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Torres-Esquius S, Llop-Guevara A, Gutiérrez-Enríquez S, Romey M, Teulé À, Llort G, Herrero A, Sánchez-Henarejos P, Vallmajó A, González-Santiago S, Chirivella I, Cano JM, Graña B, Simonetti S, Díaz de Corcuera I, Ramon y Cajal T, Sanz J, Serrano S, Otero A, Churruca C, Sánchez-Heras AB, Servitja S, Guillén-Ponce C, Brunet J, Denkert C, Serra V, Balmaña J. Prevalence of Homologous Recombination Deficiency Among Patients With Germline RAD51C/D Breast or Ovarian Cancer. JAMA Netw Open 2024; 7:e247811. [PMID: 38648056 PMCID: PMC11036141 DOI: 10.1001/jamanetworkopen.2024.7811] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/21/2024] [Indexed: 04/25/2024] Open
Abstract
Importance RAD51C and RAD51D are involved in DNA repair by homologous recombination. Germline pathogenic variants (PVs) in these genes are associated with an increased risk of ovarian and breast cancer. Understanding the homologous recombination deficiency (HRD) status of tumors from patients with germline PVs in RAD51C/D could guide therapeutic decision-making and improve survival. Objective To characterize the clinical and tumor characteristics of germline RAD51C/D PV carriers, including the evaluation of HRD status. Design, Setting, and Participants This retrospective cohort study included 91 index patients plus 90 relatives carrying germline RAD51C/D PV (n = 181) in Spanish hospitals from January 1, 2014, to December 31, 2021. Genomic and functional HRD biomarkers were assessed in untreated breast and ovarian tumor samples (n = 45) from June 2022 to February 2023. Main Outcomes and Measures Clinical and pathologic characteristics were assessed using descriptive statistics. Genomic HRD by genomic instability scores, functional HRD by RAD51, and gene-specific loss of heterozygosity were analyzed. Associations between HRD status and tumor subtype, age at diagnosis, and gene-specific loss of heterozygosity in RAD51C/D were investigated using logistic regression or the t test. Results A total of 9507 index patients were reviewed, and 91 patients (1.0%) were found to carry a PV in RAD51C/D; 90 family members with a germline PV in RAD51C/D were also included. A total of 157 of carriers (86.7%) were women and 181 (55.8%) had received a diagnosis of cancer, mainly breast cancer or ovarian cancer. The most prevalent PVs were c.1026+5_1026+7del (11 of 56 [19.6%]) and c.709C>T (9 of 56 [16.1%]) in RAD51C and c.694C>T (20 of 35 [57.1%]) in RAD51D. In untreated breast cancer and ovarian cancer, the prevalence of functional and genomic HRD was 55.2% (16 of 29) and 61.1% (11 of 18) for RAD51C, respectively, and 66.7% (6 of 9) and 90.0% (9 of 10) for RAD51D. The concordance between HRD biomarkers was 91%. Tumors with the same PV displayed contrasting HRD status, and age at diagnosis did not correlate with the occurrence of HRD. All breast cancers retaining the wild-type allele were estrogen receptor positive and lacked HRD. Conclusions and Relevance In this cohort study of germline RAD51C/D breast cancer and ovarian cancer, less than 70% of tumors displayed functional HRD, and half of those that did not display HRD were explained by retention of the wild-type allele, which was more frequent among estrogen receptor-positive breast cancers. Understanding which tumors are associated with RAD51C/D and HRD is key to identify patients who can benefit from targeted therapies, such as PARP (poly [adenosine diphosphate-ribose] polymerase) inhibitors.
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Affiliation(s)
- Sara Torres-Esquius
- Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
- Translational Medicine, DNA Damage Response Department, AstraZeneca, Barcelona, Spain
| | | | - Marcel Romey
- Institute of Pathology, Universitätsklinikum Marburg, Marburg, Germany
| | - Àlex Teulé
- Hereditary Cancer Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Gemma Llort
- Department of Medical Oncology, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Ana Herrero
- Department of Medical Oncology, Hospital Miguel Servet de Zaragoza, Zaragoza, Spain
| | | | - Anna Vallmajó
- Genetic Counseling Unit, Arnau de Vilanova University Hospital, Lleida, Spain
| | | | - Isabel Chirivella
- Cancer Genetic Counseling, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Juana Maria Cano
- Department of Medical Oncology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Begoña Graña
- Department of Medical Oncology, Xerencia de Xestión Integrada de A Coruña, Coruña, Spain
| | - Sara Simonetti
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | | | - Teresa Ramon y Cajal
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Judit Sanz
- Unidad de Cáncer Familiar y Hereditario, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Sara Serrano
- Department of Medical Oncology, Institute of Oncology of Southern Catalonia (IOCS), Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Andrea Otero
- Institute of Oncology and Molecular Medicine of Asturias (IMOMA) S. A., Oviedo, Spain
| | - Cristina Churruca
- Department of Medical Oncology, Hospital Universitario Donostia, San Sebastián, Gipuzkoa, Spain
| | - Ana Beatriz Sánchez-Heras
- Cancer Genetic Counselling Unit, Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
| | - Sonia Servitja
- Department of Medical Oncology, Hospital del Mar-CIBERONC, Barcelona, Spain
| | - Carmen Guillén-Ponce
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Joan Brunet
- Hereditary Cancer Program, Catalan Institute of Oncology, Girona, Spain
- Precision Oncology Group (OncoGIR-Pro), Institut d’Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Carsten Denkert
- Institute of Pathology, Universitätsklinikum Marburg, Marburg, Germany
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
- Medical Oncology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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2
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Romey M, Rodepeter F, Hattesohl A, Kaiser K, Teply-Szymanski J, Heitz F, Staebler A, Serra V, Grass A, Marmé F, Timms KM, Harter P, Llop-Guevara A, Kommoss S, Boekhoff J, Denkert C. Systematic Analysis of Homologous Recombination Deficiency Testing in Ovarian Cancer-Development of Recommendations for Optimal Assay Performance. Mod Pathol 2024; 37:100445. [PMID: 38341130 DOI: 10.1016/j.modpat.2024.100445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/20/2023] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
Homologous recombination deficiency (HRD) assays are an important element of personalized oncology in ovarian carcinomas, but the optimal tissue requirements for these complex molecular assays remain unclear. As a result, a considerable percentage of assays are not successful, leading to suboptimal diagnoses for these patients. In this study, we have systematically analyzed tumor and tissue parameters for HRD analysis in a large cohort of real-world cancer samples. The aim of this study is to give recommendations for pathologists and gynecologic oncologists for selection of tissue samples to maximize the success rate of HRD analyses. Tumor samples from 2702 patients were sent to the Institute of Pathology of the Philipps-University Marburg between October 2020 and September 2022, of which 2654 were analyzed using the Myriad MyChoice HRD+ CDx assay. A total of 2396 of 2654 samples (90.3%) were successfully tested, of which 984 of 2396 (41.1%) were HRD positive and 1412 (58.9%) were HRD negative. Three hundred sixty-three of 2396 samples (15.2%) were BRCA1/2-mutated; 27 samples had a BRCA1/2 mutation and a genomic instability score (GIS) < 42. Twenty-two samples (0.9%) failed GIS measurement but displayed a BRCA1/2 mutation. BRCA1/2-mutated samples showed significantly (P < .0001) higher GIS values than those with a wild-type BRCA1/2 status. Tumor cell content, tumor area, and histology significantly (P < .0001) affected the probability of successfully analyzing a sample. Based on a systematic analysis of tumor cell content and tumor area, we recommend selecting patient high-grade serous ovarian cancer samples that display a tumor cell content ≥30% and a tumor area ≥0.5 cm2 (based on their hematoxylin and eosin) for HRD testing to allow for optimal chances of a successful analysis and conclusive results. Considering histologic and sample conditions, success rates of up to 98% can be achieved. Our comprehensive evaluation contributes to further standardization of recommendations on HRD testing in ovarian cancer, which will have a large impact on personalized therapeutic strategies in this highly aggressive tumor type.
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Affiliation(s)
- Marcel Romey
- Institute of Pathology, Philipps-University Marburg, Marburg University Hospital, and University Cancer Center Frankfurt-Marburg, Marburg, Germany
| | - Fiona Rodepeter
- Institute of Pathology, Philipps-University Marburg, Marburg University Hospital, and University Cancer Center Frankfurt-Marburg, Marburg, Germany
| | - Akira Hattesohl
- Institute of Pathology, Philipps-University Marburg, Marburg University Hospital, and University Cancer Center Frankfurt-Marburg, Marburg, Germany
| | | | - Julia Teply-Szymanski
- Institute of Pathology, Philipps-University Marburg, Marburg University Hospital, and University Cancer Center Frankfurt-Marburg, Marburg, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany; Department of Gynecology with the Centre of Oncologic Surgery Charite Campus, Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Annette Staebler
- Institute of Pathology and Neuropathology, Tübingen University Hospital, Tubingen, Germany
| | - Violeta Serra
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Albert Grass
- Institute of Pathology, Philipps-University Marburg, Marburg University Hospital, and University Cancer Center Frankfurt-Marburg, Marburg, Germany
| | - Frederik Marmé
- Medical Faculty Mannheim, Department of Obstetrics and Gynaecology, Heidelberg University, University Hospital Mannheim, Mannheim, Germany
| | | | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | | | - Stefan Kommoss
- Department of Women's Health, Tübingen University Hospital, Tubingen, Germany; Clinic for Gynecology, Diakonie-Klinikum Schwäbisch Hall, Schwabisch Hall, Germany
| | - Jelena Boekhoff
- Institute of Gynecology, Philipps-University Marburg and Marburg University Hospital, Marburg, Germany
| | - Carsten Denkert
- Institute of Pathology, Philipps-University Marburg, Marburg University Hospital, and University Cancer Center Frankfurt-Marburg, Marburg, Germany.
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Harvey-Jones E, Raghunandan M, Robbez-Masson L, Magraner-Pardo L, Alaguthurai T, Yablonovitch A, Yen J, Xiao H, Brough R, Frankum J, Song F, Yeung J, Savy T, Gulati A, Alexander J, Kemp H, Starling C, Konde A, Marlow R, Cheang M, Proszek P, Hubank M, Cai M, Trendell J, Lu R, Liccardo R, Ravindran N, Llop-Guevara A, Rodriguez O, Balmana J, Lukashchuk N, Dorschner M, Drusbosky L, Roxanis I, Serra V, Haider S, Pettitt SJ, Lord CJ, Tutt ANJ. Longitudinal profiling identifies co-occurring BRCA1/2 reversions, TP53BP1, RIF1 and PAXIP1 mutations in PARP inhibitor-resistant advanced breast cancer. Ann Oncol 2024; 35:364-380. [PMID: 38244928 DOI: 10.1016/j.annonc.2024.01.003] [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] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Resistance to therapies that target homologous recombination deficiency (HRD) in breast cancer limits their overall effectiveness. Multiple, preclinically validated, mechanisms of resistance have been proposed, but their existence and relative frequency in clinical disease are unclear, as is how to target resistance. PATIENTS AND METHODS Longitudinal mutation and methylation profiling of circulating tumour (ct)DNA was carried out in 47 patients with metastatic BRCA1-, BRCA2- or PALB2-mutant breast cancer treated with HRD-targeted therapy who developed progressive disease-18 patients had primary resistance and 29 exhibited response followed by resistance. ctDNA isolated at multiple time points in the patient treatment course (before, on-treatment and at progression) was sequenced using a novel >750-gene intron/exon targeted sequencing panel. Where available, matched tumour biopsies were whole exome and RNA sequenced and also used to assess nuclear RAD51. RESULTS BRCA1/2 reversion mutations were present in 60% of patients and were the most prevalent form of resistance. In 10 cases, reversions were detected in ctDNA before clinical progression. Two new reversion-based mechanisms were identified: (i) intragenic BRCA1/2 deletions with intronic breakpoints; and (ii) intragenic BRCA1/2 secondary mutations that formed novel splice acceptor sites, the latter being confirmed by in vitro minigene reporter assays. When seen before commencing subsequent treatment, reversions were associated with significantly shorter time to progression. Tumours with reversions retained HRD mutational signatures but had functional homologous recombination based on RAD51 status. Although less frequent than reversions, nonreversion mechanisms [loss-of-function (LoF) mutations in TP53BP1, RIF1 or PAXIP1] were evident in patients with acquired resistance and occasionally coexisted with reversions, challenging the notion that singular resistance mechanisms emerge in each patient. CONCLUSIONS These observations map the prevalence of candidate drivers of resistance across time in a clinical setting, information with implications for clinical management and trial design in HRD breast cancers.
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Affiliation(s)
- E Harvey-Jones
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK; The Breast Cancer Now Research Unit, Guy's Hospital Cancer Centre, King's College London, UK; The City of London Cancer Research UK Centre at King's College London, UK
| | - M Raghunandan
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - L Robbez-Masson
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - L Magraner-Pardo
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - T Alaguthurai
- The Breast Cancer Now Research Unit, Guy's Hospital Cancer Centre, King's College London, UK
| | | | - J Yen
- Guardant Health Inc., Redwood City, USA
| | - H Xiao
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - R Brough
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - J Frankum
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - F Song
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - J Yeung
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - T Savy
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - A Gulati
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - J Alexander
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - H Kemp
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - C Starling
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - A Konde
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - R Marlow
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - M Cheang
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - P Proszek
- Clinical Genomics, The Royal Marsden Hospital, London, UK
| | - M Hubank
- Clinical Genomics, The Royal Marsden Hospital, London, UK
| | - M Cai
- Guardant Health Inc., Redwood City, USA
| | - J Trendell
- The Breast Cancer Now Research Unit, Guy's Hospital Cancer Centre, King's College London, UK
| | - R Lu
- The Breast Cancer Now Research Unit, Guy's Hospital Cancer Centre, King's College London, UK
| | - R Liccardo
- The Breast Cancer Now Research Unit, Guy's Hospital Cancer Centre, King's College London, UK
| | - N Ravindran
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | | | - O Rodriguez
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - J Balmana
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | | | - I Roxanis
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - V Serra
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - S Haider
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S J Pettitt
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK.
| | - C J Lord
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK.
| | - A N J Tutt
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK; The Breast Cancer Now Research Unit, Guy's Hospital Cancer Centre, King's College London, UK; The City of London Cancer Research UK Centre at King's College London, UK.
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Rezqallah A, Torres-Esquius S, Llop-Guevara A, Cruellas M, Martinez MT, Romey M, Denkert C, Serra V, Chirivella I, Balmaña J. Two Germline Pathogenic Variants in Cancer Susceptibility Genes and Their Null Implication in Breast Cancer Pathogenesis: The Importance of Tumoral Homologous Recombination Deficiency Testing. JCO Precis Oncol 2024; 8:e2300446. [PMID: 38513169 DOI: 10.1200/po.23.00446] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/28/2023] [Accepted: 01/22/2024] [Indexed: 03/23/2024] Open
Abstract
Homologous recombination proficiency in patients with breast cancer despite germline PALB2/RAD51C pathogenic variants.
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Affiliation(s)
- Alejandra Rezqallah
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Sara Torres-Esquius
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Mara Cruellas
- Medical Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - María T Martinez
- Medical Oncology Department, INCLIVA Biomedical Research Institute, Hospital Clínico de València, University of Valencia, Valencia, Spain
| | - Marcel Romey
- Institute of Pathology, Universitätsklinikum Marburg, Marburg, Germany
| | - Carsten Denkert
- Institute of Pathology, Universitätsklinikum Marburg, Marburg, Germany
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Isabel Chirivella
- Medical Oncology Department, INCLIVA Biomedical Research Institute, Hospital Clínico de València, University of Valencia, Valencia, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Medical Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Ring A, Kilburn LS, Pearson A, Moretti L, Afshari-Mehr A, Wardley AM, Gurel B, Macpherson IR, Riisnaes R, Baird RD, Martin S, Roylance R, Johnson H, Ferreira A, Winter MC, Dunne K, Copson E, Hickish T, Burcombe R, Randle K, Serra V, Llop-Guevara A, Bliss JM, Turner NC. Olaparib and Ceralasertib (AZD6738) in Patients with Triple-Negative Advanced Breast Cancer: Results from Cohort E of the plasmaMATCH Trial (CRUK/15/010). Clin Cancer Res 2023; 29:4751-4759. [PMID: 37773077 PMCID: PMC10690092 DOI: 10.1158/1078-0432.ccr-23-1696] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Approximately 10% to 15% of triple-negative breast cancers (TNBC) have deleterious mutations in BRCA1 and BRCA2 and may benefit from PARP inhibitor treatment. PARP inhibitors may also increase exogenous replication stress and thereby increase sensitivity to inhibitors of ataxia telangiectasia and Rad3-related (ATR) protein. This phase II study examined the activity of the combination of PARP inhibitor, olaparib, and ATR inhibitor, ceralasertib (AZD6738), in patients with advanced TNBC. PATIENTS AND METHODS Patients with TNBC on most recent biopsy who had received 1 or 2 lines of chemotherapy for advanced disease or had relapsed within 12 months of (neo)adjuvant chemotherapy were eligible. Treatment was olaparib 300 mg twice a day continuously and celarasertib 160 mg on days 1-7 on a 28-day cycle until disease progression. The primary endpoint was confirmed objective response rate (ORR). Tissue and plasma biomarker analyses were preplanned to identify predictors of response. RESULTS 70 evaluable patients were enrolled. Germline BRCA1/2 mutations were present in 10 (14%) patients and 3 (4%) patients had somatic BRCA mutations. The confirmed ORR was 12/70; 17.1% (95% confidence interval, 10.4-25.5). Responses were observed in patients without germline or somatic BRCA1/2 mutations, including patients with mutations in other homologous recombination repair genes and tumors with functional homologous recombination deficiency by RAD51 foci. CONCLUSIONS The response rate to olaparib and ceralasertib did not meet prespecified criteria for activity in the overall evaluable population, but responses were observed in patients who would not be expected to respond to olaparib monotherapy.
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Affiliation(s)
- Alistair Ring
- Breast Unit, The Royal Marsden Hospital, Sutton, United Kingdom
- Division of Breast Cancer Research, Institute of Cancer Research, London, United Kingdom
| | - Lucy S. Kilburn
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Alex Pearson
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Laura Moretti
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Angelica Afshari-Mehr
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | | | - Bora Gurel
- Clinical Studies – Cancer Biomarkers, The Institute of Cancer Research, London, United Kingdom
| | - Iain R. Macpherson
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ruth Riisnaes
- Clinical Studies – Cancer Biomarkers, The Institute of Cancer Research, London, United Kingdom
| | | | - Sue Martin
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust & NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Hannah Johnson
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Ana Ferreira
- Clinical Studies – Cancer Biomarkers, The Institute of Cancer Research, London, United Kingdom
| | - Matthew C. Winter
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Kathryn Dunne
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, United Kingdom
| | - Ellen Copson
- Cancer Sciences Academic Unit, University of Southampton, Southampton, United Kingdom
| | - Tamas Hickish
- Royal Bournemouth Hospital, University Hospitals Dorset NHS Foundation Trust, Bournemouth, United Kingdom
| | - Russell Burcombe
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom
| | - Kat Randle
- Independent Cancer Patients’ Voice, London, United Kingdom
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Judith M. Bliss
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Nicolas C. Turner
- Breast Unit, The Royal Marsden Hospital, Sutton, United Kingdom
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
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6
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Yndestad S, Engebrethsen C, Herencia-Ropero A, Nikolaienko O, Vintermyr OK, Lillestøl RK, Minsaas L, Leirvaag B, Iversen GT, Gilje B, Blix ES, Espelid H, Lundgren S, Geisler J, Aase HS, Aas T, Gudlaugsson EG, Llop-Guevara A, Serra V, Janssen EAM, Lønning PE, Knappskog S, Eikesdal HP. Homologous Recombination Deficiency Across Subtypes of Primary Breast Cancer. JCO Precis Oncol 2023; 7:e2300338. [PMID: 38039432 DOI: 10.1200/po.23.00338] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE Homologous recombination deficiency (HRD) is highly prevalent in triple-negative breast cancer (TNBC) and associated with response to PARP inhibition (PARPi). Here, we studied the prevalence of HRD in non-TNBC to assess the potential for PARPi in a wider group of patients with breast cancer. METHODS HRD status was established using targeted gene panel sequencing (360 genes) and BRCA1 methylation analysis of pretreatment biopsies from 201 patients with primary breast cancer in the phase II PETREMAC trial (ClinicalTrials.gov identifier: NCT02624973). HRD was defined as mutations in BRCA1, BRCA2, BRIP1, BARD1, or PALB2 and/or promoter methylation of BRCA1 (strict definition; HRD-S). In secondary analyses, a wider definition (HRD-W) was used, examining mutations in 20 additional genes. Furthermore, tumor BRCAness (multiplex ligation-dependent probe amplification), PAM50 subtyping, RAD51 nuclear foci to test functional HRD, tumor-infiltrating lymphocyte (TIL), and PD-L1 analyses were performed. RESULTS HRD-S was present in 5% of non-TNBC cases (n = 9 of 169), contrasting 47% of the TNBC tumors (n = 15 of 32). HRD-W was observed in 23% of non-TNBC (n = 39 of 169) and 59% of TNBC cases (n = 19 of 32). Of 58 non-TNBC and 30 TNBC biopsies examined for RAD51 foci, 4 of 4 (100%) non-TNBC and 13 of 14 (93%) TNBC cases classified as HRD-S had RAD51 low scores. In contrast, 4 of 17 (24%) non-TNBC and 15 of 19 (79%) TNBC biopsies classified as HRD-W exhibited RAD51 low scores. Of nine non-TNBC tumors with HRD-S status, only one had a basal-like PAM50 signature. There was a high concordance between HRD-S and either BRCAness, high TIL density, or high PD-L1 expression (each P < .001). CONCLUSION The prevalence of HRD in non-TNBC suggests that therapy targeting HRD should be evaluated in a wider breast cancer patient population. Strict HRD criteria should be implemented to increase diagnostic precision with respect to functional HRD.
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Affiliation(s)
- Synnøve Yndestad
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Genome-Directed Cancer Therapy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Christina Engebrethsen
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Genome-Directed Cancer Therapy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Oleksii Nikolaienko
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Genome-Directed Cancer Therapy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Olav K Vintermyr
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
- The Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Reidun K Lillestøl
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Genome-Directed Cancer Therapy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Laura Minsaas
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Genome-Directed Cancer Therapy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Beryl Leirvaag
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Genome-Directed Cancer Therapy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gjertrud T Iversen
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Genome-Directed Cancer Therapy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørnar Gilje
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Egil S Blix
- Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Helge Espelid
- Department of Surgery, Haugesund Hospital, Haugesund, Norway
| | - Steinar Lundgren
- Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jürgen Geisler
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hildegunn S Aase
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Turid Aas
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | | | | | - Violeta Serra
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Emiel A M Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, Stavanger University, Stavanger, Norway
| | - Per E Lønning
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Genome-Directed Cancer Therapy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Stian Knappskog
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Genome-Directed Cancer Therapy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Hans P Eikesdal
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Genome-Directed Cancer Therapy, Department of Clinical Science, University of Bergen, Bergen, Norway
- Deceased
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7
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Blanc-Durand F, Yaniz-Galende E, Llop-Guevara A, Genestie C, Serra V, Herencia-Ropero A, Klein C, Berton D, Lortholary A, Dohollou N, Desauw C, Fabbro M, Malaurie E, Bonichon-Lamaichhane N, Dubot C, Kurtz JE, de Rauglaudre G, Raban N, Chevalier-Place A, Ferron G, Kaminsky MC, Kramer C, Rouleau E, Leary A. Corrigendum to "A RAD51 functional assay as a candidate test for homologous recombination deficiency in ovarian cancer". Gynecol Oncol 2023:S0090-8258(23)00299-8. [PMID: 37271667 DOI: 10.1016/j.ygyno.2023.05.058] [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: 06/06/2023]
Affiliation(s)
- Félix Blanc-Durand
- Medical Oncology, Gynecology Unit, Gustave Roussy Institute, Villejuif, France
| | | | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Christophe Klein
- Center of Cellular Imaging and Cytometry, INSERM UMRS 1138, Cordeliers Research Center, Paris, France
| | - Dominique Berton
- Medical Oncology, GINECO & Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Alain Lortholary
- Medical Oncology, GINECO-Hôpital Privé du Confluent, Nantes, France
| | - Nadine Dohollou
- Medical Oncology, Polyclinique Bordeaux Nord Aquitain, Bordeaux, France
| | | | - Michel Fabbro
- Medical Oncology, ICM Val d'Aurelle, Montpellier, France
| | - Emmanuelle Malaurie
- Medical Oncology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Coraline Dubot
- Medical Oncology, GINECO and Institut Curie - Hôpital René Huguenin, Saint-Cloud, France
| | | | | | - Nadia Raban
- Medical Oncology, GINECO and CHU La Milétrie, Poitiers, France
| | | | - Gwenael Ferron
- Medical Oncology, GINECO and Institut Claudius Regaud, Toulouse, France
| | - Marie-Christine Kaminsky
- Medical Oncology, GINECO and Institut de Cancérologie de Lorraine, Vandoeuvre-Les-, Nancy, France
| | - Claire Kramer
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Etienne Rouleau
- Cancer Genetics Laboratory, Gustave Roussy Institute, Villejuif, France
| | - Alexandra Leary
- Medical Oncology, Gynecology Unit, Gustave Roussy Institute, Villejuif, France; INSERM UMR981, Gustave Roussy Institute, Villejuif, France.
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8
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Hutten SJ, de Bruijn R, Lutz C, Badoux M, Eijkman T, Chao X, Ciwinska M, Sheinman M, Messal H, Herencia-Ropero A, Kristel P, Mulder L, van der Waal R, Sanders J, Almekinders MM, Llop-Guevara A, Davies HR, van Haren MJ, Martin NI, Behbod F, Nik-Zainal S, Serra V, van Rheenen J, Lips EH, Wessels LFA, Wesseling J, Scheele CLGJ, Jonkers J. A living biobank of patient-derived ductal carcinoma in situ mouse-intraductal xenografts identifies risk factors for invasive progression. Cancer Cell 2023; 41:986-1002.e9. [PMID: 37116492 PMCID: PMC10171335 DOI: 10.1016/j.ccell.2023.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/21/2023] [Accepted: 04/04/2023] [Indexed: 04/30/2023]
Abstract
Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer (IBC). Due to a lack of biomarkers able to distinguish high- from low-risk cases, DCIS is treated similar to early IBC even though the minority of untreated cases eventually become invasive. Here, we characterized 115 patient-derived mouse-intraductal (MIND) DCIS models reflecting the full spectrum of DCIS observed in patients. Utilizing the possibility to follow the natural progression of DCIS combined with omics and imaging data, we reveal multiple prognostic factors for high-risk DCIS including high grade, HER2 amplification, expansive 3D growth, and high burden of copy number aberrations. In addition, sequential transplantation of xenografts showed minimal phenotypic and genotypic changes over time, indicating that invasive behavior is an intrinsic phenotype of DCIS and supporting a multiclonal evolution model. Moreover, this study provides a collection of 19 distributable DCIS-MIND models spanning all molecular subtypes.
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Affiliation(s)
- Stefan J Hutten
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands
| | - Roebi de Bruijn
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands; Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Catrin Lutz
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands
| | - Madelon Badoux
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands
| | - Timo Eijkman
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands
| | - Xue Chao
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands
| | - Marta Ciwinska
- Center for Cancer Biology, VIB, Department of Oncology, KU Leuven, 3000 Leuven, Belgium
| | - Michael Sheinman
- Oncode Institute, Amsterdam, the Netherlands; Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Hendrik Messal
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands
| | - Andrea Herencia-Ropero
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, 08035 Barcelona, Spain; Department of Biochemistry and Molecular Biology, Autonomous University of Barcelona, Barcelona, Spain
| | - Petra Kristel
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Lennart Mulder
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Rens van der Waal
- Core Facility Molecular Pathology & Biobanking, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Joyce Sanders
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Mathilde M Almekinders
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, 08035 Barcelona, Spain
| | - Helen R Davies
- Academic Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, CB2 0QQ Cambridge, UK; Early Cancer Institute, University of Cambridge, CB2 0XZ Cambridge, UK
| | - Matthijs J van Haren
- Biological Chemistry Group, Institute of Biology Leiden, Leiden University, 2302 BH Leiden, the Netherlands
| | - Nathaniel I Martin
- Biological Chemistry Group, Institute of Biology Leiden, Leiden University, 2302 BH Leiden, the Netherlands
| | - Fariba Behbod
- Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center, Kansas City, KS 66103, USA
| | - Serena Nik-Zainal
- Academic Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, CB2 0QQ Cambridge, UK; Early Cancer Institute, University of Cambridge, CB2 0XZ Cambridge, UK
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, 08035 Barcelona, Spain
| | - Jacco van Rheenen
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands
| | - Esther H Lips
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Lodewyk F A Wessels
- Oncode Institute, Amsterdam, the Netherlands; Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands; Division of Diagnostic Oncology, Netherlands Cancer Institute - Antonie van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Colinda L G J Scheele
- Center for Cancer Biology, VIB, Department of Oncology, KU Leuven, 3000 Leuven, Belgium
| | - Jos Jonkers
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands.
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9
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Petrelli A, Rizzolio S, Pietrantonio F, Bellomo SE, Benelli M, De Cecco L, Romagnoli D, Berrino E, Orrù C, Ribisi S, Moya-Rull D, Migliore C, Conticelli D, Maina IM, Puliga E, Serra V, Pellegrino B, Llop-Guevara A, Musolino A, Siena S, Sartore-Bianchi A, Prisciandaro M, Morano F, Antista M, Fumagalli U, De Manzoni G, Degiuli M, Baiocchi GL, Amisano MF, Ferrero A, Marchiò C, Corso S, Giordano S. BRCA2 Germline Mutations Identify Gastric Cancers Responsive to PARP Inhibitors. Cancer Res 2023; 83:1699-1710. [PMID: 37129948 PMCID: PMC10183806 DOI: 10.1158/0008-5472.can-22-2620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/02/2023] [Accepted: 03/02/2023] [Indexed: 05/03/2023]
Abstract
Despite negative results of clinical trials conducted on the overall population of patients with gastric cancer, PARP inhibitor (PARPi) therapeutic strategy still might represent a window of opportunity for a subpopulation of patients with gastric cancer. An estimated 7% to 12% of gastric cancers exhibit a mutational signature associated with homologous recombination (HR) failure, suggesting that these patients could potentially benefit from PARPis. To analyze responsiveness of gastric cancer to PARPi, we exploited a gastroesophageal adenocarcinoma (GEA) platform of patient-derived xenografts (PDX) and PDX-derived primary cells and selected 10 PDXs with loss-of-function mutations in HR pathway genes. Cell viability assays and preclinical trials showed that olaparib treatment was effective in PDXs harboring BRCA2 germline mutations and somatic inactivation of the second allele. Olaparib responsive tumors were sensitive to oxaliplatin as well. Evaluation of HR deficiency (HRD) and mutational signatures efficiently stratified responder and nonresponder PDXs. A retrospective analysis on 57 patients with GEA showed that BRCA2 inactivating variants were associated with longer progression-free survival upon platinum-based regimens. Five of 7 patients with BRCA2 germline mutations carried the p.K3326* variant, classified as "benign." However, familial history of cancer, the absence of RAD51 foci in tumor cells, and a high HRD score suggest a deleterious effect of this mutation in gastric cancer. In conclusion, PARPis could represent an effective therapeutic option for BRCA2-mutated and/or high HRD score patients with GEA, including patients with familial intestinal gastric cancer. SIGNIFICANCE PARP inhibition is a potential strategy for treating patients with gastric cancer with mutated BRCA2 or homologous repair deficiency, including patients with familial intestinal gastric cancer, for whom BRCA2 germline testing should be recommended.
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Affiliation(s)
| | | | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara E Bellomo
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Department of Oncology, University of Torino, Candiolo, Italy
| | - Matteo Benelli
- Bioinformatics Unit, Oncology Department, Nuovo Ospedale-Santo Stefano, Prato, Italy
| | - Loris De Cecco
- Molecular Mechanisms Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Romagnoli
- Bioinformatics Unit, Oncology Department, Nuovo Ospedale-Santo Stefano, Prato, Italy
| | - Enrico Berrino
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Claudia Orrù
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Salvatore Ribisi
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Department of Oncology, University of Torino, Candiolo, Italy
| | | | - Cristina Migliore
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Department of Oncology, University of Torino, Candiolo, Italy
| | - Daniela Conticelli
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Department of Oncology, University of Torino, Candiolo, Italy
| | - Irene M Maina
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Department of Oncology, University of Torino, Candiolo, Italy
| | | | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Benedetta Pellegrino
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Antonino Musolino
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
| | - Salvatore Siena
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Sartore-Bianchi
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Antista
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Uberto Fumagalli
- Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giovanni De Manzoni
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Section of Surgery, University of Verona, Verona, Italy
| | | | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco F Amisano
- Department of Surgery, Santo Spirito Hospital, ASL-AL, Rome, Italy
| | | | - Caterina Marchiò
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Simona Corso
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Department of Oncology, University of Torino, Candiolo, Italy
| | - Silvia Giordano
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Department of Oncology, University of Torino, Candiolo, Italy
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10
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Compadre AJ, van Biljon LN, Valentine MC, Llop-Guevara A, Graham E, Fashemi B, Herencia-Ropero A, Kotnik EN, Cooper I, Harrington SP, Kuroki LM, McCourt CK, Hagemann AR, Thaker PH, Mutch DG, Powell MA, Sun L, Mosammaparast N, Serra V, Zhao P, Lomonosova E, Khabele D, Mullen MM. RAD51 foci as a biomarker predictive of platinum chemotherapy response in ovarian cancer. Clin Cancer Res 2023:726116. [PMID: 37097615 DOI: 10.1158/1078-0432.ccr-22-3335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/31/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To determine the ability of RAD51 foci to predict platinum chemotherapy response in high-grade serous ovarian cancer (HGSOC) patient-derived samples. EXPERIMENTAL DESIGN RAD51 and γH2AX nuclear foci were evaluated by immunofluorescence in HGSOC patient-derived cell lines (n=5), organoids (n=11), and formalin-fixed, paraffin-embedded tumor samples (discovery n=31, validation n=148). Samples were defined as RAD51-High if >10% of geminin-positive cells had ≥5 RAD51 foci. Associations between RAD51 scores, platinum chemotherapy response, and survival were evaluated. RESULTS RAD51 scores correlated with in vitro response to platinum chemotherapy in established and primary ovarian cancer cell lines (Pearson r=0.96, P=0.01). Organoids from platinum-nonresponsive tumors had significantly higher RAD51 scores than those from platinum-responsive tumors (P<0.001). In a discovery cohort, RAD51-Low tumors were more likely to have a pathologic complete response (RR 5.28, P<0.001) and to be platinum-sensitive (RR ∞, P = 0.05). The RAD51 score was predictive of chemotherapy response score (AUC 0.90, 95% CI 0.78-1.0; P<0.001). A novel automatic quantification system accurately reflected the manual assay (92%). In a validation cohort, RAD51-Low tumors were more likely to be platinum-sensitive (RR ∞, P < 0.001) than RAD51-High tumors. Moreover, RAD51-Low status predicted platinum sensitivity with 100% positive predictive value and was associated with better progression-free (HR 0.53, 95% CI 0.33-0.85, P<0.001) and overall survival (HR 0.43, 95% CI 0.25-0.75, P=0.003) than RAD51-High status. CONCLUSIONS RAD51 foci are a robust marker of platinum chemotherapy response and survival in ovarian cancer. The utility of RAD51 foci as a predictive biomarker for HGSOC should be tested in clinical trials.
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Affiliation(s)
- Amanda J Compadre
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Lillian N van Biljon
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Mark C Valentine
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | | | - Emily Graham
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Bisiayo Fashemi
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | | | - Emilee N Kotnik
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Isaac Cooper
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | | | - Lindsay M Kuroki
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Carolyn K McCourt
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Andrea R Hagemann
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Premal H Thaker
- Washington University in St. Louis School of Medicine, St Louis, MO, United States
| | - David G Mutch
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, Australia
| | - Matthew A Powell
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Lulu Sun
- Washington University in St. Louis School of Medicine, Saint Louis, MO, United States
| | | | - Violeta Serra
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Peinan Zhao
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Elena Lomonosova
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
| | - Dineo Khabele
- The University of Kansas School of Medicine, Kansas City, KS, United States
| | - Mary M Mullen
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
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11
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Blanc-Durand F, Yaniz-Galende E, Llop-Guevara A, Genestie C, Serra V, Herencia-Ropero A, Klein C, Berton D, Lortholary A, Dohollou N, Desauw C, Fabbro M, Malaurie E, Bonichon-Lamaichhane N, Dubot C, Kurtz JE, de Rauglaudre G, Raban N, Chevalier-Place A, Ferron G, Kaminsky MC, Kramer C, Rouleau E, Leary A. A RAD51 functional assay as a candidate test for homologous recombination deficiency in ovarian cancer. Gynecol Oncol 2023; 171:106-113. [PMID: 36868112 DOI: 10.1016/j.ygyno.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 03/05/2023]
Abstract
RATIONALE Homologous recombination deficiency (HRD), defined as BRCA1/2 mutation (BRCAmut) or high genomic instability, is used to identify ovarian cancer (OC) patients most likely to benefit from PARP inhibitors. While these tests are useful, they are imperfect. Another approach is to measure the capacity of tumor cells to form RAD51 foci in the presence of DNA damage using an immunofluorescence assay (IF). We aimed to describe for the first time this assay in OC and correlate it to platinum response and BRCAmut. METHODS Tumor samples were prospectively collected from the randomized CHIVA trial of neoadjuvant platinum +/- nintedanib. IF for RAD51, GMN and gH2AX was performed on FFPE blocks. Tumors were considered RAD51-low if ≤10% of GMN-positive tumor cells had ≥5 RAD51 foci. BRCAmut were identified by NGS. RESULTS 155 samples were available. RAD51 assay was contributive for 92% of samples and NGS available for 77%. gH2AX foci confirmed the presence of significant basal DNA damage. 54% of samples were considered HRD by RAD51 and presented higher overall response rates to neoadjuvant platinum (P = 0.04) and longer progression-free survival (P = 0.02). In addition, 67% of BRCAmut were HRD by RAD51. Among BRCAmut, RAD51-high tumors seem to harbor poorer response to chemotherapy (P = 0.02). CONCLUSIONS We evaluated a functional assay of HR competency. OC demonstrate high levels of DNA damage, yet 54% fail to form RAD51 foci. These RAD51-low OC tend to be more sensitive to neoadjuvant platinum. The RAD51 assay also identified a subset of RAD51-high BRCAmut tumors with unexpected poor platinum response.
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Affiliation(s)
- Félix Blanc-Durand
- Medical Oncology, Gynecology Unit, Gustave Roussy Institute, Villejuif, France
| | | | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Christophe Klein
- Center of Cellular Imaging and Cytometry, INSERM UMRS 1138, Cordeliers Research Center, Paris, France
| | - Dominique Berton
- Medical Oncology, GINECO & Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Alain Lortholary
- Medical Oncology, GINECO-Hôpital Privé du Confluent, Nantes, France
| | - Nadine Dohollou
- Medical Oncology, Polyclinique Bordeaux Nord Aquitain, Bordeaux, France
| | | | - Michel Fabbro
- Medical Oncology, ICM Val d'Aurelle, Montpellier, France
| | - Emmanuelle Malaurie
- Medical Oncology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Coraline Dubot
- Medical Oncology, GINECO and Institut Curie - Hôpital René Huguenin, Saint-Cloud, France
| | | | | | - Nadia Raban
- Medical Oncology, GINECO and CHU La Milétrie, Poitiers, France
| | | | - Gwenael Ferron
- Medical Oncology, GINECO and Institut Claudius Regaud, Toulouse, France
| | | | - Claire Kramer
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Etienne Rouleau
- Cancer Genetics Laboratory, Gustave Roussy Institute, Villejuif, France
| | - Alexandra Leary
- Medical Oncology, Gynecology Unit, Gustave Roussy Institute, Villejuif, France; INSERM UMR981, Gustave Roussy Institute, Villejuif, France.
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12
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Engebrethsen C, Yndestad S, Herencia-Ropero A, Nikolaienko O, Vintermyr OK, Lillestøl RK, Minsaas L, Leirvaag B, Iversen G, Gilje B, Blix E, Espelid H, Lundgren S, Geisler J, Vassbotn LJ, Aase HS, Aas T, Llop-Guevara A, Serra V, Lønning PE, Knappskog S, Eikesdal HP. Abstract P6-10-04: Homologous recombination deficiency across subtypes of primary breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-10-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Homologous recombination deficiency (HRD) is highly prevalent in triple-negative breast cancer (TNBC) and predictive of response to PARP inhibition in the primary setting (Eikesdal et al, Ann Oncol, 2021). However, the prevalence of HRD across breast cancer subtypes has not been established. Methods: Pretreatment tumor biopsies from 201 patients (32 TNBC and 169 non-TNBC) with primary breast cancer in the phase II PETREMAC trial (ClinicalTrials #NCT02624973) were examined. These samples underwent targeted cancer gene panel sequencing and BRCA1 promoter methylation analysis to assess HRD status defined by homologous recombination repair (HRR) gene mutations and/or BRCA1 promoter methylation. HRR genes included BRCA1, BRCA2, BRIP1, BARD1, and PALB2 by strict definition (HRR-S), and additionally ABL1, ATM, ATR, ATRX, BLM, CDK12, CHEK1, EMSY, ERCC4, FANCA, FANCC, FANCD2, FANCE, FANCF, FANCG, MEN1, MRE11, NBN, PTEN, and SETD2 by wider definition (HRR-W). HRD strict (HRD-S) was defined as biallelic gene inactivation by HRR-S mutations or BRCA1 methylation. Finally, tumors underwent PAM50 gene expression subtyping and evaluation of functional HRD by RAD51 nuclear foci analysis, for which a low score has been associated with HRD. Results: HRD-S was present in 13% of the breast cancers (total: n= 27/201; TNBC: 15/32; 47%; non-TNBC: 12/169; 7%), whereas HRD-W (HRR-W or BRCA1 methylation) was observed in 29% (total: n=58/201; TNBC: 19/32; 59%; non-TNBC: 39/169; 23%). Among 190 tumors analyzed for PAM50 intrinsic subtype, HRD-S was detected in 3/60 and 4/48 (5% and 8%) of tumors classified as luminal A and B, respectively, 1/35 (3%) of HER2-enriched, 4/21 (19%) of normal-like, and 12/26 (46%) of basal-like tumors. Out of 58 non-TNBC biopsies examined by RAD51 staining, four (7%) were classified as HRD-S and all these were scored as RAD51 low. The remaining 54 non-TNBC samples were homologous recombination proficient, and none of these exhibited functional HRD by RAD51 low scores. All four HRD-S/RAD51 low tumors were hormone receptor-positive, HER2 negative, and belonged to the luminal A (n=1), luminal B (n=2), and basal-like (n=1) subtypes, with HRD caused by germline BRCA1 (gBRCA1), gBRCA2, somatic BRCA1 mutations and BRCA1 methylation, respectively. Conclusion: The prevalence of HRD across all breast cancer subtypes suggests that HRD analysis and therapy targeting such DNA repair defects should be tested in future clinical trials.
Citation Format: Christina Engebrethsen, Synnøve Yndestad, Andrea Herencia-Ropero, Oleksii Nikolaienko, Olav Karsten Vintermyr, Reidun K. Lillestøl, Laura Minsaas, Beryl Leirvaag, Gjertrud Iversen, Bjørnar Gilje, Egil Blix, Helge Espelid, Steinar Lundgren, Jürgen Geisler, Liv Jorunn Vassbotn, Hildegunn S. Aase, Turid Aas, Alba Llop-Guevara, Violeta Serra, Per Eystein Lønning, Stian Knappskog, Hans Petter Eikesdal. Homologous recombination deficiency across subtypes of primary breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-10-04.
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Affiliation(s)
| | - Synnøve Yndestad
- 2Department of Clinical Science, University of Bergen, Bergen, Hordaland, Norway
| | | | | | | | - Reidun K. Lillestøl
- 6Department of Oncology, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Laura Minsaas
- 7Department of Oncology, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Beryl Leirvaag
- 8Department of Oncology, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gjertrud Iversen
- 9Department of Oncology, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Hordaland, Norway
| | - Bjørnar Gilje
- 10Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Egil Blix
- 11Department of Oncology, University Hospital of North Norway, Tromso, Norway
| | - Helge Espelid
- 12Department of Surgery, Haugesund Hospital, Haugesund, Norway
| | | | | | | | | | - Turid Aas
- 17Haukeland University Hospital, Norway
| | | | | | - Per Eystein Lønning
- 20Department of Oncology, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Bergen, Hordaland, Norway
| | - Stian Knappskog
- 21Department of Oncology, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Hans Petter Eikesdal
- 22Department of Oncology, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Bergen, Hordaland, Norway
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13
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Balmaña J, Pascual T, Llop-Guevara A, Tolosa P, Blancas I, Perez-Lopez ME, Adamo B, Teruel I, Ponce J, Gonzalez M, Viñas G, Lema L, Salvador FJ, Martinez MT, Espinosa A, Prat A, Serra V. Abstract OT3-11-02: SOLTI-1910: Predicting olaparib sensitivity in patients with unresectable locally advanced/metastatic HER2-negative breast cancer with BRCA1/2, PALB2, RAD51C/D mutations or HRD by the RAD51 test: RADIOLA TRIAL. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot3-11-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background The OlympiAD trial evaluated the PARP inhibitor (PARPi) olaparib versus a non-platinum standard chemotherapy in HER2-negative metastatic breast cancer (MBC) patients with a germline BRCA1/2 (gBRCA) mutation. Olaparib resulted in improved progression-free survival (PFS) and doubled the response rate vs chemotherapy. Nevertheless, the response rate to PARPi is 60% in the gBRCA1/2 population with MBC (current approval), suggesting a limited positive predictive value of gBRCA1/2 status. Moreover, patients with other relevant Homologous Recombination Repair defects (HRD) such as PALB2 or RAD51C/D mutation carriers, or HRD epigenetic silencing, are not captured with a gBRCA analysis. We have previoulsy shown that the functional HRD biomarker RAD51, tested in FFPE tumor samples using an optimized immunofluorescence-based assay, is associated with platinum response in early TNBC and PARPi response in preclinical BC models. We hypothesize that the RAD51 test would help to expand the clinical benefit of PARPi by predicting response to olaparib in MBC with germline/somatic BRCA1/2, PALB2 or RAD51C/D mutation and beyond. Study design RADIOLA is an open-label, single-arm, multicentre phase II study evaluating treatment with olaparib in male or female ≥18 years patients with HER2-negative MBC with ≤ two prior chemotherapy lines in two cohorts: cohort 1 (N=41) with known germline/somatic BRCA1/2, PALB2 or RAD51C/D mutation; cohort 2 (N=25) with functional HRD, namely RAD51-low score (≤10%), in wild-type/unknown mutation status at study entry. All patients will receive olaparib 300mg po BID until progression or unacceptable toxicity. Primary objective will assess, in terms of overall response rate (ORR), the capacity of the RAD51 score to predict olaparib efficacy in cohort 1. Secondary objectives include PFS, clinical benefit rate, duration of response, safety in both cohorts and ORR in cohort 2. Recruitment Recruitment (11 sites) started in March 2022. As of July 2022, 7 patients have been enrolled in Spain. Funding This study is financially supported by AstraZeneca.
Citation Format: Judith Balmaña, Tomás Pascual, Alba Llop-Guevara, Pablo Tolosa, Isabel Blancas, Maria-Eva Perez-Lopez, Barbara Adamo, Iris Teruel, Jose Ponce, Marta Gonzalez, Gemma Viñas, Laura Lema, Francisco Javier Salvador, Mª Teresa Martinez, Alejandra Espinosa, Aleix Prat, Violeta Serra. SOLTI-1910: Predicting olaparib sensitivity in patients with unresectable locally advanced/metastatic HER2-negative breast cancer with BRCA1/2, PALB2, RAD51C/D mutations or HRD by the RAD51 test: RADIOLA TRIAL [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-11-02.
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Affiliation(s)
| | - Tomás Pascual
- 2Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Catalonia, Spain
| | | | - Pablo Tolosa
- 4SOLTI Cancer Research Group, Barcelona, Spain/Medical Oncology Department, Hospital 12 de Octubre, Madrid, Madrid, Country: Spain
| | - Isabel Blancas
- 5Medical Oncology Dept, University Hospital San Cecilio, Granada, Spain
| | | | - Barbara Adamo
- 7Medical Oncology Department, Hospital Clínic de Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Catalonia, Spain
| | - Iris Teruel
- 8Medical Oncology, Institut Català d’Oncologia Badalona(ICO Badalona), Catalonia, Spain
| | - Jose Ponce
- 9Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Comunidad Valenciana, Spain
| | | | - Gemma Viñas
- 11Medical Oncology, Institut Català d’Oncologia Girona
| | - Laura Lema
- 12Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
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14
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Serra-Camprubí Q, Verdaguer H, Oliveros W, Lupión-Garcia N, Llop-Guevara A, Molina C, Vila-Casadesús M, Turpin A, Neuzillet C, Frigola J, Querol J, Yáñez-Bartolomé M, Castet F, Fabregat-Franco C, Escudero-Iriarte C, Escorihuela M, Arenas EJ, Bernadó-Morales C, Haro N, Giles FJ, Pozo ÓJ, Miquel JM, Nuciforo PG, Vivancos A, Melé M, Serra V, Arribas J, Tabernero J, Peiró S, Macarulla T, Tian TV. Human Metastatic Cholangiocarcinoma Patient-Derived Xenografts and Tumoroids for Preclinical Drug Evaluation. Clin Cancer Res 2023; 29:432-445. [PMID: 36374558 PMCID: PMC9873249 DOI: 10.1158/1078-0432.ccr-22-2551] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/16/2022] [Revised: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Cholangiocarcinoma (CCA) is usually diagnosed at advanced stages, with limited therapeutic options. Preclinical models focused on unresectable metastatic CCA are necessary to develop rational treatments. Pathogenic mutations in IDH1/2, ARID1A/B, BAP1, and BRCA1/2 have been identified in 30%-50% of patients with CCA. Several types of tumor cells harboring these mutations exhibit homologous recombination deficiency (HRD) phenotype with enhanced sensitivity to PARP inhibitors (PARPi). However, PARPi treatment has not yet been tested for effectiveness in patient-derived models of advanced CCA. EXPERIMENTAL DESIGN We have established a collection of patient-derived xenografts from patients with unresectable metastatic CCA (CCA_PDX). The CCA_PDXs were characterized at both histopathologic and genomic levels. We optimized a protocol to generate CCA tumoroids from CCA_PDXs. We tested the effects of PARPis in both CCA tumoroids and CCA_PDXs. Finally, we used the RAD51 assay to evaluate the HRD status of CCA tissues. RESULTS This collection of CCA_PDXs recapitulates the histopathologic and molecular features of their original tumors. PARPi treatments inhibited the growth of CCA tumoroids and CCA_PDXs with pathogenic mutations of BRCA2, but not those with mutations of IDH1, ARID1A, or BAP1. In line with these findings, only CCA_PDX and CCA patient biopsy samples with mutations of BRCA2 showed RAD51 scores compatible with HRD. CONCLUSIONS Our results suggest that patients with advanced CCA with pathogenic mutations of BRCA2, but not those with mutations of IDH1, ARID1A, or BAP1, are likely to benefit from PARPi therapy. This collection of CCA_PDXs provides new opportunities for evaluating drug response and prioritizing clinical trials.
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Affiliation(s)
- Queralt Serra-Camprubí
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Helena Verdaguer
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Winona Oliveros
- Life Sciences Department, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Núria Lupión-Garcia
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alba Llop-Guevara
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Cristina Molina
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Maria Vila-Casadesús
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Anthony Turpin
- Université de Lille, CNRS INSERM UMR9020-U1277, CANTHER Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France.,Medical Oncology Department, CHRU Lille, Lille, France
| | - Cindy Neuzillet
- Gastrointestinal Oncology, Medical Oncology Department, Curie Institute, Versailles St-Quentin-Paris Saclay University, Saint-Cloud, France
| | - Joan Frigola
- Clinical Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jessica Querol
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Mariana Yáñez-Bartolomé
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Florian Castet
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carles Fabregat-Franco
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carmen Escudero-Iriarte
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Marta Escorihuela
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Enrique J. Arenas
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Cristina Bernadó-Morales
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Noemí Haro
- Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Óscar J. Pozo
- Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Josep M. Miquel
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Paolo G. Nuciforo
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Marta Melé
- Life Sciences Department, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Violeta Serra
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Joaquín Arribas
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer, Monforte de Lemos, Madrid, Spain.,Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Josep Tabernero
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sandra Peiró
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Corresponding Authors: Tian V. Tian, Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain. Phone: (34)932543450, ext. 8656; E-mail: ; Teresa Macarulla, ; and Sandra Peiró,
| | - Teresa Macarulla
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Corresponding Authors: Tian V. Tian, Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain. Phone: (34)932543450, ext. 8656; E-mail: ; Teresa Macarulla, ; and Sandra Peiró,
| | - Tian V. Tian
- Preclinical and Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Corresponding Authors: Tian V. Tian, Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain. Phone: (34)932543450, ext. 8656; E-mail: ; Teresa Macarulla, ; and Sandra Peiró,
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Serra V, Wang AT, Castroviejo-Bermejo M, Polanska UM, Palafox M, Herencia-Ropero A, Jones GN, Lai Z, Armenia J, Michopoulos F, Llop-Guevara A, Brough R, Gulati A, Pettitt SJ, Bulusu KC, Nikkilä J, Wilson Z, Hughes A, Wijnhoven PW, Ahmed A, Bruna A, Gris-Oliver A, Guzman M, Rodríguez O, Grueso J, Arribas J, Cortés J, Saura C, Lau A, Critchlow S, Dougherty B, Caldas C, Mills GB, Barrett JC, Forment JV, Cadogan E, Lord CJ, Cruz C, Balmaña J, O'Connor MJ. Identification of a Molecularly-Defined Subset of Breast and Ovarian Cancer Models that Respond to WEE1 or ATR Inhibition, Overcoming PARP Inhibitor Resistance. Clin Cancer Res 2022; 28:4536-4550. [PMID: 35921524 PMCID: PMC9561606 DOI: 10.1158/1078-0432.ccr-22-0568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/10/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE PARP inhibitors (PARPi) induce synthetic lethality in homologous recombination repair (HRR)-deficient tumors and are used to treat breast, ovarian, pancreatic, and prostate cancers. Multiple PARPi resistance mechanisms exist, most resulting in restoration of HRR and protection of stalled replication forks. ATR inhibition was highlighted as a unique approach to reverse both aspects of resistance. Recently, however, a PARPi/WEE1 inhibitor (WEE1i) combination demonstrated enhanced antitumor activity associated with the induction of replication stress, suggesting another approach to tackling PARPi resistance. EXPERIMENTAL DESIGN We analyzed breast and ovarian patient-derived xenoimplant models resistant to PARPi to quantify WEE1i and ATR inhibitor (ATRi) responses as single agents and in combination with PARPi. Biomarker analysis was conducted at the genetic and protein level. Metabolite analysis by mass spectrometry and nucleoside rescue experiments ex vivo were also conducted in patient-derived models. RESULTS Although WEE1i response was linked to markers of replication stress, including STK11/RB1 and phospho-RPA, ATRi response associated with ATM mutation. When combined with olaparib, WEE1i could be differentiated from the ATRi/olaparib combination, providing distinct therapeutic strategies to overcome PARPi resistance by targeting the replication stress response. Mechanistically, WEE1i sensitivity was associated with shortage of the dNTP pool and a concomitant increase in replication stress. CONCLUSIONS Targeting the replication stress response is a valid therapeutic option to overcome PARPi resistance including tumors without an underlying HRR deficiency. These preclinical insights are now being tested in several clinical trials where the PARPi is administered with either the WEE1i or the ATRi.
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Affiliation(s)
- Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- CIBERONC, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | | | - Marta Palafox
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Andrea Herencia-Ropero
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Biochemistry and Molecular Biology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Zhongwu Lai
- AstraZeneca Oncology R&D, Waltham, Massachusetts
| | | | | | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Rachel Brough
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Aditi Gulati
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Stephen J. Pettitt
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | | | | | - Zena Wilson
- AstraZeneca Oncology R&D, Cambridge, United Kingdom
| | - Adina Hughes
- AstraZeneca Oncology R&D, Cambridge, United Kingdom
| | | | - Ambar Ahmed
- AstraZeneca Oncology R&D, Waltham, Massachusetts
| | - Alejandra Bruna
- Cancer Research UK, Cambridge Institute, Cambridge, United Kingdom
| | - Albert Gris-Oliver
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Marta Guzman
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Olga Rodríguez
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Judit Grueso
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Joaquin Arribas
- CIBERONC, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Growth Factors Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Javier Cortés
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Cristina Saura
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Breast Cancer and Melanoma Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Alan Lau
- AstraZeneca Oncology R&D, Cambridge, United Kingdom
| | | | | | - Carlos Caldas
- Cancer Research UK, Cambridge Institute, Cambridge, United Kingdom
| | - Gordon B. Mills
- Department of Cell Development and Cancer Biology, Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Christopher J. Lord
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Cristina Cruz
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- High Risk and Familial Cancer, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Judith Balmaña
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- High Risk and Familial Cancer, Vall d'Hebron Institute of Oncology, Barcelona, Spain
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16
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Capoluongo ED, Pellegrino B, Arenare L, Califano D, Scambia G, Beltrame L, Serra V, Scaglione GL, Spina A, Cecere SC, De Cecio R, Normanno N, Colombo N, Lorusso D, Russo D, Nardelli C, D'Incalci M, Llop-Guevara A, Pisano C, Baldassarre G, Mezzanzanica D, Artioli G, Setaro M, Tasca G, Roma C, Campanini N, Cinieri S, Sergi A, Musolino A, Perrone F, Chiodini P, Marchini S, Pignata S. Alternative academic approaches for testing homologous recombination deficiency in ovarian cancer in the MITO16A/MaNGO-OV2 trial. ESMO Open 2022; 7:100585. [PMID: 36156447 PMCID: PMC9512829 DOI: 10.1016/j.esmoop.2022.100585] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background The detection of homologous recombination deficiency (HRD) can identify patients who are more responsive to platinum and poly ADP ribose polymerase inhibitors (PARPi). MyChoice CDx (Myriad) is the most used HRD test in ovarian cancer (OC). However, some limitations of commercial tests exist, because of the high rate of inconclusive results, costs, and the impossibility of evaluating functional resistance mechanisms. Patients and methods Two academic genomic tests and a functional assay, the RAD51 foci, were evaluated to detect HRD. One hundred patients with high-grade OC enrolled in the MITO16A/MaNGO-OV2 trial and treated with first-line therapy with carboplatin, paclitaxel, and bevacizumab were analyzed. Results The failure rate of the two genomic assays was 2%. The sensitivity in detecting HRD when compared with Myriad was 98.1% and 90.6%, respectively. The agreement rate with Myriad was 0.92 and 0.87, with a Cohen’s κ coefficient corresponding to 0.84 and 0.74, respectively. For the RAD51 foci assay, the failure rate was 30%. When the test was successful, discordant results for deficient and proficient tumors were observed, and additional HRD patients were identified compared to Myriad; sensitivity was 82.9%, agreement rate was 0.65, and Cohen’s κ coefficient was 0.18. The HRD detected by genomic assays and residual tumor at primary surgery and stage was correlated with progression-free survival at multivariate analysis. Conclusions Results suggest the feasibility of academic tests for assessing HRD status that show robust concordance with Myriad and correlation with clinical outcome. The contribution of the functional information related to the RAD51 foci test to the genomic data needs further investigation. Deficiency in homologous recombination repair of DNA generates genomic instability and permanent genomic changes. HRD status is fundamental for identifying OC patients suitable for platinum and PARPi treatment. HRD testing is considered a topic with urgent need for improvement, going beyond those available commercially. Within this study, two academic genomic tests and a functional assay, the RAD51 foci, were evaluated to detect HRD. Our tests compare favorably with the reference Myriad assay and correlate with the outcome of high-grade OC patients.
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Affiliation(s)
- E D Capoluongo
- Department of Molecular Medicine and Medical Biotechnology, Università degli Studi di Napoli Federico II, Naples; Azienda Ospedaliera per L'Emergenza, Cannizzaro, Catania
| | - B Pellegrino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology and Breast Unit, University Hospital of Parma, Parma; Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma
| | - L Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples
| | - D Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Naples
| | - G Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome
| | - L Beltrame
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - V Serra
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - G L Scaglione
- Advanced Biotechnology, Università Federico II-CEINGE, Naples; IDI-IRCSS, Rome
| | - A Spina
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Naples
| | - S C Cecere
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - R De Cecio
- Pathology Unit, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Napoli
| | - N Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Napoli
| | - N Colombo
- University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan
| | - D Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome
| | - D Russo
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Naples
| | - C Nardelli
- Department of Molecular Medicine and Medical Biotechnology, Università degli Studi di Napoli Federico II, Naples; Advanced Biotechnology, Università Federico II-CEINGE, Naples
| | - M D'Incalci
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan
| | | | - C Pisano
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - G Baldassarre
- Molecular Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, Aviano
| | - D Mezzanzanica
- Molecular Therapies Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - G Artioli
- Oncologia Medica, ULSS2 Marca Trevigiana, Treviso
| | - M Setaro
- Advanced Biotechnology, Università Federico II-CEINGE, Naples
| | - G Tasca
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - C Roma
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Napoli
| | - N Campanini
- Unit of Pathological Anatomy, Department of Medicine and Surgery, University Hospital of Parma, Parma
| | - S Cinieri
- Oncologia Medica, Ospedale Senatore Antonio Perrino, Brindisi
| | - A Sergi
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan
| | - A Musolino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology and Breast Unit, University Hospital of Parma, Parma; Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma
| | - F Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples
| | - P Chiodini
- Department of Mental Health and Public Medicine, Section of Statistics, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - S Marchini
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - S Pignata
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples.
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Gomez-Puerto D, Llop-Guevara A, Cruellas M, Torres-Esquius S, De La Torre J, Peg V, Balmaña J, Pimentel I. Genetic and functional homologous repair deficiency as biomarkers for platinum sensitivity in TNBC: A case report. Front Oncol 2022; 12:963728. [PMID: 36185283 PMCID: PMC9516106 DOI: 10.3389/fonc.2022.963728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
Triple-negative breast cancer is the most aggressive subtype of mammary carcinoma. In the early stage, neoadjuvant chemotherapy (NAC) is the standard of care for prognostic stratification and the best adjuvant treatment strategy. A 30-year-old female presented in the emergency room because of a gigantic right breast associated with an ulcerated lump at the upper quadrants. The right axillary nodes were palpable. An ultrasound was performed, showing the ulcerated neoformation with enlarged right axillary lymph nodes observed to level III. A core biopsy of the breast lesion was performed, and the pathological examination revealed a nonspecial type, grade 3, invasive, triple-negative breast cancer. No distant disease was found in the PET-CT scan. A germline genetic panel by next-generation sequencing identified a likely pathogenic variant in RAD51D (c.898C>T). Assessment of the functionality of the DNA homologous recombination repair pathway by RAD51 foci in the tumor revealed a profile of homologous recombination deficiency. NAC consisting of weekly carboplatin and paclitaxel followed by dose-dense doxorubicin/cyclophosphamide was performed with a complete metabolic response achieved in the PET-CT scan. The patient underwent a modified radical mastectomy plus axillary lymphadenectomy with a pathological complete response in the breast and axilla and remains disease-free after 2 years of follow-up. We report a young female with a triple-negative breast cancer stage cT4bN3M0 and a hereditary pathogenic mutation in RAD51D. The tumor was highly proliferative and homologous recombination-deficient by RAD51. The patient received platinum-based NAC, achieving a pathologic complete response. More effort should be made to identify predictive functional biomarkers of treatment response, such as RAD51 foci, for platinum sensitivity.
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Affiliation(s)
- Diego Gomez-Puerto
- Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- *Correspondence: Diego Gomez-Puerto,
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Mara Cruellas
- Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sara Torres-Esquius
- Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Javier De La Torre
- Gynecologic Oncology and the Breast Pathology Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Vicente Peg
- Pathology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Isabel Pimentel
- Medical Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Breast Cancer and Melanoma Group, Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
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18
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Pellegrino B, Llop-Guevara A, Solinas C, Campanini N, Tommasi C, Michiara M, Boggiani D, Sikokis A, Frassoldati A, Casarini C, Cretella E, Zoppoli G, Lambertini M, Dieci M, Cortesi L, Silini E, Balmaña J, Willard-Gallo K, Serra V, Musolino A. 146P HRD/TIL-low high-risk breast cancer is characterized by good prognosis (the RADIMMUNE trial). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.181] [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: 11/01/2022] Open
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19
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Llop-Guevara A, Arce-Gallego S, Oliveira M, Simonetti S, Viaplana C, Grau JF, García-Duran C, Pimentel I, Martínez P, Jimenez J, Dienstmann R, Nuciforo P, Carles J, Vivancos A, Oaknin A, Saura C, Aguilar S, Mateo J, Balmaña J, Serra V. Identification of homologous recombination deficiency (HRD) by RAD51 in a tumor molecular profiling program for precision medicine. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3137 Background: Tumor molecular profiling by panel sequencing helps to identify candidate patients for precision oncology. Mutations in genes of the homologous recombination repair (HRR) pathway confer DNA repair deficiency and sensitivity to DNA damaging agents, such as PARP inhibitors (PARPi) or platinum-based drugs. RAD51 nuclear foci is a biomarker of functional HRR deficiency (HRD). We aimed to incorporate the RAD51 test in an academic molecular profiling program to identify HRD tumors beyond genetic testing. Methods: We included patients with metastatic breast cancer (TNBC, ER+ <60y, 3rd line HER2+ BC), newly diagnosed high-grade epithelial ovarian cancer (HGOC) and metastatic and/or castration-resistant prostate adenocarcinoma (PC) undergoing tumor/germline genetic testing. A customized capture-based targeted sequencing of 450 genes was performed in FFPE tumor samples. RAD51 was manually stained by immunofluorescence and functional HRD was defined as RAD51 score ≤10%. Results: Between January 2021 and January 2022, tumor panel sequencing was performed in 279 tumors. Panel sequencing was informative in 264/279 (95%) samples and the RAD51 test was evaluable in 81/90 (90%). In total, 77 samples were evaluable for both tumor/germline sequencing and RAD51, namely 42 BC, 16 HGOC and 19 PC (Table 1). Functional HRD by RAD51 was observed in 15/77 (20%) cases. Panel sequencing identified 17/77 (22%) cases carrying HRR gene alterations, of which nine were confirmed as HRD by RAD51. In BC, 2/6 tumors with HRD by RAD51 did not carry a germline or tumor mutation in HRR genes. HRD tumor profiling triggered the germline analysis of one hereditary BRCA2 BC patient. Four g BRCA1/2 BC with HRD by RAD51 became HRR proficient (HRP) at PARPi progression. In addition, the RAD51 test identified 2/5 HGOC and 2/4 PC tumors as HRD despite not carrying a tumor HRR gene mutation. Conclusions: RAD51 testing is feasible in an established molecular profiling program and complements gene panel sequencing results by providing evidence of functional HRR status. In particular, the RAD51 test extends the identification of HRD tumors beyond those with HRR gene mutations and captures HRR restoration after PARPi treatment. We aim to expand the analysis of RAD51 to other tumor types.[Table: see text]
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Affiliation(s)
| | | | | | - Sara Simonetti
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | - Isabel Pimentel
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Paola Martínez
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jose Jimenez
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Paolo Nuciforo
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Joan Carles
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ana Vivancos
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ana Oaknin
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Cristina Saura
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Susana Aguilar
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Joaquin Mateo
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Judith Balmaña
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Violeta Serra
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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20
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Balmana J, Pascual T, Llop-Guevara A, Tolosa P, Blancas López-Barajas I, Perez Lopez M, Adamo B, Teruel-Garcia I, Ponce J, González-Cordero M, Viñas Villaro G, Lema Roso L, Salvador Bofill F, M. Martinez M, Guerrero A, Prat A, Serra Elizalde V. 57TiP SOLTI-1910: Predicting olaparib sensitivity in patients with unresectable locally advanced/metastatic HER2-negative breast cancer with BRCA1/2, PALB2, RAD51C/D mutations or HRD by the RAD51 test: RADIOLA trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.072] [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: 11/01/2022] Open
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21
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Pellegrino B, Herencia-Ropero A, Llop-Guevara A, Pedretti F, Moles-Fernández A, Viaplana C, Villacampa G, Guzmán M, Rodríguez O, Grueso J, Jiménez J, Arenas EJ, Degasperi A, Dias JML, Forment JV, O’Connor MJ, Déas O, Cairo S, Zhou Y, Musolino A, Caldas C, Nik-Zainal S, Clarke RB, Nuciforo P, Díez O, Serres-Créixams X, Peg V, Espinosa-Bravo M, Macarulla T, Oaknin A, Mateo J, Arribas J, Dienstmann R, Bellet M, Oliveira M, Saura C, Gutiérrez-Enríquez S, Balmaña J, Serra V. Preclinical In Vivo Validation of the RAD51 Test for Identification of Homologous Recombination-Deficient Tumors and Patient Stratification. Cancer Res 2022; 82:1646-1657. [PMID: 35425960 PMCID: PMC7612637 DOI: 10.1158/0008-5472.can-21-2409] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 07/22/2021] [Revised: 11/24/2021] [Accepted: 02/11/2022] [Indexed: 11/16/2022]
Abstract
PARP inhibitors (PARPi) are approved drugs for platinum-sensitive, high-grade serous ovarian cancer (HGSOC) and for breast, prostate, and pancreatic cancers (PaC) harboring genetic alterations impairing homologous recombination repair (HRR). Detection of nuclear RAD51 foci in tumor cells is a marker of HRR functionality, and we previously established a test to detect RAD51 nuclear foci. Here, we aimed to validate the RAD51 score cut off and compare the performance of this test to other HRR deficiency (HRD) detection methods. Laboratory models from BRCA1/BRCA2-associated breast cancer, HGSOC, and PaC were developed and evaluated for their response to PARPi and cisplatin. HRD in these models and patient samples was evaluated by DNA sequencing of HRR genes, genomic HRD tests, and RAD51 foci detection. We established patient-derived xenograft models from breast cancer (n = 103), HGSOC (n = 4), and PaC (n = 2) that recapitulated patient HRD status and treatment response. The RAD51 test showed higher accuracy than HRR gene mutations and genomic HRD analysis for predicting PARPi response (95%, 67%, and 71%, respectively). RAD51 detection captured dynamic changes in HRR status upon acquisition of PARPi resistance. The accuracy of the RAD51 test was similar to HRR gene mutations for predicting platinum response. The predefined RAD51 score cut off was validated, and the high predictive value of the RAD51 test in preclinical models was confirmed. These results collectively support pursuing clinical assessment of the RAD51 test in patient samples from randomized trials testing PARPi or platinum-based therapies. SIGNIFICANCE This work demonstrates the high accuracy of a histopathology-based test based on the detection of RAD51 nuclear foci in predicting response to PARPi and cisplatin.
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Affiliation(s)
- Benedetta Pellegrino
- Department of Medicine and Surgery, University of Parma, Italy
- Medical Oncology and Breast Unit, University Hospital of Parma, Italy
| | - Andrea Herencia-Ropero
- Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
- Department of Biochemistry and Molecular Biology, Autonomous University of Barcelona, Barcelona, Spain
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Flaminia Pedretti
- Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
- Department of Biochemistry and Molecular Biology, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Cristina Viaplana
- Oncology Data Science Group (ODysSey Group), Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Guillermo Villacampa
- Oncology Data Science Group (ODysSey Group), Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Marta Guzmán
- Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Olga Rodríguez
- Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Judit Grueso
- Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Jose Jiménez
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Enrique J. Arenas
- Growth Factors Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
- CIBERONC, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Andrea Degasperi
- Academic Department of Medical Genetics, University of Cambridge, Addenbrooke's Treatment Centre, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- MRC Cancer Unit, Hutchison/MRC Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0XZ, UK
| | - João M. L. Dias
- Academic Department of Medical Genetics, University of Cambridge, Addenbrooke's Treatment Centre, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- MRC Cancer Unit, Hutchison/MRC Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0XZ, UK
| | | | - Mark J. O’Connor
- DDR Biology Group, Bioscience, Oncology R&D, AstraZeneca, Cambridge, UK
| | | | | | - Yinghui Zhou
- TESARO: A GSK company, 1000 Winter Street, Waltham, MA, 02451, USA
| | - Antonino Musolino
- Department of Medicine and Surgery, University of Parma, Italy
- Medical Oncology and Breast Unit, University Hospital of Parma, Italy
| | - Carlos Caldas
- Cancer Research UK Cambridge Institute and Department of Oncology, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Breast Cancer Programme, Cancer Research UK (CRUK) Cambridge Cancer Centre, Cambridge, UK
| | - Serena Nik-Zainal
- Academic Department of Medical Genetics, University of Cambridge, Addenbrooke's Treatment Centre, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- MRC Cancer Unit, Hutchison/MRC Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0XZ, UK
| | - Robert B. Clarke
- Manchester Breast Centre, Division of Cancer Sciences, University of Manchester, Oglesby Cancer Research Building, Manchester, UK
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Orland Díez
- Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
- Area of Clinical and Molecular Genetics, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Xavier Serres-Créixams
- Department of Radiology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Vicente Peg
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Martín Espinosa-Bravo
- Breast Surgical Unit, Breast Cancer Center, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Teresa Macarulla
- Gastrointestinal and Endocrine Tumors Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
- Department of Medical Oncology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Ana Oaknin
- Department of Medical Oncology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
- Gynecological Malignancies Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Joaquin Mateo
- Department of Medical Oncology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
- Prostate Cancer Translational Research Group, Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
| | - Joaquín Arribas
- Department of Biochemistry and Molecular Biology, Autonomous University of Barcelona, Barcelona, Spain
- Growth Factors Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
- CIBERONC, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Rodrigo Dienstmann
- Oncology Data Science Group (ODysSey Group), Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Meritxell Bellet
- Department of Medical Oncology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
- Breast Cancer and Melanoma Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Mafalda Oliveira
- Department of Medical Oncology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
- Breast Cancer and Melanoma Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Cristina Saura
- Department of Medical Oncology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
- Breast Cancer and Melanoma Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
- Department of Medical Oncology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
- CIBERONC, Vall d’Hebron Institute of Oncology, Barcelona, Spain
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22
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Guffanti F, Alvisi MF, Anastasia A, Ricci F, Chiappa M, Llop-Guevara A, Serra V, Fruscio R, Degasperi A, Nik-Zainal S, Bani MR, Lupia M, Giavazzi R, Rulli E, Damia G. Basal expression of RAD51 foci predicts olaparib response in patient-derived ovarian cancer xenografts. Br J Cancer 2022; 126:120-128. [PMID: 34732853 PMCID: PMC8727677 DOI: 10.1038/s41416-021-01609-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 06/07/2021] [Revised: 10/07/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The search for biomarkers to evaluate ovarian cancer (OC) homologous recombination (HR) function and predict the response to therapy is an urgent clinical need to improve the selection of patients who could benefit from platinum- and olaparib (poly-ADP ribose polymerase inhibitors, PARPi)-based therapies. METHODS We used a large collection of OC patient-derived xenografts (PDXs) (n = 47) and evaluated their HR status based on BRCA1/2 mutations, BRCA1 promoter methylation and the HRDetect score. RAD51 foci were quantified in formalin-fixed, paraffin-embedded untreated tumour specimens by immunofluorescence and the messenger RNA expression of 21 DNA repair genes by real-time PCR. RESULTS Tumour HR deficiency predicted both platinum and olaparib responses. The basal level of RAD51 foci evaluated in geminin-positive/replicating cells strongly inversely correlated with olaparib response (p = 0.011); in particular, the lower the foci score, the greater the sensitivity to olaparib, while low RAD51 foci score seems to associate with platinum activity. CONCLUSIONS The basal RAD51 foci score is a candidate predictive biomarker of olaparib response in OC patients as it can be easily translatable in a clinical setting. Moreover, the findings corroborate the importance of OC-PDXs as a reliable tool to identify and validate biomarkers of response to therapy.
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Affiliation(s)
- F. Guffanti
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M F Alvisi
- grid.4527.40000000106678902Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A. Anastasia
- grid.4527.40000000106678902Laboratory of Cancer Metastasis Therapeutics, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - F. Ricci
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M. Chiappa
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A. Llop-Guevara
- grid.411083.f0000 0001 0675 8654Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - V. Serra
- grid.411083.f0000 0001 0675 8654Experimental Therapeutics Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - R. Fruscio
- grid.7563.70000 0001 2174 1754Clinic of Obstetrics and Gynecology, Department of Medicine and Surgery, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - A. Degasperi
- grid.5335.00000000121885934MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Box 197, Cambridge Biomedical Campus, Cambridge, CB2 0XZ UK ,grid.120073.70000 0004 0622 5016Academic Laboratory of Medical Genetics, Lv 6 Addenbrooke’s Treatment Centre, Addenbrooke’s Hospital, Box 238, Cambridge, CB2 0QQ UK
| | - S. Nik-Zainal
- grid.5335.00000000121885934MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Box 197, Cambridge Biomedical Campus, Cambridge, CB2 0XZ UK ,grid.120073.70000 0004 0622 5016Academic Laboratory of Medical Genetics, Lv 6 Addenbrooke’s Treatment Centre, Addenbrooke’s Hospital, Box 238, Cambridge, CB2 0QQ UK
| | - M R Bani
- grid.4527.40000000106678902Laboratory of Cancer Metastasis Therapeutics, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M. Lupia
- grid.15667.330000 0004 1757 0843Unit of Gynecological Oncology Research, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R. Giavazzi
- grid.4527.40000000106678902Laboratory of Cancer Metastasis Therapeutics, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - E. Rulli
- grid.4527.40000000106678902Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G. Damia
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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23
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Carreira S, Porta N, Arce-Gallego S, Seed G, Llop-Guevara A, Bianchini D, Rescigno P, Paschalis A, Bertan C, Baker C, Goodall J, Miranda S, Riisnaes R, Figueiredo I, Ferreira A, Pereira R, Crespo M, Gurel B, Nava Rodrigues D, Pettitt SJ, Yuan W, Serra V, Rekowski J, Lord CJ, Hall E, Mateo J, de Bono JS. Biomarkers Associating with PARP Inhibitor Benefit in Prostate Cancer in the TOPARP-B Trial. Cancer Discov 2021; 11:2812-2827. [PMID: 34045297 PMCID: PMC9414325 DOI: 10.1158/2159-8290.cd-21-0007] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/23/2021] [Accepted: 05/21/2021] [Indexed: 01/07/2023]
Abstract
PARP inhibitors are approved for treating advanced prostate cancers (APC) with various defective DNA repair genes; however, further studies to clinically qualify predictive biomarkers are warranted. Herein we analyzed TOPARP-B phase II clinical trial samples, evaluating whole-exome and low-pass whole-genome sequencing and IHC and IF assays evaluating ATM and RAD51 foci (testing homologous recombination repair function). BRCA1/2 germline and somatic pathogenic mutations associated with similar benefit from olaparib; greater benefit was observed with homozygous BRCA2 deletion. Biallelic, but not monoallelic, PALB2 deleterious alterations were associated with clinical benefit. In the ATM cohort, loss of ATM protein by IHC was associated with a better outcome. RAD51 foci loss identified tumors with biallelic BRCA and PALB2 alterations while most ATM- and CDK12-altered APCs had higher RAD51 foci levels. Overall, APCs with homozygous BRCA2 deletion are exceptional responders; PALB2 biallelic loss and loss of ATM IHC expression associated with clinical benefit. SIGNIFICANCE: Not all APCs with DNA repair defects derive similar benefit from PARP inhibition. Most benefit was seen among patients with BRCA2 homozygous deletions, biallelic loss of PALB2, and loss of ATM protein. Loss of RAD51 foci, evaluating homologous recombination repair function, was found primarily in tumors with biallelic BRCA1/2 and PALB2 alterations.This article is highlighted in the In This Issue feature, p. 2659.
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Affiliation(s)
| | - Nuria Porta
- The Institute of Cancer Research, London, United Kingdom
| | - Sara Arce-Gallego
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona, Spain
| | - George Seed
- The Institute of Cancer Research, London, United Kingdom
| | - Alba Llop-Guevara
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona, Spain
| | - Diletta Bianchini
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Pasquale Rescigno
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alec Paschalis
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Claudia Bertan
- The Institute of Cancer Research, London, United Kingdom
| | - Chloe Baker
- The Institute of Cancer Research, London, United Kingdom
| | - Jane Goodall
- The Institute of Cancer Research, London, United Kingdom
| | - Susana Miranda
- The Institute of Cancer Research, London, United Kingdom
| | - Ruth Riisnaes
- The Institute of Cancer Research, London, United Kingdom
| | | | - Ana Ferreira
- The Institute of Cancer Research, London, United Kingdom
| | - Rita Pereira
- The Institute of Cancer Research, London, United Kingdom
| | - Mateus Crespo
- The Institute of Cancer Research, London, United Kingdom
| | - Bora Gurel
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Wei Yuan
- The Institute of Cancer Research, London, United Kingdom
| | - Violeta Serra
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jan Rekowski
- The Institute of Cancer Research, London, United Kingdom
| | | | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
| | - Joaquin Mateo
- The Institute of Cancer Research, London, United Kingdom.
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona, Spain
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Johann S de Bono
- The Institute of Cancer Research, London, United Kingdom.
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
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24
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Castells-Roca L, Gutiérrez-Enríquez S, Bonache S, Bogliolo M, Carrasco E, Aza-Carmona M, Montalban G, Muñoz-Subirana N, Pujol R, Cruz C, Llop-Guevara A, Ramírez MJ, Saura C, Lasa A, Serra V, Diez O, Balmaña J, Surrallés J. Clinical consequences of BRCA2 hypomorphism. NPJ Breast Cancer 2021; 7:117. [PMID: 34504103 PMCID: PMC8429460 DOI: 10.1038/s41523-021-00322-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/13/2020] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
The tumor suppressor FANCD1/BRCA2 is crucial for DNA homologous recombination repair (HRR). BRCA2 biallelic pathogenic variants result in a severe form of Fanconi anemia (FA) syndrome, whereas monoallelic pathogenic variants cause mainly hereditary breast and ovarian cancer predisposition. For decades, the co-occurrence in trans with a clearly pathogenic variant led to assume that the other allele was benign. However, here we show a patient with biallelic BRCA2 (c.1813dup and c.7796 A > G) diagnosed at age 33 with FA after a hypertoxic reaction to chemotherapy during breast cancer treatment. After DNA damage, patient cells displayed intermediate chromosome fragility, reduced survival, cell cycle defects, and significantly decreased RAD51 foci formation. With a newly developed cell-based flow cytometric assay, we measured single BRCA2 allele contributions to HRR, and found that expression of the missense allele in a BRCA2 KO cellular background partially recovered HRR activity. Our data suggest that a hypomorphic BRCA2 allele retaining 37–54% of normal HRR function can prevent FA clinical phenotype, but not the early onset of breast cancer and severe hypersensitivity to chemotherapy.
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Affiliation(s)
- Laia Castells-Roca
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sandra Bonache
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Massimo Bogliolo
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER) U-745, Barcelona, Spain
| | - Estela Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Miriam Aza-Carmona
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Montalban
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CHU de Québec - Université Laval Research Center, Oncology division, 9 Rue McMahon, Québec city, G1R 3S3, Québec, Canada
| | - Núria Muñoz-Subirana
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Roser Pujol
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER) U-745, Barcelona, Spain
| | - Cristina Cruz
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - María J Ramírez
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER) U-745, Barcelona, Spain
| | - Cristina Saura
- Breast Cancer and Melanoma Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Adriana Lasa
- Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER) U-705, Barcelona, Spain
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Orland Diez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Jordi Surrallés
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Center for Biomedical Network Research on Rare Diseases (CIBERER) U-745, Barcelona, Spain.
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25
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Aziz D, Portman N, Fernandez KJ, Lee C, Alexandrou S, Llop-Guevara A, Phan Z, Yong A, Wilkinson A, Sergio CM, Ferraro D, Etemadmoghadam D, Bowtell DD, Serra V, Waring P, Lim E, Caldon CE. Synergistic targeting of BRCA1 mutated breast cancers with PARP and CDK2 inhibition. NPJ Breast Cancer 2021; 7:111. [PMID: 34465787 PMCID: PMC8408175 DOI: 10.1038/s41523-021-00312-x] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/28/2021] [Indexed: 12/18/2022] Open
Abstract
Basal-like breast cancers (BLBC) are aggressive breast cancers that respond poorly to targeted therapies and chemotherapies. In order to define therapeutically targetable subsets of BLBC we examined two markers: cyclin E1 and BRCA1 loss. In high grade serous ovarian cancer (HGSOC) these markers are mutually exclusive, and define therapeutic subsets. We tested the same hypothesis for BLBC. Using a BLBC cohort enriched for BRCA1 loss, we identified convergence between BRCA1 loss and high cyclin E1 protein expression, in contrast to HGSOC in which CCNE1 amplification drives increased cyclin E1. In cell lines, BRCA1 loss was associated with stabilized cyclin E1 during the cell cycle, and BRCA1 siRNA led to increased cyclin E1 in association with reduced phospho-cyclin E1 T62. Mutation of cyclin E1 T62 to alanine increased cyclin E1 stability. We showed that tumors with high cyclin E1/BRCA1 mutation in the BLBC cohort also had decreased phospho-T62, supporting this hypothesis. Since cyclin E1/CDK2 protects cells from DNA damage and cyclin E1 is elevated in BRCA1 mutant cancers, we hypothesized that CDK2 inhibition would sensitize these cancers to PARP inhibition. CDK2 inhibition induced DNA damage and synergized with PARP inhibitors to reduce cell viability in cell lines with homologous recombination deficiency, including BRCA1 mutated cell lines. Treatment of BRCA1 mutant BLBC patient-derived xenograft models with combination PARP and CDK2 inhibition led to tumor regression and increased survival. We conclude that BRCA1 status and high cyclin E1 have potential as predictive biomarkers to dictate the therapeutic use of combination CDK inhibitors/PARP inhibitors in BLBC.
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Affiliation(s)
- Diar Aziz
- Centre for Translational Pathology, Department of Pathology and Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Peter MacCallum Cancer Institute, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Pathology Department, College of Medicine, University of Mosul, Mosul, Iraq
| | - Neil Portman
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Kristine J Fernandez
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Christine Lee
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Sarah Alexandrou
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Zoe Phan
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Aliza Yong
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Ashleigh Wilkinson
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - C Marcelo Sergio
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Danielle Ferraro
- Centre for Translational Pathology, Department of Pathology and Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
| | - Dariush Etemadmoghadam
- Peter MacCallum Cancer Institute, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - David D Bowtell
- Peter MacCallum Cancer Institute, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Paul Waring
- Centre for Translational Pathology, Department of Pathology and Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
| | - Elgene Lim
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - C Elizabeth Caldon
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW, Australia.
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.
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26
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Arce-Gallego S, Llop-Guevara A, Carreira S, Porta N, Fasani R, Bianchini D, Seed G, Rescigno P, Paschalis A, Bertan C, Baker C, Goodall J, Miranda S, Riisnaes R, Figueiredo I, Ferreira A, Pereira R, Gurel B, Rodrigues DN, Yuan W, Rekowski J, Hall E, Serra V, de Bono JS, Mateo J. Abstract CT161: A homologous recombination repair (HRR) functional assay to stratify patients with metastatic prostate cancer for PARP inhibitor treatment in the TOPARP-B clinical trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: PARP inhibitors (PARPi) are approved for the treatment of metastatic prostate cancer (mPC) associated to various DNA damage repair (DDR) gene mutations; but clinical benefit differs among patients. Biomarkers of homologous recombination repair (HRR) deficiency may help refine patient stratification for a more precise therapy selection. We report an exploratory analysis from the TOPARP-B phase II clinical trial of olaparib in mPC (NCT01682772), investigating the predictive value of an HRR function assay detecting RAD51 foci by immunofluorescence in tumor biopsies. Design: We analyzed formalin-fixed paraffin-embedded (FFPE) primary or metastatic biopsies from mPC patients treated with olaparib in the clinical trial. We evaluated baseline HRR function based on detection of RAD51 and γH2AX foci in geminin-positive tumor cells by immunofluorescence (IF). All samples were scored by two trained readers blinded to genomic and clinical data. Samples were considered HRR deficient (HRD) when RAD51 scores were low, pre-defined as <10% tumor cells presenting ≥5 RAD51 foci/cell. The association of the RAD51 score, response to olaparib and survival (radiographic progression-free survival, rPFS, and overall survival, OS) was analyzed by Chi-Square and log-rank tests. Results: RAD51 and γH2AX were successfully scored in 52 cases, in the same biopsies previously used for NGS in the clinical trial. All tumors showed abundant DNA damage (γH2AX scores >40%). The intra-class correlation score (ICC) between the two blinded readers was 0.88. Overall, 22 of 52 (42%) cases were considered as HRD based on low RAD51 scores. Response rate (based on the composite RECIST/PSA/CTC trial criteria) was 15/22 (68%) vs 7/30 (23%) for patients with low vs high RAD51 scores (p=0.001). Patients with low RAD51 scores also had longer rPFS (median 9.3 vs 2.9 months p=0.002) and overall survival (median 17.4 vs 9.5 months, p=0.05) from initiation of olaparib. All 16/16 cases with BRCA1/2 alterations were identified as RAD51 low. For patients with PALB2 mutations, 2/2 patients with biallelic loss showed RAD51 low scores and responded to olaparib, whereas 2/2 patients with monoallelic PALB2 mutations showed RAD51 high scores and did not respond to olaparib. Mutations in ATM and CDK12 did not associate with low RAD51. Indeed, 10/11 ATM-mutated and 8/10 CDK12-mutated tumors presented high RAD51 scores; RECIST/PSA responses were observed in two patients with ATM mutations and high RAD51 scores. Conclusion: A RAD51-based IF assay performed on FFPE biopsies can detect prostate cancers with deficient HRR function, including BRCA1/2 and biallelic PALB2 mutated cases, and may be useful for patient stratification for PARP inhibitor treatment in prostate cancer. Further validation of the assay in larger cohorts is warranted.
Citation Format: Sara Arce-Gallego, Alba Llop-Guevara, Suzanne Carreira, Nuria Porta, Roberta Fasani, Diletta Bianchini, George Seed, Pasquale Rescigno, Alec Paschalis, Claudia Bertan, Chloe Baker, Jane Goodall, Susana Miranda, Ruth Riisnaes, Ines Figueiredo, Ana Ferreira, Rita Pereira, Bora Gurel, Daniel Nava Rodrigues, Wei Yuan, Jan Rekowski, Emma Hall, Violeta Serra, Johann S. de Bono, Joaquin Mateo. A homologous recombination repair (HRR) functional assay to stratify patients with metastatic prostate cancer for PARP inhibitor treatment in the TOPARP-B clinical trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT161.
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Affiliation(s)
- Sara Arce-Gallego
- 1Vall d'Hebron Institute of Oncology and Vall d'Hebron Institute of Research, Barcelona, Spain
| | | | | | - Nuria Porta
- 3The Institute of Cancer Research, London, United Kingdom
| | | | - Diletta Bianchini
- 4The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - George Seed
- 3The Institute of Cancer Research, London, United Kingdom
| | - Pasquale Rescigno
- 4The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alec Paschalis
- 4The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Claudia Bertan
- 3The Institute of Cancer Research, London, United Kingdom
| | - Chloe Baker
- 3The Institute of Cancer Research, London, United Kingdom
| | - Jane Goodall
- 3The Institute of Cancer Research, London, United Kingdom
| | - Susana Miranda
- 3The Institute of Cancer Research, London, United Kingdom
| | - Ruth Riisnaes
- 3The Institute of Cancer Research, London, United Kingdom
| | | | - Ana Ferreira
- 3The Institute of Cancer Research, London, United Kingdom
| | - Rita Pereira
- 3The Institute of Cancer Research, London, United Kingdom
| | - Bora Gurel
- 3The Institute of Cancer Research, London, United Kingdom
| | | | - Wei Yuan
- 3The Institute of Cancer Research, London, United Kingdom
| | - Jan Rekowski
- 3The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- 3The Institute of Cancer Research, London, United Kingdom
| | - Violeta Serra
- 5Vall d'Hebron Institute of Oncology and Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Johann S. de Bono
- 4The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Joaquin Mateo
- 6Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital, Barcelona, Spain
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27
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Blanc-Durand F, Yaniz E, Genestie C, Rouleau E, Berton D, Lortholary A, Dohollou N, Desauw C, Fabbro M, Malaurie E, Bonichon-Lamichhane N, Dubot C, Kurtz JE, De Rauglaudre G, Raban N, Abdeddaim C, Ferron G, Kaminsky MC, Llop-Guevara A, Leary A. Evaluation of a RAD51 functional assay in advanced ovarian cancer, a GINECO/GINEGEPS study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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
5513 Background: Homologous recombination deficiency (HRD), defined as BRCA1/2 mutation ( BRCAmut)or high genomic instability, is currently used to identify patients (pts) with epithelial ovarian cancer (EOC) most likely to benefit from PARP inhibitors. While these genomic tests are useful, they are imperfect: some BRCAm EOC demonstrate primary PARPi resistance and some HR-proficient benefit. Another approach to evaluate HRD is to measure the capacity of tumor cells to recruit nuclear RAD51 foci during S/G2 phase in the presence of double strand DNA damage using multiplexed immunofluorescence (IF) for RAD51, geminin (GMN) and yH2AX. We aimed to describe for the 1st time HRD using this RAD51 functional assay in EOC and correlate RAD51 status to platinum response and BRCAmut. Methods: Tumor samples and clinical data were collected prospectively from pts in the randomized CHIVA trial of neoadjuvant platinum chemotherapy +/- nintedanib. IF for RAD51, GMN, and DAPI was performed on a 3uM slide from FFPE blocks, where feasible, yH2AX was positively scored on a consecutive slide. Tumors were considered RAD51-deficient if < 10% of gem+ tumor cells (TC) had > 5 RAD51+ foci. BRCAmut were identified by NGS. Results: 155 baseline chemotherapy naïve EOC samples were available. All were advanced stage (IIIC/IV), 75% were G3, 7% G2, 2% G1, and 16% grade UK. A contributive RAD51 result was obtained for 90% (139/155) of samples. Contributive NGS results were available for 130 samples. Overall, yH2AX scores were high (median % TC+: 86%, IQR: 56%-100%) confirming the presence of significant basal DNA damage in high grade EOC. Only 8 samples were yH2AX-low, including two of the three G1 tumors. In contrast, 55% (76/155) of samples were considered RAD51-deficient (score < 10%). With regard to outcome, pts with RAD51-deficient tumors had significantly higher overall response rates to neoadjuvant platinum (68% vs 37%, p = 0.04) and significantly longer median progression-free survival (HR 0.50, IC95% 0.25-0.98, p = 0.02). Considering BRCA status, 15% of tumors harbored a deleterious BRCAmut and 67% of these were RAD51-deficient. Importantly among BRCAmut EOC, the RAD51-proficient tumors had significantly poorer response to neoadjuvant chemotherapy (RR = 17% vs 75%, p = 0.02). Conclusions: We evaluated a novel functional assay of HR functionality in advanced EOC. The assay requires minimal tissue and yields contributive results in 90% of cases. Overall, EOC demonstrate high levels of basal DNA damage, yet 55% fail to recruit RAD51 foci during S/G2 cell cycle phase. These RAD51-deficient EOC have improved outcome after neoadjuvant platinum. Conversely, the RAD51 assay also identified a small subset of RAD51-high BRCAmut tumors with poor platinum response. Whether this RAD51 functional assay may also predict PARP inhibitor benefit is currently being investigated.
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Affiliation(s)
| | - Elisa Yaniz
- Gustave Roussy Cancer Center, Inserm U981, Villejuif, France
| | | | | | - Dominique Berton
- GINECO & Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | - Alain Lortholary
- Institut of Cancerology Catherine de Sienne GINECO-Hôpital Privé du Confluent, Nantes, France
| | | | | | | | | | | | - Coraline Dubot
- GINECO and Institut Curie-Hôpital René Huguenin, Saint-Cloud, France
| | | | | | - Nadia Raban
- GINECO and CHU La Milétrie, Poitiers, France
| | - Cyril Abdeddaim
- Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
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Serra Elizalde V, Llop-Guevara A, Pearson A, Cruz C, Castroviejo-Bermejo M, Chopra N, Tovey H, Toms C, Kriplani D, Gevensleben H, Roylance R, Chan S, Tutt A, Skene A, Evans A, Davies H, Bliss J, Nik-Zainal S, Balmaña J, Turner N. 1O Detection of homologous recombination repair deficiency (HRD) in treatment-naive early triple-negative breast cancer (TNBC) by RAD51 foci and comparison with DNA-based tests. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Llop-Guevara A, Vladimirova V, Schneeweiss A, Villacampa G, Karn T, Zahm DM, Herencia-Ropero A, Jank P, van Mackelenbergh M, Fasching P, Marmé F, Stickeler E, Schem C, Dienstmann R, Florian S, Nekljudova V, Balmaña J, Denkert C, Loibl S, Serra V. 2O Association of RAD51 with homologous recombination deficiency (HRD) and clinical outcomes in untreated triple-negative breast cancer (TNBC): Analysis of the GeparSixto randomized clinical trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.016] [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: 10/21/2022] Open
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30
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Pellegrino B, Musolino A, Llop-Guevara A, Serra V, De Silva P, Hlavata Z, Sangiolo D, Willard-Gallo K, Solinas C. Homologous Recombination Repair Deficiency and the Immune Response in Breast Cancer: A Literature Review. Transl Oncol 2020; 13:410-422. [PMID: 31901781 PMCID: PMC6948367 DOI: 10.1016/j.tranon.2019.10.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [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: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 12/11/2022] Open
Abstract
The success of cancer immunotherapy with immune checkpoint blockade (ICB) has demonstrated the importance of targeting a preexisting immune response in a broad spectrum of tumors. This is particularly novel and relevant for less immunogenic tumors, such as breast cancer (BC), where the efficacy of ICB was more evident in the triple-negative (TNBC) subtype, in earlier stages, and in association with chemotherapy. Tumors harboring homologous recombination DNA repair (HRR) deficiency (HRD) are supposed to have a higher number of mutations, hence a higher tumor mutational burden, which could potentially make them more sensitive to immunotherapy. However, the mechanisms involved in ICB sensitivity and patient selection are still yet to be defined in BC: whether the innate system could play a role and how the adaptive immunity could be linked with HRR pathways are the two key points of debate that we will discuss in this article. The aim of this review was to close the loop between what was found in clinical trial results so far, go back to laboratory theory and preclinical results and point out what needs to be clarified from now on.
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Affiliation(s)
- B Pellegrino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy.
| | - A Musolino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - A Llop-Guevara
- Experimental Therapeutics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - V Serra
- Experimental Therapeutics Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - P De Silva
- Molecular Immunology Unit, Institut Jules Bordet and Universitè Libre de Bruxelles, Bruxelles, Belgium
| | - Z Hlavata
- Medical Oncology Department, CHR Mons-Hainaut, Mons, Belgium
| | - D Sangiolo
- Department of Oncology, University of Torino, Torino, Italy; Candiolo Cancer Institute FPO-IRCCS, Candiolo, Torino, Italy
| | - K Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet and Universitè Libre de Bruxelles, Bruxelles, Belgium
| | - C Solinas
- Molecular Immunology Unit, Institut Jules Bordet and Universitè Libre de Bruxelles, Bruxelles, Belgium; Regional Hospital of Valle D'Aosta, Aosta, Italy.
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31
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Wang Y, Bernhardy AJ, Nacson J, Krais JJ, Tan YF, Nicolas E, Radke MR, Handorf E, Llop-Guevara A, Balmaña J, Swisher EM, Serra V, Peri S, Johnson N. BRCA1 intronic Alu elements drive gene rearrangements and PARP inhibitor resistance. Nat Commun 2019; 10:5661. [PMID: 31827092 PMCID: PMC6906494 DOI: 10.1038/s41467-019-13530-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 03/16/2018] [Accepted: 11/14/2019] [Indexed: 12/28/2022] Open
Abstract
BRCA1 mutant carcinomas are sensitive to PARP inhibitor (PARPi) therapy; however, resistance arises. BRCA1 BRCT domain mutant proteins do not fold correctly and are subject to proteasomal degradation, resulting in PARPi sensitivity. In this study, we show that cell lines and patient-derived tumors, with highly disruptive BRCT domain mutations, have readily detectable BRCA1 protein expression, and are able to proliferate in the presence of PARPi. Peptide analyses reveal that chemo-resistant cancers contain residues encoded by BRCA1 intron 15. Mechanistically, cancers with BRCT domain mutations harbor BRCA1 gene breakpoints within or adjacent to Alu elements in intron 15; producing partial gene duplications, inversions and translocations, and terminating transcription prior to the mutation-containing BRCT domain. BRCA1 BRCT domain-deficient protein isoforms avoid mutation-induced proteasomal degradation, support homology-dependent DNA repair, and promote PARPi resistance. Taken together, Alu-mediated BRCA1 gene rearrangements are responsible for generating hypomorphic proteins, and may represent a biomarker of PARPi resistance.
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Affiliation(s)
- Yifan Wang
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Andrea J Bernhardy
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Joseph Nacson
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19111, USA
| | - John J Krais
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Yin-Fei Tan
- Genomics Facility, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Emmanuelle Nicolas
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
- Genomics Facility, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Marc R Radke
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Elizabeth Handorf
- Bioinformatics and Statistics, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Elizabeth M Swisher
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Suraj Peri
- Bioinformatics and Statistics, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Neil Johnson
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA.
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32
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Pellegrino B, Llop-Guevara A, Pedretti F, Cruz C, Castroviejo M, Cedro-Tanda A, Fasani R, Mateo F, Musolino A, Pujana M, Nuciforo P, Gros A, Balmana J, O’Connor M, Serra Elizalde V. PARP inhibition increases immune infiltration in homologous recombination repair (HRR)-deficient tumors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Cedrés S, Felip E, Cruz C, Martinez de Castro A, Pardo N, Navarro A, Martinez-Marti A, Remon J, Zeron-Medina J, Balmaña J, Llop-Guevara A, Miquel JM, Sansano I, Nuciforo P, Mancuso F, Serra V, Vivancos A. Activity of HSP90 Inhibiton in a Metastatic Lung Cancer Patient With a Germline BRCA1 Mutation. J Natl Cancer Inst 2019. [PMID: 29529211 PMCID: PMC6093313 DOI: 10.1093/jnci/djy012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 12/24/2022] Open
Abstract
Heat shock proteins (HSPs) are molecular chaperones that maintain proteins in their correct conformation to ensure stability and protect carcinoma cells from apoptosis. HSP90 inhibitors (HSP90i) block multiple targets simultaneously, and despite responses in a selected population, no HSP90i have yet been approved. We present a patient with a lung tumor with an exceptional response to cisplatin/gemcitabine in combination with HSP90i, which nowadays continues with HSP90i maintenance after three years. Whole-exome sequencing of the lung tumor unveiled a BRCA1/2 deficiency mutational signature, and mutation analysis confirmed a germline BRCA1 mutation. The striking efficacy of HSP90i plus chemotherapy vs chemotherapy alone was reproduced in a patient-derived xenograft (PDX) model from a breast cancer patient with a BRCA1 mutation (mean tumor volume [SD], No. of tumors: vehicle 8.38 [7.07] mm3, n = 3; HSP90i 4.18 [1.93] mm3, n = 5; cisplatin plus gemcitabine 3.31 [1.95] mm3, n = 5; cisplatin plus gemcitabine plus HSP90i 0.065 [0.076] mm3, n = 6). This case and the PDX demonstrate the efficacy for therapeutic inhibition of HSP90 in a BRCA-mutated patient, opening a new potential avenue for better identifying patients who might benefit most from HSP90i.
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Affiliation(s)
- Susana Cedrés
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital
| | - Enriqueta Felip
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Cristina Cruz
- Experimental Therapeutic Group, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital
| | - Ana Martinez de Castro
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital
| | - Nuria Pardo
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Alejandro Navarro
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Alex Martinez-Marti
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital.,Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Jordin Remon
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital
| | | | - Judith Balmaña
- Thoracic Tumors Group, Vall d'hebron Institute of Oncology, Barcelona, Spain.,Oncology Department, Vall d'hebron University Hsopital.,Universidad Autonoma de Barcelona, Barcelona, Spain
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O'Connor MJ, Cruz C, Castroviejo-Bermejo M, Polanska UM, Jones GN, Wang A, Lai Z, Forment J, Bulusu K, Llop-Guevara A, Dougherty B, Saura C, Brough R, Lord CJ, Bruna A, Caldas C, Fawell S, Barrett JC, Critchlow SE, Balmaña J, Cadogan E, Serra V. Abstract 932: Reversing PARP inhibitor resistance by targeting the replication stress response. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
PARP1/2 inhibitors (PARPi) are the first approved targeted DNA damage response (DDR) inhibitors and have been shown to have clinical benefit, particularly in tumors harboring mutations in BRCA1/BRCA2 and other genes of homologous recombination repair (HRR). However, resistance to PARPi monotherapy will impact on both the breadth and depth of response. We showed that HRR-mutant TNBC and ovarian cancer patient-derived tumor xenograft (PDX) models frequently exhibit innate or acquired PARP inhibitor resistance and that this resistance is linked to a proficient or reactivated HRR, indicated by the ability to form RAD51 foci. A key component of PARPi mechanism of action results from trapping PARP onto DNA, which has the potential to generate replication stress. Moreover, recent data demonstrate that PARP1, along with components of the HRR, are associated with the re-start and protection of stalled replication forks. Here, we assessed whether combinations of the PARPi olaparib together with inhibitors of the replication stress response (RSR) could reverse PARPi resistance in our PDX cohort and we analyzed the effects on RSR by immunofluorescence and immunoblotting. Our data demonstrate that 7/27 models exhibit WEE1i (AZD1775) single agent activity measured as tumor regressions (≤ -30% change in tumor volume), all of which were PARPi resistant. Of the PARPi and WEE1i resistant models, 5 responded to combination treatment and demonstrated a significant increase in the RSR markers pRPA32 and pan-γH2AX compared to either single agent treatment alone. For monotherapy ATRi treatment, there were three models showing tumor regression with AZD6738, all harbored ATM mutations, two also responding to WEE1i monotherapy and one responded to olaparib monotherapy. There were an additional two models that responded to the combination of PARPi plus ATRi, and one of these also responded to the WEE1i/PARPi combination. Together, our analysis demonstrates that by targeting the replication stress response we could cause tumor regression in 13/20 PARPi resistant PDX models and in 6 of these cases the response required PARP inhibition, with DDR signalling indicating that the PARPi was impacting on the RSR. Further insights will be presented into which genetic backgrounds and acquired PARPi resistant mechanisms are reversed by targeting either WEE1 or ATR, thus highlighting the potential for how PARPi resistance can be reversed by targeting alternative DDR dependencies.
Citation Format: Mark J. O'Connor, Cristina Cruz, Marta Castroviejo-Bermejo, Urszula M. Polanska, Gemma N. Jones, Anderson Wang, Zhongwu Lai, Josep Forment, Krishna Bulusu, Alba Llop-Guevara, Brian Dougherty, Cristina Saura, Rachel Brough, Chris J. Lord, Alejandra Bruna, Carlos Caldas, Stephen Fawell, J Carl Barrett, Susan E. Critchlow, Judith Balmaña, Elaine Cadogan, Violeta Serra. Reversing PARP inhibitor resistance by targeting the replication stress response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 932.
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Affiliation(s)
| | - Cristina Cruz
- 2Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | - Rachel Brough
- 4Institute of Cancer Research, London, United Kingdom
| | - Chris J. Lord
- 4Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | | | | | | | - Violeta Serra
- 2Vall d'Hebron Institute of Oncology, Barcelona, Spain
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35
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Castroviejo-Bermejo M, Cruz C, Llop-Guevara A, Gutiérrez-Enríquez S, Ducy M, Ibrahim YH, Gris-Oliver A, Pellegrino B, Bruna A, Guzmán M, Rodríguez O, Grueso J, Bonache S, Moles-Fernández A, Villacampa G, Viaplana C, Gómez P, Vidal M, Peg V, Serres-Créixams X, Dellaire G, Simard J, Nuciforo P, Rubio IT, Dienstmann R, Barrett JC, Caldas C, Baselga J, Saura C, Cortés J, Déas O, Jonkers J, Masson JY, Cairo S, Judde JG, O'Connor MJ, Díez O, Balmaña J, Serra V. A RAD51 assay feasible in routine tumor samples calls PARP inhibitor response beyond BRCA mutation. EMBO Mol Med 2018; 10:e9172. [PMID: 30377213 PMCID: PMC6284440 DOI: 10.15252/emmm.201809172] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [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: 04/04/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 12/22/2022] Open
Abstract
Poly(ADP-ribose) polymerase (PARP) inhibitors (PARPi) are effective in cancers with defective homologous recombination DNA repair (HRR), including BRCA1/2-related cancers. A test to identify additional HRR-deficient tumors will help to extend their use in new indications. We evaluated the activity of the PARPi olaparib in patient-derived tumor xenografts (PDXs) from breast cancer (BC) patients and investigated mechanisms of sensitivity through exome sequencing, BRCA1 promoter methylation analysis, and immunostaining of HRR proteins, including RAD51 nuclear foci. In an independent BC PDX panel, the predictive capacity of the RAD51 score and the homologous recombination deficiency (HRD) score were compared. To examine the clinical feasibility of the RAD51 assay, we scored archival breast tumor samples, including PALB2-related hereditary cancers. The RAD51 score was highly discriminative of PARPi sensitivity versus PARPi resistance in BC PDXs and outperformed the genomic test. In clinical samples, all PALB2-related tumors were classified as HRR-deficient by the RAD51 score. The functional biomarker RAD51 enables the identification of PARPi-sensitive BC and broadens the population who may benefit from this therapy beyond BRCA1/2-related cancers.
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Affiliation(s)
| | - Cristina Cruz
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- High Risk and Familial Cancer Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Mandy Ducy
- Genome Stability Laboratory, CHU de Québec Research Center, Québec City, QC, Canada
- Department of Molecular Biology, Medical Biochemistry and Pathology, Laval University Cancer Research Center, Québec City, QC, Canada
- CHU de Quebec - Université Laval Research Center, Genomics Center CHUL, Québec City, QC, Canada
| | - Yasir Hussein Ibrahim
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Albert Gris-Oliver
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Benedetta Pellegrino
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Medical Oncology, University Hospital of Parma, Parma, Italy
| | - Alejandra Bruna
- Cancer Research UK Cambridge Institute and Department of Oncology, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
| | - Marta Guzmán
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Olga Rodríguez
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Judit Grueso
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Sandra Bonache
- Oncogenetics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Guillermo Villacampa
- Oncology Data Science (OdysSey Group), Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Cristina Viaplana
- Oncology Data Science (OdysSey Group), Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Patricia Gómez
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Breast Cancer and Melanoma Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Maria Vidal
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Breast Cancer and Melanoma Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Vicente Peg
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Xavier Serres-Créixams
- Department of Radiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Graham Dellaire
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Jacques Simard
- CHU de Quebec - Université Laval Research Center, Genomics Center CHUL, Québec City, QC, Canada
| | - Paolo Nuciforo
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Isabel T Rubio
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
- Breast Surgical Unit, Breast Cancer Center, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rodrigo Dienstmann
- Oncology Data Science (OdysSey Group), Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Carlos Caldas
- Cancer Research UK Cambridge Institute and Department of Oncology, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Breast Cancer Programme, Cancer Research UK (CRUK) Cambridge Cancer Centre, Cambridge, UK
| | - José Baselga
- Human Oncology and Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina Saura
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Breast Cancer and Melanoma Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Javier Cortés
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
- Department of Oncology, Ramón y Cajal University Hospital, Madrid, Spain
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Jos Jonkers
- Division of Molecular Pathology and Cancer Genomics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jean-Yves Masson
- Genome Stability Laboratory, CHU de Québec Research Center, Québec City, QC, Canada
- Department of Molecular Biology, Medical Biochemistry and Pathology, Laval University Cancer Research Center, Québec City, QC, Canada
| | | | | | - Mark J O'Connor
- Oncology Innovative Medicines and Early Clinical Development Biotech Unit, AstraZeneca, Cambridge, UK
| | - Orland Díez
- Oncogenetics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Clinical and Molecular Genetics Area, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Judith Balmaña
- High Risk and Familial Cancer Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
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Pellegrino B, Llop-Guevara A, Cruz C, Castroviejo M, Cedro-Tanda A, Fasani R, Nuciforo P, Gros A, Balmaña J, O'Connor M, Serra Elizalde V. Dissecting the antitumor immune response upon PARP inhibition in homologous recombination repair (HRR)-deficient tumors. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy493.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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37
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Cruz C, Llop-Guevara A, Garber JE, Arun BK, Pérez Fidalgo JA, Lluch A, Telli ML, Fernández C, Kahatt C, Galmarini CM, Soto-Matos A, Alfaro V, Pérez de la Haza A, Domchek SM, Antolin S, Vahdat L, Tung NM, Lopez R, Arribas J, Vivancos A, Baselga J, Serra V, Balmaña J, Isakoff SJ. Multicenter Phase II Study of Lurbinectedin in BRCA-Mutated and Unselected Metastatic Advanced Breast Cancer and Biomarker Assessment Substudy. J Clin Oncol 2018. [PMID: 30240327 DOI: 10.1200/jco.2018.78.6558.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This multicenter phase II trial evaluated lurbinectedin (PM01183), a selective inhibitor of active transcription of protein-coding genes, in patients with metastatic breast cancer. A unicenter translational substudy assessed potential mechanisms of lurbinectedin resistance. PATIENTS AND METHODS Two arms were evaluated according to germline BRCA1/2 status: BRCA1/2 mutated (arm A; n = 54) and unselected ( BRCA1/2 wild-type or unknown status; arm B; n = 35). Lurbinectedin starting dose was a 7-mg flat dose and later, 3.5 mg/m2 in arm A. The primary end point was objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors (RECIST). The translational substudy of resistance mechanisms included exome sequencing (n = 13) and in vivo experiments with patient-derived xenografts (n = 11) from BRCA1/2-mutated tumors. RESULTS ORR was 41% (95% CI, 28% to 55%) in arm A and 9% (95% CI, 2% to 24%) in arm B. In arm A, median progression-free survival was 4.6 months (95% CI, 3.0 to 6.0 months), and median overall survival was 20.0 months (95% CI, 11.8 to 26.6 months). Patients with BRCA2 mutations showed an ORR of 61%, median progression-free survival of 5.9 months, and median overall survival of 26.6 months. The safety profile improved with lurbinectedin dose adjustment to body surface area. The most common nonhematologic adverse events seen at 3.5 mg/m2 were nausea (74%; grade 3, 5%) and fatigue (74%; grade 3, 21%). Neutropenia was the most common severe hematologic adverse event (grade 3, 47%; grade 4, 10%). Exome sequencing showed mutations in genes related to the nucleotide excision repair pathway in four of seven tumors at primary or acquired resistance and in one patient with short-term stable disease. In vivo, sensitivity to cisplatin and lurbinectedin was evidenced in lurbinectedin-resistant (one of two) and cisplatin-resistant (two of three) patient-derived xenografts. CONCLUSION Lurbinectedin showed noteworthy activity in patients with BRCA1/2 mutations. Response and survival was notable in those with BRCA2 mutations. Additional clinical development in this subset of patients with metastatic breast cancer is warranted.
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Affiliation(s)
- Cristina Cruz
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Alba Llop-Guevara
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Judy E Garber
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Banu K Arun
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - José A Pérez Fidalgo
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Ana Lluch
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Melinda L Telli
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Cristian Fernández
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Carmen Kahatt
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Carlos M Galmarini
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Arturo Soto-Matos
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Vicente Alfaro
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Aitor Pérez de la Haza
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Susan M Domchek
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Silvia Antolin
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Linda Vahdat
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Nadine M Tung
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Rafael Lopez
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Joaquín Arribas
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Ana Vivancos
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - José Baselga
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Violeta Serra
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Judith Balmaña
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Steven J Isakoff
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
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Cruz C, Llop-Guevara A, Garber JE, Arun BK, Pérez Fidalgo JA, Lluch A, Telli ML, Fernández C, Kahatt C, Galmarini CM, Soto-Matos A, Alfaro V, Pérez de la Haza A, Domchek SM, Antolin S, Vahdat L, Tung NM, Lopez R, Arribas J, Vivancos A, Baselga J, Serra V, Balmaña J, Isakoff SJ. Multicenter Phase II Study of Lurbinectedin in BRCA-Mutated and Unselected Metastatic Advanced Breast Cancer and Biomarker Assessment Substudy. J Clin Oncol 2018; 36:3134-3143. [PMID: 30240327 PMCID: PMC6209089 DOI: 10.1200/jco.2018.78.6558] [Citation(s) in RCA: 40] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose This multicenter phase II trial evaluated lurbinectedin (PM01183), a selective inhibitor of active transcription of protein-coding genes, in patients with metastatic breast cancer. A unicenter translational substudy assessed potential mechanisms of lurbinectedin resistance. Patients and Methods Two arms were evaluated according to germline BRCA1/2 status: BRCA1/2 mutated (arm A; n = 54) and unselected (BRCA1/2 wild-type or unknown status; arm B; n = 35). Lurbinectedin starting dose was a 7-mg flat dose and later, 3.5 mg/m2 in arm A. The primary end point was objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors (RECIST). The translational substudy of resistance mechanisms included exome sequencing (n = 13) and in vivo experiments with patient-derived xenografts (n = 11) from BRCA1/2-mutated tumors. Results ORR was 41% (95% CI, 28% to 55%) in arm A and 9% (95% CI, 2% to 24%) in arm B. In arm A, median progression-free survival was 4.6 months (95% CI, 3.0 to 6.0 months), and median overall survival was 20.0 months (95% CI, 11.8 to 26.6 months). Patients with BRCA2 mutations showed an ORR of 61%, median progression-free survival of 5.9 months, and median overall survival of 26.6 months. The safety profile improved with lurbinectedin dose adjustment to body surface area. The most common nonhematologic adverse events seen at 3.5 mg/m2 were nausea (74%; grade 3, 5%) and fatigue (74%; grade 3, 21%). Neutropenia was the most common severe hematologic adverse event (grade 3, 47%; grade 4, 10%). Exome sequencing showed mutations in genes related to the nucleotide excision repair pathway in four of seven tumors at primary or acquired resistance and in one patient with short-term stable disease. In vivo, sensitivity to cisplatin and lurbinectedin was evidenced in lurbinectedin-resistant (one of two) and cisplatin-resistant (two of three) patient-derived xenografts. Conclusion Lurbinectedin showed noteworthy activity in patients with BRCA1/2 mutations. Response and survival was notable in those with BRCA2 mutations. Additional clinical development in this subset of patients with metastatic breast cancer is warranted.
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Affiliation(s)
- Cristina Cruz
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Alba Llop-Guevara
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Judy E Garber
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Banu K Arun
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - José A Pérez Fidalgo
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Ana Lluch
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Melinda L Telli
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Cristian Fernández
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Carmen Kahatt
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Carlos M Galmarini
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Arturo Soto-Matos
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Vicente Alfaro
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Aitor Pérez de la Haza
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Susan M Domchek
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Silvia Antolin
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Linda Vahdat
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Nadine M Tung
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Rafael Lopez
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Joaquín Arribas
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Ana Vivancos
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - José Baselga
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Violeta Serra
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Judith Balmaña
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
| | - Steven J Isakoff
- Cristina Cruz and Judith Balmaña, Vall d'Hebron Hospital; Cristina Cruz, Alba Llop-Guevara, Joaquín Arribas, Ana Vivancos, Violeta Serra, and Judith Balmaña, Vall d'Hebron Institute of Oncology; José A. Pérez Fidalgo, Ana Lluch, Joaquín Arribas, and Violeta Serra, Centro de Investigación Biomédica en Red; Joaquín Arribas, Institució Catalana de Recerca i Estudis Avançats, Barcelona; José A. Pérez Fidalgo and Ana Lluch, Hospital Clínico de Valencia, Valencia; Cristian Fernández, Carmen Kahatt, Carlos M. Galmarini, Arturo Soto-Matos, Vicente Alfaro, and Aitor Pérez de la Haza, PharmaMar, Madrid; Silvia Antolin, Complejo Universitario Hospitalario La Coruña, La Coruña; Rafael Lopez, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain; Judy E. Garber, Dana Farber Cancer Institute; Nadine M. Tung, Beth Israel Deaconess Medical Center; José Baselga and Steven J. Isakoff, Massachusetts General Hospital Cancer Center, Boston, MA; Banu K. Arun, MD Anderson Cancer Center, Houston, TX; Melinda L. Telli, Stanford University School of Medicine, Stanford, CA; Susan M. Domchek, University of Pennsylvania, Philadelphia, PA; and Linda Vahdat, Weill Cornell Medicine, New York, NY
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Cruz C, Castroviejo-Bermejo M, Gutiérrez-Enríquez S, Llop-Guevara A, Ibrahim YH, Gris-Oliver A, Bonache S, Morancho B, Bruna A, Rueda OM, Lai Z, Polanska UM, Jones GN, Kristel P, de Bustos L, Guzman M, Rodríguez O, Grueso J, Montalban G, Caratú G, Mancuso F, Fasani R, Jiménez J, Howat WJ, Dougherty B, Vivancos A, Nuciforo P, Serres-Créixams X, Rubio IT, Oaknin A, Cadogan E, Barrett JC, Caldas C, Baselga J, Saura C, Cortés J, Arribas J, Jonkers J, Díez O, O'Connor MJ, Balmaña J, Serra V. RAD51 foci as a functional biomarker of homologous recombination repair and PARP inhibitor resistance in germline BRCA-mutated breast cancer. Ann Oncol 2018; 29:1203-1210. [PMID: 29635390 PMCID: PMC5961353 DOI: 10.1093/annonc/mdy099] [Citation(s) in RCA: 255] [Impact Index Per Article: 42.5] [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] [Indexed: 11/24/2022] Open
Abstract
Background BRCA1 and BRCA2 (BRCA1/2)-deficient tumors display impaired homologous recombination repair (HRR) and enhanced sensitivity to DNA damaging agents or to poly(ADP-ribose) polymerase (PARP) inhibitors (PARPi). Their efficacy in germline BRCA1/2 (gBRCA1/2)-mutated metastatic breast cancers has been recently confirmed in clinical trials. Numerous mechanisms of PARPi resistance have been described, whose clinical relevance in gBRCA-mutated breast cancer is unknown. This highlights the need to identify functional biomarkers to better predict PARPi sensitivity. Patients and methods We investigated the in vivo mechanisms of PARPi resistance in gBRCA1 patient-derived tumor xenografts (PDXs) exhibiting differential response to PARPi. Analysis included exome sequencing and immunostaining of DNA damage response proteins to functionally evaluate HRR. Findings were validated in a retrospective sample set from gBRCA1/2-cancer patients treated with PARPi. Results RAD51 nuclear foci, a surrogate marker of HRR functionality, were the only common feature in PDX and patient samples with primary or acquired PARPi resistance. Consistently, low RAD51 was associated with objective response to PARPi. Evaluation of the RAD51 biomarker in untreated tumors was feasible due to endogenous DNA damage. In PARPi-resistant gBRCA1 PDXs, genetic analysis found no in-frame secondary mutations, but BRCA1 hypomorphic proteins in 60% of the models, TP53BP1-loss in 20% and RAD51-amplification in one sample, none mutually exclusive. Conversely, one of three PARPi-resistant gBRCA2 tumors displayed BRCA2 restoration by exome sequencing. In PDXs, PARPi resistance could be reverted upon combination of a PARPi with an ataxia-telangiectasia mutated (ATM) inhibitor. Conclusion Detection of RAD51 foci in gBRCA tumors correlates with PARPi resistance regardless of the underlying mechanism restoring HRR function. This is a promising biomarker to be used in the clinic to better select patients for PARPi therapy. Our study also supports the clinical development of PARPi combinations such as those with ATM inhibitors.
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Affiliation(s)
- C Cruz
- Experimental Therapeutics Group; High Risk and Familial Cancer, Vall d'Hebron Institute of Oncology, Barcelona; Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona
| | | | | | | | | | | | | | - B Morancho
- Growth Factors Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - A Bruna
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge
| | - O M Rueda
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge
| | - Z Lai
- AstraZeneca, Gatehouse Park, Waltham, USA
| | - U M Polanska
- DNA Damage Response Biology Area, Oncology iMed, AstraZeneca, Cancer Research UK Cambridge Institute, Cambridge, UK
| | - G N Jones
- DNA Damage Response Biology Area, Oncology iMed, AstraZeneca, Cancer Research UK Cambridge Institute, Cambridge, UK
| | - P Kristel
- Division of Molecular Pathology and Cancer Genomics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | - R Fasani
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - J Jiménez
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - W J Howat
- DNA Damage Response Biology Area, Oncology iMed, AstraZeneca, Cancer Research UK Cambridge Institute, Cambridge, UK
| | | | | | - P Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona
| | | | - I T Rubio
- Breast Surgical Unit, Breast Cancer Center, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona
| | - A Oaknin
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona; Gynecological Malignancies Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - E Cadogan
- DNA Damage Response Biology Area, Oncology iMed, AstraZeneca, Cancer Research UK Cambridge Institute, Cambridge, UK
| | | | - C Caldas
- Department of Oncology and Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cambridge Breast Unit, NIHR Cambridge Biomedical Research Centre and Cambridge Experimental Cancer Medicine Centre at Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Baselga
- Human Oncology and Pathogenesis Program (HOPP); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - C Saura
- Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona; Breast Cancer and Melanoma Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - J Cortés
- Ramón y Cajal University Hospital, Madrid; Vall d'Hebron Institute of Oncology, Barcelona
| | - J Arribas
- Growth Factors Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Department of Biochemistry and Molecular Biology, Building M, Campus UAB, Bellaterra (Cerdanyola del Vallès); Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona; CIBERONC, Barcelona
| | | | - O Díez
- Oncogenetics Group; Clinical and Molecular Genetics Area, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M J O'Connor
- DNA Damage Response Biology Area, Oncology Innovative Medicine and Early Development Biotech Unit, AstraZeneca, Cambridge, UK
| | - J Balmaña
- High Risk and Familial Cancer, Vall d'Hebron Institute of Oncology, Barcelona; Department of Medical Oncology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona
| | - V Serra
- Experimental Therapeutics Group; CIBERONC, Barcelona.
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Llop-Guevara A, Porras M, Cendón C, Di Ceglie I, Siracusa F, Madarena F, Rinotas V, Gómez L, van Lent PL, Douni E, Chang HD, Kamradt T, Román J. Simultaneous inhibition of JAK and SYK kinases ameliorates chronic and destructive arthritis in mice. Arthritis Res Ther 2015; 17:356. [PMID: 26653844 PMCID: PMC4675041 DOI: 10.1186/s13075-015-0866-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 09/04/2015] [Accepted: 11/19/2015] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Despite the broad spectrum of antirheumatic drugs, RA is still not well controlled in up to 30-50 % of patients. Inhibition of JAK kinases by means of the pan-JAK inhibitor tofacitinib has demonstrated to be effective even in difficult-to-treat patients. Here, we discuss whether the efficacy of JAK inhibition can be improved by simultaneously inhibiting SYK kinase, since both kinases mediate complementary and non-redundant pathways in RA. METHODS Efficacy of dual JAK + SYK inhibition with selective small molecule inhibitors was evaluated in chronic G6PI-induced arthritis, a non-self-remitting and destructive arthritis model in mice. Clinical and histopathological scores, as well as cytokine and anti-G6PI antibody production were assessed in both preventive and curative protocols. Potential immunotoxicity was also evaluated in G6PI-induced arthritis and in a 28-day TDAR model, by analysing the effects of JAK + SYK inhibition on hematological parameters, lymphoid organs, leukocyte subsets and cell function. RESULTS Simultaneous JAK + SYK inhibition completely prevented mice from developing arthritis. This therapeutic strategy was also very effective in ameliorating already established arthritis. Dual kinase inhibition immediately resulted in greatly decreased clinical and histopathological scores and led to disease remission in over 70 % of the animals. In contrast, single JAK inhibition and anti-TNF therapy (etanercept) were able to stop disease progression but not to revert it. Dual kinase inhibition decreased Treg and NK cell counts to the same extent as single JAK inhibition but overall cytotoxicity remained intact. Interestingly, treatment discontinuation rapidly reversed such immune cell reduction without compromising clinical efficacy, suggesting long-lasting curative effects. Dual kinase inhibition reduced the Th1/Th17 cytokine cascade and the differentiation and function of joint cells, in particular osteoclasts and fibroblast-like synoviocytes. CONCLUSIONS Concurrent JAK + SYK inhibition resulted in higher efficacy than single kinase inhibition and TNF blockade in a chronic and severe arthritis model. Thus, blockade of multiple immune signals with dual JAK + SYK inhibition represents a reasonable therapeutic strategy for RA, in particular in patients with inadequate responses to current treatments. Our data supports the multiplicity of events underlying this heterogeneous and complex disease.
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Affiliation(s)
| | - Mónica Porras
- Draconis Pharma S.L., Calle Pallars 179, Barcelona, Spain.
| | - Carla Cendón
- Draconis Pharma S.L., Calle Pallars 179, Barcelona, Spain.
- Deutsches Rheuma-Forschungszentrum, Berlin, Germany.
| | | | | | | | - Vagelis Rinotas
- Laboratory of Genetics, Department of Biotechnology, Agricultural University of Athens, Athens, Greece.
| | - Lluís Gómez
- Draconis Pharma S.L., Calle Pallars 179, Barcelona, Spain.
| | | | - Eleni Douni
- Laboratory of Genetics, Department of Biotechnology, Agricultural University of Athens, Athens, Greece.
- Biomedical Sciences Research Center "Alexander Fleming", Vari, Greece.
| | | | | | - Juan Román
- Draconis Pharma S.L., Calle Pallars 179, Barcelona, Spain.
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Llop-Guevara A, Cendόn C, Di Ceglie I, Porras M, van Lent P, Kamradt T, Gόmez-Casajús L, Román J. THU0044 Simultaneous Inhibition of JAK and Syk Kinases Ameliorates Chronic, Severe and Destructive Arthritis in Mice. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1445] [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: 11/03/2022]
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Chu DK, Al-Garawi A, Llop-Guevara A, Pillai RA, Radford K, Shen P, Walker TD, Goncharova S, Calhoun WJ, Nair P, Jordana M. Therapeutic potential of anti-IL-6 therapies for granulocytic airway inflammation in asthma. Allergy Asthma Clin Immunol 2015; 11:14. [PMID: 25878673 PMCID: PMC4397814 DOI: 10.1186/s13223-015-0081-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 04/07/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Determining the cellular and molecular phenotypes of inflammation in asthma can identify patient populations that may best benefit from targeted therapies. Although elevated IL-6 and polymorphisms in IL-6 signalling are associated with lung dysfunction in asthma, it remains unknown if elevated IL-6 levels are associated with a specific cellular inflammatory phenotype, and how IL-6 blockade might impact such inflammatory responses. METHODS Patients undergoing exacerbations of asthma were phenotyped according to their airway inflammatory characteristics (normal cell count, eosinophilic, neutrophilic, mixed granulocytic), sputum cytokine profiles, and lung function. Mice were exposed to the common allergen, house dust-mite (HDM), in the presence or absence of endogenous IL-6. The intensity and nature of lung inflammation, and levels of pro-granulocytic cytokines and chemokines under these conditions were analyzed. RESULTS Elevated IL-6 was associated with a lower FEV1 in patients with mixed eosinophilic-neutrophilic bronchitis. In mice, allergen exposure increased lung IL-6 and IL-6 was produced by dendritic cells and alveolar macrophages. Loss-of-function of IL-6 signalling (knockout or antibody-mediated neutralization) abrogated elevations of eosinophil and neutrophil recruiting cytokines/chemokines and allergen-induced airway inflammation in mice. CONCLUSIONS We demonstrate the association of pleiotropic cellular airway inflammation with IL-6 using human and animal data. These data suggest that exacerbations of asthma, particularly those with a combined eosinophilic and neutrophilic bronchitis, may respond to therapies targeting the IL-6 pathway and therefore, provide a rational basis for initiation of clinical trials to evaluate this.
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Affiliation(s)
- Derek K Chu
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Amal Al-Garawi
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Alba Llop-Guevara
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Regina A Pillai
- Division of Pulmonary and Critical Care Medicine, and Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas USA
| | - Katherine Radford
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Pamela Shen
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Tina D Walker
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - Susanna Goncharova
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
| | - William J Calhoun
- Division of Pulmonary and Critical Care Medicine, and Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas USA
| | - Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Manel Jordana
- Department of Pathology & Molecular Medicine, McMaster Immunology Research Centre, Hamilton, ON Canada
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Chu DK, Jimenez-Saiz R, Verschoor CP, Walker TD, Goncharova S, Llop-Guevara A, Shen P, Gordon ME, Barra NG, Bassett JD, Kong J, Fattouh R, McCoy KD, Bowdish DM, Erjefält JS, Pabst O, Humbles AA, Kolbeck R, Waserman S, Jordana M. Indigenous enteric eosinophils control DCs to initiate a primary Th2 immune response in vivo. ACTA ACUST UNITED AC 2014; 211:1657-72. [PMID: 25071163 PMCID: PMC4113937 DOI: 10.1084/jem.20131800] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [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: 12/30/2022]
Abstract
Eosinophils natively inhabit the small intestine, but a functional role for them there has remained elusive. Here, we show that eosinophil-deficient mice were protected from induction of Th2-mediated peanut food allergy and anaphylaxis, and Th2 priming was restored by reconstitution with il4(+/+) or il4(-/-) eosinophils. Eosinophils controlled CD103(+) dendritic cell (DC) activation and migration from the intestine to draining lymph nodes, events necessary for Th2 priming. Eosinophil activation in vitro and in vivo led to degranulation of eosinophil peroxidase, a granule protein whose enzymatic activity promoted DC activation in mice and humans in vitro, and intestinal and extraintestinal mouse DC activation and mobilization to lymph nodes in vivo. Further, eosinophil peroxidase enhanced responses to ovalbumin seen after immunization. Thus, eosinophils can be critical contributors to the intestinal immune system, and granule-mediated shaping of DC responses can promote both intestinal and extraintestinal adaptive immunity.
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Affiliation(s)
- Derek K Chu
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Rodrigo Jimenez-Saiz
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Christopher P Verschoor
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Tina D Walker
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Susanna Goncharova
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Alba Llop-Guevara
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Pamela Shen
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Melissa E Gordon
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Nicole G Barra
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Jennifer D Bassett
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Joshua Kong
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Ramzi Fattouh
- Clinical Microbiology, Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario M5S 1A8, Canada
| | - Kathy D McCoy
- Maurice Müller Laboratories, Universitätsklinik für Viszerale Chirurgie und Medizin (UVCM), University of Bern, 3008 Bern, Switzerland
| | - Dawn M Bowdish
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Jonas S Erjefält
- Department of Experimental Medical Science, Lund University, SE-22184 Lund, Sweden Department of Respiratory Medicine and Allergology, Lund University Hospital, SE-22185 Lund, Sweden
| | - Oliver Pabst
- Institute of Molecular Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Alison A Humbles
- Department of Respiratory, Inflammation and Autoimmunity, MedImmune LLC, Gaithersburg, MA 20878
| | - Roland Kolbeck
- Department of Respiratory, Inflammation and Autoimmunity, MedImmune LLC, Gaithersburg, MA 20878
| | - Susan Waserman
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
| | - Manel Jordana
- McMaster Immunology Research Centre (MIRC), Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
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Chu D, Mohammed-Ali Z, Walker T, Goncharova S, Llop-Guevara A, Barra N, Gillgrass A, Ashkar A, Bramson J, Humbles A, Kolbeck R, Waserman S, Jordana M. Initiation of food allergy by a CD4+ T cell-intrinsic IL-4 program, controlled by OX40L (P6204). The Journal of Immunology 2013. [DOI: 10.4049/jimmunol.190.supp.62.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Intestinal Th2 immunity in food allergy results in the production of IgG1 and IgE, and upon antigen challenge, anaphylaxis and eosinophilic inflammation. Although allergic sensitization critically requires IL-4 to develop, the source and control of IL-4 during the initiation of Th2 immunity remains unclear. Non-intestinal and non-food allergy systems have suggested a role for innate lymphocytes such as NKT or γδ T cells as a rapid source of IL-4 required to induce Th2 polarization. In contrast, we show here that NKT-deficient IL-15 KO, β2m KO and anti-NK1.1 treated mice have completely intact Th2 food allergic responses comparable to NKT-sufficient mice, including antigen-specific IgG1 and IgE, anaphylaxis, eosinophilic inflammation and cytokine production. Likewise, γδ T cell-deficient TCRδ KO mice mount comparable Th2 immune responses to oral antigen as their WT counterparts. By restricting IL-4 expression to only CD4+ Th cells, we find that IL-4 from CD4+ Th cells themselves induce food allergy. Further, IL-4 reporter mice show that CD4+ Th cell production of IL-4 in vivo is dependent on OX40L, a costimulatory molecule that we have shown to be highly expressed on allergen-exposed dendritic cells (DCs). Although NKT and γδ T cells express IL-4, this is not upregulated after allergen priming. Together, these data show that intestinal Th2 immunity in food allergy is initiated by a CD4+ Th cell-intrinsic IL-4 program that is controlled by DC-OX40L and not NKT or γδ T cells.
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Affiliation(s)
- Derek Chu
- 1Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Zahraa Mohammed-Ali
- 1Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Tina Walker
- 1Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Susanna Goncharova
- 1Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Alba Llop-Guevara
- 1Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Nicole Barra
- 1Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Amy Gillgrass
- 1Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Ali Ashkar
- 1Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Jonathan Bramson
- 1Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Alison Humbles
- 3Respiratory, Inflammation and Autoimmunity, MedImmune LLC, Gathersburg, MD
| | - Roland Kolbeck
- 3Respiratory, Inflammation and Autoimmunity, MedImmune LLC, Gathersburg, MD
| | | | - Manel Jordana
- 1Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
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Botelho FM, Llop-Guevara A, Trimble NJ, Nikota JK, Bauer CMT, Lambert KN, Kianpour S, Jordana M, Stämpfli MR. Cigarette smoke differentially affects eosinophilia and remodeling in a model of house dust mite asthma. Am J Respir Cell Mol Biol 2011; 45:753-60. [PMID: 21317378 DOI: 10.1165/rcmb.2010-0404oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although a similar prevalence of smoking is evident among patients with asthma and the general population, little is known about the impact of cigarette smoke on the immune inflammatory processes elicited by common environmental allergens. We investigated the impact of exposure to cigarette smoke on house dust mite (HDM)-induced allergic airway inflammation and its consequences for tissue remodeling and lung physiology in mice. BALB/c mice received intranasal HDMs daily, 5 days per week, for 3 weeks to establish chronic airway inflammation. Subsequently, mice were concurrently exposed to HDMs plus cigarette smoke, 5 days per week, for 2 weeks (HDMs + smoke). We observed significantly attenuated eosinophilia in the bronchoalveolar lavage of mice exposed to HDMs + smoke, compared with animals exposed only to HDMs. A similar activation of CD4 T cells and expression of IL-5, IL-13, and transforming growth factor-β was observed between HDM-treated and HDM + smoke-treated animals. Consistent with an effect on eosinophil trafficking, HDMs + smoke exposure attenuated the HDM-induced expression of eotaxin-1 and vascular cell adhesion molecule-1, whereas the survival of eosinophils and the numbers of blood eosinophils were not affected. Exposure to cigarette smoke also reduced the activation of B cells and the concentrations of serum IgE. Although the production of mucus decreased, collagen deposition significantly increased in animals exposed to HDMs + smoke, compared with animals exposed only to HDMs. Although airway resistance was unaffected, tissue resistance was significantly decreased in mice exposed to HDMs + smoke. Our findings demonstrate that cigarette smoke affects eosinophil migration without affecting airway resistance or modifying Th2 cell adaptive immunity in a murine model of HDM-induced asthma.
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Affiliation(s)
- Fernando M Botelho
- Department of Pathology and Molecular Medicine, Centre for Gene Therapeutics, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5 Canada
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Chu D, Llop-Guevara A, Walker T, Flader K, Moore C, Goncharova S, Boudreau J, Khan W, Comeau M, Budelsky A. The Epithelial-derived Cytokines TSLP, IL-33, and IL-25 Converge on OX40L to Elicit Peanut Allergy and Anaphylaxis in Mice. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2011.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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47
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Fritz DK, Kerr C, Fattouh R, Llop-Guevara A, Khan WI, Jordana M, Richards CD. A Mouse Model of Airway Disease: Oncostatin M-Induced Pulmonary Eosinophilia, Goblet Cell Hyperplasia, and Airway Hyperresponsiveness Are STAT6 Dependent, and Interstitial Pulmonary Fibrosis Is STAT6 Independent. J I 2010; 186:1107-18. [DOI: 10.4049/jimmunol.0903476] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Llop-Guevara A, Colangelo M, Chu DK, Moore CL, Stieber NA, Walker TD, Goncharova S, Coyle AJ, Lundblad LKA, O'Byrne PM, Lovric M, Jordana M. In vivo-to-in silico iterations to investigate aeroallergen-host interactions. PLoS One 2008; 3:e2426. [PMID: 18545674 PMCID: PMC2409221 DOI: 10.1371/journal.pone.0002426] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 05/03/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Allergic asthma is a complex process arising out of the interaction between the immune system and aeroallergens. Yet, the relationship between aeroallergen exposure, allergic sensitization and disease remains unclear. This knowledge is essential to gain further insight into the origin and evolution of allergic diseases. The objective of this research is to develop a computational view of the interaction between aeroallergens and the host by investigating the impact of dose and length of aeroallergen exposure on allergic sensitization and allergic disease outcomes, mainly airway inflammation and to a lesser extent lung dysfunction and airway remodeling. METHODS AND PRINCIPAL FINDINGS BALB/C mice were exposed intranasally to a range of concentrations of the most pervasive aeroallergen worldwide, house dust mite (HDM), for up to a quarter of their lifespan (20 weeks). Actual biological data delineating the kinetics, nature and extent of responses for local (airway inflammation) and systemic (HDM-specific immunoglobulins) events were obtained. Mathematical equations for each outcome were developed, evaluated, refined through several iterations involving in vivo experimentation, and validated. The models accurately predicted the original biological data and simulated an extensive array of previously unknown responses, eliciting two- and three-dimensional models. Our data demonstrate the non-linearity of the relationship between aeroallergen exposure and either allergic sensitization or airway inflammation, identify thresholds, behaviours and maximal responsiveness for each outcome, and examine inter-variable relationships. CONCLUSIONS This research provides a novel way to visualize allergic responses in vivo and establishes a basic experimental platform upon which additional variables and perturbations can be incorporated into the system.
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Affiliation(s)
- Alba Llop-Guevara
- Department of Pathology and Molecular Medicine, Division of Respiratory Diseases and Allergy, Centre for Gene Therapeutics, McMaster University, Hamilton, Ontario, Canada
| | - Marc Colangelo
- Department of Pathology and Molecular Medicine, Division of Respiratory Diseases and Allergy, Centre for Gene Therapeutics, McMaster University, Hamilton, Ontario, Canada
| | - Derek K. Chu
- Department of Pathology and Molecular Medicine, Division of Respiratory Diseases and Allergy, Centre for Gene Therapeutics, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Lynn Moore
- Department of Pathology and Molecular Medicine, Division of Respiratory Diseases and Allergy, Centre for Gene Therapeutics, McMaster University, Hamilton, Ontario, Canada
| | - Nicole A. Stieber
- Department of Pathology and Molecular Medicine, Division of Respiratory Diseases and Allergy, Centre for Gene Therapeutics, McMaster University, Hamilton, Ontario, Canada
| | - Tina D. Walker
- Department of Pathology and Molecular Medicine, Division of Respiratory Diseases and Allergy, Centre for Gene Therapeutics, McMaster University, Hamilton, Ontario, Canada
| | - Susanna Goncharova
- Department of Pathology and Molecular Medicine, Division of Respiratory Diseases and Allergy, Centre for Gene Therapeutics, McMaster University, Hamilton, Ontario, Canada
| | - Anthony J. Coyle
- Department of Pathology and Molecular Medicine, Division of Respiratory Diseases and Allergy, Centre for Gene Therapeutics, McMaster University, Hamilton, Ontario, Canada
- Department of Inflammation and Autoimmunity, MedImmune Inc., Gaithersburg, Maryland, United States of America
| | - Lennart K. A. Lundblad
- Vermont Lung Center, University of Vermont, Burlington, Vermont, United States of America
| | - Paul M. O'Byrne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Miroslav Lovric
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Manel Jordana
- Department of Pathology and Molecular Medicine, Division of Respiratory Diseases and Allergy, Centre for Gene Therapeutics, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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Cates EC, Fattouh R, Johnson JR, Llop-Guevara A, Jordana M. Modeling responses to respiratory house dust mite exposure. Contrib Microbiol 2007; 14:42-67. [PMID: 17684332 DOI: 10.1159/000107054] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
House dust mite (HDM) is the most pervasive indoor aeroallergen source worldwide. Allergens derived from HDM are associated with sensitization and allergic asthma. Allergic asthma is an immunologically driven disease characterized by a Th2-polarized immune response, eosinophilic inflammation, airway hyperreactivity, and remodeling. Animal models of asthma utilizing ovalbumin (OVA) exposure have afforded us considerable insight with respect to the mediators and cell types involved in allergic airway inflammation. However, OVA preparations and HDM are two vastly different materials. This chapter is specifically concerned with modeling responses to HDM exposure in mice. These studies have furnished new information and unlocked new lines of inquiry regarding biological responses to common aeroallergens. The complexity of HDM as an allergen source, with its plethora of protein and nonprotein immunogenic components, may influence the mechanisms underlying sensitization, inflammation and remodeling. Here, we will discuss this issue, along with giving critical thought to the use of experimental models.
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Affiliation(s)
- Elizabeth C Cates
- Department of Pathology and Molecular Medicine, Division of Respiratory Diseases and Allergy, Centre for Gene Therapeutics, McMaster University, Hamilton, Ont., Canada
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