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Khan I, Gril B, Paranjape AN, Robinson CM, Difilippantonio S, Biernat W, Bieńkowski M, Pęksa R, Duchnowska R, Jassem J, Brastianos PK, Metellus P, Bialecki E, Woodroofe CC, Wu H, Swenson RE, Steeg PS. Comparison of Three Transcytotic Pathways for Distribution to Brain Metastases of Breast Cancer. Mol Cancer Ther 2023; 22:646-658. [PMID: 36912773 PMCID: PMC10164055 DOI: 10.1158/1535-7163.mct-22-0815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/07/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
Advances in drug treatments for brain metastases of breast cancer have improved progression-free survival but new, more efficacious strategies are needed. Most chemotherapeutic drugs infiltrate brain metastases by moving between brain capillary endothelial cells, paracellular distribution, resulting in heterogeneous distribution, lower than that of systemic metastases. Herein, we tested three well-known transcytotic pathways through brain capillary endothelial cells as potential avenues for drug access: transferrin receptor (TfR) peptide, low-density lipoprotein receptor 1 (LRP1) peptide, albumin. Each was far-red labeled, injected into two hematogenous models of brain metastases, circulated for two different times, and their uptake quantified in metastases and uninvolved (nonmetastatic) brain. Surprisingly, all three pathways demonstrated distinct distribution patterns in vivo. Two were suboptimal: TfR distributed to uninvolved brain but poorly in metastases, while LRP1 was poorly distributed. Albumin distributed to virtually all metastases in both model systems, significantly greater than in uninvolved brain (P < 0.0001). Further experiments revealed that albumin entered both macrometastases and micrometastases, the targets of treatment and prevention translational strategies. Albumin uptake into brain metastases was not correlated with the uptake of a paracellular probe (biocytin). We identified a novel mechanism of albumin endocytosis through the endothelia of brain metastases consistent with clathrin-independent endocytosis (CIE), involving the neonatal Fc receptor, galectin-3, and glycosphingolipids. Components of the CIE process were found on metastatic endothelial cells in human craniotomies. The data suggest a reconsideration of albumin as a translational mechanism for improved drug delivery to brain metastases and possibly other central nervous system (CNS) cancers.In conclusion, drug therapy for brain metastasis needs improvement. We surveyed three transcytotic pathways as potential delivery systems in brain-tropic models and found that albumin has optimal properties. Albumin used a novel endocytic mechanism.
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Affiliation(s)
- Imran Khan
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Brunilde Gril
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Anurag N. Paranjape
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Christina M. Robinson
- Laboratory Animal Sciences Program, Frederick National Laboratory for Cancer Research (FNLCR), Frederick, MD
| | - Simone Difilippantonio
- Laboratory Animal Sciences Program, Frederick National Laboratory for Cancer Research (FNLCR), Frederick, MD
| | | | | | - Rafał Pęksa
- Department of Pathology, Medical University of Gdańsk, Poland
| | - Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Poland
| | - Priscilla K. Brastianos
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Philippe Metellus
- Ramsay Général de Santé, Hôpital Privé Clairval, Département de Neurochirurgie and Aix-Marseille Université, Institut de Neurophysiopathologie – UMR 7051, Marseille, France
| | - Emilie Bialecki
- Ramsay Général de Santé, Hôpital Privé Clairval, Département de Neurochirurgie and Aix-Marseille Université, Institut de Neurophysiopathologie – UMR 7051, Marseille, France
| | - Carolyn C. Woodroofe
- Chemistry and Synthesis Center, National Heart, Lung and Blood Institute, NIH, Bethesda, MD
| | - Haitao Wu
- Chemistry and Synthesis Center, National Heart, Lung and Blood Institute, NIH, Bethesda, MD
| | - Rolf E. Swenson
- Chemistry and Synthesis Center, National Heart, Lung and Blood Institute, NIH, Bethesda, MD
| | - Patricia S. Steeg
- Women’s Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
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Tomasik B, Bieńkowski M, Górska Z, Gutowska K, Kumięga P, Jassem J, Duchnowska R. Molecular aspects of brain metastases in breast cancer. Cancer Treat Rev 2023; 114:102521. [PMID: 36736124 DOI: 10.1016/j.ctrv.2023.102521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/29/2023]
Abstract
Brain metastases (BM) are a common and devastating manifestation of breast cancer (BC). BM are particularly frequent in the HER2-positive and triple-negative breast cancer phenotypes and usually occur following the metastatic spread to extracranial sites. Several genes mediating BM and biomarkers predicting their risk in BC have been reported in the past decade. These findings have advanced the understanding of BM pathobiology and paved the way for developing new therapeutic strategies but they still warrant a thorough clinical validation. Hence, a better understanding of the mechanistic aspects of BM and delineating the interactions of tumor cells with the brain microenvironment are of utmost importance. This review discusses the molecular basis of the metastatic cascade: the epithelial-mesenchymal transition, cancer, and tumor microenvironment interaction and intravasation, priming of the metastatic niche in the brain, and survival in the new site. We also outline the postulated mechanisms of BC cells' brain tropism. Finally, we discuss advances in the field of biomarkers (both tissue-based and liquid-based) that predict BM from BC.
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Affiliation(s)
- Bartłomiej Tomasik
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, 17 Smoluchowskiego St., 80-214 Gdansk, Poland.
| | - Michał Bieńkowski
- Department of Pathology, Medical University of Gdańsk, 17 Smoluchowskiego St., 80-214 Gdańsk, Poland.
| | - Zuzanna Górska
- Department of Oncology, Military Institute of Medicine, 128 Szaserów St., 04-141 Warsaw, Poland.
| | - Klaudia Gutowska
- Department of Internal Diseases and Endocrinology, Medical University of Warsaw, 02-091 Warsaw, Poland; Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland.
| | - Paulina Kumięga
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland.
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, 17 Smoluchowskiego St., 80-214 Gdansk, Poland.
| | - Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, 128 Szaserów St., 04-141 Warsaw, Poland.
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Lugowska I, Stanczak A, Roszkowski K, Dziadziuszko R, Duchnowska R, Kubiatowski T, Bodnar L, Szczylik C, Chorostowska Wynimko J, Popiel D, Skupinska M, Judycka A, Rudzki P, Pieczykolan J, Wieczorek M. 46O Preliminary results from a phase IA trial of selective FGFR1-3 inhibitor CPL304110 in patients with FGFR-deregulated advanced solid malignancies. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Gorczyński A, Miszewski K, Gager Y, Koch S, Pötschke J, Ugrinovski D, Gabert J, Pospieszyńska A, Wydra D, Duchnowska R, Szymanowski B, Cierniak S, Kruecken I, Neumann K, Mirkov K, Biernat W, Czapiewski P. Prognostic value of ALK overexpression and molecular abnormalities in high-grade serous ovarian carcinoma. Cancer Biomark 2023; 38:17-26. [PMID: 37522200 DOI: 10.3233/cbm-230117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND ALK receptor tyrosine kinase (ALK) aberrations have an established role in pathogenesis of many neoplasms, but their clinical significance in high grade serous ovarian carcinoma (HGSOC) is unclear. OBJECTIVE To analyse the frequency of ALK overexpression, molecular abnormalities of ALK, and their impact on the progression-free survival (PFS) and overall survival (OS) in HGSOC. METHODS Protein expression was examined by immunohistochemistry (IHC) using three different clones of anti-ALK antibody. The presence of translocations was analysed using fluorescent in situ hybridization. Next-generation sequencing was used for studying the copy number variation, as well as point mutation and translocations involving other commonly rearranged genes. RESULTS ALK overexpression was demonstrated in up to 52% of tumours, whereas ALK copy gains in 8.2%, with no clear impact on survival. ALK point mutations were identified in 13 tumours (8.9%), with 3 belonging to the class IV showing significantly better OS. A trend suggesting better PFS was also noticed in these cases. Additionally, three gene fusions were found: ERBB2-GRB7, PRKCA-BRCA1 and SND1-BRAF, none of which has been previously described in HGSOC. CONCLUSIONS HGSOC harbouring activating ALK mutations might be associated with a better survival, while ALK overexpression and ALK amplification does not impact the prognosis.
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Affiliation(s)
- Adam Gorczyński
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
| | - Kevin Miszewski
- Department of Urology, Medical University of Gdansk, Gdansk, Poland
| | | | | | | | | | | | - Agata Pospieszyńska
- Department of Gynecology, Obstetrics and Neonatology, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Wydra
- Department of Gynecology, Obstetrics and Neonatology, Medical University of Gdansk, Gdansk, Poland
| | - Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, National Research Institute, Warsaw, Poland
| | - Bartosz Szymanowski
- Department of Oncology, Military Institute of Medicine, National Research Institute, Warsaw, Poland
| | - Szczepan Cierniak
- Department of Pathology, Military Institute of Medicine, National Research Institute, Warsaw, Warsaw, Poland
| | - Irene Kruecken
- PathoNext GmbH, Leipzig, Germany
- Institute of Pathology, University of Leipzig, Leipzig, Germany
| | - Karsten Neumann
- Institute of Pathology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Katarina Mirkov
- Institute of Pathology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
| | - Piotr Czapiewski
- Institute of Pathology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane, Dessau, Germany
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Duchnowska R, Supernat AM, Pęksa R, Łukasiewicz M, Stokowy T, Ronen R, Dutkowski J, Umińska M, Iżycka-Świeszewska E, Kowalczyk A, Och W, Rucińska M, Olszewski WP, Mandat T, Jarosz B, Bieńkowski M, Biernat W, Jassem J. Pathway-level mutation analysis in primary high-grade serous ovarian cancer and matched brain metastases. Sci Rep 2022; 12:20537. [PMID: 36446793 PMCID: PMC9708673 DOI: 10.1038/s41598-022-23788-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/04/2022] [Indexed: 11/30/2022] Open
Abstract
Brain metastases (BMs) in ovarian cancer (OC) are a rare event. BMs occur most frequently in high-grade serous (HGS) OC. The molecular features of BMs in HGSOC are poorly understood. We performed a whole-exome sequencing analysis of ten matched pairs of formalin-fixed paraffin-embedded samples from primary HGSOC and corresponding BMs. Enrichment significance (p value; false discovery rate) was computed using the Reactome, the Kyoto Encyclopedia of Genes and Genomes pathway collections, and the Gene Ontology Biological Processes. Germline DNA damage repair variants were found in seven cases (70%) and involved the BRCA1, BRCA2, ATM, RAD50, ERCC4, RPA1, MLHI, and ATR genes. Somatic mutations of TP53 were found in nine cases (90%) and were the only stable mutations between the primary tumor and BMs. Disturbed pathways in BMs versus primary HGSOC constituted a complex network and included the cell cycle, the degradation of the extracellular matrix, cell junction organization, nucleotide metabolism, lipid metabolism, the immune system, G-protein-coupled receptors, intracellular vesicular transport, and reaction to chemical stimuli (Golgi vesicle transport and olfactory signaling). Pathway analysis approaches allow for a more intuitive interpretation of the data as compared to considering single-gene aberrations and provide an opportunity to identify clinically informative alterations in HGSOC BM.
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Affiliation(s)
- Renata Duchnowska
- grid.415641.30000 0004 0620 0839Oncology Department, Military Institute of Medicine - National Research Institute, Szaserów St. 128, 04-141 Warsaw, Poland
| | - Anna Maria Supernat
- grid.11451.300000 0001 0531 3426Laboratory of Translational Oncology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | - Rafał Pęksa
- grid.11451.300000 0001 0531 3426Department of Pathology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marta Łukasiewicz
- grid.11451.300000 0001 0531 3426Laboratory of Translational Oncology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Stokowy
- grid.7914.b0000 0004 1936 7443Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | | | | | - Ewa Iżycka-Świeszewska
- grid.11451.300000 0001 0531 3426Department of Pathology and Neuropathology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kowalczyk
- grid.11451.300000 0001 0531 3426Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Waldemar Och
- Neurosurgery Department, Regional Specialist Hospital, Olsztyn, Poland
| | - Monika Rucińska
- grid.412607.60000 0001 2149 6795Department of Oncology, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Wojciech P. Olszewski
- grid.418165.f0000 0004 0540 2543Department of Pathology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Tomasz Mandat
- grid.418165.f0000 0004 0540 2543Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Bożena Jarosz
- grid.411484.c0000 0001 1033 7158Department of Neurosurgery and Paediatric Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Michał Bieńkowski
- grid.11451.300000 0001 0531 3426Department of Pathology, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Biernat
- grid.11451.300000 0001 0531 3426Department of Pathology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jacek Jassem
- grid.11451.300000 0001 0531 3426Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Radecka B, Czech J, Siedlaczek A, Maczkiewicz M, Jagiełło-Gruszfeld A, Duchnowska R. Chemotherapy compliance in elderly patients with solid tumors: a real-world clinical practice data. Oncol Clin Pract 2022. [DOI: 10.5603/ocp.2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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7
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Kaźmierczak-Siedlecka K, Skonieczna-Żydecka K, Hupp T, Duchnowska R, Marek-Trzonkowska N, Połom K. Next-generation probiotics - do they open new therapeutic strategies for cancer patients? Gut Microbes 2022; 14:2035659. [PMID: 35167406 PMCID: PMC8855854 DOI: 10.1080/19490976.2022.2035659] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Gut microbiota and its association with cancer development/treatment has been intensively studied during the past several years. Currently, there is a growing interest toward next-generation probiotics (NGPs) as therapeutic agents that alter gut microbiota and impact on cancer development. In the present review we focus on three emerging NGPs, namely Faecalibacterium prausnitzii, Akkermansia muciniphila, and Bacteroides fragilis as their presence in the digestive tract can have an impact on cancer incidence. These NGPs enhance gastrointestinal immunity, maintain intestinal barrier integrity, produce beneficial metabolites, act against pathogens, improve immunotherapy efficacy, and reduce complications associated with chemotherapy and radiotherapy. Notably, the use of NGPs in cancer patients does not have a long history and, although their safety remains relatively undefined, recently published data has shown that they are non-toxigenic. Notwithstanding, A. muciniphila may promote colitis whereas enterotoxigenic B. fragilis stimulates chronic inflammation and participates in colorectal carcinogenesis. Nevertheless, the majority of B. fragilis strains provide a beneficial effect to the host, are non-toxigenic and considered as the best current NGP candidate. Overall, emerging studies indicate a beneficial role of these NGPs in the prevention of carcinogenesis and open new promising therapeutic options for cancer patients.
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Affiliation(s)
- Karolina Kaźmierczak-Siedlecka
- Department of Surgical Oncology, Medical University of Gdansk, Gdańsk, Poland,CONTACT Karolina Kaźmierczak-Siedlecka Department of Surgical Oncology, Medical University of Gdansk, Ul. Smoluchowskiego 18, 80-214Gdańsk, Poland
| | | | - Theodore Hupp
- International Centre for Cancer Vaccine Science, University of Gdansk, Gdansk, Poland,Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland, UK
| | - Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | - Natalia Marek-Trzonkowska
- International Centre for Cancer Vaccine Science University of Gdańsk, Gdańsk, Poland,Laboratory of Immunoregulation and Cellular Therapies, Department of Family Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Karol Połom
- Department of Surgical Oncology, Medical University of Gdansk, Gdańsk, Poland
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Duchnowska R, Saad ED, Banaszek M, Pawłowska E, Liberek H, Cichowska-Cwalińska N, Jassem J. Patient Eligibility and Results for Brain Metastasis in Phase 3 Trials of Advanced Breast Cancer: A Scoping Review. Cancers (Basel) 2021; 13:cancers13215306. [PMID: 34771468 PMCID: PMC8582366 DOI: 10.3390/cancers13215306] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 08/26/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Even though up to 20% of patients with cancer eventually develop brain metastases (BM), most clinical trials have historically forbidden the enrolment of individuals with BM. The reasons for this practice include considerations regarding safety and efficacy, but there is a pressing need to verify whether new treatments also work for patients with BM. In this article, we assessed the literature on breast cancer and found that there has been an increase over time of trials allowing enrolment of breast cancer patients with BM, and that when the results for these patients were reported separately, they tended to go in the same direction as those observed for all patients. Our results suggest that further efforts are needed to increase the assessment of new treatments for patients with BM. Abstract Background: Although brain metastases (BM) affect 5% of all breast cancer patients and 14% of those with metastatic disease, patients with BM are often excluded from participation in clinical trials. We conducted a structured assessment of the contemporary restrictions to enrolment of, and results for, patients with BM in phase 3 trials published over a period of 23 years in advanced breast cancer. Methods: We used PubMed to search for completed randomized trials published between 01/98 and 12/20. For all eligible trials, two authors independently abstracted data on general characteristics of the studies and detailed information on patient eligibility regarding the presence of BM. Results: We analyzed 210 trials, which enrolled 92,409 eligible patients. Of that total, 162 (77.1%) publications explicitly mentioned eligibility criteria related to the presence of BM and 75 (35.7%) trials reportedly allowed patients with BM, usually with restrictions related to prior brain treatment or stability of lesions. There was a significant increase over time in the percentages of trials allowing patients with BM (p < 0.001), and these trials were more frequently dedicated to HER2-positive or triple-negative disease (p = 0.001). Only 11 trials reported separate results for patients with BM at baseline. The direct treatment activity on BM was usually not reported, although in subgroup analyses the treatment effect in relative terms was usually better among patients with BM than in overall populations. Conclusion: Nearly 36% of phase 3 trials in advanced breast cancer over a 23-year period allowed patients with BM, and this practice is increasing over time. More research is needed to establish the activity of current and promising therapies in patients with BM.
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Affiliation(s)
- Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, Szaserów St128, 04-141 Warsaw, Poland
- Correspondence: (R.D.); (E.D.S.); Tel.: +48-261-817-235 (R.D.)
| | - Everardo D. Saad
- Dendrix Research, Sao Paulo 04508-011, Brazil
- Correspondence: (R.D.); (E.D.S.); Tel.: +48-261-817-235 (R.D.)
| | - Małgorzata Banaszek
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, 80-214 Gdańsk, Poland; (M.B.); (E.P.); (H.L.); (N.C.-C.); (J.J.)
| | - Ewa Pawłowska
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, 80-214 Gdańsk, Poland; (M.B.); (E.P.); (H.L.); (N.C.-C.); (J.J.)
| | - Hanna Liberek
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, 80-214 Gdańsk, Poland; (M.B.); (E.P.); (H.L.); (N.C.-C.); (J.J.)
| | - Natalia Cichowska-Cwalińska
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, 80-214 Gdańsk, Poland; (M.B.); (E.P.); (H.L.); (N.C.-C.); (J.J.)
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, 80-214 Gdańsk, Poland; (M.B.); (E.P.); (H.L.); (N.C.-C.); (J.J.)
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Żok J, Bieńkowski M, Radecka B, Korniluk J, Adamowicz K, Duchnowska R. Impact of relative dose intensity of oxaliplatin in adjuvant therapy among stage III colon cancer patients on early recurrence: a retrospective cohort study. BMC Cancer 2021; 21:529. [PMID: 33971834 PMCID: PMC8112028 DOI: 10.1186/s12885-021-08183-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 06/14/2020] [Accepted: 04/13/2021] [Indexed: 02/04/2023] Open
Abstract
Background Oxaliplatin-based therapy with FOLFOX-4 or CAPOX administered over 6 months remains the standard adjuvant treatment for stage III colon cancer (CC) patients. However, many patients experience dose reduction or early termination of chemotherapy due to oxaliplatin toxicity, which may increase the risk of early recurrence. The objective of this study was to analyze the relationship between the relative dose intensity of oxaliplatin (RDI-O) and early recurrence among stage III CC patients. Methods The study included 365 patients treated at five oncology centers in Poland between 2000 and 2014. Survival analysis was performed using the Kaplan-Meier method. Univariate analysis was performed using the Cox proportional hazard model; multivariate analysis was performed with the stepwise forward approach. For all analyses the α level of 0.05 was employed. Results The median follow-up was 51.8 months (range 8.2–115.1). Early recurrence < 36 months after surgery occurred in 130 patients (37.8%). In this group 51 (39.2%) and 87 (66.9%) of patients were low and high-risk, respectively. Receipt < 60% of RDI-O was associated with early recurrence within 18 months after surgery (OR = 2.05; 95%CI: 1.18–3.51; p = 0.010), especially in low-risk group (HR = 1.56 (95%CI: 0.96–2.53), p = 0.07). In the multivariate analysis early recurrence was correlated with grade (OR = 2.47; 95% CI: 1.25–4.8; p = 0.008), pN (OR = 2.63; 95% CI: 1.55–4.54; p < 0.001), the number of lymph nodes harvested (OR = 0.51; 95% CI: 0.29–0.86; p = 0.013) and RDI-O (OR = 1.91; 95%CI: 1.06–3.39; p = 0.028). The early vs. late recurrence negatively correlated with OS regardless of the RDI-O (HR = 22.9 (95%CI: 13.9–37.6; p < 0.001). Conclusions RDI-O < 60% in adjuvant therapy among stage III CC (especially in low-risk group) increases the risk of early recurrence within 18 months of surgery. Patients with early recurrence showed worse overall survival regardless of the RDI-O.
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Affiliation(s)
- Jolanta Żok
- Department of Chemotherapy, Center of Pulmonology and Chemotherapy, 58-580, Szklarska Poręba, Poland
| | - Michał Bieńkowski
- Department of Pathomorphology, Medical University of Gdańsk, 80-214, Gdańsk, Poland
| | - Barbara Radecka
- Department of Oncology, Institute of Medical Science, University of Opole, 46-020, Opole, Poland
| | - Jan Korniluk
- Department of Oncology, Military Institute of Medicine, 04-141, Warsaw, Poland
| | | | - Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, 04-141, Warsaw, Poland.
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10
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Pęksa R, Kunc M, Popęda M, Piątek M, Bieńkowski M, Żok J, Starzyńska A, Perdyan A, Sowa M, Duchnowska R, Biernat W. Combined Assessment of Immune Checkpoint Regulator VISTA on Tumor-Associated Immune Cells and Platelet-to-Lymphocyte Ratio Identifies Advanced Germ Cell Tumors with Higher Risk of Unfavorable Outcomes. Cancers (Basel) 2021; 13:cancers13081750. [PMID: 33916925 PMCID: PMC8067539 DOI: 10.3390/cancers13081750] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 01/28/2021] [Revised: 03/16/2021] [Accepted: 04/02/2021] [Indexed: 01/15/2023] Open
Abstract
Simple Summary Testicular germ cell tumors (GCTs) are the most common malignancies in young males. The current treatment regimens are usually highly effective and curative. Nevertheless, a portion of patients presents with recurrence or succumbs due to the disease. There is an undoubtful necessity to investigate new prognostic markers to stratify the risk of such events. The current study aimed to evaluate the prognostic significance of markers of the tumor microenvironment and systemic inflammation markers in GCTs. We found that low expression of immune checkpoint proteins VISTA (V-domain Ig suppressor of T cell activation) and PD-L1 (programmed death-ligand 1) on tumor-associated immune cells and elevated inflammatory marker platelet-to-lymphocyte ratio are associated with a higher risk of events in testicular GCTs. It indicates a role of both local anti-tumor immune response and systemic inflammation in these tumors. Abstract In the current study, we aimed to investigate whether expression of immune checkpoint proteins (V-domain Ig suppressor of T cell activation (VISTA) and programmed death-ligand 1 (PD-L1)) and markers of systemic inflammation could predict progression/relapse and death in the cohort of 180 patients with testicular germ-cell tumors (GCTs). Expression of PD-L1 and VISTA was assessed by immunohistochemistry utilizing tissue microarrays. To estimate systemic inflammation neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) were calculated. We found high PD-L1 and VISTA expression on tumor-associated immune cells (TAICs) in 89 (49.44%) and 63 (37.22%) of GCTs, respectively, whereas tumor cells besides trophoblastic elements were almost uniformly negative. High PD-L1 was associated with seminomatous histology and lower stage. Relapses in stage I patients occurred predominantly in cases with low numbers of PD-L1 and VISTA-expressing TAICs. In stage II/III disease, the combination of low VISTA-expressing TAICs and high PLR was identified as predictor of shorter event-free survival (HR 4.10; 1.48–11.36, p = 0.006) and overall survival (HR 15.56, 95% CI 1.78–135.51, p = 0.001) independently of tumor histology and location of metastases. We demonstrated that the assessment of immune checkpoint proteins on TAICs may serve as a valuable prognostic factor in patients with high-risk testicular GCTs. Further study is warranted to explore the predictive utility of these biomarkers in GCTs.
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Affiliation(s)
- Rafał Pęksa
- Department of Pathomorphology, Medical University of Gdansk, 80214 Gdansk, Poland; (M.K.); (M.B.); (W.B.)
- Correspondence: ; Tel.: +48-58-349-3750
| | - Michał Kunc
- Department of Pathomorphology, Medical University of Gdansk, 80214 Gdansk, Poland; (M.K.); (M.B.); (W.B.)
| | - Marta Popęda
- Laboratory of Translational Oncology, Intercollegiate Faculty of Biotechnology, Medical University of Gdansk, 80211 Gdansk, Poland;
| | - Michał Piątek
- Department of Clinical Oncology/Chemotherapy, St Barbara Regional Specialist Hospital No 5, 41200 Sosnowiec, Poland;
| | - Michał Bieńkowski
- Department of Pathomorphology, Medical University of Gdansk, 80214 Gdansk, Poland; (M.K.); (M.B.); (W.B.)
| | - Jolanta Żok
- Department of Oncology, Regional Oncology Center in Gdansk, 80219 Gdansk, Poland;
| | - Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdansk, 80211 Gdansk, Poland;
| | - Adrian Perdyan
- Student Scientific Circle of Pathomorphology, Medical University of Gdansk, 80214 Gdansk, Poland;
| | - Marek Sowa
- Department of Urology, Medical University of Gdansk, 80214 Gdansk, Poland;
| | - Renata Duchnowska
- Department of Oncology, Military Institute in Warsaw, 01755 Warsaw, Poland;
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, 80214 Gdansk, Poland; (M.K.); (M.B.); (W.B.)
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11
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Walczak K, Luczynska K, Kupryjanczyk J, Duchnowska R. Long-term response to hormone therapy in a young woman with aggressive pelvic angiomyxoma. Ginekol Pol 2021; 92:82-83. [PMID: 33448013 DOI: 10.5603/gp.a2020.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/22/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Klaudia Walczak
- Student Scientific Circle "Spero", Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | - Kamila Luczynska
- Student Scientific Circle "Spero", Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | | | - Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland, Warsaw, Poland.
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12
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Hryciuk B, Pęksa R, Bieńkowski M, Szymanowski B, Radecka B, Winnik K, Żok J, Cichowska N, Iliszko M, Duchnowska R. Expression of Female Sex Hormone Receptors, Connective Tissue Growth Factor and HER2 in Gallbladder Cancer. Sci Rep 2020; 10:1871. [PMID: 32024900 PMCID: PMC7002405 DOI: 10.1038/s41598-020-58777-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/27/2019] [Indexed: 01/14/2023] Open
Abstract
Gallbladder cancer (GBC) is a highly malignant tumor with poorly understood etiology. An insight into phenotypic features of this malignancy may add to the knowledge of its carcinogenesis and pave the way to new therapeutic approaches. We assessed the expression of female sex hormone receptors (ERα, ERβ, PR), connective tissue growth factor (CTGF) and HER2 in GBC, and adjacent normal tissue (NT), and determined their prognostic impact. Immunohistochemical (IHC) expression of all biomarkers was performed in formalin-fixed, paraffin-embedded specimens in 60 Caucasian GBC patients (51 women and 9 men). ERβ, cytoPR and CTGF expression were found in 89%, 27%, 91% of GBC, and in 63%, 87%, 100% of NT, respectively. No ERα expression was found in GBC and NT. Strong (3+) HER2 expression by IHC or HER2 amplification was seen in five GBC (10.4%). A positive correlation was found between HER2 and CTGF and ERβ expression in GBC and matched NT. In the multivariate analysis, patient age >70 years, tumor size and ERβ expression in GBC was highly predictive for OS (p = 0.003). The correlation between HER2, CTGF and ERβ expression in GBC and NT may indicate the interaction of these pathways in physiological processes and gallbladder pathology.
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Affiliation(s)
- Beata Hryciuk
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
- Mazovian Center for Lung Diseases and Tuberculosis, Division III in Otwock, Otwock, Poland
| | - Rafał Pęksa
- Pathology Department, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | - Barbara Radecka
- University of Opole, Institute of Medical Science, Opole, Poland
| | - Kamil Winnik
- Pathology Department Provincial Specialist Hospital, Słupsk, Poland
| | - Jolanta Żok
- Department of Chemotherapy, Center of Pulmonology and Chemotherapy, Szklarska Poręba, Poland
| | - Natalia Cichowska
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Mariola Iliszko
- Department of Biology and Medical Genetics, Medical University of Gdańsk, Gdańsk, Poland
| | - Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland.
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13
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Hryciuk B, Pęksa R, Bieńkowski M, Szymanowski B, Radecka B, Perdyan A, Winnik K, Zok J, Cichowska N, Iliszko M, Duchnowska R. Expression of female sex hormone receptors, connective tissue growth factor, and HER2 in gallbladder cancer and adjacent normal tissue. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Zok J, Radecka B, Adamowicz K, Korniluk J, Bieńkowski M, Duchnowska R. Multidisciplinary approach associated with improved overall survival in metastatic colorectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Duchnowska R, Supernat AM, Pęksa R, Łukasiewicz M, Stokowy T, Umińska M, Iżycka-Świeszewska E, Kowalczyk A, Och W, Rucinska M, Olszewski WP, Mandat T, Jarosz B, Bieńkowski M, Biernat W, Jassem J. Genomic characterization of brain metastases (BM) in high-grade serous ovarian cancer (HGSOC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13580 Background: BM are a rare occurrence in ovarian cancer (OC) and their molecular characteristics is virtually unknown. DNA damage repair (DDR) deficiency is prevalent in OC, and co-mutated TP53 and any DDR denotes high tumor mutation burden (TMB). We genetically characterized a unique series of high-grade serous ovarian cancer (HGSOC) patients who developed BM to identify alterations of potential clinical relevance. Methods: Whole-exome sequencing (2x150bp, SureSelectXT Library Prep Kit, Illumina’s NovaSeq platform) was performed in matched BM, primary tumors (PT) and normal tissue. DNA was extracted from FFPE samples using QIAamp DNA FFPE Tissue Kit (Qiagen, Germany). All mutations were checked with Catalogue of Somatic Mutations in Cancer (COSMIC) and Integrative Genomics Viewer (IGV). Results: Study group included 10 HGSOC patients (International Federation of Gynecology and Obstetrics classification (FIGO) II-IV, mean age at diagnosis 48 years, range 35-59). Median time from primary HGSOC diagnosis to BM was 38 months (range, 18 to 149). TP53 somatic mutations were found in both primary tumor (PT) and BM in 8 patients. The other 2 cases harbored TP53 mutations not reported in COSMIC catalogue: p.S60L and intronic TP53 mutation preceding p.I322 (IGV). In 9 cases TP53 mutations coexisted with germline or somatic DNA damage repair deficiency. Four cases contained BRCA1 mutations (all germline), and none harbored germline BRCA2 mutation. Other mutated genes included MLH1 (2 somatic, 2 germline), ATR (4 germline, 1 somatic), AMT (1 somatic), RAD50 (1 somatic), ERCC4 (1 somatic), FANCD2 (1 somatic) and RPA1 (1 germline). Three mutation signatures defined in the COSMIC database were indentified in BM: 6, 20 and 30. In 6 cases these mutations were shared in PT, and in another 4 their presence in PT could not be determined due to technical reasons. Median survival from BM was 31 months (range, 5 to 184). Conclusions: Genomic analysis of BM provides an opportunity to identify potentially clinically informative alterations. Mutational profiles in PT are generally reflected in BM. Detected genetic alterations suggest their potential sensitivity to PARP inhibitors and immunotherapy.
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Affiliation(s)
| | | | - Rafał Pęksa
- Department of Pathology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marta Łukasiewicz
- Laboratory of Cell Biology, Intercollegiate Faculty of Biotechnology, University of Gdańsk, Gdańsk, Poland
| | - Tomasz Stokowy
- Computational Biology Unit, Institute of Informatics, University of Bergen, Bergen, Norway
| | - Monika Umińska
- Oncology Unit, Copernicus Hospital Gdańsk, Gdańsk, Poland
| | - Ewa Iżycka-Świeszewska
- Department of Pathology and Neuropathology Medical University of Gdańsk; Department of Pathomorphology, Copernicus Hospitals, Gdańsk, Poland
| | - Anna Kowalczyk
- Medical University of Gdańsk, Oncology and Radiotherapy, Gdańsk, Poland
| | | | - Monika Rucinska
- Department of Oncology Collegium Medicum School of Medicine Univeristy of Warmia and Mazury, Olsztyn, Poland
| | - Wojciech P Olszewski
- Department of Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | | | | | - Wojciech Biernat
- Medical University of Gdańsk, Department of Pathology, Gdańsk, Poland
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Hryciuk B, Szymanowski B, Bieńkowski M, Perdyan A, Korwat A, Winnik K, Radecka B, Żok J, Cichowska N, Sosińska-Mielcarek K, Pęksa R, Duchnowska R. Consistency in biomarkers expression between matched tissue microarray cores from primary gallblader and ovarian cancers. Oncol Clin Pract 2019. [DOI: 10.5603/ocp.2019.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Krawczyk P, Duchnowska R, Nicoś M, Kowalski D, Wojas-Krawczyk K. Preventing central nervous system metastases in non-small cell lung cancer. Expert Rev Anticancer Ther 2018; 18:1077-1083. [PMID: 30198357 DOI: 10.1080/14737140.2018.1521273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION There are no effective central nervous system (CNS) metastases prevention methods in lung cancer patients. Prophylactic cranial irradiation has a limited effectiveness and relatively high toxicity. Systemic chemotherapy is not relevant in reducing the risk of CNS in lung cancer patients. The understanding of molecular background of brain metastases in non-small cell lung cancer (NSCLC) patients could contribute to the development of personalized treatments for such patients. Areas covered: This article summarizes the latest clinical trials concerning the use of radiotherapy, chemotherapy, molecularly targeted therapies, and immunotherapy in lung cancer patients, with particular consideration of brain lung cancer metastasis prevention. The literature search was undertaken via PubMed and EMBASE searches and relevant articles are included in this review. Expert commentary: The recent data supports that EGFR-TKIs and ALK inhibitors are clinically relevant for first-line treatment to prevent and treat CNS metastases in molecularly selected NSCLC patients. In the future, high hopes for the prevention of CNS metastases in NSCLC patients are associated with immunotherapy concerning immune check-points inhibitors.
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Affiliation(s)
- Paweł Krawczyk
- a Department of Pneumonology , Oncology and Allergology, Medical University of Lublin , Lublin , Poland
| | - Renata Duchnowska
- b Department of Oncology , Military Institute in Warsaw , Warszawa , Poland
| | - Marcin Nicoś
- a Department of Pneumonology , Oncology and Allergology, Medical University of Lublin , Lublin , Poland
| | - Dariusz Kowalski
- c Department of Lung and Chest Tumors , Oncology Centre - Institute in Warsaw , Warszawa , Poland
| | - Kamila Wojas-Krawczyk
- a Department of Pneumonology , Oncology and Allergology, Medical University of Lublin , Lublin , Poland
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18
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Wu NC, Wong W, Ho KE, Chu VC, Rizo A, Davenport S, Kelly D, Makar R, Jassem J, Duchnowska R, Biernat W, Radecka B, Fujita T, Klein JL, Stonecypher M, Ohta S, Juhl H, Weidler JM, Bates M, Press MF. Comparison of central laboratory assessments of ER, PR, HER2, and Ki67 by IHC/FISH and the corresponding mRNAs (ESR1, PGR, ERBB2, and MKi67) by RT-qPCR on an automated, broadly deployed diagnostic platform. Breast Cancer Res Treat 2018; 172:327-338. [PMID: 30120700 PMCID: PMC6208911 DOI: 10.1007/s10549-018-4889-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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] [Received: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 01/08/2023]
Abstract
Purpose The methods (IHC/FISH) typically used to assess ER, PR, HER2, and Ki67 in FFPE specimens from breast cancer patients are difficult to set up, perform, and standardize for use in low and middle-income countries. Use of an automated diagnostic platform (GeneXpert®) and assay (Xpert® Breast Cancer STRAT4) that employs RT-qPCR to quantitate ESR1, PGR, ERBB2, and MKi67 mRNAs from formalin-fixed, paraffin-embedded (FFPE) tissues facilitates analyses in less than 3 h. This study compares breast cancer biomarker analyses using an RT-qPCR-based platform with analyses using standard IHC and FISH for assessment of the same biomarkers. Methods FFPE tissue sections from 523 patients were sent to a College of American Pathologists-certified central reference laboratory to evaluate concordance between IHC/FISH and STRAT4 using the laboratory’s standard of care methods. A subset of 155 FFPE specimens was tested for concordance with STRAT4 using different IHC antibodies and scoring methods. Results Concordance between STRAT4 and IHC was 97.8% for ESR1, 90.4% for PGR, 93.3% for ERBB2 (IHC/FISH for HER2), and 78.6% for MKi67. Receiver operating characteristic curve (ROC) area under the curve (AUC) values of 0.99, 0.95, 0.99, and 0.85 were generated for ESR1, PGR, ERBB2, and MKi67, respectively. Minor variabilities were observed depending on the IHC antibody comparator used. Conclusion Evaluation of breast cancer biomarker status by STRAT4 was highly concordant with central IHC/FISH in this blinded, retrospectively analyzed collection of samples. STRAT4 may provide a means to cost-effectively generate standardized diagnostic results for breast cancer patients in low- and middle-income countries. Electronic supplementary material The online version of this article (10.1007/s10549-018-4889-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natalie C Wu
- Division of Oncology Research and Development, Cepheid, Sunnyvale, CA, USA
| | - Wendy Wong
- Division of Oncology Research and Development, Cepheid, Sunnyvale, CA, USA
| | - Kenneth E Ho
- Division of Oncology Research and Development, Cepheid, Sunnyvale, CA, USA
| | - Victor C Chu
- Division of Oncology Research and Development, Cepheid, Sunnyvale, CA, USA
| | - Annaliza Rizo
- Division of Oncology Research and Development, Cepheid, Sunnyvale, CA, USA
| | - Simon Davenport
- Department of Pathology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, STE. 5409, Los Angeles, CA, 90033-0800, USA
| | - Devon Kelly
- Oregon Health and Science University/Knight Cancer Institute, Portland, OR, USA
| | - Rosemary Makar
- Oregon Health and Science University/Knight Cancer Institute, Portland, OR, USA
| | | | | | | | | | - Tomoyuki Fujita
- Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan
| | | | | | - Shoichiro Ohta
- Department of Human Life Science, School of Nursing, Josai University, Sakado, Japan
| | | | - Jodi M Weidler
- Medical and Scientific Affairs and Strategy, Oncology, Cepheid, Sunnyvale, CA, USA
| | - Michael Bates
- Medical and Scientific Affairs and Strategy, Oncology, Cepheid, Sunnyvale, CA, USA
| | - Michael F Press
- Department of Pathology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, STE. 5409, Los Angeles, CA, 90033-0800, USA.
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Gril B, Paranjape AN, Woditschka S, Hua E, Dolan EL, Hanson J, Wu X, Kloc W, Izycka-Swieszewska E, Duchnowska R, Pęksa R, Biernat W, Jassem J, Nayyar N, Brastianos PK, Hall OM, Peer CJ, Figg WD, Pauly GT, Robinson C, Difilippantonio S, Bialecki E, Metellus P, Schneider JP, Steeg PS. Reactive astrocytic S1P3 signaling modulates the blood-tumor barrier in brain metastases. Nat Commun 2018; 9:2705. [PMID: 30006619 PMCID: PMC6045677 DOI: 10.1038/s41467-018-05030-w] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/07/2018] [Indexed: 02/08/2023] Open
Abstract
Brain metastases are devastating complications of cancer. The blood-brain barrier (BBB), which protects the normal brain, morphs into an inadequately characterized blood-tumor barrier (BTB) when brain metastases form, and is surrounded by a neuroinflammatory response. These structures contribute to poor therapeutic efficacy by limiting drug uptake. Here, we report that experimental breast cancer brain metastases of low- and high permeability to a dextran dye exhibit distinct microenvironmental gene expression patterns. Astrocytic sphingosine-1 phosphate receptor 3 (S1P3) is upregulated in the neuroinflammatory response of the highly permeable lesions, and is expressed in patients' brain metastases. S1P3 inhibition functionally tightens the BTB in vitro and in vivo. S1P3 mediates its effects on BTB permeability through astrocytic secretion of IL-6 and CCL2, which relaxes endothelial cell adhesion. Tumor cell overexpression of S1P3 mimics this pathway, enhancing IL-6 and CCL-2 production and elevating BTB permeability. In conclusion, neuroinflammatory astrocytic S1P3 modulates BTB permeability.
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Affiliation(s)
- Brunilde Gril
- Women's Malignancies Branch, CCR, NCI, Bethesda, 20892, MD, USA.
| | | | - Stephan Woditschka
- Women's Malignancies Branch, CCR, NCI, Bethesda, 20892, MD, USA
- Department of Biology and Marine Biology, University of North Carolina at Wilmington, 601 South College Road, Wilmington, NC, 28403, USA
| | - Emily Hua
- Women's Malignancies Branch, CCR, NCI, Bethesda, 20892, MD, USA
| | - Emma L Dolan
- Women's Malignancies Branch, CCR, NCI, Bethesda, 20892, MD, USA
| | - Jeffrey Hanson
- Laboratory of Pathology, CCR, NCI, Bethesda, 20892, MD, USA
| | - Xiaolin Wu
- Genomics Laboratory, Frederick National Laboratory for Cancer Research, Frederick, 21702, MD, USA
| | - Wojciech Kloc
- Department of Neurology & Neurosurgery, Varmia & Masuria University, Olsztyn, 10-719, Poland
- Department of Neurosurgery, Copernicus Hospital Gdańsk, Gdańsk, 80-803, Poland
| | - Ewa Izycka-Swieszewska
- Department of Pathology & Neuropathology, Medical University of Gdańsk, Gdańsk, 80-210, Poland
- Department of Pathomorphology, Copernicus Hospital Gdańsk, Gdańsk, 80-803, Poland
| | - Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, Warsaw, 04-141, Poland
| | - Rafał Pęksa
- Department of Pathology, Medical University of Gdańsk, 7 Dębinki St, 80-211, Gdańsk, Poland
| | - Wojciech Biernat
- Department of Pathology, Medical University of Gdańsk, 7 Dębinki St, 80-211, Gdańsk, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, 80-211, Poland
| | - Naema Nayyar
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, 02114, MA, USA
| | - Priscilla K Brastianos
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, 02114, MA, USA
| | - O Morgan Hall
- Genitourinary Malignancies Branch, CCR, NCI, Bethesda, 20892, MD, USA
| | - Cody J Peer
- Genitourinary Malignancies Branch, CCR, NCI, Bethesda, 20892, MD, USA
| | - William D Figg
- Genitourinary Malignancies Branch, CCR, NCI, Bethesda, 20892, MD, USA
| | - Gary T Pauly
- Chemical Biology Laboratory, CCR, NCI, Frederick, 21702, MD, USA
| | - Christina Robinson
- Laboratory Animal Sciences Program, Frederick National Laboratory for Cancer Research, Frederick, 21702, MD, USA
| | - Simone Difilippantonio
- Laboratory Animal Sciences Program, Frederick National Laboratory for Cancer Research, Frederick, 21702, MD, USA
| | - Emilie Bialecki
- Département de Neurochirurgie, Hôpital Privé Clairval, Ramsay Général de Santé, Marseille, 13009, France
| | - Philippe Metellus
- Département de Neurochirurgie, Hôpital Privé Clairval, Ramsay Général de Santé, Marseille, 13009, France
- Institut de Neurophysiopathologie-UMR 7051, Aix-Marseille Université, Marseille, 13344, France
| | - Joel P Schneider
- Chemical Biology Laboratory, CCR, NCI, Frederick, 21702, MD, USA
| | - Patricia S Steeg
- Women's Malignancies Branch, CCR, NCI, Bethesda, 20892, MD, USA.
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Zok J, Radecka B, Adamowicz K, Korniluk JAN, Duchnowska R, Wysokinska EM. Cumulative dose of oxaliplatin in adjuvant therapy for stage III colon cancer patients: Impact on survival. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jolanta Zok
- Department of Oncology, Pomeranian Centre of Oncology, Marine Hospital in Gdynia, Gdynia, Poland
| | | | | | - JAN Korniluk
- Oncology Department Military Institute of Medicine, Warsaw, Poland
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Duchnowska R, Loibl S, Jassem J. Tyrosine kinase inhibitors for brain metastases in HER2-positive breast cancer. Cancer Treat Rev 2018; 67:71-77. [PMID: 29772459 DOI: 10.1016/j.ctrv.2018.05.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 01/11/2023]
Abstract
Approximately 30-50% of advanced HER2-positive breast cancer patients will develop central nervous system (CNS) metastases, with an annual risk of around 10%, and a half of them will die from brain progression. An increased risk of brain metastases is also seen in patients with early HER2-positive breast cancer administered curative therapy. Brain metastases in HER2-positive breast cancer patients usually constitute the first site of recurrence. The administration of anti-HER2 monoclonal antibodies, trastuzumab and pertuzumab, considerably delays the onset of symptomatic brain disease: however, the limited penetration of these compounds into the CNS hinders their efficacy. The small-molecule tyrosine kinase inhibitors of epidermal growth factor receptors family have established activity in HER2-positive breast cancer in both advanced disease and neoadjuvant setting. Favorable physico-chemical properties of these compounds allow them for a more efficient penetration through the blood-brain barrier, and hold the promise for more effective prevention and treatment of brain metastases. In this article we review the role of currently available or investigational HER2 tyrosine kinase inhibitors: lapatinib, neratinib, afatinib and tucatinib in the treatment of brain metastases in HER2-positive breast cancer patients.
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Affiliation(s)
- Renata Duchnowska
- Military Institute of Medicine, Department of Oncology, Warsaw, Poland.
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany; Sana-Klinikum Offenbach, Germany.
| | - Jacek Jassem
- Medical University of Gdańsk, Department of Oncology and Radiotherapy, Gdańsk, Poland.
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Steeg PS, Lyle TR, Paranjapee A, Lockman PR, Duchnowska R, Brastianos PK, Peer C, Figg WD, Pauly GT, Schneider JP, Smith QR, Gril B. Abstract P1-01-01: The blood-Tumor barrier as a therapeutic target to improve therapy of brain metastases of breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-01-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Objectives: Brain metastases of breast cancer demonstrate low and heterogeneous levels of permeability to drugs in mouse models and human craniotomies. The Blood-Brain Barrier (BBB), the protective lining of CNS blood vessels, impedes drug entry into the normal brain. When a metastasis forms, the BBB is locally altered to a poorly characterized Blood-Tumor Barrier (BTB). Quantitative experimental models indicate that most brain metastases have increased permeability over the normal BBB, but BTB permeability is both heterogeneous and ˜2 logs less than that of systemic metastases. We have interrogated three hematogenous models of brain metastasis of breast cancer to ask (1) whether the BTB is an ordered structure or a random breakdown of the BBB; (2) among brain metastases, whether consistent differences underlie the BTBs of lesions with low- and high permeabilities to fluorescent markers and drugs; (3) if alterations in BTB composition can functionally change its permeability. Our long term goal is to enhance uptake of drugs into brain metastases to effective levels.
Results: When uninvolved brain was compared with any brain metastasis, alterations in endothelial, pericytic, astrocytic, and microglial components of the BBB were observed. Both the pericyte and astrocyte components of the BTB were consistently altered with increased permeability: When metastases with relatively low and high permeability were compared, increased expression of a desmin+ subpopulation of pericytes was associated with higher permeability (231-BR6 P=0.0002; JIMT-1-BR3 P = 0.004; SUM190-BR3 P=0.008). A trend toward reduced CD13+ pericytes was observed in highly permeable metastases (231-BR6 P =0.014; JIMT-1-BR3 P =0.002, SUM190-BR3, NS). For GFAP+ astrocytes in the neuroinflammatory response surrounding metastases, no overall difference in cell number was observed between low and high permeability lesions. However, gene expression profiling of laser capture microdissected low and high permeabililty lesions demonstrated overexpression of the sphingosine-1 phosphate receptor 3 (S1P3) in the astrocytes of highly permeable lesions, which was confirmed at the protein expression level in all three models (231-BR6 P=0.034; JIMT-1-BR3 P = 0.01; SUM190-BR3 P=0.016). Inhibition of S1P3 via S1PR3 shRNA or a selective antagonist (TY-52156) functionally tightened the BTB in an in vitro model. Administration of TY-52156 to mice harboring 231-BR6 brain metastases had no effect on metastasis number, but decreased uptake of Texas Red Dextran dye into metastases (P=0.016). S1P3 mediated its effects on BTB permeability through astrocytic secretion of IL-6 and CCL2, which altered endothelial expression and localization of adhesive proteins, a potentially translatable pathway. Both desmin+ pericytes and S1P3+ astrocytes are present in human craniotomy specimens.
Conclusions: These experiments demonstrate that the BTB is a structure with consistent properties, and that further consistent changes underlie the transition from a low to high permeability BTB. While proof of principle, S1P3 inhibition studies indicate that the BTB permeability can be functionally modulated in vivo.
Citation Format: Steeg PS, Lyle TR, Paranjapee A, Lockman PR, Duchnowska R, Brastianos PK, Peer C, Figg WD, Pauly GT, Schneider JP, Smith QR, Gril B. The blood-Tumor barrier as a therapeutic target to improve therapy of brain metastases of breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-01-01.
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Affiliation(s)
- PS Steeg
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
| | - TR Lyle
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
| | - A Paranjapee
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
| | - PR Lockman
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
| | - R Duchnowska
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
| | - PK Brastianos
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
| | - C Peer
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
| | - WD Figg
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
| | - GT Pauly
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
| | - JP Schneider
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
| | - QR Smith
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
| | - B Gril
- Women's Malignancies Branch, CCR, NCI, Bethesda, MD; Purdue University College of Veterinary Medicine, West Layfayette, IN; West Virginia University Cancer Institute, Morgantown, WV; Military Institute of Warsaw, Warsaw, Poland; Massachusetts General Hospital Cancer Center, Boston, MA; Genitourinary Malignancies Branch, CCR, NCI, Bethesda, MD; Chemical Biology Laboratory, CCR, NCI, Frederick, MD
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Duchnowska R, Sperinde J, Czartoryska-Arłukowicz B, Myśliwiec P, Winslow J, Radecka B, Petropoulos C, Demlova R, Orlikowska M, Kowalczyk A, Lang I, Ziółkowska B, Dębska-Szmich S, Merdalska M, Grela-Wojewoda A, Żawrocki A, Biernat W, Huang W, Jassem J. Predictive value of quantitative HER2, HER3 and p95HER2 levels in HER2-positive advanced breast cancer patients treated with lapatinib following progression on trastuzumab. Oncotarget 2017; 8:104149-104159. [PMID: 29262628 PMCID: PMC5732794 DOI: 10.18632/oncotarget.22027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Received: 08/13/2017] [Accepted: 09/21/2017] [Indexed: 12/27/2022] Open
Abstract
Lapatinib is a HER1 and HER2 tyrosine kinase inhibitor (TKI) approved in second line treatment of advanced or metastatic breast cancer following progression on trastuzumab-containing therapy. Biomarkers for activity of lapatinib and other TKIs are lacking. Formalin-fixed, paraffin-embedded primary tumor samples were obtained from 189 HER2-positive patients treated with lapatinib plus capecitabine following progression on trastuzumab. The HERmark® Breast Cancer Assay was used to quantify HER2 protein expression. HER3 and p95HER2 protein expression was quantified using the VeraTag® technology. Overall survival (OS) was inversely correlated with HER2 (HR = 1.9/log; P = 0.009) for patients with tumors above the cut-off positivity level by the HERmark assay. OS was significantly shorter for those with above median HER2 levels (HR = 1.7; P = 0.015) and trended shorter for those below the cut-off level of positivity by the HERmark assay (HR = 1.7; P = 0.057) compared to cases with moderate HER2 overexpression. The relationship between HER2 protein expression and OS was best captured with a U-shaped parabolic function (P = 0.004), with the best prognosis at moderate levels of HER2 protein overexpression. In a multivariate model including HER2, increasing p95HER2 expression was associated with longer OS (HR = 0.35/log; P = 0.027). Continuous HER3 did not significantly correlate with OS. Patients with moderately overexpressed HER2 levels and high p95HER2 expression may have best outcomes while receiving lapatinib following progression on trastuzumab. Further study is warranted to explore the predictive utility of quantitative HER2 and p95HER2 in guiding HER2-directed therapies.
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Affiliation(s)
| | - Jeff Sperinde
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
| | | | | | - John Winslow
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
| | | | - Christos Petropoulos
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
| | | | | | | | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | | | | | | | | | | | | | - Weidong Huang
- Monogram Biosciences, Integrated Oncology, Laboratory Corporation of America Holdings, South San Francisco, CA, USA
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Hryciuk B, Szymanowski B, Romanowska A, Salt E, Wasąg B, Grala B, Jassem J, Duchnowska R. Severe acute toxicity following gemcitabine administration: A report of four cases with cytidine deaminase polymorphisms evaluation. Oncol Lett 2017; 15:1912-1916. [PMID: 29434889 DOI: 10.3892/ol.2017.7473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/06/2017] [Indexed: 01/17/2023] Open
Abstract
Gemcitabine (GCB) is a pyrimidine antimetabolite widely used in various solid tumors as a single agent or as a component of multidrug regimens. In the majority of patients, GCB is well tolerated, however life-threatening complications occasionally occur. The current report presents four cases of severe acute toxicity, which included two that were fatal, following administration of GCB alone or in combination with cisplatin. Of the four cases, in one, a Naranjo Adverse Drug Reaction Probability Score was definite, in two, probable and in one possible. To determine the potential causes of these toxicities, polymorphic variants of cytidine deaminase, the primary enzyme involved in the hepatic metabolism of GCB, were assessed. The homogeneous c.435TT variant was detected in one patient and a heterozygotic c.435CT variant in two, one of whom additionally harbored a heterozygotic c.79AC variant.
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Affiliation(s)
- Beata Hryciuk
- Department of Oncology, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Bartosz Szymanowski
- Department of Oncology, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Anna Romanowska
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Ewa Salt
- Department of Oncology, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Bartosz Wasąg
- Department of Biology and Genetics, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Bartłomiej Grala
- Department of Pathology, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, 04-141 Warsaw, Poland
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Gril B, Paranjape AN, Woditschka S, Hanson J, Wu X, Duchnowska R, Brastianos PK, Peer C, Figg WD, Pauly GT, Schneider JP, Steeg PS. SCDT-11. ASTROCYTIC S1P3 SIGNALING MODULATES BLOOD-TUMOR BARRIER PERMEABILITY IN BRAIN METASTASES. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gril B, Paranjape AN, Woditschka S, Hanson J, Wu X, Duchnowska R, Brastianos PK, Peer C, Figg WD, Pauly GT, Schneider JP, Steeg P. TMIC-19. ASTROCYTIC S1P3 SIGNALING MODULATES BLOOD-TUMOR BARRIER PERMEABILITY IN BRAIN METASTASES. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Paranjape AN, Gril B, Woditschka S, Hua E, Hanson JC, Wu X, Duchnowska R, Brastianos PK, Liewehr DL, Steinberg SM, Peer C, Figg WD, Pauly GT, Robinson C, Schneider JP, Steeg PS. Abstract 4330: Astrocytic S1P3 regulates blood-brain/tumor barrier permeability. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Introduction: Incidence of breast cancer brain metastasis is increasing owing to prolonged life-span and better detection techniques. Prognosis of patients with brain metastases is extremely poor with median survival time of one year. One of the major impediments in treating brain metastases is presence of blood-brain/tumor barrier that limits the permeability of chemotherapeutic drugs into the brain parenchyma. Understanding the mechanisms that regulate blood-brain/tumor barrier permeability in context of brain metastases is imperative to developing successful therapy.
Methods: Mouse models with brain-tropic sublines of MDA-MB-231 (231), JIMT-1, and SUM190 were used to generate breast cancer brain metastases. Using laser capture microscopy, the permeable and non-permeable lesions from mouse brains were isolated and profiled for gene expression using microarray. Immortalized human brain endothelial cells, astrocytes, and pericytes were used for developing in vitro blood-brain/tumor barrier model along with spheres generated with 231-BR6 or JIMT-1-BR3 cells. Secreted cytokines were evaluated using human cytokine profiler. Transendothelial electrical resistance (TEER) was measured using EVOM2 volt/ohm meter.
Results: Gene expression profiling and immunostaining of mouse brains, harboring breast cancer metastases showed that astrocytes at permeable regions express elevated S1P3. Pharmacological inhibition of S1P3 using antagonist TY-52156 (10mg/kg) in mice bearing 231-BR6 brain metastases showed reduction in 3KDa Texas red dextran (TRD) uptake. To investigate the role of S1P3 in regulating barrier permeability, we established in vitro blood-brain/tumor barrier models. Treatment of astrocytes with TY-52156 (2μM) significantly increased mean TEER values (33.9 to 55.8 Ω.cm2; p<0.001, after 24 hrs), while there was a decrease in permeability for TRD (1.9 fold; p<0.0001) and doxorubicin (1.3 folds; p<0.05). Immunostaining on endothelial monolayer showed increased membranous ZO-1 and VE-cadherin expression. The dynamics of increase in TEER was faster when 231-BR6 spheres were included. We observed similar results when S1P3 was knocked down using shRNA. Astrocytes with down-modulated S1P3 showed decreased secretion of various cytokines including IL-6, IL-8, CCL2, CXCL1, and GM-CSF. Inhibition of these cytokines individually using neutralizing antibodies recapitulated the effects of S1P3 inhibition, while treatment of endothelial monolayer with activated cytokines increased the permeability. This study provides a proof of concept for role of S1P3 and downstream cytokine signaling in regulating blood-brain/tumor barrier permeability in breast cancer brain metastases.
Conclusion: Our study shows that astrocytic S1P3 regulates blood-brain/tumor barrier permeability in breast cancer brain metastases by modulating cytokine secretion. This observation might lead to discovery of novel strategies for augmenting drug efficacy.
Citation Format: Anurag N. Paranjape, Brunilde Gril, Stephan Woditschka, Emily Hua, Jeffrey C. Hanson, Xiaolin Wu, Renata Duchnowska, Priscilla K. Brastianos, David L. Liewehr, Seth M. Steinberg, Cody Peer, William D. Figg, Gary T. Pauly, Christina Robinson, Joel P. Schneider, Patricia S. Steeg. Astrocytic S1P3 regulates blood-brain/tumor barrier permeability [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4330. doi:10.1158/1538-7445.AM2017-4330
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Affiliation(s)
| | | | | | - Emily Hua
- 1National Cancer Institute, Bethesda, MD
| | | | - Xiaolin Wu
- 3Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | | | | | | | - Cody Peer
- 1National Cancer Institute, Bethesda, MD
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Gril B, Lyle LT, Lockman PR, Adkins CE, Mohammad AS, Sechrest E, Hua E, Palmieri D, Liewehr DJ, Steinberg SM, Kloc W, Izycka-Swieszewska E, Duchnowska R, Naema N, Brastianos PK, Steeg PS. Abstract 4933: Desmin+pericyte subpopulations correlated with blood-tumor barrier permeability in brain metastases of breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Breast cancer brain metastases remain incurable. The blood-brain barrier (BBB) is a multicellular dynamic structure regulating exchanges between the blood and the central nervous system. As cancer cells colonize the brain, the BBB evolves into a blood-tumor barrier (BTB). The BTB limits compound penetration and therefore contributes to poor efficacy of chemotherapy. While the BBB has been well characterized in developmental and neurodegenerative disease studies, the BTB composition remains unknown.
We have characterized the BTB in three model systems of brain metastasis of breast cancer developed in the laboratory: a triple negative (231-BR6), and two HER2 overexpressing (SUM190-BR3, JIMT-1-BR3) subtypes. Using Texas Red dextran (TRD) as a marker of permeability and quantitative immunofluorescence staining, we analyzed the cellular and molecular composition of: 1) unaltered BBB vs. BTB, and 2) BTB in highly permeable metastases vs. BTB in poorly permeable metastases.
The BTB developed from the BBB in a series of alterations, including a neuroinflammatory reaction with astrogliosis, endothelial cell dilation, increased VEGF, reduced astrocyte endfoot polarity, and decrease in PDGFR+ pericytes. Only 10% of the metastatic lesions harbored a profound TRD exudation, which correlated with paclitaxel efficacy. We hypothesized that specific cellular and molecular changes account for the heterogeneity and increase in TRD diffusion. When metastases with relatively low- and high-TRD diffusion were compared, highly permeable metastases correlated with an increased expression of desmin+ pericytes in three models (231-BR6 p=0.0002; JIMT-1-BR3 p=0.004; SUM190-BR3 p=0.008) and a decrease in CD13+ pericytes in two model systems (231-BR6 p=0.014; JIMT-1-BR3 p=0.002). Decreased expression of laminin α2 in the parenchymal basement membrane (231-BR6 p=0.001; JIMT-1-BR3 p=0.049; SUM190-BR3 p=0.023) were associated with higher permeability. Desmin+ pericytes have been associated with pathological conditions such as fibrosis and spinal cord injury. Seven over nine human craniotomy specimens were positive for Desmin staining, validating clinically the relevance of our findings. We subsequently hypothesized that the desmin+ pericyte subpopulation functionally contributes to increased permeability. Desmin+ pericytes were produced in vitro by co-culturing primary mouse pericytes with astrocytes. When desmin+ or CD13+ pericytes were added to in vitro transendothelial electrical resistance (TEER) models of the BBB, the desmin+ pericytes exhibited less resistance, indicative of higher permeability. The data suggest that desmin+ pericytes may facilitate the permeability of the BTB. These studies show that the BTB in brain metastasis model systems involves consistent molecular changes. These data may identify new strategies to selectively permeabilize the BTB and enhance chemotherapeutic efficacy.
Citation Format: Brunilde Gril, L. Tiffany Lyle, Paul R. Lockman, Chris E. Adkins, Afroz Shareef Mohammad, Emily Sechrest, Emily Hua, Diane Palmieri, David J. Liewehr, Seth M. Steinberg, Wojciech Kloc, Ewa Izycka-Swieszewska, Renata Duchnowska, Nayyar Naema, Priscilla K. Brastianos, Patricia S. Steeg. Desmin+pericyte subpopulations correlated with blood-tumor barrier permeability in brain metastases of breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4933. doi:10.1158/1538-7445.AM2017-4933
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Affiliation(s)
| | - L. Tiffany Lyle
- 2 Purdue University College of Veterinary Medicine, West Lafayette, IN
| | - Paul R. Lockman
- 3West Virginia University Health Sciences Center, Morgantown, WV
| | - Chris E. Adkins
- 3West Virginia University Health Sciences Center, Morgantown, WV
| | | | - Emily Sechrest
- 3West Virginia University Health Sciences Center, Morgantown, WV
| | | | | | | | | | - Wojciech Kloc
- 5University of Varmia & Masuria University, Olsztyn, Poland
| | | | | | - Nayyar Naema
- 8Massachusetts General Hospital Cancer CenterHarvard Medical School, Boston, MA
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Zok J, Duchnowska R, Radecka B, Adamowicz K, Korniluk J, Orlikowska M. Body mass index and long-term outcomes in stage III colon cancer patients administered postoperative chemotherapy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx261.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wu NC, Wong W, Ho KE, Chu VC, Rizo A, Davonport S, Kelly D, Makar R, Jassem J, Duchnowska R, Biernat W, Radecka B, Fujita T, Klein JL, Stonecypher M, Ohta S, Juhl H, Weidler JM, Bates M, Press MF. Abstract P1-03-03: High concordance of ER, PR, HER2 and Ki67 by central IHC and FISH with mRNA measurements by GeneXpert® breast cancer stratifier assay. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-03-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Current methods for the assessment of ER, PR, Her2, and Ki67 using FFPE tissues are hard to standardize and difficult to perform in Low and Middle Income Countries (LMIC). The GeneXpert® breast cancer stratifier assay (RUO) (BC Strat) is a cartridge-based, RT-qPCR assay of ESR1, PGR, ERBB2, and MKi67 mRNAs using FFPE specimens. The assay is fast (<2 hours, including <10 minutes of hands-on time) and easy to perform.
The aims of this study were: 1) to evaluate the concordance of BC Strat using different IHC antibodies and scoring methods in a preliminary dataset (Part I); and 2) to assess concordance between BC Strat and high quality standard methods in an expanded dataset (Part II).
Methods
Part I: IHC Antibody Variability
To assess BC Strat concordance with various IHC antibodies, 155 invasive ductal carcinoma blocks were sourced from 3 sites. Twenty-four adjacent slide sections from each block were prepared and shipped to different labs for BC Strat analysis(Cepheid) or IHC and FISH testing. Table 1 summarizes the IHC antibodies and scoring methods used in each reference lab.
Table 1:IHC antibodies and scoring methods used in reference labs Antibody for IHClabIHC scoringERSP1MPLNAutomated (Aperio)ER6F11Path IncAutomated (Aperio)ER6F11USCManualPRIE2MPLNAutomated (Aperio)PR16Path IncAutomated (Aperio)PRPGR636USCManualHer2*4B5MPLNAutomated (Aperio)Her2*HercepTestUSCManualKi6730-9MPLNAutomated (Aperio)Ki67MIB1Path IncAutomated (Aperio)Ki67MIB1USCManual*HER2 FISH (all with PathVysion kit) was performed at USC
Part II: Concordance Study
522 invasive ductal carcinoma FFPE samples were sourced from 5 sites. All BC Strat analysis was performed at Cepheid and all IHC and FISH was performed in the Press laboratory at USC. Overall percent agreement (OPA), positive percent agreement (PPA), and negative percent agreement (NPA) between BC Strat and IHC were determined.
Results
Part I: IHC Antibody Variability
Table 2 summarizes the OPA for BC Strat analysis and IHC performed with different IHC antibodies and scoring methods. Slightly better concordance for ER and PR was observed between the BC Strat and the IHC methods performed at USC. Discordant IHC results were also observed among the reference labs' standard methodologies.
Table 2: Overall Percent Agreement between IHC and BC Strat Reference LabOPA with BC StratERMPLN92%ERPath Inc96%ERUSC98%PRMPLN84%PRPath Inc83%PRUSC87%Her2*MPLN*93%Her2*USC*91%Ki67MPLN75%Ki67Path Inc67%Ki67USC81%*for IHC 2+(equivocal), FISH HER2/CEP17 ratio was examined
Part II: Concordance Study
Of the 522 samples tested, 499 (96%) yielded valid results for both BC Strat and IHC (IHC and FISH for Her2). OPA between BC Strat and IHC was 98% for ESR1, 91% for PGR, 93% for ERBB2 (IHC and FISH, 97% for Her2 IHC excluding IHC2+), and 81% for MKi67.
Conclusion
BC Strat assay measurements for ESR1, PGR, ERBB2 and MKi67 mRNA expression in FFPE breast tumor tissues are highly concordant with IHC and FISH performed by high quality reference labs. Further investigations using clinical outcomes from independent studies including prospective-retrospective clinical trials are in progress.
Citation Format: Wu NC, Wong W, Ho KE, Chu VC, Rizo A, Davonport S, Kelly D, Makar R, Jassem J, Duchnowska R, Biernat W, Radecka B, Fujita T, Klein JL, Stonecypher M, Ohta S, Juhl H, Weidler JM, Bates M, Press MF. High concordance of ER, PR, HER2 and Ki67 by central IHC and FISH with mRNA measurements by GeneXpert® breast cancer stratifier assay [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-03-03.
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Affiliation(s)
- NC Wu
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - W Wong
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - KE Ho
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - VC Chu
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - A Rizo
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - S Davonport
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - D Kelly
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - R Makar
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - J Jassem
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - R Duchnowska
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - W Biernat
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - B Radecka
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - T Fujita
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - JL Klein
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - M Stonecypher
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - S Ohta
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - H Juhl
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - JM Weidler
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - M Bates
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
| | - MF Press
- Cepheid, Sunnyavale, CA; Keck School of Medicine/University of Southern California, Los Angeles, CA; Geneuity/MPLN, Maryville, TN; Oregon Health & Science University, Portland, OR; Medical University of Gdansk, Gdansk, Poland; Military Institute of Medicine, Warsaw, Poland; Oncology Center, Opole, Poland; Tokyo Medical University, Ibaraki, Japan; Indivumed GmbH, Humburg, Germany; Josai University, Sakado, Japan
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Duchnowska R, Sperinde J, Czartoryska-Arlukowicz B, Mysliwiec P, Winslow J, Radecka B, Petropoulos C, Demlova R, Orlikowska M, Kowalczyk A, Lang I, Ziólkowska B, Debska-Szmich S, Merdalska M, Grela-Wojewoda A, Zawrocki A, Biernat W, Huang W, Jassem J. Abstract P2-05-21: Predictive value of quantitative HER2 and HER3 levels combined with downstream signaling markers in HER2-positive advanced breast cancer patients treated with lapatinib. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: Clinical correlates of lapatinib resistance have not been well defined. Previous studies implicated genes regulated by the estrogen receptor (ER) and activation or mutation of proteins downstream from HER family receptors. In the current study, HER2 and HER3 expression levels were quantitatively measured using a VeraTag® fluorescence-based assay, in addition to seven downstream signaling proteins determined by IHC. All biomarkers were correlated with overall survival (OS) in patients treated with lapatinib.
Methods: Formalin-fixed, paraffin-embedded samples were obtained from the primary tumor of 191 patients treated with lapatinib plus capecitabine following progression on trastuzumab. The HERmark® Breast Cancer Assay (Monogram Biosciences, South San Francisco) was used to quantify HER2 protein expression levels. HER3 protein expression was quantified using the VeraTag® technology (Monogram Biosciences). Expression of ER, PTEN, Cyclin E, HIF-2alpha, p-p70S6K, p-AMPK and p-MAPK were determined by IHC (Duchnowska et al., Oncotarget 2016; 7:550). OS analyses of HER2 and HER3 were stratified by key clinical variables, including stage and presence of a brain metastasis prior to lapatinib-based therapy.
Results: Among the downstream signaling molecules, HIF-2alpha (r = -0.23; p = 0.047) and ER (r = -0.27; p = 0.005) were negatively correlated with HER2 expression after adjustment for multiple testing. PTEN appeared to correlate with HER3, but was not significant after adjustment for multiple testing. OS was significantly shorter for both those below the cut-off level of positivity by the HERmark assay (HR = 1.8; p = 0.029), and those with above median HER2 levels (HR = 1.7; p = 0.009), as compared to cases with in between levels. The relationship between HER2 and OS is also captured by a U-shaped, parabolic function in HER2 (p = 0.005). Elevated HER3 showed a trend toward a correlation with longer OS (HR = 0.66/log; p = 0.16), somewhat stronger in the ER-negative subset (HR = 0.55/log; p = 0.085) and in the subset with above-median HER2 (0.48/log; p = 0.10), where inhibiting HER2 activation of HER3 may be more important. In multivariate Cox models, HER2 (parabola, intermediate HER2 best, p = 0.001), presence of brain metastases (HR = 2; p < 0.001), ER (HR = 0.60; p = 0.009) and either p-p70S6K (HR = 0.66; p = 0.018) or p-AMPK (HR = 0.67; p = 0.022) were significantly associated with OS (p-p70S6K and p-AMPK were mutually correlated).
Conclusions: Patients with moderately increased HER2 levels may have best outcomes while receiving lapatinib following progression on trastuzumab. This supports recent findings of a less benefit from lapatinib in patients with high HER2 expression (Nunciforo et al., SABCS 2015, P3-07-08). HER3 levels do not seem to substantially impact the prognosis. Further studies are warranted to explore the predictive utility of quantitative HER2 and HER3 in guiding HER2-directed therapies.
Citation Format: Duchnowska R, Sperinde J, Czartoryska-Arlukowicz B, Mysliwiec P, Winslow J, Radecka B, Petropoulos C, Demlova R, Orlikowska M, Kowalczyk A, Lang I, Ziólkowska B, Debska-Szmich S, Merdalska M, Grela-Wojewoda A, Zawrocki A, Biernat W, Huang W, Jassem J. Predictive value of quantitative HER2 and HER3 levels combined with downstream signaling markers in HER2-positive advanced breast cancer patients treated with lapatinib [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-21.
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Affiliation(s)
- R Duchnowska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - J Sperinde
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - B Czartoryska-Arlukowicz
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - P Mysliwiec
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - J Winslow
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - B Radecka
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - C Petropoulos
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - R Demlova
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - M Orlikowska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - A Kowalczyk
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - I Lang
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - B Ziólkowska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - S Debska-Szmich
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - M Merdalska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - A Grela-Wojewoda
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - A Zawrocki
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - W Biernat
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - W Huang
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
| | - J Jassem
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Inc. Laboratory Corporation of America® Holdings, South San Francisco, CA; Białystok Oncology Center, Bialystok, Poland; Oncology Center, Zielona Go´ra, Poland; Opole Oncology Center, Opole, Poland; Masaryk Memorial Cancer Institute, Brno, Czech Republic; Warmia and Masuria Oncology Center, Olsztyn, Poland; Medical University of Gdan´sk, Gdan´sk, Poland; National Institute of Oncology, Budapest, Hungary; Regional Hospital, Wrocław, Poland; Medical University of Łódź, Lo´dz´, Poland; Oncology Center, Kielce, Poland; Oncology Institute, Krako´w, Poland
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Duchnowska R, Wysocki PJ, Korski K, Czartoryska-Arłukowicz B, Niwińska A, Orlikowska M, Radecka B, Studziński M, Demlova R, Ziółkowska B, Merdalska M, Hajac Ł, Myśliwiec P, Zuziak D, Dębska-Szmich S, Lang I, Foszczyńska-Kłoda M, Karczmarek-Borowska B, Żawrocki A, Kowalczyk A, Biernat W, Jassem J. Immunohistochemical prediction of lapatinib efficacy in advanced HER2-positive breast cancer patients. Oncotarget 2016; 7:550-64. [PMID: 26623720 PMCID: PMC4808017 DOI: 10.18632/oncotarget.6375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Received: 05/19/2015] [Accepted: 11/13/2015] [Indexed: 12/22/2022] Open
Abstract
Molecular mechanisms of lapatinib resistance in breast cancer are not well understood. The aim of this study was to correlate expression of selected proteins involved in ErbB family signaling pathways with clinical efficacy of lapatinib. Study group included 270 HER2-positive advanced breast cancer patients treated with lapatinib and capecitabine. Immunohistochemical expression of phosphorylated adenosine monophosphate-activated protein (p-AMPK), mitogen-activated protein kinase (p-MAPK), phospho (p)-p70S6K, cyclin E, phosphatase and tensin homolog were analyzed in primary breast cancer samples. The best discriminative value for progression-free survival (PFS) was established for each biomarker and subjected to multivariate analysis. At least one biomarker was determined in 199 patients. Expression of p-p70S6K was independently associated with longer (HR 0.45; 95% CI: 0.25–0.81; p = 0.009), and cyclin E with shorter PFS (HR 1.83; 95% CI: 1.06–3.14; p = 0.029). Expression of p-MAPK (HR 1.61; 95% CI 1.13–2.29; p = 0.009) and cyclin E (HR 2.99; 95% CI: 1.29–6.94; p = 0.011) was correlated with shorter, and expression of estrogen receptor (HR 0.65; 95% CI 0.43–0.98; p = 0.041) with longer overall survival. Expression of p-AMPK negatively impacted response to treatment (HR 3.31; 95% CI 1.48–7.44; p = 0.004) and disease control (HR 3.07; 95% CI 1.25–7.58; p = 0.015). In conclusion: the efficacy of lapatinib seems to be associated with the activity of downstream signaling pathways – AMPK/mTOR and Ras/Raf/MAPK. Further research is warranted to assess the clinical utility of these data and to determine a potential role of combining lapatinib with MAPK pathway inhibitors.
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Affiliation(s)
| | | | | | | | - Anna Niwińska
- The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | | | | | | | | | | | | | | | | | | | - Istvan Lang
- Department of Medical Oncology, National Institute of Oncology, Budapest, Hungary
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Duchnowska R, Jarząb M, Żebracka-Gala J, Matkowski R, Kowalczyk A, Radecka B, Kowalska M, Pfeifer A, Foszczyńska-Kłoda M, Musolino A, Czartoryska-Arłukowicz B, Litwiniuk M, Surus-Hyla A, Szabłowska-Siwik S, Karczmarek-Borowska B, Dębska-Szmich S, Głodek-Sutek B, Sosińska-Mielcarek K, Chmielowska E, Kalinka-Warzocha E, Olszewski WP, Patera J, Żawrocki A, Pliszka A, Tyszkiewicz T, Rusinek D, Oczko-Wojciechowska M, Jassem J, Biernat W. Brain Metastasis Prediction by Transcriptomic Profiling in Triple-Negative Breast Cancer. Clin Breast Cancer 2016; 17:e65-e75. [PMID: 27692773 DOI: 10.1016/j.clbc.2016.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/14/2016] [Accepted: 08/25/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) lacks expression of steroid hormone receptors (estrogen receptor α and progesterone) and epidermal growth factor receptor type 2. This phenotype shows high metastatic potential, with particular predilection to lungs and brain. Determination of TNBC transcriptomic profiles associated with high risk of brain metastasis (BM) might identify patients requiring alternative, more aggressive, or specific preventive and therapeutic approaches. PATIENTS AND METHODS Using a cDNA-mediated annealing, selection, extension, and ligation assay, we investigated expression of 29,369 gene transcripts in primary TNBC tumor samples from 119 patients-71 in discovery cohort A and 48 in independent cohort B-that included best discriminating genes. Expression of mRNA was correlated with the occurrence of symptomatic BM. RESULTS In cohort A, the difference at the noncorrected P < .005 was found for 64 transcripts (P = .23 for global test), but none showed significant difference at a preset level of false-discovery rate of < 10%. Of the 30 transcripts with the largest differences between patients with and without BM in cohort A, none was significantly associated with BM in cohort B. CONCLUSION Analysis based on the primary tumor gene transcripts alone is unlikely to predict BM development in advanced TNBC. Despite its negative findings, the study adds to the knowledge on the biology of TNBC and paves the way for future projects using more advanced molecular assays.
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Affiliation(s)
- Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland.
| | - Michał Jarząb
- 3rd Department of Radiotherapy and Chemotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Jadwiga Żebracka-Gala
- Laboratory of Molecular Diagnostics and Functional Genomics, Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Rafał Matkowski
- Department of Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Anna Kowalczyk
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Małgorzata Kowalska
- Laboratory of Molecular Diagnostics and Functional Genomics, Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Aleksandra Pfeifer
- Laboratory of Molecular Diagnostics and Functional Genomics, Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | | | | | | | - Maria Litwiniuk
- Department of Oncology, Greater Poland Cancer Center, Poznań, Poland
| | - Anna Surus-Hyla
- Department of Oncology, Warmia and Masuria Oncology Center, Olsztyn, Poland
| | | | | | | | | | | | | | | | - Wojciech P Olszewski
- Department of Pathology and Laboratory Diagnostic, Oncology Center-Institute, Warsaw, Poland
| | - Janusz Patera
- Department of Pathology, Military Institute of Medicine, Warsaw, Poland
| | - Anton Żawrocki
- Department of Pathology, Medical University of Gdańsk, Gdańsk, Poland
| | - Agnieszka Pliszka
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Tyszkiewicz
- Laboratory of Molecular Diagnostics and Functional Genomics, Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Dagmara Rusinek
- Laboratory of Molecular Diagnostics and Functional Genomics, Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Małgorzata Oczko-Wojciechowska
- Laboratory of Molecular Diagnostics and Functional Genomics, Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Biernat
- Department of Pathology, Medical University of Gdańsk, Gdańsk, Poland
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Lyle LT, Lockman PR, Adkins CE, Mohammad AS, Sechrest E, Hua E, Palmieri D, Liewehr DJ, Steinberg SM, Kloc W, Izycka-Swieszewska E, Duchnowska R, Nayyar N, Brastianos PK, Steeg PS, Gril B. Alterations in Pericyte Subpopulations Are Associated with Elevated Blood-Tumor Barrier Permeability in Experimental Brain Metastasis of Breast Cancer. Clin Cancer Res 2016; 22:5287-5299. [PMID: 27245829 DOI: 10.1158/1078-0432.ccr-15-1836] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 05/19/2016] [Indexed: 01/23/2023]
Abstract
PURPOSE The blood-brain barrier (BBB) is modified to a blood-tumor barrier (BTB) as a brain metastasis develops from breast or other cancers. We (i) quantified the permeability of experimental brain metastases, (ii) determined the composition of the BTB, and (iii) identified which elements of the BTB distinguished metastases of lower permeability from those with higher permeability. EXPERIMENTAL DESIGN A SUM190-BR3 experimental inflammatory breast cancer brain metastasis subline was established. Experimental brain metastases from this model system and two previously reported models (triple-negative MDA-231-BR6, HER2+ JIMT-1-BR3) were serially sectioned; low- and high-permeability lesions were identified with systemic 3-kDa Texas Red dextran dye. Adjoining sections were used for quantitative immunofluorescence to known BBB and neuroinflammatory components. One-sample comparisons against a hypothesized value of one were performed with the Wilcoxon signed-rank test. RESULTS When uninvolved brain was compared with any brain metastasis, alterations in endothelial, pericytic, astrocytic, and microglial components were observed. When metastases with relatively low and high permeability were compared, increased expression of a desmin+ subpopulation of pericytes was associated with higher permeability (231-BR6 P = 0.0002; JIMT-1-BR3 P = 0.004; SUM190-BR3 P = 0.008); desmin+ pericytes were also identified in human craniotomy specimens. Trends of reduced CD13+ pericytes (231-BR6 P = 0.014; JIMT-1-BR3 P = 0.002, SUM190-BR3, NS) and laminin α2 (231-BR6 P = 0.001; JIMT-1-BR3 P = 0.049; SUM190-BR3 P = 0.023) were also observed with increased permeability. CONCLUSIONS We provide the first account of the composition of the BTB in experimental brain metastasis. Desmin+ pericytes and laminin α2 are potential targets for the development of novel approaches to increase chemotherapeutic efficacy. Clin Cancer Res; 22(21); 5287-99. ©2016 AACR.
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Affiliation(s)
- L Tiffany Lyle
- Women's Malignancies Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Paul R Lockman
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Chris E Adkins
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Afroz Shareef Mohammad
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Emily Sechrest
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Emily Hua
- Women's Malignancies Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Diane Palmieri
- Women's Malignancies Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - David J Liewehr
- Biostatistics and Data Management Section, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Wojciech Kloc
- Departments of Neurology & Neurosurgery, University of Varmia & Masuria University, Olsztyn, Poland.,Department of Neurosurgery, Copernicus Hospital Gdańsk, Poland
| | - Ewa Izycka-Swieszewska
- Departments of Pathology & Neuropathology, Medical University of Gdańsk, Poland.,Department of Pathomorphology, Copernicus Hospital, Gdańsk, Poland
| | - Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | - Naema Nayyar
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Priscilla K Brastianos
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Patricia S Steeg
- Women's Malignancies Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Brunilde Gril
- Women's Malignancies Branch, Center for Cancer Research, NCI, Bethesda, Maryland.
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35
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Duchnowska R, Jarzab M, Zebracka J, Matkowski R, Kowalczyk A, Radecka B, Foszczynska-Kloda M, Musolino A, Czartoryska-Arlukowicz B, Litwiniuk MM, Szablowska-Siwik S, Karczmarek-Borowska B, Sosinska-Mielcarek K, Chmielowska E, Olszewski WP, Patera J, Zawrocki A, Rusinek D, Jassem J, Biernat W. Brain metastasis (BM) prediction by transcriptomic profiling in triple-negative breast cancer (TNBC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Michal Jarzab
- MSC Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Jadwiga Zebracka
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Rafal Matkowski
- Department of Oncology, Medical University of Wroclaw, Wroclaw, Poland
| | - Anna Kowalczyk
- Medical University of Gdansk, Oncology and Radiotherapy, Gdansk, Poland
| | | | | | | | | | | | | | | | | | | | - Wojciech P Olszewski
- Department of Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Janusz Patera
- Department of Pathology, Military Institute of Medicine, Warsaw, Poland
| | - Anton Zawrocki
- Department of Pathology, Medical University of Gdańsk, Gdansk, Poland
| | - Dagmara Rusinek
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | | | - Wojciech Biernat
- Department of Pathology, Medical University of Gdansk, Gdansk, Poland
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36
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Duchnowska R, Pęksa R, Radecka B, Mandat T, Trojanowski T, Jarosz B, Czartoryska-Arłukowicz B, Olszewski WP, Och W, Kalinka-Warzocha E, Kozłowski W, Kowalczyk A, Loi S, Biernat W, Jassem J. Immune response in breast cancer brain metastases and their microenvironment: the role of the PD-1/PD-L axis. Breast Cancer Res 2016; 18:43. [PMID: 27117582 PMCID: PMC4847231 DOI: 10.1186/s13058-016-0702-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/04/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A better understanding of immune response in breast cancer brain metastases (BCBM) may prompt new preventive and therapeutic strategies. METHODS Immunohistochemical expression of stromal tumor-infiltrating lymphocytes (TILs: CD4, CD8, CTLA4), macrophage/microglial cells (CD68), programmed cell death protein 1 receptor (PD-1), programmed cell death protein 1 receptor ligand (PD-L)1, PD-L2 and glial fibrillary acid protein was assessed in 84 BCBM and their microenvironment. RESULTS Median survival after BCBM excision was 18.3 months (range 0-99). Median number of CD4+, CD8+ TILs and CD68+ was 49, 69 and 76 per 1 mm(2), respectively. PD-L1 and PD-L2 expression in BCBM was present in 53 % and 36 % of cases, and was not related to BCBM phenotype. PD-1 expression on TILs correlated positively with CD4+ and CD8+ TILs (r = 0.26 and 0.33), and so did CD68+ (r = 0.23 and 0.27, respectively). In the multivariate analysis, survival after BCBM excision positively correlated with PD-1 expression on TILs (hazard ratio (HR) = 0.3, P = 0.003), CD68+ infiltration (HR = 0.2, P < 0.001), brain radiotherapy (HR = 0.1, P < 0.001), endocrine therapy (HR = 0.1, P < 0.001), and negatively with hormone-receptor-negative/human epidermal growth factor receptor 2 (HER2)-positive phenotype of primary tumor (HR = 2.6, P = 0.01), HER2 expression in BCBM (HR = 4.9, P = 0.01). CONCLUSIONS PD-L1 and PD-L2 expression is a common occurrence in BCBM, irrespective of primary tumor and BCBM phenotype. Favorable prognostic impact of PD-1 expression on TILs suggests a beneficial effect of preexisting immunity and implies a potential therapeutic role of immune checkpoint inhibitors in BCBM.
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Affiliation(s)
- Renata Duchnowska
- />Department of Oncology, Military Institute of Medicine, Szaserów St 128, 04-141 Warsaw, Poland
| | - Rafał Pęksa
- />Department of Pathology, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
| | - Barbara Radecka
- />Department of Oncology, Regional Oncology Center, 66a Katowicka St, 45-060 Opole, Poland
| | - Tomasz Mandat
- />Department of Neurosurgery, Oncology Center-Institute, 5 Roentgena St, 02-781 Warsaw, Poland
| | - Tomasz Trojanowski
- />Department of Neurosurgery, Medical University of Lublin, 1 Al. Racławickie, 20-059 Lublin, Poland
| | - Bożena Jarosz
- />Department of Neurosurgery, Medical University of Lublin, 1 Al. Racławickie, 20-059 Lublin, Poland
| | | | - Wojciech P. Olszewski
- />Department of Pathology, Oncology Center-Institute, 5 Roentgena St, 02-781 Warsaw, Poland
| | - Waldemar Och
- />Department of Neurosurgery, Regional Hospital, 18 Żołnierska St, 10-561 Olsztyn, Poland
| | - Ewa Kalinka-Warzocha
- />Department of Oncology, Regional Oncology Center, 62 Pabianicka St, 93-513 Łódź, Poland
| | - Wojciech Kozłowski
- />Department of Pathology, Military Institute of Medicine, Szaserów St 128, 04-141 Warsaw, Poland
| | - Anna Kowalczyk
- />Department of Oncology and Radiotherapy, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
| | - Sherene Loi
- />Division of Cancer Medicine and Research, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, East Melbourne, VIC 8006 Australia
| | - Wojciech Biernat
- />Department of Pathology, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
| | - Jacek Jassem
- />Department of Oncology and Radiotherapy, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
| | - for the Polish Brain Metastasis Consortium
- />Department of Oncology, Military Institute of Medicine, Szaserów St 128, 04-141 Warsaw, Poland
- />Department of Pathology, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
- />Department of Oncology, Regional Oncology Center, 66a Katowicka St, 45-060 Opole, Poland
- />Department of Neurosurgery, Oncology Center-Institute, 5 Roentgena St, 02-781 Warsaw, Poland
- />Department of Neurosurgery, Medical University of Lublin, 1 Al. Racławickie, 20-059 Lublin, Poland
- />Department of Oncology, Regional Oncology Center, 12 Ogrodowa St, 15-027 Białystok, Poland
- />Department of Pathology, Oncology Center-Institute, 5 Roentgena St, 02-781 Warsaw, Poland
- />Department of Neurosurgery, Regional Hospital, 18 Żołnierska St, 10-561 Olsztyn, Poland
- />Department of Oncology, Regional Oncology Center, 62 Pabianicka St, 93-513 Łódź, Poland
- />Department of Pathology, Military Institute of Medicine, Szaserów St 128, 04-141 Warsaw, Poland
- />Department of Oncology and Radiotherapy, Medical University of Gdańsk, 7 Dębinki St, 80-211 Gdańsk, Poland
- />Division of Cancer Medicine and Research, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, East Melbourne, VIC 8006 Australia
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Jeong J, Audet R, Chang J, Wong H, Willis S, Young B, Edgerton S, Thor A, Sledge G, Duchnowska R, Jassem J, Adamowicz K, Leyland-Jones B, Shen C. A comparison between DASL and Affymetrix on probing the whole-transcriptome. J Korean Stat Soc 2016. [DOI: 10.1016/j.jkss.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Szymanowski B, Duchnowska R, Bilski M, Łapińska G, Hryciuk B, Kamiński G, Szczylik C. Problems of diagnostic assessment in advanced pancreatic neuroendocrine neoplasm and treatment implications: a case report and literature review. Nucl Med Rev Cent East Eur 2016; 19:54-7. [PMID: 26838946 DOI: 10.5603/nmr.2016.0011] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 12/18/2015] [Indexed: 11/25/2022] Open
Abstract
We are reporting a case of a 55-year-old woman who was diagnosed as having a non-functioning pancreatic neuroendocrine neoplasm (NF-PNEN), the World Health Organization (WHO) low grade (G1) with liver metastases. In the staging process the positron emission tomography - computed tomography with Fluorine-18-Fluorodeoxyglucose (F-FDG PET-CT) and spiral CT then the gallium-DOTA-octreotate positron emission tomography - computer tomography (⁶⁸Ga-DOTATATE PET-CT) shown difference in burden of disease. In first line therapy, everolimus (Afinitor®, Novartis Pharma GmbH, Germany) at the oral dose of 10 mg once daily and octreotide long-acting release (Sandostatin LAR®) 30 mg i.m. every 4 weeks were administered. Then, due to disease progression - radioisotope therapy with b-emitter Yttrium-90 (⁹⁰Y). Based on this experience and on the review of the literature, we recommend that the discrepancy between the imaging studies could be due to heterogeneity of proliferation rate and somatostatin receptors (SSTR) expression within a primary PNEN and metastases. Therefore in such cases of advanced PNEN WHO G1 in the lack of response to everolimus and octreotide LAR administration isotope therapy without a prior chemotherapy should be considered as a palliative treatment according to ESMO Clinical Practice Guidelines and Polish Network of Neuroendocrine Tumors.
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39
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Winczura P, Sosińska-Mielcarek K, Duchnowska R, Badzio A, Lakomy J, Majewska H, Pęksa R, Pieczyńska B, Radecka B, Dębska-Szmich S, Adamowicz K, Biernat W, Jassem J. Immunohistochemical Predictors of Bone Metastases in Breast Cancer Patients. Pathol Oncol Res 2015; 21:1229-36. [PMID: 26062800 PMCID: PMC4550640 DOI: 10.1007/s12253-015-9957-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/26/2015] [Indexed: 11/22/2022]
Abstract
Bones are the most common metastatic site of relapse in breast cancer patients and the prediction of bone metastases (BM) risk might prompt developing preventive and therapeutic strategies. The aim of the study was to correlate imumohistochemical (IHC) expression of selected proteins in primary breast cancer with the occurrence of BM. We analyzed expression of proteins potentially associated with BM in primary tumors of 184 patients with metastatic breast cancer (113 with- and 71 without BM). Expression of estrogen receptor (ER) in primary tumor was more common in patients with- compared to those without BM (74 vs. 45 % respectively, p = 0.0001), whereas in this subset less common was expression of parathyroid hormone related protein receptor type 1 (16 vs. 34 %, respectively, p = 0.007) and cytoplasmic expression of osteopontin (OPNcyt; 1.9 vs. 14 %, respectively, p = 0.002). The relationship between expression of ER and OPNcyt and the occurrence of BM was confirmed in the multivariate analysis. The ER-positive/OPNcyt negative phenotype was significantly more common in patients with- compared to those without BM (75 and 25 %, p < 0.0001, respectively; HR 1.79, p = 0.013). Luminal A (43 vs. 23 % respectively, p = 0.009) and luminal B/HER2-positive (16 vs. 4.9 % respectively, p = 0.032) subtypes were more common in patients with- compared to those without BM, whereas triple negative breast cancer subtype was less common (16 vs. 38 %, p = 0.002).
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40
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Duchnowska R, Pęksa R, Radecka B, Mandat T, Trojanowski T, Jarosz B, Czartoryska-Arlukowicz B, Olszewski W, Och W, Kalinka-Warzocha E, Kowalczyk A, Biernat W, Jassem J. Immune response in breast cancer brain metastases (BM) and their microenvironment. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e22112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Rafał Pęksa
- Medical University of Gdańsk, Pathology Department, Gdańsk, Poland
| | | | | | | | | | | | - Wojciech Olszewski
- Department of Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | | | - Anna Kowalczyk
- Medical University of Gdańsk, Oncology and Radiotherapy, Gdańsk, Poland
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
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41
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Duchnowska R, Sperinde J, Chenna A, Huang W, Weidler JM, Winslow J, Haddad M, Paquet A, Lie Y, Trojanowski T, Mandat T, Kowalczyk A, Czartoryska-Arłukowicz B, Radecka B, Jarosz B, Staszkiewicz R, Kalinka-Warzocha E, Chudzik M, Biernat W, Jassem J. Quantitative HER2 and p95HER2 levels in primary breast cancers and matched brain metastases. Neuro Oncol 2015; 17:1241-9. [PMID: 25681308 DOI: 10.1093/neuonc/nov012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/15/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients with advanced breast cancer positive for human epidermal growth factor receptor 2 (HER2) are at high risk for brain metastasis (BM). The prevalence and significance of expression of HER2 and its truncated form p95HER2 (p95) in BM is unknown. METHODS Seventy-five pairs of formalin-fixed paraffin-embedded samples from matched primary breast cancers (PBCs) and BM were assayed for quantitative p95 and HER2-total (H2T) protein expression using the p95 VeraTag and HERmark assays, respectively. RESULTS There was a net increase in p95 and H2T expression in BM relative to the matched PBC (median 1.5-fold, P = .0007 and 2.1-fold, P < .0001, respectively). Cases with H2T-positive tumors were more likely to have the largest (≥5-fold) increase in p95 (odds ratio = 6.3, P = .018). P95 positivity in PBC correlated with progression-free survival (hazard ratio [HR] = 2.2, P = .013), trended with shorter time to BM (HR = 1.8, P = .070), and correlated with overall survival (HR = 2.1, P = .042). P95 positivity in BM correlated with time to BM (HR = 2.0, P = .016) but did not correlate with overall survival from the time of BM diagnosis (HR = 1.2, P = .61). CONCLUSIONS This is the first study of quantitative p95 and HER2 expression in matched PBC and BM. BM of breast cancer shows significant increases in expression of both biomarkers compared with matched PBC. These data provide a rationale for future correlative studies on p95 and HER2 levels in BM.
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Affiliation(s)
- Renata Duchnowska
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Jeff Sperinde
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Ahmed Chenna
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Weidong Huang
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Jodi M Weidler
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - John Winslow
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Mojgan Haddad
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Agnes Paquet
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Yolanda Lie
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Tomasz Trojanowski
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Tomasz Mandat
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Anna Kowalczyk
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Bogumiła Czartoryska-Arłukowicz
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Barbara Radecka
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Bożena Jarosz
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Rafal Staszkiewicz
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Ewa Kalinka-Warzocha
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Małgorzata Chudzik
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Wojciech Biernat
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
| | - Jacek Jassem
- Military Institute of Medicine, Warsaw, Poland (R.D.); Monogram Biosciences, Inc, South San Francisco, California (J.S., A.C., W.H., J.M.W., J.W., M.H., A.P., Y.L.); Medical University of Lublin, Lublin, Poland (T.T., B.J.); Institute of Oncology, Warsaw, Poland (T.M.); Białystok Oncology Center, Białystok, Poland (B.C.-A.); Opole Oncology Center, Opole, Poland (B.R.); Interior Affairs Hospital, Olsztyn, Poland (R.S.); Regional Oncology Center, Łódź, Poland (E.K.-W.); Oncology Center, Warsaw, Poland (M.C.); Medical University of Gdańsk, Gdańsk, Poland (A.K., W.B., J.J.)
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Duchnowska R, Ziajka E, Góralska A, Grala B. Recurrent pyoderma gangrenosum precipitated by breast cancer: a case report and review of the literature. J Med Case Rep 2014; 8:226. [PMID: 24965126 PMCID: PMC4090656 DOI: 10.1186/1752-1947-8-226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 04/29/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pyoderma gangrenosum is a rare clinical entity of poorly understood pathogenesis, characterized by rapidly progressing skin necrosis. In around half of patients pyoderma gangrenosum is a manifestation of underlying systemic diseases, such as rheumatoid arthritis, inflammatory bowel disease or myeloproliferative disorders. There have been very few reports on the association of pyoderma gangrenosum with solid malignancies. CASE PRESENTATION We report a case of a 68-year-old Caucasian woman in whom pyoderma gangrenosum first appeared around 30 years earlier, at the time of exacerbation of rheumatoid arthritis, and recurred as a manifestation of locally advanced breast cancer. The causative role of the neoplastic process was partly confirmed by the healing of the skin ulceration only following effective endocrine cancer therapy, whereas earlier attempts with standard anti-inflammatory therapy were unsuccessful. CONCLUSIONS Pyoderma gangrenosum has a recurrent nature and may be reactivated by various causes within several years. Therefore, a prompt and thorough diagnosis accompanied by treatment of the underlying disease is necessary.
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Affiliation(s)
- Renata Duchnowska
- Department of Oncology, Military Institute of Medicine, Szaserów 128 Street, 04-141 Warsaw, Poland.
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Woditschka S, Evans L, Duchnowska R, Reed LT, Palmieri D, Qian Y, Badve S, Sledge G, Gril B, Aladjem MI, Fu H, Flores NM, Gökmen-Polar Y, Biernat W, Szutowicz-Zielińska E, Mandat T, Trojanowski T, Och W, Czartoryska-Arlukowicz B, Jassem J, Mitchell JB, Steeg PS. DNA double-strand break repair genes and oxidative damage in brain metastasis of breast cancer. J Natl Cancer Inst 2014; 106:dju145. [PMID: 24948741 DOI: 10.1093/jnci/dju145] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Breast cancer frequently metastasizes to the brain, colonizing a neuro-inflammatory microenvironment. The molecular pathways facilitating this colonization remain poorly understood. METHODS Expression profiling of 23 matched sets of human resected brain metastases and primary breast tumors by two-sided paired t test was performed to identify brain metastasis-specific genes. The implicated DNA repair genes BARD1 and RAD51 were modulated in human (MDA-MB-231-BR) and murine (4T1-BR) brain-tropic breast cancer cell lines by lentiviral transduction of cDNA or short hairpin RNA (shRNA) coding sequences. Their functional contribution to brain metastasis development was evaluated in mouse xenograft models (n = 10 mice per group). RESULTS Human brain metastases overexpressed BARD1 and RAD51 compared with either matched primary tumors (1.74-fold, P < .001; 1.46-fold, P < .001, respectively) or unlinked systemic metastases (1.49-fold, P = .01; 1.44-fold, P = .008, respectively). Overexpression of either gene in MDA-MB-231-BR cells increased brain metastases by threefold to fourfold after intracardiac injections, but not lung metastases upon tail-vein injections. In 4T1-BR cells, shRNA-mediated RAD51 knockdown reduced brain metastases by 2.5-fold without affecting lung metastasis development. In vitro, BARD1- and RAD51-overexpressing cells showed reduced genomic instability but only exhibited growth and colonization phenotypes upon DNA damage induction. Reactive oxygen species were present in tumor cells and elevated in the metastatic neuro-inflammatory microenvironment and could provide an endogenous source of genotoxic stress. Tempol, a brain-permeable oxygen radical scavenger suppressed brain metastasis promotion induced by BARD1 and RAD51 overexpression. CONCLUSIONS BARD1 and RAD51 are frequently overexpressed in brain metastases from breast cancer and may constitute a mechanism to overcome reactive oxygen species-mediated genotoxic stress in the metastatic brain.
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Affiliation(s)
- Stephan Woditschka
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA.
| | - Lynda Evans
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Renata Duchnowska
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - L Tiffany Reed
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Diane Palmieri
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Yongzhen Qian
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Sunil Badve
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - George Sledge
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Brunilde Gril
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Mirit I Aladjem
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Haiqing Fu
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Natasha M Flores
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Yesim Gökmen-Polar
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Wojciech Biernat
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Ewa Szutowicz-Zielińska
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Tomasz Mandat
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Tomasz Trojanowski
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Waldemar Och
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Bogumiła Czartoryska-Arlukowicz
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Jacek Jassem
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - James B Mitchell
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA
| | - Patricia S Steeg
- Affiliations of authors: Women's Malignancies Branch (SW, LE, TR, DP, BG, NMF, PSS), DNA Replication Group, Laboratory of Molecular Pharmacology (MIA, HF), and Tumor Biology Section, Radiation Biology Branch (JBM), Center for Cancer Research, National Cancer Institute, Bethesda, MD; Department of Oncology, Military Institute of Medicine, Warsaw, Poland (RD); Laboratory Animal Sciences Program, Frederick National Laboratory, Frederick MD (YQ); Departments of Pathology and Laboratory Medicine (SB), and Departments of Medicine (GS, YG-P), Indiana University School of Medicine, Indianapolis, IN; Department of Pathology (WB), and Department of Oncology and Radiotherapy (ES-Z, JJ), Medical University of Gdańsk, Gdańsk, Poland; Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland (TM); Department of Neurosurgery and Children's Neurosurgery Clinic, Medical University of Lublin, Lublin, Poland (TT); Department of Neurosurgery, Interior Affairs Hospital, Olsztyn, Poland (WO); Department of Clinical Oncology, Białystok Oncology Center, Białystok, Poland (BC-A); Present addresses: Teach for America, Baltimore, MD (LE); National Heart, Lung, and Blood Institute, Bethesda, MD (DP); Cancer Biology Program (NMF), and Department of Oncology (GS), Stanford University, Stanford, CA.
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Duchnowska R, Wysocki PJ, Korski K, Czartoryska-Arlukowicz B, Niwinska A, Orlikowska M, Radecka B, Studziński M, Demlova R, Ziolkowska B, Merdalska M, Hajac L, Myśliwiec P, Zuziak D, Debska S, Lang I, Foszczynska-Kloda M, Kowalczyk A, Biernat W, Jassem J. Immunohistochemical (IHC) prediction of lapatinib efficacy in HER2-positive advanced breast cancer patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Anna Niwinska
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | | | | | | | | | | | | | | | | | | | - Istvan Lang
- Országos Onkológiai Intézet, Budapest, Hungary
| | | | | | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Jassem
- Medical University of Gdansk, Department of Oncology and Radiotherapy, Gdańsk, Poland
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Khan MI, Czarnecka AM, Duchnowska R, Kukwa W, Szczylik C. Metastasis-Initiating Cells in Renal Cancer. ACTA ACUST UNITED AC 2014; 8:240-246. [PMID: 25152705 PMCID: PMC4141324 DOI: 10.2174/1574362409666140206222431] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 11/27/2013] [Accepted: 01/29/2014] [Indexed: 02/07/2023]
Abstract
Metastasis is a complex process that propagates cells from the primary or initial site of the cancer occurrence to distant parts of the body. Cancer cells break from the cancer site and circulate through the bloodstream or lymph vessels, allowing them to reach nearly all parts of the body. These circulating tumour cells (CTCs) contain specialized metastasis-initiating cells (MICs) that reside in the biological heterogeneous primary tumour. Researchers have hypothesized that metastasis of renal cell carcinoma is initiated by circulation of MICs in patients’ blood and bone marrow. Based on the cancer stem/progenitor cell concept of carcinogenesis, understanding the molecular phenotypes of metastasis-initiating cells (MICs) in renal cancer could play a vital role in developing strategies for therapeutic interventions in renal cancer. Existence of MICs among CTCs in renal carcinoma has not been proven in large scale. However, some studies have reported that specialized markers are found on the surface of circulating cells from the primary tumour. In mice, MICs have been isolated from CTCs using such markers, which have then been transplanted into xenograft model to show whether they give rise to metastasis in different organs. Considering these findings, in this review we have attempted to summarize the studies connected with MICs and their gene expression profiles that are responsible for metastasis in renal cancer.
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Affiliation(s)
- Mohammed I Khan
- Molecular Oncology Laboratory, Clinic of Oncology, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland
| | - Anna M Czarnecka
- Molecular Oncology Laboratory, Clinic of Oncology, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland
| | - Renata Duchnowska
- Molecular Oncology Laboratory, Clinic of Oncology, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland
| | - Wojciech Kukwa
- Department of Otolaryngology, Czerniakowski Hospital, Medical University of Warsaw, ul. Stepinska 19/25, Warsaw, Poland
| | - Cezary Szczylik
- Molecular Oncology Laboratory, Clinic of Oncology, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warsaw, Poland
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Duchnowska R, Sperinde J, Chenna A, Haddad M, Paquet A, Lie Y, Weidler JM, Huang W, Winslow J, Jankowski T, Czartoryska-Arłukowicz B, Wysocki PJ, Foszczyńska-Kłoda M, Radecka B, Litwiniuk MM, Zok J, Wiśniewski M, Zuziak D, Biernat W, Jassem J. Quantitative measurements of tumoral p95HER2 protein expression in metastatic breast cancer patients treated with trastuzumab: independent validation of the p95HER2 clinical cutoff. Clin Cancer Res 2014; 20:2805-13. [PMID: 24668646 DOI: 10.1158/1078-0432.ccr-13-2782] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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
PURPOSE P95HER2 (p95) is a truncated form of the HER2, which lacks the trastuzumab-binding site and contains a hyperactive kinase domain. Previously, an optimal clinical cutoff of p95 expression for progression-free survival (PFS) and overall survival (OS) was defined using a quantitative VeraTag assay (Monogram Biosciences) in a training set of trastuzumab-treated metastatic breast cancer (MBC) patients. EXPERIMENTAL DESIGN In the current study, the predictive value of the p95 VeraTag assay cutoff established in the training set was retrospectively validated for PFS and OS in an independent series of 240 trastuzumab-treated MBC patients from multiple institutions. RESULTS In the subset of 190 tumors assessed as HER2-total (H2T)-positive using the quantitative HERmark assay (Monogram Biosciences), p95 VeraTag values above the predefined cutoff correlated with shorter PFS (HR = 1.43; P = 0.039) and shorter OS (HR = 1.94; P = 0.0055) where both outcomes were stratified by hormone receptor status and tumor grade. High p95 expression correlated with shorter PFS (HR = 2.41; P = 0.0003) and OS (HR = 2.57; P = 0.0025) in the hormone receptor-positive subgroup of patients (N = 78), but not in the hormone receptor-negative group. In contrast with the quantitative p95 VeraTag measurements, p95 immunohistochemical expression using the same antibody was not significantly correlated with outcomes. CONCLUSIONS The consistency in the p95 VeraTag cutoff across different cohorts of patients with MBC treated with trastuzumab justifies additional studies using blinded analyses in larger series of patients.
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Affiliation(s)
- Renata Duchnowska
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Jeff Sperinde
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Ahmed Chenna
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Mojgan Haddad
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Agnes Paquet
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Yolanda Lie
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Jodi M Weidler
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Weidong Huang
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - John Winslow
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Tomasz Jankowski
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Bogumiła Czartoryska-Arłukowicz
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Piotr J Wysocki
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Małgorzata Foszczyńska-Kłoda
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Barbara Radecka
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Maria M Litwiniuk
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Jolanta Zok
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Michał Wiśniewski
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Dorota Zuziak
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Wojciech Biernat
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
| | - Jacek Jassem
- Authors' Affiliations: Military Institute of Medicine, Warsaw; Lublin Oncology Center, Lublin; Białystok Oncology Center, Białystok; Greater Poland Cancer Center, Poznań; West Pomeranian Oncology Center, Szczecin; Opole Oncology Center, Opole; Warmia and Masuria Oncology Center, Olsztyn; Bydgoszcz Oncology Center, Bydgoszcz; Beskidy Oncology Center, Bielsko-Biała; Medical University of Gdańsk, Gdańsk, Poland; and Monogram Biosciences, Inc., South San Francisco, California
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Palmieri D, Duchnowska R, Woditschka S, Hua E, Qian Y, Biernat W, Sosińska-Mielcarek K, Gril B, Stark AM, Hewitt SM, Liewehr DJ, Steinberg SM, Jassem J, Steeg PS. Profound prevention of experimental brain metastases of breast cancer by temozolomide in an MGMT-dependent manner. Clin Cancer Res 2014; 20:2727-39. [PMID: 24634373 DOI: 10.1158/1078-0432.ccr-13-2588] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE Brain metastases of breast cancer cause neurocognitive damage and are incurable. We evaluated a role for temozolomide in the prevention of brain metastases of breast cancer in experimental brain metastasis models. EXPERIMENTAL DESIGN Temozolomide was administered in mice following earlier injection of brain-tropic HER2-positive JIMT-1-BR3 and triple-negative 231-BR-EGFP sublines, the latter with and without expression of O(6)-methylguanine-DNA methyltransferase (MGMT). In addition, the percentage of MGMT-positive tumor cells in 62 patient-matched sets of breast cancer primary tumors and resected brain metastases was determined immunohistochemically. RESULTS Temozolomide, when dosed at 50, 25, 10, or 5 mg/kg, 5 days per week, beginning 3 days after inoculation, completely prevented the formation of experimental brain metastases from MGMT-negative 231-BR-EGFP cells. At a 1 mg/kg dose, temozolomide prevented 68% of large brain metastases, and was ineffective at a dose of 0.5 mg/kg. When the 50 mg/kg dose was administered beginning on days 18 or 24, temozolomide efficacy was reduced or absent. Temozolomide was ineffective at preventing brain metastases in MGMT-transduced 231-BR-EGFP and MGMT-expressing JIMT-1-BR3 sublines. In 62 patient-matched sets of primary breast tumors and resected brain metastases, 43.5% of the specimens had concordant low MGMT expression, whereas in another 14.5% of sets high MGMT staining in the primary tumor corresponded with low staining in the brain metastasis. CONCLUSIONS Temozolomide profoundly prevented the outgrowth of experimental brain metastases of breast cancer in an MGMT-dependent manner. These data provide compelling rationale for investigating the preventive efficacy of temozolomide in a clinical setting.
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Affiliation(s)
- Diane Palmieri
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Renata Duchnowska
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Stephan Woditschka
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Emily Hua
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Yongzhen Qian
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Wojciech Biernat
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Katarzyna Sosińska-Mielcarek
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Brunilde Gril
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Andreas M Stark
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Stephen M Hewitt
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - David J Liewehr
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Seth M Steinberg
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Jacek Jassem
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, GermanyAuthors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
| | - Patricia S Steeg
- Authors' Affiliations: Women's Malignancies Branch; Laboratory of Pathology, Center for Cancer Research; Biostatistics and Data Management Section, NCI, NIH, Bethesda; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick, Maryland; Department of Oncology, Military Institute of Medicine, Warsaw; Departments of Pathomorphology, and Oncology and Radiotherapy, Medical University; Regional Cancer Center, Gdańsk, Poland; and Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany
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Duchnowska R, Sperinde J, Chenna A, Huang W, Weidler J, Winslow J, Haddad M, Paquet A, Lie Y, Trojanowski T, Mandat T, Kowalczyk A, Czartoryska-Arlukowicz B, Radecka B, Jarosz B, Staszkiewicz R, Kalinka-Warzocha E, Chudzik M, Biernat W, Jassem J. Abstract P6-11-07: Quantitative p95HER2 levels in primary breast cancers and in matched brain metastases. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-11-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: Patients with HER2-positive breast cancer are at high risk for brain metastases. A large number of HER2-positive tumors also express p95HER2 (p95), a truncated form of HER2 that lacks the trastuzumab binding site but retains kinase activity. Although p95 expression in primary breast tumors is well studied, the prevalence and significance of p95 expression in brain metastases is unknown. In the current study we examined expression of p95 in brain metastases and in matched primary breast tumors.
Methods: Seventy-five pairs of formalin-fixed paraffin-embedded samples from matched primary breast cancers and brain metastases were assayed for quantitative p95 protein expression using the p95 VeraTag® assay (Clin Cancer Res, 16:4226, 2010) specific for the M611 form of p95. Sufficient material to obtain p95 data in both primary and matched brain metastasis samples was available in 52 cases. In the remaining 23 cases, a p95 measurement was obtained in either the primary or brain metastasis sample. Estrogen (ER) and progesterone (PR) receptor status were scored using immunohistochemistry. Hormone receptor positivity was defined as either ER or PR positive. Quantitative HER2 protein expression was measured using the HERmark® assay. Both the p95 VeraTag assay and the HERmark assay measure tumor-averaged protein expression in units of relative fluorescence per mm2 tumor (RF/mm2). Measurements of p95 > 2.8 RF/mm2 and HER2 > 17.8 RF/mm2 were considered as positive results.
Results: There was a net increase in p95 expression in brain metastases relative to the matched primary tumor with a median increase of 1.5-fold (p = 0.001, range 0.2-fold to 35-fold). The increase in p95 expression was only weakly correlated with the increase in quantitative HER2 expression (R2 = 0.18; p = 0.0018). Cases with HERmark-positive tumors were more likely to have the largest (≥ 5-fold) increase in p95 expression compared to those with lower HER2 expression (odds ratio = 6.3; p = 0.018). Changes in p95 levels from primary to brain metastasis were unrelated to hormone receptor status (p = 0.59). P95 positivity in the primary tumor correlated with time from breast cancer diagnosis to first progression (HR = 2.2; p = 0.012) when stratified by hormone receptor status and tumor grade. Although there was a trend towards correlation of p95 positivity in the brain metastasis with time from diagnosis to brain metastasis (HR = 1.7; p = 0.058, stratified as above), p95 positivity did not correlate with overall survival from the time of brain metastasis diagnosis (HR = 1.3; p = 0.42, stratified as above).
Conclusions: This is the first study of quantitative p95 expression in matched primary tumors and brain metastases. Brain metastases of breast cancer show significant increases in p95 protein expression compared to matched primary tumors. These data provide a rationale for future correlative studies on p95 levels in brain metastases.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-11-07.
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Affiliation(s)
- R Duchnowska
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - J Sperinde
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - A Chenna
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - W Huang
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - J Weidler
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - J Winslow
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - M Haddad
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - A Paquet
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - Y Lie
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - T Trojanowski
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - T Mandat
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - A Kowalczyk
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - B Czartoryska-Arlukowicz
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - B Radecka
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - B Jarosz
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - R Staszkiewicz
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - E Kalinka-Warzocha
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - M Chudzik
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - W Biernat
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
| | - J Jassem
- Military Institute of Medicine, Warsaw, Poland; Monogram Biosciences, Integrated Oncology, LabCorp, South San Francisco, CA; Medical University of Lublin, Lublin, Poland; Institute of Oncology, Warsaw, Poland; Medical University of Gdansk, Gdansk, Poland; Bialystok Oncology Center, Bialystok, Poland; Opole Oncology Center, Opole, Poland; Interior Affairs Hospital, Olsztyn, Poland; Regional Oncology Center, Lodz, Poland; Oncology Center, Warsaw, Poland
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Jassem J, Duchnowska R, Hua E, Qian Y, Biernat W, Sosinska-Mielcarek K, Gril B, Stark A, Hewitt S, Liewehr DJ, Steinberg SM, Palmieri D, Steeg PS. Abstract P6-11-04: Profound prevention of experimental brain metastases of breast cancer by temozolomide in a MGMT-dependent manner. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-11-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Purpose: Brain metastases of breast cancer cause neurocognitive damage and are incurable. We evaluated in experimental brain metastasis model a role of temozolomide, an oral brain permeable alkylating agent characterized by significant uptake in the central nervous system, in the prevention of brain metastases of breast cancer.
Material and methods: To assess preventive role of temozolomide, mice were inoculated with 175,000 triple-negative 231-BR-EGFP cells in 0.1 mL PBS in the left ventricle of the heart. Three days after tumor cell inoculation, mice were randomized to temozolomide at the dose of 50 mg/kg delivered by oral gavage in saline, 5 days a week for 4 weeks, or vehicle. Subsequent experiments used temozolomide doses of 25, 10, 5, 1 and 0.5 mg/kg. To evaluate the efficacy of temozolomide in treating established BM, mice received temozolomide (50 mg/kg) beginning on either day 18 or day 24 post-injection of 231-BR-EGFR cells, 5 days a week for two and one week, respectively. To investigate the impact of temozolomide on survival, mice injected with 231-BR-EGFP cells were randomized to vehicle, temozolomide on days 3-14, or temozolomide on days 17-28 post-injection, per the schedule described above. To determine the functional contribution of MGMT expression in the BM preventive model, similar experiments were performed using 231-BR-EGFP cells with induced MGMT expression, and MGMT-positive Jimt-1 cells. Metastases were counted in step sections of one hemisphere of each brain. Additionally, the percentage of MGMT-positive tumor cells in 62 patient-matched sets of breast cancer primary tumors and resected brain metastases was determined immunohistochemically.
Results: Temozolomide, when dosed at 50, 25, 10 or 5 mg/kg, 5 days/week, beginning 3 days after inoculation, completely prevented the formation of experimental brain metastases from MGMT-negative 231-BR-EGFP cell line. At a 1 mg/kg dose, temozolomide prevented 68% of large brain metastases, and was ineffective at a dose of 0.5 mg/kg. When the 50 mg/kg dose was administered beginning on days 18 or 24, temozolomide efficacy was reduced or absent. Both schedules of temozolomide (days 3-14 and days 17-28) significantly increased survival (P = .0003 by long-rank test). Earlier administration of temozolomide resulted in long term survival of 6 and 2 out of 10 mice, respectively; a significant difference compared to vehicle (P < .0001 and .0003, respectively).Temozolomide was ineffective at preventing brain metastases in the MGMT-positive 231-BR-EGFP and Jimt-BR3 sublines. In 62 patient-matched sets of primary breast tumors and resected brain metastases 43.5% of the specimens had concordant low MGMT expression, while in another 14.5% sets high MGMT staining in the primary tumor corresponded with low staining in the brain metastasis.
Conclusions: Temozolomide profoundly prevents the outgrowth of experimental brain metastases of breast cancer in a MGMT-dependent manner. The majority of patients had low MGMT expressing brain metastases. These data provide a compelling rationale for investigating preventive efficacy of temozolomide in high-risk advanced breast cancer patients.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-11-04.
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Affiliation(s)
- J Jassem
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - R Duchnowska
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - E Hua
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - Y Qian
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - W Biernat
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - K Sosinska-Mielcarek
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - B Gril
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - A Stark
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - S Hewitt
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - DJ Liewehr
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - SM Steinberg
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - D Palmieri
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
| | - PS Steeg
- Medical University of Gdansk, Gdansk, Poland; Women's Cancers Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, NCI, NIH, Bethesda, MD; National Heart, Lung and Blood Institute, NIH, Bthesda, MD; Military Institute of Medicine, Warsaw, Poland; Regional Cancer Center, Gdansk, Poland; Laboratory Animal Sciences Program, SAIC-Frederick, NCI, NIH, Frederick; Klinik fur Neurochirurgie UKSH Campus Kiel, Kiel, Germany; Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, MD; NCI, NIH, Bethesda, MD
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Sosińska-Mielcarek K, Duchnowska R, Winczura P, Badzio A, Majewska H, Lakomy J, Pęksa R, Pieczyńska B, Radecka B, Dębska S, Biernat W, Jassem J. Immunohistochemical prediction of brain metastases in patients with advanced breast cancer: the role of Rad51. Breast 2013; 22:1178-83. [PMID: 24060578 DOI: 10.1016/j.breast.2013.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/06/2013] [Accepted: 08/30/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There are no clinically useful biomarkers predictive of brain metastases (BM) in breast cancer. In this study, we investigated the correlation between expression of selected proteins in the primary tumor and the risk of BM in patients with metastatic breast cancer (MBC). METHODS The study included 198 MBC patients (96 with and 102 without BM). Using tissue microarrays derived from the primary tumor, we assessed by immunohistochemical expression of ER, PR, HER2, Ki-67, CK5/6, EGFR, HER3, CXCR4, Rad51, E-cadherin, and claudin 3 and 4. RESULTS Ki-67 ≥14% (hazard ratio [HR] 2.76; P < 0.001), cytoplasmic expression of Rad51 (HR 1.87; P = 0.014) and ER-negativity (HR 1.72; P = 0.029) were associated with increased risk of BM in the multivariate analysis. A three-biomarker profile including ER, Ki-67 and Rad51 vs. other subtypes combined yielded an HR of 4.43 (P < 0.001). CONCLUSIONS ER-negativity, cytoplasmic expression of Rad51 and high Ki-67 are associated with increased risk of BM.
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