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D'Agostino E, Mastrodomenico L, Ponzoni O, Baldessari C, Piombino C, Pipitone S, Giuseppa Vitale M, Sabbatini R, Dominici M, Toss A. Molecular characterization as new driver in prognostic signatures and therapeutic strategies for endometrial cancer. Cancer Treat Rev 2024; 126:102723. [PMID: 38555857 DOI: 10.1016/j.ctrv.2024.102723] [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: 01/12/2024] [Revised: 02/28/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Endometrial cancer (EC) incidence and mortality rates have been increasing, particularly among young females. Although more than 90% of ECs are sporadic, 5-10% are hereditary, a majority of which occurs within Hereditary Non-Polyposis Colorectal Cancer syndrome (HNPCC) or Lynch syndrome. The traditional histopathological classification differentiates EC between two main groups: type I (or endometrioid) and type II (including all other histopathological subtypes). However, this classification lacks reproducibility and does not account for the emerging molecular heterogeneity. In 2013, The Cancer Genome Atlas (TCGA) project proposed EC molecular classification defining four groups with different prognostic and predictive values and the current international guidelines are progressively establishing EC risk stratification and treatment based on both histopathological and molecular criteria. Our manuscript aims to summarize the current state of EC molecular characterizations, including germline alterations at the basis of hereditary EC predisposition, to discuss their clinical utility as prognostic and predictive markers.
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Affiliation(s)
- Elisa D'Agostino
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
| | - Luciana Mastrodomenico
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
| | - Ornella Ponzoni
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
| | - Cinzia Baldessari
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
| | - Claudia Piombino
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
| | - Stefania Pipitone
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Giuseppa Vitale
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
| | - Roberto Sabbatini
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy.
| | - Massimo Dominici
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy; Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Angela Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy; Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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Canino F, Tornincasa A, Bettelli S, Manfredini S, Barbolini M, Moscetti L, Omarini C, Toss A, Tamburrano F, Antonelli G, Baglio F, Belluzzi L, Martinelli G, Natalizio S, Ponzoni O, Dominici M, Piacentini F. Real-World Data and Clinical Implications of Next-Generation Sequencing (NGS)-Based Analysis in Metastatic Breast Cancer Patients. Int J Mol Sci 2024; 25:2490. [PMID: 38473737 DOI: 10.3390/ijms25052490] [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: 01/16/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
Over the last two decades, the use of Next-Generation Sequencing (NGS) in medical oncology has increased the likelihood of identifying druggable mutations that may be potentially susceptible to targeted treatments. The European Society for Medical Oncology (ESMO) currently does not recommend the use of the NGS test to determine the therapeutic course of patients with metastatic breast cancer (mBC) in daily clinical practice. However, the aim of this work is to evaluate the potential contribution of the NGS test in selecting targeted therapies for patients with mBC. Data were retrospectively collected from 101 patients diagnosed with metastatic breast cancer and treated at the Modena Cancer Center between January 2015 and April 2022. A NGS test was performed on the tumor tissue of each patient at the Laboratory of Molecular Pathology of the University Hospital of Modena. This study analyzed the clinical-pathological characteristics and mutational profile of the population using NGS tests, with a focus on actionable mutations that could be targeted in advanced stages of clinical development. The indicator of this study was to quantify the actionable mutations that resulted in a change of cancer treatment. In total, 101 patients with metastatic breast cancer were analyzed, including 86 with luminal phenotype, 10 who were HER2-positive and 5 who were triple-negative. Median age was 52 years. NGS analysis was conducted on 47 samples of primary breast cancer, 52 on metastatic sites of disease and 2 on liquid biopsies. A total of 85 gene mutations were found. The most common mutations were identified in the PIK3CA (47%), FGFR (19%) and ERBB2 genes (12%), and to a lesser extent in other genes. Of the 61 patients with pathogenic mutations, 46 (75%) had at least one actionable mutation. Of these, nine received treatment with a molecular target drug: eight patients with a mutation of the PIK3CA gene were treated with alpelisib and fulvestrant; one patient with FGFR1/2 amplifications received TAS120. Median PFS for these patients was 3.8 months. The study results show that using the NGS test on cancer tissue of metastatic breast cancer could influence the therapeutic choices, considering the small sample size and limited follow-up. About 9% of the study population had their therapy modified based on the results of NGS. The growing number of detectable mutations and increased accessibility of the test may lead to a greater number of potential therapeutic implications for the NGS assay. Perspectives suggest that NGS analysis can be implemented in daily clinical practice, particularly in contexts where a Molecular Tumor Board (MTB) is active.
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Affiliation(s)
- Fabio Canino
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), 43126 Parma, Italy
| | - Antonio Tornincasa
- Unità Operativa di Oncologia, ASL I dell'Umbria, 06012 Città di Castello, Italy
| | - Stefania Bettelli
- Molecular Pathology and Predictive Medicine, Azienda Ospedaliero, Universitaria Policlinico di Modena, 41124 Modena, Italy
| | - Samantha Manfredini
- Molecular Pathology and Predictive Medicine, Azienda Ospedaliero, Universitaria Policlinico di Modena, 41124 Modena, Italy
| | - Monica Barbolini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), 43126 Parma, Italy
| | - Luca Moscetti
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), 43126 Parma, Italy
- Division of Medical Oncology, Department of Oncology and Ematology, Azienda Ospedaliero, Universitaria Policlinico di Modena, 41124 Modena, Italy
| | - Claudia Omarini
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), 43126 Parma, Italy
- Division of Medical Oncology, Department of Oncology and Ematology, Azienda Ospedaliero, Universitaria Policlinico di Modena, 41124 Modena, Italy
| | - Angela Toss
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Fabio Tamburrano
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Giuseppina Antonelli
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Federica Baglio
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Lorenzo Belluzzi
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Giulio Martinelli
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), 43126 Parma, Italy
| | - Salvatore Natalizio
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Ornella Ponzoni
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Massimo Dominici
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Federico Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41124 Modena, Italy
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), 43126 Parma, Italy
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Toss A, Ponzoni O, Riccò B, Piombino C, Moscetti L, Combi F, Palma E, Papi S, Tenedini E, Tazzioli G, Dominici M, Cortesi L. Management of PALB2-associated breast cancer: A literature review and case report. Clin Case Rep 2023; 11:e7747. [PMID: 37621724 PMCID: PMC10444947 DOI: 10.1002/ccr3.7747] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/08/2023] [Accepted: 07/15/2023] [Indexed: 08/26/2023] Open
Abstract
Germline pathogenic variants (PV) of the PALB2 tumor suppressor gene are associated with an increased risk of breast, pancreatic, and ovarian cancer. In previous research, PALB2-associated breast cancer showed aggressive clinicopathological phenotypes, particularly triple-negative subtype, and higher mortality regardless of tumor stage, type of chemotherapy nor hormone receptor status. The identification of this germline alteration may have an impact on clinical management of breast cancer (BC) from the surgical approach to the systemic treatment choice. We herein report the case of a patient with a germline PV of PALB2, diagnosed with locally advanced PD-L1 positive triple-negative BC, who progressed after an immune checkpoint inhibitor (ICI)-containing regimen and then experienced a pathologic complete response after platinum-based chemotherapy. This case report hints a major role of the germline PALB2 alteration compared to the PD-L1 expression as cancer driver and gives us the opportunity to extensively review and discuss the available literature on the optimal management of PALB2-associated BC. Overall, our case report and review of the literature provide additional evidence that the germline analysis of PALB2 gene should be included in routine genetic testing for predictive purposes and to refine treatment algorithms.
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Affiliation(s)
- Angela Toss
- Department of Oncology and HematologyAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
- Department of Medical and Surgical SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Ornella Ponzoni
- Department of Oncology and HematologyAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
| | - Beatrice Riccò
- Department of Oncology and HematologyAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
| | - Claudia Piombino
- Department of Oncology and HematologyAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
| | - Luca Moscetti
- Department of Oncology and HematologyAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
| | - Francesca Combi
- Unit of Breast Surgical OncologyAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
- Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental MedicineUniversity of Modena and Reggio EmiliaModenaItaly
| | - Enza Palma
- Unit of Breast Surgical OncologyAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
| | - Simona Papi
- Unit of Breast Surgical OncologyAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
| | - Elena Tenedini
- Department of Laboratory Medicine and Pathology, Diagnostic Hematology and Clinical Genomics UnitAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
| | - Giovanni Tazzioli
- Department of Medical and Surgical SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Unit of Breast Surgical OncologyAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
| | - Massimo Dominici
- Department of Oncology and HematologyAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
- Department of Medical and Surgical SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Laura Cortesi
- Department of Oncology and HematologyAzienda Ospedaliero‐Universitaria di ModenaModenaItaly
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Canino F, Barbolini M, De Giorgi U, Dominici M, Gianni L, Moscetti L, Omarini C, Zamagni C, Molinaro A, Antonelli G, Baglio F, Martinelli G, Natalizio S, Ponzoni O, Piacentini F. P120 Cardiac safety of pertuzumab, trastuzumab and standard chemotherapy as neoadjuvant treatment for HER2 positive breast cancer: real world data from NeoPowER trial. Breast 2023. [DOI: 10.1016/s0960-9776(23)00237-0] [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: 03/18/2023] Open
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Riccò B, Meduri B, Venturelli M, Cortesi L, Barbieri E, Ponzoni O, Moscetti L, Omarini C, Piacentini F, Dominici M, Toss A. 190P Staging strategies of newly diagnosed triple-negative breast cancer (TNBC): Comparison between CT scan and 18F-FDG-PET/CT. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.225] [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: 11/15/2022] Open
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