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An E, Ock CY, Kim TY, Lee KH, Han SW, Im SA, Kim TY, Liao WL, Cecchi F, Blackler A, Thyparambil S, Kim WH, Burrows J, Hembrough T, Catenacci DVT, Oh DY, Bang YJ. Quantitative proteomic analysis of HER2 expression in the selection of gastric cancer patients for trastuzumab treatment. Ann Oncol 2017; 28:110-115. [PMID: 27687309 PMCID: PMC5378223 DOI: 10.1093/annonc/mdw442] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background A wide range of response rates have been reported in HER2-positive gastric cancer (GC) patients treated with trastuzumab. Other HER2-targeted therapies for GC have yet to show efficacy in clinical trials. These findings raise question about the ability of standard HER2 diagnostics to accurately distinguish between GC patients who would and would not benefit from anti-HER2 therapies. Patients and methods GC patients (n = 237), including a subset from the Trastuzumab in GC (ToGA) trial were divided into three groups based on HER2 status and history of treatment with standard chemotherapy or chemotherapy plus trastuzumab. We applied mass spectrometry-based proteomic analysis to quantify HER2 protein expression in formalin-fixed tumor samples. Using HER2 expression as a continuous variable, we defined a predictive protein level cutoff to identify which patients would benefit from trastuzumab. We compared quantitated protein level with clinical outcome and HER2 status as determined by conventional HER2 diagnostics. Results Quantitative proteomics detected a 115-fold range of HER2 protein expression among patients diagnosed as HER2 positive by standard methods. A protein level of 1825 amol/µg was predicted to determine benefit from the addition of trastuzumab to chemotherapy. Trastuzumab treated patients with HER2 protein levels above this cutoff had twice the median overall survival (OS) of their counterparts below the cutoff (35.0 versus 17.5 months, P = 0.011). Conversely, trastuzumab-treated patients with HER2 levels below the cutoff had outcomes similar to HER2-positive patients treated with chemotherapy. (Progression-free survival = 7.0 versus 6.5 months: P = 0.504; OS = 17.5 versus 12.6 months: P = 0.520). HER2 levels were not prognostic for response to chemotherapy. Conclusions Proteomic analysis of HER2 expression demonstrated a quantitative cutoff that improves selection of GC patients for trastuzumab as compared with current diagnostic methods.
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Affiliation(s)
- E An
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - C-Y Ock
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea
| | - T-Y Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea
| | - K-H Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
| | - S-W Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
| | - S-A Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
| | - T-Y Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
| | - W-L Liao
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - F Cecchi
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - A Blackler
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - S Thyparambil
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - W H Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - J Burrows
- Oncoplex Diagnostics, Rockville, USA
| | - T Hembrough
- NantOmics, Rockville, USA,Oncoplex Diagnostics, Rockville, USA
| | - D V T Catenacci
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, USA
| | - D-Y Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
| | - Y-J Bang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Seoul, Korea
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Nuciforo P, Thyparambil S, Galván P, Vilaro M, Jimenez J, Liao WL, Cecchi F, Blackler A, Press MF, Gagnon R, Ellis C, Hembrough T, Johnston S, Prat A. Abstract P3-07-08: Quantitative HER family proteins assessment as prognostic and predictive biomarkers in the EGF30008 clinical trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-07-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Combined targeted strategy with letrozole (Le) and lapatinib (La) improves progression-free survival (PFS) in patients with metastatic breast cancer (MBC) co-expressing hormone receptor-positive (HR+) and HER2+ but not in HR+/HER2-negative (HER-) disease (Johnston J Clin Oncol 2009). However, among HER2+ tumors, quantitative levels of HER2 are heterogeneous with a broad dynamic range corresponding to approximately 163.7 to 17446.7 amol/µg as previously reported (Nuciforo SABCS 2014). In addition, within HER2- tumors, quantitative measurement of HER family proteins may identify those patients most likely to benefit from the addition of La to Le. In this retrospective study, we tested the prognostic and predictive ability of HER proteins quantification in clinically HER2+ tumor samples from the EGF30008 study.
Methods
Formalin-fixed paraffin-embedded primary tumor tissues sections from HER2+ MBC population were used. After laser microdissection, tissue lysates were prepared for selected reaction monitoring mass spectrometry (SRM-MS) analysis. Absolute quantitation was accomplished through simultaneous detection of endogenous target and synthetic labeled heavy peptide identical to analytical targets (EGFR, HER2, HER3). HER2 protein levels were correlated with PAM50 molecular subtypes, ERBB2 and ESR1 genes by nCounter. PFS and overall survival (OS) were analyzed by Kaplan–Meier and log-rank test. To determine whether HER2 protein levels were predictive of La benefit, we tested the interaction term of HER2 protein as a continuous variable by treatment arm in a Cox model.
Results
Within the HER2+ study cohort (n=219), 107 had an available tumor block; 84 cases had sufficient material for HER expression measurement by SRM-MS. Average HER2 levels were
2321.1 amol/ug (median, 817.6). HER2 levels were lower in Le+La (n=43; mean, 1761 amol/ug) compared to Le (n=41; mean, 2908 amol/ug) arms, although the difference was non-significant (p=0.108). No expression of EGFR and HER3 was observed. HER2 protein levels were significantly different among PAM50 subtypes with HER2-enriched (HER2E) tumors showing the highest expression followed by Basal-like, Luminal A, Luminal B, and Normal-like (p<0.001). A correlation between HER2 protein, ERBB2 (r=0.5, p<0.001) and ESR1 (r=-0.5, p=0.001) gene expression was found. In patients with disease that expresses HER2 protein levels above the median a trend towards worse PFS (2.9 vs 7.7 months, p=0.092) and OS (21 vs 39 months, p=0.071) were observed. A statistically significant interaction was observed between HER2 protein levels and La treatment for both PFS (p=0.049) and OS (p<0.001). HER2+ tumors with lower expression of HER2 benefited more from La than those with higher expression.
Conclusions
Levels of HER2 protein in HER2+ MBC are extremely heterogeneous. An association between HER2 protein and gene expression by nCounter was observed. HER2E tumors by PAM50 showed the highest levels of HER2 protein. Within the group of HER2+ MBC by standard IHC/FISH, tumors with high HER2 protein had a statistically non-significant worse outcome and do not seem to benefit from La. Further validation of these findings is warranted.
Citation Format: Nuciforo P, Thyparambil S, Galván P, Vilaro M, Jimenez J, Liao W-L, Cecchi F, Blackler A, Press MF, Gagnon R, Ellis C, Hembrough T, Johnston S, Prat A. Quantitative HER family proteins assessment as prognostic and predictive biomarkers in the EGF30008 clinical trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-08.
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Affiliation(s)
- P Nuciforo
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - S Thyparambil
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - P Galván
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - M Vilaro
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - J Jimenez
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - W-L Liao
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - F Cecchi
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - A Blackler
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - MF Press
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - R Gagnon
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - C Ellis
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - T Hembrough
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - S Johnston
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
| | - A Prat
- Vall D'Hebron Institute of Oncology, Barcelona, Spain; OncoPlex Diagnostics, Rockville, MD; NantOmics, Culver City, CA; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Novartis Oncology, East Hanover, NJ; GlaxoSmithKline Oncology, Collegeville, PA; Royal Marsden Hospital, London, United Kingdom; Hospital Clínic, Barcelona, Spain
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