Kellogg School of Science and Technology, The Scripps Research Institute, La Jolla, CA 92037, USA
| |
Collapse
|
33
|
|
34
|
ER, PgR, HER-2, Ki-67, topoisomerase IIα, and nm23-H1 proteins expression as predictors of pathological complete response to neoadjuvant chemotherapy for locally advanced breast cancer. Med Oncol 2010; 28 Suppl 1:S48-54. [PMID: 20872186 DOI: 10.1007/s12032-010-9693-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 09/16/2010] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to evaluate the importance of biological markers to predict pathologic complete response (pCR) to neoadjuvant chemotherapy (NCT) in patients with locally advanced breast cancer (LABC) One hundred and twelve consecutive patients with clinical stage III LABC who had received NCT with docetaxel and epirubicin from March 2006 to March 2009 were included in this retrospective study. The pre-NCT treatment expression levels of Ki-67 proliferation index, estrogen receptor (ER), progesterone receptor (PgR), epidermal growth factor receptor 2 (HER-2), Topoisomerase II alpha (Topo-II), and nm23-H1 were detected by immunohistochemistry (IHC). A total of 361 cycles were administered with the median number of three cycles per patient (range, 2-6). The pCR rate was 9.8% (95% CI, 4.3-15.3%). In univariate analysis, poor tumor differentiation, both negative of ER/PgR, negative Topo-II, and positive nm23-H1 were found to be significantly predictive of a pCR. ER/PgR status and nm23-H1 were significant for pCR on multivariate analysis (P = 0.006 and 0.025, respectively). ER/PgR status and nm23-H1 are independent predictive factors of pCR to neoadjuvant docetaxel plus epirubicin combination chemotherapy in patients with LABC.
Collapse
|
35
|
Li XR, Liu M, Zhang YJ, Wang JD, Zheng YQ, Li J, Ma B, Song X. Evaluation of ER, PgR, HER-2, Ki-67, cyclin D1, and nm23-H1 as predictors of pathological complete response to neoadjuvant chemotherapy for locally advanced breast cancer. Med Oncol 2010; 28 Suppl 1:S31-8. [DOI: 10.1007/s12032-010-9676-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 09/01/2010] [Indexed: 02/01/2023]
|
36
|
Accuracy of MRI in prediction of pathologic complete remission in breast cancer after preoperative therapy: a meta-analysis. AJR Am J Roentgenol 2010; 195:260-8. [PMID: 20566826 DOI: 10.2214/ajr.09.3908] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Prediction of pathologic complete remission in breast cancer after preoperative therapy presents difficulties. We performed a meta-analysis to determine the ability of MRI to predict pathologic complete remission in patients with breast cancer after preoperative therapy. MATERIALS AND METHODS Medical subject heading terms ("MRI" and "Breast Neoplasm") and key words ("neoadjuvant" or "primary systemic" or "preoperative" or "presurgery") were used for a literature search in the MEDLINE database. A meta-analysis of pooled data from eligible studies was performed to estimate the accuracy of MRI in predicting pathologic complete remission after preoperative therapy in patients with breast cancer. RESULTS Twenty-five studies were included in this meta-analysis. Pooled weighted estimates of sensitivity and specificity were 0.63 (range, 0.56-0.70) and 0.91 (range, 90.89-0.92), respectively. Heterogeneity between studies was highly influenced by the pathologic complete remission rate, with a regression coefficient of -6.160 (p = 0.020). Subgroup analysis showed that the specificity of MRI in studies with a pathologic complete remission rate of > or = 20% was lower than that in studies with a pathologic complete remission rate of < 20% (p = 0.0003). CONCLUSION This meta-analysis indicates that MRI has high specificity and relatively lower sensitivity in predicting pathologic complete remission after preoperative therapy in patients with breast cancer. The pathologic complete remission rate may influence the performance of MRI accuracy in this setting, which deserves further investigation.
Collapse
|
37
|
Dumontet C, Krajewska M, Treilleux I, Mackey JR, Martin M, Rupin M, Lafanechère L, Reed JC. BCIRG 001 Molecular Analysis: Prognostic Factors in Node-Positive Breast Cancer Patients Receiving Adjuvant Chemotherapy. Clin Cancer Res 2010; 16:3988-97. [DOI: 10.1158/1078-0432.ccr-10-0079] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
38
|
Precht LM, Lowe KA, Atwood M, Beatty JD. Neoadjuvant chemotherapy of breast cancer: tumor markers as predictors of pathologic response, recurrence, and survival. Breast J 2010; 16:362-8. [PMID: 20443786 DOI: 10.1111/j.1524-4741.2010.00935.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study reports the value of the tumor markers estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) in predicting the response of breast cancer to neoadjuvant chemotherapy. A community cancer center prospectively maintained breast cancer database containing over 8,000 patient records was used. Since 1989, 464 patients were treated with neoadjuvant chemotherapy followed by surgical resection and were tested for ER and PR. Estrogen receptor and/or PR positive patients were considered hormone receptor (HR) positive. Human epidermal growth factor receptor 2 status was available on 368 patients. Total, breast, and nodal pathologic complete response (pCR) rates, recurrence, and overall survival were assessed. Total and breast pCR rates were higher in HR negative (HR-) patients (26% and 32%, respectively) than in HR positive (HR+) patients (4% and 7%, respectively; p < 0.001). Compared to HR+ patients, HR- patients had higher recurrence rates (38% versus 22%; p < 0.001), a shorter time to recurrence (1.28 versus 2.14 years; p < 0.001), and decreased overall survival (67% versus 81%; p < 0.001). Human epidermal growth factor receptor 2 positive patients treated with neoadjuvant trastuzumab (NAT) demonstrated higher total pCR (34% versus 13%; p = 0.008), breast pCR (37% versus 17%; p = 0.02), and nodal pCR rates (47% versus 23%; p = 0.05) compared to HER2+ patients not treated with NAT. Furthermore, HER2+ patients who received NAT had lower recurrence rates (5% versus 42%; p < 0.001) and increased overall survival (97% versus 68%; p < 0.001). In conclusion, breast cancer HR status is predictive of total and breast pCR rates after neoadjuvant chemotherapy. Although HR- patients derive greater benefit from neoadjuvant chemotherapy in terms of pathologic response, they have worse outcomes in terms of recurrence and survival. Hormone receptor positive patients demonstrate significantly less response to neoadjuvant chemotherapy, but significantly better overall outcome. For both HR- and HR+, addition of NAT for HER2+ tumors results in both a superior response and outcome.
Collapse
Affiliation(s)
- Lisa M Precht
- Swedish Cancer Institute, Swedish Medical Center, Seattle, Washington, USA
| | | | | | | |
Collapse
|
39
|
Tan MC, Al Mushawah F, Gao F, Aft RL, Gillanders WE, Eberlein TJ, Margenthaler JA. Predictors of complete pathological response after neoadjuvant systemic therapy for breast cancer. Am J Surg 2009; 198:520-5. [PMID: 19800460 DOI: 10.1016/j.amjsurg.2009.06.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 06/14/2009] [Accepted: 06/14/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of the current study was to identify predictors of pathologic complete response (pCR) following neoadjuvant therapy. METHODS From 2000 to 2007, 518 breast cancer patients received neoadjuvant therapy. Data were compared using chi(2) and Fisher's exact tests and multivariate analysis of variance, as appropriate. RESULTS Of 518 breast cancer patients receiving neoadjuvant therapy, 81 (16%) had pCR (77 of 456 [17%] with chemotherapy, 4 of 62 [6%] with endocrine therapy; P < .05). Four factors were associated with pCR: higher tumor grade (P = .015), lack of estrogen receptor (ER) and progesterone receptor (PR) expression (P < .0001), HER2/neu amplification (P = .025), and negative lymph node status (P < .0001). On multivariate analysis, ER and PR negativity, HER2/neu amplification, and negative lymph node status were found to significantly correlate with pCR. CONCLUSIONS Patients with ER-negative and PR-negative and HER2/neu-amplified breast cancer phenotypes are more likely to experience pCR to neoadjuvant therapy. Although pCR is more frequently observed following neoadjuvant chemotherapy, it is rare following neoadjuvant endocrine therapy.
Collapse
Affiliation(s)
- Marcus C Tan
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | | | | | | |
Collapse
|
40
|
Wang L, Jiang Z, Sui M, Shen J, Xu C, Fan W. The potential biomarkers in predicting pathologic response of breast cancer to three different chemotherapy regimens: a case control study. BMC Cancer 2009; 9:226. [PMID: 19591668 PMCID: PMC2716368 DOI: 10.1186/1471-2407-9-226] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 07/11/2009] [Indexed: 12/31/2022] Open
Abstract
Background Preoperative chemotherapy (PCT) has become the standard of care in locally advanced breast cancer. The identification of patient-specific tumor characteristics that can improve the ability to predict response to therapy would help optimize treatment, improve treatment outcomes, and avoid unnecessary exposure to potential toxicities. This study is to determine whether selected biomarkers could predict pathologic response (PR) of breast tumors to three different PCT regimens, and to identify a subset of patients who would benefit from a given type of treatment. Methods 118 patients with primary breast tumor were identified and three PCT regimens including DEC (docetaxel+epirubicin+cyclophosphamide), VFC (vinorelbine/vincristine+5-fluorouracil+cyclophosphamide) and EFC (epirubicin+5-fluorouracil+cyclophosphamide) were investigated. Expression of steroid receptors, HER2, P-gp, MRP, GST-pi and Topo-II was evaluated by immunohistochemical scoring on tumor tissues obtained before and after PCT. The PR of breast carcinoma was graded according to Sataloff's classification. Chi square test, logistic regression and Cochran-Mantel-Haenszel assay were performed to determine the association between biomarkers and PR, as well as the effectiveness of each regimen on induction of PR. Results There was a clear-cut correlation between the expression of ER and decreased PR to PCT in all three different regimens (p < 0.05). HER2 expression is significantly associated with increased PR in DEC regimen (p < 0.05), but not predictive for PR in EFC and VFC groups. No significant correlation was found between biomarkers PgR, Topo-II, P-gp, MRP or GST-pi and PR to any tested PCT regimen. After adjusted by a stratification variable of ER or HER2, DEC regimen was more effective in inducing PR in comparison with VFC and EFC regimens. Conclusion ER is an independent predictive factor for PR to PCT regimens including DEC, VFC and EFC in primary breast tumors, while HER2 is only predictive for DEC regimen. Expression of PgR, Topo-II, P-gp, MRP and GST-pi are not predictive for PR to any PCT regimens investigated. Results obtained in this clinical study may be helpful for the selection of appropriate treatments for breast cancer patients.
Collapse
Affiliation(s)
- Linbo Wang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, PR China.
| | | | | | | | | | | |
Collapse
|
41
|
Alvarado-Miranda A, Arrieta O, Gamboa-Vignolle C, Saavedra-Perez D, Morales-Barrera R, Bargallo-Rocha E, Zinser-Sierra J, Perez-Sanchez V, Ramirez-Ugalde T, Lara-Medina F. Concurrent chemo-radiotherapy following neoadjuvant chemotherapy in locally advanced breast cancer. Radiat Oncol 2009; 4:24. [PMID: 19591689 PMCID: PMC2716349 DOI: 10.1186/1748-717x-4-24] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 07/11/2009] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Despite broad advances in multimodal treatment of locally advanced breast cancer (LABC), 30 to 40% of patients develop loco-regional relapse. The aim of this study was to analyze in a retrospective manner the effectiveness of concurrent chemo-radiotherapy (CCRTh) after neoadjuvant chemotherapy (NCT) in patients with LABC. METHODS One hundred twelve patients with LABC (stage IIB-IIIB) were treated with NCT (5-fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, and cyclophosphamide 500 mg/m2 (FAC), or doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2 (AC) IV in four 21-day courses) followed by CCRTh (60 Gy breast irradiation and weekly mitomycin 5 mg/m2, 5-fluorouracil 500 mg/m2, and dexamethasone 16 mg, or cisplatin 30 mg/m2, gemcitabine 100 mg/m2 and dexamethasone 16 mg), and 6-8 weeks later, surgery and two additional courses of FAC, AC, or paclitaxel 90 mg/m2 weekly for 12 weeks, and in case of estrogen-receptor positive patients, hormonal therapy. RESULTS Stages IIB, IIIA and -B were 21.4, 42.9, and 35.7%, respectively. Pathological complete response (pCR) in the breast was 42% (95% CI, 33.2-50.5%) and, 29.5% (95% CI, 21.4-37.5%) if including both the breast and the axillary nodes. Multivariate analysis showed that the main determinant of pCR was negative estrogen-receptor status (HR=3.8; 95% CI, 1.5-9; p=0.016). The 5-year disease-free survival (DFS) was 76.9% (95% CI, 68.2-84.7%). No relationship between pCR and DFS was found. Multivariate analysis demonstrated that the main DFS determinant was clinical stage (IIB and IIIA vs. IIIB, HR=3.1; 95% CI, 1.02-9.74; p=0.04). Only one patient had local recurrence. Five-year overall survival was 84.2% (95% CI, 75-93.2%). The toxicity profile was acceptable. CONCLUSION This non-conventional multimodal treatment has good loco-regional control for LABC. Randomized clinical trials of preoperative CCRTh following chemotherapy, in patients with LABC are warranted.
Collapse
Affiliation(s)
| | - Oscar Arrieta
- Department of Medical Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - David Saavedra-Perez
- Department of Medical Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | | | - Juan Zinser-Sierra
- Department of Medical Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Victor Perez-Sanchez
- Department of Pathology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Teresa Ramirez-Ugalde
- Department of Breast Tumors, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Fernando Lara-Medina
- Department of Medical Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
- Department of Breast Tumors, Instituto Nacional de Cancerologia, Mexico City, Mexico
| |
Collapse
|
42
|
Bondiau PY, Lallement M, Bahadoran P, Birtwisle-Peyrottes I, Chapellier C, Chamorey E, Courdi A, Quielle-Roussel C, Ferrero JM. CyberKnife® et chimiothérapie néoadjuvante pour les tumeurs du sein localement évoluées : résultats préliminaires. Cancer Radiother 2009; 13:79-84. [DOI: 10.1016/j.canrad.2008.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 04/23/2008] [Accepted: 04/30/2008] [Indexed: 11/29/2022]
|
43
|
Liu R, Wang L, Chen G, Katoh H, Chen C, Liu Y, Zheng P. FOXP3 up-regulates p21 expression by site-specific inhibition of histone deacetylase 2/histone deacetylase 4 association to the locus. Cancer Res 2009; 69:2252-9. [PMID: 19276356 DOI: 10.1158/0008-5472.can-08-3717] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
p21 loss has been implicated in conferring oncogenic activity to known tumor suppressor gene KLF4 and cancer drug tamoxifen. Regulators of p21, therefore, play critical roles in tumorigenesis. Here, we report that X-linked tumor suppressor FOXP3 is essential for p21 expression in normal epithelia and that lack of FOXP3 is associated with p21 down-regulation in breast cancer samples. A specific FOXP3 binding site in the intron 1 is essential for p21 induction by FOXP3. FOXP3 specifically inhibited binding of histone deacetylase 2 (HDAC2) and HDAC4 to the site and increased local histone H3 acetylation. Short hairpin RNA silencing of either HDAC2 or HDAC4 is sufficient to induce p21 expression. Our data provides a novel mechanism for transcription activation by FOXP3 and a genetic mechanism for lack of p21 in a large proportion of breast cancer.
Collapse
Affiliation(s)
- Runhua Liu
- Division of Immunotherapy and Department of Surgery, University of Michigan School of Medicine and Cancer Center, Ann Arbor, Michigan, USA
| | | | | | | | | | | | | |
Collapse
|
44
|
Choi JP, Han TH, Park RW. A Hybrid Bayesian Network Model for Predicting Breast Cancer Prognosis. ACTA ACUST UNITED AC 2009. [DOI: 10.4258/jksmi.2009.15.1.49] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Pill Choi
- Department of Medical Informatics, Ajou Univ. School of Medicine, Korea
- Division of Bio-Medical Informatics, Center for Genome Science, National Institute of Health, KCDC, Korea
| | - Tae Hwa Han
- Department of Medical Informatics, Ajou Univ. School of Medicine, Korea
| | - Rae Woong Park
- Department of Medical Informatics, Ajou Univ. School of Medicine, Korea
| |
Collapse
|
45
|
Ribeiro-Silva A, Zucoloto S. Expression of apoptosis-related protein Bcl-2 correlates with breast carcinomas of luminal or basal-like subtype. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1755-9294.2008.00025.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
46
|
Fiegl H, Jones A, Hauser-Kronberger C, Hutarew G, Reitsamer R, Jones RL, Dowsett M, Mueller-Holzner E, Windbichler G, Daxenbichler G, Goebel G, Ensinger C, Jacobs I, Widschwendter M. Methylated NEUROD1 promoter is a marker for chemosensitivity in breast cancer. Clin Cancer Res 2008; 14:3494-502. [PMID: 18519782 DOI: 10.1158/1078-0432.ccr-07-4557] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Chemotherapy can be an integral component of the adjuvant management strategy for women with early stage breast cancer. To date, no tool is available to predict or monitor the efficacy of these therapies. The aim of this proof-of-principle study was to assess whether NEUROD1 DNA methylation is able to predict the response to neoadjuvant and adjuvant chemotherapy. EXPERIMENTAL DESIGN Recently, we showed that NEUROD1 DNA is differentially methylated in neoplastic versus nonneoplastic breast tissue samples. In this study, we used MethyLight and analyzed NEUROD1 methylation in (a) 74 breast cancer tissue samples, (b) two independent sets of pretreatment core biopsies of 23 (training set) and 21 (test set) neoadjuvantly treated breast cancer patients, and (c) pretherapeutic and posttherapeutic serum samples from 107 breast cancer patients treated with adjuvant chemotherapy. RESULTS High-grade tumors showed higher NEUROD1 methylation levels. Estrogen receptor-negative breast cancers with high NEUROD1 methylation were 10.8-fold more likely to respond with a complete pathologic response following neoadjuvant chemotherapy. Patients with positive serum pretreatment NEUROD1 methylation, which persisted after chemotherapy, indicated poor relapse-free and overall survival in univariate and multivariate analyses (relative risk for relapse, 6.2; 95% confidence interval, 1.6-24; P = 0.008, and relative risk for death, 14; 95% confidence interval, 1.6-120; P = 0.02). CONCLUSIONS These data support the view that NEUROD1 methylation is a chemosensitivity marker in estrogen receptor-negative breast cancer.
Collapse
Affiliation(s)
- Heidi Fiegl
- Department of Gynecological Oncology, UCL Institute for Women's Health, University College London, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Predictive value of serum anti-p53 antibodies, carcino-embryonic antigen, carbohydrate antigen 15-3, estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 in taxane-based and anthracycline-based neoadjuvant chemotherapy in locally advanced breast cancer patients. Anticancer Drugs 2008; 19:317-23. [PMID: 18510179 DOI: 10.1097/cad.0b013e3282f3d018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast carcinoma is the most common malignancy in Chinese women. The purpose of this study is to evaluate the predictive value of serum anti-p53 antibodies (p53 Abs), carcino-embryonic antigen (CEA), carbohydrate antigen (CA) 15-3, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER)-2 in taxane-based and anthracycline-based neoadjuvant chemotherapy (NAC). Sixty-eight patients with locally advanced breast carcinoma were included. Thirty-two were treated with taxane (the taxane group) and 36 with anthracycline (the anthracycline group). The standard dosage of docetaxel was 100 mg/m2 (day 1) and those of cyclophosphamide, adriamycin and 5-flurouracil were 500 mg/m2 (day 1-8), 40 mg/m2 (day 1) and 500 mg/m2 (day 1-8), respectively. The p53 Abs were detected by enzyme-linked immunosorbent assay; CEA and CA15-3 were detected by Elecsys 2010 Disc System; ER, PR and HER-2 were detected by immunohistochemistry staining. The biomarkers p53 Abs, CEA and CA15-3 were detected in serum samples, and the immunohistochemistry staining for ER, PR and HER-2 was performed in tumor samples before and after NAC. The expression of p53 Abs was significantly reduced by taxane (P = 0.006). The serum CEA and CA15-3 levels were significantly affected by both taxane (P = 0.004 and P = 0.008) and anthracycline (P = 0.002 and P = 0.000) drugs. HER-2-negative status (pre-neoadjuvant) was correlated with a high objective response rate (OR) in both taxane-based and anthracycline-based chemotherapy (P = 0.022 and P = 0.025), whereas p53 Ab-negative status (pre-neoadjuvant) was correlated with high OR rate in anthracycline-based chemotherapy (P = 0.039). This study shows that the serum p53 Ab level is easily changed by taxane. CEA and CA15-3 levels are easily changed by taxane and anthracycline. The p53 Ab-negative patients may predict a high clinical OR rate in anthracycline-based NAC. HER-2-negative may predict a high OR in both taxane-based and anthracycline-based NAC.
Collapse
|
48
|
Nolen BM, Marks JR, Ta'san S, Rand A, Luong TM, Wang Y, Blackwell K, Lokshin AE. Serum biomarker profiles and response to neoadjuvant chemotherapy for locally advanced breast cancer. Breast Cancer Res 2008; 10:R45. [PMID: 18474099 PMCID: PMC2481492 DOI: 10.1186/bcr2096] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 04/24/2008] [Accepted: 05/12/2008] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Neoadjuvant chemotherapy has become the standard of care for the diverse population of women diagnosed with locally advanced breast cancer. Serum biomarker levels are increasingly being investigated for their ability to predict therapy response and aid in the development of individualized treatment regimens. Multianalyte profiles may offer greater predictive power for neoadjuvant treatment response than the individual biomarkers currently in use. METHODS Serum samples were collected from 44 patients enrolled in a phase I-II, open-label study of liposomal doxorubicin and paclitaxel in combination with whole breast hyperthermia for the neoadjuvant treatment of locally advanced breast cancer (stage IIB or stage III). Samples were collected prior to each of four rounds of treatment and prior to definitive surgery. Samples were assayed by Luminex assay for 55 serum biomarkers, including cancer antigens, growth/angiogenic factors, apoptosis-related molecules, metastasis-related molecules, adhesion molecules, adipokines, cytokines, chemokines, hormones, and other proteins. RESULTS Biomarker levels were compared retrospectively with clinical and pathologic treatment responses. Univariate analysis of the data identified several groups of biomarkers that differed significantly among treatment outcome groups early in the course of neoadjuvant chemotherapy. Multivariate statistical analysis revealed multibiomarker panels that could differentiate between treatment response groups with high sensitivity and specificity. CONCLUSION We demonstrate here that serum biomarker profiles may offer predictive power concerning treatment response and outcome in the neoadjuvant setting. The continued development of these findings will be of considerable clinical utility in the design of treatment regimens for individual breast cancer patients. TRIAL REGISTRATION #NCT00346229.
Collapse
Affiliation(s)
- Brian M Nolen
- University of Pittsburgh Cancer Institute, Hillman Cancer Center, Suite 1.19d, 5117 Centre Avenue, Pittsburgh, PA 15213, USA
| | - Jeffrey R Marks
- Department of Surgery, Duke University Medical Center, Box 3873 Med Ctr Durham, NC 27710, USA
| | - Shlomo Ta'san
- Department of Mathematical Sciences, Carnegie Mellon University, Wean Hall, Room 6113, Pittsburgh, PA 15213-3890, USA
| | - Alex Rand
- Department of Mathematical Sciences, Carnegie Mellon University, Wean Hall, Room 6113, Pittsburgh, PA 15213-3890, USA
| | - The Minh Luong
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 130 Desoto Street, 311 Parran Hall, Pittsburgh, PA 15261, USA
| | - Yun Wang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 130 Desoto Street, 311 Parran Hall, Pittsburgh, PA 15261, USA
| | - Kimberly Blackwell
- Department of Radiation Oncology, Duke University Medical Center, Box 3893 Med Ctr Durham, NC 27710, USA
- Department of Medicine, Duke University Medical Center, Box 3893 Med Ctr Durham, NC 27710, USA
| | - Anna E Lokshin
- University of Pittsburgh Cancer Institute, Hillman Cancer Center, Suite 1.19d, 5117 Centre Avenue, Pittsburgh, PA 15213, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, 1218 Scaife Hall 3550 Terrace Street, Pittsburgh, PA 15213, USA
- Department of Pathology, University of Pittsburgh, S-417 BST, 200 Lothrop Street, Pittsburgh, PA 15261, USA
- Department of Obstetrics and Gynecology RS, University of Pittsburgh, 300 Halket Street Pittsburgh, PA 15213, USA
| |
Collapse
|
49
|
Holm NT, Abreo F, Johnson LW, Li BDL, Chu QD. Elevated chemokine receptor CXCR4 expression in primary tumors following neoadjuvant chemotherapy predicts poor outcomes for patients with locally advanced breast cancer (LABC). Breast Cancer Res Treat 2008; 113:293-9. [DOI: 10.1007/s10549-008-9921-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 01/28/2008] [Indexed: 11/25/2022]
|
50
|
Guo LL, Gao P, Wu YG, Jian WC, Hao CY, Li H, Lin XY. Alteration of cyclin D1 in Chinese patients with breast carcinoma and its correlation with Ki-67, pRb, and p53. Arch Med Res 2007; 38:846-52. [PMID: 17923265 DOI: 10.1016/j.arcmed.2007.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 05/24/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND For the female population in Asia, systematic investigation on alterations of cyclin D1 in breast carcinoma is rare, and correlation between cyclin D1 expression with clinicopathological parameters, survival rate, and other prognostic marker associated with cell cycle is unclear. METHODS Expression of cyclin D1 protein, Ki-67, pRb, and p53 was determined by immunohistochemistry in 18 cases of early breast carcinomas and 80 cases of invasive ductal carcinomas. Genetic alteration of cyclin D1 gene and overexpression of cyclin D1 mRNA were detected by Southern blot and RT-PCR, respectively. RESULTS Expression of cyclin D1 is negative in usual ductal hyperplasia (UDH) and atypical ductal hyperplasia (ADH). However, in 52.0% (51/98) of all breast carcinomas, positive expression of cyclin D1 was observed. Five-year survival rate of the patients with positive expression of cyclin D1 (52.7%) is significantly lower than the cases with negative expression of cyclin D1 (72.1%). Positive rate of cyclin D1 protein in invasive ductal carcinoma (52.5%) is slightly higher than overexpression rate (40.8%) of cyclin D1 mRNA but significantly higher than amplification rate of cyclin D1 gene (18.4%). Expression of cyclin D1 is correlated with Ki-67 expression, but not correlated with pRb and p53 expression. CONCLUSIONS Positive expression of cyclin D1 could serve as a poor prognostic marker for Chinese patients with breast carcinoma independent of nodal metastasis and clinical stage. Expression of cyclin D1 protein is affected more directly by overexpression of cyclin D1 mRNA rather than cyclin D1 gene amplification. The cooperation between pRb and p53 with cyclin D1 protein in the carcinogenesis of breast carcinoma is not supported by the results.
Collapse
Affiliation(s)
- Ling-Ling Guo
- Department of Pathology, School of Medicine, Soochow University, Suzhu, PR China
| | | | | | | | | | | | | |
Collapse
|