Collagen IV levels are elevated in the serum of patients with primary breast cancer compared to healthy volunteers

Collagen IV is a major component of the vascular basement membrane and may be a marker of angiogenesis. Serum levels of this protein are elevated in some human cancers. Our objectives were to compare collagen IV levels in the serum of breast cancer patients and healthy women and to examine changes during preoperative chemotherapy. Sera from 51 patients with stage II–III breast cancer and 55 healthy controls were analysed. Collagen IV level was measured by a commercially available sandwich enzyme link immunoassay. Baseline serum levels were compared between cancer patients and healthy women and paired pre- and post-chemotherapy measurements were also performed in 39 patients who received preoperative chemotherapy and were correlated with response to therapy. The median serum collagen IV concentration was significantly higher in cancer patients (166 μg l⁻¹) than in healthy women (115 μg l⁻¹), P<0.001. Chemotherapy induced a significant further increase in serum collagen IV (167 μg l⁻¹ prechemo vs 206 μg l⁻¹ postchemo, P=0.001). There were no correlations between baseline collagen IV levels and response to therapy, age, clinical stage or HER2 status. In conclusion, patients with breast cancer have elevated levels of collagen IV compared to healthy women and collagen IV levels increase further during chemotherapy.

Increased incidence of brain metastases in ERCC1-negative NSCLC patients treated with adjuvant cisplatin-based chemotherapy

7581

Background: We have recently demonstrated that ERCC1 is a predictor of the benefit of cisplatin-based adjuvant chemotherapy in resected non-small cell lung cancer (NSCLC). Non-squamous carcinomas have an increased risk of brain metastases (BM). Since brain is considered as a sanctuary site for chemotherapy, we hypothesised that there was an increased incidence of BM in ERCC1- negative non-squamous NSCLC patients treated with adjuvant cisplatin-based chemotherapy. Methods: Incidence of BM and histo- clinical parameters were analyzed in a population of 783 patients enrolled in the IALT trial. A subgroup analysis was performed in ERCC1 negative non-squamous NSCLC patients. Results: One hundred and one patients out of 783 (13%) developed BM alone or in association with other metastatic sites. In multivariate analysis, the clinical parameters associated with the occurrence of BM were nodal status (p=0.02), histological type (p=0.001) and pleural invasion (p=0.02). There is no effect of chemotherapy on BM (HR 1.38 [0.91–2.07], p=0.13). In patients with non-squamous histology (n=335) adjuvant chemotherapy was associated with an increased risk of BM (HR=2.10, [1.01–4.32], p=0.04) for ERCC1-negative tumours whereas there was no evidence of an effect on brain metastasis for ERCC1-positive tumours (HR=1.07 [0.38–2.99] p=0.90). These 2 effects are nevertheless not different (p for interaction=0.30) possibly by lack of power in this subsample. Conclusions: This study would suggest that cisplatin-based adjuvant chemotherapy is associated with an increased risk of BM in resected NSCLC patients with chemosensitive tumors. This data, if confirmed, could provide a rationale to evaluate prophylactic strategies in this subset of patients.

No significant financial relationships to disclose.

Differential response to primary chemotherapy and long-term survival in patients with triple-negative breast cancer

10519

Objective. Triple-negative breast cancer is defined as a subtype of invasive breast cancer which lacks estrogen and progesterone receptor expression as well as HER2/neu expression and is highly similar to the basal-like subtype defined by gene expression profiling. Method. 1,143 patients treated at MD Anderson Cancer Center in neoadjuvant trials were included in a retrospective comparative analysis between triple-negative tumors and non-triple-negative tumors for response to neoadjuvant chemotherapy as well as long- term survival. Results. 827/1,143 (72%) patients had received taxanes, either as a single-agent (n=60) or in combination with anthracycline (n=767), whereas the remainder patients received an anthracycline-only chemotherapy. Overall 258/1,143 (23%) tumors were triple- negative. Complete pathological response (pCR) was achieved in 63/257 (25%) patients with triple-negative tumors compared to 99/888 (11%) in patients with non-triple-negative tumors (odds ratio [OR] 1.14, 95%CI: 1.09–1.20, p=.0082). Triple-negative status correlated significantly with high nuclear grade (p<.0001), whereas no significant correlation with any established clinicopathologic parameter was observed. However, 5-year overall survival (5yrOS) was 66% in the triple-negative group compared to 83% in the non-triple-negative control group (OR 2.1, 95%CI: 1.6–2.8, p<.0001). In multivariate analyses, triple-negative status (hazard ratio [HR] 2.0, 95%CI: 1.4–2.8, p<.0001), high nuclear grade, increased tumor size (HR 1.5, 95%CI: 1.3–1.8, p<.0001), positive nodal status (HR 1.4, 95%CI: 1.2–1.7, p=.0002) and high nuclear grade (HR 1.7, 95%CI: 1.1- 2.4, p=.0089) were significantly associated with decreased 5yrOS. When survival was analyzed according to both response rate and triple negative status, achievement of pCR was a stronger predictor of survival compared to triple-negative status. Conclusion. Triple- negative expression status among patients with breast cancer constitutes an independent unfavorable prognostic factor with regards to overall survival unless achieving pCR after neoadjuvant chemotherapy.

No significant financial relationships to disclose.

Gene expression profiling can predict pathological complete response (pCR) to anthracycline-based therapy in estrogen- receptor (ER) negative breast cancer (BC) patients

10564

Background: Breast cancers show variable sensitivity to anthracycline (A)-based therapy. Here we aimed to identify gene expression profiles associated with pCR to this treatment. As it has repeatedly and consistently been shown that ER is the most dominant factor influencing the molecular composition of breast cancer, defining different types of BC disease and because we wanted to eliminate the confounding effect of indirect ovarian suppression in ER+ BC, we focused in this study on ER-negative patients only. Methods: We analyzed Affymetrix gene expression profiles generated from 132 ER- pre-treatment samples, constituting the largest series of ER- preoperatively A-treated BC (n=132/35 pCR). Sixty-two samples derived from the prospective multicentric TOP trial (epirubicin single-agent), 41 from Institut G. Roussy (retrospective selection/ FEC) and 27 from MD Anderson (prospective study/ FAC). Results: A student t- test analysis on the combined population of A-treated pts was performed identifying 102 genes that were significantly associated with pCR (p<.01). These genes were mainly involved in cell death, DNA replication and recombination, molecular transport, cell cycle and morphology. Interestingly, 14 of these genes were located on the topoIIa amplicon. Of interest, none of these 14 genes seem to carry any prognostic value in untreated ER- pts (N=161). When we considered gene expression indices for specific A-targets such as topoIIa and helicase, we found that both were associated with pCR. However, subgroup analysis revealed that topoIIa index was predictive in ERBB2+ but not in ERBB2- subgroup. None of the genes from the adriamycin predictor (Potti et al.) or the p53 signature (Miller et al.) were significantly associated with pCR. Conclusions: This study suggests that a group of genes associated with topoIIa can identify ER-negative BC pts likely to respond to A-based therapy. These promising results are currently being validated in a larger series.

No significant financial relationships to disclose.

Development and application of stable carbon isotope analysis to the detection of cortisol administration in cattle

The use of anabolic agents in food-producing animals has been prohibited within the EU since 1988. The control of the illegal use of natural steroid hormones in cattle is still an exciting analytical challenge as no definitive method and nonambiguous analytical criteria are available. We have used gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS) to demonstrate the administration of cortisol to cattle. The method consisted of an efficient combination between OASIS HLB solid-phase extraction (SPE), oxidation, SiOH SPE and semi-preparative high-performance liquid chromatography (HPLC) for glucocorticoid purification. By comparison of the (13)C/(12)C isotopic ratio of the oxidised product of cortisol, i.e. 5 beta-androstane-3,11,17-trione (5 beta AAT), with an endogenous reference compound (ERC), dehydroepiandrosterone (DHEA), the differentiation of cortisol metabolite origin, either endogenous or exogenous, has been achieved. After treatment of an animal, the delta(13)C(VPDB) values of 5 beta AAT reached -30 to -32 per thousand, whereas the delta(13)C(VPDB) values of DHEA remained at -25 per thousand. A significant difference in the delta(13)C(VPDB) values between DHEA and 5 beta AAT was measurable over a period of 3 days after a single administration of cortisol to the animal.

LC–ESI-MS/MS determination of phenylurea and triazine herbicides and their dealkylated degradation products in oysters

A method was developed for the determination of several phenylurea and triazine herbicides and their transformation products in oysters at the low microg/kg level. Pressurised liquid extraction (PLE) of lyophilisated samples had required successive SPE combined with a liquid/liquid extraction to provide relatively clean extracts for the determination in LC-MS/MS. This procedure was validated according to the 2002/657/EC analytical decision. Efficiency of the analytical method led to confirmatory CCalpha values ranging from 0.1 to 14 microg/kg with an R.S.D. value ranging from 14% to 66% and a recovery yield ranging from 32% to 46% for phenylureas and from 29% to 75% for triazines.

A mathematical model to predict for pre-malignant or malignant diagnosis among patients with Birad 4 breast lesions

10578

Background: Preoperative cytological or histological diagnosis of breast lesions is mandatory in order to avoid unnecessary surgical biopsies, but on the other side preoperative work-up may dangerously delay specific care of breast cancer. Solid lesions or microcalcifications (M) scored as Birad 4 are increasingly prevalent in western countries. A highly variable proportion of these lesions (20–80%) are breast cancer. Tools to help clinicians recognize cancers and preneoplastic lesions among true benign conditions may be very helpful in clinical practice. Methods: Radiological, clinical and pathological data of consecutive patients with Birad 4 breast M (N = 384 biopsies among 354 patients) or nodular lesions (N = 172 FNAC among 167 patients) seen in a multidisciplinary breast clinic were prospectively recorded. A multivariate analysis of factors predicting for a final cancer or pre-malignant diagnosis was performed and two nomograms were constructed using the R statistical package for both nodular lesions and M. They were validated by bootstrapping. Variables tested included age, size and palpability of lesion, Gail score, menopausal status, HRT use, progression of lesion (M), and presence of associated symptoms. Results: Median age was 57 years (18–92) for the entire population. Patients with nodular lesions were menopausal in 64.5%, median size of their lesion was 12 mm (4–50), 32% were palpable; 43% had a final diagnosis of breast cancer and 3.5% of atypical hyperplasia or LCIS. 69% of patients with M were menopausal, 31.25% had a final diagnosis of breast cancer and 9.8% of atypical hyperplasia or LCIS. Among patients with nodular lesions, age and palpability were the sole independent predictors of cancer or precancerous lesions (p = 0.04 and 0.004), but the other variables (Gail, menopause, HRT) added discrimination with a concordance index of 0.71. Among patients with M, the only independent predictive variable was the recent progression of the lesions (p = 0.01). The nomogram had a concordance index of 0.69. Conclusion: Our study provides two original nomograms for the prediction of the pre-malignant or malignant nature of recently discovered solid breast lesions and M. Gail model alone is not a highly useful tool in daily individual cancer prediction.

No significant financial relationships to disclose.

Toll like receptor 3 expression and efficacy of adjuvant treatment with polyadenylic-polyuridylic acid in patients with axillary node positive breast cancer: Results from two randomized trials

10563

Background: Toll like receptor 3 (TLR3) are transmembrane receptors involved in the cellular response to danger signal and specifically activated by double stranded RNA. Based on these data, we hypothesized that the TLR3 expression by tumor cells is associated with the efficacy of a treatment with double stranded RNA in cancer patients. Patients and Methods: TLR3 expression was assessed by immunohistochemistry in 336 patients with axillary node positive breast cancer. These patients were selected to have been included in two randomized trials that compared a post-operative administration of polyadenylic-polyuridylic acid (polyAU) to either no treatment (n = 174, trial I) or an adjuvant chemotherapy by CMF regimen (n = 162, trial II). In the trial II, locoregional and pelvic radiotherapy were given in the polyAU arm. Results: TLR3 was found to be overexpressed in 45 tumors (13%). Median follow-up were 23 and 17 years for living patients included in the trials I and II respectively. When the analysis focused on the first trial, the 20 year overall survival rates were 87% (95% CI: 53–97%) and 32% (95% CI: 12–63%) for patients with TLR3-overexpressing tumour treated (n = 8) or not (n = 11) with polyAU (p = 0.03). In the same trial, the 20 year overall survival rates were 43% (95% CI: 33–54%) and 35% (95% CI: 25–46%) for patients with TLR3-negative tumor treated (n = 81) or not (n = 74) with polyAU (p = 0.32). When the analysis focused on the Trial II, the 15 year overall survival were 62% (95% CI: 45%-91%) and 21% (95% CI: 8%-47%) for patients with TLR3-overexpressing tumors treated (n = 12) or not (n = 14) with polyAU (p = 0.005). In the same trial, 15 year overall survival rates were 31% (95% CI: 21%-42%) and 39% (95% CI: 28%-51%) for patients with TLR3-negative tumors treated (n = 66) or not (n = 70) with polyAU (p = 0.39). Conclusion: This study suggests that the post-operative administration of polyadenylic-polyuridylic acid improves outcome of patient with TLR3-overexpressing, node-positive breast cancer.

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Immunohistochemical staining of the Excision Repair Cross-Complementing 1 (ERCC1) protein as predictor for benefit of adjuvant chemotherapy (CT) in the International Lung Cancer Trial (IALT)

7010

Background: Adjuvant cisplatin-based chemotherapy improves survival in patients with completely resected non-small-cell lung cancer, but no clinical or biological predictor of the benefit of CT has yet been validated in large trials. ERCC1 is a highly conserved excision nuclease within the nucleotide excision repair (NER) pathway and is essential for efficient repair of DNA-adducts induced from alkylating agents. Methods: Using a standard protocol of immunohistochemistry, we evaluated ERCC1 expression in 783 resected tumor tissues from patients enrolled in the IALT. For each case, a semi-quantitative histology score (H-score) was calculated on the basis of both the percentage of positive tumor nuclei and staining intensity. The median value of H-scores was a priori chosen as the cut-off point to classify ERCC1 positive and negative tumors. Overall survival was analyzed with a Cox model adjusted on clinical and pathological factors. Results: After immunostaining, 761 out of 783 cases (97%) were of sufficient quality for analysis. For 335 patients (44%), ERCC1 status was positive (H-score exceeding 1.0, i.e. tumors with a staining intensity score of 2 and 50% or more positive nuclei or a staining intensity score of 3 and 10% or more positive nuclei). The benefit of cisplatin-based adjuvant CT was correlated with the ERCC1 status (test for interaction, P<0.009). Patients with ERCC1-negative tumors randomized to CT had significantly prolonged survival compared with patients with ERCC1-negative tumors randomized to observation (adjusted hazard ratio for death, 0.67; 95% confidence interval [0.51–0.89], P<0.006). There was no survival difference with CT among ERCC1 positive patients (adjusted hazard ratio for death, 1.18; [0.87–1.61], P=0.29). When analyzing only patients randomized to observation, the subgroup with ERCC1 positive tumors had a better survival compared to those with ERCC1 negative tumors (0.65; [0.48–0.89], P<0.008). Conclusions: Patients with completely resected NSCLC and ERCC1-negative tumors derive a substantial benefit from adjuvant cisplatin-based CT. Unrestricted grants: Eli-Lilly, PHRC, Cancéropôle Rhône-Alpes, Austrian Science Fund

No significant financial relationships to disclose.

hTert, MMP1, Her2 expressions by preneoplastic lesions and breast cancer risk

10510

Background: Although it is well established that preneoplastic lesions are associated with an increased risk of breast cancer, there is no available tool to identify which patients will develop breast cancer. Telomerase, matrix metalloprotease 1 (MMP1) and Her2 have all been involved in the early steps of carcinogenesis. In the present study, we have looked at whether the expression of hTert, MMP1 and her2 in preneoplastic lesions were associated with higher risk of breast cancer. Methods: hTert, MMP1 and Her2 expressions by preneoplastic lesions were determined by immunohistochemistry in 34 patients who have subsequently developed a breast cancer (cases), and in 32 patients who did not present breast cancer in the follow-up (control). Patients were matched for age, length of follow-up and type of preneoplastic lesion. The expression of the three biomarkers was compared in the two groups. The initially planned sample size of the study was 90 matched patients, but only 66 samples could be proceed for technical reasons. Results: Median age was 47 and 49 years old in patients with and without further cancer respectively. In the group of patients who subsequently developed breast cancer (cases), preneoplastic lesions consisted in lobular hyperplasia or lobular in situ carcinoma in 17 cases, ductal atypical hyperplasia in 12 cases and mixed lesions in 5 cases. In the control group, preneoplastic lesions consisted in lobular hyperplasia or lobular in situ carcinoma in 18 cases, ductal atypical hyperplasia in 12 cases, mixed lesions in 2 cases. The median interval between the diagnosis of preneoplastic lesion and the occurrence of breast cancer was 72 months (17–291). hTert was expressed in 8 (27%) and 2 (7%) assessable lesions in cases and controls respectively (p = 0.04). MMP1 was expressed in 21 (65%) and 22 (73%) assessable lesions in cases and control respectively (p = 0.49). Her2 was expressed in 6 preneoplastic lesions both in cases and controls (20%). Conclusions: This study suggests that hTert expression by preneoplastic lesions could be associated with an increased risk breast cancer.

No significant financial relationships to disclose.