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Cai A, Chen Y, Wang LS, Cusick JK, Shi Y. Depicting Biomarkers for HER2-Inhibitor Resistance: Implication for Therapy in HER2-Positive Breast Cancer. Cancers (Basel) 2024; 16:2635. [PMID: 39123362 PMCID: PMC11311605 DOI: 10.3390/cancers16152635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
HER2 (human epidermal growth factor receptor 2) is highly expressed in a variety of cancers, including breast, lung, gastric, and pancreatic cancers. Its amplification is linked to poor clinical outcomes. At the genetic level, HER2 is encoded by the ERBB2 gene (v-erb-b2 avian erythroblastic leukemia viral oncogene homolog 2), which is frequently mutated or amplified in cancers, thus spurring extensive research into HER2 modulation and inhibition as viable anti-cancer strategies. An impressive body of FDA-approved drugs, including anti-HER2 monoclonal antibodies (mAbs), antibody-drug conjugates (ADCs), and HER2-tyrosine kinase inhibitors (TKIs), have demonstrated success in enhancing overall survival (OS) and disease progression-free survival (PFS). Yet, drug resistance remains a persistent challenge and raises the risks of metastatic potential and tumor relapse. Research into alternative therapeutic options for HER2+ breast cancer therefore proves critical for adapting to this ever-evolving landscape. This review highlights current HER2-targeted therapies, discusses predictive biomarkers for drug resistance, and introduces promising emergent therapies-especially combination therapies-that are aimed at overcoming drug resistance in the context of HER2+ breast cancer.
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Affiliation(s)
- Alvan Cai
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA; (A.C.); (J.K.C.)
| | - Yuan Chen
- Section Pathology of the Institute of Forensic Medicine, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany;
| | - Lily S. Wang
- University of California, Berkeley, CA 94720, USA;
| | - John K. Cusick
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA; (A.C.); (J.K.C.)
| | - Yihui Shi
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA; (A.C.); (J.K.C.)
- California Pacific Medical Center Research Institute, Sutter Bay Hospitals, San Francisco, CA 94107, USA
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Camejo N, Castillo C, Amarillo D, de los Santos H, Samurio G, Silva-Marquez A, Sosa F, Vera C, Xavier R, Herrera G, Alonso I, Krygier G. Efficacy of First-Line Treatment With Pertuzumab and Trastuzumab in Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer in Routine Clinical Practice. World J Oncol 2024; 15:454-462. [PMID: 38751695 PMCID: PMC11092421 DOI: 10.14740/wjon1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/06/2024] [Indexed: 05/18/2024] Open
Abstract
Background The first-line treatment for human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (MBC) involves a combination of trastuzumab, pertuzumab, and a taxane (TPH). This study assessed the efficacy of trastuzumab and pertuzumab (PH) in routine practice, following the treatment protocols of Uruguay's National Resources Fund (FNR), akin to clinical trials. Methods Patients with advanced MBC treated with PH between 2008 and 2022 per FNR protocols were evaluated. The Kaplan-Meyer method and log-rank test were utilized for analyzing overall survival (OS). Demographic and clinical variables, including age, menopausal status, and hormone receptors (HR), were analyzed. Results The study included 318 PH-treated patients. The median age was 56 years, with 63.2% being postmenopausal and 60.4% HR and HER-2 positive. With a median follow-up of 17.2 months, the median OS was 29 months. OS varied based on HR status and the presence of metastases at different sites, significantly lower in patients with brain, cutaneous/subcutaneous, and pulmonary metastases. Additionally, OS was higher in patients treated at private institutions compared to public ones. Conclusions This study demonstrates the disparity in oncological treatment efficacy between clinical trials and clinical reality in Uruguay, emphasizing the importance of authentic environment research for more representative and effective medicine in Latin America.
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Affiliation(s)
- Natalia Camejo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Cecilia Castillo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Dahiana Amarillo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | | | - Gaston Samurio
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | | | - Franco Sosa
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Claudia Vera
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Rocio Xavier
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Guadalupe Herrera
- Department of Quantitative Methods, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | | | - Gabriel Krygier
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
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Wyrwicz L, Rodríguez Sánchez CA, Sánchez-Rovira P, Lewis S, Sandschafer D, San T. Real-world clinical scenarios during introduction of trastuzumab biosimilar for HER2-positive breast cancer in the European Union. Future Oncol 2024; 20:821-832. [PMID: 38305004 DOI: 10.2217/fon-2023-0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Aim: Trastuzumab-anns is an intravenously administered biosimilar to trastuzumab approved by the EMA and US FDA for treatment of HER2+ early and metastatic breast cancer as well as metastatic gastric cancer. Lack of real-world characterization of biosimilar use has hindered uptake. Methods: This observational chart review characterizes 488 patients who received trastuzumab-anns in EU clinical practice settings. Results: Approximately 2/3rds of patients initiated trastuzumab-anns in adjuvant and neoadjuvant settings and most were naive new starters (70%). 30% were switchers from another trastuzumab, among whom 48% switched from trastuzumab iv. reference product. Common reasons for trastuzumab-anns discontinuation were a switch to another biosimilar product (34.8%, n = 85) or to trastuzumab reference product (15.6%, n = 38). Conclusion: Trastuzumab-anns was widely used in various treatment settings for HER2+ breast cancer.
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Affiliation(s)
- Lucjan Wyrwicz
- Department of Oncology & Radiotherapy, Maria Sklodowska Curie National Cancer Research Institute, Warsaw, Poland
| | | | | | - Sandra Lewis
- Global Medical Affairs, Amgen Inc., Thousand Oaks, CA 91320, USA
| | | | - Tevy San
- Centre Oncologie et Radiothérapie, Chambray-lès-Tours, Centre-Val de Loire, France
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Third- and Late Line Treatments of Metastatic Gastric Cancer: Still More to Be Done. Curr Oncol 2022; 29:6433-6444. [PMID: 36135075 PMCID: PMC9497544 DOI: 10.3390/curroncol29090506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 12/24/2022] Open
Abstract
In recent years, advances of anticancer and supportive therapies have determined a gradual improvement in survival rates and patients’ general conditions in metastatic gastric cancer (mGC), allowing them to receive further treatments. The choice of treatment is driven by performance status, age, stage of disease, number of metastatic sites and time from the first to third line of treatment. Targets such as microsatellite instability, PD-L1 expression, and HER2 overexpression or amplification may be addressed to personalise treatment and prolong survival. Despite a growing number of third line options that have provided clinicians with greater opportunities to customise treatments, up to date few agents have been demonstrated as effective after two standard lines for mGC; for these reasons, chemotherapy, immunotherapy, and targeted therapy were all widely investigated in both phase II and phase III studies. Overall, TAS-102, apatinib, regorafenib, nilotinib, trastuzumab, and pembrolizumab were demonstrated to be valid options in the third line scenario for mGC patient refractory to at least two lines of therapy. A multimodal approach based on chemotherapy, immunotherapy, targeted agents, a personalised nutritional programme as well as the research of new predictive biomarkers may pave the way to new strategies to identify the best treatment for each patient.
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Castillo C, Camejo N, Etcheverria C, Ferradaz J, Ferreira A, Fontan A, Gabin AS, Herrera G, Artagaveytia N, Parma G, Delgado L. Trastuzumab-induced cardiotoxicity in early breast cancer over a 10-year period in Uruguay. Medicine (Baltimore) 2022; 101:e29927. [PMID: 35905268 PMCID: PMC9333491 DOI: 10.1097/md.0000000000029927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This srudy aimed to estimate the prevalence of trastuzumab-induced cardiotoxicity in Uruguayan women diagnosed with human epidermal growth factor receptor 2 (HER2)-positive breast cancer over a 10-year period, who were treated under the financial coverage of the National Resources Fund (Fondo Nacional de Recursos). This was an observational, descriptive study based on the analysis of an anonymized database of Uruguayan women diagnosed with HER2-positive breast cancer who received adjuvant trastuzumab treatment from to 2006 to 2016, provided by the Fondo Nacional de Recursos. Statistical analysis was performed using SPSS Statistics version 25, and variables were assessed using measures of central tendency, dispersion, contingency tables, and proportions. The chi-square test was used to analyze the association between the different variables. The study included 1401 patients diagnosed with stage I to III HER2-positive breast cancer. The mean age at diagnosis was 52 years. The prevalence of cardiotoxicity was 20.3%. Most patients who discontinued treatment owing to cardiotoxicity eventually resumed treatment (92.6%). Moreover, the prevalence of cardiotoxicity was similar among patients who received regimens with and without anthracyclines. No association was observed between prior cardiovascular events or trastuzumab administration (concurrent vs sequential) and the development of cardiotoxicity. In the present study, the prevalence of cardiotoxicity was similar to that reported nationally and internationally. Most patients did not develop cardiotoxicity, while the ones who developed it remained asymptomatic and cardiotoxicity was reversible.
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Affiliation(s)
- Cecilia Castillo
- Servicio de Oncología Clínica. Hospital de Clínicas “Dr. Manuel Quintela”. Universidad de la República, Montevideo, Uruguay
- *Correspondence: Cecilia Castillo, Hospital de Clinicas. Av Italia s/n. CP 11600, Montevideo, Uruguay (e-mail: )
| | - Natalia Camejo
- Servicio de Oncología Clínica. Hospital de Clínicas “Dr. Manuel Quintela”. Universidad de la República, Montevideo, Uruguay
| | | | | | | | - Analia Fontan
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Ana Sofia Gabin
- School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Guadalupe Herrera
- Department of Quantitative Methods, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Nora Artagaveytia
- Servicio de Oncología Clínica. Hospital de Clínicas “Dr. Manuel Quintela”. Universidad de la República, Montevideo, Uruguay
| | - Gabriel Parma
- Unidad de Imagen Cardíaca, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la Rpública
| | - Lucía Delgado
- Servicio de Oncología Clínica. Hospital de Clínicas “Dr. Manuel Quintela”. Universidad de la República, Montevideo, Uruguay
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Liu J, Ding H, Quan H, Han J. Anthelminthic niclosamide inhibits tumor growth and invasion in cisplatin-resistant human epidermal growth factor receptor 2-positive breast cancer. Oncol Lett 2021; 22:666. [PMID: 34386088 PMCID: PMC8299033 DOI: 10.3892/ol.2021.12927] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 06/02/2021] [Indexed: 01/03/2023] Open
Abstract
Chemotherapy-resistant breast cancer displays aggressive clinical behavior, is poorly differentiated and is associated with the occurrence of epithelial-mesenchymal transition and the presence of cancer stem cells. The anthelmintic drug niclosamide has been shown to have numerous clinical applications in the treatment of malignant tumors, in addition to its traditional use in tapeworm disease. Our previous study demonstrated that niclosamide had an antiproliferative effect and could inhibit the stem-like phenotype of the breast cancer cells, suggesting that it might have the potential to be used in the treatment of triple-negative breast cancer. However, the specific function and underlying mechanism of action of niclosamide in chemoresistant human epidermal growth factor receptor 2 (HER2)-positive breast cancer remain unknown. The present study aimed to determine whether niclosamide can inhibit cell proliferation, invasion and epithelial-to-mesenchymal transition, as well as the stem-like phenotype in cisplatin-resistant HER2-positive breast cancer. Alamar Blue and Annexin V/7-AAD staining, mammosphere formation and Transwell assays were performed to assess the viability, apoptosis, stem-like phenotype and invasion ability of breast cancer cell lines, respectively. Signaling molecule expression was detected via western blotting and a xenograft model was used to verify the inhibitory effect of niclosamide in vivo. The results from the present study demonstrated that niclosamide inhibited the resistance of HER2-positive breast cancer to cisplatin both in vitro and in vivo. Furthermore, niclosamide combined with cisplatin could inhibit breast cancer cell invasion, epithelial-mesenchymal transition and cell stemness. The inhibitory effect of niclosamide was mediated by apoptosis induction and Bcl-2 downregulation. Taken together, the results of the present study suggested that niclosamide combined with cisplatin may be considered as a novel treatment for chemoresistant HER2-positive breast cancer.
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Affiliation(s)
- Junjun Liu
- Department of Breast Surgery, Shanghai East Hospital, Tongji University, Shanghai 200120, P.R. China
| | - Hanzhi Ding
- Department of Breast Surgery, Shanghai East Hospital, Tongji University, Shanghai 200120, P.R. China
| | - Hong Quan
- Department of Breast Surgery, Shanghai East Hospital, Tongji University, Shanghai 200120, P.R. China
| | - Jing Han
- Department of Breast Surgery, Shanghai East Hospital, Tongji University, Shanghai 200120, P.R. China
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