Abstract P3-11-16: Immunosuppressive profiles in liquid biopsy predict response to neoadjuvant chemotherapy in triple negative breast cancer

BACKGROUND

Despite the recent advances in triple negative breast cancer (TNBC) stratification, TNBC is still a highly heterogeneous subtype that clusters distinct molecular and genetic alterations with diverse responses to neoadjuvant chemotherapy (NAC). Molecular profiling after NAC has unraveled a group of actionable targets in residual TNBC that supports the implementation of targeted therapies in a personalized manner. However, unresponsive or poor NAC responders after first line treatment are committed to poorer outcome. Therefore, early identification of poor NAC responders is essential to select patients that may benefit from alternative therapies, including initial tumor resection before chemotherapy.

MATERIAL AND METHODS

We have conducted a study on 37 non-metastatic TNBC patients at La Fe Hospital that were homogeneously treated with anthracycline and cyclophosphamide followed by paclitaxel. Tissue and blood-derived biopsies were obtained at diagnosis. Metabolites and miRNA exosomes in plasma were analyzed by ultra-performance liquid chromatography-electrospray ionization tandem mass spectrometric and by miRNA 3.0 arrays (Affymetrix) respectively. Immunosuppressive subpopulations of cells were quantified by flow cytometry with specific markers. IDO1 in situ expression was assessed by immunohistochemistry on the tissue biopsies.

RESULTS

In order to identify blood-derived liquid biopsy NAC predictor biomarkers in TNBC we have studied blood circulating cells and molecules known for their immunomodulation capacity and found that eMDSC and a profile of tryptophan-derived metabolites predict NAC response. In addition, we identified a circulating exosome miRNA profile that identifies poor NAC responders. Interestingly, this profile of miRNAs target pathways involved in the immune response. IDO1 expression in the tumor inversely correlated with circulating tryptophan levels and directly associated with eMDSC. We also observed a trend correlating IDO1 expression levels with poorer response.

CONCLUSIONS

Our results strongly support the role of immunosuppression in TNBC poor responders and establish an easy and non-invasive tool for the early identification of poor NAC responders, opening the possibility to use alternative strategies.

Acknowledgements:

The authors would like to thank the Cytomics Unit, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain for its technical support.

This work was partially financed with FEDER funds (CIBERONC (CB16/ 12/00284)) and AMACMA breast cancer association.

Citation Format: Salvador-Coloma C, Font De Mora J, Cordón L, Palomar L, Santaballa A. Immunosuppressive profiles in liquid biopsy predict response to neoadjuvant chemotherapy in triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-11-16.

Abstract P3-14-07: Early detection of chemotherapy-induced cardiotoxicity in breast cancer patients

BACKGROUND

The incidence of cardiotoxicity in patients receiving treatment for breast cancer is unknown. There is not enough evidence about early detection and appropriate management of cardiotoxicity. The aim of this study is to identify early markers of risk of cardiac toxicity.

MATERIAL AND METHOD

Prospective study was conducted between 2014 and 2017 based on a cohort of 97 patients diagnosed with breast cancer treated with chemotherapy. Analytical biomarkers (natriuretic peptide, ultra-sensitive T troponin), echocardiogram parameters (left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS)) and electrocardiogram were performed. Analytical biomarkers were measured each chemotherapy cycle and cardiology test were performed before starting chemotherapy, 3 months afterwards, and then every six months during 5 years.

Cardiotoxicity was defined as a reduction in basal LVEF >10% with LVEF<55% in asymptomatic patients or >5% with LVEF<55% in symptomatic patients.

RESULTS

Patients characteristics are shown in table 1

Patients characteristicsVariablesNo cardiotoxicity (n=88)Cardiotoxicity (n=12)Gender (women/men)88/012/0Median age (range)53 years (29-79)47 years (37-70)Smoker (former smoker)13 (3)2 (2)Arterial hypertension202Dyslipemia160Diabetes62Previous chemotherapy11Prior mediastinal radiation therapy01

. All patients had the basal LVEF in normal range. Median follow-up was 26.5 months (13,5-39,6 months). A total of 10.3% had cardiotoxicity with reduction in basal LVEF >10% with LVEF<55% being asymptomatic and 2.1% were symptomatic. Five of these patients were treated with heart failure therapy: 5 with ACE (angiotensin converting enzyme) inhibitors and 3 with beta- blockers. Two of those (40%) who received specific treatment recovered basal LVEF-levels, 2 maintained LVEF dysfunction, and 1 died during follow-up due to tumor-related causes. In 83.3% of patients, cardiotoxicity occurred within the first year of follow-up.

In 50 patients SLG was calculated, in 30% it was lower than -12% in some measurement phase. In 5 cases the LVEF fell below 55% and the LRP decreased by 12% coincided.

The others patients, although they did not develop cardiotoxicity according to the established criteria, a decrease of the LVEF is observed during the treatment and in the first control, between 3-7%, which subsequently tends to recover spontaneously.

miRNA 21-5p, miRNA-133b, miRNA 210-3p, miRNA 423-5p, and miRNA-663b were analyzed. A model has been evaluated where a correlation between the levels of miRNA-133b, miRNA-21-5p and miRNA-210-3p and the decrease of LVEF in relation to treatment was observed.

CONCLUSIONS

Control by echocardiography and serum markers allowed us to detect early cardiotoxicity events and provide us an opportunity to start heart failure therapy on time with the aim of improving the control and evolution of it.Levels of miR-133b, miR-21-5p and miR-210 may alert for a risk of cardiotoxicity and can help to make decisions about treatments.

Acknowledgements: Project funded by European Comission (Hecatos FP7-HEALTH-2013-INNOVATION-1. Reference: CP-IP 602156-1) and RETICS program (RD12/0019/0025) cofunded by FEDER "una manera de hacer Europa”.

Citation Format: Salvador-Coloma C, Hernándiz A, Tejedor S, Miró V, Palomar L, Salvador A, Sepúlveda P, Santaballa A. Early detection of chemotherapy-induced cardiotoxicity in breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-14-07.