1
|
Khor CC, Winter S, Sutiman N, Mürdter TE, Chen S, Lim JSL, Li Z, Li J, Sim KS, Ganchev B, Eccles D, Eccles B, Tapper W, Zgheib NK, Tfayli A, Ng RCH, Yap YS, Lim E, Wong M, Wong NS, Ang PCS, Dent R, Tremmel R, Klein K, Schaeffeler E, Zhou Y, Lauschke VM, Eichelbaum M, Schwab M, Brauch HB, Chowbay B, Schroth W. Cross-Ancestry Genome-Wide Association Study Defines the Extended CYP2D6 Locus as the Principal Genetic Determinant of Endoxifen Plasma Concentrations. Clin Pharmacol Ther 2023; 113:712-723. [PMID: 36629403 DOI: 10.1002/cpt.2846] [Citation(s) in RCA: 5] [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] [Received: 10/28/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023]
Abstract
The therapeutic efficacy of tamoxifen is predominantly mediated by its active metabolites 4-hydroxy-tamoxifen and endoxifen, whose formation is catalyzed by the polymorphic cytochrome P450 2D6 (CYP2D6). Yet, known CYP2D6 polymorphisms only partially determine metabolite concentrations in vivo. We performed the first cross-ancestry genome-wide association study with well-characterized patients of European, Middle-Eastern, and Asian descent (n = 497) to identify genetic factors impacting active and parent metabolite formation. Genome-wide significant variants were functionally evaluated in an independent liver cohort (n = 149) and in silico. Metabolite prediction models were validated in two independent European breast cancer cohorts (n = 287, n = 189). Within a single 1-megabase (Mb) region of chromosome 22q13 encompassing the CYP2D6 gene, 589 variants were significantly associated with tamoxifen metabolite concentrations, particularly endoxifen and metabolic ratio (MR) endoxifen/N-desmethyltamoxifen (minimal P = 5.4E-35 and 2.5E-65, respectively). Previously suggested other loci were not confirmed. Functional analyses revealed 66% of associated, mostly intergenic variants to be significantly correlated with hepatic CYP2D6 activity or expression (ρ = 0.35 to -0.52), and six hotspot regions in the extended 22q13 locus impacting gene regulatory function. Machine learning models based on hotspot variants (n = 12) plus CYP2D6 activity score (AS) increased the explained variability (~ 9%) compared with AS alone, explaining up to 49% (median R2 ) and 72% of the variability in endoxifen and MR endoxifen/N-desmethyltamoxifen, respectively. Our findings suggest that the extended CYP2D6 locus at 22q13 is the principal genetic determinant of endoxifen plasma concentration. Long-distance haplotypes connecting CYP2D6 with adjacent regulatory sites and nongenetic factors may account for the unexplained portion of variability.
Collapse
Affiliation(s)
- Chiea Chuen Khor
- Division of Human Genetics, Genome Institute of Singapore, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Clinical Pharmacology, SingHealth, Singapore, Singapore
| | - Stefan Winter
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University Tübingen, Tübingen, Germany
| | - Natalia Sutiman
- Clinical Pharmacology Laboratory, Division of Cellular and Molecular Research, National Cancer Centre, Singapore, Singapore
| | - Thomas E Mürdter
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University Tübingen, Tübingen, Germany
| | - Sylvia Chen
- Clinical Pharmacology Laboratory, Division of Cellular and Molecular Research, National Cancer Centre, Singapore, Singapore
| | - Joanne Siok Liu Lim
- Clinical Pharmacology Laboratory, Division of Cellular and Molecular Research, National Cancer Centre, Singapore, Singapore
| | - Zheng Li
- Division of Human Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Jingmei Li
- Division of Human Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Kar Seng Sim
- Division of Human Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Boian Ganchev
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University Tübingen, Tübingen, Germany
| | - Diana Eccles
- Faculty of Medicine, Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.,University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - Bryony Eccles
- Faculty of Medicine, Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.,University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - William Tapper
- Faculty of Medicine, Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.,University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - Nathalie K Zgheib
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Arafat Tfayli
- Hematology-Oncology Division, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Elaine Lim
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Mabel Wong
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Nan Soon Wong
- OncoCare Cancer Centre, Mount Elizabeth Novena Medical Centre, Singapore, Singapore
| | - Peter Cher Siang Ang
- OncoCare Cancer Centre, Mount Elizabeth Novena Medical Centre, Singapore, Singapore
| | - Rebecca Dent
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Roman Tremmel
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University Tübingen, Tübingen, Germany
| | - Kathrin Klein
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University Tübingen, Tübingen, Germany
| | - Elke Schaeffeler
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University Tübingen, Tübingen, Germany.,Image-Guided and Functionally Instructed Tumor Therapies Cluster of Excellence (iFIT), University of Tübingen, Tübingen, Germany
| | - Yitian Zhou
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Volker M Lauschke
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University Tübingen, Tübingen, Germany.,Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Michel Eichelbaum
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University Tübingen, Tübingen, Germany
| | - Matthias Schwab
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,Image-Guided and Functionally Instructed Tumor Therapies Cluster of Excellence (iFIT), University of Tübingen, Tübingen, Germany.,Department of Clinical Pharmacology, University of Tübingen, Tübingen, Germany.,Department of Biochemistry and Pharmacy, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center, Partner Site Tübingen, Tübingen, Germany
| | - Hiltrud B Brauch
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University Tübingen, Tübingen, Germany.,Image-Guided and Functionally Instructed Tumor Therapies Cluster of Excellence (iFIT), University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center, Partner Site Tübingen, Tübingen, Germany
| | - Balram Chowbay
- Clinical Pharmacology, SingHealth, Singapore, Singapore.,Clinical Pharmacology Laboratory, Division of Cellular and Molecular Research, National Cancer Centre, Singapore, Singapore.,Centre for Clinician-Scientist Development, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Werner Schroth
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University Tübingen, Tübingen, Germany
| |
Collapse
|
2
|
Poonia S, Goel A, Chawla S, Bhattacharya N, Rai P, Lee YF, Yap YS, West J, Bhagat AA, Tayal J, Mehta A, Ahuja G, Majumdar A, Ramalingam N, Sengupta D. Marker-free characterization of full-length transcriptomes of single live circulating tumor cells. Genome Res 2023; 33:80-95. [PMID: 36414416 PMCID: PMC9977151 DOI: 10.1101/gr.276600.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
The identification and characterization of circulating tumor cells (CTCs) are important for gaining insights into the biology of metastatic cancers, monitoring disease progression, and medical management of the disease. The limiting factor in the enrichment of purified CTC populations is their sparse availability, heterogeneity, and altered phenotypes relative to the primary tumor. Intensive research both at the technical and molecular fronts led to the development of assays that ease CTC detection and identification from peripheral blood. Most CTC detection methods based on single-cell RNA sequencing (scRNA-seq) use a mix of size selection, marker-based white blood cell (WBC) depletion, and antibodies targeting tumor-associated antigens. However, the majority of these methods either miss out on atypical CTCs or suffer from WBC contamination. We present unCTC, an R package for unbiased identification and characterization of CTCs from single-cell transcriptomic data. unCTC features many standard and novel computational and statistical modules for various analyses. These include a novel method of scRNA-seq clustering, named deep dictionary learning using k-means clustering cost (DDLK), expression-based copy number variation (CNV) inference, and combinatorial, marker-based verification of the malignant phenotypes. DDLK enables robust segregation of CTCs and WBCs in the pathway space, as opposed to the gene expression space. We validated the utility of unCTC on scRNA-seq profiles of breast CTCs from six patients, captured and profiled using an integrated ClearCell FX and Polaris workflow that works by the principles of size-based separation of CTCs and marker-based WBC depletion.
Collapse
Affiliation(s)
- Sarita Poonia
- Department of Computational Biology, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India
| | - Anurag Goel
- Department of Computer Science and Engineering, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India;,Department of Computer Science and Engineering, Delhi Technological University, New Delhi 110042, India
| | - Smriti Chawla
- Department of Computational Biology, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India
| | - Namrata Bhattacharya
- Department of Computer Science and Engineering, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India
| | - Priyadarshini Rai
- Department of Computational Biology, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India
| | - Yi Fang Lee
- Biolidics Limited, Singapore 118257, Singapore
| | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Jay West
- Fluidigm Corporation, South San Francisco, California 94080, USA
| | | | - Juhi Tayal
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre-Delhi (RGCIRC-Delhi), New Delhi 110085, India
| | - Anurag Mehta
- Department of Laboratory Services and Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre-Delhi (RGCIRC-Delhi), New Delhi 110085, India
| | - Gaurav Ahuja
- Department of Computational Biology, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India
| | - Angshul Majumdar
- Department of Computer Science and Engineering, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India;,Centre for Artificial Intelligence, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India;,Department of Electronics & Communications Engineering, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India
| | | | - Debarka Sengupta
- Department of Computational Biology, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India;,Department of Computer Science and Engineering, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India;,Centre for Artificial Intelligence, Indraprastha Institute of Information Technology-Delhi (IIIT-Delhi), New Delhi 110020, India
| |
Collapse
|
3
|
Isaac S, Pasha MA, Yap YS, Chan J. Isolated Facial Nerve Palsy Due to Temporal Bone Metastasis. Cureus 2022; 14:e26931. [PMID: 35865180 PMCID: PMC9293256 DOI: 10.7759/cureus.26931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 11/05/2022] Open
|
4
|
Tan AC, Tan TJY, Saw SPL, Lam JYC, Yap YS, Lim WT, Tai DWM, Ng MCH, Tan DSW. Trials without borders – decentralized trials and ensuring access to novel cancer therapies during a global pandemic. ESMO Open 2022; 7:100537. [PMID: 35868220 PMCID: PMC9247261 DOI: 10.1016/j.esmoop.2022.100537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- A C Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - T J Y Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - S P L Saw
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - J Y C Lam
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Y S Yap
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - W-T Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - D W M Tai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - M C H Ng
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - D S W Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
| |
Collapse
|
5
|
Loo SY, Toh LP, Xie WH, Pathak E, Tan W, Ma S, Lee MY, Shatishwaran S, Yeo JZZ, Yuan J, Ho YY, Peh EKL, Muniandy M, Torta F, Chan J, Tan TJ, Sim Y, Tan V, Tan B, Madhukumar P, Yong WS, Ong KW, Wong CY, Tan PH, Yap YS, Deng LW, Dent R, Foo R, Wenk MR, Lee SC, Ho YS, Lim EH, Tam WL. Fatty acid oxidation is a druggable gateway regulating cellular plasticity for driving metastasis in breast cancer. Sci Adv 2021; 7:eabh2443. [PMID: 34613780 PMCID: PMC8494440 DOI: 10.1126/sciadv.abh2443] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Cell state transitions control the functional behavior of cancer cells. Epithelial-to-mesenchymal transition (EMT) confers cancer stem cell-like properties, enhanced tumorigenicity and drug resistance to tumor cells, while mesenchymal-epithelial transition (MET) reverses these phenotypes. Using high-throughput chemical library screens, retinoids are found to be potent promoters of MET that inhibit tumorigenicity in basal-like breast cancer. Cell state transitions are defined by reprogramming of lipid metabolism. Retinoids bind cognate nuclear receptors, which target lipid metabolism genes, thereby redirecting fatty acids for β-oxidation in the mesenchymal cell state towards lipid storage in the epithelial cell state. Disruptions of key metabolic enzymes mediating this flux inhibit MET. Conversely, perturbations to fatty acid oxidation (FAO) rechannel fatty acid flux and promote a more epithelial cell phenotype, blocking EMT-driven breast cancer metastasis in animal models. FAO impinges on the epigenetic control of EMT through acetyl-CoA-dependent regulation of histone acetylation on EMT genes, thus determining cell states.
Collapse
Affiliation(s)
- Ser Yue Loo
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
| | - Li Ping Toh
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore 117597, Singapore
| | - William Haowei Xie
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
| | - Elina Pathak
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
| | - Wilson Tan
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
| | - Siming Ma
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
| | - May Yin Lee
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
| | - S. Shatishwaran
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
| | - Joanna Zhen Zhen Yeo
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore
| | - Ju Yuan
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
| | - Yin Ying Ho
- Bioprocessing Technology Institute, Agency for Science, Technology and Research (A*STAR), 20 Biopolis Way, Singapore 138668, Singapore
| | - Esther Kai Lay Peh
- Bioprocessing Technology Institute, Agency for Science, Technology and Research (A*STAR), 20 Biopolis Way, Singapore 138668, Singapore
| | - Magendran Muniandy
- Singapore Lipidomics Incubator, Life Sciences Institute, National University of Singapore, 28 Medical Drive, Singapore 117456, Singapore
| | - Federico Torta
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore 117597, Singapore
- Singapore Lipidomics Incubator, Life Sciences Institute, National University of Singapore, 28 Medical Drive, Singapore 117456, Singapore
- Precision Medicine Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore 117597, Singapore
| | - Jack Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Tira J. Tan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Yirong Sim
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Veronique Tan
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Benita Tan
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Preetha Madhukumar
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Wei Sean Yong
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Kong Wee Ong
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Chow Yin Wong
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, 20 College Rd., Singapore 169856, Singapore
| | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Lih-Wen Deng
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore 117597, Singapore
| | - Rebecca Dent
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Roger Foo
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
| | - Markus R. Wenk
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore 117597, Singapore
- Singapore Lipidomics Incubator, Life Sciences Institute, National University of Singapore, 28 Medical Drive, Singapore 117456, Singapore
- Precision Medicine Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore 117597, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore 117599, Singapore
| | - Ying Swan Ho
- Bioprocessing Technology Institute, Agency for Science, Technology and Research (A*STAR), 20 Biopolis Way, Singapore 138668, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
- Corresponding author. (E.H.L.); (W.L.T.)
| | - Wai Leong Tam
- Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore 138672, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore 117597, Singapore
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, Singapore 117599, Singapore
- NUS Center for Cancer Research, Yong Loo Lin School of Medicine, National University Singapore, 14 Medical Drive, Singapore 117599, Singapore
- Corresponding author. (E.H.L.); (W.L.T.)
| |
Collapse
|
6
|
Dai MS, Feng YH, Chen SW, Masuda N, Yau T, Chen ST, Lu YS, Yap YS, Ang PCS, Chu SC, Kwong A, Lee KS, Ow S, Kim SB, Lin J, Chung HC, Ngan R, Kok VC, Rau KM, Sangai T, Ng TY, Tseng LM, Bryce R, Bebchuk J, Chen MC, Hou MF. Analysis of the pan-Asian subgroup of patients in the NALA Trial: a randomized phase III NALA Trial comparing neratinib+capecitabine (N+C) vs lapatinib+capecitabine (L+C) in patients with HER2+metastatic breast cancer (mBC) previously treated with two or more HER2-directed regimens. Breast Cancer Res Treat 2021; 189:665-676. [PMID: 34553296 PMCID: PMC8505315 DOI: 10.1007/s10549-021-06313-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/08/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Neratinib, an irreversible pan-HER tyrosine kinase inhibitor, has demonstrated systemic efficacy and intracranial activity in various stages of HER2+breast cancer. NALA was a phase III randomized trial that assessed the efficacy and safety of neratinib+capecitabine (N+C) against lapatinib+capecitabine (L+C) in HER2+ metastatic breast cancer (mBC) patients who had received ≥ 2 HER2-directed regimens. Descriptive analysis results of the Asian subgroup in the NALA study are reported herein. METHODS 621 centrally assessed HER2+ mBC patients were enrolled, 202 of whom were Asian. Those with stable, asymptomatic brain metastases (BM) were eligible for study entry. Patients were randomized 1:1 to N (240 mg qd) + C (750 mg/m2 bid, day 1-14) with loperamide prophylaxis or to L (1250 mg qd) + C (1000 mg/m2 bid, day 1-14) in 21-day cycles. Co-primary endpoints were centrally assessed progression-free survival (PFS) and overall survival (OS). Secondary endpoints included time to intervention for central nervous system (CNS) disease, objective response rate, duration of response (DoR), clinical benefit rate, and safety. RESULTS 104 and 98 Asian patients were randomly assigned to receive N+C or L+C, respectively. Median PFS of N+C and L+C was 7.0 and 5.4 months (P = 0.0011), respectively. Overall cumulative incidence of intervention for CNS disease was lower with N+C (27.9 versus 33.8%; P = 0.039). Both median OS (23.8 versus 18.7 months; P = 0.185) and DoR (11.1 versus 4.2 months; P < 0.0001) were extended with N+C, compared to L+C. The incidences of grade 3/4 treatment emergent adverse events (TEAEs) and TEAEs leading to treatment discontinuation were mostly comparable between the two arms. Diarrhea and palmar-plantar erythrodysesthesia were the most frequent TEAEs in both arms, similar to the overall population in incidence and severity. CONCLUSION Consistent with the efficacy profile observed in the overall study population, Asian patients with HER2+ mBC, who had received ≥ 2 HER2-directed regimens, may also benefit from N+C. No new safety signals were noted. CLINICAL TRIAL REGISTRATION NCT01808573.
Collapse
Affiliation(s)
- Ming Shen Dai
- Department of Hematology-Oncology, Tri-Service General Hospital, Taipei, Taiwan
| | - Yin Hsun Feng
- Department of Hematology-Oncology, Chi Mei Medical Center-Yongkang Branch, Tainan, Taiwan
| | - Shang Wen Chen
- Department of Hematology-Oncology, Chi Mei Medical Center-LiouYing Branch, Tainan, Taiwan
| | - Norikazu Masuda
- Department of Surgery and Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Thomas Yau
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shou Tung Chen
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yen Shen Lu
- Division of Medical Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yoon Sim Yap
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Peter C S Ang
- Department of Medical Oncology, OncoCare Cancer Centre, Singapore, Singapore
| | - Sung Chao Chu
- Department of Hematology-Oncology, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Ava Kwong
- Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - Keun Seok Lee
- Center for Breast Cancer, National Cancer Center, Goyang-si, South Korea
| | - Samuel Ow
- Department of Haematology and Oncology, National University Cancer Institute, Singapore, Singapore
| | - Sung Bae Kim
- Department of Oncology, Asan Medical Center, Seoul, South Korea
| | - Johnson Lin
- Department of Hematology-Oncology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hyun Cheol Chung
- Department of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Roger Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Victor C Kok
- Division of Medical Oncology, Kuang Tien General Hospital Cancer Center, Taichung, Taiwan
| | - Kun Ming Rau
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Takafumi Sangai
- Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ting Ying Ng
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Ling Ming Tseng
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Judith Bebchuk
- Department of Biostatistics, Puma Biotechnology Inc., Los Angeles, USA
| | - Mei Chieh Chen
- Clinical Development and Medical Affairs, CANbridge Pharmaceuticals Inc., Taipei, Taiwan
| | - Ming Feng Hou
- Division of Breast Oncology and Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.
| |
Collapse
|
7
|
Kong SL, Liu X, Tan SJ, Tai JA, Phua LY, Poh HM, Yeo T, Chua YW, Haw YX, Ling WH, Ng RCH, Tan TJ, Loh KWJ, Tan DSW, Ng QS, Ang MK, Toh CK, Lee YF, Lim CT, Lim TKH, Hillmer AM, Yap YS, Lim WT. Complementary Sequential Circulating Tumor Cell (CTC) and Cell-Free Tumor DNA (ctDNA) Profiling Reveals Metastatic Heterogeneity and Genomic Changes in Lung Cancer and Breast Cancer. Front Oncol 2021; 11:698551. [PMID: 34336686 PMCID: PMC8322849 DOI: 10.3389/fonc.2021.698551] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/21/2021] [Accepted: 06/30/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction Circulating tumor cells (CTCs) and cell-free tumor DNA (ctDNA) are tumor components present in circulation. Due to the limited access to both CTC enrichment platforms and ctDNA sequencing in most laboratories, they are rarely analyzed together. Methods Concurrent isolation of ctDNA and single CTCs were isolated from lung cancer and breast cancer patients using the combination of size-based and CD45-negative selection method via DropCell platform. We performed targeted amplicon sequencing to evaluate the genomic heterogeneity of CTCs and ctDNA in lung cancer and breast cancer patients. Results Higher degrees of genomic heterogeneity were observed in CTCs as compared to ctDNA. Several shared alterations present in CTCs and ctDNA were undetected in the primary tumor, highlighting the intra-tumoral heterogeneity of tumor components that were shed into systemic circulation. Accordingly, CTCs and ctDNA displayed higher degree of concordance with the metastatic tumor than the primary tumor. The alterations detected in circulation correlated with worse survival outcome for both lung and breast cancer patients emphasizing the impact of the metastatic phenotype. Notably, evolving genetic signatures were detected in the CTCs and ctDNA samples during the course of treatment and disease progression. Conclusions A standardized sample processing and data analysis workflow for concurrent analysis of CTCs and ctDNA successfully dissected the heterogeneity of metastatic tumor in circulation as well as the progressive genomic changes that may potentially guide the selection of appropriate therapy against evolving tumor clonality.
Collapse
Affiliation(s)
- Say Li Kong
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Xingliang Liu
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Swee Jin Tan
- Clearbridge mFluidics Pte Ltd, Singapore, Singapore
| | - Joyce A Tai
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Ler Yee Phua
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Huay Mei Poh
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Trifanny Yeo
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Yong Wei Chua
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Yu Xuan Haw
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Wen Huan Ling
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore
| | - Raymond Chee Hui Ng
- Division of Medical Oncology, National Cancer Center, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Tira J Tan
- Division of Medical Oncology, National Cancer Center, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Kiley Wei Jen Loh
- Division of Medical Oncology, National Cancer Center, Singapore, Singapore
| | | | - Quan Sing Ng
- Division of Medical Oncology, National Cancer Center, Singapore, Singapore
| | - Mei Kim Ang
- Division of Medical Oncology, National Cancer Center, Singapore, Singapore
| | - Chee Keong Toh
- Division of Medical Oncology, National Cancer Center, Singapore, Singapore
| | | | - Chwee Teck Lim
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Tony Kiat Hon Lim
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Axel M Hillmer
- Cancer Therapeutics and Stratified Oncology, Genome Institute of Singapore, Singapore, Singapore.,Institute of Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Center, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Wan-Teck Lim
- Division of Medical Oncology, National Cancer Center, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,IMCB-NCCS-MP Singapore OncoGenome Laboratory, Institute of Molecular and Cell Biology, Singapore, Singapore
| |
Collapse
|
8
|
Zhu G, Guo YA, Ho D, Poon P, Poh ZW, Wong PM, Gan A, Chang MM, Kleftogiannis D, Lau YT, Tay B, Lim WJ, Chua C, Tan TJ, Koo SL, Chong DQ, Yap YS, Tan I, Ng S, Skanderup AJ. Tissue-specific cell-free DNA degradation quantifies circulating tumor DNA burden. Nat Commun 2021; 12:2229. [PMID: 33850132 PMCID: PMC8044092 DOI: 10.1038/s41467-021-22463-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 05/10/2020] [Accepted: 03/11/2021] [Indexed: 02/08/2023] Open
Abstract
Profiling of circulating tumor DNA (ctDNA) may offer a non-invasive approach to monitor disease progression. Here, we develop a quantitative method, exploiting local tissue-specific cell-free DNA (cfDNA) degradation patterns, that accurately estimates ctDNA burden independent of genomic aberrations. Nucleosome-dependent cfDNA degradation at promoters and first exon-intron junctions is strongly associated with differential transcriptional activity in tumors and blood. A quantitative model, based on just 6 regulatory regions, could accurately predict ctDNA levels in colorectal cancer patients. Strikingly, a model restricted to blood-specific regulatory regions could predict ctDNA levels across both colorectal and breast cancer patients. Using compact targeted sequencing (<25 kb) of predictive regions, we demonstrate how the approach could enable quantitative low-cost tracking of ctDNA dynamics and disease progression. Circulating tumour DNA (ctDNA) represents a non-invasive option to monitor cancer progression. Here, the authors perform deep sequencing of plasma cell-free DNA, and find that nucleosome-dependent cfDNA degradation at 6 specific regulatory regions is predictive of ctDNA burden.
Collapse
Affiliation(s)
- Guanhua Zhu
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore
| | - Yu A Guo
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore
| | - Danliang Ho
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore
| | - Polly Poon
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore
| | - Zhong Wee Poh
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore
| | - Pui Mun Wong
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore
| | - Anna Gan
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore
| | - Mei Mei Chang
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore
| | | | - Yi Ting Lau
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore
| | - Brenda Tay
- National Cancer Center Singapore, Singapore, Singapore
| | - Wan Jun Lim
- National Cancer Center Singapore, Singapore, Singapore
| | - Clarinda Chua
- National Cancer Center Singapore, Singapore, Singapore
| | - Tira J Tan
- National Cancer Center Singapore, Singapore, Singapore
| | - Si-Lin Koo
- National Cancer Center Singapore, Singapore, Singapore
| | - Dawn Q Chong
- National Cancer Center Singapore, Singapore, Singapore
| | - Yoon Sim Yap
- National Cancer Center Singapore, Singapore, Singapore
| | - Iain Tan
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore. .,National Cancer Center Singapore, Singapore, Singapore. .,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
| | - Sarah Ng
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore.
| | - Anders J Skanderup
- Genome Institute of Singapore (GIS), A*STAR, Singapore, Singapore. .,National Cancer Center Singapore, Singapore, Singapore.
| |
Collapse
|
9
|
Shang M, Lim SB, Jiang K, Yap YS, Khoo BL, Han J, Lim CT. Microfluidic studies of hydrostatic pressure-enhanced doxorubicin resistance in human breast cancer cells. Lab Chip 2021; 21:746-754. [PMID: 33502419 DOI: 10.1039/d0lc01103g] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Acquired multidrug resistance in tumors is a big challenge in cancer therapy. As an important physical stimulus in the tumor microenvironment, elevated interstitial fluid pressure has been reported to inhibit drug delivery and promote metastasis in solid tumors. However, the direct influence of this fluid pressure on anticancer drug resistance remains unclear. Here, we develop a pressurized in vitro circulating tumor cell (CTC) culture platform for anticancer drug screening. By using human breast cancer cell line MCF-7 and MDA-MB-231, we find that doxorubicin resistance can be increased by up to 2.5 times under 30 mmHg culture condition, through ABCC1 overexpression that reduces intracellular doxorubicin concentration. A similar chemoresistance change is also observed in clinical metastatic circulating tumor cells samples. These findings provide a new insight into the chemoresistance mechanism of metastatic human breast cancer cells and elucidate the significance of abnormal hydrostatic pressure in cancer progression.
Collapse
Affiliation(s)
- Menglin Shang
- Critical Analytics for Manufacturing Personalized-Medicine (CAMP) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore and Department of Biomedical Engineering, National University of Singapore, Singapore.
| | - Su Bin Lim
- The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kuan Jiang
- Department of Biomedical Engineering, National University of Singapore, Singapore.
| | - Yoon Sim Yap
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Bee Luan Khoo
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong
| | - Jongyoon Han
- Critical Analytics for Manufacturing Personalized-Medicine (CAMP) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore and Department of Electrical Engineering and Computer Science, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA and Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Chwee Teck Lim
- Critical Analytics for Manufacturing Personalized-Medicine (CAMP) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore and Department of Biomedical Engineering, National University of Singapore, Singapore. and Institute for Health Innovation and Technology, 14 Medical Drive, Singapore and Mechanobiology Institute, National University of Singapore, Singapore
| |
Collapse
|
10
|
Iyer A, Gupta K, Sharma S, Hari K, Lee YF, Ramalingam N, Yap YS, West J, Bhagat AA, Subramani BV, Sabuwala B, Zea Tan T, Thiery JP, Jolly MK, Ramalingam N, Sengupta D. Erratum: Iyer, A., et al. Integrative Analysis and Machine Learning Based Characterization of Single Circulating Tumor Cells. J. Clin. Med. 2020, 9, 1206. J Clin Med 2021; 10:jcm10020370. [PMID: 33478182 PMCID: PMC7844618 DOI: 10.3390/jcm10020370] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Arvind Iyer
- Department of Computational Biology, Indraprastha Institute of Information Technology, New Delhi 110020, India;
| | - Krishan Gupta
- Department of Computer Science and Engineering Indraprastha Institute of Information Technology, New Delhi 110020, India; (K.G.); (S.S.)
| | - Shreya Sharma
- Department of Computer Science and Engineering Indraprastha Institute of Information Technology, New Delhi 110020, India; (K.G.); (S.S.)
| | - Kishore Hari
- Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India; (K.H.); (M.K.J.)
| | - Yi Fang Lee
- Biolidics Limited, 81 Science Park Drive, 02-03 The Chadwick, Singapore 118257, Singapore; (Y.F.L.); (A.A.B.)
| | - Neevan Ramalingam
- Qualcomm Incorporated, 5775 Morehouse Drive, San Diego, CA 92121, USA;
| | - Yoon Sim Yap
- National Cancer Centre, 11 Hospital Dr, Singapore 169610, Singapore;
| | - Jay West
- Fluidigm Corporation, 2 Tower Place, Suite 2000, South San Francisco, CA 94080, USA;
| | - Ali Asgar Bhagat
- Biolidics Limited, 81 Science Park Drive, 02-03 The Chadwick, Singapore 118257, Singapore; (Y.F.L.); (A.A.B.)
| | - Balaram Vishnu Subramani
- School of Mathematics, Indian Institute of Science Education and Research, Thiruvananthapuram 695551, India;
| | - Burhanuddin Sabuwala
- Department of Biotechnology, Indian Institute of Technology Madras, Chennai 600036, India;
| | - Tuan Zea Tan
- Cancer Science Institute of Singapore, National University of Singapore, Center for Translational Medicine, Singapore 117599, Singapore;
| | - Jean Paul Thiery
- Guangzhou Regenerative Medicine and Health; Guangdong laboratory, Guangzhou 510530, China;
| | - Mohit Kumar Jolly
- Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India; (K.H.); (M.K.J.)
| | - Naveen Ramalingam
- Fluidigm Corporation, 2 Tower Place, Suite 2000, South San Francisco, CA 94080, USA;
- Correspondence: (N.R.); (D.S.)
| | - Debarka Sengupta
- Department of Computational Biology, Indraprastha Institute of Information Technology, New Delhi 110020, India;
- Department of Computer Science and Engineering Indraprastha Institute of Information Technology, New Delhi 110020, India; (K.G.); (S.S.)
- Center for Artificial Intelligence, Indraprastha Institute of Information Technology, New Delhi 110020, India
- Correspondence: (N.R.); (D.S.)
| |
Collapse
|
11
|
Ng DQ, Tan CJ, Soh BC, Tan MML, Loh SY, Tan YE, Ong HH, Teng PPC, Chan JJ, Chay WY, Lee J, Lai G, Beh SY, Tan TJY, Yap YS, Lee GE, Wong M, Dent R, Lo YL, Chan A, Loh KWJ. Impact of Cryotherapy on Sensory, Motor, and Autonomic Neuropathy in Breast Cancer Patients Receiving Paclitaxel: A Randomized, Controlled Trial. Front Neurol 2020; 11:604688. [PMID: 33424755 PMCID: PMC7793726 DOI: 10.3389/fneur.2020.604688] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/29/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: We conducted a randomized controlled trial evaluating the efficacy and tolerability of cryotherapy in preventing chemotherapy-induced peripheral neuropathy (CIPN) in patients with early breast cancer receiving neo/adjuvant weekly paclitaxel. Methods: Patients were recruited from the National Cancer Centre Singapore and randomized (1:1) to receive either cryotherapy or usual care. Cryotherapy was applied as frozen gloves and socks on all extremities from 15 min before paclitaxel until 15 min post-infusion every cycle. Efficacy was measured by patient-reported outcomes (Patient Neurotoxicity Questionnaire [PNQ] and EORTC QLQ-CIPN20) and electrophysiological assessments. The primary endpoint was PNQ severity at 2 weeks after 12 cycles of weekly paclitaxel. Results: A total of 46 patients were recruited, of which 8 dropped out before paclitaxel treatment, leaving 38 evaluable. There was no significant difference in PNQ severity between cryotherapy and usual care at 2 weeks after paclitaxel treatment (sensory: p = 0.721; motor: p = 1.000). A benefit was observed at 3 months post-paclitaxel based on PNQ (sensory: 14.3 vs. 41.2%, p = 0.078; motor: 0 vs. 29.4%, p = 0.012) and CIPN20 (sensory: β = −3.6, 95%CI = −10.5–3.4, p = 0.308; motor: β = −7.3, 95%CI = −14.6–0, p = 0.051). Additionally, cryotherapy subjects have lower CIPN20 autonomic score (β = −5.84, 95%CI = −11.15 to −0.524, p = 0.031) and higher sympathetic skin response hand amplitudes (β = 0.544, 95%CI = 0.108–0.98, p = 0.014), suggesting possible autonomic benefits from cryotherapy. Temporary interruption with cryotherapy occurred in 80.9% of the subjects due to cold intolerance. Conclusions: There is insufficient evidence that cryotherapy prevents sensory neuropathy which may be due to the high rates of cryotherapy interruption in this study. The autonomic benefits of cryotherapy should be further investigated with appropriate outcome measures. Clinical Trial Registration:ClinicalTrials.gov: NCT03429972.
Collapse
Affiliation(s)
- Ding Quan Ng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore.,Department of Clinical Pharmacy Practice, University of California, Irvine, Irvine, CA, United States
| | - Chia Jie Tan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Boon Chua Soh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mabel May Leng Tan
- Division of Nursing, National Cancer Centre Singapore, Singapore, Singapore
| | - Soon Yue Loh
- Division of Nursing, National Cancer Centre Singapore, Singapore, Singapore
| | - Yam Eng Tan
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | - Hui Hui Ong
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | | | - Jack Junjie Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Joycelyn Lee
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Gillianne Lai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Sok Yuen Beh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Tira Jing Ying Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Guek Eng Lee
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mabel Wong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Rebecca Dent
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Yew Long Lo
- Department of Neurology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,National Neuroscience Institute, Singapore, Singapore
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, University of California, Irvine, Irvine, CA, United States.,Duke-NUS Medical School, Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Kiley Wei-Jen Loh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
12
|
Saura C, Oliveira M, Feng YH, Dai MS, Chen SW, Hurvitz SA, Kim SB, Moy B, Delaloge S, Gradishar W, Masuda N, Palacova M, Trudeau ME, Mattson J, Yap YS, Hou MF, De Laurentiis M, Yeh YM, Chang HT, Yau T, Wildiers H, Haley B, Fagnani D, Lu YS, Crown J, Lin J, Takahashi M, Takano T, Yamaguchi M, Fujii T, Yao B, Bebchuk J, Keyvanjah K, Bryce R, Brufsky A. Neratinib Plus Capecitabine Versus Lapatinib Plus Capecitabine in HER2-Positive Metastatic Breast Cancer Previously Treated With ≥ 2 HER2-Directed Regimens: Phase III NALA Trial. J Clin Oncol 2020; 38:3138-3149. [PMID: 32678716 PMCID: PMC7499616 DOI: 10.1200/jco.20.00147] [Citation(s) in RCA: 323] [Impact Index Per Article: 80.8] [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] [Indexed: 01/15/2023] Open
Abstract
PURPOSE NALA (ClinicalTrials.gov identifier: NCT01808573) is a randomized, active-controlled, phase III trial comparing neratinib, an irreversible pan-HER tyrosine kinase inhibitor (TKI), plus capecitabine (N+C) against lapatinib, a reversible dual TKI, plus capecitabine (L+C) in patients with centrally confirmed HER2-positive, metastatic breast cancer (MBC) with ≥ 2 previous HER2-directed MBC regimens. METHODS Patients, including those with stable, asymptomatic CNS disease, were randomly assigned 1:1 to neratinib (240 mg once every day) plus capecitabine (750 mg/m2 twice a day 14 d/21 d) with loperamide prophylaxis, or to lapatinib (1,250 mg once every day) plus capecitabine (1,000 mg/m2 twice a day 14 d/21 d). Coprimary end points were centrally confirmed progression-free survival (PFS) and overall survival (OS). NALA was considered positive if either primary end point was met (α split between end points). Secondary end points were time to CNS disease intervention, investigator-assessed PFS, objective response rate (ORR), duration of response (DoR), clinical benefit rate, safety, and health-related quality of life (HRQoL). RESULTS A total of 621 patients from 28 countries were randomly assigned (N+C, n = 307; L+C, n = 314). Centrally reviewed PFS was improved with N+C (hazard ratio [HR], 0.76; 95% CI, 0.63 to 0.93; stratified log-rank P = .0059). The OS HR was 0.88 (95% CI, 0.72 to 1.07; P = .2098). Fewer interventions for CNS disease occurred with N+C versus L+C (cumulative incidence, 22.8% v 29.2%; P = .043). ORRs were N+C 32.8% (95% CI, 27.1 to 38.9) and L+C 26.7% (95% CI, 21.5 to 32.4; P = .1201); median DoR was 8.5 versus 5.6 months, respectively (HR, 0.50; 95% CI, 0.33 to 0.74; P = .0004). The most common all-grade adverse events were diarrhea (N+C 83% v L+C 66%) and nausea (53% v 42%). Discontinuation rates and HRQoL were similar between groups. CONCLUSION N+C significantly improved PFS and time to intervention for CNS disease versus L+C. No new N+C safety signals were observed.
Collapse
Affiliation(s)
- Cristina Saura
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), SOLTI Breast Cancer Cooperative Group, Barcelona, Spain
| | - Mafalda Oliveira
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), SOLTI Breast Cancer Cooperative Group, Barcelona, Spain
| | - Yin-Hsun Feng
- Chi Mei Medical Centre, Liouying, Tainan, Taiwan and Tri-Service General Hospital, Taipei, Taiwan
| | - Ming-Shen Dai
- Chi Mei Medical Centre, Liouying, Tainan, Taiwan and Tri-Service General Hospital, Taipei, Taiwan
| | - Shang-Wen Chen
- Chi Mei Medical Centre, Liouying, Tainan, Taiwan and Tri-Service General Hospital, Taipei, Taiwan
| | - Sara A Hurvitz
- University of California Los Angeles/Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Sung-Bae Kim
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - William Gradishar
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Norikazu Masuda
- National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | | | | | - Johanna Mattson
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | | | - Ming-Feng Hou
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | - Yu-Min Yeh
- National Cheng Kung University, Tainan, Taiwan
| | | | - Thomas Yau
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Hans Wildiers
- University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | | | | | - Yen-Shen Lu
- National Taiwan University Hospital, Taipei City, Taiwan
| | - John Crown
- St Vincent's University Hospital, Dublin, Ireland
| | | | - Masato Takahashi
- National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | | | - Miki Yamaguchi
- Department of Breast Surgery, JCHO Kurume General Hospital, Kurume, Japan
| | - Takaaki Fujii
- Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Bin Yao
- Puma Biotechnology, Los Angeles, CA
| | | | | | | | | | | |
Collapse
|
13
|
Lin CH, Yap YS, Lee KH, Im SA, Naito Y, Yeo W, Ueno T, Kwong A, Li H, Huang SM, Leung R, Han W, Tan B, Hu FC, Huang CS, Cheng AL, Lu YS. Contrasting Epidemiology and Clinicopathology of Female Breast Cancer in Asians vs the US Population. J Natl Cancer Inst 2020; 111:1298-1306. [PMID: 31093668 DOI: 10.1093/jnci/djz090] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/29/2019] [Accepted: 05/06/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The incidence of breast cancer among younger East Asian women has been increasing rapidly over recent decades. This international collaborative study systemically compared the differences in age-specific incidences and pathological characteristics of breast cancer in East Asian women and women of predominantly European ancestry. METHODS We excerpted analytic data from six national cancer registries (979 675 cases) and eight hospitals (18 008 cases) in East Asian countries and/or regions and, for comparisons, from the US Surveillance, Epidemiology, and End Results program database. Linear regression analyses of age-specific incidences of female breast cancer and logistic regression analyses of age-specific pathological characteristics of breast cancer were performed. All statistical tests were two-sided. RESULTS Unlike female colorectal cancer, the age-specific incidences of breast cancer among East Asian women aged 59 years and younger increased disproportionally over recent decades relative to rates in US contemporaries. For years 2010-2014, the estimated age-specific probability of estrogen receptor positivity increased with age in American patients, whereas that of triple-negative breast cancer (TNBC) declined with age. No similar trends were evident in East Asian patients; their probability of estrogen receptor positivity at age 40-49 years was statistically significantly higher (odd ratio [OR] = 1.50, 95% confidence interval [CI] = 1.36 to 1.67, P < .001) and of TNBC was statistically significantly lower (OR = 0.79, 95% CI = 0.71 to 0.88, P < .001), whereas the probability of ER positivity at age 50-59 years was statistically significantly lower (OR = 0.88, 95% CI = 0.828 to 0.95, P < .001). Subgroup analyses of US Surveillance, Epidemiology, and End Results data showed similarly distinct patterns between East Asian American and white American patients. CONCLUSIONS Contrasting age-specific incidences and pathological characteristics of breast cancer between East Asian and American women, as well as between East Asian Americans and white Americans, suggests racial differences in the biology.
Collapse
|
14
|
Lee SC, Shimasaki N, Lim JSJ, Wong A, Yadav K, Yong WP, Tan LK, Koh LP, Poon MLM, Tan SH, Ow SGW, Bharwani L, Yap YS, Foo MZQ, Coustan-Smith E, Sundar R, Tan HL, Chong WQ, Kumarakulasinghe NB, Lieow JLM, Koe PJX, Goh BC, Campana D. Phase I Trial of Expanded, Activated Autologous NK-cell Infusions with Trastuzumab in Patients with HER2-positive Cancers. Clin Cancer Res 2020; 26:4494-4502. [PMID: 32522887 DOI: 10.1158/1078-0432.ccr-20-0768] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/30/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Natural killer (NK) cells exert antibody-dependent cell cytotoxicity (ADCC). We infused expanded, activated autologous NK cells to potentiate trastuzumab-mediated ADCC in patients with HER2-positive malignancies. PATIENTS AND METHODS In a phase I trial, patients with treatment-refractory HER2-positive solid tumors received trastuzumab, with or without bevacizumab, and autologous NK cells expanded by 10-day coculture with K562-mb15-41BBL cells. Primary objectives included safety and recommended phase II dose determination; secondary objectives included monitoring NK-cell activity and RECIST antitumor efficacy. RESULTS In 60 cultures with cells from 31 subjects, median NK-cell expansion from peripheral blood was 340-fold (range, 91-603). NK cells expressed high levels of CD16, the mediator of ADCC, and exerted powerful killing of trastuzumab-targeted cells. In the 22 subjects enrolled in phase I dose escalation, trastuzumab plus NK cells were well tolerated; MTD was not reached. Phase IB (n = 9) included multiple cycles of NK cells (1 × 107/kg) and addition of bevacizumab. Although no objective response was observed, 6 of 19 subjects who received at least 1 × 107/kg NK cells at cycle 1 had stable disease for ≥6 months (median, 8.8 months; range 6.0-12.0). One patient, the only one with the high-affinity F158V CD16 variant, had a partial response. Peripheral blood NK cells progressively downregulated CD16 postinfusion; paired tumor biopsies showed increased NK cells, lymphocytic infiltrates, and apoptosis posttreatment. CONCLUSIONS NK-cell therapy in combination with trastuzumab was well tolerated, with target engagement and preliminary antitumor activity, supporting continued assessment of this approach in phase II trials.
Collapse
Affiliation(s)
- Soo-Chin Lee
- Department of Hematology-Oncology, National University Cancer Institute, Singapore. .,Experimental Therapeutics Programme, Cancer Science Institute, Singapore
| | - Noriko Shimasaki
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joline S J Lim
- Department of Hematology-Oncology, National University Cancer Institute, Singapore.,Experimental Therapeutics Programme, Cancer Science Institute, Singapore
| | - Andrea Wong
- Department of Hematology-Oncology, National University Cancer Institute, Singapore.,Experimental Therapeutics Programme, Cancer Science Institute, Singapore
| | - Kritika Yadav
- Experimental Therapeutics Programme, Cancer Science Institute, Singapore
| | - Wei Peng Yong
- Department of Hematology-Oncology, National University Cancer Institute, Singapore.,Experimental Therapeutics Programme, Cancer Science Institute, Singapore
| | - Lip Kun Tan
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Liang Piu Koh
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Michelle L M Poon
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | | | - Samuel G W Ow
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Lavina Bharwani
- Department of Medical Oncology, Tan Tock Seng Hospital, Singapore
| | - Yoon Sim Yap
- Department of Medical Oncology, National Cancer Centre, Singapore
| | - Mabel Z Q Foo
- Experimental Therapeutics Programme, Cancer Science Institute, Singapore
| | - Elaine Coustan-Smith
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raghav Sundar
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Hon Lyn Tan
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Wan Qin Chong
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | | | - Jedidah L M Lieow
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Priscillia J X Koe
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Boon Cher Goh
- Department of Hematology-Oncology, National University Cancer Institute, Singapore.,Experimental Therapeutics Programme, Cancer Science Institute, Singapore
| | - Dario Campana
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
15
|
Yardley DA, Nusch A, Yap YS, Sonke GS, Bachelot T, Chan A, Neven P, Slamon DJ, Wheatley-Price P, Lteif A, Sondhi M, Rodriguez-Lorenc K, Gaur A, Chia SKL. Overall survival (OS) in patients (pts) with advanced breast cancer (ABC) with visceral metastases (mets), including those with liver mets, treated with ribociclib (RIB) plus endocrine therapy (ET) in the MONALEESA (ML) -3 and -7 trials. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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
1054 Background: In the Phase III ML-3 (NCT02422615) and ML-7 (NCT02278120) trials, RIB + ET demonstrated a significant OS benefit (ML-3: HR, 0.72, P = 0.00455; ML-7: HR, 0.71, P = 0.00973) over placebo (PBO) + ET in pts with HR+/HER2- ABC (Im et al. N Engl J Med. 2019; Slamon et al. N Engl J Med. 2019). The presence of visceral mets generally portends a poor prognosis, which is especially poor in pts with liver mets (He et al. Ann Oncol. 2019). Here we report OS in pts with visceral mets with a focus on those with liver mets in ML-3 and ML-7. Methods: In ML-3, postmenopausal pts were randomized 2:1 to receive RIB + fulvestrant (FUL) or PBO + FUL as first- (1L) or second-line (2L) treatment. In ML-7, premenopausal pts were randomized 1:1 to receive RIB + ET or PBO + ET (this analysis included only pts who received an NSAI as ET partner to match approved indication). Results: Visceral mets were identified in 293 pts (60.5%) in the RIB arm and 147 (60.7%) in the PBO arm in ML-3 and 150 (44.8%) and 142 pts (42.1%), respectively, in ML-7. In ML-3, the median age of pts with visceral mets was 63 and 65 years in the RIB and PBO arms, and in ML-7 it was 42.5 and 45.0 years, respectively. In ML-3, 214 pts with visceral mets received 1L therapy (RIB, n = 137; PBO, n = 77), while 219 pts received 2L therapy or had early relapse (RIB, n = 151; PBO, n = 68). Lung and liver were the most common sites of visceral mets for pts in ML-3 (49.8% and 44.8%, respectively) and ML-7 (51.4% and 58.2%, respectively). OS HRs in pts with visceral mets were consistent with the benefit in the overall pt populations and suggested a particularly substantial OS benefit in pts with liver mets (HR for liver mets group in ML-3, 0.629 [95% CI, 0.421-0.942]; HR in ML-7, 0.531 [95% CI, 0.321-0.877]; Table). No new safety signals were observed. Conclusions: Approximately half of the pts in ML-3 and ML-7 had visceral mets. The OS data in these pts are consistent with the benefit observed with RIB in the overall populations of each trial. In pts with liver mets, a group with an especially poor prognosis, RIB + ET demonstrated a substantial OS benefit compared with PBO + ET. Clinical trial information: NCT02422615; NCT02278120 . [Table: see text]
Collapse
Affiliation(s)
- Denise A. Yardley
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN
| | - Arnd Nusch
- Onkologische Praxis Velbert, Velbert, Germany
| | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | - Gabe S. Sonke
- DGOG and Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Arlene Chan
- Breast Cancer Research Centre-Western Australia, Nedlands, Australia
| | - Patrick Neven
- Multidisciplinary Breast Centre, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | | | - Agnes Lteif
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Manu Sondhi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Anil Gaur
- Novartis Healthcare Pvt Ltd, Hyderabad, India
| | | |
Collapse
|
16
|
Lin CH, Yap YS, Lee KH, Yeo W, Ueno T, Li H, Huang SM, Lu YS. Response to Sung, Rosenberg, and Yang. J Natl Cancer Inst 2020; 112:547-548. [PMID: 31545369 DOI: 10.1093/jnci/djz191] [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] [Received: 08/21/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Kyung-Hun Lee
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Winnie Yeo
- Chinese University of Hong Kong, Hong Kong, China
| | | | - Huiping Li
- Peking University Cancer Hospital, Beijing, China
| | | | - Yen-Shen Lu
- National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
17
|
Iyer A, Gupta K, Sharma S, Hari K, Lee YF, Ramalingam N, Yap YS, West J, Bhagat AA, Subramani BV, Sabuwala B, Tan TZ, Thiery JP, Jolly MK, Ramalingam N, Sengupta D. Integrative Analysis and Machine Learning based Characterization of Single Circulating Tumor Cells. J Clin Med 2020; 9:jcm9041206. [PMID: 32331451 PMCID: PMC7230872 DOI: 10.3390/jcm9041206] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 02/23/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 12/28/2022] Open
Abstract
We collated publicly available single-cell expression profiles of circulating tumor cells (CTCs) and showed that CTCs across cancers lie on a near-perfect continuum of epithelial to mesenchymal (EMT) transition. Integrative analysis of CTC transcriptomes also highlighted the inverse gene expression pattern between PD-L1 and MHC, which is implicated in cancer immunotherapy. We used the CTCs expression profiles in tandem with publicly available peripheral blood mononuclear cell (PBMC) transcriptomes to train a classifier that accurately recognizes CTCs of diverse phenotype. Further, we used this classifier to validate circulating breast tumor cells captured using a newly developed microfluidic system for label-free enrichment of CTCs.
Collapse
Affiliation(s)
- Arvind Iyer
- Department of Computational Biology, Indraprastha Institute of Information Technology, New Delhi 110020, India;
| | - Krishan Gupta
- Department of Computer Science and Engineering, Indraprastha Institute of Information Technology, New Delhi 110020, India; (K.G.); (S.S.)
| | - Shreya Sharma
- Department of Computer Science and Engineering, Indraprastha Institute of Information Technology, New Delhi 110020, India; (K.G.); (S.S.)
| | - Kishore Hari
- Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India; (K.H.); (M.K.J.)
| | - Yi Fang Lee
- Biolidics Limited, 81 Science Park Drive, 02-03 The Chadwick, Singapore 118257, Singapore; (Y.F.L.); (A.A.B.)
| | - Neevan Ramalingam
- Qualcomm Incorporated, 5775 Morehouse Drive, San Diego, CA 92121, USA;
| | - Yoon Sim Yap
- National Cancer Centre Singapore, 11 Hospital Dr, Singapore 169610, Singapore;
| | - Jay West
- Fluidigm Corporation, 2 Tower Place, Suite 2000, South San Francisco, CA 94080, USA;
| | - Ali Asgar Bhagat
- Biolidics Limited, 81 Science Park Drive, 02-03 The Chadwick, Singapore 118257, Singapore; (Y.F.L.); (A.A.B.)
| | - Balaram Vishnu Subramani
- School of Mathematics, Indian Institute of Science Education and Research, Thiruvananthapuram 695551, India;
| | - Burhanuddin Sabuwala
- Department of Biotechnology, Indian Institute of Technology Madras, Chennai 600036, India;
| | - Tuan Zea Tan
- Cancer Science Institute of Singapore, National University of Singapore, Center for Translational Medicine, Singapore 117599, Singapore;
| | - Jean Paul Thiery
- Guangzhou Regenerative Medicine and Health; Guangdong laboratory, Chinese Academy of Science, Guangzhou 510530, China;
| | - Mohit Kumar Jolly
- Centre for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India; (K.H.); (M.K.J.)
| | - Naveen Ramalingam
- Fluidigm Corporation, 2 Tower Place, Suite 2000, South San Francisco, CA 94080, USA;
- Correspondence: (N.R.); (D.S.); Tel.: +91-11-26907446 (D.S.)
| | - Debarka Sengupta
- Department of Computational Biology, Indraprastha Institute of Information Technology, New Delhi 110020, India;
- Department of Computer Science and Engineering, Indraprastha Institute of Information Technology, New Delhi 110020, India; (K.G.); (S.S.)
- Center for Artificial Intelligence, Indraprastha Institute of Information Technology, New Delhi 110020, India
- Correspondence: (N.R.); (D.S.); Tel.: +91-11-26907446 (D.S.)
| |
Collapse
|
18
|
Hortobagyi GN, Stemmer SM, Burris HA, Yap YS, Sonke GS, Paluch-Shimon S, Campone M, Petrakova K, Blackwell KL, Winer EP, Janni W, Verma S, Conte P, Arteaga CL, Cameron DA, Mondal S, Su F, Miller M, Elmeliegy M, Germa C, O'Shaughnessy J. Updated results from MONALEESA-2, a phase III trial of first-line ribociclib plus letrozole versus placebo plus letrozole in hormone receptor-positive, HER2-negative advanced breast cancer. Ann Oncol 2019; 30:1842. [PMID: 31407010 PMCID: PMC6927326 DOI: 10.1093/annonc/mdz215] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Yeo W, Ueno T, Lin CH, Liu Q, Lee KH, Leung R, Naito Y, Park YH, Im SA, Li H, Yap YS, Lu YS. Treating HR+/HER2− breast cancer in premenopausal Asian women: Asian Breast Cancer Cooperative Group 2019 Consensus and position on ovarian suppression. Breast Cancer Res Treat 2019; 177:549-559. [DOI: 10.1007/s10549-019-05318-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/08/2019] [Indexed: 12/19/2022]
|
20
|
Saw S, Lim J, Lim SH, Wong M, Lim C, Yap YS. Patterns of relapse after neoadjuvant chemotherapy in breast cancer: implications for surveillance in clinical practice. Breast Cancer Res Treat 2019; 177:197-206. [PMID: 31147984 DOI: 10.1007/s10549-019-05290-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/19/2019] [Accepted: 05/20/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to identify patterns of relapse after neoadjuvant chemotherapy (NAC) for breast cancer to refine follow-up recommendations. METHODS Retrospective analysis on 523 breast cancer patients treated with NAC at two public hospitals in Singapore between 2000 and 2014. RESULTS Majority of patients (71.9%) had locally advanced disease. Median follow-up was 55 months. 5-year recurrence rate was significantly higher in triple negative breast cancer (TNBC) than non-TNBC subtypes (38.4% vs. 29.5%; p = 0.042); 85% of recurrences involved distant sites. Among TNBC and HR (hormone receptor)-/HER2+ subtypes, 97.0% and 95.0% of relapses occurred within 3 years from diagnosis respectively while 10.6% of relapses among HR+ subgroup occurred beyond 5 years. Recurrence risk in high-grade tumours decreased with time. Stage III at diagnosis (hazard ratio = 2.94; p < 0.001), grade 3 tumours (hazard ratio = 2.87; p = 0.018), not achieving pathologic complete response (pCR) (hazard ratio = 8.77; p = 0.003) and not receiving adjuvant radiotherapy (hazard ratio = 3.19; p < 0.001) were independent predictors of inferior recurrence-free survival. Serum CA 15-3 was raised in 49% of patients upon relapse; it correlated with inferior post-relapse survival (median 11 months vs. 22 months; p = 0.019). CONCLUSIONS While more intensive follow-up during the first 3 years may be required for patients who do not achieve pCR, especially those with TNBC and HR-/HER2+ tumours, the benefit from blood tests such as CA 15-3 appears limited, and the benefit from intensification of surveillance remains to be addressed in prospective studies on high-risk patients.
Collapse
Affiliation(s)
- Stephanie Saw
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - John Lim
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Swee Ho Lim
- Breast Department, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Mabel Wong
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Cindy Lim
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
| |
Collapse
|
21
|
Iwata H, Masuda N, Kim SB, Inoue K, Rai Y, Fujita T, Chiu J, Ohtani S, Takahashi M, Miyaki T, Lu YS, Xu B, Yap YS, Bustam A, Yao B, Zhang B, Bryce R, Chan A. Neratinib after trastuzumab-based adjuvant therapy in patients from Asia with early stage HER2-positive breast cancer. Future Oncol 2019; 15:2489-2501. [PMID: 31140297 DOI: 10.2217/fon-2019-0143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the efficacy and safety of neratinib as extended adjuvant therapy in patients from Asia based on exploratory analyses of the Phase III ExteNET trial. Patients & methods: A total of 2840 women with early stage HER2-positive breast cancer were randomly assigned to neratinib 240 mg/day or placebo for 1 year after trastuzumab-based adjuvant therapy. Results: A total of 341 patients were from Asia (neratinib, n = 165; placebo, n = 176). 2-year invasive disease-free survival rates were 92.8 and 90.8% with neratinib and placebo, respectively (HR: 0.70; 95% CI: 0.31-1.55), and 5-year rates were 91.9 and 87.2%, respectively (HR: 0.57; 95% CI: 0.27-1.13). Diarrhea was the most common adverse event with neratinib. Conclusion: Extended adjuvant therapy with neratinib reduces disease recurrences in Asian women with HER2-positive breast cancer. Trial registration: Clinicaltrials.gov NCT00878709.
Collapse
Affiliation(s)
- Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Norikazu Masuda
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, 540-0006, Japan
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KS013, Korea
| | - Kenichi Inoue
- Division of Breast Oncology, Saitama Cancer Center, Saitama, 362-0806, Japan
| | - Yoshiaki Rai
- Hakuaikai Medical Corporation Sagara Hospital, Kagoshima City, 892-0845, Japan
| | - Takashi Fujita
- Department of Breast Oncology, Jichi Medical University Hospital, Tochigi, 329-0498, Japan
| | - Joanne Chiu
- Department of Medicine, Queen Mary Hospital, Hong Kong Island, Hong Kong
| | - Shoichiro Ohtani
- Department of Breast Surgery, Hiroshima City Hospital, Hiroshima, 730-8518, Japan
| | - Masato Takahashi
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, 063-0005, Japan
| | - Toshiko Miyaki
- Division of Breast Surgery, Chiba Cancer Center, Chiba, 260-8717, Japan
| | - Yen-Shen Lu
- National Taiwan University Hospital, Taipei City, Taiwan
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, PR China
| | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre Singapore, 169610, Singapore
| | - Anita Bustam
- Clinical Oncology Unit, University Malaya Medical Centre, Kuala Lumpur, 50603, Malaysia
| | - Bin Yao
- Puma Biotechnology, Inc., Los Angeles, CA 90024, USA
| | - Bo Zhang
- Puma Biotechnology, Inc., Los Angeles, CA 90024, USA
| | - Richard Bryce
- Puma Biotechnology, Inc., Los Angeles, CA 90024, USA
| | - Arlene Chan
- Breast Cancer Research Centre-WA & Curtin University, Perth, Australia
| |
Collapse
|
22
|
Prawira A, Munusamy P, Yuan J, Chan CHT, Koh GL, Shuen TWH, Hu J, Yap YS, Tan MH, Ang P, Lee ASG. Assessment of PARP4 as a candidate breast cancer susceptibility gene. Breast Cancer Res Treat 2019; 177:145-153. [PMID: 31119570 DOI: 10.1007/s10549-019-05286-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 10/29/2018] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE PARP4 has been proposed as a candidate breast cancer susceptibility gene. However, its function and involvement in breast carcinogenesis is unclear. We sought to determine the variant frequency of PARP4 in BRCA-negative women referred for genetic testing from Singapore and to perform functional analyses of PARP4. METHODS Next-generation sequencing of PARP4 was conducted for 198 BRCA-negative cases from Singapore. Three independent case-control association analyses of PARP4 were performed for (1) our Singaporean cohort, (2) three dbGaP datasets, and (3) cases from TCGA, with controls from the Exome Aggregation Consortium (ExAC). PARP4 knockout cells were generated utilizing the CRISPR-Cas9 approach in MDA-MB-231 (breast cancer) and MCF10A (normal breast) cell lines, and colony formation, cell proliferation, and migration assays carried out. RESULTS Candidate variants in PARP4 were identified in 5.5% (11/198) of our Singapore cohort. Case-control association studies for our cases and the dbGaP datasets showed no significant association. However, a significant association was observed for PARP4 variants when comparing 988 breast cancer cases from the TCGA provisional data and 53,105 controls from ExAC (ALL) (OR 0.249, 95% CI 0.139-0.414, P = 2.86 × 10-11). PARP4 knockout did not affect the clonogenicity, proliferation rate, and migration of normal breast cells, but appeared to decrease the proliferation rate and clonogenicity of breast cancer cells. CONCLUSIONS Taken together, our results do not support that PARP4 functions as a cancer susceptibility gene. This study highlights the importance of performing functional analyses for candidate cancer predisposition genes.
Collapse
Affiliation(s)
- Aldo Prawira
- Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore, Singapore
| | - Prabhakaran Munusamy
- Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore, Singapore
| | - Jimin Yuan
- Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore, Singapore
| | - Claire Hian Tzer Chan
- Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore, Singapore
| | - Geok Ling Koh
- Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore, Singapore
| | | | - Jiancheng Hu
- Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore, Singapore.,Cancer and Stem Cell Biology Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Yoon Sim Yap
- Department of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Min Han Tan
- Department of Medical Oncology, National Cancer Centre, Singapore, Singapore.,Institute of Bioengineering and Nanotechnology, Singapore, Singapore.,Lucence Diagnostics Pte Ltd, Singapore, Singapore
| | - Peter Ang
- Department of Medical Oncology, National Cancer Centre, Singapore, Singapore.,Oncocare Cancer Centre, Gleneagles Medical Centre, Singapore, Singapore
| | - Ann Siew Gek Lee
- Division of Cellular and Molecular Research, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore, Singapore. .,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Office of Clinical and Academic Faculty Affairs, Duke-NUS Medical School, Singapore, Singapore.
| |
Collapse
|
23
|
Saura C, Oliveira M, Feng YH, Dai MS, Hurvitz SA, Kim SB, Moy B, Delaloge S, Gradishar WJ, Masuda N, Palacova M, Trudeau ME, Mattson J, Yap YS, Bryce R, Yao B, Bebchuk JD, Keyvanjah K, Brufsky A. Neratinib + capecitabine versus lapatinib + capecitabine in patients with HER2+ metastatic breast cancer previously treated with ≥ 2 HER2-directed regimens: Findings from the multinational, randomized, phase III NALA trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1002] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [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
1002 Background: NALA (ClinicalTrials.gov NCT01808573) is a multinational, randomized, open-label, phase III trial of neratinib (an irreversible pan-HER tyrosine kinase inhibitor [TKI]) + capecitabine (N+C) vs lapatinib (a reversible dual TKI) + capecitabine (L+C) in patients with stage IV HER2+ metastatic breast cancer (MBC) who had received ≥2 prior HER2-directed regimens for MBC. Methods: Patients were randomized 1:1 to N (240 mg qd po) + C (750 mg/m2 bid po) or L (1250 mg qd po) + C (1000 mg/m2 bid po). Co-primary endpoints were centrally assessed progression-free survival (PFS) and overall survival (OS). Secondary endpoints were investigator-assessed PFS; objective response rate (ORR); duration of response (DoR); clinical benefit rate (CBR); time to intervention for symptomatic metastatic central nervous system (CNS) disease; safety; and patient-reported health outcomes. Results: 621 patients were randomized (307 to N+C; 314 to L+C). The risk of disease progression or death was reduced by 24% with N+C vs L+C (HR = 0.76; 95% CI 0.63–0.93; p = 0.006); 6- and 12-month PFS rates were 47.2% vs 37.8% and 28.8% vs 14.8% for N+C vs L+C, respectively. OS rates at 6 and 12 months were 90.2% vs 87.5% and 72.5% vs 66.7% for N+C vs L+C, respectively (HR = 0.88; 95% CI 0.72–1.07; p = 0.2086). ORR in patients with measurable disease at screening was improved with N+C vs L+C (32.8% vs 26.7%; p = 0.1201), as was CBR (44.5% vs 35.6%; p = 0.0328) and DoR (HR = 0.50; 95% CI 0.33–0.74; p = 0.0004). Time to intervention for symptomatic CNS disease (overall cumulative incidence 22.8% vs 29.2%; p = 0.043) was delayed with N+C vs L+C. Treatment-emergent adverse events (TEAEs) were similar between arms, but there was a higher rate of grade 3 diarrhea with N+C vs L+C (24.4% vs 12.5%). TEAEs leading to neratinib/lapatinib discontinuation were lower with neratinib (10.9%) than with lapatinib (14.5%). Conclusions: N+C significantly improved PFS with a trend towards improved OS vs L+C. N+C also resulted in a delayed time to intervention for symptomatic CNS disease. Tolerability was similar between the two arms, with no new safety signals observed. Clinical trial information: NCT01808573.
Collapse
Affiliation(s)
| | - Mafalda Oliveira
- Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Sara A. Hurvitz
- UCLA Hematology / Oncology Clinical Research Unit, Santa Monica, CA
| | - Sung-Bae Kim
- University of Ulsan College of Medicine, Seoul, South Korea
| | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | | | | | | | - Johanna Mattson
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Bin Yao
- Puma Biotechnology Inc, Los Angeles, CA
| | | | | | | | | |
Collapse
|
24
|
Seow YH, Wong RX, Lim JHC, Lian W, Yap YS, Wong FY. Validation of a Risk Score Incorporating Tumor Characteristics into the American Joint Committee on Cancer Anatomic Stage for Breast Cancer. J Breast Cancer 2019; 22:260-273. [PMID: 31281728 PMCID: PMC6597407 DOI: 10.4048/jbc.2019.22.e16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/15/2018] [Accepted: 03/09/2019] [Indexed: 02/08/2023] Open
Abstract
Purpose The American Joint Committee on Cancer 8th edition (AJCC8) prognostic stage (PS) was implemented January 1, 2018, but it is complex due to multiple permutations. A North American group proposed a simpler system using the anatomic stage with a risk score system (RSS) of 1 point each for grade 3 tumor and human epithelial growth factor receptor 2 (HER2) and estrogen receptor (ER) negativity. Here we aimed to evaluate this risk score system with our database of Asian breast cancer patients and compare it against the AJCC8 PS. Methods Patients diagnosed with breast cancer stage I–IV in 2006–2012 were identified in the SingHealth Joint Breast Cancer Registry. Five-year breast cancer-specific survival (CSS) and overall survival (OS) were calculated for each anatomic stage according to the risk score and compared with the AJCC8 PS. Results A total of 6,656 patients were analyzed. The median follow-up was 61 (interquartile range, 37–90) months. There was a high receipt of endocrine therapy (84.6% of ER+ patients), chemotherapy (84.3% of node-positive patients), and trastuzumab (86.0% of HER2+ patients). Within each anatomic stage, there were significant differences in survival in all sub-stages except IIIB. On multivariate analysis, the hazard ratio for negative ER was 1.74 (1.48–2.06), for negative HER2 was 1.49 (1.26–1.74), and for grade 3 was 1.84 (1.55–2.19). On multivariate analysis controlled for age, ethnicity, and receipt of chemotherapy, the RSS (Akaike information criterion [AIC] = 10,649.45; Harrell's Concordance Index [C] = 0.85) was not inferior to the AJCC8 PS (AIC = 10,726.65; C = 0.84) for CSS, nor was the RSS (AIC = 14,714.4; C = 0.82) inferior to the AJCC8 PS (AIC = 14,784.69; C = 0.81) for OS. Conclusion The RSS is comparable to the AJCC8 PS for a patient population receiving chemotherapy as well as endocrine- and HER2-targeted therapy and further stratifies stage IV patients.
Collapse
Affiliation(s)
- Yi Heng Seow
- Lee Kong Chian School of Medicine, Nangyang Technological University of Singapore, Singapore
| | - Ru Xin Wong
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - John Heng Chi Lim
- Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Weixiang Lian
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Yoon Sim Yap
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Fuh Yong Wong
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
| |
Collapse
|
25
|
Frayling IM, Mautner VF, van Minkelen R, Kallionpaa RA, Aktaş S, Baralle D, Ben-Shachar S, Callaway A, Cox H, Eccles DM, Ferkal S, LaDuca H, Lázaro C, Rogers MT, Stuenkel AJ, Summerour P, Varan A, Yap YS, Zehou O, Peltonen J, Evans DG, Wolkenstein P, Upadhyaya M. Breast cancer risk in neurofibromatosis type 1 is a function of the type of NF1 gene mutation: a new genotype-phenotype correlation. J Med Genet 2018; 56:209-219. [DOI: 10.1136/jmedgenet-2018-105599] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/30/2018] [Accepted: 11/15/2018] [Indexed: 01/19/2023]
Abstract
BackgroundNeurofibromatosis type 1 (NF1) predisposes to breast cancer (BC), but no genotype-phenotype correlations have been described.MethodsConstitutional NF1 mutations in 78 patients with NF1 with BC (NF1-BC) were compared with the NF1 Leiden Open Variation Database (n=3432).ResultsNo cases were observed with whole or partial gene deletions (HR 0.10; 95% CI 0.006 to 1.63; p=0.014, Fisher’s exact test). There were no gross relationships with mutation position. Forty-five (64.3%; HR 6.4–83) of the 70 different mutations were more frequent than expected (p<0.05), while 52 (74.3%; HR 5.3–83) were significant when adjusted for multiple comparisons (adjusted p≤0.125; Benjamini-Hochberg). Higher proportions of both nonsense and missense mutations were also observed (adjusted p=0.254; Benjamini-Hochberg). Ten of the 11 missense cases with known age of BC occurred at <50 years (p=0.041). Eighteen cases had BRCA1/2 testing, revealing one BRCA2 mutation.DiscussionThese data strongly support the hypothesis that certain constitutional mutation types, and indeed certain specific variants in NF1 confer different risks of BC. The lack of large deletions and excess of nonsenses and missenses is consistent with gain of function mutations conferring risk of BC, and also that neurofibromin may function as a dimer. The observation that somatic NF1 amplification can occur independently of ERBB2 amplification in sporadic BC supports this concept. A prospective clinical-molecular study of NF1-BC needs to be established to confirm and build on these findings, but regardless of NF1 mutation status patients with NF1-BC warrant testing of other BC-predisposing genes.
Collapse
|
26
|
Tan CJ, Lim SWT, Toh YL, Ng T, Yeo A, Shwe M, Foo KM, Chu P, Jain A, Koo SL, Dent RA, Ng RCH, Yap YS, Lim EH, Loh KWJ, Chay WY, Lee GE, Tan TJY, Beh SY, Wong M, Chan JJ, Khor CC, Ho HK, Chan A. Replication and Meta-analysis of the Association between BDNF Val66Met Polymorphism and Cognitive Impairment in Patients Receiving Chemotherapy. Mol Neurobiol 2018; 56:4741-4750. [PMID: 30382534 PMCID: PMC6647505 DOI: 10.1007/s12035-018-1410-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 09/21/2018] [Accepted: 10/24/2018] [Indexed: 01/23/2023]
Abstract
Cancer-related cognitive impairment (CRCI) adversely affects cancer patients. We had previously demonstrated that the BDNF Val66Met genetic polymorphism is associated with lower odds of subjective CRCI in the multitasking and verbal ability domains among breast cancer patients receiving chemotherapy. To further assess our previous findings, we evaluated the association of BDNF Val66Met polymorphism with subjective and objective CRCI in a temporally separate cohort of patients and pooled findings from both the original (n = 145) and current (n = 193) cohorts in a meta-analysis. Subjective CRCI was assessed using FACT-Cog. Objective CRCI was evaluated using computerized neuropsychological tests. Genotyping was carried out using Sanger sequencing. The association of BDNF Val66Met genotypes and CRCI was examined with logistic regression. A fixed-effect meta-analysis was conducted using the inverse variance method. In the meta-analysis (n = 338), significantly lower odds of CRCI were associated with Met allele carriers based on the global FACT-Cog score (OR = 0.52, 95% CI 0.29–0.94). Furthermore, Met allele carriers were at lower odds of developing impairment in the domains of memory (OR = 0.34, 95% CI: 0.17–0.70), multitasking (OR = 0.33, 95% CI: 0.18–0.59), and verbal ability (OR = 0.46, 95% CI: 0.24–0.88). Consistent with the previous study, lower odds of subjective CRCI among patients with the BDNF Met allele was observed after adjusting for potential confounders in the multitasking (OR = 0.30, 95% CI: 0.14–0.67) domain. In conclusion, carriers of the BDNF Met allele were protected against global subjective CRCI, particularly in the domains of memory, multitasking, and verbal ability. Our findings further contribute to the understanding of CRCI pathophysiology.
Collapse
Affiliation(s)
- Chia Jie Tan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Sheree Wan Ting Lim
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Yi Long Toh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Terence Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Angie Yeo
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Maung Shwe
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Koon Mian Foo
- Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore, Singapore
| | - Pat Chu
- Singapore Cord Blood Bank, Singapore, Singapore
| | - Amit Jain
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Si-Lin Koo
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Rebecca A Dent
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | | | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Elaine H Lim
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Kiley Wei-Jen Loh
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Guek Eng Lee
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Tira Jing Ying Tan
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Sok Yuen Beh
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Mabel Wong
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Jack Junjie Chan
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Chiea Chuen Khor
- Human Genetics, Genome Institute of Singapore, Singapore, Singapore.,Glaucoma Research Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Han Kiat Ho
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Alexandre Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore, 117543, Singapore. .,Department of Pharmacy, National Cancer Centre, Singapore, Singapore. .,Duke-NUS Graduate Medical School, Singapore, Singapore.
| |
Collapse
|
27
|
Hortobagyi GN, Paluch-Shimon S, Petrakova K, Villanueva C, Chan A, Nusch A, Yap YS, Hart L, Favret A, Marschner N, Sonke GS, Oma Ohnstad H, Arteaga C, Su F, He W, Miller MK, Stemmer SM. First-line ribociclib (RIB) + letrozole (LET) in hormone receptor-positive (HR+), HER2-negative (HER2–) advanced breast cancer (ABC): MONALEESA-2 biomarker analyses. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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)
| | | | | | | | - Arlene Chan
- Breast Cancer Research Centre - WA & Curtin University, Perth, Australia
| | - Arnd Nusch
- Onkologische Praxis Velbert, Velbert, Germany
| | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | - Lowell Hart
- Florida Cancer Specialists, Sarah Cannon Research Institute, Fort Myers, FL
| | | | - Norbert Marschner
- Joint Practice for Interdisciplinary Oncology and Hematology, Freiburg, Germany
| | - Gabe S. Sonke
- Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands
| | - Hege Oma Ohnstad
- Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Carlos Arteaga
- Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Fei Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Wei He
- Novartis Institute for Biomedical Research, Cambridge, MA
| | | | - Salomon M. Stemmer
- Davidoff Center, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
28
|
Iwata H, Masuda N, Kim SB, Inoue K, Rai Y, Fujita T, Shen ZZ, Chiu JW, Ohtani S, Takahashi M, Yamamoto N, Miyaki T, Sun Q, Yen-Shen L, Xu B, Yap YS, Bustam AZ, Lee JR, Zhang B, Bryce R, Chan A. Abstract P1-13-11: Neratinib in the extended adjuvant treatment of patients from Asia with early-stage HER2+ breast cancer after trastuzumab-based therapy: Exploratory analyses from the phase III ExteNET trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-11] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Current breast cancer knowledge is based largely on studies conducted in western populations. Their findings may not be generalizable to Asian women because of ethnic, genetic and lifestyle differences. Neratinib (N) is an irreversible tyrosine kinase inhibitor of HER1, 2 and 4. The international, randomized, placebo (P)-controlled phase III ExteNET trial showed that 1 year (yr) of N after trastuzumab (T)-based adjuvant therapy significantly improved 2-yr invasive disease-free survival (iDFS) in patients (pts) with early-stage HER2+ breast cancer (HR 0.67; 95% CI 0.50–0.91; p=0.009) [Chan et al. Lancet Oncol 2016]. The significant iDFS benefit with N was shown to be durable after 5 yrs' follow-up (HR 0.73; 95% CI 0.57-0.92; p=0.008) [Martin et al. ESMO 2017]. We report efficacy and safety findings from pts enrolled from Asian centers (China, Hong Kong, Japan, Korea, Malaysia, Singapore, and Taiwan) on the ExteNET trial to better characterize the effects of N in Asian women.
Methods: Pts with early-stage HER2+ breast cancer were randomly assigned to oral N 240 mg/day or P for 1 yr after standard primary therapy and T-based adjuvant therapy. Antidiarrheal prophylaxis was not required by protocol. Data concerning disease recurrences were collected prospectively during yr 1-2 post-randomization, and from medical records during yr 3–5 post-randomization. Primary endpoint: iDFS. HR (95% CI) estimated using Cox proportional-hazards models stratified by nodal status, hormone-receptor status and prior T regimen. Data cut-off: 2-yr analysis, July 2014; 5-yr analysis, March 2017. Clinicaltrials.gov:NCT00878709.
Results: Of 2840 randomized pts (N, n=1420; P, n=1420), 341 (12%) were enrolled from Asian centers (N, n=165; P, n=176). Baseline characteristics: median age 53 yr; hormone receptor-positive 48%. Median treatment duration was similar in both groups (N, 351 days; P, 352 days). iDFS events in Asian vs ITT populations are shown in the Table.
Primary 2-yr analysisa5-yr analysis NPNPAsian population, n165176165176iDFS events, n10151222HR (95% CI)b0.71 (0.31-1.57)0.54 (0.26-1.08)P-value (2-sided)0.4040.085ITT population, n1420142014201420iDFS events, n67106116163HR (95% CI)b0.66 (0.49-0.90)0.73 (0.57-0.92)P-value (2-sided)0.0080.008a. Primary study endpoint; b. Neratinib vs placebo
The incidence of grade 3/4 diarrhea with N was slightly higher in Asian pts (46.1% vs ITT, 39.8%). All other grade 3/4 adverse events with N were rare among Asian pts (elevated ALT, mucosal inflammation, 2 pts each; other events, 1 pt each). Compliance with N in Asian pts was also improved (71% vs ITT, 61%).
Conclusions: In Asian pts enrolled into ExteNET, compliance with N was better and the magnitude of N effect was similar or greater that that observed in the ITT population. Although N-related grade 3/4 diarrhea was more common in Asian pts than in the ITT population, all other grade 3/4 events were rare. Despite small pt numbers, our analyses suggest that the findings from ExteNET are applicable to Asian pts, and support the conclusion that N reduces disease recurrences in Asian pts with early-stage HER2+ breast cancer after T-based adjuvant therapy.
Citation Format: Iwata H, Masuda N, Kim S-B, Inoue K, Rai Y, Fujita T, Shen Z-Z, Chiu JW, Ohtani S, Takahashi M, Yamamoto N, Miyaki T, Sun Q, Yen-Shen L, Xu B, Yap YS, Bustam AZ, Lee JR, Zhang B, Bryce R, Chan A. Neratinib in the extended adjuvant treatment of patients from Asia with early-stage HER2+ breast cancer after trastuzumab-based therapy: Exploratory analyses from the phase III ExteNET trial [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 P1-13-11.
Collapse
Affiliation(s)
- H Iwata
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - N Masuda
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - S-B Kim
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - K Inoue
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - Y Rai
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - T Fujita
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - Z-Z Shen
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - JW Chiu
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - S Ohtani
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - M Takahashi
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - N Yamamoto
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - T Miyaki
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - Q Sun
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - L Yen-Shen
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Xu
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - YS Yap
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - AZ Bustam
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - JR Lee
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Zhang
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - R Bryce
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - A Chan
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| |
Collapse
|
29
|
Ng T, Dorajoo SR, Cheung YT, Lam YC, Yeo HL, Shwe M, Gan YX, Foo KM, Loh WJK, Koo SL, Jain A, Lee GE, Dent R, Yap YS, Ng R, Chan A. Distinct and heterogeneous trajectories of self-perceived cognitive impairment among Asian breast cancer survivors. Psychooncology 2018; 27:1185-1192. [DOI: 10.1002/pon.4635] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Terence Ng
- Department of Pharmacy; National University of Singapore; Singapore
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | | | - Yin Ting Cheung
- Department of Pharmacy; National University of Singapore; Singapore
| | - Yick Ching Lam
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Hui Ling Yeo
- Department of Pharmacy; National University of Singapore; Singapore
| | - Maung Shwe
- Department of Pharmacy; National University of Singapore; Singapore
| | - Yan Xiang Gan
- Department of Pharmacy; National Cancer Centre Singapore; Singapore
| | - Koon Mian Foo
- Department of Pharmacy; KK Women's and Children's Hospital; Singapore
| | - Wei-Jen Kiley Loh
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Si-Lin Koo
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Amit Jain
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Guek Eng Lee
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Rebecca Dent
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
- Duke-NUS Graduate Medical School Singapore; Singapore
| | - Yoon Sim Yap
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Raymond Ng
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
- Duke-NUS Graduate Medical School Singapore; Singapore
| | - Alexandre Chan
- Department of Pharmacy; National University of Singapore; Singapore
- Department of Pharmacy; National Cancer Centre Singapore; Singapore
- Duke-NUS Graduate Medical School Singapore; Singapore
| |
Collapse
|
30
|
Chae JW, Chua PS, Ng T, Yeo AHL, Shwe M, Gan YX, Dorajoo S, Foo KM, Loh KWJ, Koo SL, Chay WY, Tan TJY, Beh SY, Lim EH, Lee GE, Dent R, Yap YS, Ng R, Ho HK, Chan A. Association of mitochondrial DNA content in peripheral blood with cancer-related fatigue and chemotherapy-related cognitive impairment in early-stage breast cancer patients: a prospective cohort study. Breast Cancer Res Treat 2018; 168:713-721. [DOI: 10.1007/s10549-017-4640-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/23/2017] [Indexed: 12/24/2022]
|
31
|
Sim Yap Y, Leong M, Singh G, HengChi Lim J, Lee G, Lim E, Dent R, Ng R, Loh K, Lim D. Label-free recovery of circulating tumor cells with ClearCell® FX platform and prognostic relevance in breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx697.020] [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
|
32
|
Sutiman N, Lim JSL, Muerdter TE, Singh O, Cheung YB, Ng RCH, Yap YS, Wong NS, Ang PCS, Dent R, Schroth W, Schwab M, Khor CC, Chowbay B. Pharmacogenetics of UGT1A4, UGT2B7 and UGT2B15 and Their Influence on Tamoxifen Disposition in Asian Breast Cancer Patients. Clin Pharmacokinet 2017; 55:1239-1250. [PMID: 27098059 DOI: 10.1007/s40262-016-0402-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Tamoxifen (TAM) is an established endocrine treatment for all stages of oestrogen receptor (ER)-positive breast cancer. Its complex metabolism leads to the formation of multiple active and inactive metabolites. One of the main detoxification and elimination pathways of tamoxifen and its active metabolites, 4-hydroxytamoxifen (4-OHT) and endoxifen, is via glucuronidation catalysed by uridine 5'-diphospho-glucuronosyltransferases (UGTs). However, few studies have comprehensively examined the impact of variations in the genes encoding the major hepatic UGTs on the disposition of tamoxifen and its metabolites. In the present study, we systematically sequenced exons, exon/intron boundaries, and flanking regions of UGT1A4, UGT2B7 and UGT2B15 in 240 healthy subjects of different Asian ethnicities (Chinese, Malays and Indians) to identify haplotype tagging single nucleotide polymorphisms. Subsequently, 202 Asian breast cancer patients receiving tamoxifen were genotyped for 50 selected variants in the three UGT genes to comprehensively investigate their associations with steady-state plasma levels of tamoxifen, its active metabolites and their conjugated counterparts. The UGT1A4 haplotype (containing variant 142T>G, L48 V defining the *3 allele) was strongly associated with higher plasma levels of TAM-N-glucuronide, with a twofold higher metabolic ratio of TAM-N-glucuronide/TAM observed in carriers of this haplotype upon covariate adjustment (P < 0.0001). Variants in UGT2B7 were not associated with altered O-glucuronidation of both 4-OHT and endoxifen, while UGT2B15 haplotypes had a modest effect on (E)-endoxifen plasma levels after adjustment for CYP2D6 genotypes. Our findings highlight the influence of UGT1A4 haplotypes on tamoxifen disposition in Asian breast cancer patients, while genetic variants in UGT2B7 and UGT2B15 appear to be of minor importance.
Collapse
Affiliation(s)
| | - Joanne Siok Liu Lim
- Clinical Pharmacology Laboratory, Division of Medical Sciences, Humphrey Oei Institute of Cancer Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Thomas E Muerdter
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University of Tubingen, Tubingen, Germany
| | - Onkar Singh
- Clinical Pharmacology Laboratory, Division of Medical Sciences, Humphrey Oei Institute of Cancer Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Yin Bun Cheung
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore.,Department for International Health, University of Tampere, Tampere, Finland
| | | | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Nan Soon Wong
- OncoCare Cancer Centre, Mount Elizabeth Novena Medical Centre, Singapore, Singapore
| | - Peter Cher Siang Ang
- OncoCare Cancer Centre, Mount Elizabeth Novena Medical Centre, Singapore, Singapore
| | - Rebecca Dent
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Werner Schroth
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,University of Tubingen, Tubingen, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.,Department of Clinical Pharmacology, University Hospital, Tubingen, Germany
| | - Chiea Chuen Khor
- Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Human Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Balram Chowbay
- Clinical Pharmacology, SingHealth, Singapore, Singapore. .,Clinical Pharmacology Laboratory, Division of Medical Sciences, Humphrey Oei Institute of Cancer Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. .,Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore.
| |
Collapse
|
33
|
Chan CHT, Munusamy P, Loke SY, Koh GL, Wong ESY, Law HY, Yoon CS, Tan MH, Yap YS, Ang P, Lee ASG. Identification of Novel Breast Cancer Risk Loci. Cancer Res 2017; 77:5428-5437. [DOI: 10.1158/0008-5472.can-17-0992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/09/2017] [Accepted: 07/25/2017] [Indexed: 11/16/2022]
|
34
|
Hortobagyi GN, Stemmer SM, Burris HA, Yap YS, Sonke GS, Paluch-Shimon S, Campone M, Petrakova K, Blackwell KL, Winer EP, Janni W, Verma S, Conte PF, Arteaga CL, Cameron DA, Xuan F, Miller MK, Germa C, Hirawat S, O'Shaughnessy J. Updated results from MONALEESA-2, a phase 3 trial of first-line ribociclib + letrozole in hormone receptor-positive (HR+), HER2-negative (HER2–), advanced breast cancer (ABC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1038] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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
1038 Background: Endocrine therapy (ET) is the basis of first-line (1L) treatment for HR+ ABC. However, ET resistance are almost universal. At the first interim analysis (IA) of MONALEESA-2 (NCT01958021), ribociclib (RIB; cyclin-dependent kinase 4/6 inhibitor) + letrozole (LET) significantly prolonged progression-free survival (PFS) vs placebo (PBO) + LET in patients (pts) with HR+, HER2– ABC.1 Here we report updated efficacy and safety data from MONALEESA-2 with a further ~11 months of follow-up. Methods: Postmenopausal women with no prior therapy for ABC were randomized 1:1 toRIB (600 mg/day, 3-weeks-on/1-week-off) + LET(2.5 mg/day, continuous) vs PBO + LET. The primary endpoint was locally assessed PFS. Secondary endpoints include overall survival (OS; key) and safety. OS significance was defined by a p-value threshold of 3.15 x 10-5. Tumor assessments were performed every 8 weeks for the first 18 months, and every 12 weeks, thereafter. Results: 668 pts were enrolled (334 in each arm). At the second IA for OS (data cut-off Jan 2, 2017), the median duration of follow-up was 26.4 months; 116 deaths and 345 PFS events had occurred. OS data remain immature, with 15.0% vs 19.8% of pt deaths in the RIB + LET vs PBO + LET arm (HR = 0.746; 95% CI: 0.517–1.078; p= 0.059). Updated PFS analyses confirmed continued treatment benefit in the RIB + LET vs PBO + LET arm. The 24-month PFS rates (RIB + LET vs PBO + LET) were 54.7% vs 35.9%. Treatment benefit was consistent across pt subgroups. The most common Grade 3/4 laboratory abnormalities (≥10% of pts; RIB + LET vs PBO + LET) were decreased neutrophils (62.6% vs 1.5%), decreased leukocytes (36.8% vs 1.5%), decreased lymphocytes (16.2% vs 3.9%), and elevated alanine aminotransferase (11.4% vs 1.2%). Conclusion: After 26+ months of follow-up, treatment benefit with 1LRIB + LET persists in postmenopausal women with HR+, HER2– ABC. The study remains immature for OS analysis. The safety profile of RIB + LET remains manageable. 1. Hortobagyi G, et al. N Engl J Med 2016;375:1738–48. Clinical trial information: NCT01958021.
Collapse
Affiliation(s)
| | | | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | - Gabe S. Sonke
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Mario Campone
- Institut de Cancérologie de l'Ouest - René Gauducheau, Saint-Herblain, France
| | | | | | | | | | - Sunil Verma
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Pier Franco Conte
- University of Padova and Istituto Oncologico Veneto IRCCS, Padua, Italy
| | | | | | - Fengjuan Xuan
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | - Samit Hirawat
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | |
Collapse
|
35
|
Dorajoo SR, NG T, Chae JW, Yeo HLA, Shwe M, Gan YX, Foo KM, Loh WJK, Koo SL, Chay WY, Tan TJY, Beh SY, Lim EH, Lee GE, Dent RA, Yap YS, Ng RC, Chan A. A web-based tool to predict chemotherapy-associated cognitive impairment during survivorship. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e21609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21609 Background: Chemotherapy-associated cognitive impairment (CACI) experienced during survivorship can dramatically impair quality of life, particularly among patients receiving treatment with curative intent. We construct a web-based tool to predict the risk of self-perceived CACI at 15 months post-chemotherapy initiation among early stage breast cancer patients, to facilitate screening and early intervention. Methods: We recruited patients receiving chemotherapy for early-stage breast cancer between 2011 and 2014. Subjective cognitive function was assessed using FACT-Cog before, during and at 15 months after initiating chemotherapy. Based on a previously established minimal clinically important difference, an 11-point reduction in FACT-Cog score relative to that at baseline was considered as clinically significant CACI. Factors evaluated as potential predictors of CACI included clinical, laboratory and demographic factors, behavioural symptom and quality of life assessments (EORTC-QLQ-C30). Logistic regression was used to construct a model predicting CACI. Validation was performed on an external cohort recruited between 2015 and 2016. Model discrimination and calibration were evaluated using the receiver operating curve (ROC) and Hosmer-Lemeshow goodness-of-fit, respectively. The model was implemented as a web-based tool. Results: A total of 131 patients were recruited for model development. The model consisted of baseline EORTC-QLQ-C30 fatigue subscale percentage [effect size (95% confidence interval), 5.0% (2.0% to 7.0%), p < 0.001] and the change in FACT-Cog score after 2 cycles of chemotherapy, relative to baseline [-4.0% (-7.0% to -1.0%), p = 0.007]. The model was validated on an external cohort of 33 patients, with an ROC of 0.60, Hosmer-Lemeshow goodness-of-fit statistic of 5.86 (p = 0.44), sensitivity of 57.1% and specificity of 76.9%. The web application is accessible at http://bit.ly/CognitiveRisk Conclusions: A web application to predict CACI risk has been developed and externally validated. The tool facilitates early screening for patients at high risk for CACI and allows timely interventions to prevent or minimize the impact of CACI during survivorship.
Collapse
Affiliation(s)
| | - Terence NG
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Jung-Woo Chae
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Hui Ling Angie Yeo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Maung Shwe
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Koon Mian Foo
- Department of Pharmacy, K.K. Women’s and Children’s Hospital, Singapore, Singapore
| | | | - Si-Lin Koo
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Wen Yee Chay
- National Cancer Centre Singapore, Singapore, Singapore
| | - Tira Jing Ying Tan
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Sok Yuen Beh
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Elaine H. Lim
- Singapore Oncology Consultants, Singapore, Singapore
| | - Guek Eng Lee
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | - Raymond C.H. Ng
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| |
Collapse
|
36
|
Chae JW, Chua PS, NG T, Yeo HLA, Shwe M, Gan YX, Dorajoo SR, Foo KM, Loh KWJ, Koo SL, Chay WY, Tan TJY, Beh SY, Lim HE, Lee GE, Dent RA, Yap YS, Ng RC, Ho HK, Chan A. Mitochondrial DNA content in peripheral blood as a biomarker for cancer-related fatigue in early-stage breast cancer patients: A prospective cohort study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10018 Background: Cancer-related fatigue (CRF) is reported to be associated with mitochondrial dysfunction. Hence, mitochondrial DNA (mtDNA) content, a biomarker of mitochondrial dysfunction, is hypothesized to correlate with the onset of CRF. This study aimed to evaluate the association between peripheral blood mtDNA content and CRF in patients receiving chemotherapy. Methods: This was a prospective cohort study. Early-stage breast cancer patients (Stages I to III) receiving anthracycline or taxane-based chemotherapy were recruited. CRF was assessed using the validated Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) at two time points: baseline (T1; prior to treatment) and 6 weeks after initiation of treatment (T2). Worsening of CRF was defined as ≥10% increase in the overall MFSI-SF score at T2. Peripheral blood mtDNA content was measured at both time points using real-time quantitative polymerase chain reaction. Multiple logistic regression was utilized to evaluate the association between mtDNA reduction and worsening of CRF, adjusting for age, anxiety, insomnia and other clinically important covariates. Results: A total of 91 patients [mean age (±SD): 51.3 (9.2) years; 81.3% Chinese; 63.3% receiving anthracycline-based chemotherapy] were recruited. Proportions of patients with worsening of CRF increased from the lower to the upper quartiles of mtDNA reduction (26.1%, 30.4%, 52.2%, and 59.1% in quartiles 1, 2, 3, and 4, respectively, P = 0.010 for trend). Reduction of mtDNA content was significantly greater among those with worsening of CRF compared to those without CRF [mean reduction (±SD): 16.3 (23.5) vs 6.0 (17.3), P = 0.018]. After adjusting for covariates, every 1-unit reduction of the mtDNA content was associated with a 4% increase risk for worsening of CRF (95% CI, 1%-8%; P = 0.016). Conclusions: This is the first study to show that reduction of mtDNA content in peripheral blood is associated with onset of CRF in patients receiving chemotherapy. Further validation studies are required to confirm the findings.
Collapse
Affiliation(s)
- Jung-Woo Chae
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Peh Siang Chua
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Terence NG
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Hui Ling Angie Yeo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Maung Shwe
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Koon Mian Foo
- Department of Pharmacy, K.K. Women’s and Children’s Hospital, Singapore, Singapore
| | - Kiley Wei Jen Loh
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Si-Lin Koo
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Tira Jing Ying Tan
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Sok Yuen Beh
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Hsuen Elaine Lim
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Guek Eng Lee
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | - Raymond C.H. Ng
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Han Kiat Ho
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| |
Collapse
|
37
|
NG T, Yeo HLA, Shwe M, Gan YX, Foo KM, Loh WJK, Koo SL, Chay WY, Tan TJY, Beh SY, Lim HE, Lee GE, Dent RA, Yap YS, Ng RC, Chu PYP, Khor CC, Ho HK, Chan A. A genome-wide association study (GWAS) meta-analysis of chemotherapy-associated cognitive impairment (CACI) in Asian early-stage breast cancer patients (ESBC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10096 Background: Genetic variations among genes regulating neuronal function, neurotransmission and plasticity may contribute to varying risk of CACI. In order to fully elucidate the complex genetic structure underlying CACI, a GWAS meta-analysis was performed to identify genetic variants associated with CACI among ESBC patients. Methods: A GWAS meta-analysis of two independent cohorts totaling 266 chemotherapy-receiving ESBC patients (mean age: 51.0 ± 9.2 years; 80.8% Chinese) was performed. Patients’ self-perceived cognitive function was assessed using the validated FACT-Cog (v.3). Genome-wide genotyping was performed using the Illumina HumanOmniExpress-24 version 1.1 BeadChips kits. Each beadchip contains over 700,000 genetic markers. Covariates included in the meta-analysis were the first two dimensions of the multi-dimensional scaling. Results: After applying stringent quality control measures and removing four population outliers, data from 546,399 SNPs were available for 84 cases and 170 controls. In the meta-analysis, two SNPs (rs6443264 and rs4686371) exceeded the suggestive threshold of P < 1×10-5 (Table). Following adjustment for the first two MDS dimensions in the meta-analysis, both SNPs remained as top two SNPs with P < 1×10-4. Both rs6443264 and rs4686371 are located in chromosome 3p25 and lie in the intronic regions encoding OGG1 and ARPC4 genes, respectively. Alteration of the OGG1 gene could compromise the functions of downstream neuronal genes, and modification of the ARPC4 gene could affect the formation of the actin-related protein 2/3 complex and impair memory formation. Conclusions: To the best of our knowledge, this is the first GWAS meta-analysis to identify two loci, namely rs6443264 and rs4686371 that are suggestive of genome-wide association with CACI among Asian ESBC patients. [Table: see text]
Collapse
Affiliation(s)
- Terence NG
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Hui Ling Angie Yeo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Maung Shwe
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Koon Mian Foo
- Department of Pharmacy, K.K. Women’s and Children’s Hospital, Singapore, Singapore
| | | | - Si-Lin Koo
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Tira Jing Ying Tan
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Sok Yuen Beh
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Hsuen Elaine Lim
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Guek Eng Lee
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | - Raymond C.H. Ng
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | | | | | - Han Kiat Ho
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| |
Collapse
|
38
|
Gernaat SAM, Ho PJ, Rijnberg N, Lee SC, Lim SH, Yap YS, Grobbee DE, Hartman M, Verkooijen HM. Risk of death from cardiovascular disease following breast cancer in Southeast Asia: a prospective cohort study. Sci Rep 2017; 7:1365. [PMID: 28465587 PMCID: PMC5430976 DOI: 10.1038/s41598-017-01540-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/31/2017] [Indexed: 01/24/2023] Open
Abstract
Breast cancer incidence and survival is high in Southeast Asia. As such, many women diagnosed with breast cancer are at risk of dying of other causes. Given the increased risk of cardiotoxicity induced by breast cancer treatments, it is important to identify patients at high risk of cardiovascular disease (CVD) mortality. The aim of this study was to investigate if this risk varies by age and ethnicity. Patient details were obtained from 5,868 Chinese, Malay, and Indian women diagnosed with in situ or non-metastasized invasive breast cancer at the National University Hospital of Singapore and KK Women's and Children's Hospital in Singapore. Death causes were obtained from the National Registry of Births and Deaths. Flexible parametric survival models estimated CVD mortality rates and hazard ratios. During a median follow-up of six years, 1,010 deaths occurred of which 6.8% were due to CVD. CVD mortality rates of older women peaked within the first year following diagnosis and increased over time since diagnosis. Indian had more than double the risk of CVD mortality than Chinese, independent of age at diagnosis and stage. Taking ethnicity and age into account may promote CVD risk stratification and management in (Southeast Asian) women with breast cancer.
Collapse
Affiliation(s)
- S A M Gernaat
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Epidemiology, Utrecht, 3584, CX, The Netherlands.
| | - P J Ho
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, 117549, Singapore
| | - N Rijnberg
- Academic Medical Center, Division of Internal Medicine, Amsterdam, 1105 AZ, The Netherlands
| | - S C Lee
- National University Cancer Institute, National University Health System, Department of Hematology-oncology, Singapore, 119074, Singapore
| | - S H Lim
- KK Women's and Children's Hospital, KK Breast Department, Singapore, 229899, Singapore
| | - Y S Yap
- National Cancer Centre Singapore, Division of Medical Oncology, Singapore, 169610, Singapore
| | - D E Grobbee
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Epidemiology, Utrecht, 3584, CX, The Netherlands
| | - M Hartman
- National University Hospital Singapore, Department of Surgery, Singapore, 119074, Singapore
| | - H M Verkooijen
- University Medical Center Utrecht, Imaging Division, Utrecht, 3584 CX, The Netherlands
| |
Collapse
|
39
|
Burris HA, Chan A, Campone M, Blackwell KL, Winer EP, Janni W, Verma S, Burdaeva O, Alba E, Favret AM, Mondal S, Miller M, Germa C, Hirawat S, Yap YS. Abstract P4-22-16: First-line ribociclib + letrozole in patients with HR+, HER2– advanced breast cancer (ABC) presenting with visceral metastases or bone-only disease: A subgroup analysis of the MONALEESA-2 trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-22-16] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients with ABC who present with visceral metastases have a worse outcome than patients with non-visceral disease, while patients with bone-only disease tend to have a better prognosis. Ribociclib (LEE011) is an oral, selective inhibitor of cyclin-dependent kinase (CDK) 4/6. In a Phase 3, placebo-controlled, randomized trial (MONALEESA-2; NCT01958021), first-line ribociclib (R) + letrozole (L) significantly prolonged progression-free survival (PFS) vs placebo (P) + L in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) ABC, with a hazard ratio of 0.556 (95% confidence interval [CI]: 0.429–0.720; p=0.00000329) at the interim analysis cut-off date (Jan 29, 2016). Here, we present subgroup analyses in patients with visceral metastases, and those with bone-only disease.
Methods: Postmenopausal women with HR+, HER2– ABC were randomized 1:1 to receive R (600 mg/day; 3-weeks-on/1-week-off) + L (2.5 mg/day; continuous) or P+L, stratified by the presence of liver and/or lung metastases. No prior CDK4/6 inhibitors or systemic therapy for ABC were allowed. Eligible patients had Eastern Cooperative Oncology Group performance status ≤1, baseline alanine/aspartate aminotransferase levels <5× upper limit of normal (ULN) or <2.5× ULN for patients with or without liver metastases, respectively, and ≥1 predominantly lytic bone lesion at baseline for patients with bone-only disease. Locally assessed PFS was analyzed for all patients (primary endpoint), and for predefined patient subgroups.
Results: Overall, 668 patients were randomized; 393 had visceral metastases and 147 had bone-only disease.
Visceral metastasesBone-only disease n=393n=147 R+LP+LR+LP+L n=197n=196n=69n=78Median age, years (range)63 (23–91)63 (29–88)65 (37–85)63 (37–84)De novo metastatic disease, n (%)53 (27)55 (28)28 (41)24 (31)Non-de novo disease-free interval, n (%)≤24 months12 (6)15 (8)5 (7)6 (8)>24 months132 (67)126 (64)36 (52)48 (62)Discontinued treatment, n (%)83 (42)111 (57)29 (42)40 (51)Reason for discontinuation, n (%)Disease progression56 (28)93 (47)17 (25)31 (40)Patient/physician decision10 (5)15 (8)7 (10)6 (8)Adverse events16 (8)3 (2)4 (6)2 (3)Protocol deviation001 (1)1 (1)Death1 (<1)000
In patients with visceral metastases: Median PFS was not reached in the R+L arm (95% CI: 19.3–not estimable [NE]) vs 13.0 months (95% CI: 12.6 –16.5) in the P+L arm, with hazard ratio 0.535 (95% CI: 0.385–0.742). Median duration of exposure was 12.0 and 13.0 months (R and L, respectively) in the R+L arm, and 12.1 and 12.2 months (P and L, respectively) in the P+L arm.
In patients with bone-only disease: Median PFS was not reached in the R+L arm (95% CI: NE–NE) vs 15.3 months (95% CI: 13.8–NE) in the P+L arm, with hazard ratio 0.690 (95% CI: 0.381–1.249). Median duration of exposure was 12.1 and 12.6 months (R and L, respectively) in the R+L arm, and 12.7 and 12.9 months (P and L, respectively) in the P+L arm.
Conclusions: First-line R+L was well tolerated and significantly prolonged PFS vs P+L in postmenopausal women with HR+, HER2– ABC, both in patients with visceral metastases and those with bone-only disease.
Keywords: Advanced breast cancer; CDK4/6 inhibitor; Letrozole; Ribociclib
Citation Format: Burris HA, Chan A, Campone M, Blackwell KL, Winer EP, Janni W, Verma S, Burdaeva O, Alba E, Favret AM, Mondal S, Miller M, Germa C, Hirawat S, Yap YS. First-line ribociclib + letrozole in patients with HR+, HER2– advanced breast cancer (ABC) presenting with visceral metastases or bone-only disease: A subgroup analysis of the MONALEESA-2 trial [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 P4-22-16.
Collapse
Affiliation(s)
- HA Burris
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - A Chan
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - M Campone
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - KL Blackwell
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - EP Winer
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - W Janni
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - S Verma
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - O Burdaeva
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - E Alba
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - AM Favret
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - S Mondal
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - M Miller
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - C Germa
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - S Hirawat
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| | - YS Yap
- Sarah Cannon Research Institute, Nashville, TN; Breast Cancer Research Centre WA & Curtin University, Perth, Australia; Institut de Cancérologie de l'Ouest – René Gauducheau Centre de Recherche en Cancérologie, Nantes, France; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; Universitätsklinikum Ulm, Ulm, Germany; Tom Baker Cancer Centre, Calgary, Canada; Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russian Federation; Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; Virginia Cancer Specialists, Arlington, VA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; National Cancer Center Singapore, Singapore
| |
Collapse
|
40
|
Lim LY, Miao H, Lim JSJ, Lee SC, Bhoo‐Pathy N, Yip CH, Taib NABM, Chan P, Tan EY, Lim SH, Lim GH, Woo E, Tan YS, Lee JA, Wong M, Tan PH, Ong KW, Wong FY, Yap YS, Hartman M. Outcome after neoadjuvant chemotherapy in Asian breast cancer patients. Cancer Med 2017; 6:173-185. [PMID: 28000426 PMCID: PMC5269707 DOI: 10.1002/cam4.985] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 07/16/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 01/27/2023] Open
Abstract
We aim to identify clinicopathologic predictors for response to neoadjuvant chemotherapy and to evaluate the prognostic value of pathologic complete response (pCR) on survival in Asia. This study included 915 breast cancer patients who underwent neoadjuvant chemotherapy at five public hospitals in Singapore and Malaysia. pCR following neoadjuvant chemotherapy was defined as 1) no residual invasive tumor cells in the breast (ypT0/is) and 2) no residual invasive tumor cells in the breast and axillary lymph nodes (ypT0/is ypN0). Association between pCR and clinicopathologic characteristics and treatment were evaluated using chi-square test and multivariable logistic regression. Kaplan-Meier analysis and log-rank test, stratified by other prognostic factors, were conducted to compare overall survival between patients who achieved pCR and patients who did not. Overall, 4.4% of nonmetastatic patients received neoadjuvant chemotherapy. The median age of preoperatively treated patients was 50 years. pCR rates were 18.1% (pCR ypT0/is) and 14.4% (pCR ypT0/is ypN0), respectively. pCR rate was the highest among women who had higher grade, smaller size, estrogen receptor negative, human epidermal growth factor receptor 2-positive disease or receiving taxane-based neoadjuvant chemotherapy. Patients who achieved pCR had better overall survival than those who did not. In subgroup analysis, the survival advantage was only significant among women with estrogen receptor-negative tumors. Patients with poor prognostic profile are more likely to achieve pCR and particularly when receiving taxane-containing chemotherapy. pCR is a significant prognostic factor for overall survival especially in estrogen receptor-negative breast cancers.
Collapse
Affiliation(s)
- Li Yan Lim
- Department of SurgeryNational University Health System1E Kent Ridge RoadSingapore119228Singapore
| | - Hui Miao
- Saw Swee Hock School of Public HealthNational University of SingaporeTahir Foundation Building, 12 Science Drive 2Singapore117549Singapore
| | - Joline S. J. Lim
- Department of Hematology OncologyNational University Health System1E Kent Ridge RoadSingapore119228Singapore
| | - Soo Chin Lee
- Department of Hematology OncologyNational University Health System1E Kent Ridge RoadSingapore119228Singapore
| | - Nirmala Bhoo‐Pathy
- Julius Centre University MalayaFaculty of MedicineUniversity of MalayaKuala Lumpur50603Malaysia
| | - Cheng Har Yip
- Department of SurgeryFaculty of MedicineUniversity of MalayaKuala Lumpur50603Malaysia
| | - Nur Aishah B. M. Taib
- Department of SurgeryFaculty of MedicineUniversity of MalayaKuala Lumpur50603Malaysia
| | - Patrick Chan
- Department of SurgeryTan Tock Seng Hospital11 Jalan Tan Tock SengSingapore308433Singapore
| | - Ern Yu Tan
- Department of SurgeryTan Tock Seng Hospital11 Jalan Tan Tock SengSingapore308433Singapore
| | - Swee Ho Lim
- Breast DepartmentKK Women's and Children's Hospital100 Bukit Timah RoadSingapore229899Singapore
| | - Geok Hoon Lim
- Breast DepartmentKK Women's and Children's Hospital100 Bukit Timah RoadSingapore229899Singapore
| | - Evan Woo
- Breast DepartmentKK Women's and Children's Hospital100 Bukit Timah RoadSingapore229899Singapore
| | - Yia Swam Tan
- Breast DepartmentKK Women's and Children's Hospital100 Bukit Timah RoadSingapore229899Singapore
| | - Jung Ah Lee
- Breast DepartmentKK Women's and Children's Hospital100 Bukit Timah RoadSingapore229899Singapore
| | - Mabel Wong
- Department of Medical OncologyNational Cancer Centre Singapore11 Hospital DriveSingapore169610Singapore
| | - Puay Hoon Tan
- Department of PathologySingapore General Hospital20 College RoadSingapore169856Singapore
| | - Kong Wee Ong
- Division of Surgical OncologyNational Cancer Centre Singapore11 Hospital DriveSingapore169610Singapore
| | - Fuh Yong Wong
- Division of Radiation OncologyNational Cancer Centre Singapore11 Hospital DriveSingapore169610Singapore
| | - Yoon Sim Yap
- Breast DepartmentKK Women's and Children's Hospital100 Bukit Timah RoadSingapore229899Singapore
- Department of Medical OncologyNational Cancer Centre Singapore11 Hospital DriveSingapore169610Singapore
| | - Mikael Hartman
- Saw Swee Hock School of Public HealthNational University of SingaporeTahir Foundation Building, 12 Science Drive 2Singapore117549Singapore
- Department of SurgeryNational University of Singapore and National University Health System1E Kent Ridge RoadSingapore119228Singapore
| |
Collapse
|
41
|
NG T, Chian MT, Yeo HLA, Shwe M, Gan YX, Loh WJK, Koo SL, Jain A, Lee GE, Dent RA, Yap YS, Ng RC, Cham MT, Lee JA, Chu PYP, Khor CC, Ho HK, Chan A. DNA methyltransferase 1 (DNMT1) polymorphism and chemotherapy-associated cognitive impairment in early-stage breast cancer patients (ESBC): A prospective, longitudinal study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Terence NG
- National University of Singapore, Singapore, Singapore
| | | | | | - Maung Shwe
- National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Si-Lin Koo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Amit Jain
- National Cancer Centre Singapore, Singapore, Singapore
| | - Guek Eng Lee
- National Cancer Center Singapore, Singapore, Singapore
| | | | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Mooi Tai Cham
- K.K. Women's and Children's Hospital, Singapore, Singapore
| | - Jung Ah Lee
- K.K. Women's and Children's Hospital, Singapore, Singapore
| | - Pak Yan Pa Chu
- Singapore Cord Blood Bank, K.K. Women's and Children's Hospital, Singapore, Singapore
| | | | - Han Kiat Ho
- National University of Singapore, Singapore, Singapore
| | | |
Collapse
|
42
|
Lee SC, Chin SY, Shimasaki N, Tan LK, Koh LP, Lieow JJM, Kono K, Kwan HY, Coustan-Smith E, Wong ALA, Soo RA, Tan B, Poon MLM, Yap YS, Yong WP, Goh BC, Campana D. Phase Ib/II trial of expanded and activated autologous natural killer (NK) cells with trastuzumab (Tras) in refractory HER2+ metastatic breast cancer (MBC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3045] [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)
- Soo-Chin Lee
- National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Si Yin Chin
- National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | | | - Lip Kun Tan
- National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Liang Piu Koh
- National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Jedidah JM Lieow
- National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Koji Kono
- University of Yamanashi, Minami Alps Yamanashi, Japan
| | | | | | - Andrea Li Ann Wong
- National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Ross A. Soo
- National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Belinda Tan
- National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Michelle Li Mei Poon
- National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Wei-Peng Yong
- National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Boon C. Goh
- National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore
| | - Dario Campana
- National University of Singapore, Singapore, Singapore
| |
Collapse
|
43
|
Lim JSL, Sutiman N, Muerdter TE, Singh O, Cheung YB, Ng RCH, Yap YS, Wong NS, Ang PCS, Dent R, Schroth W, Schwab M, Chowbay B. Association of CYP2C19*2 and associated haplotypes with lower norendoxifen concentrations in tamoxifen-treated Asian breast cancer patients. Br J Clin Pharmacol 2016; 81:1142-52. [PMID: 26799162 DOI: 10.1111/bcp.12886] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 08/27/2015] [Revised: 01/05/2016] [Accepted: 01/19/2016] [Indexed: 12/25/2022] Open
Abstract
AIM The aim was to examine the influence of CYP2C19 variants and associated haplotypes on the disposition of tamoxifen and its metabolites, particularly norendoxifen (NorEND), in Asian patients with breast cancer. METHODS Sixty-six CYP2C19 polymorphisms were identified in healthy Asians (n = 240), of which 14 were found to be tightly linked with CYP2C19*2, CYP2C19*3 and CYP2C19*17. These 17 SNPs were further genotyped in Asian breast cancer patients receiving tamoxifen (n = 201). Steady-state concentrations of tamoxifen and its metabolites were quantified using liquid chromatography–mass spectrometry. Non-parametric tests and regression methods were implemented to evaluate genotypic–phenotypic associations and haplotypic effects of the SNPs. RESULTS CYP2C19 functional polymorphisms and their linked SNPs were not significantly associated with plasma concentrations of tamoxifen and its main metabolites N-desmethyltamoxifen, (Z)-4-hydroxytamoxifen and (Z)-Endoxifen. However, CYP2C19*2 and its seven linked SNPs were significantly associated with lower NorEND concentrations, MRNorEND/NDDM and MRNorEND/(Z)-END. Specifically, patients carrying the CYP2C19*2 variant allele A had significantly lower NorEND concentrations [median (range), GG vs. GA vs. AA: 1.51 (0.38–3.28) vs. 1.28 (0.30–3.36) vs. 1.15 ng ml−1 (0.26–2.45, P = 0.010)] as well as significantly lower MRNorEND/(Z)-END [GG vs. GA vs. AA: 9.40 (3.27–28.35) vs. 8.15 (2.67–18.9) vs. 6.06 (4.47–14.6), P < 0.0001] and MRNorEND/NDDM [GG vs. GA vs. AA: 2.75 (0.62–6.26) vs. 2.43 (0.96–4.18) vs. 1.75 (1.10–2.49), P < 0.00001]. CYP2C19 H2 haplotype, which included CYP2C19*2, was also significantly associated with lower NorEND concentrations (P = 0.0020), MRNorEND/NDDM (P < 0.0001) and MRNorEND/(Z)-END (P < 0.0001), indicating significantly lower formation rates of NorEND. CONCLUSION These data highlight the potential relevance of CYP2C19 pharmacogenetics in influencing NorEND concentrations in tamoxifen-treated patients, which may influence treatment outcomes.
Collapse
Affiliation(s)
- Joanne Siok Liu Lim
- Laboratory of Clinical Pharmacology, Division of Medical Sciences, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore
| | | | - Thomas E Muerdter
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University Tubingen, Germany
| | - Onkar Singh
- Laboratory of Clinical Pharmacology, Division of Medical Sciences, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore
| | - Yin Bun Cheung
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.,Department of International Health, University of Tampere, Finland
| | | | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Nan Soon Wong
- OncoCare Cancer Centre, Mount Elizabeth Novena Medical Centre, Singapore
| | | | - Rebecca Dent
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Werner Schroth
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University Tubingen, Germany
| | - Matthias Schwab
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and Department of Clinical Pharmacology, University Hospital, Tubingen, Germany
| | - Balram Chowbay
- Laboratory of Clinical Pharmacology, Division of Medical Sciences, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore.,Clinical Pharmacology, SingHealth, Singapore.,Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
| |
Collapse
|
44
|
Ro J, Cheng FTF, Sriuranpong V, Villalon A, Smruti BK, Tsang J, Yap YS. Patient Management with Eribulin in Metastatic Breast Cancer: A Clinical Practice Guide. J Breast Cancer 2016; 19:8-17. [PMID: 27066091 PMCID: PMC4822111 DOI: 10.4048/jbc.2016.19.1.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/18/2016] [Indexed: 01/07/2023] Open
Abstract
Eribulin, an antimicrotubule chemotherapeutic agent, is approved for the treatment of pretreated metastatic breast cancer (mBC) based on the positive outcomes of phase II and phase III clinical trials, which enrolled mainly Western patients. Eribulin has recently been approved in an increasing number of Asian countries; however, there is limited clinical experience in using the drug in certain countries. Therefore, we established an Asian working group to provide practical guidance for eribulin use based on our clinical experience. This paper summarizes the key clinical trials, and the management recommendations for the reported adverse events (AEs) of eribulin in mBC treatment, with an emphasis on those that are relevant to Asian patients, followed by further elaboration of our eribulin clinical experience. It is anticipated that this clinical practice guide will improve the management of AEs resulting from eribulin treatment, which will ensure that patients receive the maximum treatment benefit.
Collapse
Affiliation(s)
- Jungsil Ro
- Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | | | - Virote Sriuranpong
- Division of Medical Oncology, Department of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Antonio Villalon
- Department of Internal Medicine, Manila Doctor Hospital, Manila, Philippines
| | - B. K Smruti
- Division of Medical Oncology, Bombay Hospital Institute of Medical Sciences & Lilavati Hospital, Mumbai, India
| | - Janice Tsang
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Yoon Sim Yap
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | |
Collapse
|
45
|
Ng T, Teo SM, Yeo HL, Shwe M, Gan YX, Cheung YT, Foo KM, Cham MT, Lee JA, Tan YP, Fan G, Yong WS, Preetha M, Loh WJK, Koo SL, Jain A, Lee GE, Wong M, Dent R, Yap YS, Ng R, Khor CC, Ho HK, Chan A. Brain-derived neurotrophic factor genetic polymorphism (rs6265) is protective against chemotherapy-associated cognitive impairment in patients with early-stage breast cancer. Neuro Oncol 2015; 18:244-51. [PMID: 26289590 PMCID: PMC4724179 DOI: 10.1093/neuonc/nov162] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [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: 05/08/2015] [Accepted: 07/17/2015] [Indexed: 12/31/2022] Open
Abstract
Background Brain-derived neurotrophic factor (BDNF), a neurotrophin that regulates neuronal function and development, is implicated in several neurodegenerative conditions. Preliminary data suggest that a reduction of BDNF concentrations may lead to postchemotherapy cognitive impairment. We hypothesized that a single nucleotide polymorphism (rs6265) of the BDNF gene may predispose patients to cognitive impairment. This study aimed to evaluate the effect of BDNF gene polymorphism on chemotherapy-associated cognitive impairment. Methods Overall, 145 patients receiving chemotherapy for early-stage breast cancer (mean age: 50.8 ± 8.8 y; 82.1% Chinese) were recruited. Patients' cognitive functions were assessed longitudinally using the validated Functional Assessment of Cancer Therapy–Cognitive Function (v.3) and an objective computerized tool, Headminder. Genotyping was performed using Sanger sequencing. Logistic regression was used to evaluate the association between BDNF Val66Met polymorphism and cognition after adjusting for ethnicity and clinically important covariates. Results Of the 145 patients, 54 (37%) reported cognitive impairment postchemotherapy. The Met/Met genotype was associated with statistically significant lower odds of developing cognitive impairment (odds ratio [OR] = 0.26; 95% CI: 0.08–0.92; P = .036). The Met carriers were less likely to experience impairment in the domains of verbal fluency (OR = 0.34; 95% CI: 0.12–0.90; P = .031) and multitasking ability (OR = 0.37; 95% CI: 0.15–0.91; P = .030) compared with the Val/Val homozygote. No associations were observed between Headminder and the BDNF Val66Met polymorphism. Conclusions This is the first study to provide evidence that carriers of the BDNF Met allele are protected against chemotherapy-associated cognitive impairment. Further studies are required to validate the findings.
Collapse
Affiliation(s)
- Terence Ng
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Shu Mei Teo
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Hui Ling Yeo
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Maung Shwe
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Yan Xiang Gan
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Yin Ting Cheung
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Koon Mian Foo
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Mooi Tai Cham
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Jung Ah Lee
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Yee Pin Tan
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Gilbert Fan
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Wei Sean Yong
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Madhukumar Preetha
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Wei-Jen Kiley Loh
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Si-Lin Koo
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Amit Jain
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Guek Eng Lee
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Mabel Wong
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Rebecca Dent
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Yoon Sim Yap
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Raymond Ng
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Chiea Chuen Khor
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Han Kiat Ho
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| |
Collapse
|
46
|
NG T, Teo SMJ, Yeo HLA, Shwe M, Gan YX, Cheung YT, Tan YP, Yong WS, Madhukumar P, Loh KWJ, Koo SL, Jain A, Lee GE, Wong M, Dent RA, Yap YS, Ng RC, Khor CC, Ho HK, Chan A. Evaluation of brain-derived neurotrophic factor (BDNF) genetic polymorphism (rs6265) on chemotherapy-associated cognitive impairment in early-stage breast cancer (ESBC) patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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)
- Terence NG
- National University of Singapore, Singapore, Singapore
| | | | | | - Maung Shwe
- National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Yee Pin Tan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Wei Sean Yong
- National Cancer Centre Singapore, Singapore, Singapore
| | | | | | - Si-Lin Koo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Amit Jain
- National Cancer Centre Singapore, Singapore, Singapore
| | - Guek Eng Lee
- National Cancer Center Singapore, Singapore, Singapore
| | - Mabel Wong
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore
| | | | | | - Han Kiat Ho
- National University of Singapore, Singapore, Singapore
| | | |
Collapse
|
47
|
NG T, Yap SY, Shwe M, Gan YX, Cheung YT, Fan G, Yong WS, Madhukumar P, Loh KWJ, Koo SL, Jain A, Lee GE, Wong M, Dent RA, Yap YS, Ng RC, Ho HK, Chan A. Evaluation of pro-inflammatory cytokines and anxiety symptoms in early-stage breast cancer (ESBC) patients: A prospective, longitudinal study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20742] [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)
- Terence NG
- National University of Singapore, Singapore, Singapore
| | - Shi Yin Yap
- National University of Singapore, Singapore, Singapore
| | - Maung Shwe
- National University of Singapore, Singapore, Singapore
| | - Yan Xiang Gan
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Gilbert Fan
- National Cancer Centre Singapore, Singapore, Singapore
| | - Wei Sean Yong
- National Cancer Centre Singapore, Singapore, Singapore
| | | | | | - Si-Lin Koo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Amit Jain
- National Cancer Centre Singapore, Singapore, Singapore
| | - Guek Eng Lee
- National Cancer Center Singapore, Singapore, Singapore
| | - Mabel Wong
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore
| | | | - Han Kiat Ho
- National University of Singapore, Singapore, Singapore
| | | |
Collapse
|
48
|
Yap YS, Kwok LL, Ng RC, Wong NS, Lo SK, Chay WY, Chia JWK, Tham CK, Tan SL, Mok VZY, Koh JKX, Loh M, Toh HC, Koo WH, Soong RCT, Choo S. Predictors of hand-foot syndrome (HFS) in randomised double-blind, placebo-controlled trial of pyridoxine for prevention of capecitabine induced HFS. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9596] [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)
- Yoon Sim Yap
- National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore
| | - Li-Lian Kwok
- National Cancer Centre Singapore, Singapore, Singapore
| | | | | | - Soo Kien Lo
- National Cancer Centre Singapore, Singapore, Singapore
| | | | | | | | - Si Li Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Vanessa Zuan Yu Mok
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | | | - Marie Loh
- Oncology Research Institute, National University of Singapore, Singapore, Singapore
| | | | - Wen Hsin Koo
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - SuPin Choo
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| |
Collapse
|
49
|
Cheung YT, Ng T, Shwe M, Ho HK, Foo KM, Cham MT, Lee JA, Fan G, Tan YP, Yong WS, Madhukumar P, Loo SK, Ang SF, Wong M, Chay WY, Ooi WS, Dent RA, Yap YS, Ng R, Chan A. Association of proinflammatory cytokines and chemotherapy-associated cognitive impairment in breast cancer patients: a multi-centered, prospective, cohort study. Ann Oncol 2015; 26:1446-51. [PMID: 25922060 PMCID: PMC4478978 DOI: 10.1093/annonc/mdv206] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [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: 11/13/2014] [Accepted: 04/20/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Existing evidence suggests that proinflammatory cytokines play an intermediary role in postchemotherapy cognitive impairment. This is one of the largest multicentered, cohort studies conducted in Singapore to evaluate the prevalence and proinflammatory biomarkers associated with cognitive impairment in breast cancer patients. PATIENTS AND METHODS Chemotherapy-receiving breast cancer patients (stages I-III) were recruited. Proinflammatory plasma cytokines concentrations [interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating factor, interferon-γ and tumor necrosis factor-α] were evaluated at 3 time points (before chemotherapy, 6 and 12 weeks after chemotherapy initiation). The FACT-Cog (version 3) was utilized to evaluate patients' self-perceived cognitive disturbances and a computerized neuropsychological assessment (Headminder) was administered to evaluate patients' memory, attention, response speed and processing speed. Changes of cognition throughout chemotherapy treatment were compared against the baseline. Linear mixed-effects models were applied to test the relationships of clinical variables and cytokine concentrations on self-perceived cognitive disturbances and each objective cognitive domain. RESULTS Ninety-nine patients were included (age 50.5 ± 8.4 years; 81.8% Chinese; mean duration of education = 10.8 ± 3.3 years). Higher plasma IL-1β was associated with poorer response speed performance (estimate: -0.78; 95% confidence interval (CI) -1.34 to -0.03; P = 0.023), and a higher concentration of IL-4 was associated with better response speed performance (P = 0.022). Higher concentrations of IL-1β and IL-6 were associated with more severe self-perceived cognitive disturbances (P = 0.018 and 0.001, respectively). Patients with higher concentrations of IL-4 also reported less severe cognitive disturbances (P = 0.022). CONCLUSIONS While elevated concentrations of IL-6 and IL-1β were observed in patients with poorer response speed performance and perceived cognitive disturbances, IL-4 may be protective against chemotherapy-associated cognitive impairment. This study is important because cytokines would potentially be mechanistic mediators of chemotherapy-associated cognitive changes.
Collapse
Affiliation(s)
- Y T Cheung
- Department of Pharmacy, National University of Singapore, Singapore Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - T Ng
- Department of Pharmacy, National University of Singapore, Singapore Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - M Shwe
- Department of Pharmacy, National University of Singapore, Singapore
| | - H K Ho
- Department of Pharmacy, National University of Singapore, Singapore
| | | | - M T Cham
- Breast Centre, KK Women's and Children's Hospital, Singapore
| | - J A Lee
- Breast Centre, KK Women's and Children's Hospital, Singapore
| | - G Fan
- Departments of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
| | - Y P Tan
- Departments of Psychosocial Oncology, National Cancer Centre Singapore, Singapore
| | - W S Yong
- Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - P Madhukumar
- Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - S K Loo
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - S F Ang
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - M Wong
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - W Y Chay
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - W S Ooi
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - R A Dent
- Medical Oncology, National Cancer Centre Singapore, Singapore Clinical Sciences, DUKE-NUS Graduate Medical School, Singapore, Singapore
| | - Y S Yap
- Medical Oncology, National Cancer Centre Singapore, Singapore
| | - R Ng
- Medical Oncology, National Cancer Centre Singapore, Singapore Clinical Sciences, DUKE-NUS Graduate Medical School, Singapore, Singapore
| | - A Chan
- Department of Pharmacy, National University of Singapore, Singapore Department of Pharmacy, National Cancer Centre Singapore, Singapore Clinical Sciences, DUKE-NUS Graduate Medical School, Singapore, Singapore
| |
Collapse
|
50
|
Saladores P, Mürdter T, Eccles D, Chowbay B, Zgheib NK, Winter S, Ganchev B, Eccles B, Gerty S, Tfayli A, Lim JSL, Yap YS, Ng RCH, Wong NS, Dent R, Habbal MZ, Schaeffeler E, Eichelbaum M, Schroth W, Schwab M, Brauch H. Tamoxifen metabolism predicts drug concentrations and outcome in premenopausal patients with early breast cancer. Pharmacogenomics J 2015; 15:84-94. [PMID: 25091503 PMCID: PMC4308646 DOI: 10.1038/tpj.2014.34] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/30/2014] [Accepted: 06/04/2014] [Indexed: 12/11/2022]
Abstract
Tamoxifen is the standard-of-care treatment for estrogen receptor-positive premenopausal breast cancer. We examined tamoxifen metabolism via blood metabolite concentrations and germline variations of CYP3A5, CYP2C9, CYP2C19 and CYP2D6 in 587 premenopausal patients (Asians, Middle Eastern Arabs, Caucasian-UK; median age 39 years) and clinical outcome in 306 patients. N-desmethyltamoxifen (DM-Tam)/(Z)-endoxifen and CYP2D6 phenotype significantly correlated across ethnicities (R(2): 53%, P<10(-77)). CYP2C19 and CYP2C9 correlated with norendoxifen and (Z)-4-hydroxytamoxifen concentrations, respectively (P<0.001). DM-Tam was influenced by body mass index (P<0.001). Improved distant relapse-free survival (DRFS) was associated with decreasing DM-Tam/(Z)-endoxifen (P=0.036) and increasing CYP2D6 activity score (hazard ratio (HR)=0.62; 95% confidence interval (CI), 0.43-0.91; P=0.013). Low (<14 nM) compared with high (>35 nM) endoxifen concentrations were associated with shorter DRFS (univariate P=0.03; multivariate HR=1.94; 95% CI, 1.04-4.14; P=0.064). Our data indicate that endoxifen formation in premenopausal women depends on CYP2D6 irrespective of ethnicity. Low endoxifen concentration/formation and decreased CYP2D6 activity predict shorter DRFS.
Collapse
Affiliation(s)
- P Saladores
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - T Mürdter
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - D Eccles
- Faculty of Medicine, Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - B Chowbay
- Clinical Pharmacology Laboratory, Division of Medical Sciences, Humphrey Oei Institute of Cancer Research, National Cancer Centre Singapore, Singapore, Singapore
- Academic Medicine Research Institute, Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore, Singapore
- SingHealth Clinical Pharmacology Core, Academia, Singapore Health Services, Singapore, Singapore
| | - N K Zgheib
- Faculty of Medicine, Department of Pharmacology and Toxicology, American University of Beirut, Beirut, Lebanon
| | - S Winter
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - B Ganchev
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - B Eccles
- Faculty of Medicine, Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Gerty
- Faculty of Medicine, Cancer Sciences Academic Unit and University of Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Tfayli
- Hematology-Oncology Division, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - J S L Lim
- Clinical Pharmacology Laboratory, Division of Medical Sciences, Humphrey Oei Institute of Cancer Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Y S Yap
- Department of Medical Oncology, Humphrey Oei Institute of Cancer Research, National Cancer Centre Singapore, Singapore, Singapore
| | - R C H Ng
- Department of Medical Oncology, Humphrey Oei Institute of Cancer Research, National Cancer Centre Singapore, Singapore, Singapore
| | - N S Wong
- Department of Medical Oncology, Humphrey Oei Institute of Cancer Research, National Cancer Centre Singapore, Singapore, Singapore
| | - R Dent
- Department of Medical Oncology, Humphrey Oei Institute of Cancer Research, National Cancer Centre Singapore, Singapore, Singapore
| | - M Z Habbal
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - E Schaeffeler
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - M Eichelbaum
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - W Schroth
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - M Schwab
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H Brauch
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|