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Xu L, Xie Y, Gou Q, Cai R, Bao R, Huang Y, Tang R. HER2-targeted therapies for HER2-positive early-stage breast cancer: present and future. Front Pharmacol 2024; 15:1446414. [PMID: 39351085 PMCID: PMC11439691 DOI: 10.3389/fphar.2024.1446414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 08/30/2024] [Indexed: 10/04/2024] Open
Abstract
Breast cancer (BC) has the second highest incidence among cancers and is the leading cause of death among women worldwide. The human epidermal growth factor receptor 2 (HER2) is overexpressed in approximately 20%-30% of BC patients. The development of HER2-targeted drugs, including monoclonal antibodies (mAbs), tyrosine kinase inhibitors (TKIs) and antibody-drug conjugates (ADCs), has improved the operation rate and pathological remission rate and reduced the risk of postoperative recurrence for HER2-positive early-stage BC (HER2+ EBC) patients. This review systematically summarizes the mechanisms, resistance, therapeutic modalities and safety of HER2-targeted drugs and helps us further understand these drugs and their use in clinical practice for patients with HER2+ EBC.
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Affiliation(s)
- Luying Xu
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Breast Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxin Xie
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Breast Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiheng Gou
- Department of Radiation Oncology and Department of Head & Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Cai
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Breast Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Bao
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Breast Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yucheng Huang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Breast Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ruisi Tang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Breast Disease Center, West China Hospital, Sichuan University, Chengdu, China
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Wang H, Li Y, Qi Y, Zhao E, Kong X, Yang C, Yang Q, Zhang C, Liu Y, Song Z. Pegylated Liposomal Doxorubicin, Docetaxel, and Trastuzumab as Neoadjuvant Treatment for HER2-Positive Breast Cancer Patients: A Phase II and Biomarker Study. Front Oncol 2022; 12:909426. [PMID: 35875123 PMCID: PMC9304895 DOI: 10.3389/fonc.2022.909426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Combined neoadjuvant chemotherapy with trastuzumab and pertuzumab is the standard regimen for human epidermal growth receptor 2 (HER2)-positive breast cancer (BC). However, pertuzumab is not available because it is not on the market or covered by medicare in some regions or poor economy. Anthracyclines and taxanes are cornerstones in BC chemotherapy, and their combination contributes to satisfactory efficiency in neoadjuvant settings. Nonetheless, concomitant administration of trastuzumab and an anthracycline is generally avoided clinically due to cardiotoxicity. Pegylated liposomal doxorubicin (PLD) is less cardiotoxic compared with traditional anthracyclines. Here, we conducted this prospective study to evaluate the efficacy, safety, and potential biomarkers for PLD plus trastuzumab and docetaxel as neoadjuvant treatment in HER2-positive BC. Patients and Methods Patients with stage II or III HER2-positive BC were recruited in this multicenter, open-label, single-arm, phase II study. Eligible patients were given 6 cycles of PLD plus docetaxel and trastuzumab. Primary endpoint was total pathological complete response (tpCR, ypT0/is ypN0). Secondary endpoints were breast pathological complete response (bpCR, ypT0/is), objective response rate (ORR), operation rate, breast-conserving surgery rate, and safety. Metadherin (MTDH), glutaminyl-peptide cyclotransferase (QPCT), topoisomerase II alpha (TOP2A), programmed death ligand 1 (PD-L1), and tumor-infiltrating lymphocytes (TILs) were evaluated in BC tissues pre-neoadjuvant for potential biomarkers. Results Between March 2019 and February 2021, 54 patients were enrolled, 50 were included in the analysis, and 35 (70.0%) completed 6 cycles of neoadjuvant treatment. Forty-nine (98.0%) patients underwent surgery with a breast-conserving rate of 44.0%. The tpCR rate, bpCR rate, and ORR were 48.0% (95% CI, 33.7%–62.6%), 60.0% (95% CI, 45.2%–73.6%), and 84.0% (95% CI, 70.9%–92.8%), respectively. tpCR was associated with MTDH (p = 0.002) and QPCT (p = 0.036) expression but not with TOP2A (p = 0.75), PD-L1 (p = 0.155), or TILs (p = 0.76). Patients with HR-negative status were more likely to achieve bpCR compared with those with HR-positive status (76.2% vs. 48.3%, p = 0.047). Grade ≥3 adverse events occurred in 38.0% of patients. Left ventricular ejection fraction decline by ≥10% was reported in 18.0% of patients, and no patient experienced congestive heart failure. Conclusions PLD plus docetaxel and trastuzumab might be a potential neoadjuvant regimen for HER2-positive BC with a high tpCR rate and manageable tolerability. MTDH and QPCT are potential predictive markers for tpCR.
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Affiliation(s)
- Haoqi Wang
- Breast Center, Fourth Hospital of Hebei Medical University, Key Laboratory for Breast Cancer Molecular Medicine of Hebei Province, Shijiazhuang, China
| | - Yuntao Li
- Breast Center, Fourth Hospital of Hebei Medical University, Key Laboratory for Breast Cancer Molecular Medicine of Hebei Province, Shijiazhuang, China
| | - Yixin Qi
- Breast Center, Fourth Hospital of Hebei Medical University, Key Laboratory for Breast Cancer Molecular Medicine of Hebei Province, Shijiazhuang, China
| | - Erbao Zhao
- Department of Breast Center, Shanxi Cancer Hospital, Taiyuan, China
| | - Xiangshun Kong
- Department of Breast Surgery, Xingtai People’s Hospital, Xingtai, China
| | - Chao Yang
- Breast Center, Fourth Hospital of Hebei Medical University, Key Laboratory for Breast Cancer Molecular Medicine of Hebei Province, Shijiazhuang, China
| | - Qiqi Yang
- Breast Center, Fourth Hospital of Hebei Medical University, Key Laboratory for Breast Cancer Molecular Medicine of Hebei Province, Shijiazhuang, China
| | - Chengyuan Zhang
- Breast Center, Fourth Hospital of Hebei Medical University, Key Laboratory for Breast Cancer Molecular Medicine of Hebei Province, Shijiazhuang, China
| | - Yueping Liu
- Pathology Department, Fourth Hospital of Hebei Medical University, Hebei Province Key Laboratory of Breast Cancer Molecular Medicine, Shijiazhuang, China
- *Correspondence: Zhenchuan Song, ; Yueping Liu,
| | - Zhenchuan Song
- Breast Center, Fourth Hospital of Hebei Medical University, Key Laboratory for Breast Cancer Molecular Medicine of Hebei Province, Shijiazhuang, China
- *Correspondence: Zhenchuan Song, ; Yueping Liu,
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Ohtaki Y, Kaira K, Yajima T, Erkhem-Ochir B, Kawashima O, Kamiyoshihara M, Igai H, Onozato R, Ibe T, Kosaka T, Nakazawa S, Nagashima T, Oyama T, Shirabe K. Comprehensive expressional analysis of chemosensitivity-related markers in large cell neuroendocrine carcinoma of the lung. Thorac Cancer 2021; 12:2666-2679. [PMID: 34453496 PMCID: PMC8520808 DOI: 10.1111/1759-7714.14102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives Various drug‐sensitivity markers have been reported to be associated with tumor progression and chemotherapy resistance. Detailed expression profiles of sensitivity markers for cytotoxic chemotherapy in pulmonary large cell neuroendocrine carcinoma (LCNEC) remain unclear. Herein, we aimed to clarify the correlation between the expression of drug‐sensitivity markers and clinicopathological features, prognostic impact, and status of tumor immunity in patients with LCNEC. Methods We retrospectively analyzed the correlation between clinicopathological features and the expression of drug‐sensitivity‐related markers, including vascular endothelial growth factor 2 (VEGFR2), thymidylate synthase (TS), tubulin beta 3 class III (TUBB3), topoisomerase I (Topo‐I), and Topo‐II in 92 surgically resected LCNEC samples. Furthermore, we examined the prognostic significance of expression of these and their correlation with the immune cell status. Results Overall, high expression of TS, TUBB3, VEGFR2, Topo‐I, and Topo‐II was detected in 50 (54%), 31 (34%), 23 (25%), 65 (71%), and 36 (39%) samples, respectively. Univariate and multivariate analyses revealed that advanced pathological T and N factors, positive lymphatic permeation, and Topo‐II expression were independent unfavorable prognosticators for recurrence‐free survival, and advanced pathological T and N factors, Topo‐II positive expression, and TS positive expression were independent unfavorable prognosticators for overall survival. In terms of correlation with immune cell status, higher expression of VEGFR2 was closely linked to negative PD‐L1 expression. Conclusions These findings suggest that elevated Topo‐II and TS expression may contribute to poor outcomes through protumoral biology in patients with LCNEC, and elevated VEGFR2 expression might negatively impact tumor immune reactions in LCNEC.
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Affiliation(s)
- Yoichi Ohtaki
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Toshiki Yajima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Bilguun Erkhem-Ochir
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Osamu Kawashima
- Department of General Thoracic Surgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | | | - Hitoshi Igai
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Ryoichi Onozato
- Department of General Thoracic Surgery, Gunma Prefectural Cancer Center, Ota, Japan
| | - Takashi Ibe
- Department of General Thoracic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Takayuki Kosaka
- Department of General Thoracic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshiteru Nagashima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of General Thoracic Surgery, Gunma Prefectural Cancer Center, Ota, Japan
| | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ken Shirabe
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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Mollaei M, Hassan ZM, Khorshidi F, Langroudi L. Chemotherapeutic drugs: Cell death- and resistance-related signaling pathways. Are they really as smart as the tumor cells? Transl Oncol 2021; 14:101056. [PMID: 33684837 PMCID: PMC7938256 DOI: 10.1016/j.tranon.2021.101056] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
Chemotherapeutic drugs kill cancer cells or control their progression all over the patient's body, while radiation- and surgery-based treatments perform in a particular site. Based on their mechanisms of action, they are classified into different groups, including alkylating substrates, antimetabolite agents, anti-tumor antibiotics, inhibitors of topoisomerase I and II, mitotic inhibitors, and finally, corticosteroids. Although chemotherapeutic drugs have brought about more life expectancy, two major and severe complications during chemotherapy are chemoresistance and tumor relapse. Therefore, we aimed to review the underlying intracellular signaling pathways involved in cell death and resistance in different chemotherapeutic drug families to clarify the shortcomings in the conventional single chemotherapy applications. Moreover, we have summarized the current combination chemotherapy applications, including numerous combined-, and encapsulated-combined-chemotherapeutic drugs. We further discussed the possibilities and applications of precision medicine, machine learning, next-generation sequencing (NGS), and whole-exome sequencing (WES) in promoting cancer immunotherapies. Finally, some of the recent clinical trials concerning the application of immunotherapies and combination chemotherapies were included as well, in order to provide a practical perspective toward the future of therapies in cancer cases.
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Affiliation(s)
- Mojtaba Mollaei
- Department of Immunology, School of Medicine, Tarbiat Modares University, Tehran, Iran.
| | | | - Fatemeh Khorshidi
- Department of Immunology, School of Medicine, Tarbiat Modares University, Tehran, Iran; Department of Immunology, Pasteur Institute of Iran, Tehran, Iran
| | - Ladan Langroudi
- Department of Immunology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Voutsadakis IA. Amplification of 8p11.23 in cancers and the role of amplicon genes. Life Sci 2020; 264:118729. [PMID: 33166592 DOI: 10.1016/j.lfs.2020.118729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/31/2020] [Accepted: 11/04/2020] [Indexed: 02/08/2023]
Abstract
Copy number alterations are widespread in cancer genomes and are part of the genomic instability underlying the pathogenesis of neoplastic diseases. Recurrent copy number alterations of specific chromosomal loci may result in gains of oncogenes or losses of tumor suppressor genes and become entrenched in the genomic framework of certain types of cancers. The locus at chromosome 8p11.23 presents recurrent amplifications most commonly in squamous lung carcinomas, breast cancers, squamous esophageal carcinomas, and urothelial carcinomas. Amplification is rare in other cancers. The amplified segment involves several described oncogenes that may promote cancer cell survival and proliferation, as well as less well characterized genes that could also contribute to neoplastic processes. Genes proposed to be "drivers" in 8p11.23 amplifications include ZNF703, FGFR1 and PLPP5. Additional genes in the locus that could be functionally important in neoplastic networks include co-chaperone BAG4, lysine methyltransferase NSD3, ASH2L, a member of another methyltransferase complex, MLL and the mRNA processing and translation regulators LSM1 and EIF4EBP1. In this paper, genes located in the amplified segment of 8p11.23 will be examined for their role in cancer and data arguing for their importance for cancers with the amplification will be presented.
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Affiliation(s)
- Ioannis A Voutsadakis
- Algoma District Cancer Program, Sault Area Hospital, Sault Ste. Marie, Ontario, Canada; Section of Internal Medicine, Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
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Narui K, Ishikawa T, Shimizu D, Yamada A, Tanabe M, Sasaki T, Oba MS, Morita S, Nawata S, Kida K, Mogaki M, Doi T, Tsugawa K, Ogata H, Ota T, Kosaka Y, Sengoku N, Kuranami M, Niikura N, Saito Y, Suzuki Y, Suto A, Arioka H, Chishima T, Ichikawa Y, Endo I, Tokuda Y. Anthracycline could be essential for triple-negative breast cancer: A randomised phase II study by the Kanagawa Breast Oncology Group (KBOG) 1101. Breast 2019; 47:1-9. [DOI: 10.1016/j.breast.2019.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/25/2019] [Accepted: 06/10/2019] [Indexed: 01/16/2023] Open
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Bandyopadhyay S, Bluth MH, Ali-Fehmi R. Breast Carcinoma: Updates in Molecular Profiling 2018. Clin Lab Med 2019; 38:401-420. [PMID: 29776638 DOI: 10.1016/j.cll.2018.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The most significant contribution of molecular subtyping of breast carcinomas has been the identification of estrogen-positive and estrogen-negative tumor subtypes. Knowledge of genetic alterations in these tumors will help clinicians identify novel therapeutic targets. Understanding the progression pathways involved in the transition of in situ carcinoma to invasive carcinoma might lead to efficient risk stratification in these patients. The Cancer Genome Analysis Network has collected genomic and epigenomic data to provide comprehensive information regarding carcinogenesis and pathway interactions. Such information improves understanding of the disease process and also provides more accurate information toward identifying targetable mutations for treatment.
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Affiliation(s)
- Sudeshna Bandyopadhyay
- Department of Pathology, Detroit Medical Center, Harper University Hospital 3990 John R, Detroit, MI 48201, USA.
| | - Martin H Bluth
- Department of Pathology, Wayne State University, School of Medicine, 540 East Canfield Street, Detroit, MI 48201, USA; Pathology Laboratories, Michigan Surgical Hospital, 21230 Dequindre Road, Warren, MI 48091, USA
| | - Rouba Ali-Fehmi
- Department of Pathology, Detroit Medical Center, Harper University Hospital 3990 John R, Detroit, MI 48201, USA
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Shah AN, Gradishar WJ. Adjuvant Anthracyclines in Breast Cancer: What Is Their Role? Oncologist 2018; 23:1153-1161. [PMID: 30120159 DOI: 10.1634/theoncologist.2017-0672] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/08/2018] [Indexed: 01/03/2023] Open
Abstract
Anthracyclines have been a mainstay of breast cancer therapy for decades, with strong evidence demonstrating their impact on breast cancer survival. However, concerns regarding rare but serious long-term toxicities including cardiotoxicity and hematologic malignancies have driven interest in alternative adjuvant therapy options with more favorable toxicity profiles. This article provides an update of data that help inform clinicians of the role anthracyclines should play in adjuvant breast cancer therapy. Two recently reported large randomized trials-the Anthracycline in Early Breast Cancer and Western German Study Plan B studies-compared a taxane and cyclophosphamide regimen with an anthracycline, taxane, and cyclophosphamide regimen. Although the studies had conflicting results, together these studies suggest that the benefit of adjuvant anthracycline therapy over a nonanthracycline taxane-containing regimen is modest at best and may be primarily seen in patients with especially high-risk disease (i.e., triple-negative breast cancer, involvement of multiple lymph nodes). A third study-the MINDACT study-compared an anthracycline-based regimen to a nonanthracycline regimen, with similar outcomes in both groups. Despite the toxicities, no adjuvant breast cancer regimen has been shown to be superior to an anthracycline-taxane regimen in high-risk patients. These data can directly inform clinical decision-making in determining which patients warrant use of adjuvant anthracycline therapy. Future research may focus on confirming subgroups for whom it is reasonable to forgo adjuvant anthracyclines and validating predictive biomarkers or scores for anthracycline benefit. IMPLICATIONS FOR PRACTICE In patients with early breast cancer, the choice of adjuvant chemotherapy should be based on its effectiveness in reducing breast cancer recurrences and its short- and long-term toxicities. Although adjuvant anthracycline and taxane chemotherapy has the most data supporting its effectiveness, anthracyclines carry a small but important increased risk for cardiotoxicity and leukemia. Two recent clinical trials help describe the degree of benefit with adjuvant anthracycline therapy compared with taxane therapy alone. They suggest that in patients with hormone receptor-positive breast cancer and limited lymph node involvement, nonanthracycline taxane-based adjuvant therapy may be adequate.
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Affiliation(s)
- Ami N Shah
- Lynn Sage Breast Cancer Program, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William J Gradishar
- Lynn Sage Breast Cancer Program, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Wu YT, Xu Z, Arshad B, Wu JS, Zhang K, Wu H, Li X, Li H, Li YC, Wang ZL, Wu KN, Kong LQ. Significantly higher pathologic complete response (pCR) after the concurrent use of trastuzumab and anthracycline-based neoadjuvant chemotherapy for HER2-positive breast cancer: Evidence from a meta-analysis of randomized controlled trials. J Cancer 2018; 9:3168-3176. [PMID: 30210640 PMCID: PMC6134822 DOI: 10.7150/jca.24701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/21/2018] [Indexed: 12/23/2022] Open
Abstract
Objectives: To investigate the effect of the concurrent use of trastuzumab and anthracycline-based neoadjuvant chemotherapy (NAC) for HER2-positive breast cancer in terms of pCR and cardiotoxicity. Methods: We systematically searched Pubmed, Embase, Cochrane and SinoMed databases from inception until 1 July 2017 for relevant articles of randomized controlled studies. After identified all relevant studies that reported the concurrent use of trastuzumab and anthracycline-based NAC for HER2-positive locally advanced breast cancer, five eligible randomized studies were extracted relevant data and assessed for design and quality, and the meta-analysis was conducted to evaluate the risk ratio (RR) of pCR and other interesting outcomes, such as left ventricular ejection fraction (LVEF) decrease more than 10%, responses, recurrence free survival (RFS) and overall survival (OS). Results: A total of five randomized controlled studies were included in the meta-analysis, including 232 HER2-positive locally advanced breast cancer patients received the concurrent use of trastuzumab and anthracycline-based NAC. The results showed that the pCR rate was significantly higher in the group received the concurrent use of trastuzumab and anthracycline-based NAC (48%) than that in the non-concurrent use of trastuzumab and anthracycline-based NAC group (26%) (RR: 1.76, 95%CI: 1.37-2.26, p<0.0001). Besides, higher rate of RFS (RR: 1.14, 95%CI: 1.03-1.26, p=0.009) was observed in the concurrent use of trastuzumab and anthracycline-based NAC group. No significant differences in LVEF decreased more than 10% (p=0.50) between both groups. Conclusions: Our meta-analysis of randomized controlled studies showed that pCR rates are significantly higher in the concurrent use of trastuzumab and anthracycline-based NAC compared with the non-concurrent use of trastuzumab and anthracycline-based NAC for certain HER2-positive breast cancer, meanwhile without significant increase of the cardiotoxicity.
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Affiliation(s)
- Yu-Tuan Wu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhou Xu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bilal Arshad
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jiu-Song Wu
- Department of General Surgery, Children's Hospital of Chongqing Medical University, Chongqing 400020, China
| | - Ke Zhang
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, Chongqing 400020, China
| | - He Wu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin Li
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hao Li
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ying-Cun Li
- Department of General Surgery, Children's Hospital of Chongqing Medical University, Chongqing 400020, China
| | - Zhong-Liang Wang
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, Chongqing 400020, China
| | - Kai-Nan Wu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ling-Quan Kong
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Targeting an oncogenic kinase/phosphatase signaling network for cancer therapy. Acta Pharm Sin B 2018; 8:511-517. [PMID: 30109176 PMCID: PMC6089844 DOI: 10.1016/j.apsb.2018.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 01/10/2023] Open
Abstract
Protein kinases and phosphatases signal by phosphorylation and dephosphorylation to precisely control the activities of their individual and common substrates for a coordinated cellular outcome. In many situations, a kinase/phosphatase complex signals dynamically in time and space through their reciprocal regulations and their cooperative actions on a substrate. This complex may be essential for malignant transformation and progression and can therefore be considered as a target for therapeutic intervention. p38γ is a unique MAPK family member that contains a PDZ motif at its C-terminus and interacts with a PDZ domain-containing protein tyrosine phosphatase PTPH1. This PDZ-coupled binding is required for both PTPH1 dephosphorylation and inactivation of p38γ and for p38γ phosphorylation and activation of PTPH1. Moreover, the p38γ/PTPH1 complex can further regulate their substrates phosphorylation and dephosphorylation, which impacts Ras transformation, malignant growth and progression, and therapeutic response. This review will use the p38γ/PTPH1 signaling network as an example to discuss the potential of targeting the kinase/phosphatase signaling complex for development of novel targeted cancer therapy.
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Shigematsu H, Ozaki S, Yasui D, Yamamoto H, Zaitsu J, Taniyama D, Saitou A, Kuraoka K, Hirata T, Taniyama K. Overexpression of topoisomerase II alpha protein is a factor for poor prognosis in patients with luminal B breast cancer. Oncotarget 2018; 9:26701-26710. [PMID: 29928479 PMCID: PMC6003555 DOI: 10.18632/oncotarget.25468] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/05/2018] [Indexed: 12/12/2022] Open
Abstract
Background The prognostic value and the best method of testing of topoisomerase II alpha (TOP2A) status have not been established in modern tailored therapy based on breast cancer subtype. Results The frequencies of TOP2A overexpression and TOP2A amplified were 55.8% and 9.5%, respectively. TOP2A overexpression correlated strongly with non-luminal A subtype (χ2-test, p < 0.001). TOP2A overexpression was significantly associated with relapse-free survival in luminal B breast cancer (n = 316; log rank test, p < 0.001) but not in other breast cancer subtypes. Cox regression analysis showed that TOP2A overexpression is a significant prognostic factor in luminal B breast cancer (hazard ratio (HR) 4.00, 95% confidence interval (CI) 1.65–9.54, p = 0.002). TOP2A amplified was recognized in HER2 positive breast cancer (p < 0.001). In HER2 positive breast cancer, TOP2A amplified (HR 0.30, 95% CI 0.085–1.07, p = 0.063) appeared to be a better prognostic factor. Conclusion In modern tailored therapy, TOP2A overexpression can be a poor prognostic factor in luminal B breast cancer. In contrast, TOP2A amplified could be a better prognostic factor in HER2 positive breast cancer. Materials and methods Between May 2005 and April 2015, a total of 643 consecutive non-metastatic invasive breast cancers were evaluated for TOP2A amplified using fluorescence in situ hybridization analysis (FISH) and for TOP2A overexpression using the immunohistochemistry assay. FISH ratios of 2 or higher were designated as TOP2A amplified, and TOP2A staining >10% was defined as TOP2A overexpression. The prognostic values of TOP2A amplified and TOP2A overexpression were retrospectively evaluated.
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Affiliation(s)
- Hideo Shigematsu
- Department of Breast Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure-City, Hiroshima, Japan
| | - Shinji Ozaki
- Department of Breast Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure-City, Hiroshima, Japan
| | - Daisuke Yasui
- Department of Breast Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure-City, Hiroshima, Japan
| | - Hideki Yamamoto
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure-City, Hiroshima, Japan
| | - Junichi Zaitsu
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure-City, Hiroshima, Japan
| | - Daiki Taniyama
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure-City, Hiroshima, Japan
| | - Akihisa Saitou
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure-City, Hiroshima, Japan
| | - Kazuya Kuraoka
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure-City, Hiroshima, Japan
| | - Taizo Hirata
- Department of Medical Oncology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure-City, Hiroshima, Japan
| | - Kiyomi Taniyama
- National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure-City, Hiroshima, Japan
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12
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Bahl A, Singh R, Wadhwa J, Gupta S, Ahmed M, Uppal PN, Parikh PM, Aggarwal S. Practical consensus recommendations regarding the management of HER2 neu positive early breast cancer. South Asian J Cancer 2018; 7:102-105. [PMID: 29721473 PMCID: PMC5909284 DOI: 10.4103/sajc.sajc_111_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Over-expression of HER2 is generally considered to be a negative prognostic feature because it accompanies an increase in breast cancer mortality. However, the development of agents that specifically target HER2 has improved the management of patients with these tumours. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations with regards to the use of these agents and the management of HER2 neu early breast cancer for the benefit of community oncologists.
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Affiliation(s)
- A. Bahl
- Deparment of Medical Oncology, Max Hospital, New Delhi, India
| | - R. Singh
- Department of Medical Oncology, Artemis Hospital, Gurugram, India
| | - J. Wadhwa
- Department of Medical Oncology, Medanta Hospital, Gurugram, India
| | - S. Gupta
- Department of Medical Oncology, Sarvodaya Hospital, New Delhi, India
| | - M. Ahmed
- Department of Radiation Oncology, Jolly Grant Himalayan Institute, Dehradoon, India
| | - P. N. Uppal
- Department of Surgical Oncology, Jaipur Golden Hospital, New Delhi, India
| | - Purvish M. Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S. Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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13
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HER2 and TOP2A Gene Amplification and Protein Expression in Upper Tract Urothelial Carcinomas. Pathol Oncol Res 2017; 24:575-581. [DOI: 10.1007/s12253-017-0260-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 06/21/2017] [Indexed: 11/30/2022]
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14
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Curigliano G, Criscitiello C, Esposito A, Pruneri G. Over-using chemotherapy in the adjuvant setting. Breast 2016; 31:303-308. [PMID: 27866835 DOI: 10.1016/j.breast.2016.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 02/07/2023] Open
Abstract
Avoidance of unnecessary or ineffective treatment should be one of the main goals in adjuvant breast oncology today. Unfortunately, both patients and doctors hunt for tiny statistical differences in survival curves. This search could not only lead to an oncological approach of unlimited addition that we will not be able to afford, but would also end inevitably in indeterminate overtreatment with substantial risks of unexpected toxic effects eating away whatever progress we might make. "Do not harm" remains the main principle in medicine. To be able to follow this rule, we need to better understand the biology of breast cancer. The mistake of "one treatment fits all" can only be changed when we critically review trial designs of adjuvant breast oncology. The risk of overtreatment is there and selection of precisely defined cohorts for phase 3 trials is necessary, despite pressure of scientific ambition, pragmatism, and demands of industry. The "add on" clinical trial design model accepts the inability to confirm that standard therapy is still necessary if a positive result from the addition of the new therapy is obtained. The same model can be applied to "extended" adjuvant treatments in breast cancer subtypes. Addition of "miraculin" to the standard of care should generate a new standard. Such trials that show a modest benefit on average at a population level take us a step away from refining care for the individual, and might support the use of multiple and costly interventions with potential short and long term side effects. It is essential to escalate treatment when necessary and to de-escalate when un-necessary.
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Affiliation(s)
- Giuseppe Curigliano
- Istituto Europeo di Oncologia, Division of Early Drug Development for Innovative Therapies, Via Ripamonti 435, 20133 Milano, Italy.
| | - Carmen Criscitiello
- Istituto Europeo di Oncologia, Division of Early Drug Development for Innovative Therapies, Via Ripamonti 435, 20133 Milano, Italy
| | - Angela Esposito
- Istituto Europeo di Oncologia, Division of Early Drug Development for Innovative Therapies, Via Ripamonti 435, 20133 Milano, Italy
| | - Giancarlo Pruneri
- Division of Pathology, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141 Milano, Italy; University of Milan, Breast Cancer Program, Via Ripamonti 435, 20133 Milano, Italy
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15
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Mohammed ZMA, Going JJ, McMillan DC, Orange C, Mallon E, Doughty JC, Edwards J. Comparison of visual and automated assessment of HER2 status and their impact on outcome in primary operable invasive ductal breast cancer. Histopathology 2016; 61:675-84. [PMID: 22747525 DOI: 10.1111/j.1365-2559.2012.04280.x] [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] [Indexed: 11/30/2022]
Abstract
AIMS To compare visual and computerized image analysis of HER2 immunohistochemistry (IHC) with fluorescence in-situ hybridization (FISH) for HER2 status, and to examine the relationships with outcome in patients with primary operable invasive ductal breast cancer. METHODS AND RESULTS Tissue microarrays for 431 breast cancer patients were used to compare different approaches to the assessment of HER2 status. The cores were scored visually and with the Slidepath Tissue IA system, using the NICE-approved scoring system for the HercepTest, as well as by FISH. The agreement between visual and image analysis of HER2 IHC was excellent [interclass correlation coefficient (ICCC) = 0.95, rs = 0.90, r = 0.91, k = 0.81, and P < 0.001]. The agreement of HER2 FISH with visual and image analysis of HER2 IHC was also excellent (ICCC = 0.95 and ICCC = 0.92, respectively). Univariate survival analysis showed equivalent associations of visual and image analysis of HER2 and HER2 FISH with both recurrence-free survival (all P < 0.01) and cancer-specific survival (all P < 0.05) in patients with invasive ductal breast cancer. CONCLUSION Computerized image analysis of HER2 IHC gives results comparable to those obtained with visual assessment, with possible advantages in diagnostic pathology.
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Affiliation(s)
- Zahra M A Mohammed
- Academic Unit of Surgery, College of Medical, Veterinary and Life Sciences, University of Glasgow, Royal InfirmaryUniversity Department of PathologyUnit of Experimental Therapeutics, Institute of Cancer, College of Medical, Veterinary and Life Sciences, University of Glasgow, Royal and Western InfirmaryDepartment of Surgery, Western Infirmary, Glasgow, UK
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16
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Spears M, Lyttle N, D'Costa A, Chen BE, Yao CQ, Boutros PC, Burnell M, Levine MN, O'Brien P, Shepherd L, Bartlett JMS. A four gene signature of chromosome instability (CIN4) predicts for benefit from taxanes in the NCIC-CTG MA21 clinical trial. Oncotarget 2016; 7:49099-49106. [PMID: 27056899 PMCID: PMC5226493 DOI: 10.18632/oncotarget.8542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/17/2016] [Indexed: 01/26/2023] Open
Abstract
Recent evidence demonstrated CIN4 as a predictive marker of anthracycline benefit in early breast cancer. An analysis of the NCIC CTG MA.21 clinical trial was performed to test the role of existing CIN gene expression signatures as prognostic and predictive markers in the context of taxane based chemotherapy. RNA was extracted from patients in cyclophosphamide, epirubicin and fluorouracil (CEF) and epirubicin, cyclophosphamide and paclitaxel (EC/T) arms of the NCIC CTG MA.21 trial and analysed using NanoString technology. After multivariate analysis both high CIN25 and CIN70 score was significantly associated with an increased in RFS (HR 1.76, 95%CI 1.07-2.86, p=0.0018 and HR 1.59, 95%CI 1.12-2.25, p=0.0096 respectively). Patients whose tumours had low CIN4 gene expression scores were associated with an increase in RFS (HR: 0.64, 95% CI 0.39-1.03, p=0.06) when treated with EC/T compared to patients treated with CEF. In conclusion we have demonstrated CIN25 and CIN70 as prognostic markers in breast cancer and that CIN4 is a potential predictive maker of benefit from taxane treatment.
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Affiliation(s)
- Melanie Spears
- Transformative Pathology, Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Nicola Lyttle
- Transformative Pathology, Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON, Canada
| | - Alister D'Costa
- Transformative Pathology, Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON, Canada.,Informatics and Bio-Computing, Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON, Canada
| | - Bingshu E Chen
- NCIC Clinical Trials Group (NCIC CTG) and Queen's University, Kingston, ON, Canada
| | - Cindy Q Yao
- Transformative Pathology, Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON, Canada.,Informatics and Bio-Computing, Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON, Canada
| | - Paul C Boutros
- Informatics and Bio-Computing, Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada
| | | | - Mark N Levine
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
| | - Patti O'Brien
- NCIC Clinical Trials Group (NCIC CTG) and Queen's University, Kingston, ON, Canada
| | - Lois Shepherd
- NCIC Clinical Trials Group (NCIC CTG) and Queen's University, Kingston, ON, Canada
| | - John M S Bartlett
- Transformative Pathology, Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Edinburgh Cancer Research UK Centre, MRC IGMM, University of Edinburgh, Edinburgh, UK
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17
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Makino T, Mikami T, Hata Y, Otsuka H, Koezuka S, Isobe K, Tochigi N, Shibuya K, Homma S, Iyoda A. Comprehensive Biomarkers for Personalized Treatment in Pulmonary Large Cell Neuroendocrine Carcinoma: A Comparative Analysis With Adenocarcinoma. Ann Thorac Surg 2016; 102:1694-1701. [PMID: 27368130 DOI: 10.1016/j.athoracsur.2016.04.100] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prognosis for patients with large cell neuroendocrine carcinoma (LCNEC) of the lung is extremely poor, and optimal treatment strategies have not yet been established. To improve prognoses in patients with LCNEC, this study analyzed immunohistochemical expression and gene mutations of several known molecular targets in LCNECs and compared the expression levels of these targets with those in lung adenocarcinomas. METHODS Twenty-six patients with primary LCNEC and 40 patients with adenocarcinoma were analyzed. Excision repair cross-complementation group 1 (ERCC1), class III β-tubulin, topoisomerase I, topoisomerase II, epidermal growth factor receptor (EGFR)-L858R, and somatostatin receptor expression were evaluated by immunohistochemistry, and EGFR mutations were evaluated using direct DNA sequencing and the Scorpion-amplified refractory mutation system. RESULTS In patients with LCNEC and adenocarcinoma, positive rates of topoisomerase I, topoisomerase II, ERCC1, class III β-tubulin, EGFR-L858R, and somatostatin were 100.0% and 100.0%, 65.4% and 15.0% (p < 0.0001), 42.3% and 17.5% (p = 0.0462), 46.2% and 62.5%, 0.0% and 20.0% (p = 0.0182), and 50.0% and 5.0% (p < 0.0001), respectively. The frequencies of EGFR mutations were 0.0% and 37.5% in LCNEC and adenocarcinoma (p = 0.0002), respectively. Five-year overall survival rates were 64% in LCNEC and 91% in adenocarcinoma in stage I (p = 0.0132). Multivariate analysis showed that LCNEC histologic type was an independent prognostic factor in stage I. CONCLUSIONS LCNEC showed overexpression of topoisomerase II, somatostatin, and ERCC1. These findings suggested that it was possible to have good response to treatment with etoposide and octreotide and that LCNEC may be resistant to platinum-based therapy compared with adenocarcinoma. EGFR mutations were not observed in LCNEC. These results may indicate a favorable response to adjuvant treatments that are not typically prescribed for non-small cell lung cancer.
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Affiliation(s)
- Takashi Makino
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Tetuo Mikami
- Department of Pathology, Toho University School of Medicine, Tokyo, Japan
| | - Yoshinobu Hata
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Kazutoshi Isobe
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo, Japan
| | - Sakae Homma
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Akira Iyoda
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan.
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18
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Dai X, Xiang L, Li T, Bai Z. Cancer Hallmarks, Biomarkers and Breast Cancer Molecular Subtypes. J Cancer 2016; 7:1281-94. [PMID: 27390604 PMCID: PMC4934037 DOI: 10.7150/jca.13141] [Citation(s) in RCA: 247] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 05/19/2016] [Indexed: 12/13/2022] Open
Abstract
Breast cancer is a complex disease encompassing multiple tumor entities, each characterized by distinct morphology, behavior and clinical implications. Besides estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2, novel biomarkers have shown their prognostic and predictive values, complicating our understanding towards to the heterogeneity of such cancers. Ten cancer hallmarks have been proposed by Weinberg to characterize cancer and its carcinogenesis. By reviewing biomarkers and breast cancer molecular subtypes, we propose that the divergent outcome observed from patients stratified by hormone status are driven by different cancer hallmarks. 'Sustaining proliferative signaling' further differentiates cancers with positive hormone receptors. 'Activating invasion and metastasis' and 'evading immune destruction' drive the differentiation of triple negative breast cancers. 'Resisting cell death', 'genome instability and mutation' and 'deregulating cellular energetics' refine breast cancer classification with their predictive values. 'Evading growth suppressors', 'enabling replicative immortality', 'inducing angiogenesis' and 'tumor-promoting inflammation' have not been involved in breast cancer classification which need more focus in the future biomarker-related research. This review novels in its global view on breast cancer heterogeneity, which clarifies many confusions in this field and contributes to precision medicine.
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Affiliation(s)
- Xiaofeng Dai
- National Engineering Laboratory for Cereal Fermentation Technology, School of Biotechnology, Jiangnan University, Wuxi, Jiangsu, P.R.China
| | - Liangjian Xiang
- National Engineering Laboratory for Cereal Fermentation Technology, School of Biotechnology, Jiangnan University, Wuxi, Jiangsu, P.R.China
| | - Ting Li
- National Engineering Laboratory for Cereal Fermentation Technology, School of Biotechnology, Jiangnan University, Wuxi, Jiangsu, P.R.China
| | - Zhonghu Bai
- National Engineering Laboratory for Cereal Fermentation Technology, School of Biotechnology, Jiangnan University, Wuxi, Jiangsu, P.R.China
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19
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Hofmann E, Seeboeck R, Jacobi N, Obrist P, Huter S, Klein C, Oender K, Wiesner C, Hundsberger H, Eger A. The combinatorial approach of laser-captured microdissection and reverse transcription quantitative polymerase chain reaction accurately determines HER2 status in breast cancer. Biomark Res 2016; 4:8. [PMID: 27057311 PMCID: PMC4823853 DOI: 10.1186/s40364-016-0062-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/01/2016] [Indexed: 01/03/2023] Open
Abstract
Background HER2 expression in breast cancer correlates with increased metastatic potential, higher tumor recurrence rates and improved response to targeted therapies. Fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) are two methods commonly used for the analysis of HER2 in the clinic. However, lack of standardization, technical variability in laboratory protocols and subjective interpretation are major problems associated with these testing procedures. Methods Here we evaluated the applicability of reverse-transcription quantitative polymerase chain reaction (RT-qPCR) for HER2 testing in breast cancer. We tested thirty formaldehyde-fixed and paraffin-embedded tumor samples by RT-qPCR, FISH and IHC and analysed and compared the data from the three methods. Results We found that laser-captured microdissection is essential for the accurate determination of HER2 expression by RT-qPCR. When isolating RNA from total tumor tissue we obtained a significant number of false negative results. However, when using RNA from purified cancer cells the RT-qPCR data were fully consistent with FISH and IHC. In addition we provide evidence that ductal carcinomas might be further classified by the differential expression of HER3 and HER4. Conclusions Laser-captured microdissection in combination with RT-qPCR is a precise and cost-effective diagnostic approach for HER2 testing in cancer. The PCR assay is simple, accurate and robust and can easily be implemented and standardized in clinical laboratories.
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Affiliation(s)
- Elisabeth Hofmann
- Department Life Sciences, IMC University of Applied Sciences Krems, Piaristengasse 1, A-3500 Krems, Austria
| | - Rita Seeboeck
- Department Life Sciences, IMC University of Applied Sciences Krems, Piaristengasse 1, A-3500 Krems, Austria.,Pathology Laboratory Obrist and Brunhuber, Klostergasse 1, A-6511 Zams, Austria
| | - Nico Jacobi
- Department Life Sciences, IMC University of Applied Sciences Krems, Piaristengasse 1, A-3500 Krems, Austria
| | - Peter Obrist
- Pathology Laboratory Obrist and Brunhuber, Klostergasse 1, A-6511 Zams, Austria
| | - Samuel Huter
- Pathology Laboratory Obrist and Brunhuber, Klostergasse 1, A-6511 Zams, Austria
| | - Christian Klein
- Department Life Sciences, IMC University of Applied Sciences Krems, Piaristengasse 1, A-3500 Krems, Austria
| | - Kamil Oender
- Research Program for Rational Drug Design in Dermatology and Rheumatology, Department of Dermatology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria
| | - Christoph Wiesner
- Department Life Sciences, IMC University of Applied Sciences Krems, Piaristengasse 1, A-3500 Krems, Austria
| | - Harald Hundsberger
- Department Life Sciences, IMC University of Applied Sciences Krems, Piaristengasse 1, A-3500 Krems, Austria
| | - Andreas Eger
- Department Life Sciences, IMC University of Applied Sciences Krems, Piaristengasse 1, A-3500 Krems, Austria
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20
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Baiocchi G, Poliseli FLV, De Brot L, Mantoan H, Schiavon BN, Faloppa CC, Vassallo J, Soares FA, Cunha IW. TOP2A copy number and TOP2A expression in uterine benign smooth muscle tumours and leiomyosarcoma. J Clin Pathol 2016; 69:884-9. [PMID: 26994023 DOI: 10.1136/jclinpath-2015-203561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/03/2016] [Indexed: 11/04/2022]
Abstract
AIMS To examine TOP2A copy number, TOP2A expression, and its prognostic value in uterine leiomyosarcoma (LMS) and other benign smooth muscle tumours. METHODS We analysed 37 patients treated for uterine LMS with immunohistochemistry for protein expression and fluorescence in situ hybridisation (FISH) for copy number. Twelve cases of leiomyoma variants (LMVs), 4 smooth muscle tumours of uncertain malignant potential (STUMP) and 23 leiomyomas (LMs) were also included. RESULTS Eighteen patients with LMS (48.6%) were International Federation of Gynecology and Obstetrics (FIGO) stage I, six (16.2%) were stage II, four (10.8%) were stage III, and nine (24.3%) were stage IV. Twenty-one (56.8%) patients with LMS showed high expression of TOP2A. Greater TOP2A levels were found in patients with stage ≥II disease compared with stage I and also in high mitotic index tumours (>20/10 HPF (high power field)). Eleven (36.7%) cases had abnormal TOP2A copy numbers. There was no link between TOP2A copy number and TOP2A expression. All patients with benign smooth muscle tumours had low TOP2A immunohistochemical expression and one (7.7%) patient had TOP2A amplification. TOP2A expression and TOP2A copy number had no impact on disease outcomes. Only the presence of disease outside of the uterus negatively impacted survival compared with early disease (53.4 vs 15.8 months; p<0.001). CONCLUSIONS TOP2A is highly expressed in advanced LMS but not in non-malignant diseases. TOP2A expression does not correlate with FISH results and does not predict outcome. TOP2A levels are higher in high-mitotic index tumours and in more advanced stages of disease.
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Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Louise De Brot
- Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | - Jose Vassallo
- Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
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21
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Trastuzumab, non-pegylated liposomal-encapsulated doxorubicin and paclitaxel in the neoadjuvant setting of HER-2 positive breast cancer. Int J Clin Pharm 2016; 38:446-53. [PMID: 26951122 DOI: 10.1007/s11096-016-0278-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUD Neoadjuvant treatment based on the combination of trastuzumab plus chemotherapy is the standard of care in patients with HER2-positive early or locally advanced breast cancer. The concurrent use of trastuzumab, anthracyclines and taxanes is frequently used in this setting despite the potential cardiotoxicity of both anthracyclines and trastuzumab. However, not much information is available about this chemotherapy scheme. OBJECTIVE We wanted to evaluate the efficacy and safety profile of the combination of trastuzumab, liposome-encapsulated doxorubicin and paclitaxel as neoadjuvant scheme. We also tried to establish predictive factors of pathologic complete response. SETTING The study was carried out in a tertiary University Hospital of Spain. METHOD This is a descriptive study of the clinical practice performed in our hospital. MAIN OUTCOME MEASURE Efficacy was measured in terms of pathologic complete response, which was defined as the absence of invasive cancer cells in the breast and the axilla after neoadjuvant treatment. RESULTS Thirty patients were included, the median age was 48. Seventeen (56.7 %) were hormonal receptor (HR) positive, 14 (46.6 %) had IIIa-b clinical stage and one of them had inflammatory breast cancer. 12 patients (40 %) achieved pCR. Patients with HR-negative BC achieved a higher pCR rate than those ones with HR-positive BC (61.5 % and 23.5 %, respectively; p value = 0.035). 21 patients (70 %) underwent breast conservative surgery. The treatment was in general well tolerated, most frequent grade 3-4 adverse events were neutropenia (20 %), asthenia and liver enzyme alteration (10 %) and febrile neutropenia (6.7 %). No patient developed heart failure, but one (3.3 %) presented a 10 % asymptomatic absolute reduction in left ventricular fraction ejection. CONCLUSIONS The studied treatment for the neoadjuvant setting of HER2 positive breast cancer seems to be an effective therapeutic option. Despite the expected high rate of cardiotoxicity of this regimen, the study results shows that this treatment regimen appears to be safe. The combination of trastuzumab, non-pegylated liposomal-encapsulated doxorubicin and paclitaxel should be considered for the treatment of HER2-overexpressing breast cancer.
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22
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A phase II trial of dose-dense (biweekly) paclitaxel plus carboplatin as neoadjuvant chemotherapy for operable breast cancer. Breast Cancer Res Treat 2016; 156:117-24. [PMID: 26936755 DOI: 10.1007/s10549-016-3735-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/25/2016] [Indexed: 10/22/2022]
Abstract
The aim of the present study is to investigate the efficacy and safety of dose-dense (biweekly) carboplatin and paclitaxel as a neoadjuvant treatment for operable breast cancer. Patients with previously untreated breast cancer (stages Ic-III) were treated with four cycles of paclitaxel (175 mg/m(2), intravenous drip, D1) and carboplatin (area under the curve of 5, D1). Patients with HER2+ disease simultaneously received trastuzumab (6 mg/kg initial dose with subsequent doses of 4 mg/kg biweekly). The primary endpoint was a pathologically complete response (pCR). Between January 2012 and February 2014, 110 patients were enrolled. The overall pCR rate was 35.45 % (39 of 110). The pCR rates for the different cancer subtypes were as follows: 10.53 % (2 of 19) among the patients with the luminal A subtype, 12.50 % (5 of 40) among the patients with the luminal B (HER2-) subtype, 58.33 % (14 of 24) among the patients with the luminal B (HER2+) subtype, 57.14 % (8 of 14) among the patients with the triple-negative subtype, and 76.92 % (10 of 13) among the patients with the HER2+ subtype. The patients experienced the following toxicity side effects: grade 3/4 neutropenia (N = 27, 24.55 %), grade 3/4 anemia (N = 6, 5.45 %), grade 3/4 thrombocytopenia (N = 2, 1.82 %), grade 3 alanine aminotransferase (ALT) elevation (N = 1, 0.91 %), grade 3 neuropathy (N = 3, 2.73 %), grade 3 pain (N = 2, 1.82 %), and grade 3 fatigue (N = 1, 0.91 %). In total, 19.09 % of the patients experienced treatment delay or discontinuation due to hematological toxicity, and one patient discontinued treatment due to non-hematological toxicity. Neoadjuvant biweekly paclitaxel plus carboplatin is a feasible therapy that achieved high pCR rates in patients with the HER2+, triple-negative, and luminal B (HER2+) cancer subtypes (NCT0205986).
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23
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Bartlett JMS, McConkey CC, Munro AF, Desmedt C, Dunn JA, Larsimont DP, O'Malley FP, Cameron DA, Earl HM, Poole CJ, Shepherd LE, Cardoso F, Jensen MB, Caldas C, Twelves CJ, Rea DW, Ejlertsen B, Di Leo A, Pritchard KI. Predicting Anthracycline Benefit: TOP2A and CEP17-Not Only but Also. J Clin Oncol 2015; 33:1680-7. [PMID: 25897160 DOI: 10.1200/jco.2013.54.7869] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024] Open
Abstract
PURPOSE Evidence supporting the clinical utility of predictive biomarkers of anthracycline activity is weak, with a recent meta-analysis failing to provide strong evidence for either HER2 or TOP2A. Having previously shown that duplication of chromosome 17 pericentromeric alpha satellite as measured with a centromere enumeration probe (CEP17) predicted sensitivity to anthracyclines, we report here an individual patient-level pooled analysis of data from five trials comparing anthracycline-based chemotherapy with CMF (cyclophosphamide, methotrexate, and fluorouracil) as adjuvant chemotherapy for early breast cancer. PATIENTS AND METHODS Fluorescent in situ hybridization for CEP17, HER2, and TOP2A was performed in three laboratories on samples from 3,846 of 4,864 eligible patients from five trials evaluating anthracycline-containing chemotherapy versus CMF. Methodologic differences did not affect HER2-to-CEP17 ratios but necessitated different definitions for CEP17 duplication: > 1.86 observed copies per cell for BR9601, NEAT, Belgian, and DBCG89D trials and > 2.25 for the MA.5 trial. RESULTS Fluorescent in situ hybridization data were available in 89.3% (HER2), 83.9% (CEP17), and 80.6% (TOP2A) of 3,846 patient cases with available tissue. Both CEP17and TOP2A treatment-by-marker interactions remained significant in adjusted analyses for recurrence-free and overall survival, whereas HER2 did not. A combined CEP17 and TOP2A-adjusted model predicted anthracycline benefit across all five trials for both recurrence-free (hazard ratio, 0.64; 95% CI, 0.51 to 0.82; P = .001) and overall survival (hazard ratio, 0.66; 95% CI, 0.51 to 0.85; P = .005). CONCLUSION This prospectively planned individual-patient pooled analysis of patient cases from five adjuvant trials confirms that patients whose tumors harbor either CEP17 duplication or TOP2A aberrations, but not HER2 amplification, benefit from adjuvant anthracycline chemotherapy.
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Affiliation(s)
- John M S Bartlett
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy.
| | - Christopher C McConkey
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Alison F Munro
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Christine Desmedt
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Janet A Dunn
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Denis P Larsimont
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Frances P O'Malley
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - David A Cameron
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Helena M Earl
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Christopher J Poole
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Lois E Shepherd
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Fatima Cardoso
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Maj-Britt Jensen
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Carlos Caldas
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Christopher J Twelves
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Daniel W Rea
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Bent Ejlertsen
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Angelo Di Leo
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
| | - Kathleen I Pritchard
- John M.S. Bartlett, Ontario Institute for Cancer Research; Frances P. O'Malley, St Michael's Hospital; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto; John M.S. Bartlett, Frances P. O'Malley, and Lois E. Shepherd, National Cancer Institute of Canada Clinical Trials Group; Lois E. Shepherd, Queen's University, Kingston, Canada; John M.S. Bartlett, Alison F. Munro, and David A. Cameron, University of Edinburgh, Edinburgh; Christopher C. McConkey, Janet A. Dunn, and Christopher J. Poole, University of Warwick, Coventry; Helena M. Earl and Carlos Caldas, University of Cambridge, Cambridge; Christopher J. Twelves, St James's University Hospital, Leeds; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Christine Desmedt and Denis P. Larsimont, Université Libre de Bruxelles, Brussels, Belgium; Fatima Cardoso, Champalimaud Cancer Centre, Lisbon, Portugal; Maj-Britt Jensen and Bent Ejlertsen, Rigshospitalet, Copenhagen, Denmark; and Angelo Di Leo, Hospital of Prato, Prato, Italy
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Prognostic and predictive investigation of PAM50 intrinsic subtypes in the NCIC CTG MA.21 phase III chemotherapy trial. Breast Cancer Res Treat 2015; 149:439-48. [PMID: 25552364 DOI: 10.1007/s10549-014-3259-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 12/21/2014] [Indexed: 12/11/2022]
Abstract
PAM50-defined breast cancer intrinsic subtypes and risk-of-relapse (ROR) scores are prognostic and predictive of endocrine therapy and some chemotherapy. We investigated the prognostic and predictive effect of PAM50 classifications by chemotherapy type. NCIC CTG MA.21 randomized 2,104 patients to doxorubicin, cyclophosphamide, and paclitaxel (AC/T); dose-intense cyclophosphamide, epirubicin, and flurouracil (CEF); or dose-dense, dose-intense epirubicin, cyclophosphamide, and paclitaxel (EC/T). Patients were ≤60 years, with node-positive or high-risk node-negative disease, with median 8-year follow-up. Intrinsic subtypes and ROR were determined from RNA extracted from formalin-fixed paraffin-embedded sections by the NanoString PAM50 test. Univariate effects on relapse-free survival (RFS) were assessed with stratified log-rank test; multivariate analyses utilized stratified Cox regression. Among 1094 cases completing PAM50 intrinsic subtyping, 27 % were classified as luminal A, 23 % luminal B, 18 % HER2E, and 32 % basal-like. CEF and EC/T were superior to AC/T (p = 0.01). Higher continuous ROR was multivariately associated with worse RFS (p = 0.03), although categorical ROR was neither prognostic nor predictive. Intrinsic subtypes had a significant multivariate prognostic effect on RFS (p = 0.002). Compared with luminal A, hazard ratios were luminal B = 1.48 (95 % CI 0.92-2.37); HER2E = 2.68 (95 % CI 1.60-4.48); and basal-like = 1.97 (95 % CI 1.10-3.53). Intrinsic subtypes were not predictive of treatment benefit (AC/T vs. EC/T + CEF); however, subgroup analysis indicated subtypes (non-luminal vs. luminal) was predictive of taxane benefit (EC/T vs. CEF; p = 0.05). Both NanoString PAM50 subtypes and continuous ROR had significant prognostic effects on RFS for breast cancer patients treated with CEF, EC/T, and AC/T. Non-luminal tumors differentially responded to EC/T (with taxane) over CEF.
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Mirtavoos Mahyari H, Khosravi A, Mirtavoos Mahyari Z, Esfahani Monfared Z, Khosravi N. Overexpression of HER2/neu as a Prognostic Value in Iranian Women With Early Stage Breast Cancer; A Single Institute Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e16005. [PMID: 25763209 PMCID: PMC4329964 DOI: 10.5812/ircmj.16005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/19/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
Abstract
Background: Patients with early stage breast cancer with same treatment strategy can have markedly different outcomes. Human epidermal growth factor receptor 2 (HER2/nue) gene amplification or the subsequent overexpression of protein has been proved to be associated with patient's outcome and response to anthracyclins-based regimens. Objectives: This study assessed prognostic value of HER2/nue marker in patients with early stage breast cancer who received adjuvant chemotherapy with anthracyclins-based regimens. Materials and Methods: Fifty tissue samples from patients with primary breast cancer of moderate risk receiving sequential adjuvant chemotherapy with anthracyclins-based regimens were assessed to evaluate HER2/nue gene status (quantified by Immunohistochemistry and fluorescence in situ hybridization) retrospectively. Besides, correlation of HER2/neu with patients' characteristics and outcome was studied. Results: HER2/neu amplification was identified in 19 (38%) of 50 patients. No significant difference regarding HER2/neu status was seen in clinic pathological characteristics of patients. Although Progression Free Survival (PFS) was shorter in HER2 overexpressed group, but uni/multivariate analysis adjusted for HER2 overexpression, nodal involvement, hormone receptor status, age and tumor size revealed no significant predictive and/or prognostic value for HER2 regarding PFS. Conclusions: This study on a limited number of patients treated with adjutant anthracyclins-based regimens, revealed that HER2/neu is not a unique strong predictor for outcome, thus according to combination of HER2/neu status and other clinical factors, it is necessary to distinguish patients at high risk of recurrence.
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Affiliation(s)
- Hanifeh Mirtavoos Mahyari
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Adnan Khosravi
- Hematology and Medical Oncology, Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Adnan Khosravi, Hematology and Medical Oncology, Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2126109946, E-mail:
| | | | - Zahra Esfahani Monfared
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Negin Khosravi
- North Tehran Branch, Azad University of Tehran, Tehran, IR Iran
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Esposito A, Criscitiello C, Salè EO, Curigliano G. Optimal adjuvant chemotherapy in breast cancer: selection of agents. Expert Rev Clin Pharmacol 2014; 7:605-11. [PMID: 25080998 DOI: 10.1586/17512433.2014.945429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Historically, the selection of the most effective adjuvant regimen for breast cancer patients was based on tumor size and nodal status but this approach took into account the stage only, without considering that the biology of the tumor matters as well, as breast cancer is a heterogeneous disease at the molecular level. In the present manuscript we will attempt to address the issue of selecting the most appropriate cytotoxic agents for adjuvant programs in the clinically and biologically distinct subgroups of endocrine responsive (luminal A and luminal B), HER2 positive and triple negative breast cancer patients.
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Affiliation(s)
- Angela Esposito
- Division of Early Drug Development for Innovative Therapies, Istituto Europeo di Oncologia, Via Ripamonti 435, 20133 Milano, Italy
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Abstract
The most significant contribution of molecular subtyping of breast carcinomas has been the identification of estrogen-positive and estrogen-negative tumor subtypes, which are 2 distinct entities with differing prognoses and requiring different therapy. Molecular and genetic analyses can provide prognostic information; however, a thorough histopathologic evaluation with an evaluation of predictive biomarkers will provide similar information. Knowledge of genetic alterations in these tumors will help identify novel therapeutic targets, which might have an impact on prognosis. Understanding the progression pathways involved in the transition of in situ carcinoma to invasive carcinoma might lead to efficient risk stratification in these patients.
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Affiliation(s)
- Sudeshna Bandyopadhyay
- Department of Pathology, Wayne State University, 540 E Canfield Street, Detroit, MI 48201, USA.
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Efficacy and safety of neoadjuvant chemotherapy with concurrent liposomal-encapsulated doxorubicin, paclitaxel and trastuzumab for human epidermal growth factor receptor 2-positive breast cancer in clinical practice. Int J Clin Oncol 2014; 20:480-9. [PMID: 25011497 DOI: 10.1007/s10147-014-0727-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Based on previous results obtained with non-pegylated liposomal-encapsulated doxorubicin (TLC-D99) together with paclitaxel and trastuzumab in patients with human epidermal growth factor receptor 2 (HER2)-positive locally advanced or metastatic breast cancer (BC), a similar regimen was evaluated in the neoadjuvant setting in a prospectively selected series of consecutive patients with clinical stage II-III BC. Primary and secondary objectives included the rate of pathologic complete response (pCR), safety, and predictive factors of pCR. METHODS Patients received six cycles of TLC-D99 (50 mg/m(2) every 3 weeks), paclitaxel (80 mg/m(2) weekly) and trastuzumab (4 mg/kg initial dose and 2 mg/kg weekly). All patients underwent surgery after treatment. pCR was defined as the absence of invasive cancer cells in the breast and the axilla. RESULTS Sixty-two patients with a median age of 46.6 years were analyzed. Stage IIIA was diagnosed in 43.5% of patients and 14.5% had inflammatory BC. Conservative surgery was performed in 46.8% of the patients and pCR was achieved in 63% (95% CI 50.5-75.5). Patients with estrogen receptor (ER)-negative tumors presented a significantly higher pCR rate than patients with ER-positive tumors (74.4 vs 43.5%; P = 0.028). Forty-five patients (72.6%) completed study treatment and 80.6% received at least five treatment cycles. No patients developed congestive heart failure and 14.5% of patients showed a ≥ 10 % decrease in the left ventricular ejection fraction. CONCLUSION The triple combination therapy assessed is effective and safe, offering a high pCR rate in patients with HER2-positive BC.
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Almeida D, Gerhard R, Leitão D, Davilla C, Damasceno M, Schmitt F. Topoisomerase II-alfa gene as a predictive marker of response to anthracyclines in breast cancer. Pathol Res Pract 2014; 210:675-9. [PMID: 25042383 DOI: 10.1016/j.prp.2014.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/06/2014] [Accepted: 06/24/2014] [Indexed: 11/17/2022]
Abstract
Amplification or deletion of the topoisomerase IIα (TOP2A) gene in breast cancer has been related with responsiveness to anthracyclines-based chemotherapy. The purpose of this study was to evaluate the predictive value of TOP2A gene for the efficacy of neo-adjuvant anthracycline in a population with locally advanced breast cancer. Sixty-two patients were included, and the status of TOP2A gene was determined by in situ hybridization method. Treatment efficacy was determined by clinical and pathological response and overall survival. TOP2A gene alterations were found in 22.6% (21.0% of cases with amplification and 1.6% with deletion), and these tumors were biologically more aggressive, with higher nuclear grade, more frequently with HER2 amplification and inflammatory type. Also in these tumors response to chemotherapy appeared to be increased. There was a higher clinical and pathological response rate (complete pathological response of 21.4% vs. 8.3%), a trend toward longer progression-free survival (82.51 vs. 63.12 months) and a trend to increased overall survival (92.08 months; 95% CI 82.81-101.35 vs. 73.40 months; 95% CI 63.44-83.36; p=0.113). These results corroborate that the TOP2A gene alterations may play an important role in determining anthracycline sensitivity in breast cancer.
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Affiliation(s)
- Daniela Almeida
- Medical Oncology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Renê Gerhard
- Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto and Department of Pathology, University Health Network, Toronto, Canada
| | - Dina Leitão
- Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal; Department of Pathology and Oncology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cristina Davilla
- Medical Oncology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Margarida Damasceno
- Medical Oncology Department, Centro Hospitalar de São João, Porto, Portugal; Department of Pathology and Oncology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto and Department of Pathology, University Health Network, Toronto, Canada.
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García-Caballero T, Prieto O, Vázquez-Boquete Á, Gude F, Viaño P, Otero M, Curiel T, Fernández-Rodríguez B, Parrado C, Fraga M, Antúnez JR. Dual-colour CISH is a reliable alternative to FISH for assessment of topoisomerase 2-alpha amplification in breast carcinomas. Breast Cancer Res Treat 2013; 143:81-9. [DOI: 10.1007/s10549-013-2791-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 11/23/2013] [Indexed: 01/19/2023]
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Schildhaus HU, Schroeder L, Merkelbach-Bruse S, Binot E, Büttner R, Kuhn W, Rudlowski C. Therapeutic strategies in male breast cancer: clinical implications of chromosome 17 gene alterations and molecular subtypes. Breast 2013; 22:1066-71. [PMID: 24080492 DOI: 10.1016/j.breast.2013.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 08/04/2013] [Accepted: 08/30/2013] [Indexed: 01/27/2023] Open
Abstract
Male breast cancer (MBC) is a rare disease. To date, therapy is mainly based on studies and clinical experiences with breast cancer in women. Only little is known about molecular typing of MBC, particularly with regard to potential biological predictors for adjuvant therapy. In female breast cancer tumors with chromosome 17 centromere (CEP17) duplication, HER2 and/or Topoisomerase II alpha (Topo II-α) gene alterations have been suggested to be associated with poor prognosis and increased sensitivity to anthracycline-containing regimens. In a well characterized cohort of 96 primary invasive MBC, we studied CEP17, HER2 and Topo II-α alterations by fluorescence in-situ hybridization (FISH), and expression of hormone receptors (HR), HER2 and Ki67 by immunohistochemistry to define molecular subtypes. Tumor characteristics and follow-up data were available and correlated with molecular findings. HER2 amplification and Topo II-α amplification/deletion were exceptionally rare in MBC (6.3% and 3.1%, respectively). CEP17 polysomy were found in 9.4% of tumors. HER2, Topo II-α and CEP17 gene alterations were not correlated to patients outcome. 96.9% of our cases were HR positive. Triple negative tumors were found in only 3.1% of the cases. In nodal negative tumors luminal A subtypes were significantly associated with better overall survival. Our results provide evidence for a predominant male breast cancer phenotype, characterized by HR expression and a lack of HER2/Topo II-α alterations and CEP17 duplicates. Therefore, the impact of anthracycline sensitivity linked to HER2/Topo II-α alterations as found in female breast cancer has low clinical significance for this specific male breast cancer phenotype.
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Ribeiro J, Sousa B, Cardoso F. Optimal approach in early breast cancer: Adjuvant and neoadjuvant treatment. EJC Suppl 2013; 11:3-22. [PMID: 26217109 PMCID: PMC4041408 DOI: 10.1016/j.ejcsup.2013.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | | | - F. Cardoso
- Champalimaud Cancer Center, Breast Unit, Lisbon, Portugal
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Chen WW, Chang DY, Huang SM, Lin CH, Hsu C, Lin MH, Huang CS, Lu YS, Cheng AL. The first two lines of chemotherapy for anthracycline-naive metastatic breast cancer: a comparative study of the efficacy of anthracyclines and non-anthracyclines. Breast 2013; 22:1148-54. [PMID: 23968865 DOI: 10.1016/j.breast.2013.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 06/11/2013] [Accepted: 07/16/2013] [Indexed: 01/08/2023] Open
Abstract
For anthracycline-naive metastatic breast cancer (AN-MBC), early anthracycline treatment is a common practice. However, with the availability of newer chemotherapies, comparative studies on the efficacy of anthracyclines and non-anthracyclines as early treatments for AN-MBC are lacking. We collected retrospective clinicopathological data from 253 AN-MBC patients treated at National Taiwan University Hospital between 2001 and 2006. Patients were categorised into anthracycline or non-anthracycline groups according to their regimens in the first two lines of chemotherapy. The overall survival (OS, 33.3 vs. 34.2 months, p = 0.179), time to treatment failure of the first two lines of chemotherapy drugs (13.3 vs. 12.7 months, p = 0.104) and best composite response rate (59.5% vs. 61.1%, p = 0.81) were not significantly different between the two groups. Multivariate analysis showed that early anthracycline treatment was not a significant prognostic factor of OS (p = 0.052). Thus, the results of this study show that anthracyclines may not be necessary as an early treatment option for AN-MBC.
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Affiliation(s)
- Wei-Wu Chen
- Department of Oncology, National Taiwan University Hospital, Yun-Lin Branch, No. 579, Sec. 2, Yunlin Rd., Douliou, Yunlin 640, Taiwan; Department of Oncology, National Taiwan University Hospital, No. 7, Chung Shan South Rd., Taipei 100, Taiwan
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TOP2A overexpression as a poor prognostic factor in patients with nasopharyngeal carcinoma. Tumour Biol 2013; 35:179-87. [PMID: 23897556 DOI: 10.1007/s13277-013-1022-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/12/2013] [Indexed: 01/18/2023] Open
Abstract
Despite the advances in diagnostic imaging and treatment modalities, the risk stratification and final outcomes in patients with nasopharyngeal carcinomas (NPC) still remain suboptimal. Through data mining from published transcriptomic database, topoisomerase IIα (TOP2A) was first identified as a differentially upregulated gene in NPC tissues, which implicates cell division via selective cleavage, rearrangement, and re-ligation of DNA strands. Given the roles of TOP2A in prognostication and in the frontline therapeutic regimen of common carcinomas, such as breast cancer, we explored TOP2A immunoexpression status and its associations with clinicopathological variables and survival in a well-defined cohort of NPC patients. TOP2A immunohistochemistry was retrospectively performed and analyzed using H-score method for biopsy specimens from 124 NPC patients who received standard treatment without distant metastasis at initial diagnosis. Those cases with H-score larger than the median value were construed as featuring TOP2A overexpression. The findings were correlated with the clinicopathological variables, disease-specific survival (DSS) and distant metastasis-free survival (DMFS). TOP2A overexpression was significantly associated with American Joint of Cancer Committee (AJCC) stages III-IV (p = 0.019) and univariately predictive of adverse outcomes for DSS (p = 0.0078) and DMFS (p = 0.0003). In the multivariate comparison, TOP2A overexpression remained prognostically independent to portend worse DSS (p = 0.047, hazard ratio = 1.732) and DMFS (p = 0.003, hazard ratio = 2.569), together with advanced AJCC stages III-IV. TOP2A expression is upregulated in a subset of NPCs and its increased immunoexpression significantly correlated with advanced stages and tumor aggressiveness, justifying the potentiality of TOP2A as a prognostic biomarker and a novel therapeutic target of NPC.
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Patani N, Martin LA, Dowsett M. Biomarkers for the clinical management of breast cancer: international perspective. Int J Cancer 2013; 133:1-13. [PMID: 23280579 DOI: 10.1002/ijc.27997] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 12/07/2012] [Indexed: 12/14/2022]
Abstract
The higher incidence of breast cancer in developed countries has been tempered by reductions in mortality, largely attributable to mammographic screening programmes and advances in adjuvant therapy. Optimal systemic management requires consideration of clinical, pathological and biological parameters. Oestrogen receptor alpha (ERα), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) are established biomarkers evaluated at diagnosis, which identify cardinal subtypes of breast cancer. Their prognostic and predictive utility effectively guides systemic treatment with endocrine, anti-HER2 and chemotherapy. Hence, accurate and reliable determination remains of paramount importance. However, the goals of personalized medicine and targeted therapies demand further information regarding residual risk and potential benefit of additional treatments in specific circumstances. The need for biomarkers which are fit for purpose, and the demands placed upon them, is therefore expected to increase. Technological advances, in particular high-throughput global gene expression profiling, have generated multi-gene signatures providing further prognostic and predictive information. The rational integration of routinely evaluated clinico-pathological parameters with key indicators of biological activity, such as proliferation markers, also provides a ready opportunity to improve the information available to guide systemic therapy decisions. The additional value of such information and its proper place in patient management is currently under evaluation in prospective clinical trials. Expanding the utility of biomarkers to lower resource settings requires an emphasis on cost effectiveness, quality assurance and possible international variations in tumor biology; the potential for improved clinical outcomes should be justified against logistical and economic considerations.
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Affiliation(s)
- Neill Patani
- The Breakthrough Breast Cancer Research Center, The Institute of Cancer Research, London, United Kingdom
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Moreno-Aspitia A, Hillman DW, Dyar SH, Tenner KS, Gralow J, Kaufman PA, Davidson NE, Lafky JM, Reinholz MM, Lingle WL, Kutteh LA, Carney WP, Dueck AC, Perez EA. Soluble human epidermal growth factor receptor 2 (HER2) levels in patients with HER2-positive breast cancer receiving chemotherapy with or without trastuzumab: results from North Central Cancer Treatment Group adjuvant trial N9831. Cancer 2013; 119:2675-82. [PMID: 23744760 DOI: 10.1002/cncr.28130] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 02/18/2013] [Accepted: 03/19/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Increased soluble human epidermal growth factor receptor 2 (sHER2) is an indicator of a poor prognosis in HER2-positive metastatic breast cancer. In this study, the authors evaluated levels of sHER2 during treatment and at the time of disease recurrence in the adjuvant North Central Cancer Treatment Group N9831 clinical trial. METHODS The objectives were to describe sHER2 levels during treatment and at the time of recurrence in patients who were randomized to treatment arms A (standard chemotherapy), B (standard chemotherapy with sequential trastuzumab), and C (standard chemotherapy with concurrent trastuzumab). Baseline samples were available from 2318 patients, serial samples were available from 105 patients, and recurrence samples were available from 124 patients. The cutoff sHER2 value for the assay was 15 ng/mL. Statistical methods included repeated measures linear models, Wilcoxon rank-sum tests, and Cox regression models. RESULTS There were differences between groups in terms of age, menopausal status, and hormone receptor status. Within treatment arms A, B, and C, patients who had baseline sHER2 levels ≥15 ng/mL had worse disease-free survival than patients who had baseline sHER2 levels <15 ng/mL (arm A: hazard ratio, 1.81; P = .0014; arm B: hazard ratio, 2.08; P = .0015; arm C: hazard ratio, 1.96; P = .01). Among the 124 patients who experienced disease recurrence, sHER2 levels increased from baseline to the time of recurrence in arms A and B but remained unchanged in arm C. Patients who had recurrence sHER2 levels ≥15 ng/mL had a shorter survival after recurrence with a 3-year overall survival rate of 51% compared with 77% for those who had recurrence sHER2 levels <15 ng/mL (hazard ratio, 2.36; 95% confidence interval, 1.19-4.70; P = .01). CONCLUSIONS In patients with early stage, HER2-positive breast cancer, a high baseline sHER2 level was identified as a prognostic marker associated with shorter disease-free survival, and a high sHER2 level at recurrence was predictive of shorter survival.
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The HER2 amplicon in breast cancer: Topoisomerase IIA and beyond. Biochim Biophys Acta Rev Cancer 2013; 1836:146-57. [PMID: 23628726 DOI: 10.1016/j.bbcan.2013.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/17/2013] [Accepted: 04/19/2013] [Indexed: 12/20/2022]
Abstract
HER2 gene amplification is observed in about 15% of breast cancers. The subgroup of HER2-positive breast cancers appears to be heterogeneous and presents complex patterns of gene amplification at the locus on chromosome 17q12-21. The molecular variations within the chromosome 17q amplicon and their clinical implications remain largely unknown. Besides the well-known TOP2A gene encoding Topoisomerase IIA, other genes might also be amplified and could play functional roles in breast cancer development and progression. This review will focus on the current knowledge concerning the HER2 amplicon heterogeneity, its clinical and biological impact and the pitfalls associated with the evaluation of gene amplifications at this locus, with particular attention to TOP2A and the link between TOP2A and anthracycline benefit. In addition it will discuss the clinical and biological implications of the amplification of ten other genes at this locus (MED1, STARD3, GRB7, THRA, RARA, IGFPB4, CCR7, KRT20, KRT19 and GAST) in breast cancer.
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Abstract
The incidence of thyroid cancer is increasing worldwide and thyroid nodules are a frequent clinical finding. Diagnosing follicular cell-derived cancers is, however, challenging both histopathologically and especially cytopathologically. The advent of high-throughput molecular technologies has prompted many researchers to explore the transcriptome and, in recent years, also the miRNome in order to generate new molecular classifiers capable of classifying thyroid tumours more accurately than by conventional cytopathological and histopathological methods. This has led to a number of molecular classifiers that may differentiate malignant from benign thyroid nodules. Molecular classification models based on global RNA profiles from fine-needle aspirations are currently being evaluated; results are preliminary and lack validation in prospective clinical trials. There is no doubt that molecular classification will not only contribute to our biological insight but also improve clinical and pathological examinations, thus advancing thyroid tumour diagnosis and ultimately preventing superfluous surgery. This review evaluates the status of classification and biological insights gained from molecular profiling of follicular cell-derived thyroid cancers.
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Affiliation(s)
- Maria Rossing
- Centre for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Fountzilas G, Christodoulou C, Bobos M, Kotoula V, Eleftheraki AG, Xanthakis I, Batistatou A, Pentheroudakis G, Xiros N, Papaspirou I, Koumarianou A, Papakostas P, Bafaloukos D, Skarlos DV, Kalogeras KT. Topoisomerase II alpha gene amplification is a favorable prognostic factor in patients with HER2-positive metastatic breast cancer treated with trastuzumab. J Transl Med 2012; 10:212. [PMID: 23092535 PMCID: PMC3499161 DOI: 10.1186/1479-5876-10-212] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 10/16/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The vast majority of patients with HER2-positive metastatic breast cancer (MBC) treated with trastuzumab eventually develop resistance to this agent. There is an unmet need therefore, for identifying biological markers with possible prognostic/predictive value in such patients. The aim of this study was to investigate the prognostic role of topoisomerase II alpha gene (TOP2A) amplification and protein (TopoIIa) expression in patients treated with trastuzumab-containing regimens. METHODS Formalin-fixed paraffin-embedded tumor tissue samples were retrospectively collected from 225 eligible patients treated with trastuzumab. Protein expression of ER, PgR, Ki67, PTEN, HER2 and TopoIIa were centrally assessed by immunohistochemistry. HER2 and TOP2A gene amplification was evaluated by fluorescence in situ hybridization. PIK3CA mutations were identified by single nucleotide polymorphism genotyping. Survival was evaluated from the initiation of trastuzumab as 1st line treatment to the date of last follow-up or death. RESULTS Among the 225 samples analyzed, only 137 (61%) were found to be HER2-positive. TOP2A was amplified in 41% and deleted in 16% of such tumors. TOP2A gene amplification was more frequent in ER-negative tumors. TopoIIa protein expression was observed in the majority (65%) of the samples and was associated with ER-positive status, high Ki67 expression, presence of PTEN protein and PIK3CA mutations. Median follow-up for patients treated in the 1st line was 51 months. Survival was more prolonged with trastuzumab-containing treatment in HER2-positive patients (50 months, log-rank, p=0.007). TOP2A non-amplified or deleted tumors were associated with increased risk for death compared to TOP2A amplified tumors (HR=2.16, Wald's p=0.010 and HR=2.67, p=0.009, respectively). In multivariate analysis, a significant interaction of TOP2A with anthracycline treatment (either in the adjuvant or the 1st line setting) was observed for survival (Wald's p=0.015). Among the TOP2A amplified subgroup, anthracycline-treated patients were associated with decreased risk for death. CONCLUSIONS TOP2A gene amplification was shown to be a favorable prognostic marker in HER2-positive MBC patients treated with trastuzumab, such an effect however, appears to rather be related to treatment with anthracyclines (predictive marker for benefit from anthracyclines). The results of the present retrospective study warrant validation in larger cohorts of patients treated in the context of randomized trials.
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Affiliation(s)
- George Fountzilas
- Department of Medical Oncology, Papageorgiou Hospital, Aristotle University of Thessaloniki School of Medicine, 564 03, Thessaloniki, Macedonia, Greece.
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Sousa B, Cardoso F. Neoadjuvant treatment for HER-2-positive and triple-negative breast cancers. Ann Oncol 2012; 23 Suppl 10:x237-42. [DOI: 10.1093/annonc/mds348] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Muramatsu M, Arisue Y. [Characteristics of reactions of target enzymes of drugs containing new active ingredients (NAIs) and changes of the NAIs approvals over three decades from 1980 to 2009 in Japan]. YAKUGAKU ZASSHI 2012; 132:733-52. [PMID: 22687733 DOI: 10.1248/yakushi.132.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We analyzed the target enzymes of drugs containing new active ingredients (NAIs) focusing on the characteristics of the reaction of the enzymes, and attempted to prepare a comprehensive overview of the changes in the approval of the drugs over a 3 decade period from 1980 to 2009 in Japan. Fifty-eight enzyme therapeutic targets of 235 NAIs were found to be primarily distributed to EC1, EC2 and EC3 classes, and the enzymes were unevenly distributed to 21 of 64 sub-classes and 34 of 264 sub-subclasses, respectively, classified by the enzyme nomenclature of the International Union of Biochemistry and Molecular Biology (IUBMB). Though the number of NAIs approved that targeted EC1 class enzymes decreased over the time frame studied, the number of NAIs which targeted EC2 class enzymes increased over the same time. There was no clear change in the number of NAIs which targeted other classes of enzymes. More than 80% of NAIs targeted one enzyme as a primary target, and less than 20% of NAIs targeted more than two enzymes as secondary targets. NAIs which primarily targeted EC2 and EC3 class enzymes had more secondary target enzymes than other classes. The results of this study revealed the characteristics of the reactions of the target enzymes of NAIs and the changes in NAI approvals in Japan during the three decades studied, and provided information regarding possible future trends of NAIs.
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Affiliation(s)
- Makoto Muramatsu
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Nihon Pharmaceutical University, Saitama, Japan.
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Ma J, Luo DX, Huang C, Shen Y, Bu Y, Markwell S, Gao J, Liu J, Zu X, Cao Z, Gao Z, Lu F, Liao DF, Cao D. AKR1B10 overexpression in breast cancer: association with tumor size, lymph node metastasis and patient survival and its potential as a novel serum marker. Int J Cancer 2012; 131:E862-71. [PMID: 22539036 DOI: 10.1002/ijc.27618] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 03/13/2012] [Indexed: 12/22/2022]
Abstract
Aldo-keto reductase 1B10 (AKR1B10) is a secretory protein that is upregulated with tumorigenic transformation of human mammary epithelial cells. This study demonstrated that AKR1B10 was overexpressed in 20 (71.4%) of 28 ductal carcinomas in situ, 184 (83.6%) of 220 infiltrating carcinomas and 28 (87.5%) of 32 recurrent tumors. AKR1B10 expression in breast cancer was correlated positively with tumor size (p = 0.0012) and lymph node metastasis (p = 0.0123) but inversely with disease-related survival (p = 0.0120). Univariate (p = 0.0077) and multivariate (p = 0.0192) analyses both suggested that AKR1B10, alone or together with tumor size and node status, is a significant prognostic factor for breast cancer. Silencing of AKR1B10 in BT-20 human breast cancer cells inhibited cell growth in culture and tumorigenesis in female nude mice. Importantly, AKR1B10 in the serum of breast cancer patients was significantly increased to 15.18 ± 9.08 ng/ml [n = 50; 95% confidence interval (CI), 12.60-17.76], with a high level up to 58.4 ng/ml, compared to 3.34 ± 2.27 ng/ml in healthy donors (n = 60; 95% CI, 2.78-3.90). In these patients, AKR1B10 levels in serum were correlated with its expression in tumors (r = 0.8066; p < 0.0001). Together our data suggests that AKR1B10 is overexpressed in breast cancer and may be a novel prognostic factor and serum marker for this deadly disease.
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Affiliation(s)
- Jun Ma
- Department of Medical Microbiology, Immunology, and Cell Biology, Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL 62794, USA
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Meng XL, Su D, Wang L, Gao Y, Hu YJ, Yang HJ, Xie SN. Low expression of stathmin in tumor predicts high response to neoadjuvant chemotherapy with docetaxel-containing regimens in locally advanced breast cancer. Genet Test Mol Biomarkers 2012; 16:689-94. [PMID: 22480216 DOI: 10.1089/gtmb.2011.0298] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We performed this retrospective study to evaluate the value of clinicopathological factors and a novel molecular marker stathmin in predicting treatment response to neoadjuvant chemotherapy (NCT) with docetaxel-containing regimens in patients with locally advanced breast cancer. METHODS Fifty-four consecutive locally advanced patients receiving docetaxel-containing NCT between January 2006 and July 2010 in Zhejiang Cancer Hospital were included. The expression levels of estrogen receptor (ER), progesterone receptor (PgR), epidermal growth factor receptor-2 (HER-2), and p53 were detected by immunohistochemistry, while expression of stathmin mRNA was measured by Quanti-Gene assay. RESULTS The overall clinical objective response (cOR) rate was 75.9% (41/54) in breast. A total of 34 patients (63.0%) experienced pathological OR (pOR), with pathological complete remission (pCR) rate of 20.4% (11/54) in breast and 16.7% (9/54) in both breast and axilla. In univariate analysis, there were associations of pOR in both breast and axilla with age (p=0.054), ER status (p=0.059), subtypes (p=0.062), p53 (p=0.030), and stathmin expression (three terciles) (p=0.039). Mean expression of stathmin in pOR group was 0.410, compared with that in no response group of 0.556 (p=0.051 by Student's t-test). Similarly, a lower expression of stathmin might represent a higher pCR rate (p=0.061). Moreover, the LOWESS smoothing plot showed the same trend, that is, that tumor with a lower level of stathmin expression had a higher probability of response to docetaxel-containing NCT. After multivariate adjustment, both ER and stathmin remained significant with hazard ratio of 4.58 (95% CI: 1.11-18.94, p=0.036) and 2.94 (95% CI: 1.26-6.86, p=0.012), respectively. CONCLUSIONS In conclusion, ER and stathmin were independent predictive factors for NCT with docetaxel-containing regimens.
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Affiliation(s)
- Xu-Li Meng
- Department of Breast Cancer Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
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Lee Y, Ryu Y, Jeong H, Chang H, Kim Y, Kim A. Effectiveness of silver-enhanced in situ hybridization for evaluating HER2 gene status in invasive breast carcinoma: a comparative study. Arch Med Res 2012; 43:139-44. [PMID: 22475781 DOI: 10.1016/j.arcmed.2012.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 03/07/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS HER2 gene amplification occurs in breast cancers and has implications for treatment and prognosis. Recently, a new direct evaluation technique, silver enhanced in situ hybridization (SISH) was developed for evaluating HER2 gene status. This study was performed to evaluate the SISH technique for clinical use by comparing it to that of fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC). METHODS We studied 543 cases of excised breast specimens diagnosed as invasive ductal carcinoma by IHC, FISH, and SISH using a tissue microarray. IHC, FISH, and SISH results were interpreted according to the American Society of Clinical Oncology/College of American Pathologists guidelines. A total of seven English studies that reported the concordance rates of SISH and BDISH compared to FISH published before July 2011 were retrieved. RESULTS The consensus concordance rate between SISH and FISH was 96.69% (kappa value = 0.9175). The pooled sensitivity was 0.94 [95% confidence interval (CI) = 0.91-0.97], and the pooled specificity was 0.98 (95% CI = 0.96-099) in a meta-analysis of the retrieved studies and this study. Area under the receiver operating characteristics curve was 0.9906. CONCLUSIONS SISH technique is an effective modality and is comparable with FISH for evaluating HER2 gene amplification in patients with breast carcinoma.
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Affiliation(s)
- Youngseok Lee
- Department of Pathology, Korea University Guro Hospital, Guro-gu, Seoul, Korea
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da Cunha IW, De Brot L, Carvalho KC, Rocha RM, Fregnani JH, Falzoni R, de Oliveira Ferreira F, Júnior SA, Lopes A, Muto NH, Reis LFL, Soares FA, Vassallo J. Prognostication of Soft Tissue Sarcomas Based on Chromosome 17q Gene and Protein Status: Evaluation of TOP2A, HER-2/neu, and Survivin. Ann Surg Oncol 2011; 19:1790-9. [DOI: 10.1245/s10434-011-2184-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Indexed: 01/11/2023]
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Brunello E, Brunelli M, Manfrin E, Nottegar A, Bersani S, Vergine M, Molino A, Fiorio E, Chilosi M, Gobbo S, Martignoni G, Bonetti F. Classical lobular breast carcinoma consistently lacks topoisomerase-IIα gene amplification: implications for the tailored use of anthracycline-based chemotherapies. Histopathology 2011; 60:482-8. [DOI: 10.1111/j.1365-2559.2011.04067.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hertel PB, Tu D, Ejlertsen B, Jensen MB, Balslev E, Jiang S, O'Malley FP, Pritchard KI, Shepherd LE, Bartels A, Brünner N, Nielsen TO. TIMP-1 in combination with HER2 and TOP2A for prediction of benefit from adjuvant anthracyclines in high-risk breast cancer patients. Breast Cancer Res Treat 2011; 132:225-34. [PMID: 22160637 DOI: 10.1007/s10549-011-1896-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 11/21/2011] [Indexed: 11/25/2022]
Abstract
HER2 amplification, TOP2A aberrations, and absence of tissue inhibitor of metalloproteinase (TIMP-1) expression in breast carcinomas have been shown to be associated with incremental benefit from anthracycline-containing adjuvant chemotherapy, and this study was undertaken to validate these findings in a similar, but independent, randomized clinical trial. TIMP-1 was examined by immunohistochemistry in archival tumor tissue from 403 of 716 premenopausal high-risk patients with known HER2 and TOP2A status who were randomized to cyclophosphamide, epirubicin, and fluorouracil (CEF) or cyclophosphamide, methotrexate, and fluorouracil (CMF) in the MA.5 trial. Ninety-eight (24%) patients had no TIMP-1 staining of tumor cells, 27% were HER2 amplified, and 18% were TOP2A aberrant. Forty-four percentage was classified as HT responsive (HER2 amplified and/or TIMP-1 negative) and 37% as 2T responsive (TOP2A aberrant and/or TIMP-1 negative). There was no heterogeneity in treatment effect of CEF versus CMF according to TIMP-1. In HT-responsive patients, CEF was superior to CMF with an improved RFS (adjusted HR, 0.64; 95% CI, 0.42-0.97), but this was not significant for OS (adjusted HR, 0.66; 95% CI, 0.42-1.04). A significant HT profile versus treatment interaction was detected for OS (P = 0.03). In 2T-responsive patients, CEF seemed to improve RFS compared to CMF (adjusted HR, 0.67; 95% CI, 0.43-1.03) and improved OS (adjusted HR, 0.58; 95% CI, 0.36-0.93). A significant 2T profile versus treatment interaction was detected for OS (P = 0.01). With this study, we validate a more substantial reduction in mortality by CEF compared to CMF in patients with an HT- or 2T-responsive profile; however, we could not show a similarly significant reduction in RFS events, where a benefit of CEF over CMF was found irrespective of TIMP-1 status. Further studies are necessary before the HT and 2T profiles may be used to direct the use of anthracyclines.
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Affiliation(s)
- Pernille Braemer Hertel
- Department of Veterinary Disease Biology, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark.
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Davidson A, Gelmon K. Do anthracyclines still have a role in adjuvant chemotherapy of breast cancer? Future Oncol 2011; 7:37-55. [PMID: 21174537 DOI: 10.2217/fon.10.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Anthracycline-based regimens became the standard of care for early breast cancer patients based on the survival advantage they provide over nonanthracycline-containing regimens. The addition of taxanes, and subsequently trastuzumab in HER2-overexpressing patients, to anthracyclines further improved their efficacy in several studies involving high-risk early breast cancer patients. Concern over toxicity initially surfaced after anthracyclines were reported to carry an increased risk of cardiotoxicity and secondary leukemia. Trastuzumab has since been shown to compound the risk of cardiotoxicity in patients who have received an anthracycline. This has led to the development of regimens featuring a taxane without an anthracycline; these protocols vary in design and have different toxicity and efficacy profiles. Ongoing investigations are centered on the optimization of nonanthracycline regimens, prospective exploration of molecular markers to identify populations of patients who will derive maximal benefit from anthracycline-based chemotherapy, and the identification of less cardiotoxic formulations of existing anthracycline agents. Perhaps most importantly, a rapidly growing understanding of the biological heterogeneity of breast cancer is likely to lead to an individualized standard of care guided by particular patient and tumor characteristics.
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Affiliation(s)
- Ashley Davidson
- BC Cancer Agency, Vancouver Cancer Centre, Vancouver, BC V5Z 4E6, Canada
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