1
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Chan DS, Vieira R, Abar L, Aune D, Balducci K, Cariolou M, Greenwood DC, Markozannes G, Nanu N, Becerra‐Tomás N, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK. Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:572-599. [PMID: 36279884 PMCID: PMC10092239 DOI: 10.1002/ijc.34322] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/29/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited-suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist-hip-ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random-effects meta-analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre-defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all-cause mortality (64 studies, 32 507 deaths), breast cancer-specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05-1.10), 1.10 (1.06-1.14) and 1.14 (1.04-1.26), with high between-study heterogeneity (I2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist-hip-ratio and all-cause and breast cancer-specific mortality. There was limited-suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited-no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease-free-survival, but more intervention trials and well-designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes.
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Affiliation(s)
- Doris S.M. Chan
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Katia Balducci
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Margarita Cariolou
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Nerea Becerra‐Tomás
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Nutrition, Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism Section, International Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
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2
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Pizzuti L, Sergi D, Sperduti I, Lauro LD, Mazzotta M, Botti C, Izzo F, Marchetti L, Tomao S, Marchetti P, Natoli C, Grassadonia A, Gamucci T, Mentuccia L, Magnolfi E, Vaccaro A, Cassano A, Rossi E, Botticelli A, Sini V, Sarobba MG, Fabbri MA, Moscetti L, Astone A, Michelotti A, De Angelis C, Bertolini I, Angelini F, Ciliberto G, Maugeri-Saccà M, Giordano A, Barba M, Vici P. Body mass index in HER2-negative metastatic breast cancer treated with first-line paclitaxel and bevacizumab. Cancer Biol Ther 2018; 19:328-334. [PMID: 29336662 DOI: 10.1080/15384047.2017.1416938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The evidence emerged from the TOURANDOT trial encourages evaluating the role of anthropometric determinants on treatment outcomes in HER2-negative metastatic breast cancer patients treated with bevacizumab-including regimens. We thus analyzed data from a subgroup of these patients from a larger cohort previously assessed for treatment outcomes. Patients were included in the present analysis if body mass index values had been recorded at baseline. Clinical benefit rates, progression free survival and overall survival were assessed for the overall study population and subgroups defined upon molecular subtype. One hundred ninety six patients were included (N:196). Body mass index showed no impact on clinical benefit rates in the overall study sample and in the luminal cancer subset (p = 0.12 and p = 0.79, respectively), but did so in the triple negative subgroup, with higher rates in patients with body mass index ≥25 (p = 0.03). In the overall study sample, body mass index did no impact progression free or overall survival (p = 0.33 and p = 0.67, respectively). Conversely, in triple negative patients, progression free survival was significantly longer with body mass index ≥25 (6 vs 14 months, p = 0.04). In this subset, overall survival was more favorable (25 vs 19 months, p = 0.02). The impact of the molecular subtype was confirmed in multivariate models including the length of progression free survival, and number of metastatic sites (p < 0.0001). Further studies are warranted to confirm our findings in more adequately sized, ad hoc, prospective studies.
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Affiliation(s)
- Laura Pizzuti
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Domenico Sergi
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Isabella Sperduti
- b Biostatistics Unit and Clinical Trial Center, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Luigi Di Lauro
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Marco Mazzotta
- c Medical Oncology Unit, Policlinico Sant'Andrea , Rome , Italy
| | - Claudio Botti
- d Department of Surgery , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Fiorentino Izzo
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Luca Marchetti
- e Division of Medical Oncology, Villa San Pietro Hospital , Rome , Italy
| | - Silverio Tomao
- f Department of Medical-Surgical Sciences and Biotechnologies , La "Sapienza" University of Rome , Italy
| | - Paolo Marchetti
- c Medical Oncology Unit, Policlinico Sant'Andrea , Rome , Italy
| | - Clara Natoli
- g Department of Medical , Oral and Biotechnological Sciences and CeSI-MeT, G. D'Annunzio University , Chieti , Italy
| | - Antonino Grassadonia
- g Department of Medical , Oral and Biotechnological Sciences and CeSI-MeT, G. D'Annunzio University , Chieti , Italy
| | - Teresa Gamucci
- h Medical Oncology Unit, ASL Frosinone , Frosinone , Italy
| | | | | | - Angela Vaccaro
- h Medical Oncology Unit, ASL Frosinone , Frosinone , Italy
| | - Alessandra Cassano
- i Department of Medical Oncology , Catholic University of Sacred Heart , Rome , Italy
| | - Ernesto Rossi
- i Department of Medical Oncology , Catholic University of Sacred Heart , Rome , Italy
| | | | - Valentina Sini
- c Medical Oncology Unit, Policlinico Sant'Andrea , Rome , Italy.,j Oncology Unit , ASL Roma 1, Santo Spirito Hospital , Rome , Italy
| | | | - Maria Agnese Fabbri
- l Division of Oncology, Complesso Ospedaliero Belcolle, AUSL Viterbo , Viterbo , Italy
| | - Luca Moscetti
- m Division of Medical Oncology , Department of Oncology and Hematology, University Hospital of Modena , Modena , Italy
| | - Antonio Astone
- e Division of Medical Oncology, Villa San Pietro Hospital , Rome , Italy.,i Department of Medical Oncology , Catholic University of Sacred Heart , Rome , Italy
| | - Andrea Michelotti
- n Oncology Unit I, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Claudia De Angelis
- n Oncology Unit I, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Ilaria Bertolini
- n Oncology Unit I, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Francesco Angelini
- o Medical Oncology Unit, Regina Apostolorum Hospital , Albano, Rome , Italy
| | - Gennaro Ciliberto
- p Scientific Direction, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Marcello Maugeri-Saccà
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy.,p Scientific Direction, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Antonio Giordano
- q Sbarro Institute for Cancer Research and Molecular Medicine e del Center for Biotechnology, College of Science and Technology, Temple University , Philadelphia , USA
| | - Maddalena Barba
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy.,p Scientific Direction, IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Patrizia Vici
- a Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
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3
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Pizzuti L, Marchetti P, Natoli C, Gamucci T, Santini D, Scinto AF, Iezzi L, Mentuccia L, D'Onofrio L, Botticelli A, Moscetti L, Sperati F, Botti C, Ferranti F, Buglioni S, Sanguineti G, Di Filippo S, di Lauro L, Sergi D, Catenaro T, Tomao S, Giordano A, Maugeri-Saccà M, Barba M, Vici P. Fasting glucose and body mass index as predictors of activity in breast cancer patients treated with everolimus-exemestane: The EverExt study. Sci Rep 2017; 7:10597. [PMID: 28878375 PMCID: PMC5587713 DOI: 10.1038/s41598-017-10061-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/24/2017] [Indexed: 11/20/2022] Open
Abstract
Evidence on everolimus in breast cancer has placed hyperglycemia among the most common high grade adverse events. Anthropometrics and biomarkers of glucose metabolism were investigated in a observational study of 102 postmenopausal, HR + HER2- metastatic breast cancer patients treated with everolimus-exemestane in first and subsequent lines. Best overall response (BR) and clinical benefit rate (CBR) were assessed across subgroups defined upon fasting glucose (FG) and body mass index (BMI). Survival was estimated by Kaplan-Meier method and log-rank test. Survival predictors were tested in Cox models. Median follow up was 12.4 months (1.0–41.0). The overall cohort showed increasing levels of FG and decreasing BMI (p < 0.001). Lower FG fasting glucose at BR was more commonly associated with C/PR or SD compared with PD (p < 0.001). We also observed a somewhat higher BMI associated with better response (p = 0.052). More patients in the lowest FG category achieved clinical benefit compared to the highest (p < 0.001), while no relevant differences emerged for BMI. Fasting glucose at re-assessment was also predictive of PFS (p = 0.037), as confirmed in models including BMI and line of therapy (p = 0.049). Treatment discontinuation was significantly associated with changes in FG (p = 0.014). Further research is warranted to corroborate these findings and clarify the underlying mechanisms.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology Unit Policlinico Sant'Andrea, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. d'Annunzio University, Via dei Vestini, 66100, Chieti, Italy
| | - Teresa Gamucci
- Medical Oncology Unit, SS Trinità Hospital, S.Marciano, 03039, Sora, Frosinone, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 200, 00128, Roma, Italy
| | - Angelo Fedele Scinto
- Medical Oncology, Ospedale San Giovanni Calibita Fatebenefratelli, ISOLA TIBERINA, Piazza In Piscinula 13 -, 00153, Roma, Italy
| | - Laura Iezzi
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. d'Annunzio University, Via dei Vestini, 66100, Chieti, Italy
| | - Lucia Mentuccia
- Medical Oncology Unit, SS Trinità Hospital, S.Marciano, 03039, Sora, Frosinone, Italy
| | - Loretta D'Onofrio
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo, 200, 00128, Roma, Italy
| | - Andrea Botticelli
- Medical Oncology Unit Policlinico Sant'Andrea, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - Luca Moscetti
- Department of Oncology and Haematology, Azienda Ospedaliera Policlinico, Via del Pozzo 71, 41124, Modena, Italy
| | - Francesca Sperati
- Biostatistics Unit, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Claudio Botti
- Department of Surgery, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Francesca Ferranti
- Department of Radiology, Regina Elena National Cancer Institue, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Simonetta Buglioni
- Department of Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Simona Di Filippo
- Emergency Department, Santa Maria Goretti Hospital, Via Canova 3, 04100, Latina, Italy
| | - Luigi di Lauro
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Teresa Catenaro
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Silverio Tomao
- Department of Medico-Surgical Sciences and Biotechnologies, La "Sapienza" University of Rome, Oncology Unit, Istituto Chirurgico Ortopedico Traumatologico, Via Franco Faggiana 1668, 04100, Latina, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine e del Center for Biotechnology, College of Science and Technology, 1900 N, 12th Street, Temple University, Philadelphia, PA, USA
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.,Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. .,Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Patrizia Vici
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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4
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Barba M, Vici P, Pizzuti L, Di Lauro L, Sergi D, Di Benedetto A, Ercolani C, Sperati F, Terrenato I, Botti C, Mentuccia L, Iezzi L, Gamucci T, Natoli C, Vitale I, Mottolese M, De Maria R, Maugeri-Saccà M. Body mass index modifies the relationship between γ-H2AX, a DNA damage biomarker, and pathological complete response in triple-negative breast cancer. BMC Cancer 2017; 17:101. [PMID: 28166748 PMCID: PMC5294880 DOI: 10.1186/s12885-016-3045-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/30/2016] [Indexed: 02/08/2023] Open
Abstract
Background Body mass index (BMI) is largely investigated as a prognostic and predictive factor in triple-negative breast cancer (TNBC). Overweight and obesity are linked to a variety of pathways regulating tumor-promoting functions, including the DNA damage response (DDR). The DDR physiologically safeguards genome integrity but, in a neoplastic background, it is aberrantly engaged and protects cancer cells from chemotherapy. We herein verified the role of BMI on a previously assessed association between DDR biomarkers and pathological complete response (pCR) in TNBC patients treated with neoadjuvant chemotherapy (NACT). Methods In this retrospective analysis 54 TNBC patients treated with NACT were included. The relationship between DDR biomarkers, namely phosphorylated H2A Histone Family Member X (γ-H2AX) and phosphorylated checkpoint kinase 1 (pChk1), and pCR was reconsidered in light of BMI data. The Pearson’s Chi-squared test of independence (2-tailed) and the Fisher Exact test were employed to assess the relationship between clinical-molecular variables and pCR. Uni- and multivariate logistic regression models were used to identify variables impacting pCR. Internal validation was carried out. Results We observed a significant association between elevated levels of the two DDR biomarkers and pCR in patients with BMI < 25 (p = 0.009 and p = 0.022 for γ-H2AX and pChk1, respectively), but not in their heavier counterpart. Results regarding γ-H2AX were confirmed in uni- and multivariate models and, again, for leaner patients only (γ-H2AXhigh vs γ-H2AXlow: OR 10.83, 95% CI: 1.79–65.55, p = 0.009). The consistency of this finding was confirmed upon internal validation. Conclusions The predictive significance of γ-H2AX varies according to BMI status. Indeed, elevated levels of γ-H2AX seemed associated with lower pCR rate only in leaner patients, whereas differences in pCR rate according to γ-H2AX levels were not appreciable in heavier patients. Larger investigations are warranted concerning the potential role of BMI as effect modifier of the relationship between DDR-related biomarkers and clinical outcomes in TNBC.
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Affiliation(s)
- Maddalena Barba
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. .,Scientific Direction, "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Patrizia Vici
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Luigi Di Lauro
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Anna Di Benedetto
- Department of Pathology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Cristiana Ercolani
- Department of Pathology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- Biostatistics-Scientific Direction, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Department of Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Laura Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio", Chieti, Italy
| | | | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Ilio Vitale
- Scientific Direction, "Regina Elena" National Cancer Institute, Rome, Italy.,Department of Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Marcella Mottolese
- Department of Pathology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Ruggero De Maria
- Institute of General Pathology, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 10, 00168, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. .,Scientific Direction, "Regina Elena" National Cancer Institute, Rome, Italy.
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5
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Triple negative breast cancer: looking for the missing link between biology and treatments. Oncotarget 2016; 6:26560-74. [PMID: 26387133 PMCID: PMC4694936 DOI: 10.18632/oncotarget.5306] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/24/2015] [Indexed: 12/11/2022] Open
Abstract
The so called “Triple Negative Breast Cancer” (TNBC) represents approximately 15-20% of breast cancers. This acronym simply means that the tumour does not express oestrogen receptor (ER) and progesterone receptor (PR) and does not exhibit amplification of the human epidermal growth factor receptor 2 (HER2) gene. Despite this unambiguous definition, TNBCs are an heterogeneous group of tumours with just one common clinical feature: a distinctly aggressive nature with higher rates of relapse and shorter overall survival in the metastatic setting compared with other subtypes of breast cancer. Because of the absence of well-defined molecular targets, cytotoxic chemotherapy is currently the only treatment option for TNBC. In the last decades, the use of more aggressive chemotherapy has produced a clear improvement of the prognosis in women with TNBC, but this approach results in an unacceptable deterioration in the quality of life, also if some support therapies try to relieve patients from distress. In addition, there is the general belief that it is impossible to further improve the prognosis of TNBC patients with chemotherapy alone. In view of that, there is a feverish search for new “clever drugs” able both to rescue chemo-resistant, and to reduce the burden of chemotherapy in chemo-responsive TNBC patients. A major obstacle to identifying actionable targets in TNBC is the vast disease heterogeneity both inter-tumour and intra-tumour and years of study have failed to demonstrate a single unifying alteration that is targetable in TNBC. TNBC is considered the subtype that best benefits from the neoadjuvant model, since the strong correlation between pathological Complete Response and long-term Disease-Free-Survival in these patients. In this review, we discuss the recent discoveries that have furthered our understanding of TNBC, with a focus on the subtyping of TNBC. We also explore the implications of these discoveries for future treatments and highlight the need for a completely different type of clinical trials.
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6
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Cimini A, d'Angelo M, Benedetti E, D'Angelo B, Laurenti G, Antonosante A, Cristiano L, Di Mambro A, Barbarino M, Castelli V, Cinque B, Cifone MG, Ippoliti R, Pentimalli F, Giordano A. Flavopiridol: An Old Drug With New Perspectives? Implication for Development of New Drugs. J Cell Physiol 2016; 232:312-322. [PMID: 27171480 DOI: 10.1002/jcp.25421] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/10/2016] [Indexed: 12/30/2022]
Abstract
Glioblastoma, the most common brain tumor, is characterized by high proliferation rate, invasion, angiogenesis, and chemo- and radio-resistance. One of most remarkable feature of glioblastoma is the switch toward a glycolytic energetic metabolism that leads to high glucose uptake and consumption and a strong production of lactate. Activation of several oncogene pathways like Akt, c-myc, and ras induces glycolysis and angiogenesis and acts to assure glycolysis prosecution, tumor proliferation, and resistance to therapy. Therefore, the high glycolytic flux depends on the overexpression of glycolysis-related genes resulting in an overproduction of pyruvate and lactate. Metabolism of glioblastoma thus represents a key issue for cancer research. Flavopiridol is a synthetic flavonoid that inhibits a wide range of Cyclin-dependent kinase, that has been demonstrate to inactivate glycogen phosphorylase, decreasing glucose availability for glycolysis. In this work the study of glucose metabolism upon flavopiridol treatment in the two different glioblastoma cell lines. The results obtained point towards an effect of flavopiridol in glycolytic cells, thus suggesting a possible new use of this compound or flavopiridol-derived formulations in combination with anti-proliferative agents in glioblastoma patients. J. Cell. Physiol. 232: 312-322, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Annamaria Cimini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. .,National Institute for Nuclear Physics (INFN), Gran Sasso National Laboratory (LNGS), Assergi, Italy. .,Sbarro Institute for Cancer Research and Molecular Medicine and Center for Biotechnology, Temple University, Philadelphia, Pennsylvania.
| | - Michele d'Angelo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Elisabetta Benedetti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Barbara D'Angelo
- Sbarro Institute for Cancer Research and Molecular Medicine and Center for Biotechnology, Temple University, Philadelphia, Pennsylvania
| | - Giulio Laurenti
- Institute of Metabolism and System Research, University of Birmingham, Birmingham, United Kingdom
| | - Andrea Antonosante
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Loredana Cristiano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonella Di Mambro
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marcella Barbarino
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Vanessa Castelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Benedetta Cinque
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Grazia Cifone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rodolfo Ippoliti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Pentimalli
- Department of Experimental Oncology, National Institute of Tumors "G. Pascale", Naples, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine and Center for Biotechnology, Temple University, Philadelphia, Pennsylvania. .,Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
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7
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Vici P, Pizzuti L, Di Lauro L, Conti L, Mandoj C, Antenucci A, Digiesi G, Sergi D, Amodio A, Marchetti P, Sperati F, Valle M, Garofalo A, Vizza E, Corrado G, Vincenzoni C, Tomao F, Kayal R, Marsella A, Carosi M, Antoniani B, Giordano A, Maugeri-Saccà M, Barba M. Metabolic Determinants and Anthropometric Indicators Impact Clinical-pathological Features in Epithelial Ovarian Cancer Patients. J Cancer 2016; 7:516-22. [PMID: 26958087 PMCID: PMC4780127 DOI: 10.7150/jca.13578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/08/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Over the last twenty years, the efforts of the scientific community devoted to the comprehension and treatment of ovarian cancer have remained poorly remunerative, with the case-fatality ratio of this disease remaining disappointedly high. Limited knowledge of the basic principles regulating ovarian carcinogenesis and factors impacting the course of disease may significantly impair our ability to intervene in early stages and lessen our expectations in terms of treatment outcomes. In the present study, we sought to assess whether metabolic factors and anthropometric indicators, i.e., pre-treatment fasting glucose and body mass index, are associated with renown cancer related prognostic factors such as tumour stage and grade at diagnosis. MATERIALS AND METHODS Study participants were 147 women diagnosed with epithelial ovarian cancer and treated with platinum based regimens and/or surgery at the Regina Elena National Cancer Institute of Rome, Italy. Glucose levels were assessed at the institutional laboratories on venous blood collected in overnight fasting conditions and prior to any therapeutic procedure. Stage was coded according to the FIGO staging system based on the results of the diagnostic workup, while tumour grade was locally assessed by an expert pathologist. Participants' characteristics were descriptively analyzed for the overall study population and in a subgroup of 70 patients for whom data on body mass index (BMI) were available. FIGO stage and grade were compared by categories of pre-treatment fasting glucose defined upon the median value, i.e., 89 mg/dl. The association of interest was tested in regression models including BMI. RESULTS For the overall study population, patients in the lowest category of fasting glucose were significantly more likely to exhibit a FIGO stage III-IV at diagnosis compared with their counterpart in the highest glucose category (81.3 vs 66.7%, p: 0.021). Subgroup analysis in 70 patients with BMI data confirmed this association (81.5 vs 55.8, p: 0.049), which remained significant when tested in regression models including BMI (OR: 0.28 95% CI 0.086-0.89, p: 0.031). No relevant evidence emerged when testing the association between fasting glucose and tumour grade. CONCLUSIONS In patients diagnosed with epithelial ovarian cancer, pre-treatment glucose levels appear to be inversely associated with FIGO stage. Further studies are warranted to eventually confirm and correctly interpret the implications of this novel finding.
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Affiliation(s)
- Patrizia Vici
- 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Luigi Di Lauro
- 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Conti
- 2. Division of Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Chiara Mandoj
- 2. Division of Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Antenucci
- 2. Division of Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanna Digiesi
- 2. Division of Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Domenico Sergi
- 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonella Amodio
- 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- 3. Oncology Unit, Sant'Andrea Hospital, La Sapienza University of Rome, Italy
| | - Francesca Sperati
- 4. Biostatistics Unit-Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Mario Valle
- 5. General Surgery, Regina Elena National Institute, Rome, Italy
| | - Alfredo Garofalo
- 5. General Surgery, Regina Elena National Institute, Rome, Italy
| | - Enrico Vizza
- 6. Gynecological Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giacomo Corrado
- 6. Gynecological Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Cristina Vincenzoni
- 6. Gynecological Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Tomao
- 7. Department of Gynecologic Oncology, University “Sapienza”, Viale del Policlinico 155, 00161 Rome, Italy
| | - Ramy Kayal
- 8. Department of Radiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Annalise Marsella
- 8. Department of Radiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Mariantonia Carosi
- 9. Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Barbara Antoniani
- 9. Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Giordano
- 10. Sbarro Institute for Cancer Research and Molecular Medicine e del Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, USA
- 11. Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Marcello Maugeri-Saccà
- 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
- 12. Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
- 12. Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
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8
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Vacchelli E, Aranda F, Bloy N, Buqué A, Cremer I, Eggermont A, Fridman WH, Fucikova J, Galon J, Spisek R, Zitvogel L, Kroemer G, Galluzzi L. Trial Watch-Immunostimulation with cytokines in cancer therapy. Oncoimmunology 2015; 5:e1115942. [PMID: 27057468 DOI: 10.1080/2162402x.2015.1115942] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 02/07/2023] Open
Abstract
During the past decade, great efforts have been dedicated to the development of clinically relevant interventions that would trigger potent (and hence potentially curative) anticancer immune responses. Indeed, developing neoplasms normally establish local and systemic immunosuppressive networks that inhibit tumor-targeting immune effector cells, be them natural or elicited by (immuno)therapy. One possible approach to boost anticancer immunity consists in the (generally systemic) administration of recombinant immunostimulatory cytokines. In a limited number of oncological indications, immunostimulatory cytokines mediate clinical activity as standalone immunotherapeutic interventions. Most often, however, immunostimulatory cytokines are employed as immunological adjuvants, i.e., to unleash the immunogenic potential of other immunotherapeutic agents, like tumor-targeting vaccines and checkpoint blockers. Here, we discuss recent preclinical and clinical advances in the use of some cytokines as immunostimulatory agents in oncological indications.
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Affiliation(s)
- Erika Vacchelli
- INSERM, U1138, Paris, France; Université Paris Descartes/Paris V, Sorbonne Paris Cité, Paris, France; Université Pierre et Marie Curie/Paris VI, Paris, France; Equipe 11 labellisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers, Paris, France; Gustave Roussy Cancer Campus, Villejuif, France
| | - Fernando Aranda
- Group of Immune receptors of the Innate and Adaptive System, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS)
| | - Norma Bloy
- INSERM, U1138, Paris, France; Université Paris Descartes/Paris V, Sorbonne Paris Cité, Paris, France; Université Pierre et Marie Curie/Paris VI, Paris, France; Equipe 11 labellisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers, Paris, France; Gustave Roussy Cancer Campus, Villejuif, France
| | - Aitziber Buqué
- INSERM, U1138, Paris, France; Université Paris Descartes/Paris V, Sorbonne Paris Cité, Paris, France; Université Pierre et Marie Curie/Paris VI, Paris, France; Equipe 11 labellisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers, Paris, France; Gustave Roussy Cancer Campus, Villejuif, France
| | - Isabelle Cremer
- INSERM, U1138, Paris, France; Université Paris Descartes/Paris V, Sorbonne Paris Cité, Paris, France; Université Pierre et Marie Curie/Paris VI, Paris, France; Equipe 13, Center de Recherche des Cordeliers, Paris, France
| | | | - Wolf Hervé Fridman
- INSERM, U1138, Paris, France; Université Paris Descartes/Paris V, Sorbonne Paris Cité, Paris, France; Université Pierre et Marie Curie/Paris VI, Paris, France; Equipe 13, Center de Recherche des Cordeliers, Paris, France
| | - Jitka Fucikova
- Sotio, Prague, Czech Republic; Dept. of Immunology, 2nd Faculty of Medicine and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Jérôme Galon
- INSERM, U1138, Paris, France; Université Paris Descartes/Paris V, Sorbonne Paris Cité, Paris, France; Université Pierre et Marie Curie/Paris VI, Paris, France; Laboratory of Integrative Cancer Immunology, Center de Recherche des Cordeliers, Paris, France
| | - Radek Spisek
- Sotio, Prague, Czech Republic; Dept. of Immunology, 2nd Faculty of Medicine and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Laurence Zitvogel
- Gustave Roussy Cancer Campus, Villejuif, France; INSERM, U1015, CICBT507, Villejuif, France
| | - Guido Kroemer
- INSERM, U1138, Paris, France; Université Paris Descartes/Paris V, Sorbonne Paris Cité, Paris, France; Université Pierre et Marie Curie/Paris VI, Paris, France; Equipe 11 labellisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers, Paris, France; Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France; Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Lorenzo Galluzzi
- INSERM, U1138, Paris, France; Université Paris Descartes/Paris V, Sorbonne Paris Cité, Paris, France; Université Pierre et Marie Curie/Paris VI, Paris, France; Equipe 11 labellisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers, Paris, France; Gustave Roussy Cancer Campus, Villejuif, France
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9
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Barba M, Pizzuti L, Sperduti I, Natoli C, Gamucci T, Sergi D, Di Lauro L, Moscetti L, Izzo F, Rinaldi M, Mentuccia L, Vaccaro A, Iezzi L, Grassadonia A, Michelotti A, Landucci E, Perracchio L, Pescarmona E, Di Filippo F, Giordano A, Maugeri-Saccà M, Vici P. Body Mass Index and Treatment Outcomes in Metastatic Breast Cancer Patients Treated With Eribulin. J Cell Physiol 2015; 231:986-91. [PMID: 26449308 DOI: 10.1002/jcp.25213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 01/27/2023]
Abstract
Eribulin has shown survival advantage and manageable toxicity in heavily pre-treated metastatic breast cancer (mBC). We assessed whether body mass index (BMI) impacts treatment outcomes in 101 patients treated with eribulin at six Italian Oncologic Centers. BMI was addressed as a categorical variable (18.5-24.9 vs. at least 25). Clinical benefit rate (CBR) was assessed overall and in subgroups defined by BMI, line of therapy (LOT), and hormone receptor (HR) status. Analysis of CBR by LOT and HR status were further stratified by BMI. Survival curves were compared using the Kaplan-Meier method and log-rank test. Predictors of survival were tested in Cox models. Patients treated with eribulin as third line showed greater CBR when their BMI was in the lowest category (77.8 vs. 58.1%, P = 0.03). Median progression free survival (PFS) and overall survival (OS) in normal and overweight patients were 4 (95% CI, 3-5) versus 3 (2.1-4) months, P = 0.02 and 13 (11-15) versus 12 (6-18) months, P = 0.96, respectively. Median PFS and OS in estrogen receptor (ER) positive and negative tumours were 4 (3-5) versus 3 (2-4) months, P = 0.005 and 14 (10-18) versus 7 (4-10), P = 0.02, respectively. In multivariate analyses, BMI impacted PFS at a nearly significant extent (P = 0.05), while ER expression significantly affected PFS and OS (P = 0.01 and 0.02, respectively). No relevant findings emerged concerning toxicity. We found evidence of greater efficacy of eribulin in leaner mBC patients, particularly if given as third line and in ER positive tumors. Further studies are warranted to confirm our findings.
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Affiliation(s)
- Maddalena Barba
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.,Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Biostatistics Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio", Chieti, Italy
| | | | - Domenico Sergi
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Luigi Di Lauro
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Moscetti
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | - Fiorentino Izzo
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Rinaldi
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Laura Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio", Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio", Chieti, Italy
| | - Andrea Michelotti
- Oncology Unit I, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Letizia Perracchio
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Edoardo Pescarmona
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Franco Di Filippo
- Surgery Division A, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine e del Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania.,Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.,Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
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10
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Vici P, Crispo A, Giordano A, Di Lauro L, Sperati F, Terrenato I, Pizzuti L, Sergi D, Mottolese M, Botti C, Grimaldi M, Capasso I, D'Aiuto G, Di Bonito M, Di Paola F, Maugeri-Saccà M, Montella M, Barba M. Anthropometric, metabolic and molecular determinants of human epidermal growth factor receptor 2 expression in luminal B breast cancer. J Cell Physiol 2015; 230:1708-12. [PMID: 25510909 DOI: 10.1002/jcp.24891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/12/2014] [Indexed: 12/12/2022]
Abstract
Genomic and trascriptomic profiling has recently contributed details to the characterization of luminal B breast cancer. We explored the contribution of anthropometric, metabolic, and molecular determinants to the multifaceted heterogeneity of this breast cancer subtype, with a specific focus on the association between body mass index (BMI), pre-treatment fasting glucose, hormone receptors, and expression of human epidermal growth factor receptor 2 (HER2). Extensively annotated specimens were obtained from 154 women with luminal B breast cancer diagnosed at two Italian comprehensive cancer centres. Participants' characteristics were descriptively analyzed overall and by HER2 status (positive vs. negative). BMI (<25 vs ≥25), pre-treatment fasting glucose (<median value of 94 mg/dl vs. ≥94) and percentage of hormone receptors were tested for association with HER2 expression in regression models. In univariate models, BMI, fasting glucose and, at a lesser extent, percentage of estrogen receptors (ER) were significantly and inversely associated with HER2 expression (OR: 0.32, 95% CI: 0.16-0.66; 0.43, 0.23-0.82; 0.96, 0.94-0.97, respectively). The multivariate models confirmed the protective role of BMI and ER on HER2 expression, with luminal B HER2 positive patients being significantly less frequent among women within the highest category of BMI and percentage expression of ER compared with their counterparts (OR: 0.22, 95% CI: 0.09-0.53; 0.95, 0.93-0.97). In conclusions, BMI and percentage of ER representation are inversely associated with HER2 expression in luminal B breast cancers. Upon confirmatory findings, this might help identify patient subgroups who may best benefit from the use of interventions targeting insulin resistance in well depicted breast cancer scenarios.
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Affiliation(s)
- Patrizia Vici
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
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11
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Pizzuti L, Vici P, Di Lauro L, Sergi D, Della Giulia M, Marchetti P, Maugeri-Saccà M, Giordano A, Barba M. Metformin and breast cancer: basic knowledge in clinical context. Cancer Treat Rev 2015; 41:441-7. [PMID: 25816698 DOI: 10.1016/j.ctrv.2015.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/06/2015] [Accepted: 03/09/2015] [Indexed: 01/22/2023]
Abstract
Although preclinical work is vital in unraveling the molecular tenets which apply to metformin action in breast cancer, it is by nature unable to capture the host's response to metformin in terms of insulin-mediated effects and related changes in the hormonal and metabolic asset at the systemic level. The latter might sound seemingly paradoxical when considering the inveterate use of metformin in dysmetabolisms and pathologic conditions with underlying hormonal disruption. Bridging the gap between the molecular target and characteristics of breast cancer patients may help lab-based experiments and clinical work converge into one or more well characterized sub-populations instead of a sub optimally selected one. An appropriate patient selection is the main key to the most suitable outcome interpretation and amelioration, in an attempt to meet our patients needs midway between overestimation of benefits and efficacy dilution for any given intervention and/or co-intervention.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology B, Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy.
| | - Patrizia Vici
- Division of Medical Oncology B, Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy.
| | - Luigi Di Lauro
- Division of Medical Oncology B, Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy.
| | - Domenico Sergi
- Division of Medical Oncology B, Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy.
| | - Marina Della Giulia
- Division of Medical Oncology B, Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy
| | - Paolo Marchetti
- Oncology Unit, Sant'Andrea Hospital, La Sapienza University of Rome, Italy
| | - Marcello Maugeri-Saccà
- Medical Oncology B-Scientific Direction, Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology Temple University, Philadelphia, USA; Department of Human Pathology and Oncology, University of Siena, Siena, Italy
| | - Maddalena Barba
- Medical Oncology B-Scientific Direction, Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy.
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