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Malorni L, Migliaccio I, Biagioni C, Rossi L, De Santo I, Love RL, McCartney A, Bergqvist M, Bonechi M, De Luca F, Galardi F, Benelli M, Romagnoli D, Risi E, Biganzoli L, Laudico A, Van Dinh N, Leo AD. Abstract P5-06-11: Serum thymidine kinase-1 activity (TKa) as a prognostic marker in premenopausal women with hormone receptor positive (HR+) operable breast cancer (BC). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-06-11] [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
Introduction: Thymidine kinase is an established marker of cancer cell proliferation and its activity can be measured in blood. We and others have recently shown that baseline and dynamic evaluation of circulating thymidine kinase activity (TKa) during treatment gives prognostic and predictive information in patients with HR+, HER2-negative metastatic BC treated with endocrine therapy alone, as well as in the setting of CDK4/6 inhibition. However, there is limited data regarding the role of TKa as a prognostic biomarker in operable BC. Here we present a retrospective analysis of TKa in serum samples collected in a cohort of premenopausal women with operable BC enrolled in a phase III adjuvant multicenter clinical trial (NCT00201851).
Materials and methods: Serum samples were available for 644 (87%) of participants prospectively enrolled in a randomized trial between 2003 and 2009 in South East Asia. All women were premenopausal, had stage II-IIIB HR+ operable BC and uniformly received bilateral surgical oophorectomy concurrent with mastectomy followed by tamoxifen alone for five years. Patients did not receive chemotherapy or targeted therapy pre- or post-operatively. Participants were randomized in the study according to the timing of surgery with respect to the phase of the menstrual cycle. Serum samples were collected preoperatively on the day of surgery. Serum TKa was measured using the ELISA-based DiviTum™ assay (Biovica, Sweden). TKa analysis was performed at a central laboratory, blind to clinical data. Baseline TKa values were correlated with clinico-pathological characteristics and clinical outcome. Clinical outcome was estimated using the Kaplan-Meier method.
Results: The majority of patients had both estrogen and progesterone receptor positive tumors (94% and 92% respectively), 65% were HER2 negative (18% positive; 17% unknown). Most had pT2 or pT3 disease (60% and 27% respectively), and more than half were node-positive (pN0 42%, pN1 27%, pN2 19%, pN3 11%, pNx 1%). The overall median TKa value was 65.4 Du/L. At five years, patients with a baseline TKa value below the median had a disease-free survival (DFS) rate of 75% versus 61% in those with a baseline over the median (HR 1.82, 95% CI 1.37-2.4, p<0.001). Similar results were observed when women with HER2+ disease were excluded from analysis (HR 1.71, 95% CI 1.21-2.42, p=0.0025). Further prognostic precision was achieved when TKa values were divided by quartiles, with a 5 year DFS rate of 81%, 69%, 63% and 58% observed in the 1st, 2nd, 3rd and 4th quartiles respectively. After adjusting for major prognostic factors and randomization arm, TKa remained an independent marker.
Conclusions: This study shows pre-operative TKa measured in serum is a strong prognostic marker in a large cohort of women with HR+ operable BC uniformly treated within a clinical trial. The notable rate of recurrence seen within this cohort of patients derived from non-high income countries may be mainly attributed to the relative degree of disease burden at diagnosis. TKa may be seen as a potential circulating marker of proliferation akin to tumor Ki67, which may provide useful prognostic information to guide adjuvant therapies.
Citation Format: Luca Malorni, Ilenia Migliaccio, Chiara Biagioni, Lorenzo Rossi, Irene De Santo, Richard L Love, Amelia McCartney, Mattias Bergqvist, Martina Bonechi, Francesca De Luca, Francesca Galardi, Matteo Benelli, Dario Romagnoli, Emanuela Risi, Laura Biganzoli, Adriano Laudico, Nguyen Van Dinh, Angelo Di Leo. Serum thymidine kinase-1 activity (TKa) as a prognostic marker in premenopausal women with hormone receptor positive (HR+) operable breast cancer (BC) [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 P5-06-11.
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Affiliation(s)
- Luca Malorni
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Ilenia Migliaccio
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Chiara Biagioni
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Lorenzo Rossi
- 2Institute of Oncology of Southern Switzerland, Bellinzona, Switzerland
| | | | - Richard L Love
- 4Department of Computer Science, Marquette University, Milwakee, WI
| | - Amelia McCartney
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | | | - Martina Bonechi
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Francesca De Luca
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Francesca Galardi
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Matteo Benelli
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Dario Romagnoli
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Emanuela Risi
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | - Laura Biganzoli
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | | | | | - Angelo Di Leo
- 1"Sandro Pitigliani" Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
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Delaney SK, Hultner ML, Jacob HJ, Ledbetter DH, McCarthy JJ, Ball M, Beckman KB, Belmont JW, Bloss CS, Christman MF, Cosgrove A, Damiani SA, Danis T, Delledonne M, Dougherty MJ, Dudley JT, Faucett WA, Friedman JR, Haase DH, Hays TS, Heilsberg S, Huber J, Kaminsky L, Ledbetter N, Lee WH, Levin E, Libiger O, Linderman M, Love RL, Magnus DC, Martland A, McClure SL, Megill SE, Messier H, Nussbaum RL, Palaniappan L, Patay BA, Popovich BW, Quackenbush J, Savant MJ, Su MM, Terry SF, Tucker S, Wong WT, Green RC. Toward clinical genomics in everyday medicine: perspectives and recommendations. Expert Rev Mol Diagn 2016; 16:521-32. [PMID: 26810587 PMCID: PMC4841021 DOI: 10.1586/14737159.2016.1146593] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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] [Indexed: 11/08/2022]
Abstract
Precision or personalized medicine through clinical genome and exome sequencing has been described by some as a revolution that could transform healthcare delivery, yet it is currently used in only a small fraction of patients, principally for the diagnosis of suspected Mendelian conditions and for targeting cancer treatments. Given the burden of illness in our society, it is of interest to ask how clinical genome and exome sequencing can be constructively integrated more broadly into the routine practice of medicine for the betterment of public health. In November 2014, 46 experts from academia, industry, policy and patient advocacy gathered in a conference sponsored by Illumina, Inc. to discuss this question, share viewpoints and propose recommendations. This perspective summarizes that work and identifies some of the obstacles and opportunities that must be considered in translating advances in genomics more widely into the practice of medicine.
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Affiliation(s)
- Susan K Delaney
- a Coriell Institute for Medical Research , Camden , NJ , USA
| | - Michael L Hultner
- b Lockheed Martin , Information Systems & Global Solutions , Rockville , MD , USA
| | - Howard J Jacob
- c HudsonAlpha Institute for Biotechnology , Huntsville , AL , USA
| | | | - Jeanette J McCarthy
- e Duke University , Center for Applied Genomics and Precision Medicine , Durham , NC , USA
| | | | - Kenneth B Beckman
- g University of Minnesota , Genomics Center ,, Minneapolis , MN , USA
| | - John W Belmont
- h Baylor College of Medicine , Children's Nutrition Research Center , Houston , TX , USA
| | - Cinnamon S Bloss
- i University of California, San Diego , School of Medicine , La Jolla , CA , USA
| | | | | | - Stephen A Damiani
- k Mission Massimo Foundation , Elsternwick , VIC , Australia .,l Mission Massimo Foundation Inc ., Westlake Village , CA , USA
| | | | | | - Michael J Dougherty
- o The American Society of Human Genetics , Bethesda , MD , USA.,p Department of Pediatrics , University of Colorado School of Medicine , Aurora , CO , USA
| | - Joel T Dudley
- q Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | | | - Jennifer R Friedman
- r University of California, San Diego , Departments of Neurosciences and Pediatrics and Rady Children's Hospital , San Diego , CA , USA
| | | | - Tom S Hays
- t University of Minnesota , Department of Genetics, Cell Biology and Development , Minneapolis , MN , USA
| | | | - Jeff Huber
- u Google Inc ., Mountain View , CA , USA
| | | | | | | | - Elissa Levin
- q Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | | | | | | | - David C Magnus
- y Stanford Center for Biomedical Ethics , Stanford School of Medicine , Stanford , CA , USA
| | | | | | | | - Helen Messier
- ab Healix Health, Ltd , West Vancouver , BC , Canada
| | | | | | | | | | | | | | - Michael M Su
- ai Anthem Blue Cross , Woodland Hills , CA , USA
| | | | - Steven Tucker
- ak Novena Specialist Center , Singapore , Republic of Singapore
| | | | - Robert C Green
- am Division of Genetics, Department of Medicine, Brigham and Women's Hospital , the Broad Institute, Harvard Medical School and Partners Healthcare Personalized Medicine , Boston , MA , USA
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