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Rönnlund C, Sifakis EG, Schagerholm C, Yang Q, Karlsson E, Chen X, Foukakis T, Weidler J, Bates M, Fredriksson I, Robertson S, Hartman J. Prognostic impact of HER2 biomarker levels in trastuzumab-treated early HER2-positive breast cancer. Breast Cancer Res 2024; 26:24. [PMID: 38321542 PMCID: PMC10848443 DOI: 10.1186/s13058-024-01779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Overexpression of human epidermal growth factor receptor 2 (HER2) caused by HER2 gene amplification is a driver in breast cancer tumorigenesis. We aimed to investigate the prognostic significance of manual scoring and digital image analysis (DIA) algorithm assessment of HER2 copy numbers and HER2/CEP17 ratios, along with ERBB2 mRNA levels among early-stage HER2-positive breast cancer patients treated with trastuzumab. METHODS This retrospective study comprised 371 early HER2-positive breast cancer patients treated with adjuvant trastuzumab, with HER2 re-testing performed on whole tumor sections. Digitized tumor tissue slides were manually scored and assessed with uPath HER2 Dual ISH image analysis, breast algorithm. Targeted ERBB2 mRNA levels were assessed by the Xpert® Breast Cancer STRAT4 Assay. HER2 copy number and HER2/CEP17 ratio from in situ hybridization assessment, along with ERBB2 mRNA levels, were explored in relation to recurrence-free survival (RFS). RESULTS The analysis showed that patients with tumors with the highest and lowest manually counted HER2 copy number levels had worse RFS than those with intermediate levels (HR = 2.7, CI 1.4-5.3, p = 0.003 and HR = 2.1, CI 1.1-3.9, p = 0.03, respectively). A similar trend was observed for HER2/CEP17 ratio, and the DIA algorithm confirmed the results. Moreover, patients with tumors with the highest and the lowest values of ERBB2 mRNA had a significantly worse prognosis (HR = 2.7, CI 1.4-5.1, p = 0.003 and HR = 2.8, CI 1.4-5.5, p = 0.004, respectively) compared to those with intermediate levels. CONCLUSIONS Our findings suggest that the association between any of the three HER2 biomarkers and RFS was nonlinear. Patients with tumors with the highest levels of HER2 gene amplification or ERBB2 mRNA were associated with a worse prognosis than those with intermediate levels, which is of importance to investigate in future clinical trials studying HER2-targeted therapy.
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Affiliation(s)
- Caroline Rönnlund
- Department of Oncology and Pathology, Karolinska Institutet, Visionsgatan 56, CCK R8:04, 17176, Stockholm, Sweden.
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden.
| | - Emmanouil G Sifakis
- Department of Oncology and Pathology, Karolinska Institutet, Visionsgatan 56, CCK R8:04, 17176, Stockholm, Sweden
| | - Caroline Schagerholm
- Department of Oncology and Pathology, Karolinska Institutet, Visionsgatan 56, CCK R8:04, 17176, Stockholm, Sweden
| | - Qiao Yang
- Department of Oncology and Pathology, Karolinska Institutet, Visionsgatan 56, CCK R8:04, 17176, Stockholm, Sweden
| | - Emelie Karlsson
- Department of Oncology and Pathology, Karolinska Institutet, Visionsgatan 56, CCK R8:04, 17176, Stockholm, Sweden
| | - Xinsong Chen
- Department of Oncology and Pathology, Karolinska Institutet, Visionsgatan 56, CCK R8:04, 17176, Stockholm, Sweden
| | - Theodoros Foukakis
- Department of Oncology and Pathology, Karolinska Institutet, Visionsgatan 56, CCK R8:04, 17176, Stockholm, Sweden
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Jodi Weidler
- Medical and Scientific Affairs and Strategy, Oncology, Cepheid, Sunnyvale, CA, USA
| | - Michael Bates
- Medical and Scientific Affairs and Strategy, Oncology, Cepheid, Sunnyvale, CA, USA
| | - Irma Fredriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast-, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Stephanie Robertson
- Department of Oncology and Pathology, Karolinska Institutet, Visionsgatan 56, CCK R8:04, 17176, Stockholm, Sweden
| | - Johan Hartman
- Department of Oncology and Pathology, Karolinska Institutet, Visionsgatan 56, CCK R8:04, 17176, Stockholm, Sweden
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
- Medtechlabs, Bioclinicum, Karolinska University Hospital, Stockholm, Sweden
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Griguolo G, Brasó-Maristany F, González-Farré B, Pascual T, Chic N, Saurí T, Kates R, Gluz O, Martínez D, Paré L, Tsvetkova V, Pesantez D, Vidal M, Adamo B, Muñoz M, Galván P, Barberá L, Cuatrecasas M, Christgen M, Kreipe H, Monge-Escartín I, Villagrasa P, Soy D, Giarratano T, Dieci MV, Conte P, Harbeck N, Guarneri V, Prat A. ERBB2 mRNA Expression and Response to Ado-Trastuzumab Emtansine (T-DM1) in HER2-Positive Breast Cancer. Cancers (Basel) 2020; 12:E1902. [PMID: 32674482 PMCID: PMC7409149 DOI: 10.3390/cancers12071902] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 06/13/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022] Open
Abstract
Trastuzumab emtansine (T-DM1) is approved for the treatment of human epidermal growth factor receptor 2 (HER2)-positive (HER2+) metastatic breast cancer (BC) and for residual disease after neoadjuvant therapy; however, not all patients benefit. Here, we hypothesized that the heterogeneity in the response seen in patients is partly explained by the levels of human epidermal growth factor receptor 2 gene (ERBB2) mRNA. We analyzed ERBB2 expression using a clinically applicable assay in formalin-fixed paraffin-embedded (FFPE) tumors (primary or metastatic) from a retrospective series of 77 patients with advanced HER2+ BC treated with T-DM1. The association of ERBB2 levels and response was further validated in 161 baseline tumors from the West German Study (WGS) Group ADAPT phase II trial exploring neoadjuvant T-DM1 and 9 in vitro BC cell lines. Finally, ERBB2 expression was explored in 392 BCs from an in-house dataset, 368 primary BCs from The Cancer Genome Atlas (TCGA) dataset and 10,071 tumors representing 33 cancer types from the PanCancer TCGA dataset. High ERBB2 mRNA was found associated with better response and progression-free survival in the metastatic setting and higher rates of pathological complete response in the neoadjuvant setting. ERBB2 expression also correlated with in vitro response to T-DM1. Finally, our assay identified 0.20-8.41% of tumors across 15 cancer types as ERBB2-high, including gastric and esophagus adenocarcinomas, urothelial carcinoma, cervical squamous carcinoma and pancreatic cancer. In particular, we identified high ERBB2 mRNA in a patient with HER2+ advanced gastric cancer who achieved a long-lasting partial response to T-DM1. Our study demonstrates that the heterogeneity in response to T-DM1 is partly explained by ERBB2 levels and provides a clinically applicable assay to be tested in future clinical trials of breast cancer and other cancer types.
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Affiliation(s)
- Gaia Griguolo
- Division of Medical Oncology 2, Istituto Oncologico Veneto IOV—IRCCS, 35128 Padova, Italy; (G.G.); (T.G.); (M.V.D.); (P.C.); (V.G.)
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35124 Padova, Italy;
| | - Fara Brasó-Maristany
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
| | - Blanca González-Farré
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
- Department of Pathology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - Tomás Pascual
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
- SOLTI breast cancer cooperative group, 08008 Barcelona, Spain; (L.P.); (P.V.)
| | - Núria Chic
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
| | - Tamara Saurí
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
| | - Ronald Kates
- The West German Study Group, 41061 Mönchengladbach, Germany; (R.K.); (O.G.)
| | - Oleg Gluz
- The West German Study Group, 41061 Mönchengladbach, Germany; (R.K.); (O.G.)
- Ev. Hospital Bethesda, Breast Center Niederrhein, 41061 Mönchengladbach, Germany
- University Clinics Cologne, 50937 Cologne, Germany
| | - Débora Martínez
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
| | - Laia Paré
- SOLTI breast cancer cooperative group, 08008 Barcelona, Spain; (L.P.); (P.V.)
| | - Vassilena Tsvetkova
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35124 Padova, Italy;
| | - David Pesantez
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
| | - Maria Vidal
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
- SOLTI breast cancer cooperative group, 08008 Barcelona, Spain; (L.P.); (P.V.)
| | - Barbara Adamo
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
| | - Montserrat Muñoz
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
- SOLTI breast cancer cooperative group, 08008 Barcelona, Spain; (L.P.); (P.V.)
| | - Patricia Galván
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
| | - Laura Barberá
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
| | - Miriam Cuatrecasas
- Department of Pathology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - Mathias Christgen
- Medical School Hannover, Institute of Pathology, 30625 Hannover, Germany; (M.C.); (H.K.)
| | - Hans Kreipe
- Medical School Hannover, Institute of Pathology, 30625 Hannover, Germany; (M.C.); (H.K.)
| | - Inés Monge-Escartín
- Pharmacy Department, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (I.M.-E.); (D.S.)
| | - Patricia Villagrasa
- SOLTI breast cancer cooperative group, 08008 Barcelona, Spain; (L.P.); (P.V.)
| | - Dolors Soy
- Pharmacy Department, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (I.M.-E.); (D.S.)
| | - Tommaso Giarratano
- Division of Medical Oncology 2, Istituto Oncologico Veneto IOV—IRCCS, 35128 Padova, Italy; (G.G.); (T.G.); (M.V.D.); (P.C.); (V.G.)
| | - Maria Vittoria Dieci
- Division of Medical Oncology 2, Istituto Oncologico Veneto IOV—IRCCS, 35128 Padova, Italy; (G.G.); (T.G.); (M.V.D.); (P.C.); (V.G.)
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35124 Padova, Italy;
| | - Pierfranco Conte
- Division of Medical Oncology 2, Istituto Oncologico Veneto IOV—IRCCS, 35128 Padova, Italy; (G.G.); (T.G.); (M.V.D.); (P.C.); (V.G.)
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35124 Padova, Italy;
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, University of Munich (LMU) and CCCLMU, 80337 Munich, Germany;
| | - Valentina Guarneri
- Division of Medical Oncology 2, Istituto Oncologico Veneto IOV—IRCCS, 35128 Padova, Italy; (G.G.); (T.G.); (M.V.D.); (P.C.); (V.G.)
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35124 Padova, Italy;
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (F.B.-M.); (T.P.); (N.C.); (T.S.); (D.M.); (D.P.); (M.V.); (B.A.); (M.M.); (P.G.); (L.B.)
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain;
- SOLTI breast cancer cooperative group, 08008 Barcelona, Spain; (L.P.); (P.V.)
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