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Rugo HS, Lerebours F, Ciruelos E, Drullinsky P, Ruiz-Borrego M, Neven P, Park YH, Prat A, Bachelot T, Juric D, Turner N, Sophos N, Zarate JP, Arce C, Shen YM, Turner S, Kanakamedala H, Hsu WC, Chia S. Alpelisib plus fulvestrant in PIK3CA-mutated, hormone receptor-positive advanced breast cancer after a CDK4/6 inhibitor (BYLieve): one cohort of a phase 2, multicentre, open-label, non-comparative study. Lancet Oncol 2021; 22:489-498. [PMID: 33794206 DOI: 10.1016/s1470-2045(21)00034-6] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Alpelisib, a PI3Kα-selective inhibitor and degrader, plus fulvestrant showed efficacy in hormone receptor-positive, HER2-negative, PIK3CA-mutated advanced breast cancer in SOLAR-1; limited data are available in the post-cyclin-dependent kinase 4/6 inhibitor setting. BYLieve aimed to assess alpelisib plus endocrine therapy in this setting in three cohorts defined by immediate previous treatment; here, we report results from cohort A. METHODS This ongoing, phase 2, multicentre, open-label, non-comparative study enrolled patients with hormone receptor-positive, HER2-negative, advanced breast cancer with tumour PIK3CA mutation, following progression on or after previous therapy, including CDK4/6 inhibitors, from 114 study locations (cancer centres, medical centres, university hospitals, and hospitals) in 18 countries worldwide. Participants aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 2 or less, with no more than two previous anticancer treatments and no more than one previous chemotherapy regimen, were enrolled in three cohorts. In cohort A, patients must have had progression on or after a CDK4/6 inhibitor plus an aromatase inhibitor as the immediate previous treatment. Patients received oral alpelisib 300 mg/day (continuously) plus fulvestrant 500 mg intramuscularly on day 1 of each 28-day cycle and on day 15 of cycle 1. The primary endpoint was the proportion of patients alive without disease progression at 6 months per local assessment using Response Evaluation Criteria in Solid Tumors, version 1.1, in patients with a centrally confirmed PIK3CA mutation. This trial is registered with ClinicalTrials.gov, NCT03056755. FINDINGS Between Aug 14, 2017, and Dec 17, 2019 (data cutoff), 127 patients with at least 6 months' follow-up were enrolled into cohort A. 121 patients had a centrally confirmed PIK3CA mutation. At data cutoff, median follow-up was 11·7 months (IQR 8·5-15·9). 61 (50·4%; 95% CI 41·2-59·6) of 121 patients were alive without disease progression at 6 months. The most frequent grade 3 or worse adverse events were hyperglycaemia (36 [28%] of 127 patients), rash (12 [9%]), and rash maculopapular (12 [9%]). Serious adverse events occurred in 33 (26%) of 127 patients. No treatment-related deaths were reported. INTERPRETATION BYLieve showed activity of alpelisib plus fulvestrant with manageable toxicity in patients with PIK3CA-mutated, hormone receptor-positive, HER2-negative advanced breast cancer, after progression on a CDK4/6 inhibitor plus an aromatase inhibitor. FUNDING Novartis Pharmaceuticals.
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Affiliation(s)
- Hope S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
| | | | - Eva Ciruelos
- Medical Oncology Department, Breast Cancer Unit, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Manuel Ruiz-Borrego
- Department of Oncology, Hospital Virgen del Rocío de Sevilla, Seville, Spain
| | - Patrick Neven
- University Hospital Leuven Breast Centre, Leuven, Belgium
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Thomas Bachelot
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - Dejan Juric
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Nicholas Turner
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Nickolas Sophos
- Global Medical Affairs, Oncology, Novartis, East Hanover, NJ, USA
| | | | - Christina Arce
- Global Medical Affairs, Oncology, Novartis, East Hanover, NJ, USA
| | - Yu-Ming Shen
- Global Medical Affairs, Biostatistics, Novartis, Munich, Germany
| | - Stuart Turner
- Global Medical Affairs, Oncology, Novartis, East Hanover, NJ, USA
| | | | - Wei-Chun Hsu
- RWE Analytics, Genesis Research, Hoboken, NJ, USA
| | - Stephen Chia
- British Columbia Cancer Agency, Vancouver, BC, Canada
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Elmi A, Makvandi M, Weng CC, Hou C, Clark AS, Mach RH, Mankoff DA. Cell-Proliferation Imaging for Monitoring Response to CDK4/6 Inhibition Combined with Endocrine-Therapy in Breast Cancer: Comparison of [ 18F]FLT and [ 18F]ISO-1 PET/CT. Clin Cancer Res 2019; 25:3063-3073. [PMID: 30692100 PMCID: PMC9788667 DOI: 10.1158/1078-0432.ccr-18-2769] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 08/24/2018] [Revised: 11/11/2018] [Accepted: 01/14/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in combination with endocrine-therapy have emerged as an important regimen of care for estrogen receptor (ER)-positive metastatic breast cancer, although identifying predictive biomarkers remains a challenge. We assessed the ability of two PET-proliferation tracers, [18F]FLT and [18F]ISO-1, for evaluating response to CDK4/6-inhibitor (palbociclib) and ER-antagonist (fulvestrant). EXPERIMENTAL DESIGN To determine the effect of CDK4/6 inhibition combined with estrogen-blockade, we assessed cell proliferation in six breast cancer cell lines after 1, 3, and 6 days of treatment with palbociclib and/or fulvestrant. These data were correlated to in vitro radiotracer assays and results were verified by longitudinal [18F]FLT and [18F]ISO-1 micro-PET imaging performed in MCF7 tumor-bearing mice. RESULTS All palbociclib-sensitive cell lines showed decreased [18F]FLT accumulation and S-phase depletion after treatment, with both measures augmented by combination therapy. In contrast, these cells showed changes in [18F]ISO-1 analogue-binding and G0 arrest only after prolonged treatment. MicroPET imaging of MCF7 xenografts showed a significant decrease in [18F]FLT but no changes in [18F]ISO-1 uptake in all treated mice on day 3. On day 14, however, mice treated with combination therapy showed a significant decrease in [18F]ISO-1, corresponding to G0 arrest, while maintaining reduced [18F]FLT uptake, which corresponded to S-phase depletion. CONCLUSIONS Our data suggest complementary roles of [18F]FLT and [18F]ISO-1 PET in evaluating tumor-proliferation after combined CDK4/6 inhibitor and endocrine therapy in breast cancer. [18F]FLT is more sensitive to immediate changes in S-phase, whereas [18F]ISO-1 can assess more delayed changes related to cell-cycle arrest and transition to G0 quiescence from combination therapy. These data suggest a potential role for early prediction of long-term response using these imaging biomarkers.
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Affiliation(s)
- Azadeh Elmi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mehran Makvandi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chi-Chang Weng
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Hou
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy S Clark
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert H Mach
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A Mankoff
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Robertson JFR, Jiang Z, Di Leo A, Ohno S, Pritchard KI, Ellis M, Bradbury I, Campbell C. A meta-analysis of clinical benefit rates for fulvestrant 500 mg vs. alternative endocrine therapies for hormone receptor-positive advanced breast cancer. Breast Cancer 2019; 26:703-711. [PMID: 31079343 PMCID: PMC6821663 DOI: 10.1007/s12282-019-00973-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/31/2018] [Accepted: 04/22/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fulvestrant, a selective estrogen receptor degrader, is approved for first- and second-line treatment of postmenopausal women with hormone receptor-positive advanced breast cancer (ABC). METHODS Meta-analysis of randomized controlled trials (RCTs) evaluating fulvestrant 500 mg in postmenopausal hormone receptor-positive ABC, to evaluate differences in clinical benefit rate (CBR; proportion of patients experiencing best overall response of complete response, partial response, or stable disease for ≥ 24 weeks) between fulvestrant 500 mg and comparator endocrine therapies. Odds ratios (OR) and 95% confidence intervals (CI) for CBR were calculated; fixed effects (FE) models were constructed (first- and second-line data, alone and combined). RESULTS Six RCTs were included. Four studies evaluated fulvestrant 500 mg vs. fulvestrant 250 mg; two evaluated fulvestrant 500 mg vs. anastrozole 1 mg. In total, 1054 and 534 patients were included (first- and second-line treatment, respectively). Analysis of OR and 95% CI of CBR by therapy line favored fulvestrant 500 mg vs. comparator therapy. Assessing all results combined in the FE model indicated significant improvement in CBR with fulvestrant 500 mg vs. comparator treatments (OR 1.33; 95% CI 1.13-1.57; p = 0.001). Restricting the FE model to therapy line demonstrated significant improvement in CBR vs. comparator treatments (OR 1.33; 95% CI 1.02-1.73; p = 0.035) for first-line, and a trend to improvement vs. comparator treatments (OR 1.27; 95% CI 0.90-1.79; p = 0.174) for second-line. CONCLUSIONS In postmenopausal patients with hormone receptor-positive ABC, fulvestrant 500 mg first-line was associated with significantly greater CBR (more patients benefiting from treatment) vs. comparator endocrine therapy.
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Affiliation(s)
- John F R Robertson
- Division of Breast Surgery, The University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Zefei Jiang
- Department of Breast Cancer, Affiliated Hospital of Academy of Military Medical Sciences, No. 8 Dongda Street, Fengtai District, Beijing, 100071, China
| | - Angelo Di Leo
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Piazza Dell'ospedale 2, 59100, Prato, Italy
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kathleen I Pritchard
- Sunnybrook Odette Cancer Centre and the University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Matthew Ellis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, 6620 S Main St #1350, Houston, TX, 77030, USA
| | - Ian Bradbury
- Frontier Science, Grampian View, Kincraig, Kingussie, PH21 1NA, UK
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Mehta RS, Barlow WE, Albain KS, Vandenberg TA, Dakhil SR, Tirumali NR, Lew DL, Hayes DF, Gralow JR, Linden HH, Livingston RB, Hortobagyi GN. Overall Survival with Fulvestrant plus Anastrozole in Metastatic Breast Cancer. N Engl J Med 2019; 380:1226-1234. [PMID: 30917258 PMCID: PMC6885383 DOI: 10.1056/nejmoa1811714] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND We previously reported prolonged progression-free survival and marginally prolonged overall survival among postmenopausal patients with hormone receptor-positive metastatic breast cancer who had been randomly assigned to receive the aromatase inhibitor anastrozole plus the selective estrogen-receptor down-regulator fulvestrant, as compared with anastrozole alone, as first-line therapy. We now report final survival outcomes. METHODS We randomly assigned patients to receive either anastrozole or fulvestrant plus anastrozole. Randomization was stratified according to adjuvant tamoxifen use. Analysis of survival was performed by means of two-sided stratified log-rank tests and Cox regression. Efficacy and safety were compared between the two groups, both overall and in subgroups. RESULTS Of 707 patients who had undergone randomization, 694 had data available for analysis. The combination-therapy group had 247 deaths among 349 women (71%) and a median overall survival of 49.8 months, as compared with 261 deaths among 345 women (76%) and a median overall survival of 42.0 months in the anastrozole-alone group, a significant difference (hazard ratio for death, 0.82; 95% confidence interval [CI], 0.69 to 0.98; P = 0.03 by the log-rank test). In a subgroup analysis of the two strata, overall survival among women who had not received tamoxifen previously was longer with the combination therapy than with anastrozole alone (median, 52.2 months and 40.3 months, respectively; hazard ratio, 0.73; 95% CI, 0.58 to 0.92); among women who had received tamoxifen previously, overall survival was similar in the two groups (median, 48.2 months and 43.5 months, respectively; hazard ratio, 0.97; 95% CI, 0.74 to 1.27) (P = 0.09 for interaction). The incidence of long-term toxic effects of grade 3 to 5 was similar in the two groups. Approximately 45% of the patients in the anastrozole-alone group crossed over to receive fulvestrant. CONCLUSIONS The addition of fulvestrant to anastrozole was associated with increased long-term survival as compared with anastrozole alone, despite substantial crossover to fulvestrant after progression during therapy with anastrozole alone. The results suggest that the benefit was particularly notable in patients without previous exposure to adjuvant endocrine therapy. (Funded by the National Cancer Institute and AstraZeneca; ClinicalTrials.gov number, NCT00075764.).
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Affiliation(s)
- Rita S Mehta
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
| | - William E Barlow
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
| | - Kathy S Albain
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
| | - Ted A Vandenberg
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
| | - Shaker R Dakhil
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
| | - Nagendra R Tirumali
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
| | - Danika L Lew
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
| | - Daniel F Hayes
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
| | - Julie R Gralow
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
| | - Hannah H Linden
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
| | - Robert B Livingston
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
| | - Gabriel N Hortobagyi
- From the Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange (R.S.M.); the SWOG Statistics and Data Management Center (W.E.B., D.L.L.) and Seattle Cancer Care Alliance and University of Washington Medical Center (J.R.G., H.H.L.) - both in Seattle; Loyola University Chicago Stritch School of Medicine, Maywood, IL (K.S.A.); London Health Sciences Centre and the National Cancer Institute of Canada Clinical Trials Group, London, ON, Canada (T.A.V.); the Cancer Center of Kansas and Wichita National Cancer Institute Community Oncology Research Program (NCORP), Wichita (S.R.D.); Kaiser Permanente NCORP, Portland, OR (N.R.T.); the University of Michigan, Ann Arbor (D.F.H.); the University of Arizona Cancer Center, Tucson (R.B.L.); and the University of Texas M.D. Anderson Cancer Center, Houston (G.N.H.)
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Rabaglino MB, Keller‐Wood M, Wood CE. A transcriptomics model of estrogen action in the ovine fetal hypothalamus: evidence for estrogenic effects of ICI 182,780. Physiol Rep 2018; 6:e13871. [PMID: 30221477 PMCID: PMC6139289 DOI: 10.14814/phy2.13871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 01/13/2023] Open
Abstract
Estradiol plays a critical role in stimulating the fetal hypothalamus-pituitary-adrenal axis at the end of gestation. Estradiol action is mediated through nuclear and membrane receptors that can be modulated by ICI 182,780, a pure antiestrogen compound. The objective of this study was to evaluate the transcriptomic profile of estradiol and ICI 182,780, testing the hypothesis that ICI 182,780 antagonizes the action of estradiol in the fetal hypothalamus. Chronically catheterized ovine fetuses were infused for 48 h with: vehicle (Control, n = 6), 17β-estradiol 500 μg/kg/day (Estradiol, n = 4), ICI 182,780 5 μg/kg/day (ICI 5 μg, n = 4) and ICI 182,780 5 mg/kg/day (ICI 5 mg, n = 5). Fetal hypothalami were collected afterward, and gene expression was measured through microarray. Statistical analysis of transcriptomic data was performed with Bioconductor-R and Cytoscape software. Unexpectedly, 35% and 15.5% of the upregulated differentially expressed genes (DEG) by Estradiol significantly overlapped (P < 0.05) with upregulated DEG by ICI 5 mg and ICI 5 μg, respectively. For the downregulated DEG, these percentages were 29.9% and 15.5%, respectively. There was almost no overlap for DEG following opposite directions between Estradiol and ICI ICI 5 mg or ICI 5 μg. Furthermore, most of the genes in the estrogen signaling pathway - after activation of the epidermal growth factor receptor - followed the same direction in Estradiol, ICI 5 μg or ICI 5 mg compared to Control. In conclusion, estradiol and ICI 182,780 have estrogenic genomic effects in the developing brain, suggesting the possibility that the major action of estradiol on the fetal hypothalamus involves another receptor system rather than estrogen receptors.
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Affiliation(s)
- Maria Belen Rabaglino
- Department of Physiology and Functional GenomicsCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Maureen Keller‐Wood
- PharmacodynamicsCollege of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Charles E. Wood
- Department of Physiology and Functional GenomicsCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
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Al-Khyatt W, Tufarelli C, Khan R, Iftikhar SY. Selective oestrogen receptor antagonists inhibit oesophageal cancer cell proliferation in vitro. BMC Cancer 2018; 18:121. [PMID: 29390981 PMCID: PMC5796348 DOI: 10.1186/s12885-018-4030-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 05/16/2016] [Accepted: 01/23/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Oestrogen receptors (ER) have a well-established role to the initiation, progression and regulation of responses to treatment of breast, prostate, and lung cancers. Previous data indicates altered ER expression in oesophageal cancers (OC). However the role of ER subtypes and ER specific inhibitors in the regulation of OC progression remains unclear. This study sought to assess levels of ERα and ERβ in OC. The effects of highly selective ER antagonists on cell proliferation and apoptosis in two OC adenocarcinoma cell lines was also studied. METHODS ERα and ERβ expression profiling in paired normal oesophageal mucosa and tumour tissues (n = 34; adenocarcinoma n = 28; squamous cell carcinoma n = 6) was performed using quantitative reverse transcription polymerase chain reaction (qRT-PCR). Correlation between levels of ER with the clinico-pathological features for OC was determined. The effect of selective ER antagonists on proliferation of OE33 and OE19 OC cell lines was studied. RESULTS ERα and ERβ mRNA expression was significantly higher (p < 0.05) in tumour tissues relative to their paired normal mucosa and correlated inversely with survival outcome (p < 0.05). Upregulation of ERα mRNA correlated with higher pathological T-stage (p < 0.05) and lymph node metastasis (p < 0.05) while ERβ mRNA upregulation correlated with positive vascular invasion (p < 0.05). A significant concentration-dependent inhibition of proliferation in OE33 and OE19 cell lines was induced by a highly-selective ERα antagonist (MPP) and an ERβ specific antagonist (PHTPP) (p < 0.05). Moreover, anti-oestrogens induced cell death through stimulation of apoptotic caspase activity. CONCLUSION These findings indicate that the ER system is involved in OC progression and thus may provide a novel target for the treatment of OC.
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Affiliation(s)
- Waleed Al-Khyatt
- Department of Upper GI Surgery, Royal Derby Hospital, Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE UK
- Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT UK
| | - Cristina Tufarelli
- Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT UK
| | - Raheela Khan
- Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT UK
| | - Syed Yousef Iftikhar
- Department of Upper GI Surgery, Royal Derby Hospital, Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE UK
- Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT UK
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Kim J, Frick KM. Distinct effects of estrogen receptor antagonism on object recognition and spatial memory consolidation in ovariectomized mice. Psychoneuroendocrinology 2017; 85:110-114. [PMID: 28846921 DOI: 10.1016/j.psyneuen.2017.08.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 11/18/2022]
Abstract
Exogenous treatment with the potent estrogen 17β-estradiol (E2) or selective estrogen receptor α/β (ERα/β) agonists enhances the consolidation of hippocampal-dependent object recognition (OR) and object placement (OP) memories in ovariectomized rodents. Although such data suggest that individual ERs are sufficient for memory consolidation, the necessity of a given ER for memory consolidation can only be demonstrated by blocking receptor function, for example with an ER antagonist. However, the effects on memory of antagonizing ERα or ERβ function are not well understood. Moreover, ER antagonism in ovariectomized subjects also provides indirect information about the role of individual ERs in the memory-enhancing effects of local hippocampal E2 synthesis. Therefore, this study used pharmacological inhibition of ERα and ERβ to elucidate the importance of each ER to memory consolidation. Specifically, we examined effects on OR and OP memory consolidation of immediate post-training dorsal hippocampal (DH) infusion of MPP and PHTPP, selective antagonists for ERα and ERβ, respectively. Each drug exhibited a distinct effect on OR and OP. DH infusion of MPP (0.28 or 2.78ng/hemisphere) impaired memory in OP, but not OR. However, DH infusion of PHTPP (0.21 or 2.12ng/hemisphere) impaired memory in both OR and OP. Neither drug affected the elapsed time to accumulate object exploration in either task, suggesting a specific effect on memory. These results indicate that activation of either classical ER within the dorsal hippocampus is important for hippocampal memory consolidation in ovariectomized mice, but suggest that specific ER involvement is memory- or task-specific. The findings also indirectly support a role for ERα and ERβ in mediating the memory-enhancing effects of hippocampally-synthesized E2.
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Affiliation(s)
- Jaekyoon Kim
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, United States
| | - Karyn M Frick
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, United States.
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9
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Veldhuis JD, Erickson D, Yang R, Takahashi P, Bowers C. Endogenous Estrogen Regulates Somatostatin-Induced Rebound GH Secretion in Postmenopausal Women. J Clin Endocrinol Metab 2016; 101:4298-4304. [PMID: 27459535 PMCID: PMC5095244 DOI: 10.1210/jc.2016-2080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Systemic concentrations of T, estradiol (E2), GH, IGF-1, and IGF binding protein-3 decline in healthy aging individuals. Conversely, T and E2 stimulate GH and IGF-1 production in hypogonadal patients. HYPOTHESIS Because E2 stimulates GH secretion, putatively via the nuclear estrogen receptor-α and E2 and GH fall with menopause, we postulated that diminished endogenous E2 contributes to low GH output in older women. LOCATION The study was conducted at the Mayo Center for Clinical and Translational Science. STUDY DESIGN This was a randomized, double-blind, controlled study in 60 healthy postmenopausal women treated with the following: 1) double placebo; 2) anastrozole, a potent inhibitor of aromatase-enzyme activity, which mediates E2 synthesis from T; and/or 3) fulvestrant, a selective estrogen receptor-α antagonist. METHODS GH pulse generation was quantified by frequent GH sampling before and after short-term iv somatostatin infusion, thought to induce hypothalamic GHRH-mediated rebound-like GH secretion. RESULTS On anastrozole, E2 fell from 3.1 ± 0.35 pg/mL to 0.36 ± 0.04 pg/mL, and estrone from 13 ± 1.4 pg/mL to 1.9 ± 0.01 pg/mL (P < .001) by mass spectrometry. Estrogen values were unchanged by fulvestrant. T concentrations did not change. One-hour peak GH rebound after somatostatin infusion declined markedly during both estrogen-deprivation schedules (P < .001). Mean (150 min) maximal GH rebound decreased comparably (P < .001). Measures of GH rebound correlated negatively with computed tomography-estimated abdominal visceral fat (all P < .05). CONCLUSION These data suggest a previously unrecognized dependence of hypothalamo-pituitary GH regulation on low levels of endogenous estrogen after menopause.
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Affiliation(s)
- Johannes D Veldhuis
- Endocrine Research Unit (J.D.V., D.E., R.Y.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Mayo Clinic, and Department of Primary Care Internal Medicine (P.T.), Mayo Clinic, Rochester, Minnesota 55905; and Tulane University Health Sciences Center (C.B.), Endocrinology and Metabolism Section, Peptide Research Section, New Orleans, Louisiana 70112
| | - Dana Erickson
- Endocrine Research Unit (J.D.V., D.E., R.Y.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Mayo Clinic, and Department of Primary Care Internal Medicine (P.T.), Mayo Clinic, Rochester, Minnesota 55905; and Tulane University Health Sciences Center (C.B.), Endocrinology and Metabolism Section, Peptide Research Section, New Orleans, Louisiana 70112
| | - Rebecca Yang
- Endocrine Research Unit (J.D.V., D.E., R.Y.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Mayo Clinic, and Department of Primary Care Internal Medicine (P.T.), Mayo Clinic, Rochester, Minnesota 55905; and Tulane University Health Sciences Center (C.B.), Endocrinology and Metabolism Section, Peptide Research Section, New Orleans, Louisiana 70112
| | - Paul Takahashi
- Endocrine Research Unit (J.D.V., D.E., R.Y.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Mayo Clinic, and Department of Primary Care Internal Medicine (P.T.), Mayo Clinic, Rochester, Minnesota 55905; and Tulane University Health Sciences Center (C.B.), Endocrinology and Metabolism Section, Peptide Research Section, New Orleans, Louisiana 70112
| | - Cyril Bowers
- Endocrine Research Unit (J.D.V., D.E., R.Y.), Mayo Clinic College of Medicine, Center for Translational Science Activities, Mayo Clinic, and Department of Primary Care Internal Medicine (P.T.), Mayo Clinic, Rochester, Minnesota 55905; and Tulane University Health Sciences Center (C.B.), Endocrinology and Metabolism Section, Peptide Research Section, New Orleans, Louisiana 70112
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Nagykálnai T, Landherr L, Laczó I, Pikó B. [Fulvestrant (Faslodex®) for hormone sensitive breast cancer. A review]. Magy Onkol 2015; 59:251-257. [PMID: 26339914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Indexed: 06/05/2023]
Abstract
Endocrine agents are well established standards of care in hormone-sensitive postmenopausal breast cancer. The pure estrogen receptor antagonist (down-regulator) fulvestrant after binding to the ER induces its conformational change which disrupts ER signal and accelerates ER degradation. Fulvestrant is devoid of partial agonist activity. In unselected patients there was no difference in TTP between "standard dose" fulvestrant and aromatase inhibitors, but in first-line treatment of advanced breast cancer the elevated dose of fulvestrant may delay progression and may extend the overall survival compared with aromatase inhibitors.
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Affiliation(s)
- Tamás Nagykálnai
- Onkológia, Budapest, XV. ker. Egészségügyi Intézményei, Budapest, Hungary.
| | | | - Ibolya Laczó
- Klinikai Onkológia, Békés megyei Pándy Kálmán Kórház, Gyula, Hungary
| | - Béla Pikó
- Klinikai Onkológia, Békés megyei Pándy Kálmán Kórház, Gyula, Hungary
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Marchiani S, Vignozzi L, Filippi S, Gurrieri B, Comeglio P, Morelli A, Danza G, Bartolucci G, Maggi M, Baldi E. Metabolic syndrome-associated sperm alterations in an experimental rabbit model: relation with metabolic profile, testis and epididymis gene expression and effect of tamoxifen treatment. Mol Cell Endocrinol 2015; 401:12-24. [PMID: 25451982 DOI: 10.1016/j.mce.2014.11.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/04/2014] [Accepted: 11/04/2014] [Indexed: 12/12/2022]
Abstract
The influence of metabolic syndrome (MetS) on sperm quality and function is debated. Using a well-established high fat diet (HFD) rabbit model resembling human MetS, including development of hypogonadism, we demonstrate that HFD decreased sperm motility, morphology and acrosome reaction in response to progesterone and increased sperm cholesterol content. All the above parameters were associated with most MetS features, its severity and plasma testosterone (T) at univariate analysis. After T adjustment, sperm morphology and motility retained a significant association, respectively, with mean arterial pressure and circulating cholesterol levels. MetS modified the expression of inflammatory and tissue remodelling genes in the testis and of aquaporins in the epididymis. In a multivariate analysis, sperm morphology resulted associated with testis expression of fibronectin and collagen type 1 genes, whereas motility with epididymis aquaporin 1 gene. Administration of tamoxifen, used in the treatment of idiopathic male infertility, to HFD rabbits partially restored motility, but further decreased morphology and increased spontaneous acrosome reaction, without restoring responsiveness to progesterone. Overall our results indicate that development of MetS produces detrimental effects on sperm quality and functionality by inducing metabolic disorders leading to alterations in testis and epididymis functions and evidence a role of hypertension as a new determinant of abnormal sperm morphology, in line with a previous human study from our group.
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Affiliation(s)
- Sara Marchiani
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Sandra Filippi
- Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, Departments of Experimental and Clinical Biomedical Sciences, NEUROFARBA, University of Florence, Florence, Italy
| | - Bruna Gurrieri
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Paolo Comeglio
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Annamaria Morelli
- Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanna Danza
- Endocrine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | | | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Elisabetta Baldi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
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