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Augustinsson A, Loman N, Ehrencrona H. Retrospective genetic testing (Traceback) in women with early-onset breast cancer after revised national guidelines: a clinical implementation study. Breast Cancer Res Treat 2024; 205:599-607. [PMID: 38491334 PMCID: PMC11101361 DOI: 10.1007/s10549-024-07288-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/08/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE This study focused on identifying a hereditary predisposition in women previously diagnosed with early-onset breast cancer through a retrospective outreach activity (Traceback). The objectives were to evaluate the possible clinical implementation of a simplified Traceback strategy and to identify carriers of pathogenic variants among previously untested women. METHODS Three hundred and fifteen Traceback-eligible women diagnosed with breast cancer at 36-40 years in Southern Sweden between 2000 and 2019 were identified and offered an analysis of the genes ATM, BARD1, BRCA1, BRCA2, CHEK2, PALB2, RAD51C, and RAD51D through a standardized letter. Women who chose to participate were asked about their experiences through a questionnaire. The workload for the study personnel was measured and recorded. RESULTS One hundred and seventy-six women underwent genetic testing and pathogenic variants were identified in 9.7%: ATM (n = 6), BARD1 (n = 1), BRCA1 (n = 3), CHEK2 (n = 5), and PALB2 (n = 2). Women with normal test results were informed through a standardized letter. Carriers of pathogenic variants were contacted by telephone and offered in-person genetic counseling. One hundred and thirty-four women returned the subsequent questionnaire. Most study participants were satisfied with both written pre- and post-test information and many expressed their gratitude. The extra workload as compared to routine clinical genetic counseling was modest (8 min per patient). CONCLUSION The insights from the participants' perspectives and sentiments throughout the process support the notion that the Traceback procedure is a safe and an appreciated complement to routine genetic counseling. The genetic yield of almost 10% also suggests that the associated extra workload for genetic counselors could be viewed as acceptable in clinical implementation scenarios.
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Affiliation(s)
- Annelie Augustinsson
- Care in High Technological Environments, Department of Health Sciences, Lund University, 221 00, Lund, Sweden.
- Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden.
- Oncology, Department of Clinical Sciences in Lund, Lund University, Lund, Sweden.
| | - Niklas Loman
- Oncology, Department of Clinical Sciences in Lund, Lund University, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Region Skåne, Malmö, Sweden
| | - Hans Ehrencrona
- Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden
- Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
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2
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Wang K, Zerdes I, Johansson HJ, Sarhan D, Sun Y, Kanellis DC, Sifakis EG, Mezheyeuski A, Liu X, Loman N, Hedenfalk I, Bergh J, Bartek J, Hatschek T, Lehtiö J, Matikas A, Foukakis T. Longitudinal molecular profiling elucidates immunometabolism dynamics in breast cancer. Nat Commun 2024; 15:3837. [PMID: 38714665 PMCID: PMC11076527 DOI: 10.1038/s41467-024-47932-y] [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: 05/08/2023] [Accepted: 04/12/2024] [Indexed: 05/10/2024] Open
Abstract
Although metabolic reprogramming within tumor cells and tumor microenvironment (TME) is well described in breast cancer, little is known about how the interplay of immune state and cancer metabolism evolves during treatment. Here, we characterize the immunometabolic profiles of tumor tissue samples longitudinally collected from individuals with breast cancer before, during and after neoadjuvant chemotherapy (NAC) using proteomics, genomics and histopathology. We show that the pre-, on-treatment and dynamic changes of the immune state, tumor metabolic proteins and tumor cell gene expression profiling-based metabolic phenotype are associated with treatment response. Single-cell/nucleus RNA sequencing revealed distinct tumor and immune cell states in metabolism between cold and hot tumors. Potential drivers of NAC based on above analyses were validated in vitro. In summary, the study shows that the interaction of tumor-intrinsic metabolic states and TME is associated with treatment outcome, supporting the concept of targeting tumor metabolism for immunoregulation.
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Affiliation(s)
- Kang Wang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ioannis Zerdes
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital and Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Henrik J Johansson
- Department of Oncology-Pathology, Karolinska Institutet, and Science for Life Laboratory, Stockholm, Sweden
| | - Dhifaf Sarhan
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Yizhe Sun
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Dimitris C Kanellis
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | | | - Artur Mezheyeuski
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck Laboratory, Uppsala, Sweden
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Xingrong Liu
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Loman
- Department of Hematology, Oncology and Radiation Physics, Lund University Hospital, Lund, Sweden
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Center, Theme Cancer, Karolinska University Hospital and Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Jiri Bartek
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
- Danish Cancer Institute, DK-2100, Copenhagen, Denmark
| | - Thomas Hatschek
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Center, Theme Cancer, Karolinska University Hospital and Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Janne Lehtiö
- Department of Oncology-Pathology, Karolinska Institutet, and Science for Life Laboratory, Stockholm, Sweden
- Division of Pathology, Karolinska University Hospital and Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Alexios Matikas
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Center, Theme Cancer, Karolinska University Hospital and Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Theodoros Foukakis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
- Breast Center, Theme Cancer, Karolinska University Hospital and Karolinska Comprehensive Cancer Center, Stockholm, Sweden.
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3
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Gulis K, Ellbrant J, Svensjö T, Skarping I, Vallon-Christersson J, Loman N, Bendahl PO, Rydén L. A prospective cohort study identifying radiologic and tumor related factors of importance for breast conserving surgery after neoadjuvant chemotherapy. Eur J Surg Oncol 2023; 49:1189-1195. [PMID: 37019807 DOI: 10.1016/j.ejso.2023.03.225] [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: 12/07/2022] [Revised: 03/05/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) is an established treatment option for early breast cancer, potentially downstaging the tumor and increasing the eligibility for breast-conserving surgery (BCS). The primary aim of this study was to assess the rate of BCS after NAC, and the secondary aim was to identify predictors of application of BCS after NAC. MATERIALS AND METHODS This was an observational prospective cohort study of 226 patients in the SCAN-B (Clinical Trials NCT02306096) neoadjuvant cohort during 2014-2019. Eligibility for BCS was assessed at baseline and after NAC. Uni- and multivariable logistic regression analyses were performed using covariates with clinical relevance and/or those associated with outcome (BCS versus mastectomy), including tumor subtype, by gene expression analysis. RESULTS The overall BCS rate was 52%, and this rate increased during the study period (from 37% to 52%). Pathological complete response was achieved in 69 patients (30%). Predictors for BCS were smaller tumor size on mammography, visibility on ultrasound, histological subtype other than lobular, benign axillary status, and a diagnosis of triple-negative or HER2-positive subtype, with a similar trend for gene expression subtypes. Mammographic density was negatively related to BCS in a dose-response pattern. In the multivariable logistic regression model, tumor stage at diagnosis and mammographic density showed the strongest association with BCS. CONCLUSION The rate of BCS after NAC increased during the study period to 52%. With modern treatment options for NAC the potential for tumor response and BCS eligibility might further increase.
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Affiliation(s)
- K Gulis
- Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden; Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden.
| | - J Ellbrant
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden; Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - T Svensjö
- Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden
| | - I Skarping
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden; Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | - J Vallon-Christersson
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden; Lund University Cancer Centre, Lund, Sweden
| | - N Loman
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden; Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - P O Bendahl
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - L Rydén
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden; Department of Surgery, Skåne University Hospital, Malmö, Sweden
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4
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Omran M, Johansson H, Lundgren C, Silander G, Stenmark-Askmalm M, Loman N, Baan A, Adra J, Kuchinskaya E, Blomqvist L, Tham E, Bajalica-Lagercrantz S, Brandberg Y. Whole-body MRI surveillance in TP53 carriers is perceived as beneficial with no increase in cancer worry regardless of previous cancer: Data from the Swedish TP53 Study. Cancer 2023; 129:946-955. [PMID: 36601958 DOI: 10.1002/cncr.34631] [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: 10/13/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND To evaluate the psychosocial consequences of surveillance with whole-body MRI (WB-MRI) in individuals with the heritable TP53-related cancer (hTP53rc) syndrome, also known as the Li-Fraumeni syndrome, with regard to cancer worry, perceived benefits and risks to surveillance and overall health. PATIENTS AND METHODS Since 2016, the national Swedish TP53 Study (SWEP53) has offered surveillance with WB-MRI to all individuals with hTP53rc syndrome. Seventy-five individuals have been included in the study. Sixty consecutive participants fulfilled a base-line evaluation as well as an evaluation after 1 year with structured questionnaires including the Cancer Worry Scale (CWS), perceived benefits and risks of surveillance, and the 36-item Short Form Survey (SF-36). Individuals with or without previous personal cancer diagnosis were enrolled and results at baseline and after 1 year of surveillance were compared. For SF-36, a comparison with the normal population was also made. RESULTS Participants with previous cancer tend to worry more about cancer, but both individuals with and without cancer had a positive attitude toward surveillance with no differences regarding perceived benefits and barriers to surveillance. Participants with a previous cancer scored significantly lower on some of the SF-36 subscales, but between-group differences were found only for social functioning after 1 year. CONCLUSIONS Surveillance with WB-MRI is feasible from a psychosocial point of view both among TP53 carriers with as well as without a previous history of cancer and does not increase cancer worry in any of the groups. PLAIN LANGUAGE SUMMARY Individuals with heritable TP53-related cancer syndrome (also known as the Li-Fraumeni syndrome) have a high lifetime risk of developing cancer. These TP53 carriers are offered surveillance with whole-body MRI to detect cancer early. There are few reports of the psychosocial impact of surveillance. In this study, we wanted to evaluate cancer worry, benefits and barriers to participation, and perceived overall health. Our study shows no increase in cancer worry after 1 year of surveillance, regardless of previous cancer.
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Affiliation(s)
- Meis Omran
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Cancer Theme, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Lundgren
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Gustav Silander
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Marie Stenmark-Askmalm
- Division of Clinical Genetics, Department of Laboratory Medicine, Office for Medical Services, Skåne University Hospital, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Annika Baan
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jamila Adra
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Imaging and Physiology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Emma Tham
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Svetlana Bajalica-Lagercrantz
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Cancer Theme, Karolinska University Hospital Solna, Stockholm, Sweden.,Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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Gulis K, Ellbrant J, Bendahl PO, Svensjö T, Vallon-Christersson J, Skarping ID, Loman N, Rydén L. Abstract P1-09-06: Save the breast after neoadjuvant therapy – identifying radiological and tumor related factors of importance for breast conserving surgery after neoadjuvant chemotherapy. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p1-09-06] [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: Neoadjuvant chemotherapy (NAC) is an established treatment option in early breast cancer. NAC potentially downstages the tumor and, combined with oncoplastic techniques, may increase the eligibility for breast conserving surgery (BCS). NAC can also result in less surgical morbidity of the axilla if axillary clearance can be avoided. In addition, preoperative medical treatment allows for a thorough evaluation of treatment response and lays the foundation for adjuvant treatment decisions. The aim of the study was to prospectively estimate the proportion of BCS post NAC and the relation to well-defined factors associated with BCS post NAC.
Materials and methods: This observational prospective cohort study included 226 patients in the SCAN-B neoadjuvant cohort (Clinical trials: NCT02306096) receiving NAC between 2014 and 2019. Eligibility for BCS was based on the assessment of the surgeon at time of diagnosis and again post NAC. All the covariables were defined at time of diagnosis from mammograms and core needle biopsies, except for pathological complete response (pCR). Treatment generally consisted of 6 to 7 three-weekly treatment cycles of anthracycline- and taxane-based chemotherapy, given in sequence. In HER2-positive disease, HER2-directed antibodies were added as appropriate.The primary aim was to estimate the proportion of BCS after NAC and the secondary aim was to evaluate factors as predictors of BCS, including gene expression and surrogate molecular subtypes (St. Gallen), breast density, and other putative modifying factors.Uni- and multivariable logistic regression analysis were performed including covariates of clinical relevance and/or associated with the outcome measures (BCS versus mastectomy).
Results: The BCS rate increased during the study years, from 37% to 52%. pCR was achieved in 69 patients (30%). Predictors with a negative association to BCS were larger tumor size on mammography (T3 vs T1) (odds ratio (OR)=0.20, 95% confidence interval (CI) [0.06,0.64]), lack of visibility on ultrasound (OR=0.08, 95% CI [0.001,0.63]), lobular histological subtype vs other subtypes (OR=0,20, 95% CI [0.06,0.61)). Factors positively associated with BCS were benign axillary lymph node status (OR=2.26, 95% CI [1.26,4.06]) and surrogate molecular subtypes; patients with triple negative and HER-2 positive tumors had the highest probability of receiving BCS, 65% and 54%, respectively. Gene expression subtypes had a similar trend of being associated with BCS; patients with basal like and HER-2 enriched tumors had higher odds ratio for BCT than patients with luminal subtypes (Table 1). In the multivariable logistic regression analysis, tumor size on mammography and axillary status had the strongest association to BCS (OR=0.95, 95% CI [0.92,0.98] and OR=2.08, 95% CI [0.99,4.35], respectively).
Conclusions: Our study shows that the rate of BCS after NAC increased over the study years, but mastectomy rate in the study was still close to 50%. With increasing number of patients achieving pCR after NAC, the BCS rate should be possible to increase further. Predictors of BCS after NAC were identified, and benign axillary lymph nodes and smaller tumor size defined at time of diagnosis were the strongest predictors of BCS, supporting that initial tumor stage was important for the choice of surgery after NAC.
Table 1. Baseline characteristics and univariable logistic regression. 1. Determined by biopsy or sentinel node. 2. Only tumors visible on mammography. 3. Defined as ypT0/ypTis/ypN0.
Citation Format: Kim Gulis, Julia Ellbrant, Pär-Ola Bendahl, Tor Svensjö, Johan Vallon-Christersson, Ida Dalene Skarping, Niklas Loman, Lisa Rydén. Save the breast after neoadjuvant therapy – identifying radiological and tumor related factors of importance for breast conserving surgery after neoadjuvant chemotherapy [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 P1-09-06.
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Geyer C, Garber J, Gelber R, Yothers G, Taboada M, Ross L, Rastogi P, Cui K, Arahmani A, Aktan G, Armstrong A, Arnedos M, Balmaña J, Bergh J, Bliss J, Delaloge S, Domchek S, Eisen A, Elsafy F, Fein L, Fielding A, Ford J, Friedman S, Gelmon K, Gianni L, Gnant M, Hollingsworth S, Im SA, Jager A, Jóhannsson Ó, Lakhani S, Janni W, Linderholm B, Liu TW, Loman N, Korde L, Loibl S, Lucas P, Marmé F, Martinez de Dueñas E, McConnell R, Phillips KA, Piccart M, Rossi G, Schmutzler R, Senkus E, Shao Z, Sharma P, Singer C, Španić T, Stickeler E, Toi M, Traina T, Viale G, Zoppoli G, Park Y, Yerushalmi R, Yang H, Pang D, Jung K, Mailliez A, Fan Z, Tennevet I, Zhang J, Nagy T, Sonke G, Sun Q, Parton M, Colleoni M, Schmidt M, Brufsky A, Razaq W, Kaufman B, Cameron D, Campbell C, Tutt A. Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high risk, early breast cancer. Ann Oncol 2022; 33:1250-1268. [PMID: 36228963 DOI: 10.1016/j.annonc.2022.09.159] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The randomized, double-blind OlympiA trial compared 1 year of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor, olaparib, to matching placebo as adjuvant therapy for patients with pathogenic or likely pathogenic variants in germline BRCA1 or BRCA2 (gBRCA1/2pv) and high-risk, human epidermal growth factor receptor 2-negative, early breast cancer (EBC). The first pre-specified interim analysis (IA) previously demonstrated statistically significant improvement in invasive disease-free survival (IDFS) and distant disease-free survival (DDFS). The olaparib group had fewer deaths than the placebo group, but the difference did not reach statistical significance for overall survival (OS). We now report the pre-specified second IA of OS with updates of IDFS, DDFS, and safety. PATIENTS AND METHODS One thousand eight hundred and thirty-six patients were randomly assigned to olaparib or placebo following (neo)adjuvant chemotherapy, surgery, and radiation therapy if indicated. Endocrine therapy was given concurrently with study medication for hormone receptor-positive cancers. Statistical significance for OS at this IA required P < 0.015. RESULTS With a median follow-up of 3.5 years, the second IA of OS demonstrated significant improvement in the olaparib group relative to the placebo group [hazard ratio 0.68; 98.5% confidence interval (CI) 0.47-0.97; P = 0.009]. Four-year OS was 89.8% in the olaparib group and 86.4% in the placebo group (Δ 3.4%, 95% CI -0.1% to 6.8%). Four-year IDFS for the olaparib group versus placebo group was 82.7% versus 75.4% (Δ 7.3%, 95% CI 3.0% to 11.5%) and 4-year DDFS was 86.5% versus 79.1% (Δ 7.4%, 95% CI 3.6% to 11.3%), respectively. Subset analyses for OS, IDFS, and DDFS demonstrated benefit across major subgroups. No new safety signals were identified including no new cases of acute myeloid leukemia or myelodysplastic syndrome. CONCLUSION With 3.5 years of median follow-up, OlympiA demonstrates statistically significant improvement in OS with adjuvant olaparib compared with placebo for gBRCA1/2pv-associated EBC and maintained improvements in the previously reported, statistically significant endpoints of IDFS and DDFS with no new safety signals.
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7
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Staaf J, Häkkinen J, Hegardt C, Saal LH, Kimbung S, Hedenfalk I, Lien T, Sørlie T, Naume B, Russnes H, Marcone R, Ayyanan A, Brisken C, Malterling RR, Asking B, Olofsson H, Lindman H, Bendahl PO, Ehinger A, Larsson C, Loman N, Rydén L, Malmberg M, Borg Å, Vallon-Christersson J. RNA sequencing-based single sample predictors of molecular subtype and risk of recurrence for clinical assessment of early-stage breast cancer. NPJ Breast Cancer 2022; 8:94. [PMID: 35974007 PMCID: PMC9381586 DOI: 10.1038/s41523-022-00465-3] [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: 01/26/2022] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
Multigene assays for molecular subtypes and biomarkers can aid management of early invasive breast cancer. Using RNA-sequencing we aimed to develop single-sample predictor (SSP) models for clinical markers, subtypes, and risk of recurrence (ROR). A cohort of 7743 patients was divided into training and test set. We trained SSPs for subtypes and ROR assigned by nearest-centroid (NC) methods and SSPs for biomarkers from histopathology. Classifications were compared with Prosigna in two external cohorts (ABiM, n = 100 and OSLO2-EMIT0, n = 103). Prognostic value was assessed using distant recurrence-free interval. Agreement between SSP and NC for PAM50 (five subtypes) was high (85%, Kappa = 0.78) for Subtype (four subtypes) very high (90%, Kappa = 0.84) and for ROR risk category high (84%, Kappa = 0.75, weighted Kappa = 0.90). Prognostic value was assessed as equivalent and clinically relevant. Agreement with histopathology was very high or high for receptor status, while moderate for Ki67 status and poor for Nottingham histological grade. SSP and Prosigna concordance was high for subtype (OSLO-EMIT0 83%, Kappa = 0.73 and ABiM 80%, Kappa = 0.72) and moderate and high for ROR risk category (68 and 84%, Kappa = 0.50 and 0.70, weighted Kappa = 0.70 and 0.78). Pooled concordance for emulated treatment recommendation dichotomized for chemotherapy was high (85%, Kappa = 0.66). Retrospective evaluation suggested that SSP application could change chemotherapy recommendations for up to 17% of postmenopausal ER+/HER2-/N0 patients with balanced escalation and de-escalation. Results suggest that NC and SSP models are interchangeable on a group-level and nearly so on a patient level and that SSP models can be derived to closely match clinical tests.
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Affiliation(s)
- Johan Staaf
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden.
| | - Jari Häkkinen
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Cecilia Hegardt
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Lao H Saal
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Siker Kimbung
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Tonje Lien
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway.,Department of Pathology, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway
| | - Therese Sørlie
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway.,Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Naume
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway
| | - Hege Russnes
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway.,Department of Pathology, Oslo University Hospital, POB 4953 Nydalen N-0424, Oslo, Norway
| | - Rachel Marcone
- ISREC-Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, CH-1015, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, CH-1005, Lausanne, Switzerland
| | - Ayyakkannu Ayyanan
- ISREC-Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, CH-1015, Lausanne, Switzerland
| | - Cathrin Brisken
- ISREC-Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, CH-1015, Lausanne, Switzerland
| | | | - Bengt Asking
- Department of Surgery, Region Jönköping County, Jönköping, Sweden
| | - Helena Olofsson
- Department of Clinical Pathology, Akademiska Hospital, Uppsala, Sweden.,Department of Pathology, Centre for Clinical Research of Uppsala University, Vastmanland´s Hospital Västerås, Västerås, Sweden
| | - Henrik Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Pär-Ola Bendahl
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Anna Ehinger
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden.,Department of Genetics and Pathology, Laboratory Medicine, Region Skåne, Lund, Sweden
| | - Christer Larsson
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Niklas Loman
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Lisa Rydén
- Division of Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Surgery and Gastroenterology, Skåne University Hospital Malmö, Malmö, Sweden
| | - Martin Malmberg
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Åke Borg
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Johan Vallon-Christersson
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden.
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8
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Vallon-Christersson J, Staaf J, Häkkinen J, Hegardt C, Saal L, Ehinger A, Larsson C, Loman N, Rydén L, Malmberg M, Borg Å. 52P RNA sequencing-based single sample predictors of molecular subtype and risk of recurrence for clinical assessment of early-stage breast cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.067] [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: 11/26/2022] Open
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9
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Tutt A, Garber J, Gelber R, Phillips KA, Eisen A, Johannsson O, Rastogi P, Cui K, Im SA, Yerushalmi R, Brufsky A, Taboada M, Rossi G, Yothers G, Singer C, Fein L, Loman N, Cameron D, Campbell C, Geyer C. VP1-2022: Pre-specified event driven analysis of Overall Survival (OS) in the OlympiA phase III trial of adjuvant olaparib (OL) in germline BRCA1/2 mutation (gBRCAm) associated breast cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Saghir H, Veerla S, Malmberg M, Rydén L, Ehinger A, Saal L, Vallon-Christersson J, Borg Å, Hegardt C, Hedenfalk I, Dieroff-Hay S, Larsson C, Loman N, Kimbung S. Abstract P2-08-11: How reliable are biomarkers assessed on a core needle biopsy? A study of paired core needle biopsies and surgical specimens in early breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-08-11] [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: The conventional biomarkers estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), Ki67, and Nottingham histologic grade (NHG) are used to classify breast cancer into its molecular subtypes, determine prognosis, and guide treatment. A preoperative core needle biopsy (CNB) is used to confirm the diagnosis and invasiveness of a breast lesion and forms the basis for characterizing the tumor in the case of neoadjuvant primary treatment, emphasizing the importance of obtaining reliable biomarker assessment from a diagnostic CNB. Aim: The aim of this study was to determine the similarity between biomarker status assessed on a CNB compared to a medically untreated surgical specimen. Methods: Paired CNB and surgical specimens from 267 patients that were part of the prospective Sweden Cancerome Analysis Network- Breast (SCAN-B) cohort were studied. The concordance for the five biomarkers: ER, PgR, Ki67, HER2 and molecular subtype, between paired CNB and surgical specimen were investigated using immunohistochemistry (IHC) and gene expression-based analytical methods (GEX). IHC data were collected from patient medical records and gene expression was measured by RNA sequencing. Cohen’s kappa and Mcnemar’s test were used to compare the concordance of biomarkers.Results: Moderate to very good levels of concordance were observed between the biomarker status obtained on a CNB compared with the paired surgical specimen for IHC (κappa range 0.474-0.917) and GEX (κappa range 0.528-0.776), respectively. However, a significant drift from low to high Ki67 status and from negative to positive HER2 status between the CNB and surgical specimen was observed when using IHC and GEX, respectively (McNemar p < 0.05 for both comparisons). Moderate to good concordance levels of biomarker status were generally obtained when comparing GEX and IHC status measured from the same type of sample (κappa range 0.484-0.649) except for Ki67 which consistently displayed poor concordance levels between IHC and GEX for both CNB and surgical specimen comparisons (κappa range 0.158-0.198). Notably, a significant shift from positive to negative ER status and high to low Ki67 status was observed when comparing IHC with GEX classification (McNemar p <0.001 for both comparisons). Conclusion: The tissue sampling and the method of biomarker analysis may affect the results of biomarker status and ultimately affect treatment decisions. The implications of using a preoperative CNB to determine biomarker status, prognosis, and treatment choice should be taken into consideration in neoadjuvant treatment settings.
Citation Format: Hani Saghir, Srinivas Veerla, Martin Malmberg, Lisa Rydén, Anna Ehinger, Lao Saal, Johan Vallon-Christersson, Åke Borg, Cecilia Hegardt, Ingrid Hedenfalk, Susanne Dieroff-Hay, Christer Larsson, Niklas Loman, Siker Kimbung. How reliable are biomarkers assessed on a core needle biopsy? A study of paired core needle biopsies and surgical specimens in early breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-08-11.
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Affiliation(s)
- Hani Saghir
- Division of Oncology, Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | - Srinivas Veerla
- Division of Oncology, Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | - Martin Malmberg
- Dept. of Hematology, Oncology and Radiation Physics, Lund University Hospital, Lund, Sweden
| | - Lisa Rydén
- Division of Oncology, Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | - Anna Ehinger
- Division of Oncology, Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | - Lao Saal
- Division of Oncology, Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Åke Borg
- Division of Oncology, Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | - Cecilia Hegardt
- Division of Oncology, Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology, Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Christer Larsson
- Division of Translational Cancer Research, Dept. of Laboratory Medicine, Lund University, Lund, Sweden
| | - Niklas Loman
- Dept. of Hematology, Oncology and Radiation Physics, Lund University Hospital, Lund, Sweden
| | - Siker Kimbung
- Division of Oncology, Dept. of Clinical Sciences, Lund University, Lund, Sweden
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11
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Loman N, Linderholm B, Ahlgren J, Kimbung S, Zander L, Magnusson HG, Kjellman EC, Raaberg AJ, Jensen MBR, Borg Å, Staaf J, Ståhlberg A, Bendahl PO, Laenkholm AV, Tanner M, Bjarnadóttir O, Johannsson O, Ejlertsen B, Lindman H. Abstract OT2-30-01: Nordictrip, a translational randomized phase-3study exploring the effect of the addition of capecitabine to carboplatinum-based chemotherapy in early “triple negative” breast cancer, ClinicalTrials.gov Identifier: NCT04335669. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot2-30-01] [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: A striking heterogeneity combined with an absence of highly efficient targeted treatments necessitates a continued effort to optimize the choice of chemotherapy for patients with triple negative breast cancer (TNBC). Neoadjuvant therapy has become the standard of care for high risk TNBC in order to potentially reduce breast and axillary surgery, start medical treatment early, allow genomic screening and guide post neoadjuvant therapy. Much attention is drawn to the use of immunotherapy in early TNBC, but there is also interesting data suggesting a potential to optimize the use of conventional chemotherapy. According to one meta-analysis including data from nine randomized controlled trials, the addition of platinum salts in the preoperative setting increases the pathologic complete response (pCR) rate in TNBC (Poggio 2018). A second meta-analysis, evaluating the effect of capecitabine in early breast cancer indicates an additional benefit from adding capecitabine to conventional chemotherapy in terms of an increased recurrence-free survival in the subset of TNBC (Mackelenbergh SABCS 2019). An adjuvant trial in TNBC suggests that the beneficial effect of capecitabine may be confined to patients with a non-basal like phenotype of TNBC (Lluch 2020), a subset that correlates with the homologous repair non-deficient subset which constitutes 41 % of TNBC in a mainly south Swedish population based cohort (Staaf 2019). The effect of capecitabine in platinum treated early TNBC is unknown. Objectives: We are conducting a multi-center randomized controlled trial evaluating the effect on the pCR rate by the addition of capecitabine to optimal platinum based and dose dense preoperative chemotherapy in early TNBC. Method: 820 patients (pts) with early TNBC stage 1 (≥20 mm) - 3 will be randomized 1:1 between two treatment arms A and B. A: Epirubicine Cyclophosphamide (EC) q2w x 4 followed by Carboplatin AUC 5 q3w with weekly paclitaxel x 12. B: Epirubicine Cyclophosphamide with capecitabine daily for two weeks (CEX) q3w x 4 followed by Carboplatin AUC 5 q3w with weekly paclitaxel x 12 The primary endpoint is pCR rate in the different treatment strata, and the primary translational endpoint will be the potential difference of treatment effect stratified for HRD-status in the primary tumor. Secondary endpoints include IDFS in subsets of TNBC, eg according to gene-expression-based subtypes of TNBC (Lehmann 2011, Burstein 2015), and germline mutation status of hereditary breast cancer genes. Tumor material for genotypig is collected at baseline, at surgery and optionally after two treatment cycles. Sequential blood samples are collected for tsDNA analysis during and after treatment termination. Results: The trial, which is a collaborative effort between the national breast cancer groups in the participating countries, has been postponed by the pandemic but is now recruiting according to plan. So far 56 patients out of 820 have been recruited at 15 sites in Sweden and Denmark. Additional Sites in Sweden, Denmark, Iceland and Finland are preparing to join the study. For update please see: www.NordicTrip.se; E-mail address: Nordictrip.onkologi@skane.se
Citation Format: Niklas Loman, Barbro Linderholm, Johan Ahlgren, Siker Kimbung, Lina Zander, Heidi Grill Magnusson, Eva-Christin Kjellman, Ann Julia Raaberg, Maj-Britt Raaby Jensen, Åke Borg, Johan Staaf, Anders Ståhlberg, Pär-Ola Bendahl, Anne-Vibeke Laenkholm, Minna Tanner, Olöf Bjarnadóttir, Oskar Johannsson, Bent Ejlertsen, Henrik Lindman. Nordictrip, a translational randomized phase-3study exploring the effect of the addition of capecitabine to carboplatinum-based chemotherapy in early “triple negative” breast cancer, ClinicalTrials.gov Identifier: NCT04335669 [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-30-01.
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Affiliation(s)
- Niklas Loman
- Dept of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Barbro Linderholm
- Dept of Oncology, Jubileumskliniken, Sahlgrenska University Hospital, Sweden
| | - Johan Ahlgren
- Regional Cancer Center, Central Sweden, Uppsala, Sweden
| | - Siker Kimbung
- Division of Oncology, Dept of Clinical Sciences Lund, Lund University, Sweden
| | - Lina Zander
- Dept of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Heidi Grill Magnusson
- Dept of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Eva-Christin Kjellman
- Dept of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | | | | | - Åke Borg
- Division of Oncology, Dept of Clinical Sciences Lund, Lund University, Sweden
| | - Johan Staaf
- Division of Oncology, Dept of Clinical Sciences Lund, Lund University, Sweden
| | | | - Pär-Ola Bendahl
- Division of Oncology, Dept of Clinical Sciences Lund, Lund University, Sweden
| | | | - Minna Tanner
- Dept of Oncology, Tampere University Hospital, Finland
| | | | | | - Bent Ejlertsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen, Denmark
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12
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Dahlgren M, George AM, Brueffer C, Gladchuk S, Chen Y, Vallon-Christersson J, Hegardt C, Häkkinen J, Rydén L, Malmberg M, Larsson C, Gruvberger-Saal SK, Ehinger A, Loman N, Borg Å, Saal LH. Preexisting Somatic Mutations of Estrogen Receptor Alpha ( ESR1) in Early-Stage Primary Breast Cancer. JNCI Cancer Spectr 2021; 5:pkab028. [PMID: 33937624 PMCID: PMC8060794 DOI: 10.1093/jncics/pkab028] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/29/2021] [Accepted: 03/26/2021] [Indexed: 01/26/2023] Open
Abstract
Background More than three-quarters of primary breast cancers are positive for estrogen receptor alpha (ER; encoded by the gene ESR1), the most important factor for directing anti-estrogenic endocrine therapy (ET). Recently, mutations in ESR1 were identified as acquired mechanisms of resistance to ET, found in 12% to 55% of metastatic breast cancers treated previously with ET. Methods We analyzed 3217 population-based invasive primary (nonmetastatic) breast cancers (within the SCAN-B study, ClinicalTrials.gov NCT02306096), sampled from initial diagnosis prior to any treatment, for the presence of ESR1 mutations using RNA sequencing. Mutations were verified by droplet digital polymerase chain reaction on tumor and normal DNA. Patient outcomes were analyzed using Kaplan-Meier estimation and a series of 2-factor Cox regression multivariable analyses. Results We identified ESR1 resistance mutations in 30 tumors (0.9%), of which 29 were ER positive (1.1%). In ET-treated disease, presence of ESR1 mutation was associated with poor relapse-free survival and overall survival (2-sided log-rank test P < .001 and P = .008, respectively), with hazard ratios of 3.00 (95% confidence interval = 1.56 to 5.88) and 2.51 (95% confidence interval = 1.24 to 5.07), respectively, which remained statistically significant when adjusted for other prognostic factors. Conclusions These population-based results indicate that ESR1 mutations at diagnosis of primary breast cancer occur in about 1% of women and identify for the first time in the adjuvant setting that such preexisting mutations are associated to eventual resistance to standard hormone therapy. If replicated, tumor ESR1 screening should be considered in ER-positive primary breast cancer, and for patients with mutated disease, ER degraders such as fulvestrant or other therapeutic options may be considered as more appropriate.
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Affiliation(s)
- Malin Dahlgren
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Cancer Center, Medicon Village, Lund, Sweden
| | - Anthony M George
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Cancer Center, Medicon Village, Lund, Sweden
| | - Christian Brueffer
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Cancer Center, Medicon Village, Lund, Sweden
| | - Sergii Gladchuk
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Cancer Center, Medicon Village, Lund, Sweden
| | - Yilun Chen
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Cancer Center, Medicon Village, Lund, Sweden
| | - Johan Vallon-Christersson
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Cancer Center, Medicon Village, Lund, Sweden
| | - Cecilia Hegardt
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Cancer Center, Medicon Village, Lund, Sweden
| | - Jari Häkkinen
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Cancer Center, Medicon Village, Lund, Sweden
| | - Lisa Rydén
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Martin Malmberg
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Christer Larsson
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Sofia K Gruvberger-Saal
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Current affiliation: Center for Molecular Diagnostics, Skåne University Hospital, Lund, Sweden (SKG-S)
| | - Anna Ehinger
- Department of Pathology, Skåne University Hospital, Lund, Sweden
| | - Niklas Loman
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Åke Borg
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Cancer Center, Medicon Village, Lund, Sweden
| | - Lao H Saal
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Cancer Center, Medicon Village, Lund, Sweden
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13
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Matikas A, Wang K, Lagoudaki E, Acs B, Zerdes I, Hartman J, Azavedo E, Bjöhle J, Carlsson L, Einbeigi Z, Hedenfalk I, Hellström M, Lekberg T, Loman N, Saracco A, von Wachenfeldt A, Rotstein S, Bergqvist M, Bergh J, Hatschek T, Foukakis T. Prognostic role of serum thymidine kinase 1 kinetics during neoadjuvant chemotherapy for early breast cancer. ESMO Open 2021; 6:100076. [PMID: 33714010 PMCID: PMC7957142 DOI: 10.1016/j.esmoop.2021.100076] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background Emerging data support the use of thymidine kinase 1 (TK1) activity as a prognostic marker and for monitoring of response in breast cancer (BC). The long-term prognostic value of TK1 kinetics during neoadjuvant chemotherapy is unclear, which this study aimed to elucidate. Methods Material from patients enrolled to the single-arm prospective PROMIX trial of neoadjuvant epirubicin, docetaxel and bevacizumab for early BC was used. Ki67 in baseline biopsies was assessed both centrally and by automated digital imaging analysis. TK1 activity was measured from blood samples obtained at baseline and following two cycles of chemotherapy. The associations of TK1 and its kinetics as well as Ki67 with event-free survival and overall survival (OS) were evaluated using multivariable Cox regression models. Results Central Ki67 counting had excellent correlation with the results of digital image analysis (r = 0.814), but not with the diagnostic samples (r = 0.234), while it was independently prognostic for worse OS [adjusted hazard ratio (HRadj) = 2.72, 95% confidence interval (CI) 1.19-6.21, P = 0.02]. Greater increase in TK1 activity after two cycles of chemotherapy resulted in improved event-free survival (HRadj = 0.50, 95% CI 0.26-0.97, P = 0.04) and OS (HRadj = 0.46, 95% CI 0.95, P = 0.04). There was significant interaction between the prognostic value of TK1 kinetics and Ki67 (pinteraction 0.04). Conclusion Serial measurement of serum TK1 activity during neoadjuvant chemotherapy provides long-term prognostic information in BC patients. The ease of obtaining serial samples for TK1 assessment motivates further evaluation in larger studies. This is a correlative analysis of a prospective phase II study on neoadjuvant chemotherapy for breast cancer. Serial measurement of serum TK1 activity during treatment provides independent long-term prognostic information. We demonstrate the validity and clinical utility of both central and automated image analysis-based Ki67 assessment. Finally, we explore the biologic correlations between TK1 and Ki67.
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Affiliation(s)
- A Matikas
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - K Wang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - E Lagoudaki
- Pathology Department, University Hospital of Heraklion, Heraklion, Greece
| | - B Acs
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Stockholm, Sweden
| | - I Zerdes
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - J Hartman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Pathology and Cytology, Karolinska University Laboratory, Stockholm, Sweden
| | - E Azavedo
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J Bjöhle
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - L Carlsson
- Department of Oncology, Sundsvall General Hospital, Sundsvall, Sweden
| | - Z Einbeigi
- Department of Medicine and Department of Oncology, Southern Älvsborg Hospital, Borås, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Hedenfalk
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - M Hellström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - T Lekberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - N Loman
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Hematology, Oncology and Radiation Physics Skåne University Hospital, Lund, Sweden
| | - A Saracco
- Breast Center, Södersjukhuset, Stockholm, Sweden
| | - A von Wachenfeldt
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - S Rotstein
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - M Bergqvist
- Biovica International, Uppsala Science Park, Uppsala, Sweden
| | - J Bergh
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - T Hatschek
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - T Foukakis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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14
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Haugen MH, Lingjærde OC, Hedenfalk I, Garred Ø, Borgen E, Loman N, Hatschek T, Børresen-Dale AL, Naume B, Mills GB, Mælandsmo GM, Engebraaten O. Protein Signature Predicts Response to Neoadjuvant Treatment With Chemotherapy and Bevacizumab in HER2-Negative Breast Cancers. JCO Precis Oncol 2021; 5:PO.20.00086. [PMID: 34036235 PMCID: PMC8140811 DOI: 10.1200/po.20.00086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/12/2020] [Revised: 10/21/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Antiangiogenic therapy using bevacizumab has proven effective for a number of cancers; however, in breast cancer (BC), there is an unmet need to identify patients who benefit from such treatment. PATIENTS AND METHODS In the NeoAva phase II clinical trial, patients (N = 132) with large (≥ 25 mm) human epidermal growth factor receptor 2 (HER2)-negative primary tumors were randomly assigned 1:1 to treatment with neoadjuvant chemotherapy (CTx) alone or in combination with bevacizumab (Bev plus CTx). The ratio of the tumor size after relative to before treatment was calculated into a continuous response scale. Tumor biopsies taken prior to neoadjuvant treatment were analyzed by reverse-phase protein arrays (RPPA) for expression levels of 210 BC-relevant (phospho-) proteins. Lasso regression was used to derive a predictor of tumor shrinkage from the expression of selected proteins prior to treatment. RESULTS We identified a nine-protein signature score named vascular endothelial growth factor inhibition response predictor (ViRP) for use in the Bev plus CTx treatment arm able to predict with accuracy pathologic complete response (pCR) (area under the curve [AUC] = 0.85; 95% CI, 0.74 to 0.97) and low residual cancer burden (RCB 0/I) (AUC = 0.80; 95% CI, 0.68 to 0.93). The ViRP score was significantly lower in patients with pCR (P < .001) and in patients with low RCB (P < .001). The ViRP score was internally validated on mRNA data and the resultant surrogate mRNA ViRP score significantly separated the pCR patients (P = .016). Similarly, the mRNA ViRP score was validated (P < .001) in an independent phase II clinical trial (PROMIX). CONCLUSION Our ViRP score, integrating the expression of nine proteins and validated on mRNA data both internally and in an independent clinical trial, may be used to increase the likelihood of benefit from treatment with bevacizumab combined with chemotherapy in patients with HER2-negative BC.
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Affiliation(s)
- Mads H Haugen
- Department of Tumor Biology, Institute for Cancer Research, Division of Cancer Medicine, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Ole Christian Lingjærde
- Department of Genetics, Institute for Cancer Research, Division of Cancer Medicine, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.,Department of Informatics-Biomedical Informatics, University of Oslo, Oslo, Norway.,K.G. Jebsen-Centre for B Cell Malignancies, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Hedenfalk
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Øystein Garred
- Division of Laboratory Medicine-Pathology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Elin Borgen
- Division of Laboratory Medicine-Pathology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Niklas Loman
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Skåne, Sweden
| | - Thomas Hatschek
- Department of Oncology-Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Anne-Lise Børresen-Dale
- Department of Genetics, Institute for Cancer Research, Division of Cancer Medicine, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.,Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Naume
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Gordon B Mills
- Department of Cell, Developmental and Cancer Biology, School of Medicine, Oregon Health Science University, Portland, OR
| | - Gunhild M Mælandsmo
- Department of Tumor Biology, Institute for Cancer Research, Division of Cancer Medicine, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.,Institute for Medical Biology, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Olav Engebraaten
- Department of Tumor Biology, Institute for Cancer Research, Division of Cancer Medicine, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.,Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
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15
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Mehmeti-Ajradini M, Bergenfelz C, Larsson AM, Carlsson R, Riesbeck K, Ahl J, Janols H, Wullt M, Bredberg A, Källberg E, Björk Gunnarsdottir F, Rydberg Millrud C, Rydén L, Paul G, Loman N, Adolfsson J, Carneiro A, Jirström K, Killander F, Bexell D, Leandersson K. Human G-MDSCs are neutrophils at distinct maturation stages promoting tumor growth in breast cancer. Life Sci Alliance 2020; 3:3/11/e202000893. [PMID: 32958605 PMCID: PMC7536824 DOI: 10.26508/lsa.202000893] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022] Open
Abstract
This study shows that immunosuppressive primary breast cancer patient–derived G-MDSCs (PMN-MDSCs) are neutrophils at a range of maturations stages, and provides in vivo evidence for that human G-MDSCs also promote tumor growth and myeloid immune cell exclusion. Myeloid-derived suppressor cells (MDSCs) are known to contribute to immune evasion in cancer. However, the function of the human granulocytic (G)-MDSC subset during tumor progression is largely unknown, and there are no established markers for their identification in human tumor specimens. Using gene expression profiling, mass cytometry, and tumor microarrays, we here demonstrate that human G-MDSCs occur as neutrophils at distinct maturation stages, with a disease-specific profile. G-MDSCs derived from patients with metastatic breast cancer and malignant melanoma display a unique immature neutrophil profile, that is more similar to healthy donor neutrophils than to G-MDSCs from sepsis patients. Finally, we show that primary G-MDSCs from metastatic breast cancer patients co-transplanted with breast cancer cells, promote tumor growth, and affect vessel formation, leading to myeloid immune cell exclusion. Our findings reveal a role for human G-MDSC in tumor progression and have clinical implications also for targeted immunotherapy.
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Affiliation(s)
| | - Caroline Bergenfelz
- Division of Experimental Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Anna-Maria Larsson
- Division of Oncology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Robert Carlsson
- Translational Neurology, Department of Clinical Sciences and Wallenberg Centrum for Molecular Medicine, Lund University, Lund, Sweden
| | - Kristian Riesbeck
- Department of Translational Medicine, Clinical Microbiology, Lund University, Malmö, Sweden
| | - Jonas Ahl
- Department of Infectious Diseases, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Helena Janols
- Department of Infectious Diseases, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Marlene Wullt
- Department of Infectious Diseases, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Anders Bredberg
- Department of Translational Medicine, Clinical Microbiology, Lund University, Malmö, Sweden
| | - Eva Källberg
- Department of Translational Medicine, Cancer Immunology, Lund University, Malmö, Sweden
| | | | | | - Lisa Rydén
- Division of Oncology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Surgery and Gastroenterology, Skåne University Hospital, Lund, Sweden
| | - Gesine Paul
- Translational Neurology, Department of Clinical Sciences and Wallenberg Centrum for Molecular Medicine, Lund University, Lund, Sweden
| | - Niklas Loman
- Division of Oncology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Jörgen Adolfsson
- Science for Life Laboratory Node at Linköping's University, Linköping, Sweden
| | - Ana Carneiro
- Division of Oncology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Karin Jirström
- Department of Clinical Sciences, Oncology and Therapeutic Pathology, Lund University, Lund, Sweden
| | - Fredrika Killander
- Division of Oncology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Daniel Bexell
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Karin Leandersson
- Department of Translational Medicine, Cancer Immunology, Lund University, Malmö, Sweden
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16
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Olafsdottir EJ, Borg A, Jensen MB, Gerdes AM, Johansson ALV, Barkardottir RB, Johannsson OT, Ejlertsen B, Sønderstrup IMH, Hovig E, Lænkholm AV, Hansen TVO, Olafsdottir GH, Rossing M, Jonasson JG, Sigurdsson S, Loman N, Nilsson MP, Narod SA, Tryggvadottir L. Breast cancer survival in Nordic BRCA2 mutation carriers-unconventional association with oestrogen receptor status. Br J Cancer 2020; 123:1608-1615. [PMID: 32939053 PMCID: PMC7686356 DOI: 10.1038/s41416-020-01056-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background The natural history of breast cancer among BRCA2 carriers has not been clearly established. In a previous study from Iceland, positive ER status was a negative prognostic factor. We sought to identify factors that predicted survival after invasive breast cancer in an expanded cohort of BRCA2 carriers. Methods We studied 608 women with invasive breast cancer and a pathogenic BRCA2 mutation (variant) from four Nordic countries. Information on prognostic factors and treatment was retrieved from health records and by analysis of archived tissue specimens. Hazard ratios (HR) were estimated for breast cancer-specific survival using Cox regression. Results About 77% of cancers were ER-positive, with the highest proportion (83%) in patients under 40 years. ER-positive breast cancers were more likely to be node-positive (59%) than ER-negative cancers (34%) (P < 0.001). The survival analysis included 584 patients. Positive ER status was protective in the first 5 years from diagnosis (multivariate HR = 0.49; 95% CI 0.26–0.93, P = 0.03); thereafter, the effect was adverse (HR = 1.91; 95% CI 1.07–3.39, P = 0.03). The adverse effect of positive ER status was limited to women who did not undergo endocrine treatment (HR = 2.36; 95% CI 1.26–4.44, P = 0.01) and patients with intact ovaries (HR = 1.99; 95% CI 1.11–3.59, P = 0.02). Conclusions The adverse effect of a positive ER status in BRCA2 carriers with breast cancer may be contingent on exposure to ovarian hormones.
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Affiliation(s)
| | - Ake Borg
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Marie Gerdes
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rosa B Barkardottir
- Laboratory of Cell Biology, Department of Pathology, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, BMC, Laeknagardur, University of Iceland, Reykjavik, Iceland
| | - Oskar T Johannsson
- Department of Oncology, Landspitali University Hospital, Reykjavik, Iceland
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Eivind Hovig
- Department of Tumor Biology, Institute for Cancer Research, Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Slagelse, Denmark
| | - Thomas van Overeem Hansen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Maria Rossing
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jon G Jonasson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Pathology, Landspitali University Hospital, Reykjavik, Iceland
| | - Stefan Sigurdsson
- Cancer Research Laboratory, BMC, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Martin P Nilsson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Steven A Narod
- Womens' College Research Institute, University of Toronto, Toronto, ON, Canada
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland. .,Faculty of Medicine, BMC, Laeknagardur, University of Iceland, Reykjavik, Iceland.
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17
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Brueffer C, Gladchuk S, Winter C, Vallon-Christersson J, Hegardt C, Häkkinen J, George AM, Chen Y, Ehinger A, Larsson C, Loman N, Malmberg M, Rydén L, Borg Å, Saal LH. The mutational landscape of the SCAN-B real-world primary breast cancer transcriptome. EMBO Mol Med 2020; 12:e12118. [PMID: 32926574 PMCID: PMC7539222 DOI: 10.15252/emmm.202012118] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 12/12/2022] Open
Abstract
Breast cancer is a disease of genomic alterations, of which the panorama of somatic mutations and how these relate to subtypes and therapy response is incompletely understood. Within SCAN‐B (ClinicalTrials.gov: NCT02306096), a prospective study elucidating the transcriptomic profiles for thousands of breast cancers, we developed a RNA‐seq pipeline for detection of SNVs/indels and profiled a real‐world cohort of 3,217 breast tumors. We describe the mutational landscape of primary breast cancer viewed through the transcriptome of a large population‐based cohort and relate it to patient survival. We demonstrate that RNA‐seq can be used to call mutations in genes such as PIK3CA,TP53, and ERBB2, as well as the status of molecular pathways and mutational burden, and identify potentially druggable mutations in 86.8% of tumors. To make this rich dataset available for the research community, we developed an open source web application, the SCAN‐B MutationExplorer (http://oncogenomics.bmc.lu.se/MutationExplorer). These results add another dimension to the use of RNA‐seq as a clinical tool, where both gene expression‐ and mutation‐based biomarkers can be interrogated in real‐time within 1 week of tumor sampling.
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Affiliation(s)
- Christian Brueffer
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden
| | - Sergii Gladchuk
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden
| | - Christof Winter
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden
| | - Johan Vallon-Christersson
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Cecilia Hegardt
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Jari Häkkinen
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden
| | - Anthony M George
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden
| | - Yilun Chen
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden
| | - Anna Ehinger
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden.,Department of Pathology, Skåne University Hospital, Lund, Sweden
| | - Christer Larsson
- Lund University Cancer Center, Lund, Sweden.,Division of Molecular Pathology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Niklas Loman
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden.,Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Martin Malmberg
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Lisa Rydén
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Åke Borg
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Lao H Saal
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Lund University Cancer Center, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
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18
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Dahlgren M, George AM, Brueffer C, Gladchuk S, Chen Y, Vallon-Christersson J, Hegardt C, Häkkinen J, Rydén L, Malmberg M, Larsson C, Gruvberger-Saal SK, Ehinger A, Loman N, Borg Å, Saal LH. Abstract CT074: Pre-existing ESR1 mutations in early-stage primary breast cancer predict failure of endocrine therapy and poor survival. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: More than three-quarters of primary breast cancers are positive for estrogen receptor alpha (ER; encoded by the gene ESR1), the most important factor for directing anti-estrogenic endocrine therapy. Although mutation in ESR1 is known as an acquired mechanism of resistance to endocrine therapy (ET), found in 12-55% of metastatic breast cancers treated previously with ET, the impact of ESR1 mutation on therapy response in primary breast cancer is unclear. Patients and methods: In this study we analyzed 3217 real-world and population-based early-stage primary breast cancers (within the SCAN-B study, ClinicalTrials.gov NCT02306096). Tissues were sampled from initial diagnosis prior to any treatment and analyzed for the presence of ESR1 mutations using RNA sequencing. Mutations were verified by SAGAsafe droplet digital PCR. Results: We identified ESR1 resistance mutations in 30 cases (0.9%), of which 29 were ER-positive (1.1%). In ER-positive disease, presence of ESR1 mutation was significantly associated to poor relapse-free survival (RFS) and overall survival (OS) (p=0.011 and p=0.019, respectively), and moreover predicted poor RFS and OS within the patient group that received ET (p=0.007 and p=0.010, respectively). Conclusions: These results indicate that ESR1 mutations at diagnosis of untreated primary breast cancer are rare, however we confirm for the first time that such early mutations predict eventual resistance to standard hormone therapy in the adjuvant setting. If replicated, tumor ESR1 screening may be considered in ER-positive primary breast cancer and, in mutated cases, ER-degraders such as fulvestrant or other therapeutic options may be considered as more appropriate.
Citation Format: Malin Dahlgren, Anthony M. George, Christian Brueffer, Sergii Gladchuk, Yilun Chen, Johan Vallon-Christersson, Cecilia Hegardt, Jari Häkkinen, Lisa Rydén, Martin Malmberg, Christer Larsson, Sofia K. Gruvberger-Saal, Anna Ehinger, Niklas Loman, Åke Borg, Lao H. Saal. Pre-existing ESR1 mutations in early-stage primary breast cancer predict failure of endocrine therapy and poor survival [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT074.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lisa Rydén
- 2Skåne University Hospital, Lund, Sweden
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19
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Glodzik D, Bosch A, Hartman J, Aine M, Vallon-Christersson J, Reuterswärd C, Karlsson A, Mitra S, Niméus E, Holm K, Häkkinen J, Hegardt C, Saal LH, Larsson C, Malmberg M, Rydén L, Ehinger A, Loman N, Kvist A, Ehrencrona H, Nik-Zainal S, Borg Å, Staaf J. Comprehensive molecular comparison of BRCA1 hypermethylated and BRCA1 mutated triple negative breast cancers. Nat Commun 2020; 11:3747. [PMID: 32719340 PMCID: PMC7385112 DOI: 10.1038/s41467-020-17537-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 02/20/2020] [Accepted: 07/02/2020] [Indexed: 02/08/2023] Open
Abstract
Homologous recombination deficiency (HRD) is a defining characteristic in BRCA-deficient breast tumors caused by genetic or epigenetic alterations in key pathway genes. We investigated the frequency of BRCA1 promoter hypermethylation in 237 triple-negative breast cancers (TNBCs) from a population-based study using reported whole genome and RNA sequencing data, complemented with analyses of genetic, epigenetic, transcriptomic and immune infiltration phenotypes. We demonstrate that BRCA1 promoter hypermethylation is twice as frequent as BRCA1 pathogenic variants in early-stage TNBC and that hypermethylated and mutated cases have similarly improved prognosis after adjuvant chemotherapy. BRCA1 hypermethylation confers an HRD, immune cell type, genome-wide DNA methylation, and transcriptional phenotype similar to TNBC tumors with BRCA1-inactivating variants, and it can be observed in matched peripheral blood of patients with tumor hypermethylation. Hypermethylation may be an early event in tumor development that progress along a common pathway with BRCA1-mutated disease, representing a promising DNA-based biomarker for early-stage TNBC.
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Affiliation(s)
- Dominik Glodzik
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
- Wellcome Sanger Institute, Wellcome Genome Campus, CB10 1SA, Cambridge, UK
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ana Bosch
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
- Department of Oncology, Skåne University Hospital, SE-22184, Lund, Sweden
| | - Johan Hartman
- Department of Oncology and Pathology, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - Mattias Aine
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
- Division of Molecular Hematology, Department of Laboratory Medicine, Lund University, SE-22184, Lund, Sweden
| | - Johan Vallon-Christersson
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
| | - Christel Reuterswärd
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
| | - Anna Karlsson
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
| | - Shamik Mitra
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
| | - Emma Niméus
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
- Division of Surgery, Department of Clinical Sciences, Lund University, SE-22184, Lund, Sweden
| | - Karolina Holm
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
| | - Jari Häkkinen
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
| | - Cecilia Hegardt
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
| | - Lao H Saal
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
| | - Christer Larsson
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Medicon Village, SE-22381, Lund, Sweden
| | - Martin Malmberg
- Department of Oncology, Skåne University Hospital, SE-22184, Lund, Sweden
| | - Lisa Rydén
- Division of Surgery, Department of Clinical Sciences, Lund University, SE-22184, Lund, Sweden
| | - Anna Ehinger
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
- Department of Genetics and Pathology, Laboratory Medicine, Region Skåne, SE-22184, Lund, Sweden
| | - Niklas Loman
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
- Department of Oncology, Skåne University Hospital, SE-22184, Lund, Sweden
| | - Anders Kvist
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
| | - Hans Ehrencrona
- Department of Genetics and Pathology, Laboratory Medicine, Region Skåne, SE-22184, Lund, Sweden
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, SE-22184, Lund, Sweden
| | - Serena Nik-Zainal
- Academic Department of Medical Genetics, The Clinical School University of Cambridge, Cambridge Biomedical Research Campus, CB2 0QQ, Cambridge, UK
| | - Åke Borg
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden
| | - Johan Staaf
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-22381, Lund, Sweden.
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20
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Larsson C, Ehinger A, Winslow S, Leandersson K, Klintman M, Dahl L, Vallon-Christersson J, Häkkinen J, Hegardt C, Manjer J, Saal L, Rydén L, Malmberg M, Borg Å, Loman N. Prognostic implications of the expression levels of different immunoglobulin heavy chain-encoding RNAs in early breast cancer. NPJ Breast Cancer 2020; 6:28. [PMID: 32656317 PMCID: PMC7338507 DOI: 10.1038/s41523-020-0170-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 05/27/2019] [Accepted: 06/02/2020] [Indexed: 12/22/2022] Open
Abstract
The extent and composition of the immune response in a breast cancer is one important prognostic factor for the disease. The aim of the current work was to refine the analysis of the humoral component of an immune response in breast tumors by quantifying mRNA expression of different immunoglobulin classes and study their association with prognosis. We used RNA-Seq data from two local population-based breast cancer cohorts to determine the expression of IGJ and immunoglobulin heavy (IGH) chain-encoding RNAs. The association with prognosis was investigated and public data sets were used to corroborate the findings. Except for IGHE and IGHD, mRNAs encoding heavy chains were generally detected at substantial levels and correlated with other immune-related genes. High IGHG1 mRNA was associated with factors related to poor prognosis such as estrogen receptor negativity, HER2 amplification, and high grade, whereas high IGHA2 mRNA levels were primarily associated with lower age at diagnosis. High IGHA2 and IGJ mRNA levels were associated with a more favorable prognosis both in univariable and multivariable Cox models. When adjusting for other prognostic factors, high IGHG1 mRNA levels were positively associated with improved prognosis. To our knowledge, these results are the first to demonstrate that expression of individual Ig class types has prognostic implications in breast cancer.
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Affiliation(s)
- Christer Larsson
- Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Anna Ehinger
- Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Sofia Winslow
- Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Karin Leandersson
- Cancer Immunology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Marie Klintman
- Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ludvig Dahl
- Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Jari Häkkinen
- Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Cecilia Hegardt
- Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jonas Manjer
- Surgery, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Lao Saal
- Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lisa Rydén
- Surgery, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Martin Malmberg
- Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Åke Borg
- Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Niklas Loman
- Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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21
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Brueffer C, Gladchuk S, Winter C, Vallon-Christersson J, Hegardt C, Häkkinen J, George AM, Chen Y, Ehinger A, Larsson C, Loman N, Malmberg M, Rydén L, Borg Å, Saal LH. Defining the mutational landscape of 3,217 primary breast cancer transcriptomes through large-scale RNA-seq within the Sweden Cancerome Analysis Network: Breast Project (SCAN-B; NCT03430492). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.518] [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
518 Background: Breast cancer is a disease of genomic alterations, of which the complete panorama of somatic mutations and how these relate to molecular subtypes and therapy response is incompletely understood. The Sweden Cancerome Analysis Network-Breast project (SCAN-B; ClinicalTrials.gov NCT02306096) is a multi-center population-based ongoing prospective observational study elucidating the global transcriptomic profiles for thousands of patients and tumors using RNA sequencing. Since September 2010, over 15,000 patients with breast cancer have been enrolled at 9 hospitals across a wide geography of Sweden, comprising greater than 90% of all eligible patients in the catchment area. Methods: Within SCAN-B, we developed an optimized bioinformatics pipeline for detection of single nucleotide variants and small insertions and deletions from RNA-seq data. From this, we describe the mutational landscape of 3,217 primary breast cancer transcriptomes, and relate it to patient overall survival in a real-world setting (median follow-up 75 months, range 2-105 months). Results: We demonstrate that RNA-seq can be used to call mutations in important breast cancer genes such as PIK3CA, TP53, ESR1, and ERBB2, as well as mutation status of key molecular pathways and tumor mutational burden, identify mutations in one or more potentially druggable genes in 85.3% percent of cases, and reveal significant relationships to patient outcome within specific treatment groups. To make this rich and growing mutational portraiture of breast cancer available for the wider research community, we developed an open source interactive web application, SCAN-B MutationExplorer, publicly accessible at http://oncogenomics.bmc.lu.se/MutationExplorer . Conclusions: These results add another dimension to the use of RNA-seq as a potential clinical tool, where both gene expression-based signatures and gene mutation-based biomarkers can be interrogated simultaneously and in real-time within one week of tumor sampling.
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Affiliation(s)
| | | | | | | | | | | | | | - Yilun Chen
- Lund University, Division of Oncology, Lund, Sweden
| | - Anna Ehinger
- Skåne University Hospital, Department of Pathology, Lund, Sweden
| | | | - Niklas Loman
- Skåne University Hospital, Department of Oncology, Lund, Sweden
| | - Martin Malmberg
- Skåne University Hospital, Department of Oncology, Helsingborg, Sweden
| | - Lisa Rydén
- Skåne University Hospital, Department of Surgery, Lund, Sweden
| | - Åke Borg
- Lund University, Division of Oncology, Lund, Sweden
| | - Lao H. Saal
- Lund University, Division of Oncology, Lund, Sweden
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22
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Loibl S, Huang CS, Mano M, Mamounas T, Geyer C, Untch M, von Minckwitz G, Thery JC, Schwaner I, Limentani S, Loman N, Lübbe K, Chang J, Hatschek T, Tesarowski D, Boulet T, Wiese C, Song C, Wolmark N. 96O Adjuvant trastuzumab emtansine (T-DM1) vs trastuzumab (T) in patients (pts) with residual invasive disease after neoadjuvant therapy for HER2+ breast cancer: Subgroup analysis from KATHERINE. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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23
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Mehmeti M, Bergenfelz C, Bexell D, Carlsson R, Hellsten R, Larsson AM, Loman N, Riesbeck K, Ahl J, Rydberg-Millrud C, Paul-Visse G, Rydén L, Killander F, Leandersson K. Abstract A73: Human granulocytic myeloid-derived suppressor cells (G-MDSCs) in metastatic breast cancer patients is a heterogeneous population with angiogenic potential in vivo. Cancer Immunol Res 2020. [DOI: 10.1158/2326-6074.tumimm18-a73] [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
MDSCs are potent immunosuppressive myeloid cells that have been implicated in various diseases, including cancer. In humans, MDSCs are divided into Mo-GMDSCs and G-MDSCs subgroups, depending on their surface phenotype and function. While their immunosuppressive properties have been extensively studied, knowledge about their origin and their tumor-promoting functions per se remains scarce. In this study, we demonstrate that G-MDSCs are significantly enriched in the peripheral blood of locoregional recurrent metastatic breast cancer (LRR/MBC) compared to healthy donors. The G-MDSCs display a heterogeneous population with a morphology representing one blast-like and one polymorphonuclear (PMN) population. In a breast cancer xenograft model, co-transplanting G-MDSCs sorted from LRR/MBC together with breast cancer cells significantly promoted angiogenesis and tumor growth. Gene expression profiling analysis revealed that G-MDSCs from LRR/MBC rather clustered with neutrophils from healthy donors, sharing similar expression in genes relevant for angiogenesis, lymphangiogenesis and immunosuppression, but surprisingly not with G-MDSCs from sepsis patients. We conclude that enrichment of G-MDSCs in metastatic breast cancer represents a heterogeneous population of activated neutrophils that can promote angiogenesis and tumor progression, and immature blasts of yet unknown character.
Citation Format: Meliha Mehmeti, Caroline Bergenfelz, Daniel Bexell, Robert Carlsson, Rebecka Hellsten, Anna-Maria Larsson, Niklas Loman, Kristian Riesbeck, Jonas Ahl, Camilla Rydberg-Millrud, Gesine Paul-Visse, Lisa Rydén, Fredrika Killander, Karin Leandersson. Human granulocytic myeloid-derived suppressor cells (G-MDSCs) in metastatic breast cancer patients is a heterogeneous population with angiogenic potential in vivo [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2018 Nov 27-30; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(4 Suppl):Abstract nr A73.
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Affiliation(s)
- Meliha Mehmeti
- 1Department of Translational Medicine, Cancer Immunology, Lund University, Malmö, Sweden,
| | - Caroline Bergenfelz
- 2Department of Translational Medicine, Division of Experimental Infection Medicine, Lund University, Malmö, Sweden,
| | - Daniel Bexell
- 3Translational Cancer Research, Lund University, Lund, Sweden,
| | | | | | - Anna-Maria Larsson
- 6Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden,
| | - Niklas Loman
- 6Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden,
| | | | - Jonas Ahl
- 8Department of Infectious Diseases, Lund University, Malmö, Sweden
| | | | | | - Lisa Rydén
- 6Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden,
| | - Fredrika Killander
- 6Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden,
| | - Karin Leandersson
- 1Department of Translational Medicine, Cancer Immunology, Lund University, Malmö, Sweden,
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Malmberg M, Larsson C, Vallon-Christersson J, Ehinger A, Hegardt C, Killander F, Ryden L, Saal LH, Loman N, Borg Å. Abstract P1-18-10: Preoperative treatment of HER2-positive breast cancer in South Sweden. A retrospective, comprehensive survey of neo-adjuvant treated HER2-positve breast cancer in the SCAN-B project 2010-2017. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-18-10] [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
Introduction: Over the last few years, neoadjuvant therapy has become a standard of care in HER2-positive early breast cancer. This standard has recently been confirmed by the St. Gallen Consensus for stage II and III HER2-positive disease. In neoadjuvant treatment adding anti HER2 treatment almost doubled the pathological complete response (pCR) rate. Later studies have shown a better outcome for patients achieving a pCR compared with those with a non-pCR. The aim of this study is to present a comprehensive description of preoperative treatment in HER2-positive, according to ASCO and Swedish guidelines, breast cancer with detail treatment routines, choice of drugs and regimens as well as adherence to national guidelines and treatment changes over time.
Material: During the period October 2010 to December 2017 6572 patients with early breast cancer were diagnosed in the Skåne region of South Sweden and included in the SCAN-B project (Sweden Cancerome Analysis Network - Breast project, ClinicalTrials.gov identifier NCT02306096). The SCAN-B project is a population based study that during the period included 76.7% of all primary breast cancer patients in the catchment area. The majority of all tumors have been analyzed by NGS-based RNA sequencing, RNAseq.
Results: Of the 6572 patients 672 (10.2%) were HER2 positive and of these 101 (15%) were treated in a neoadjuvant setting with chemotherapy and HER2 directed antibodies. The proportion of HER2-positive patients receiving neoadjuvant treatment with trastuzumab increased from 9% in 2010 to 29% in 2017. Patient age was 27 to 89 years, median age 54 years. Pertuzumab was introduced in 2016 and in 2017 85% of patients received the combination of trastuzumab and pertuzumab. At diagnosis tumor stage T1, T2, T3 and T4d was 19%, 60%, 14% and 5% respectively and 50% were node negative at sentinel node biopsy pre treatment. Of tumors 52% were estrogen receptor positive (ie >10% stained nuclei). During the neoadjuvant treatment period 31 patients were hospitalized at median 2 times for toxicity and a total of medium 4.7 days. At surgery 62% had a mastectomy and 38% breast conserving surgery. Follow up time is median 3.9 years and overall survival 94%.
Conclusions: This retrospective analysis of neoadjuvant treated HER2-positive breast cancer patients shows a gradual increase of neoadjuvant treatment and a very fast implementation of pertuzumab when it became available in Sweden. Overall survival is high but the follow up time is short and the material to small to analyze subgroups. Data on tumor RNAseq will be presented.
Citation Format: Martin Malmberg, Christer Larsson, Johan Vallon-Christersson, Anna Ehinger, Cecilia Hegardt, Fredrika Killander, Lisa Ryden, Lao H. Saal, Niklas Loman, Åke Borg. Preoperative treatment of HER2-positive breast cancer in South Sweden. A retrospective, comprehensive survey of neo-adjuvant treated HER2-positve breast cancer in the SCAN-B project 2010-2017 [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-18-10.
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Affiliation(s)
| | | | | | - Anna Ehinger
- 4Department of Clinical Genetics and Pathology, Lund University Hospital, Sweden
| | - Cecilia Hegardt
- 5Lund University Cancer Center, Medicon Village, Lund University, Sweden
| | | | - Lisa Ryden
- 6Department of Surgery, Lund University Hospital, Sweden
| | - Lao H. Saal
- 5Lund University Cancer Center, Medicon Village, Lund University, Sweden
| | - Niklas Loman
- 1Dept. of Oncology, Lund University Hospital, Sweden
| | - Åke Borg
- 5Lund University Cancer Center, Medicon Village, Lund University, Sweden
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Lundgren C, Bendahl PO, Borg Å, Ehinger A, Hegardt C, Larsson C, Loman N, Malmberg M, Olofsson H, Saal LH, Sjöblom T, Lindman H, Klintman M, Häkkinen J, Vallon-Christersson J, Fernö M, Rydén L, Ekholm M. Agreement between molecular subtyping and surrogate subtype classification: a contemporary population-based study of ER-positive/HER2-negative primary breast cancer. Breast Cancer Res Treat 2019; 178:459-467. [PMID: 31432367 PMCID: PMC6797629 DOI: 10.1007/s10549-019-05378-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/13/2019] [Accepted: 07/24/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Oestrogen receptor-positive (ER+) and human epidermal receptor 2-negative (HER2-) breast cancers are classified as Luminal A or B based on gene expression, but immunohistochemical markers are used for surrogate subtyping. The aims of this study were to examine the agreement between molecular subtyping (MS) and surrogate subtyping and to identify subgroups consisting mainly of Luminal A or B tumours. METHODS The cohort consisted of 2063 patients diagnosed between 2013-2017, with primary ER+/HER2- breast cancer, analysed by RNA sequencing. Surrogate subtyping was performed according to three algorithms (St. Gallen 2013, Maisonneuve and our proposed Grade-based classification). Agreement (%) and kappa statistics (κ) were used as concordance measures and ROC analysis for luminal distinction. Ki67, progesterone receptor (PR) and histological grade (HG) were further investigated as surrogate markers. RESULTS The agreement rates between the MS and St. Gallen 2013, Maisonneuve and Grade-based classifications were 62% (κ = 0.30), 66% (κ = 0.35) and 70% (κ = 0.41), respectively. PR did not contribute to distinguishing Luminal A from B tumours (auROC = 0.56). By classifying HG1-2 tumours as Luminal A-like and HG3 as Luminal B-like, agreement with MS was 80% (κ = 0.46). Moreover, by combining HG and Ki67 status, a large subgroup of patients (51% of the cohort) having > 90% Luminal A tumours could be identified. CONCLUSIONS Agreement between MS and surrogate classifications was generally poor. However, a post hoc analysis showed that a combination of HG and Ki67 could identify patients very likely to have Luminal A tumours according to MS.
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Affiliation(s)
- Christine Lundgren
- Department of Oncology, Jönköping, Region Jönköping County, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.
| | - Pär-Ola Bendahl
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Åke Borg
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Anna Ehinger
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Cecilia Hegardt
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Christer Larsson
- Department of Laboratory Medicine Lund, Division of Translational Cancer Research, Lund University, Lund, Sweden
| | - Niklas Loman
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Martin Malmberg
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Helena Olofsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Lao H Saal
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Tobias Sjöblom
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Henrik Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Marie Klintman
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Jari Häkkinen
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Johan Vallon-Christersson
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Mårten Fernö
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Lisa Rydén
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden
| | - Maria Ekholm
- Department of Oncology, Jönköping, Region Jönköping County, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
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Staaf J, Glodzik D, Bosch A, Vallon-Christersson J, Reuterswärd C, Häkkinen J, Degasperi A, Amarante TD, Saal LH, Hegardt C, Stobart H, Ehinger A, Larsson C, Rydén L, Loman N, Malmberg M, Kvist A, Ehrencrona H, Davies HR, Borg Å, Nik-Zainal S. Whole-genome sequencing of triple-negative breast cancers in a population-based clinical study. Nat Med 2019; 25:1526-1533. [PMID: 31570822 PMCID: PMC6859071 DOI: 10.1038/s41591-019-0582-4] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [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: 05/22/2019] [Accepted: 08/15/2019] [Indexed: 01/12/2023]
Abstract
Whole-genome sequencing (WGS) brings comprehensive insights to cancer genome interpretation. To explore the clinical value of WGS, we sequenced 254 triple-negative breast cancers (TNBCs) for which associated treatment and outcome data were collected between 2010 and 2015 via the population-based Sweden Cancerome Analysis Network-Breast (SCAN-B) project (ClinicalTrials.gov ID:NCT02306096). Applying the HRDetect mutational-signature-based algorithm to classify tumors, 59% were predicted to have homologous-recombination-repair deficiency (HRDetect-high): 67% explained by germline/somatic mutations of BRCA1/BRCA2, BRCA1 promoter hypermethylation, RAD51C hypermethylation or biallelic loss of PALB2. A novel mechanism of BRCA1 abrogation was discovered via germline SINE-VNTR-Alu retrotransposition. HRDetect provided independent prognostic information, with HRDetect-high patients having better outcome on adjuvant chemotherapy for invasive disease-free survival (hazard ratio (HR) = 0.42; 95% confidence interval (CI) = 0.2-0.87) and distant relapse-free interval (HR = 0.31, CI = 0.13-0.76) compared to HRDetect-low, regardless of whether a genetic/epigenetic cause was identified. HRDetect-intermediate, some possessing potentially targetable biological abnormalities, had the poorest outcomes. HRDetect-low cancers also had inadequate outcomes: ~4.7% were mismatch-repair-deficient (another targetable defect, not typically sought) and they were enriched for (but not restricted to) PIK3CA/AKT1 pathway abnormalities. New treatment options need to be considered for now-discernible HRDetect-intermediate and HRDetect-low categories. This population-based study advocates for WGS of TNBC to better inform trial stratification and improve clinical decision-making.
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Affiliation(s)
- Johan Staaf
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden.
| | - Dominik Glodzik
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Ana Bosch
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Johan Vallon-Christersson
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Christel Reuterswärd
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Jari Häkkinen
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Andrea Degasperi
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
- Academic Department of Medical Genetics, The Clinical School University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Tauanne Dias Amarante
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
- Academic Department of Medical Genetics, The Clinical School University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Lao H Saal
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Cecilia Hegardt
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | | | - Anna Ehinger
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
- Department of Clinical Genetics and Pathology, Department of Laboratory Medicine, Office for Medical Services, Lund, Sweden
| | - Christer Larsson
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Lisa Rydén
- Division of Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Martin Malmberg
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Anders Kvist
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Hans Ehrencrona
- Department of Clinical Genetics and Pathology, Department of Laboratory Medicine, Office for Medical Services, Lund, Sweden
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Helen R Davies
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
- Academic Department of Medical Genetics, The Clinical School University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK
- MRC Cancer Unit, Hutchison/MRC Research Centre, Cambridge Biomedical Research Campus, Cambridge, UK
| | - Åke Borg
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Serena Nik-Zainal
- Academic Department of Medical Genetics, The Clinical School University of Cambridge, Cambridge Biomedical Research Campus, Cambridge, UK.
- MRC Cancer Unit, Hutchison/MRC Research Centre, Cambridge Biomedical Research Campus, Cambridge, UK.
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Förnvik D, Aaltonen KE, Chen Y, George AM, Brueffer C, Rigo R, Loman N, Saal LH, Rydén L. Detection of circulating tumor cells and circulating tumor DNA before and after mammographic breast compression in a cohort of breast cancer patients scheduled for neoadjuvant treatment. Breast Cancer Res Treat 2019; 177:447-455. [PMID: 31236809 PMCID: PMC6661025 DOI: 10.1007/s10549-019-05326-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/25/2019] [Accepted: 06/17/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE It is not known if mammographic breast compression of a primary tumor causes shedding of tumor cells into the circulatory system. Little is known about how the detection of circulating biomarkers such as circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA) is affected by breast compression intervention. METHODS CTCs and ctDNA were analyzed in blood samples collected before and after breast compression in 31 patients with primary breast cancer scheduled for neoadjuvant therapy. All patients had a central venous access to allow administration of intravenous neoadjuvant chemotherapy, which enabled blood collection from superior vena cava, draining the breasts, in addition to sampling from a peripheral vein. RESULTS CTC and ctDNA positivity was seen in 26% and 65% of the patients, respectively. There was a significant increase of ctDNA after breast compression in central blood (p = 0.01), not observed in peripheral testing. No increase related with breast compression was observed for CTC. ctDNA positivity was associated with older age (p = 0.05), and ctDNA increase after breast compression was associated with high Ki67 proliferating tumors (p = 0.04). CTCs were more abundant in central compared to peripheral blood samples (p = 0.04). CONCLUSIONS There was no significant release of CTCs after mammographic breast compression but more CTCs were present in central compared to peripheral blood. No significant difference between central and peripheral levels of ctDNA was observed. The small average increase in ctDNA after breast compression is unlikely to be clinically relevant. The results give support for mammography as a safe procedure from the point of view of CTC and ctDNA shedding to the blood circulation. The results may have implications for the standardization of sampling procedures for circulating tumor markers.
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Affiliation(s)
- Daniel Förnvik
- Department of Translational Medicine, Medical Radiation Physics, Lund University, Malmö, Sweden.
| | - Kristina E Aaltonen
- Department of Laboratory Medicine, Division of Translational Cancer Research, Lund University, Lund, Sweden
| | - Yilun Chen
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Anthony M George
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Christian Brueffer
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Robert Rigo
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Niklas Loman
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Lao H Saal
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Lisa Rydén
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden
- Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden
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Vallon-Christersson J, Häkkinen J, Hegardt C, Saal LH, Larsson C, Ehinger A, Lindman H, Olofsson H, Sjöblom T, Wärnberg F, Ryden L, Loman N, Malmberg M, Borg Å, Staaf J. Cross comparison and prognostic assessment of breast cancer multigene signatures in a large population-based contemporary clinical series. Sci Rep 2019; 9:12184. [PMID: 31434940 PMCID: PMC6704148 DOI: 10.1038/s41598-019-48570-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 03/27/2019] [Accepted: 08/08/2019] [Indexed: 12/23/2022] Open
Abstract
Multigene expression signatures provide a molecular subdivision of early breast cancer associated with patient outcome. A gap remains in the validation of such signatures in clinical treatment groups of patients within population-based cohorts of unselected primary breast cancer representing contemporary disease stages and current treatments. A cohort of 3520 resectable breast cancers with RNA sequencing data included in the population-based SCAN-B initiative (ClinicalTrials.gov ID NCT02306096) were selected from a healthcare background population of 8587 patients diagnosed within the years 2010-2015. RNA profiles were classified according to 19 reported gene signatures including both gene expression subtypes (e.g. PAM50, IC10, CIT) and risk predictors (e.g. Oncotype DX, 70-gene, ROR). Classifications were analyzed in nine adjuvant clinical assessment groups: TNBC-ACT (adjuvant chemotherapy, n = 239), TNBC-untreated (n = 82), HER2+/ER- with anti-HER2+ ACT treatment (n = 110), HER2+/ER+ with anti-HER2 + ACT + endocrine treatment (n = 239), ER+/HER2-/LN- with endocrine treatment (n = 1113), ER+/HER2-/LN- with endocrine + ACT treatment (n = 243), ER+/HER2-/LN+ with endocrine treatment (n = 423), ER+/HER2-/LN+ with endocrine + ACT treatment (n = 433), and ER+/HER2-/LN- untreated (n = 200). Gene signature classification (e.g., proportion low-, high-risk) was generally well aligned with stratification based on current immunohistochemistry-based clinical practice. Most signatures did not provide any further risk stratification in TNBC and HER2+/ER- disease. Risk classifier agreement (low-, medium/intermediate-, high-risk groups) in ER+ assessment groups was on average 50-60% with occasional pair-wise comparisons having <30% agreement. Disregarding the intermediate-risk groups, the exact agreement between low- and high-risk groups was on average ~80-95%, for risk prediction signatures across all assessment groups. Outcome analyses were restricted to assessment groups of TNBC-ACT and endocrine treated ER+/HER2-/LN- and ER+/HER2-/LN+ cases. For ER+/HER2- disease, gene signatures appear to contribute additional prognostic value even at a relatively short follow-up time. Less apparent prognostic value was observed in the other groups for the tested signatures. The current study supports the usage of gene expression signatures in specific clinical treatment groups within population-based breast cancer. It also stresses the need of further development to reach higher consensus in individual patient classifications, especially for intermediate-risk patients, and the targeting of patients where current gene signatures and prognostic variables provide little support in clinical decision-making.
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Affiliation(s)
- Johan Vallon-Christersson
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Jari Häkkinen
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Cecilia Hegardt
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Lao H Saal
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Christer Larsson
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, SE 22381, Lund, Sweden
| | - Anna Ehinger
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
- Division of Clinical Genetics and Pathology, Department of Laboratory Medicine, SE 22185, Lund, Sweden
| | - Henrik Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University, SE 75185, Uppsala, Sweden
| | - Helena Olofsson
- Department of Immunology, Genetics and Pathology, Uppsala University, SE 75185, Uppsala, Sweden
- Department of Clinical Pathology, Uppsala University Hospital, SE 75185, Uppsala, Sweden
| | - Tobias Sjöblom
- Department of Immunology, Genetics and Pathology, Uppsala University, SE 75185, Uppsala, Sweden
| | - Fredrik Wärnberg
- Department of Surgical Sciences, Uppsala University, SE 75185, Uppsala, Sweden
| | - Lisa Ryden
- Division of Surgery, Department of Clinical Sciences, Lund University, SE 22185, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
- Department of Hematology, Oncology and Radiation physics, Skåne University Hospital, SE 22185, Lund, Sweden
| | - Martin Malmberg
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
- Department of Hematology, Oncology and Radiation physics, Skåne University Hospital, SE 22185, Lund, Sweden
| | - Åke Borg
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden
| | - Johan Staaf
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE 22381, Lund, Sweden.
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Dihge L, Vallon-Christersson J, Hegardt C, Saal LH, Häkkinen J, Larsson C, Ehinger A, Loman N, Malmberg M, Bendahl PO, Borg Å, Staaf J, Rydén L. Prediction of Lymph Node Metastasis in Breast Cancer by Gene Expression and Clinicopathological Models: Development and Validation within a Population-Based Cohort. Clin Cancer Res 2019; 25:6368-6381. [PMID: 31340938 DOI: 10.1158/1078-0432.ccr-19-0075] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/24/2019] [Accepted: 07/22/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE More than 70% of patients with breast cancer present with node-negative disease, yet all undergo surgical axillary staging. We aimed to define predictors of nodal metastasis using clinicopathological characteristics (CLINICAL), gene expression data (GEX), and mixed features (MIXED) and to identify patients at low risk of metastasis who might be spared sentinel lymph node biopsy (SLNB).Experimental Design: Breast tumors (n = 3,023) from the population-based Sweden Cancerome Analysis Network-Breast initiative were profiled by RNA sequencing and linked to clinicopathologic characteristics. Seven machine-learning models present the discriminative ability of N0/N+ in development (n = 2,278) and independent validation cohorts (n = 745) stratified as ER+HER2-, HER2+, and TNBC. Possible SLNB reduction rates are proposed by applying CLINICAL and MIXED predictors. RESULTS In the validation cohort, the MIXED predictor showed the highest area under ROC curves to assess nodal metastasis; AUC = 0.72. For the subgroups, the AUCs for MIXED, CLINICAL, and GEX predictors ranged from 0.66 to 0.72, 0.65 to 0.73, and 0.58 to 0.67, respectively. Enriched proliferation metagene and luminal B features were noticed in node-positive ER+HER2- and HER2+ tumors, while upregulated basal-like features were observed in node-negative TNBC tumors. The SLNB reduction rates in patients with ER+HER2- tumors were 6% to 7% higher for the MIXED predictor compared with the CLINICAL predictor accepting false negative rates of 5% to 10%. CONCLUSIONS Although CLINICAL and MIXED predictors of nodal metastasis had comparable accuracy, the MIXED predictor identified more node-negative patients. This translational approach holds promise for development of classifiers to reduce the rates of SLNB for patients at low risk of nodal involvement.
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Affiliation(s)
- Looket Dihge
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden. .,Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Johan Vallon-Christersson
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Cecilia Hegardt
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Lao H Saal
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Jari Häkkinen
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Christer Larsson
- Department of Laboratory Medicine, Division of Translational Cancer Research, Lund University, Lund, Sweden
| | - Anna Ehinger
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Niklas Loman
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Martin Malmberg
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Pär-Ola Bendahl
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Åke Borg
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Johan Staaf
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Lisa Rydén
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
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Søkilde R, Persson H, Ehinger A, Pirona AC, Fernö M, Hegardt C, Larsson C, Loman N, Malmberg M, Rydén L, Saal L, Borg Å, Vallon-Christerson J, Rovira C. Refinement of breast cancer molecular classification by miRNA expression profiles. BMC Genomics 2019; 20:503. [PMID: 31208318 PMCID: PMC6580620 DOI: 10.1186/s12864-019-5887-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background Accurate classification of breast cancer using gene expression profiles has contributed to a better understanding of the biological mechanisms behind the disease and has paved the way for better prognostication and treatment prediction. Results We found that miRNA profiles largely recapitulate intrinsic subtypes. In the case of HER2-enriched tumors a small set of miRNAs including the HER2-encoded mir-4728 identifies the group with very high specificity. We also identified differential expression of the miR-99a/let-7c/miR-125b miRNA cluster as a marker for separation of the Luminal A and B subtypes. High expression of this miRNA cluster is linked to better overall survival among patients with Luminal A tumors. Correlation between the miRNA cluster and their precursor LINC00478 is highly significant suggesting that its expression could help improve the accuracy of present day’s signatures. Conclusions We show here that miRNA expression can be translated into mRNA profiles and that the inclusion of miRNA information facilitates the molecular diagnosis of specific subtypes, in particular the clinically relevant sub-classification of luminal tumors. Electronic supplementary material The online version of this article (10.1186/s12864-019-5887-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rolf Søkilde
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Scheelevägen 2, 223 81, Lund, Sweden
| | - Helena Persson
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Scheelevägen 2, 223 81, Lund, Sweden
| | - Anna Ehinger
- Clinical Pathology, Laboratory Medicine, Skåne University Hospital, Lund, Sweden
| | - Anna Chiara Pirona
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Scheelevägen 2, 223 81, Lund, Sweden.,German Cancer Research Center DKFZ, Division of Functional Genome Analysis, Heidelberg, Germany
| | - Mårten Fernö
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Scheelevägen 2, 223 81, Lund, Sweden
| | - Cecilia Hegardt
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Scheelevägen 2, 223 81, Lund, Sweden
| | - Christer Larsson
- Division of Translational Cancer Research, Lund University, Lund, Sweden.,BioCARE, Strategic Cancer Research Program, Lund, Sweden
| | - Niklas Loman
- Division of Oncology, Skåne University Hospital, Lund, Sweden
| | - Martin Malmberg
- Division of Oncology, Skåne University Hospital, Lund, Sweden
| | - Lisa Rydén
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Lao Saal
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Scheelevägen 2, 223 81, Lund, Sweden.,BioCARE, Strategic Cancer Research Program, Lund, Sweden
| | - Åke Borg
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Scheelevägen 2, 223 81, Lund, Sweden.,BioCARE, Strategic Cancer Research Program, Lund, Sweden
| | - Johan Vallon-Christerson
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Scheelevägen 2, 223 81, Lund, Sweden
| | - Carlos Rovira
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Scheelevägen 2, 223 81, Lund, Sweden. .,BioCARE, Strategic Cancer Research Program, Lund, Sweden.
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Borgå O, Henriksson R, Bjermo H, Lilienberg E, Heldring N, Loman N. Maximum Tolerated Dose and Pharmacokinetics of Paclitaxel Micellar in Patients with Recurrent Malignant Solid Tumours: A Dose-Escalation Study. Adv Ther 2019; 36:1150-1163. [PMID: 30879251 PMCID: PMC6824363 DOI: 10.1007/s12325-019-00909-6] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 12/25/2022]
Abstract
Introduction A water-soluble Cremophor EL-free formulation of paclitaxel, in which retinoic acid derivates solubilize paclitaxel by forming micelles (paclitaxel micellar), was studied for the first time in man to establish the maximum tolerated dose (MTD) and to characterize the pharmacokinetics (PK). Methods This was an open-label, one-arm, dose-escalating study in patients with advanced solid malignant tumours, for which no standard therapy was available or had failed. Paclitaxel micellar was given as 1-h intravenous infusion every 21 days for 3 cycles, mainly without premedication. Plasma samples were collected during 24 h at the first cycle and paclitaxel concentrations were assayed by high-performance liquid chromatography. PK was evaluated using a two-compartment model. Results Thirty-four patients received paclitaxel micellar at doses ranging between 90 and 275 mg/m2. MTD was established as 250 mg/m2. Fatigue and neuropathy were the most frequent dose-limiting toxicities. No hypersensitivity reactions were observed. PK of paclitaxel was evaluated in 25 data sets. Paclitaxel micellar had a rapid initial distribution phase, mean half-life 0.55 h, estimated to be completed 3 h after dosing and a mean terminal half-life of 8.8 h. Mean clearance was 13.4 L/h/m2 with fivefold interindividual variability. The residual areas after 10 h and 24 h were 15.7 ± 8.6% and 5.7 ± 3.9% of the area under the plasma concentration–time curve to infinite time (AUCinf), respectively. Conclusion No new side effects unknown for paclitaxel were observed. Maximum plasma concentration (Cmax) and AUCinf showed a tendency to increase linearly with dose within the 150–275 mg/m2 dose range. The possibility to administer paclitaxel micellar without steroid premedication makes it an attractive candidate for further studies in combination with immunotherapy. Trial Registration EudraCT no: 2004-001821-54. Funding Oasmia Pharmaceutical AB.
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Affiliation(s)
- Olof Borgå
- Borgå PK Consulting, Pär Lagerkvists gata 34, 112 15, Stockholm, Sweden
| | - Roger Henriksson
- Department of Radiation Sciences, Oncology, Umeå University, 901 87, Umeå, Sweden
| | - Helena Bjermo
- Oasmia Pharmaceutical AB, Vallongatan 1, 752 28, Uppsala, Sweden
| | - Elsa Lilienberg
- Oasmia Pharmaceutical AB, Vallongatan 1, 752 28, Uppsala, Sweden
| | - Nina Heldring
- Oasmia Pharmaceutical AB, Vallongatan 1, 752 28, Uppsala, Sweden.
| | - Niklas Loman
- Department of Oncology, Lund University Hospital, Skåne University Hospital, 221 85, Lund, Sweden
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32
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Haugen M, Lingjærde O, Garred Ø, Hedenfalk I, Loman N, Mills G, Borresen-Dale AL, Naume B, Mælandsmo G, Engebråten O. Design of a protein signature predicting response to neo-adjuvant treatment with chemotherapy combined with bevacizumab in breast cancer patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz095.022] [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: 11/13/2022] Open
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Rydén L, Loman N, Larsson C, Hegardt C, Vallon-Christersson J, Malmberg M, Lindman H, Ehinger A, Saal LH, Borg Å. Minimizing inequality in access to precision medicine in breast cancer by real-time population-based molecular analysis in the SCAN-B initiative. Br J Surg 2018; 105:e158-e168. [PMID: 29341157 PMCID: PMC5817401 DOI: 10.1002/bjs.10741] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/30/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Selection of systemic therapy for primary breast cancer is currently based on clinical biomarkers along with stage. Novel genomic tests are continuously being introduced as more precise tools for guidance of therapy, although they are often developed for specific patient subgroups. The Sweden Cancerome Analysis Network - Breast (SCAN-B) initiative aims to include all patients with breast cancer for tumour genomic analysis, and to deliver molecular subtype and mutational data back to the treating physician. METHODS An infrastructure for collection of blood and fresh tumour tissue from all patients newly diagnosed with breast cancer was set up in 2010, initially including seven hospitals within the southern Sweden regional catchment area, which has 1.8 million inhabitants. Inclusion of patients was implemented into routine clinical care, with collection of tumour tissue at local pathology departments for transport to the central laboratory, where routines for rapid sample processing, RNA sequencing and biomarker reporting were developed. RESULTS More than 10 000 patients from nine hospitals have currently consented to inclusion in SCAN-B with high (90 per cent) inclusion rates from both university and secondary hospitals. Tumour samples and successful RNA sequencing are being obtained from more than 70 per cent of patients, showing excellent representation compared with the national quality registry as a truly population-based cohort. Molecular biomarker reports can be delivered to multidisciplinary conferences within 1 week. CONCLUSION Population-based collection of fresh tumour tissue is feasible given a decisive joint effort between academia and collaborative healthcare groups, and with governmental support. An infrastructure for genomic analysis and prompt data output paves the way for novel systemic therapy for patients from all hospitals, irrespective of size and location.
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Affiliation(s)
- L Rydén
- Department of Clinical Sciences Lund, Surgery, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - N Loman
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden.,Department of Haematology, Oncology and Radiotherapy, Skåne University Hospital, Lund, Sweden
| | - C Larsson
- Department of Laboratory Medicine Lund, Translational Cancer Research, Lund University, Lund, Sweden
| | - C Hegardt
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | - J Vallon-Christersson
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | - M Malmberg
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden.,Department of Haematology, Oncology and Radiotherapy, Skåne University Hospital, Lund, Sweden
| | - H Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - A Ehinger
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden.,Department of Pathology and Cytology, Medicinsk Service, Skåne University Hospital, Lund, Sweden
| | - L H Saal
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | - Å Borg
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden
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34
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Nilsson MP, Nilsson ED, Borg Å, Brandberg Y, Silfverberg B, Loman N. High patient satisfaction with a simplified BRCA1/2 testing procedure: long-term results of a prospective study. Breast Cancer Res Treat 2018; 173:313-318. [PMID: 30311024 PMCID: PMC6394590 DOI: 10.1007/s10549-018-5000-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 09/09/2018] [Accepted: 10/08/2018] [Indexed: 02/01/2023]
Abstract
Purpose In the BRCAsearch study, unselected breast cancer patients were prospectively offered germline BRCA1/2 mutation testing through a simplified testing procedure. The purpose of the present study was to evaluate satisfaction with the BRCAsearch testing procedure and, furthermore, to report on uptake rates of prophylactic surgeries among mutation carriers. Methods Pre-test information was provided by a standardized invitation letter instead of in-person genetic counseling. The patients were offered contact with a genetic counselor for telephone genetic counseling if they felt a need for that. Mutation carriers were telephoned and given a time for a face-to-face post-test genetic counseling appointment. Non-carriers were informed about the test result through a letter. One year after the test results were delivered, a study-specific questionnaire was mailed to the study participants who had consented to testing. The response rate was 83.1% (448 of 539). Results A great majority (96.0%) of the responders were content with the method used for providing information within the study, and 98.7% were content with having pursued genetic testing. 11.1% answered that they would have liked to receive more oral information. In an adjusted logistic regression model, patients with somatic comorbidity (OR 2.56; P = 0.02) and patients born outside of Sweden (OR 3.54; P = 0.01) were more likely, and patients with occupations requiring at least 3 years of university or college education (OR 0.37; P = 0.06) were less likely to wanting to receive more oral information. All 11 mutation carriers attended post-test genetic counseling. At a median follow-up of 2 years, the uptake of prophylactic salpingo-oophorectomy was 100%, and the uptake of prophylactic mastectomy was 55%. Conclusions Satisfaction with a simplified BRCA1/2 testing procedure was very high. Written pre-test information has now replaced in-person pre-test counseling for breast cancer patients in our health care region. Electronic supplementary material The online version of this article (10.1007/s10549-018-5000-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin P Nilsson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden. .,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
| | - Erik D Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Åke Borg
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Silfverberg
- Department of Clinical Genetics, Laboratory Medicine Region Skåne, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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Matikas A, Lövrot J, Ramberg A, Eriksson M, Lindsten T, Lekberg T, Hedenfalk I, Loman N, Bergh J, Hatschek T, Erlandsson A, Foukakis T. Dynamic evaluation of the immune infiltrate and immune function genes as predictive markers for neoadjuvant chemotherapy in hormone receptor positive, HER2 negative breast cancer. Oncoimmunology 2018; 7:e1466017. [PMID: 30228933 PMCID: PMC6140817 DOI: 10.1080/2162402x.2018.1466017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 12/29/2022] Open
Abstract
Gene expression (GE) signatures and Tumor Infiltrating Lymphocytes (TIL) enumeration are predictive for response to neoadjuvant chemotherapy in HR- and in HER2+ breast cancer, but data are conflicting in HR+/HER2- disease. This study aimed to explore their predictive value in this subset, measured both at baseline and after short exposure to chemotherapy. Specifically, the PROMIX phase 2 trial enrolled patients with locally advanced HER2- BC to receive six cycles of epirubicin and docetaxel, plus bevacizumab during cycles 3-6. Patients underwent tumor biopsies at baseline and after cycle 2 for GE profiling and enumeration of TIL, FOXP3+ T-cells and CD163+ macrophages. An immune related gene module and the quantification of the immune infiltrate were analyzed for association with pathologic complete response (pCR), decrease in tumor size and disease-free survival (DFS). Of the 150 patients enrolled in PROMIX, 113 were HR+/HER2-. Baseline GE and immune cell enumeration data were available from 71 patients, while data after 2 cycles of chemotherapy were available from 41. At baseline, only GE was statistically significantly associated with higher pCR rates (OR 2.29, 95% CI 1.05 - 5.38, p = 0.037) and decrease in tumor size (r = 0.25, p = 0.047). In contrast, longitudinal data indicate that both GE (r = 0.54, p<0.001) and TIL abundance (p = 0.009) are stronger predictors for the reduction of tumor size, while low FOXP3+ was statistically significantly associated with an improved DFS (p = 0.027). In conclusion, GE analysis, TIL and FOXP3+ enumeration after short-term exposure to chemotherapy carry important predictive information in HR+/HER2- breast cancer at the neoadjuvant setting.
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Affiliation(s)
- Alexios Matikas
- Department of Oncology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - John Lövrot
- Department of Oncology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Anna Ramberg
- Department of Clinical Pathology and Cytology, Central Hospital Karlstad, Karlstad, Sweden
| | - Margareta Eriksson
- Department of Clinical Pathology and Cytology, Central Hospital Karlstad, Karlstad, Sweden
| | - Therese Lindsten
- Department of Clinical Pathology and Cytology, Central Hospital Karlstad, Karlstad, Sweden
| | - Tobias Lekberg
- Department of Oncology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | | | - Niklas Loman
- Department of Oncology/Pathology, Lund University, Lund, Sweden
| | - Jonas Bergh
- Department of Oncology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Thomas Hatschek
- Department of Oncology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Ann Erlandsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Biology, Karlstad university, Karlstad, Sweden
| | - Theodoros Foukakis
- Department of Oncology, Karolinska Institutet and University Hospital, Stockholm, Sweden
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Larsson AM, Jansson S, Bendahl PO, Levin Tykjaer Jörgensen C, Loman N, Graffman C, Lundgren L, Aaltonen K, Rydén L. Longitudinal enumeration and cluster evaluation of circulating tumor cells improve prognostication for patients with newly diagnosed metastatic breast cancer in a prospective observational trial. Breast Cancer Res 2018; 20:48. [PMID: 29884204 PMCID: PMC5994056 DOI: 10.1186/s13058-018-0976-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/02/2018] [Indexed: 01/24/2023] Open
Abstract
Background Circulating tumor cells (CTCs) carry independent prognostic information in patients with metastatic breast cancer (MBC) on different lines of therapy. Moreover, CTC clusters are suggested to add prognostic information to CTC enumeration alone but their significance is unknown in patients with newly diagnosed MBC. We aimed to evaluate whether longitudinal enumeration of circulating tumor cells (CTCs) and CTC clusters could improve prognostication and monitoring of patients with metastatic breast cancer (MBC) starting first-line therapy. Methods This prospective study included 156 women with newly diagnosed MBC. CTCs and CTC clusters were detected using CellSearch technology at baseline (BL) and after 1, 3, and 6 months of systemic therapy. The primary end point was progression-free survival (PFS) and the secondary end point overall survival (OS). Median follow-up time was 25 (7–69) months. Results There were 79 (52%) and 30 (20%) patients with ≥ 5 CTCs and ≥ 1 CTC cluster at baseline, respectively; both factors were significantly associated with impaired survival. Landmark analyses based on follow-up measurements revealed increasing prognostic hazard ratios for ≥ 5 CTCs and CTC clusters during treatment, predicting worse PFS and OS. Both factors added value to a prognostic model based on clinicopathological variables at all time points and ≥ 5 CTCs and presence of CTC clusters enhanced the model’s C-index to > 0.80 at 1, 3, and 6 months. Importantly, changes in CTCs during treatment were significantly correlated with survival and patients with a decline from ≥ 5 CTCs at BL to < 5 CTCs at 1 month had a similar odds ratio for progression to patients with < 5 CTCs at BL and 1 month. Stratification of patients based on CTC count and CTC clusters into four groups (0 CTCs, 1–4 CTCs, ≥ 5 CTCs, and ≥ 1 CTC + CTC clusters) demonstrated that patients with CTC clusters had significantly worse survival compared to patients without clusters. Conclusions Longitudinal evaluation of CTC and CTC clusters improves prognostication and monitoring in patients with MBC starting first-line systemic therapy. The prognostic value increases over time, suggesting that changes in CTC count are clinically relevant. The presence of CTC clusters adds significant prognostic value to CTC enumeration alone. Trial registration NCT01322893. Registered on 25 March 2011. Electronic supplementary material The online version of this article (10.1186/s13058-018-0976-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna-Maria Larsson
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sara Jansson
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Pär-Ola Bendahl
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | | | - Niklas Loman
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Cecilia Graffman
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Lotta Lundgren
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Kristina Aaltonen
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Lisa Rydén
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Medicon Village, SE-223 81, Lund, Sweden. .,Department of Surgery and Gastroenterology, Skåne University Hospital, Malmö, Sweden.
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Brueffer C, Vallon-Christersson J, Grabau D, Ehinger A, Häkkinen J, Hegardt C, Malina J, Chen Y, Bendahl PO, Manjer J, Malmberg M, Larsson C, Loman N, Rydén L, Borg Å, Saal LH. Clinical Value of RNA Sequencing-Based Classifiers for Prediction of the Five Conventional Breast Cancer Biomarkers: A Report From the Population-Based Multicenter Sweden Cancerome Analysis Network-Breast Initiative. JCO Precis Oncol 2018; 2:1700135. [PMID: 32913985 PMCID: PMC7446376 DOI: 10.1200/po.17.00135] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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
Purpose In early breast cancer (BC), five conventional biomarkers-estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), Ki67, and Nottingham histologic grade (NHG)-are used to determine prognosis and treatment. We aimed to develop classifiers for these biomarkers that were based on tumor mRNA sequencing (RNA-seq), compare classification performance, and test whether such predictors could add value for risk stratification. Methods In total, 3,678 patients with BC were studied. For 405 tumors, a comprehensive multi-rater histopathologic evaluation was performed. Using RNA-seq data, single-gene classifiers and multigene classifiers (MGCs) were trained on consensus histopathology labels. Trained classifiers were tested on a prospective population-based series of 3,273 BCs that included a median follow-up of 52 months (Sweden Cancerome Analysis Network-Breast [SCAN-B], ClinicalTrials.gov identifier: NCT02306096), and results were evaluated by agreement statistics and Kaplan-Meier and Cox survival analyses. Results Pathologist concordance was high for ER, PgR, and HER2 (average κ, 0.920, 0.891, and 0.899, respectively) but moderate for Ki67 and NHG (average κ, 0.734 and 0.581). Concordance between RNA-seq classifiers and histopathology for the independent cohort of 3,273 was similar to interpathologist concordance. Patients with discordant classifications, predicted as hormone responsive by histopathology but non-hormone responsive by MGC, had significantly inferior overall survival compared with patients who had concordant results. This extended to patients who received no adjuvant therapy (hazard ratio [HR], 3.19; 95% CI, 1.19 to 8.57), or endocrine therapy alone (HR, 2.64; 95% CI, 1.55 to 4.51). For cases identified as hormone responsive by histopathology and who received endocrine therapy alone, the MGC hormone-responsive classifier remained significant after multivariable adjustment (HR, 2.45; 95% CI, 1.39 to 4.34). Conclusion Classification error rates for RNA-seq-based classifiers for the five key BC biomarkers generally were equivalent to conventional histopathology. However, RNA-seq classifiers provided added clinical value in particular for tumors determined by histopathology to be hormone responsive but by RNA-seq to be hormone insensitive.
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Affiliation(s)
- Christian Brueffer
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Johan Vallon-Christersson
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Dorthe Grabau
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Anna Ehinger
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Jari Häkkinen
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Cecilia Hegardt
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Janne Malina
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Yilun Chen
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Pär-Ola Bendahl
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Jonas Manjer
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Martin Malmberg
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Christer Larsson
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Niklas Loman
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Lisa Rydén
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Åke Borg
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
| | - Lao H Saal
- , , , , , , , , , , , and , Lund University, Lund; , , , , and , Skåne University Hospital Lund, Lund; , Blekinge County Hospital, Karlskrona; and and , Skåne University Hospital Malmö, Malmö, Sweden
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Morgan G, Larsson C, Tahin B, Vallon-Christersson J, Häkkinen J, Ehinger A, Malmberg M, Hegardt C, Borg Å, Rydén L, Saal LH, Hedenfalk I, Loman N. Abstract P3-02-02: Concordance between immunohistochemical and gene-expression based subtyping of early breast cancer using core needle biopsies and surgical specimens - experices from SCAN-B. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-02-02] [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: 11/16/2022]
Abstract
Abstract
Introduction: Preoperative chemotherapy in early breast cancer increases the rate of breast preservation and provides prognostic information. Treatment decisions in these cases rely on biomarker assessments and subtyping from tissue acquired through core needle biopsies. Tumor heterogeneity and representativity are pit-falls when limited tissue is available. Biomarker expression may change considerably as a result of preoperative chemotherapy, and in a subset of cases a complete pathological response at time of surgery may even preclude any further assessment. Therefore, the reliability and reproducibility of biomarkers in base-line core biopsies are of utmost importance for patients treated with preoperative chemotherapy.
Material and Methods: In an ongoing population-based study of early breast cancer, the SCAN-B (NCT02306096), patients were identified for whom an ultra-sound guided core needle biopsy was analyzed for biomarkers during primary clinical work-up and the patient was offered primary surgery as initial treatment. Clinical biomarker profiles including immunohistochemical (IHC) determinations of ER, PgR, HER2 and Ki67 were translated to subtypes according to modified St Gallen criteria (2013) and compared with paired samples from surgical specimens. In addition, tumor specimens for biomolecule extraction and RNA sequencing were collected fresh in RNAlater.
Results: IHC data was available from 51 paired samples. The subtype distribution in core needle biopsies was DCIS in 1 case (2 %), LCIS in 1 case (2 %) Luminal A-like in 16 cases (31 %), Luminal B-like (HER2 negative) in 26 cases (51 %), Luminal B-HER2-like (HER2 positive) in 4 cases (8 %), HER2-positive (non-luminal) in 1 case (2 %) and triple negative (ductal) breast cancer in 2 cases (4 %). The subtype distribution in surgical specimens was DCIS in 0 case (0 %), LCIS in 1 case (2 %) Luminal A-like in 18 cases (35 %), Luminal B-like (HER2negative) in 23 cases (45 %), Luminal B--like (HER2 positive) in 6 cases (12 %), HER2-positive (non-luminal) in 1 case (2 %) and triple negative (ductal) breast cancer in 2 cases (4 %). Notably, 5/16 cases classified as Luminal A-like in the core needle biopsy were reclassified as Luminal B-like (HER2-negative) in the surgical specimen, whereas 9/26 cases classified as Luminal B-like (HER2-negative) in the core needle biopsy were reclassified as either Luminal A-like (7 cases) or Luminal B-like (HER2 positive) (2 cases) in the surgical specimen. In all instances, except one, transition between Luminal A-like and Luminal B-like was due to recorded Ki67 expression. One case that was classified as a DCIS in the core needle was reclassified as Luminal B-like (HER2 negative) at time of surgery.
Discussion: In this limited material, discordance between evaluations regarding Luminal A-like and Luminal B-like was considerable. Especially the misclassification of primary HER2-positive breast cancer needs further evaluation. These findings may be caused by tumor heterogeneity, and highlight the risk of both over- and under-treatment upon biomarker assessment from core needle biopsies. Data from gene expression based subtype classifications will be presented during the meeting.
Citation Format: Morgan G, Larsson C, Tahin B, Vallon-Christersson J, Häkkinen J, Ehinger A, Malmberg M, Hegardt C, Borg Å, Rydén L, Saal LH, Hedenfalk I, Loman N. Concordance between immunohistochemical and gene-expression based subtyping of early breast cancer using core needle biopsies and surgical specimens - experices from SCAN-B [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 P3-02-02.
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Affiliation(s)
- G Morgan
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - C Larsson
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - B Tahin
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - J Vallon-Christersson
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - J Häkkinen
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - A Ehinger
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - M Malmberg
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - C Hegardt
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - Å Borg
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - L Rydén
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - LH Saal
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - I Hedenfalk
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
| | - N Loman
- Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden; Lund University Cancer Centre, Medicon Village, Lund, Sweden; Skåne Univerisity Hospital, Lund, Sweden; Skåne University Hopsital, Malmö, Sweden
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Staaf J, Vallon-Christersson J, Häkkinen J, Saal LH, Hegardt C, Larsson C, Ehinger A, Ryden L, Loman N, Malmberg M, Borg Å. Abstract P1-06-01: Putting multigene signatures to the test: Prognostic assessment in population-based contemporary clinical breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-06-01] [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
Gene expression signatures hold promise for a molecularly driven division of primary breast cancer with clinical implications. A gap still remains in the application/validation of such signatures in actual clinical treatment groups from unselected, population-based, primary breast cancer receiving current standard of care therapy. We analyzed classification proportions and overall survival (OS) of 14 reported gene expression phenotypes (GEPs) and risk predictors (RPs) in seven clinical treatments groups from an 3273-sample breast cancer cohort representative of population-based disease in the South Swedish healthcare region.
Patients and methods
Between 2010-09-01 to 2015-03-31, 5101 (87%) of 5892 patients with invasive primary disease in the healthcare region were included in the SCAN-B study (ClinicalTrials.gov ID: NCT02306096). Inclusion criteria included no generalized/prior contralateral disease and known surgery/treatment status (neo- or adjuvant). 3273 tumors were profiled by RNA sequencing and matched to clinicopathological patient data from the National Breast Cancer Register, with distribution of clinicopathological characteristics reflecting proportions in the catchment region. RNA profiles were classified according to 14 reported gene signatures featuring both GEPs (PAM50, IC10, CIT, TNBCtype) and specific risk predictors (e.g. Oncotype Dx, 70-gene, 76-gene, ROR-variants, genomic grade index). Classifications were investigated for association with patient OS by univariate and multivariate analyses in seven adjuvant clinical treatment groups: TNBC-ACT (adjuvant chemotherapy, n=228), TNBC-untreated (n=83), HER2+/ER- with trastuzumab + ACT treatment (n=101), HER2+/ER+ with trastuzumab + ACT + endocrine treatment (n=210), ER+/HER2- with endocrine treatment (n=1477), ER+/HER2- with endocrine + ACT treatment (n=637), and ER+/HER2- untreated (n=216).
Results
For the majority of signatures, analysis of classification demonstrated prognostic value limited to ER+/HER2- tumors given follow-up time. Several signatures (including Oncotype Dx, 70-gene, ROR-variants) showed strong predictive value in identifying a subset of ER+/HER2- patients receiving a combination of endocrine and ACT therapy with excellent overall survival (>96%), indicating appropriate therapy selection. In addition, for both ER+/HER2- treatment groups signature analysis identified high-risk groups of patients in clear need of additional treatment beyond standard therapeutic regimes, even with less than 5-years of follow-up.
Conclusions
Our results support the prognostic association of gene expression signatures in large unselected population-based primary breast cancer cohorts even with a short follow-up of OS.Importantly, prognostic associations are limited to specific subgroups for different classifiers and in population-based breast cancer some clinically important subgroups constitute a small proportion of cases. In this context, continued population-based inclusion and broad transcriptional profiling of breast cancer patients provides an opportunity for application to broader patient groups (e.g. TNBC and HER2+), and for consensus classification of individual risk assessments that could potentially provide more stable predictions.
Citation Format: Staaf J, Vallon-Christersson J, Häkkinen J, Saal LH, Hegardt C, Larsson C, Ehinger A, Ryden L, Loman N, Malmberg M, Borg Å. Putting multigene signatures to the test: Prognostic assessment in population-based contemporary clinical breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-06-01.
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Affiliation(s)
- J Staaf
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
| | | | - J Häkkinen
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
| | - LH Saal
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
| | - C Hegardt
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
| | - C Larsson
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
| | - A Ehinger
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
| | - L Ryden
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
| | - N Loman
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
| | - M Malmberg
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
| | - Å Borg
- Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden
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Loman N, Chen Y, Aaltonen K, Brueffer C, George AM, Zander L, Vallon-Christersson J, Häkkinen J, Förnvik D, Rigo R, Ehinger A, Malmberg M, Larsson C, Hegardt C, Borg Å, Rydén L, Saal LH. Abstract P2-02-09: Breast cancer subtype distribution and circulating tumor DNA in response to neoadjuvant chemotherapy: Experiences from a preoperative cohort within SCAN-B. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-02-09] [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
Introduction: Preoperative chemotherapy in early breast cancer increases the rate of breast preservation and provides prognostic information. In the case of residual disease, a change in subtypes may be observed. Sensitive and reproducible biomarkers predicting treatment response early during the treatment course are needed in order to better exploit the potential benefit of an individualized preoperative treatment.
Material and Methods: In an ongoing prospective study within the population-based SCAN-B project (NCT02306096), patients undergoing preoperative chemotherapy for early or locally recurrent breast cancer have been treated with iv Epirubicin and Cyclophosphamide q3w x 3 in sequence with either Docetaxel q3w x 3 or Paclitaxel q1w x 9 with a preoperative intent. HER2-positive cases also received HER2-directed treatment. At baseline, patients were staged using sentinel node biopsy for clinically node-negative patients and CT scan for cytologically confirmed node-positive cases. A clinical core needle biopsy as well as tissue from the surgical specimen was collected for determination of conventional biomarkers including ER, PgR, HER2 and Ki67. Tumor biopsies for biomolecule-extraction and RNA-sequencing were taken using ultrasound guidance and collected fresh in RNAlater at baseline, after 2 treatment cycles, as well as at surgery. Blood plasma samples were collected at baseline, after one-, three-, and six- 3w treatment cycles, and post-surgery. Using RNA-sequencing data, somatic mutations were identified in the tumor biopsies and personalized analyses for circulating tumor DNA (ctDNA) were performed. A pathological complete remission (pCR) was defined as the complete disappearance of invasive breast cancer in the breast and axilla at time of definitive surgery. Subtyping was performed using modified St Gallen criteria (2013).
Results: Thus far, 45 patients aged 24-74 years have been included, of which 34 (76 %) were clinical stage 2 and 11 (24%) were stage 3. The subtype distribution at baseline was five Luminal A-like (11 %), 21 Luminal B-like (HER2 negative) (47 %), 8 HER2-positive (18 %) and 11 Triple-negative (ductal) (24 %). The rates of pCR in 38 operated cases to date were 0/3 Luminal A-like, 3/19 Luminal B-like (HER2 negative), 2/8 HER2-positive, and 4/7 Triple-negative (overall 24 % pCR rate). One patient did not undergo surgery due to clinically progressive disease. In 25 cases with evaluable residual disease at surgery, there was a shift in the subtype in 13 (52 %), the majority of which represented a transition from Luminal B to Luminal A. No Triple-negative cases underwent a change in subtype during treatment. Results of the ctDNA analyses will be presented at the meeting.
Discussion: We have established an infrastructure allowing for an extensive evaluation of preoperative chemotherapy in early breast cancer. The goal is to develop methods to refine response-guided treatment in early breast cancer using molecular responses in the tumor as well as in the blood circulation. The patients continue to be prospectively monitored with iterative ctDNA analyses during follow-up.
Citation Format: Loman N, Chen Y, Aaltonen K, Brueffer C, George AM, Zander L, Vallon-Christersson J, Häkkinen J, Förnvik D, Rigo R, Ehinger A, Malmberg M, Larsson C, Hegardt C, Borg Å, Rydén L, Saal LH. Breast cancer subtype distribution and circulating tumor DNA in response to neoadjuvant chemotherapy: Experiences from a preoperative cohort within SCAN-B [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 P2-02-09.
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Affiliation(s)
- N Loman
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - Y Chen
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - K Aaltonen
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - C Brueffer
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - AM George
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - L Zander
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - J Vallon-Christersson
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - J Häkkinen
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - D Förnvik
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - R Rigo
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - A Ehinger
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - M Malmberg
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - C Larsson
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - C Hegardt
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - Å Borg
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - L Rydén
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
| | - LH Saal
- Deartment och Oncology, Skåne University Hospital, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Division of Molecular Pathology, Department of Laboratory Medicine, Lund, Sweden
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Larsson AM, Jansson S, Bendahl PO, Baker S, Graffman C, Lundgren C, Loman N, Aaltonen KE, Rydén L. Abstract P2-01-03: Improved prognostic information by serial monitoring of CTC enumeration and CTC-clusters from baseline to six months in patients with metastatic breast cancer scheduled for 1st line systemic therapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-01-03] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Detection and enumeration of circulating tumor cells (CTCs) allows real time monitoring of disease evolvement. In women with metastatic breast cancer (MBC), a CTC count of ≥5 CTCs is associated with decreased progression-free survival (PFS) and overall survival (OS). Serial sampling after therapy initiation has indicated that longitudinal CTC enumeration adds prognostic information, but data from long time sampling is sparse. The aim of this study was to evaluate if prospective longitudinal detection of CTC count and CTC clusters in women with newly diagnosed MBC can improve prognostication and monitoring of patients in the clinical setting.
Methods: Longitudinal blood samples were collected at baseline (BL) and after 1, 3 and 6 months in 156 women with MBC scheduled for 1st line systemic therapy. CTC enumeration and cluster detection were performed by the CellSearch® system in a prospective monitoring trial (NCT01322893). 115 patients had evaluable samples at all time-points. Primary endpoint was PFS and secondary endpoint was OS at BL in relation to CTC count and as landmark analyses during treatment. In addition, change in CTC count during therapy was compared to progressive disease (PD) versus non-PD. Structured clinical and radiological evaluation for PD was performed every 3rd month.
Results: Seventy-nine (52%) of 152 evaluable patients had ≥5 CTC and 14/79 patients had CTC-clusters (33 clustered CTC) at BL. Median follow-up time was 25 (7-69) months. Patients with ≥5 CTCs had inferior PFS and OS in uni-(data not shown) and multivariable analysis (HRPFS 1.91 (1.26-2.91), P=0.003) (HROS 3.57 (2.02-6.31), P<0.001) at BL. Presence of clusters at BL was prognostic for OS (HROS 2.37 (1.25-4.51), P=0.008). Longitudinal landmark analysis of number of CTCs and presence of CTC clusters showed a time-dependent increase in HR during treatment for CTCs and CTC-clusters and predicted worse PFS and OS at all time-points. Stratifying patients based on CTC count and presence of clusters revealed four risk groups (0, 1-4, ≥5 CTC, ≥5 CTC + clusters) where patients with clusters had inferior PFS and OS at all time points. Change in CTC count from BL to 1 and 3 months, and from 3 to 6 months was significantly related to evaluation at 3 and 6 months (PD vs non-PD, P=0.013 (3 months), P=0.016 (6 months)) and change in CTC count from BL to 1, 3 and 6 months was also significantly predictive of both PFS and OS. Notably, survival was significantly inferior for patients with persistent CTC ≥5 during treatment.
Discussion: CTC is an independent prognostic factor for MBC patients scheduled for 1st line systemic therapy. By longitudinal monitoring during treatment, the prognostic information by presence of ≥5 CTC and clusters increases over time and supports long time monitoring of patients. Importantly, detection of CTC-clusters identifies a subgroup of patients with dismal prognosis at all time-points indicating that CTC-clusters renders important clinical information. Change in CTC count during systemic therapy is related to outcome of evaluation and prognosis at all time-points.
Citation Format: Larsson A-M, Jansson S, Bendahl P-O, Baker S, Graffman C, Lundgren C, Loman N, Aaltonen KE, Rydén L. Improved prognostic information by serial monitoring of CTC enumeration and CTC-clusters from baseline to six months in patients with metastatic breast cancer scheduled for 1st line systemic therapy [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 P2-01-03.
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Affiliation(s)
- A-M Larsson
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - S Jansson
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - P-O Bendahl
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - S Baker
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - C Graffman
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - C Lundgren
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - N Loman
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - KE Aaltonen
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - L Rydén
- Clinical Sciences Lund, Lund University, Lund, Sweden
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Brueffer C, Vallon-Christersson J, Grabau D, Ehinger A, Häkkinen J, Hegardt C, Malina J, Chen Y, Bendahl PO, Manjer J, Malmberg M, Larsson C, Loman N, Ryden L, Borg Å, Saal LH. Abstract P4-09-03: On the development and clinical value of RNA-sequencing-based classifiers for prediction of the five conventional breast cancer biomarkers: A report from the population-based multicenter SCAN-B study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-09-03] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
In early breast cancer, five histopathological biomarkers are part of current clinical routines and used for determining prognosis and treatment: estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (ERBB2/HER2), Ki67, and Nottingham histological grade (NHG). We aimed to develop classifiers for these biomarkers based on tumor mRNA-sequencing (RNA-seq), compare classification performance to conventional histopathology, and test whether RNA-seq-based predictors could add value for patient risk-stratification.
Patients and Methods:
In total, 3678 breast tumors were studied. For 405 breast tumors in the training cohort, a comprehensive histopathological biomarker evaluation was performed by three pathology readings to estimate inter-pathologist variability on the original diagnostic slides as well as on repeat immunostains for this study, and the consensus biomarker status for all five conventional biomarkers was determined. Whole transcriptome gene expression profiling was performed by RNA-sequencing on the Illumina platform. Using RNA-seq-derived tumor gene expression data as input, single-gene classifiers (SGC) and multi-gene classifiers (MGC) were trained on the consensus pathology biomarker labels. The trained classifiers were tested on an independent prospective population-based series of 3273 primary breast cancer cases from the multicenter SCAN-B study with median 41 months follow-up (ClinicalTrials.gov identifier NCT02306096), and classifications were evaluated by agreement statistics and by Kaplan-Meier and Cox regression survival analyses.
Results:
For the histopathological evaluation, pathologist evaluation concordance was high for ER, PgR, and HER2 (average kappa values of .920, .891, and .899, respectively), but moderate for Ki67 and NHG (.734 and .581). Classification concordance between RNA-seq classifiers and histopathology for the independent 3273-cohort was similar to that within histopathology assessments, with SGCs slightly outperforming MGCs. Importantly, patients with discordant results, classified as hormone responsive (HoR+) by histopathology but non-hormone responsive by MGC, presented with significantly inferior overall survival compared to patients with concordant results. These results extended to patients with no adjuvant systemic therapy (hazard ratio, HR, 4.54; 95% confidence interval, CI, 1.42-14.5), endocrine therapy alone (HR 3.46; 95% CI, 2.01-5.95), or receiving chemotherapy (HR 2.57; 95% CI 1.13-5.86). For HoR+ cases receiving endocrine therapy alone, the MGC HoR classifier remained significant after multivariable adjustment (HR 3.14; 95% CI, 1.75-5.65).
Conclusions:
RNA-seq-based classifiers for the five key early breast cancer biomarkers were generally equivalent to conventional histopathology with regards to classification error rate. However, when benchmarked using overall survival, our RNA-seq classifiers provided added clinical value in particular for cases that are determined by histopathology to be hormone-responsive but by RNA-seq appear hormone-insensitive and have a significantly poorer outcome when treated with endocrine therapy alone.
Citation Format: Brueffer C, Vallon-Christersson J, Grabau D, Ehinger A, Häkkinen J, Hegardt C, Malina J, Chen Y, Bendahl P-O, Manjer J, Malmberg M, Larsson C, Loman N, Ryden L, Borg Å, Saal LH. On the development and clinical value of RNA-sequencing-based classifiers for prediction of the five conventional breast cancer biomarkers: A report from the population-based multicenter SCAN-B study [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 P4-09-03.
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Affiliation(s)
- C Brueffer
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - J Vallon-Christersson
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - D Grabau
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - A Ehinger
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - J Häkkinen
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - C Hegardt
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - J Malina
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Y Chen
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - P-O Bendahl
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - J Manjer
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - M Malmberg
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - C Larsson
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - N Loman
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - L Ryden
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - Å Borg
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
| | - LH Saal
- Lund University, Lund, Sweden; Lund University Cancer Center, Medicon Village, Lund, Sweden; Skåne University Hospital, Lund, Sweden; Blekinge County Hospital, Karlskrona, Sweden; Skåne University Hospital, Malmö, Sweden
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Foukakis T, Lövrot J, Matikas A, Zerdes I, Lorent J, Tobin N, Suzuki C, Brage SE, Carlsson L, Einbeigi Z, Linderholm B, Loman N, Malmberg M, Fernö M, Skoog L, Bergh J, Hatschek T. Immune gene expression and response to chemotherapy in advanced breast cancer. Br J Cancer 2018; 118:480-488. [PMID: 29370583 PMCID: PMC5830596 DOI: 10.1038/bjc.2017.446] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 07/24/2017] [Revised: 11/11/2017] [Accepted: 11/14/2017] [Indexed: 12/30/2022] Open
Abstract
Background: Transcriptomic profiles have shown promise as predictors of response to neoadjuvant chemotherapy in breast cancer (BC). This study aimed to explore their predictive value in the advanced BC (ABC) setting. Methods: In a Phase 3 trial of first-line chemotherapy in ABC, a fine needle aspiration biopsy (FNAB) was obtained at baseline. Intrinsic molecular subtypes and gene modules related to immune response, proliferation, oestrogen receptor (ER) signalling and recurring genetic alterations were analysed for association with objective response to chemotherapy. Gene-set enrichment analysis (GSEA) of responders vs non-responders was performed independently. Lymphocytes were enumerated in FNAB smears and the absolute abundance of immune cell types was calculated using the Microenvironment Cell Populations counter method. Results: Gene expression data were available for 109 patients. Objective response to chemotherapy was statistically significantly associated with an immune module score (odds ratio (OR)=1.62; 95% confidence interval (CI), 1.03–2.64; P=0.04). Subgroup analysis showed that this association was restricted to patients with ER-positive or luminal tumours (OR=3.54; 95%, 1.43–10.86; P=0.012 and P for interaction=0.04). Gene-set enrichment analysis confirmed that in these subgroups, immune-related gene sets were enriched in responders. Conclusions: Immune-related transcriptional signatures may predict response to chemotherapy in ER-positive and luminal ABC.
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Affiliation(s)
- Theodoros Foukakis
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - John Lövrot
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Alexios Matikas
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Ioannis Zerdes
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Julie Lorent
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Nick Tobin
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Chikako Suzuki
- Department of Radiology and Nuclear Medicine, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Suzanne Egyházi Brage
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Lena Carlsson
- Department of Oncology, Sundsvall General Hospital, Sundsvall 85643, Sweden
| | - Zakaria Einbeigi
- Department of Oncology, Sahlgrenska University Hospital, Gothenborg 41345, Sweden
| | - Barbro Linderholm
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden.,Department of Oncology, Sahlgrenska University Hospital, Gothenborg 41345, Sweden
| | - Niklas Loman
- Department of Oncology, Skåne University Hospital, Lund 22241, Sweden
| | - Martin Malmberg
- Department of Oncology, Helsingborg General Hospital, Helsingborg 25187, Sweden
| | - Mårten Fernö
- Department of Oncology, Skåne University Hospital, Lund 22241, Sweden
| | - Lambert Skoog
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Thomas Hatschek
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
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Nilsson MP, Törngren T, Henriksson K, Kristoffersson U, Kvist A, Silfverberg B, Borg Å, Loman N. BRCAsearch: written pre-test information and BRCA1/2 germline mutation testing in unselected patients with newly diagnosed breast cancer. Breast Cancer Res Treat 2017; 168:117-126. [PMID: 29164420 PMCID: PMC5847037 DOI: 10.1007/s10549-017-4584-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/16/2017] [Indexed: 12/26/2022]
Abstract
Purpose To evaluate a simplified method of pre-test information and germline BRCA1/2 mutation testing. Methods In a prospective, single-arm study, comprehensive BRCA1/2 testing was offered to unselected patients with newly diagnosed breast cancer at three hospitals in south Sweden (BRCAsearch, ClinicalTrials.gov Identifier: NCT02557776). Pre-test information was provided by a standardized invitation letter, but the patients could contact a genetic counselor for telephone genetic counseling if they felt a need for that. Noncarriers were informed about the test result through a letter. Mutation carriers were contacted and offered an appointment for in-person post-test genetic counseling. Results During the period Feb 2, 2015–Aug 26, 2016, eight hundred and eighteen patients were invited to participate in the study. Through Jan 31, 2017, five hundred and forty-two (66.2%) of them consented to analysis of BRCA1 and BRCA2. Eleven pathogenic mutations were found (BRCA1, n = 2; BRCA2, n = 9), corresponding to a mutation prevalence of 2.0%. Six out of 11 fulfilled the Swedish BRCA testing criteria, and 9 out of 11 fulfilled the NCCN testing criteria. None of the BRCA-associated tumors were of the luminal A-like subtype. Very few patients contacted us for telephone genetic counseling or practical questions, suggesting that a majority felt that the written pre-test information was sufficient for them to make a decision on testing. Conclusions Streamlining the process of pre-test information, genetic testing, and delivery of test results was feasible and was associated with an uptake of genetic testing in 2/3 of the breast cancer patients.
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Affiliation(s)
- Martin P Nilsson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
| | - Therese Törngren
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Karin Henriksson
- Department of Clinical Genetics, Laboratory Medicine Region Skåne, Lund, Sweden
| | - Ulf Kristoffersson
- Department of Clinical Genetics, Laboratory Medicine Region Skåne, Lund, Sweden
- Department of Clinical Genetics, Lund University, Lund, Sweden
| | - Anders Kvist
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Barbro Silfverberg
- Department of Clinical Genetics, Laboratory Medicine Region Skåne, Lund, Sweden
| | - Åke Borg
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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45
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Palazon A, Tyrakis PA, Macias D, Veliça P, Rundqvist H, Fitzpatrick S, Vojnovic N, Phan AT, Loman N, Hedenfalk I, Hatschek T, Lövrot J, Foukakis T, Goldrath AW, Bergh J, Johnson RS. An HIF-1α/VEGF-A Axis in Cytotoxic T Cells Regulates Tumor Progression. Cancer Cell 2017; 32:669-683.e5. [PMID: 29136509 PMCID: PMC5691891 DOI: 10.1016/j.ccell.2017.10.003] [Citation(s) in RCA: 311] [Impact Index Per Article: 44.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 05/18/2017] [Accepted: 10/04/2017] [Indexed: 12/13/2022]
Abstract
Cytotoxic T cells infiltrating tumors are thought to utilize HIF transcription factors during adaptation to the hypoxic tumor microenvironment. Deletion analyses of the two key HIF isoforms found that HIF-1α, but not HIF-2α, was essential for the effector state in CD8+ T cells. Furthermore, loss of HIF-1α in CD8+ T cells reduced tumor infiltration and tumor cell killing, and altered tumor vascularization. Deletion of VEGF-A, an HIF target gene, in CD8+ T cells accelerated tumorigenesis while also altering vascularization. Analyses of human breast cancer showed inverse correlations between VEGF-A expression and CD8+ T cell infiltration, and a link between T cell infiltration and vascularization. These data demonstrate that the HIF-1α/VEGF-A axis is an essential aspect of tumor immunity.
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MESH Headings
- Animals
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- CD8-Positive T-Lymphocytes/metabolism
- Cell Line, Tumor
- Cells, Cultured
- Disease Progression
- Female
- Gene Expression Profiling/methods
- Gene Expression Regulation, Neoplastic
- Humans
- Hypoxia-Inducible Factor 1, alpha Subunit/genetics
- Hypoxia-Inducible Factor 1, alpha Subunit/metabolism
- Mice, Inbred C57BL
- Mice, Knockout
- Neoplasms, Experimental/blood supply
- Neoplasms, Experimental/genetics
- Neoplasms, Experimental/metabolism
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/metabolism
- T-Lymphocytes, Cytotoxic/metabolism
- Vascular Endothelial Growth Factor A/genetics
- Vascular Endothelial Growth Factor A/metabolism
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Affiliation(s)
- Asis Palazon
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Petros A Tyrakis
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK; Cancer Research UK, Cambridge Institute, Cambridge CB2 0RE, UK
| | - David Macias
- Cancer Research UK, Cambridge Institute, Cambridge CB2 0RE, UK
| | - Pedro Veliça
- Department of Cell and Molecular Biology, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Helene Rundqvist
- Department of Cell and Molecular Biology, Karolinska Institute, 171 77 Stockholm, Sweden
| | | | - Nikola Vojnovic
- Department of Cell and Molecular Biology, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Anthony T Phan
- Molecular Biology Section, Division of Biological Sciences, University of California San Diego, La Jolla, CA 92161, USA
| | - Niklas Loman
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, 223 81 Lund, Sweden
| | - Ingrid Hedenfalk
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, 223 81 Lund, Sweden
| | - Thomas Hatschek
- Karolinska Oncology, Karolinska Institute and University Hospital, 171 76 Stockholm, Sweden
| | - John Lövrot
- Karolinska Oncology, Karolinska Institute and University Hospital, 171 76 Stockholm, Sweden
| | - Theodoros Foukakis
- Karolinska Oncology, Karolinska Institute and University Hospital, 171 76 Stockholm, Sweden
| | - Ananda W Goldrath
- Molecular Biology Section, Division of Biological Sciences, University of California San Diego, La Jolla, CA 92161, USA
| | - Jonas Bergh
- Karolinska Oncology, Karolinska Institute and University Hospital, 171 76 Stockholm, Sweden
| | - Randall S Johnson
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK; Department of Cell and Molecular Biology, Karolinska Institute, 171 77 Stockholm, Sweden.
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Kimbung S, Markholm I, Bjöhle J, Lekberg T, von Wachenfeldt A, Azavedo E, Saracco A, Hellström M, Veerla S, Paquet E, Bendahl PO, Fernö M, Bergh J, Loman N, Hatschek T, Hedenfalk I. Assessment of early response biomarkers in relation to long-term survival in patients with HER2-negative breast cancer receiving neoadjuvant chemotherapy plus bevacizumab: Results from the Phase II PROMIX trial. Int J Cancer 2017; 142:618-628. [PMID: 28940389 PMCID: PMC5765477 DOI: 10.1002/ijc.31070] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/17/2017] [Accepted: 09/05/2017] [Indexed: 01/13/2023]
Abstract
Pathologic complete response (pCR) is a predictor for favorable outcome after neoadjuvant treatment in early breast cancer. Modulation of gene expression may also provide early readouts of biological activity and prognosis, offering the possibility for timely response-guided treatment adjustment. The role of early transcriptional changes in predicting response to neoadjuvant chemotherapy plus bevacizumab was investigated. One-hundred-and-fifty patients with large, operable and locally advanced HER2-negative breast cancer received epirubicin and docetaxel, with the addition of bevacizumab. Patients underwent tumor biopsies at baseline, after Cycle 2 and at the time of surgery. The primary end point, pCR, and its relation with the secondary endpoints event-free survival (EFS), overall survival (OS) and gene expression profiles, are reported. The pCR rate was 13% (95% CI 8.6-20.2), with significantly more pCRs among triple-negative [28% (95% CI 14.8-45.4)] than among hormone receptor positive (HR+) tumors [9% (95% CI 4.6-16.3); (OR = 3.9 [CI = 1.5-10.3])]. pCR rates were not associated with EFS or OS. PAM50 subtypes significantly changed after Cycle 2 (p = 0.03) and an index of absolute changes in PAM50 correlations between these time-points was associated with EFS [HR = 0.62 (CI = 0.3-1.1)]. In univariable analyses, signatures for angiogenesis, proliferation, estrogen receptor signaling, invasion and metastasis, and immune response, measured after Cycle 2, were associated with pCR in HR+ tumors. Evaluation of changes in molecular subtypes and other signatures early in the course of neoadjuvant treatment may be predictive of pCR and EFS. These factors may help guide further treatment and should be considered when designing neoadjuvant trials.
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Affiliation(s)
- Siker Kimbung
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Skåne University Hospital, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Ida Markholm
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Skåne University Hospital, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Judith Bjöhle
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Tobias Lekberg
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Edward Azavedo
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Ariel Saracco
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Hellström
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Srinivas Veerla
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Skåne University Hospital, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Eric Paquet
- Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, CH-1015, Switzerland
| | - Pär-Ola Bendahl
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mårten Fernö
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jonas Bergh
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Loman
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Thomas Hatschek
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Hedenfalk
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Skåne University Hospital, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
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47
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Tobin NP, Lundberg A, Lindström LS, Harrell JC, Foukakis T, Carlsson L, Einbeigi Z, Linderholm BK, Loman N, Malmberg M, Fernö M, Czene K, Perou CM, Bergh J, Hatschek T. PAM50 Provides Prognostic Information When Applied to the Lymph Node Metastases of Advanced Breast Cancer Patients. Clin Cancer Res 2017; 23:7225-7231. [PMID: 28972041 DOI: 10.1158/1078-0432.ccr-17-2301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/29/2017] [Accepted: 09/25/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Transcriptional pathway activity and the molecular subtypes of breast cancer metastases have been shown to significantly influence patient postrelapse survival. Here, we further determine the relevance of clinically employed gene signatures in the advanced breast cancer (ABC) setting.Experimental Design: Sufficient RNA for expression profiling was obtained from distant metastatic or inoperable loco-regional relapse tissue by fine-needle aspiration from 109 patients of the Swedish TEX clinical trial. Gene signatures (GGI, 70 gene, recurrence score, cell-cycle score, risk of recurrence score, and PAM50) were applied to all metastases, and their relationship to long- (5-year) and short-term (1.5-year) postrelapse survival at all and locoregional lymph nodes (n = 40) versus other metastatic sites (n = 69) combined was assessed using Kaplan-Meier and/or multivariate Cox regression analyses.Results: The majority of metastases were classified into intermediate or high-risk groups by all signatures, and a significant association was found between metastatic signature subgroups and primary tumor estrogen receptor status and histologic grade (P < 0.05). When considering all sites of metastasis, only PAM50 was statistically significant in Kaplan-Meier analysis (Log-rank P = 0.008 and 0.008 for long- and short-term postrelapse breast cancer-specific survival, respectively). This significance remained in both uni- and multivariate models when restricting analyses to lymph node metastases only, and a similar trend was observed in other metastatic sites combined, but did not reach formal significance.Conclusions: Our findings are the first to demonstrate that the PAM50 signature can provide prognostic information from the lymph node metastases of ABC patients. Clin Cancer Res; 23(23); 7225-31. ©2017 AACR.
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Affiliation(s)
- Nicholas P Tobin
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden.
| | - Arian Lundberg
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Linda S Lindström
- Department of Biosciences and Nutrition, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - J Chuck Harrell
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Theodoros Foukakis
- Department of Oncology and Pathology, Karolinska Institutet, Radiumhemmet, Karolinska Oncology, University Hospital, Stockholm, Sweden
| | - Lena Carlsson
- Department of Oncology, Sundsvall General Hospital, Sundsvall, Sweden
| | - Zakaria Einbeigi
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Barbro K Linderholm
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden.,Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Niklas Loman
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Martin Malmberg
- Department of Oncology, Skåne University Hospital, Helsingborg, Sweden
| | - Mårten Fernö
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Medicon Village, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Charles M Perou
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institutet, Radiumhemmet, Karolinska Oncology, University Hospital, Stockholm, Sweden.,Department of Public Health, Oxford University, Oxford, United Kingdom
| | - Thomas Hatschek
- Department of Oncology and Pathology, Karolinska Institutet, Radiumhemmet, Karolinska Oncology, University Hospital, Stockholm, Sweden
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48
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Nilsson MP, Winter C, Kristoffersson U, Rehn M, Larsson C, Saal LH, Loman N. Efficacy versus effectiveness of clinical genetic testing criteria for BRCA1 and BRCA2 hereditary mutations in incident breast cancer. Fam Cancer 2017; 16:187-193. [PMID: 28120249 PMCID: PMC5357494 DOI: 10.1007/s10689-016-9953-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Indexed: 12/13/2022]
Abstract
Increasing evidence supports the benefit of identifying BRCA1 and BRCA2 germline mutations in early breast cancer. Selection of patients for genetic testing is based on defined criteria taking individual and family history related factors into account. It is important to make a distinction between efficacy and effectiveness of BRCA testing criteria. Efficacy can be defined as the performance under ideal circumstances, whereas effectiveness refers to its real life performance. To allow for an unbiased and detailed evaluation of efficacy and effectiveness of the Swedish BRCA testing criteria, we retrospectively analyzed a prospectively collected cohort of 273 breast cancer patients from the well-characterized, population-based, single-site All Breast Cancer in Malmö (ABiM) study. The patients were diagnosed with breast cancer during the years 2007 through 2009. Out of 20 mutation carriers identified, 13 fulfilled Swedish criteria at time of diagnosis. Thus, the efficacy of these criteria was 65%. Excluding three patients in whom a mutation was already known at time of diagnosis, only 3/17 had been identified in the clinical routine, corresponding to an effectiveness of 18%. Here we detail the reasons why mutation carriers in our cohort were not detected though routine health care. In conclusion, effectiveness of BRCA testing criteria was much lower than efficacy. Our results indicate that current testing criteria and procedures associated with BRCA1 and BRCA2 testing are insufficient. There is room for improvement of their efficacy, but even more so regarding effectiveness. Clinical BRCA testing routines need to be critically revised.
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Affiliation(s)
- Martin P Nilsson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Christof Winter
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ulf Kristoffersson
- Department of Clinical Genetics, Laboratory Medicine Region Skåne, Lund, Sweden.,Department of Clinical Genetics, Lund University, Lund, Sweden
| | - Martin Rehn
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Christer Larsson
- Department of Translational Cancer Research, Lund University, Lund, Sweden
| | - Lao H Saal
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,CREATE Health Strategic Centre for Translational Cancer Research, Lund University, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden. .,Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
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Matikas A, Lövrot J, Ramberg A, Eriksson M, Lindsten T, Lekberg T, Hedenfalk I, Loman N, Bergh J, Erlandsson A, Hatschek T, Foukakis T. Immune function and response to neoadjuvant chemotherapy in hormone receptor positive, HER2-negative breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx364.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Tobin NP, Lundberg A, Lindström LS, Harrell JC, Egyhazi Brage S, Frostvik Stolt M, Einbeigi Z, Loman N, Malmberg M, Perou CM, Bergh J, Hatschek T. Abstract P1-07-16: Multi-level gene expression signatures provide significant prognostic information in metastatic breast cancer patients. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-07-16] [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: We have previously demonstrated how transcriptional pathway activity and the molecular subtypes of breast cancer metastases significantly influence patient post-relapse survival. Here we extend our analysis to determine whether the prognostic information provided by gene expression signatures in primary breast tumours is also relevant in the metastatic setting. Specifically, we test the research versions of the Genomic Grade Index (GGI), Mammaprint, Recurrence score (RS) and PAM50 gene signatures along with our own cell-cycle based classifier (CCS).
Methods: 287 patients with morphologically confirmed loco-regional or distant breast cancer relapse were enrolled in the Swedish multicenter TEX trial from December 2002 until June 2007. Of these, sufficient tumour RNA for gene expression profiling was obtained from metastatic tissue by fine needle aspiration from 111 patients (totalling 120 relapse biopsies). Gene signatures were applied as described in the original research articles and their relationship to short (1.5 year) and long-term (5 year) post-relapse survival was assessed using likelihood ratio, Kaplan-Meier and Cox regression analysis.
Results: As anticipated from an aggressive metastatic cohort, the majority of samples (> 70%) were classified into intermediate or high risk groups by all signatures. In both short and long-term survival analysis only PAM50 provided statistically significant prognostic information (short: LRχ2 = 14.7, p = 0.005 and long: LRχ2 = 13.2, p = 0.010), with the cell cycle score signature displaying a prognostic trend in long-term survival only (LRχ2 = 5.2, p = 0.074). Kaplan-Meier curves and Cox regression analysis suggest that the strength of both signatures resides in their ability to select a group of low-risk patients with better long-term survival.
Conclusions: Our findings demonstrate the prognostic utility of the multi-level PAM50 and to a lesser extent, cell cycle score signatures in predicting survival of patients with metastatic breast cancer. Simpler binary gene expression signatures (GGI and Mammaprint) do not appear to capture the same prognostic information and as such may have limited utility in a metastatic setting.
Short and long term survival Likehood Ratios for five gene expression signatures in metastatic breast cancer Short term survival (1.5 year)Long term survival (5 year)Gene SignatureLRχ2P-valueLRχ2P-valueGGI1.30.2510.50.500Mammaprint1.70.1900.60.427RS3.90.1434.40.110CCS2.80.2425.20.074PAM5014.70.00513.20.010GGI: Genomic grade index; RS: Recurrence score; CCS: Cell cycle score
Citation Format: Tobin NP, Lundberg A, Lindström LS, Harrell JC, Egyhazi Brage S, Frostvik Stolt M, Einbeigi Z, Loman N, Malmberg M, Perou CM, Bergh J, Hatschek T. Multi-level gene expression signatures provide significant prognostic information in metastatic breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-07-16.
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Affiliation(s)
- NP Tobin
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
| | - A Lundberg
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
| | - LS Lindström
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
| | - JC Harrell
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
| | - S Egyhazi Brage
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
| | - M Frostvik Stolt
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
| | - Z Einbeigi
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
| | - N Loman
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
| | - M Malmberg
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
| | - CM Perou
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
| | - J Bergh
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
| | - T Hatschek
- Karolinska Institutet and University Hospital, Stockholm, Sweden; Virginia Commonwealth University, Richmond; Sahlgrenska University Hospital, Gothenburg, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital, Helsingborg, Sweden; Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill
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