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Sandoval RL, Bottosso M, Tianyu L, Polidorio N, Bychkovsky BL, Verret B, Gennari A, Cahill S, Achatz MI, Caron O, Imbert-Bouteille M, Noguès C, Mawell KN, Fortuno C, Spurdle AB, Tayob N, Andre F, Garber JE. TP53-associated early breast cancer: new observations from a large cohort. J Natl Cancer Inst 2024; 116:1246-1254. [PMID: 38569880 PMCID: PMC11308175 DOI: 10.1093/jnci/djae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND A recent large, well-annotated international cohort of patients with Li-Fraumeni syndrome and early-stage breast cancer was examined for shared features. METHODS This multicenter cohort study included women with a germline TP53 pathogenic or likely pathogenic variant and nonmetastatic breast cancer diagnosed between 2002 and 2022. Clinical and genetic data were obtained from institutional registries and clinical charts. Descriptive statistics were used to summarize proportions, and differences were assessed using χ2 or Wilcoxon rank sum tests. Metachronous contralateral breast cancer risk, radiation-induced sarcoma risk, and recurrence-free survival were analyzed using the Kaplan-Meier methodology. RESULTS Among 227 women who met study criteria, the median age of first breast cancer diagnosis was 37 years (range = 21-71), 11.9% presented with bilateral synchronous breast cancer, and 18.1% had ductal carcinoma in situ only. In total, 166 (73.1%) patients underwent mastectomies, including 67 bilateral mastectomies as first breast cancer surgery. Among those patients with retained breast tissue, the contralateral breast cancer rate was 25.3% at 5 years. Among 186 invasive tumors, 72.1% were stages I to II, 48.9% were node negative, and the most common subtypes were hormone receptor-positive/HER2-negative (40.9%) and hormone receptor positive/HER2 positive (34.4%). At a median follow-up of 69.9 months (interquartile range = 32.6-125.9), invasive hormone receptor-positive/HER2-negative disease had the highest recurrence risk among the subtypes (5-year recurrence-free survival = 61.1%, P = .001). Among those who received radiation therapy (n = 79), the 5-year radiation-induced sarcoma rate was 4.8%. CONCLUSION We observed high rates of ductal carcinoma in situ, hormone receptor-positive, and HER2-positive breast cancers, with a worse outcome in the hormone receptor-positive/HER2-negative luminal tumors, despite appropriate treatment. Confirmation of these findings in further studies could have implications for breast cancer care in those with Li-Fraumeni syndrome.
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Affiliation(s)
- Renata L Sandoval
- Medical Oncology Center, Hospital Sírio-Libanês, Brasília, DF, Brazil
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michele Bottosso
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Medical Oncology Department, Gustave Roussy Cancer Campus, INERM U981, Université Paris Saclay, France
| | - Li Tianyu
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Natalia Polidorio
- Breast Surgery Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brittany L Bychkovsky
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA, USA
| | - Benjamin Verret
- Medical Oncology Department, Gustave Roussy Cancer Campus, INERM U981, Université Paris Saclay, France
| | - Alessandra Gennari
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Sophie Cahill
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Olivier Caron
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | | | - Catherine Noguès
- Cancer Risk Management Department, Clinical Oncogenetics, Institut Paoli-Calmettes, Marseille, France
- Aix Marseille Université, INSERM, IRD, SESSTIM, Marseille, France
| | - Kara N Mawell
- Department of Medicine, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristina Fortuno
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Amanda B Spurdle
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Nabihah Tayob
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Fabrice Andre
- Medical Oncology Department, Gustave Roussy Cancer Campus, INERM U981, Université Paris Saclay, France
| | - Judy E Garber
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA, USA
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2
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Dixon-Zegeye M, Shaw R, Collins L, Perez-Smith K, Ooms A, Qiao M, Pantziarka P, Izatt L, Tischkowitz M, Harrison RE, George A, Woodward ER, Lord S, Hawkes L, Evans DG, Franklin J, Hanson H, Blagden SP. Cancer Precision-Prevention trial of Metformin in adults with Li Fraumeni syndrome (MILI) undergoing yearly MRI surveillance: a randomised controlled trial protocol. Trials 2024; 25:103. [PMID: 38308321 PMCID: PMC10837926 DOI: 10.1186/s13063-024-07929-w] [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] [Received: 10/07/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Li-Fraumeni syndrome (LFS) is a rare autosomal dominant disease caused by inherited or de novo germline pathogenic variants in TP53. Individuals with LFS have a 70-100% lifetime risk of developing cancer. The current standard of care involves annual surveillance with whole-body and brain MRI (WB-MRI) and clinical review; however, there are no chemoprevention agents licensed for individuals with LFS. Preclinical studies in LFS murine models show that the anti-diabetic drug metformin is chemopreventive and, in a pilot intervention trial, short-term use of metformin was well-tolerated in adults with LFS. However, metformin's mechanism of anticancer activity in this context is unclear. METHODS Metformin in adults with Li-Fraumeni syndrome (MILI) is a Precision-Prevention phase II open-labelled unblinded randomised clinical trial in which 224 adults aged ≥ 16 years with LFS are randomised 1:1 to oral metformin (up to 2 mg daily) plus annual MRI surveillance or annual MRI surveillance alone for up to 5 years. The primary endpoint is to compare cumulative cancer-free survival up to 5 years (60 months) from randomisation between the intervention (metformin) and control (no metformin) arms. Secondary endpoints include a comparison of cumulative tumour-free survival at 5 years, overall survival at 5 years and clinical characteristics of emerging cancers between trial arms. Safety, toxicity and acceptability of metformin; impact of metformin on quality of life; and impact of baseline lifestyle risk factors on cancer incidence will be assessed. Exploratory end-points will evaluate the mechanism of action of metformin as a cancer preventative, identify biomarkers of response or carcinogenesis and assess WB-MRI performance as a diagnostic tool for detecting cancers in participants with LFS by assessing yield and diagnostic accuracy of WB-MRI. DISCUSSION Alongside a parallel MILI study being conducted by collaborators at the National Cancer Institute (NCI), MILI is the first prevention trial to be conducted in this high-risk group. The MILI study provides a unique opportunity to evaluate the efficacy of metformin as a chemopreventive alongside exploring its mechanism of anticancer action and the biological process of mutated P53-driven tumourigenesis. TRIAL REGISTRATION ISRCTN16699730. Registered on 28 November 2022. URL: https://www.isrctn.com/ EudraCT/CTIS number 2022-000165-41.
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Affiliation(s)
- Miriam Dixon-Zegeye
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK
| | - Rachel Shaw
- Oncology Clinical Trials Office, University of Oxford, Old Road Campus Research Building, Oxford, UK
| | - Linda Collins
- Oncology Clinical Trials Office, University of Oxford, Old Road Campus Research Building, Oxford, UK
| | - Kendra Perez-Smith
- Trial Support Unit, Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, UK
| | - Alexander Ooms
- Centre for Statistics in Medicine and Oxford Clinical Trials Research Unit (OCTRU), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Headington, Oxford, UK
| | - Maggie Qiao
- Centre for Statistics in Medicine and Oxford Clinical Trials Research Unit (OCTRU), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Headington, Oxford, UK
| | - Pan Pantziarka
- George Pantziarka TP53 Trust, 7 Surbiton Cres, Kingston upon Thames, UK
| | - Louise Izatt
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Rachel E Harrison
- Department of Clinical Genetics, Nottingham University Hospitals NHS Trust, Hucknall Rd, Nottingham, UK
| | | | - Emma R Woodward
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon Lord
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK
| | - Lara Hawkes
- Oxford Centre for Genomic Medicine, ACE building, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, UK
| | - D Gareth Evans
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - James Franklin
- Institute of Medical Imaging and Visualisation, Bournemouth University, St Pauls Lane, Bournemouth, UK
| | - Helen Hanson
- Peninsula Clinical Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, UK
| | - Sarah P Blagden
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK.
- Oncology Clinical Trials Office, University of Oxford, Old Road Campus Research Building, Oxford, UK.
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3
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Kast K, Rhiem K, Larsen M, Wappenschmidt B, Schmutzler R. Phenotype analysis of families with TP53 germline variants at the Center for Familial Breast and Ovarian Cancer, Cologne. Cancer Med 2024; 13:e6920. [PMID: 38230850 PMCID: PMC10905677 DOI: 10.1002/cam4.6920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/07/2023] [Accepted: 12/31/2023] [Indexed: 01/18/2024] Open
Abstract
PURPOSE Tumor protein p53 (TP53) pathogenic variant (PV) carriers are identified during genetic testing for hereditary causes of cancer. PVs in TP53 are associated with the Li-Fraumeni syndrome (LFS), and thus, surveillance and preventive measures are important for TP53 PV carriers. However, the penetrance of TP53 PVs can be low if the Chompret criteria are not fulfilled. In this study, we compared the phenotypic characteristics of families that did and did not fulfill the LFS criteria according to Chompret. METHODS The German Consortium for Hereditary Breast and Ovarian Cancer (GC-HBOC) database was used to identify index patients with a likely pathogenic/pathogenic TP53 variant and their family members. The study investigated the type of variant, pedigree, age of onset, number of primary tumors, and histological type of BC. RESULTS TP53 PV were present in the index cases of 35 families, 57% (20/35) of which fulfilled the Chompret criteria. The median age of onset at first BC diagnosis was lower in families that fulfilled the Chompret criteria compared to those who did not. Four of all diseased individuals were minors (4%; 4/105) when malignancy was first diagnosed. Sarcomas and brain tumors occurred in 10% (10/105) and in 7% (7/105) of all diseased persons, respectively. BC was the most frequently occurring first tumor (60%; 62/105) and additional malignancy (45%; 20/44) in this cohort. Subsequent malignancies developed in 31% (20/65) of the individuals who fulfilled the Chompret criteria compared with 15% (6/40) of those who did not. CONCLUSION The tumor spectrum and age of onset found in this study showed that tumors other than BC had low disease penetrance in TP53 PV carriers identified using the GC-HBOC criteria for genetic testing.
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Affiliation(s)
- K. Kast
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical FacultyUniversity Hospital CologneCologneGermany
| | - K. Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical FacultyUniversity Hospital CologneCologneGermany
| | - M. Larsen
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical FacultyUniversity Hospital CologneCologneGermany
| | - B. Wappenschmidt
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical FacultyUniversity Hospital CologneCologneGermany
| | - R. Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical FacultyUniversity Hospital CologneCologneGermany
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Song R, Kong SY, Choi W, Lee EG, Woo J, Han JH, Lee S, Kang HS, Jung SY. Clinical Features of Li-Fraumeni Syndrome in Korea. Cancer Res Treat 2024; 56:334-341. [PMID: 37562436 PMCID: PMC10789946 DOI: 10.4143/crt.2023.794] [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] [Received: 06/28/2023] [Accepted: 08/08/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Li-Fraumeni syndrome (LFS) is a hereditary disorder caused by germline mutation in TP53. Owing to the rarity of LFS, data on its clinical features are limited. This study aimed to evaluate the clinical characteristics and prognosis of Korean patients with LFS. MATERIALS AND METHODS Patients who underwent genetic counseling and confirmed with germline TP53 mutation in the National Cancer Center in Korea between 2011 and 2022 were retrospectively reviewed. Data on family history with pedigree, types of mutation, clinical features, and prognosis were collected. RESULTS Fourteen patients with LFS were included in this study. The median age at diagnosis of the first tumor was 32 years. Missense and nonsense mutations were observed in 13 and one patients, respectively. The repeated mutations were p.Arg273His, p.Ala138Val, and pPro190Leu. The sister with breast cancer harbored the same mutation of p.Ala138Val. Seven patients had multiple primary cancers. Breast cancer was most frequently observed, and other types of tumor included sarcoma, thyroid cancer, pancreatic cancer, brain tumor, adrenocortical carcinoma, ovarian cancer, endometrial cancer, colon cancer, vaginal cancer, skin cancer, and leukemia. The median follow-up period was 51.5 months. Two and four patients showed local recurrence and distant metastasis, respectively. Two patients died of leukemia and pancreatic cancer 3 and 23 months after diagnosis, respectively. CONCLUSION This study provides information on different characteristics of patients with LFS, including types of mutation, types of cancer, and prognostic outcomes. For more appropriate management of these patients, proper genetic screening and multidisciplinary discussion are required.
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Affiliation(s)
- Ran Song
- Department of Surgery, Center of Breast Cancer, National Cancer Center, Goyang, Korea
| | - Sun-Young Kong
- Department of Laboratory Medicine, National Cancer Center, Goyang, Korea
| | - Wonyoung Choi
- Center of Rare Cancers, National Cancer Center, Goyang, Korea
| | - Eun-Gyeong Lee
- Department of Surgery, Center of Breast Cancer, National Cancer Center, Goyang, Korea
| | - Jaeyeon Woo
- Department of Surgery, Center of Breast Cancer, National Cancer Center, Goyang, Korea
| | - Jai Hong Han
- Department of Surgery, Center of Breast Cancer, National Cancer Center, Goyang, Korea
| | - Seeyoun Lee
- Department of Surgery, Center of Breast Cancer, National Cancer Center, Goyang, Korea
| | - Han-Sung Kang
- Department of Surgery, Center of Breast Cancer, National Cancer Center, Goyang, Korea
| | - So-Youn Jung
- Department of Surgery, Center of Breast Cancer, National Cancer Center, Goyang, Korea
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5
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Evans DG, Harkness EF, Woodward ER. TP53 c.455C>T p.(Pro152Leu) pathogenic variant is a lower risk allele with attenuated risks of breast cancer and sarcoma. J Med Genet 2023; 60:1057-1060. [PMID: 37076289 DOI: 10.1136/jmg-2022-109133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/10/2023] [Indexed: 04/21/2023]
Abstract
Germline (likely) pathogenic TP53 variants cause Li-Fraumeni syndrome (LFS), typically associated with sarcoma, brain, breast and adrenal tumours. Although classical LFS is highly penetrant, the p.R337H variant, common in Brazil, is typically associated with childhood adrenal tumours and an older onset age of other LFS tumours. Previously, we reported the finding of p.P152L in 6 children from 5 families with adrenal tumours. We have now assessed cancer risks over the subsequent 23 years, and in one further family with p.P152L. Cancer risks were compared with those in the 11 families known to our service with classical dominant negative mutations affecting neighbouring codons 245 and 248 (codon 245/248).Compared with codon 245/248 families, we found lower age-related risks for all non-adrenal tumours in codon 152 families (p<0.0001) with an absence of breast cancer as compared with 100% penetrance by age 36 years in codon 245/248 families (p<0.0001), and lower rates of sarcoma in non-irradiated individuals (p=0.0001). Although there were more adrenal tumours in codon 152 families (6/26 individuals, 1/27 for codon 245/248), this was not significant (p=0.05).Understanding codon-specific cancer risks in LFS is important for accurate personalised cancer risk assessment, and subsequent prevention and early detection strategies.
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Affiliation(s)
- D Gareth Evans
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Elaine F Harkness
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Emma R Woodward
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
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Lopes CDH, Antonacio FF, Moraes PMG, Asprino PF, Galante PAF, Jardim DL, de Macedo MP, Sandoval RL, Katz A, de Castro G, Achatz MI. The Clinical and Molecular Profile of Lung Cancer Patients Harboring the TP53 R337H Germline Variant in a Brazilian Cancer Center: The Possible Mechanism of Carcinogenesis. Int J Mol Sci 2023; 24:15035. [PMID: 37894716 PMCID: PMC10606350 DOI: 10.3390/ijms242015035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
In southern and southeastern Brazil, the TP53 founder variant c.1010G>A (R337H) has been previously documented with a prevalence of 0.3% within the general population and linked to a heightened incidence of lung adenocarcinomas (LUADs). In the present investigation, we cover clinical and molecular characterizations of lung cancer patients from the Brazilian Li-Fraumeni Syndrome Study (BLISS) database. Among the 175 diagnosed malignant neoplasms, 28 (16%) were classified as LUADs, predominantly occurring in females (68%), aged above 50 years, and never-smokers (78.6%). Significantly, LUADs manifested as the initial clinical presentation of Li-Fraumeni Syndrome in 78.6% of cases. Molecular profiling was available for 20 patients, with 14 (70%) revealing EGFR family alterations. In total, 23 alterations in cancer driver genes were identified, comprising 7 actionable mutations and 4 linked to resistance against systemic treatments. In conclusion, the carriers of TP53 R337H demonstrate a predisposition to LUAD development. Furthermore, our results indicate that environmental pollution potentially impacts the carcinogenesis of lung tumors in the carriers of TP53 R337H.
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Affiliation(s)
- Carlos D. H. Lopes
- Hospital Sirio Libanes, São Paulo 01308-050, Brazil; (F.F.A.); (P.M.G.M.); (P.F.A.); (P.A.F.G.); (D.L.J.); (M.P.d.M.); (R.L.S.); (A.K.); (G.d.C.J.)
| | - Fernanda F. Antonacio
- Hospital Sirio Libanes, São Paulo 01308-050, Brazil; (F.F.A.); (P.M.G.M.); (P.F.A.); (P.A.F.G.); (D.L.J.); (M.P.d.M.); (R.L.S.); (A.K.); (G.d.C.J.)
| | - Priscila M. G. Moraes
- Hospital Sirio Libanes, São Paulo 01308-050, Brazil; (F.F.A.); (P.M.G.M.); (P.F.A.); (P.A.F.G.); (D.L.J.); (M.P.d.M.); (R.L.S.); (A.K.); (G.d.C.J.)
| | - Paula F. Asprino
- Hospital Sirio Libanes, São Paulo 01308-050, Brazil; (F.F.A.); (P.M.G.M.); (P.F.A.); (P.A.F.G.); (D.L.J.); (M.P.d.M.); (R.L.S.); (A.K.); (G.d.C.J.)
| | - Pedro A. F. Galante
- Hospital Sirio Libanes, São Paulo 01308-050, Brazil; (F.F.A.); (P.M.G.M.); (P.F.A.); (P.A.F.G.); (D.L.J.); (M.P.d.M.); (R.L.S.); (A.K.); (G.d.C.J.)
| | - Denis L. Jardim
- Hospital Sirio Libanes, São Paulo 01308-050, Brazil; (F.F.A.); (P.M.G.M.); (P.F.A.); (P.A.F.G.); (D.L.J.); (M.P.d.M.); (R.L.S.); (A.K.); (G.d.C.J.)
- Oncoclínicas, São Paulo 04543-906, Brazil
| | - Mariana P. de Macedo
- Hospital Sirio Libanes, São Paulo 01308-050, Brazil; (F.F.A.); (P.M.G.M.); (P.F.A.); (P.A.F.G.); (D.L.J.); (M.P.d.M.); (R.L.S.); (A.K.); (G.d.C.J.)
| | - Renata L. Sandoval
- Hospital Sirio Libanes, São Paulo 01308-050, Brazil; (F.F.A.); (P.M.G.M.); (P.F.A.); (P.A.F.G.); (D.L.J.); (M.P.d.M.); (R.L.S.); (A.K.); (G.d.C.J.)
| | - Artur Katz
- Hospital Sirio Libanes, São Paulo 01308-050, Brazil; (F.F.A.); (P.M.G.M.); (P.F.A.); (P.A.F.G.); (D.L.J.); (M.P.d.M.); (R.L.S.); (A.K.); (G.d.C.J.)
| | - Gilberto de Castro
- Hospital Sirio Libanes, São Paulo 01308-050, Brazil; (F.F.A.); (P.M.G.M.); (P.F.A.); (P.A.F.G.); (D.L.J.); (M.P.d.M.); (R.L.S.); (A.K.); (G.d.C.J.)
| | - Maria Isabel Achatz
- Hospital Sirio Libanes, São Paulo 01308-050, Brazil; (F.F.A.); (P.M.G.M.); (P.F.A.); (P.A.F.G.); (D.L.J.); (M.P.d.M.); (R.L.S.); (A.K.); (G.d.C.J.)
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Blondeaux E, Arecco L, Punie K, Graffeo R, Toss A, De Angelis C, Trevisan L, Buzzatti G, Linn SC, Dubsky P, Cruellas M, Partridge AH, Balmaña J, Paluch-Shimon S, Lambertini M. Germline TP53 pathogenic variants and breast cancer: A narrative review. Cancer Treat Rev 2023; 114:102522. [PMID: 36739824 DOI: 10.1016/j.ctrv.2023.102522] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/02/2023]
Abstract
Approximately 10% of breast cancers are associated with the inheritance of a pathogenic variant (PV) in one of the breast cancer susceptibility genes. Multiple breast cancer predisposing genes, including TP53, are responsible for the increased breast cancer risk. Tumor protein-53 (TP53) germline PVs are associated with Li-Fraumeni syndrome, a rare autosomal dominant inherited cancer predisposition syndrome associated with early-onset pediatric and multiple primary cancers such as soft tissue and bone sarcomas, breast cancer, brain tumors, adrenocortical carcinomas and leukemias. Women harboring a TP53 PV carry a lifetime risk of developing breast cancer of 80-90%. The aim of the present narrative review is to provide a comprehensive overview of the criteria for offering TP53 testing, prevalence of TP53 carriers among patients with breast cancer, and what is known about its prognostic and therapeutic implications. A summary of the current indications of secondary cancer surveillance and survivorship issues are also provided. Finally, the spectrum of TP53 alteration and testing is discussed. The optimal strategies for the treatment of breast cancer in patients harboring TP53 PVs poses certain challenges. Current guidelines favor the option of performing mastectomy rather than lumpectomy to avoid adjuvant radiotherapy and subsequent risk of radiation-induced second primary malignancies, with careful consideration of radiation when indicated post-mastectomy. Some studies suggest that patients with breast cancer and germline TP53 PV might have worse survival outcomes compared to patients with breast cancer and wild type germline TP53 status. Annual breast magnetic resonance imaging (MRI) and whole-body MRI are recommended as secondary prevention.
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Affiliation(s)
- Eva Blondeaux
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Kevin Punie
- Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Rossella Graffeo
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Angela Toss
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Lucia Trevisan
- Hereditary Cancer Unit, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Buzzatti
- Hereditary Cancer Unit, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sabine C Linn
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Peter Dubsky
- Breast Centre, Hirslanden Klinik St Anna, Luzern, Switzerland
| | - Mara Cruellas
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Judith Balmaña
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Shani Paluch-Shimon
- Breast Cancer Unit, Sharett Institute of Oncology, Hadassah Medical Center & Faculty of Medicine, Hebrew University, 91120 Jerusalem, Israel
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Frequency of germline genetic variants in women with a personal or family history of breast cancer from Brazil. Mol Biol Rep 2022; 49:9509-9520. [PMID: 35980532 DOI: 10.1007/s11033-022-07840-0] [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: 05/28/2022] [Accepted: 08/03/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND About 5-10% of breast cancer cases are related to genetic and hereditary factors. The application of Next Generation Sequencing (NGS) in oncology has allowed the identification of genetic variants present in several genes related to the increased risk of breast cancer. This study aimed to determine the frequency of germline genetic variants in patients with a family and/or personal history of breast cancer. METHODS An analysis of positive reports from NGS panels was carried out in female individuals with a personal and/or family history of breast cancer, present in the database of a private laboratory in Brazil. RESULTS From about 2000 reports, 183 individuals presented 219 different germline genetic variants. The genes with the highest number of variants were BRCA2 (16.0%), ATM (15.0%) and BRCA1 (12.8%). Among the variants found, 78 were either pathogenic or probably pathogenic, accounting for 35% of all variants discovered. The gene with the highest proportion of pathogenic/probably pathogenic variants was TP53 (80%) and the most frequent pathogenic variant was also reported in this gene (c.1010G > A p.(Arg337His)). Furthermore, the study obtained a high proportion of variants of uncertain significance (VUS) (65%) and approximately 32% of the variants found were in genes of moderate penetrance. CONCLUSIONS Our results could improve the risk estimation and clinical follow-up of Brazilian patients with a history of breast cancer.
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Li–Fraumeni Syndrome: Mutation of TP53 Is a Biomarker of Hereditary Predisposition to Tumor: New Insights and Advances in the Treatment. Cancers (Basel) 2022; 14:cancers14153664. [PMID: 35954327 PMCID: PMC9367397 DOI: 10.3390/cancers14153664] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Li–Fraumeni Syndrome (LFS) is a rare tumor predisposition syndrome in which the tumor suppressor TP53 gene is mutated in the germ cell population. LFS patients develop a broad spectrum of cancers in their lifetime. The risk to develop these tumors is not decreased by any type of treatment and if the analysis of the TP53 mutational status in the family members was not possible, tumors are often diagnosed in already advanced stages. This review aims to report the evidence for novel mechanisms of tumor onset related to germline TP53 mutations and possible treatments. Abstract Li–Fraumeni syndrome (LFS) is a rare familial tumor predisposition syndrome with autosomal dominant inheritance, involving germline mutations of the TP53 tumor suppressor gene. The most frequent tumors that arise in patients under the age of 45 are osteosarcomas, soft-tissue sarcomas, breast tumors in young women, leukemias/lymphomas, brain tumors, and tumors of the adrenal cortex. To date, no other gene mutations have been associated with LFS. The diagnosis is usually confirmed by genetic testing for the identification of TP53 mutations; therefore, these mutations are considered the biomarkers associated with the tumor spectrum of LFS. Here, we aim to review novel molecular mechanisms involved in the oncogenic functions of mutant p53 in LFS and to discuss recent new diagnostic and therapeutic approaches exploiting TP53 mutations as biomarkers and druggable targets.
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