451
|
Hulvat M, Rajan P, Rajan E, Sarker S, Schermer C, Aranha G, Yao K. Histopathologic characteristics of the primary tumor in breast cancer patients with isolated tumor cells of the sentinel node. Surgery 2008; 144:518-24; discussion 524. [DOI: 10.1016/j.surg.2008.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 06/12/2008] [Indexed: 11/24/2022]
|
452
|
Ellis MJ, Tao Y, Luo J, A'Hern R, Evans DB, Bhatnagar AS, Chaudri Ross HA, von Kameke A, Miller WR, Smith I, Eiermann W, Dowsett M. Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics. J Natl Cancer Inst 2008; 100:1380-8. [PMID: 18812550 PMCID: PMC2556704 DOI: 10.1093/jnci/djn309] [Citation(s) in RCA: 434] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Understanding how tumor response is related to relapse risk would help clinicians make decisions about additional treatment options for patients who have received neoadjuvant endocrine treatment for estrogen receptor–positive (ER+) breast cancer. Methods Tumors from 228 postmenopausal women with confirmed ER+ stage 2 and 3 breast cancers in the P024 neoadjuvant endocrine therapy trial, which compared letrozole and tamoxifen for 4 months before surgery, were analyzed for posttreatment ER status, Ki67 proliferation index, histological grade, pathological tumor size, node status, and treatment response. Cox proportional hazards were used to identify factors associated with relapse-free survival (RFS) and breast cancer–specific survival (BCSS) in 158 women. A preoperative endocrine prognostic index (PEPI) for RFS was developed from these data and validated in an independent study of 203 postmenopausal women in the IMPACT trial, which compared treatment with anastrozole, tamoxifen, or the combination 3 months before surgery. Statistical tests were two-sided. Results Median follow-up in P024 was 61.2 months. Patients with confirmed baseline ER+ clinical stage 2 and 3 tumors that were downstaged to stage 1 or 0 at surgery had 100% RFS (compared with higher stages, P < .001). Multivariable testing of posttreatment tumor characteristics revealed that pathological tumor size, node status, Ki67 level, and ER status were independently associated with both RFS and BCSS. The PEPI model based on these factors predicted RFS in the IMPACT trial (P = .002). Conclusions Breast cancer patients with pathological stage 1 or 0 disease after neoadjuvant endocrine therapy and a low-risk biomarker profile in the surgical specimen (PEPI score 0) have an extremely low risk of relapse and are therefore unlikely to benefit from adjuvant chemotherapy.
Collapse
Affiliation(s)
- Matthew J Ellis
- Siteman Cancer Center, Washington University School of Medicine, 660 South Euclid Ave, St Louis, MO 63119, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
453
|
Banerjee S, Pancholi S, A'hern R, Ghazoui Z, Smith IE, Dowsett M, Martin LA. The effects of neoadjuvant anastrozole and tamoxifen on circulating vascular endothelial growth factor and soluble vascular endothelial growth factor receptor 1 in breast cancer. Clin Cancer Res 2008; 14:2656-63. [PMID: 18451229 DOI: 10.1158/1078-0432.ccr-07-1352] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Vascular endothelial growth factor (VEGF) is a key angiogenic factor mediating neovascularization. Soluble VEGF receptor 1 (sVEGFR-1) is an intrinsic negative counterpart of VEGF signaling and the ratio of sVEGFR-1 to VEGF has been shown to be a prognostic factor. Estrogen-bound estrogen receptor enhances VEGF expression, providing a common link between these signaling pathways that may be targeted by endocrine therapy. We investigated the effects of anastrozole and tamoxifen over time on serum VEGF and sVEGFR-1. EXPERIMENTAL DESIGN The Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen (IMPACT) trial compared the preoperative use of anastrozole with tamoxifen in postmenopausal women with estrogen receptor-positive primary operable breast cancer over 12 weeks. Circulating VEGF and sVEGFR-1 were measured by ELISA in 106 patients treated with anastrozole or tamoxifen alone at baseline and after 2 and 12 weeks of treatment. RESULTS The increase in serum VEGF from baseline to 12 weeks was significantly different between anastrozole and tamoxifen (anastrozole versus tamoxifen, 6% versus 38%; P = 0.047). There was a significant increase in sVEGFR-1 levels after 12 weeks of anastrozole (P = 0.037). The sVEGFR-1/VEGF ratio significantly decreased in the tamoxifen arm (P = 0.013) and the change in sVEGFR-1/VEGF ratio from baseline to 12 weeks was significantly different between anastrozole and tamoxifen (anastrozole versus tamoxifen, 24% increase versus 34% decrease; P = 0.013). CONCLUSIONS Treatment with anastrozole and tamoxifen resulted in differential effects on serum angiogenic markers. This may be related to the relative effectiveness of the treatments. These data provide further support for cross talk between estrogen receptor and VEGF.
Collapse
Affiliation(s)
- Susana Banerjee
- Breakthrough Breast Cancer Centre, Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
454
|
Generali D, Fox SB, Brizzi MP, Allevi G, Bonardi S, Aguggini S, Milani M, Bersiga A, Campo L, Dionisio R, Vergoni F, Giardini R, Dogliotti L, Bottini A, Harris AL, Berruti A. Down-regulation of phosphatidylinositol 3'-kinase/AKT/molecular target of rapamycin metabolic pathway by primary letrozole-based therapy in human breast cancer. Clin Cancer Res 2008; 14:2673-80. [PMID: 18451231 DOI: 10.1158/1078-0432.ccr-07-1046] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The phosphatidylinositol 3'-kinase (PI3K)/AKT/molecular target of rapamycin (mTOR) pathway is involved in the development of tumor resistance to endocrine therapy in breast cancer cell lines and represents an attractive target for pharmacologic intervention. However, the effects of endocrine therapy with aromatase inhibitors on in vivo expression of this signaling cascade, and its relation to tumor response and patient outcome, is unknown. EXPERIMENTAL DESIGN PI3K, phospho-AKT (pAKT) and phospho-mTOR were assessed by immunohistochemistry on tumor specimens collected at baseline and after 6 months of treatment in 113 elderly breast cancer patients consecutively enrolled in a randomized phase II trial of primary letrozole therapy and letrozole associated with metronomic cyclophosphamide. RESULTS Basal expression of the pathway was not significantly correlated with response or patient outcome. Both letrozole alone and letrozole with cyclophosphamide resulted in a significant reduction of PI3K expression (P = 0.02 and P < 0.005, respectively) and phospho-mTOR expression (P = 0.0001 and P = 0.0001, respectively). pAKT showed no change in the letrozole arm, whereas it was significantly decreased in the letrozole plus cyclophosphamide arm (P < 0.005). pAKT expression reduction was associated with a greater response rate (P = 0.05) and greater reduction in Ki67 expression (P = 0.05). Phospho-mTOR expression reduction was associated with a significantly longer disease-free survival in a multivariate analysis (P = 0.02). CONCLUSIONS Letrozole inhibits key molecules in the PI3K pathway that are important targets of new drugs being developed to overcome resistance. Changes in these molecules may have prognostic significance. These results should be taken into account when planning prospective trials testing up-front aromatase inhibitor with drugs targeting the PI3K/AKT/mTOR signaling pathway.
Collapse
Affiliation(s)
- Daniele Generali
- Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
455
|
Musgrove EA, Sergio CM, Loi S, Inman CK, Anderson LR, Alles MC, Pinese M, Caldon CE, Schütte J, Gardiner-Garden M, Ormandy CJ, McArthur G, Butt AJ, Sutherland RL. Identification of functional networks of estrogen- and c-Myc-responsive genes and their relationship to response to tamoxifen therapy in breast cancer. PLoS One 2008; 3:e2987. [PMID: 18714337 PMCID: PMC2496892 DOI: 10.1371/journal.pone.0002987] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Accepted: 07/29/2008] [Indexed: 11/30/2022] Open
Abstract
Background Estrogen is a pivotal regulator of cell proliferation in the normal breast and breast cancer. Endocrine therapies targeting the estrogen receptor are effective in breast cancer, but their success is limited by intrinsic and acquired resistance. Methodology/Principal Findings With the goal of gaining mechanistic insights into estrogen action and endocrine resistance, we classified estrogen-regulated genes by function, and determined the relationship between functionally-related genesets and the response to tamoxifen in breast cancer patients. Estrogen-responsive genes were identified by transcript profiling of MCF-7 breast cancer cells. Pathway analysis based on functional annotation of these estrogen-regulated genes identified gene signatures with known or predicted roles in cell cycle control, cell growth (i.e. ribosome biogenesis and protein synthesis), cell death/survival signaling and transcriptional regulation. Since inducible expression of c-Myc in antiestrogen-arrested cells can recapitulate many of the effects of estrogen on molecular endpoints related to cell cycle progression, the estrogen-regulated genes that were also targets of c-Myc were identified using cells inducibly expressing c-Myc. Selected genes classified as estrogen and c-Myc targets displayed similar levels of regulation by estrogen and c-Myc and were not estrogen-regulated in the presence of siMyc. Genes regulated by c-Myc accounted for 50% of all acutely estrogen-regulated genes but comprised 85% (110/129 genes) in the cell growth signature. siRNA-mediated inhibition of c-Myc induction impaired estrogen regulation of ribosome biogenesis and protein synthesis, consistent with the prediction that estrogen regulates cell growth principally via c-Myc. The ‘cell cycle’, ‘cell growth’ and ‘cell death’ gene signatures each identified patients with an attenuated response in a cohort of 246 tamoxifen-treated patients. In multivariate analysis the cell death signature was predictive independent of the cell cycle and cell growth signatures. Conclusions/Significance These functionally-based gene signatures can stratify patients treated with tamoxifen into groups with differing outcome, and potentially identify distinct mechanisms of tamoxifen resistance.
Collapse
Affiliation(s)
- Elizabeth A Musgrove
- Cancer Research Program, Garvan Institute of Medical Research, Sydney, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
456
|
Zoubir M, Mathieu M, Mazouni C, Liedtke C, Corley L, Geha S, Bouaziz J, Spielmann M, Drusche F, Symmans W, Delaloge S, Andre F. Modulation of ER phosphorylation on serine 118 by endocrine therapy: a new surrogate marker for efficacy. Ann Oncol 2008; 19:1402-1406. [DOI: 10.1093/annonc/mdn151] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
457
|
Sonpavde G, Amiel GE, Mims MP, Hayes TG, Lerner SP. Neoadjuvant chemotherapy preceding cystectomy for bladder cancer. Expert Opin Pharmacother 2008; 9:1885-93. [DOI: 10.1517/14656566.9.11.1885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
458
|
Jones RL, Salter J, A'Hern R, Nerurkar A, Parton M, Reis-Filho JS, Smith IE, Dowsett M. The prognostic significance of Ki67 before and after neoadjuvant chemotherapy in breast cancer. Breast Cancer Res Treat 2008; 116:53-68. [PMID: 18592370 DOI: 10.1007/s10549-008-0081-7] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 05/22/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the prognostic significance of proliferation, as assessed by Ki67 expression, in breast cancer before and after neoadjuvant chemotherapy. METHODS A retrospective search of a prospectively maintained clinical database was performed to identify patients treated with neoadjuvant chemotherapy at the Royal Marsden Hospital. The expression of Ki67 was assessed using immunohistochemistry in pre-therapy core-needle biopsy and post-therapy surgical excision specimens. The following factors were considered pre- and post-chemotherapy for their relationship with relapse-free and overall survival: age, menstrual status, T and N stage, pre-therapy operability, Ki67, ER, PgR, HER2, grade, histological subtype, vascular invasion, clinical response, chemotherapy regimen, type of surgery performed, adjuvant therapy, pathological tumour size and nodal involvement. RESULTS In a matched cohort of 103 patients, on multivariate analysis of relapse-free survival, post-therapy Ki67 was the only significant independent prognostic factor. On multivariate analysis for overall survival, both pre- and excision Ki67 were significant independent predictors but the latter showed a stronger prognostic impact. The highest and lowest tertiles of excision Ki67 had different prognosis for both 5-year relapse-free (27% vs. 77%) and overall (39% and 93%) survival. In a cohort of 284 patients with only excision samples, post-therapy Ki67 was a significant independent prognostic factor on multivariate analysis. CONCLUSION Post-chemotherapy Ki67 is a strong predictor of outcome for patients not achieving a pathological complete response.
Collapse
Affiliation(s)
- Robin L Jones
- Academic Department of Biochemistry, Royal Marsden Hospital, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
459
|
Henriksen KL, Sonne-Hansen K, Kirkegaard T, Frogne T, Lykkesfeldt AE. Development of new predictive markers for endocrine therapy and resistance in breast cancer. Acta Oncol 2008; 47:795-801. [PMID: 18465351 DOI: 10.1080/02841860802026993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Today, the decision to treat breast cancer patients with endocrine therapy relies solely on tumor expression of two predictive factors, the estrogen receptor and the progesterone receptor. Expression of these hormone receptors are, however, not a guarantee for a response to treatment and patients who experience response at first may become resistant after prolonged treatment. This paper describes the use of preclinical models to identify mechanisms and new markers for endocrine sensitivity and resistance and the translation of these data to clinical utility.
Collapse
|
460
|
|
461
|
|
462
|
Arpino G, Wiechmann L, Osborne CK, Schiff R. Crosstalk between the estrogen receptor and the HER tyrosine kinase receptor family: molecular mechanism and clinical implications for endocrine therapy resistance. Endocr Rev 2008; 29:217-33. [PMID: 18216219 PMCID: PMC2528847 DOI: 10.1210/er.2006-0045] [Citation(s) in RCA: 394] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 11/29/2007] [Indexed: 02/07/2023]
Abstract
Breast cancer evolution and tumor progression are governed by the complex interactions between steroid receptor [estrogen receptor (ER) and progesterone receptor] and growth factor receptor signaling. In recent years, the field of cancer therapy has witnessed the emergence of multiple strategies targeting these specific cancer pathways and key molecules (ER and growth factor receptors) to arrest tumor growth and achieve tumor eradication; treatment success, however, has varied and both de novo (up front) and acquired resistance have proven a challenge. Recent studies of ER biology have revealed new insights into ER action in breast cancer and have highlighted the role of an intimate crosstalk between the ER and HER family signaling pathways as a fundamental contributor to the development of resistance to endocrine therapies against the ER pathway. The aim of this review article is to summarize the current knowledge on mechanisms of resistance of breast cancer cells to endocrine therapies due to the crosstalk between the ER and the HER growth factor receptor signaling pathways and to explore new available therapeutic strategies that could prolong duration of response and circumvent endocrine resistant tumor growth.
Collapse
Affiliation(s)
- Grazia Arpino
- Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | | | | | | |
Collapse
|
463
|
Gralow JR, Burstein HJ, Wood W, Hortobagyi GN, Gianni L, von Minckwitz G, Buzdar AU, Smith IE, Symmans WF, Singh B, Winer EP. Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease. J Clin Oncol 2008; 26:814-9. [PMID: 18258991 DOI: 10.1200/jco.2007.15.3510] [Citation(s) in RCA: 283] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To review the state of the science with respect to preoperative systemic therapy and pathologic assessment in operable breast cancer. METHODS This article reviews data presented at the National Cancer Institute State of the Science Conference on Preoperative Therapy in Invasive Breast Cancer as well as supporting published data. RESULTS Preoperative chemotherapy in operable breast cancer has been shown to improve breast conservation rates as a result of tumor response to therapy. When patients are given preoperative systemic therapy, regimens should be the same as those established as safe and active in the adjuvant setting. At present, there are no data to suggest that systemic treatment should be tailored based on initial tumor response, or based on the extent of residual disease. In operable breast cancer, there seems to be no survival advantage from initiation of systemic therapy before surgery. A variety of clinical, imaging, and pathologic measurements are available to gauge tumor response to treatment. There is a clear correlation between tumor response in the breast and lymph nodes and both disease-free and overall survival. Pathologic complete response and other pathologic measures may be useful as surrogate end points in evaluating and understanding new therapies. CONCLUSION In operable breast cancer, preoperative systemic therapy is effective and can improve breast conservation rates. Unless the tumor is large or the patient is in a clinical trial, postoperative adjuvant systemic therapy is the standard of care. To achieve optimal outcomes, preoperative systemic therapy must be administered as part of a coordinated, multimodality treatment program. The preoperative setting provides a unique opportunity to study the impact of systemic therapies on breast cancer biology.
Collapse
Affiliation(s)
- Julie R Gralow
- Seattle Cancer Care Alliance, Department of Medicine, 825 Eastlake Ave, EMS G3-200, Seattle, WA 98109-1023, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
464
|
Wolff AC, Berry D, Carey LA, Colleoni M, Dowsett M, Ellis M, Garber JE, Mankoff D, Paik S, Pusztai L, Lou Smith M, Zujewski J. Research Issues Affecting Preoperative Systemic Therapy for Operable Breast Cancer. J Clin Oncol 2008; 26:806-13. [DOI: 10.1200/jco.2007.15.2983] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Preoperative systemic therapy (PST) in operable breast cancer allows a small increase in breast conservation rates and has significant potential as a research platform. PST offers the ability to discern treatment effect in vivo, and may allow smaller trials targeting specific breast cancer subtypes and making more efficient use of resources. Early observations of a specific outcome of interest in individual patient subgroups may improve the design of larger definitive randomized adjuvant trials using survival as a main outcome. PST offers the potential for therapeutic adjustments midcourse, which assumes the existence of validated intermediate end points and effective alternative therapies. This article reviews critical research issues affecting the design of PST trials, including the appropriate selection of trial end points and markers for long-term outcome, baseline marker expression as a predictor of response, and statistical considerations using novel trial designs. Key issues regarding optimal tumor subtype selection for individual trials, novel approaches using nontherapeutic window trial designs, and ethical and advocacy considerations are also discussed. PST requires an experienced and cohesive multidisciplinary team for it to fulfill its potential in both research and clinical care.
Collapse
Affiliation(s)
- Antonio C. Wolff
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| | - Donald Berry
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| | - Lisa A. Carey
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| | - Marco Colleoni
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| | - Mitchell Dowsett
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| | - Matthew Ellis
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| | - Judy E. Garber
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| | - David Mankoff
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| | - Soonmyung Paik
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| | - Lajos Pusztai
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| | - Mary Lou Smith
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| | - JoAnne Zujewski
- From the Johns Hopkins Sydney Kimmel Cancer Center, Baltimore; National Cancer Institute, Bethesda, MD; The University of Texas M.D. Anderson Cancer Center, Houston, TX; University of North Carolina, Chapel Hill, NC; European Institute of Oncology, Milan, Italy; Royal Marsden Hospital, London, United Kingdom; Washington University School of Medicine, St Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Medicine, Seattle, WA; Division of Pathology, National Surgical
| |
Collapse
|
465
|
Ellis MJ. Improving outcomes for patients with hormone receptor-positive breast cancer: back to the drawing board. J Natl Cancer Inst 2008; 100:159-61. [PMID: 18230793 DOI: 10.1093/jnci/djm325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
466
|
Cloughesy TF, Yoshimoto K, Nghiemphu P, Brown K, Dang J, Zhu S, Hsueh T, Chen Y, Wang W, Youngkin D, Liau L, Martin N, Becker D, Bergsneider M, Lai A, Green R, Oglesby T, Koleto M, Trent J, Horvath S, Mischel PS, Mellinghoff IK, Sawyers CL. Antitumor activity of rapamycin in a Phase I trial for patients with recurrent PTEN-deficient glioblastoma. PLoS Med 2008; 5:e8. [PMID: 18215105 PMCID: PMC2211560 DOI: 10.1371/journal.pmed.0050008] [Citation(s) in RCA: 450] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 11/15/2007] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is much discussion in the cancer drug development community about how to incorporate molecular tools into early-stage clinical trials to assess target modulation, measure anti-tumor activity, and enrich the clinical trial population for patients who are more likely to benefit. Small, molecularly focused clinical studies offer the promise of the early definition of optimal biologic dose and patient population. METHODS AND FINDINGS Based on preclinical evidence that phosphatase and tensin homolog deleted on Chromosome 10 (PTEN) loss sensitizes tumors to the inhibition of mammalian target of rapamycin (mTOR), we conducted a proof-of-concept Phase I neoadjuvant trial of rapamycin in patients with recurrent glioblastoma, whose tumors lacked expression of the tumor suppressor PTEN. We aimed to assess the safety profile of daily rapamycin in patients with glioma, define the dose of rapamycin required for mTOR inhibition in tumor tissue, and evaluate the antiproliferative activity of rapamycin in PTEN-deficient glioblastoma. Although intratumoral rapamycin concentrations that were sufficient to inhibit mTOR in vitro were achieved in all patients, the magnitude of mTOR inhibition in tumor cells (measured by reduced ribosomal S6 protein phosphorylation) varied substantially. Tumor cell proliferation (measured by Ki-67 staining) was dramatically reduced in seven of 14 patients after 1 wk of rapamycin treatment and was associated with the magnitude of mTOR inhibition (p = 0.0047, Fisher exact test) but not the intratumoral rapamycin concentration. Tumor cells harvested from the Ki-67 nonresponders retained sensitivity to rapamycin ex vivo, indicating that clinical resistance to biochemical mTOR inhibition was not cell-intrinsic. Rapamycin treatment led to Akt activation in seven patients, presumably due to loss of negative feedback, and this activation was associated with shorter time-to-progression during post-surgical maintenance rapamycin therapy (p < 0.05, Logrank test). CONCLUSIONS Rapamycin has anticancer activity in PTEN-deficient glioblastoma and warrants further clinical study alone or in combination with PI3K pathway inhibitors. The short-term treatment endpoints used in this neoadjuvant trial design identified the importance of monitoring target inhibition and negative feedback to guide future clinical development. TRIAL REGISTRATION http://www.ClinicalTrials.gov (#NCT00047073).
Collapse
Affiliation(s)
- Tim F Cloughesy
- Department of Neurology, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Koji Yoshimoto
- Department of Pathology and Laboratory Medicine, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Phioanh Nghiemphu
- Department of Neurology, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Kevin Brown
- Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Julie Dang
- Department of Pathology and Laboratory Medicine, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Shaojun Zhu
- Department of Pathology and Laboratory Medicine, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Teli Hsueh
- Department of Molecular and Medical Pharmacology, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Yinan Chen
- Department of Molecular and Medical Pharmacology, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Wei Wang
- Taylor Technology, Princeton, New Jersey, United States of America
| | - David Youngkin
- Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Linda Liau
- Department of Neurosurgery, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Neil Martin
- Department of Neurosurgery, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Don Becker
- Department of Neurosurgery, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Marvin Bergsneider
- Department of Neurosurgery, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Albert Lai
- Department of Neurology, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Richard Green
- Department of Neurology, Kaiser Permanente; Los Angeles, California, United States of America
| | - Tom Oglesby
- Taylor Technology, Princeton, New Jersey, United States of America
| | - Michael Koleto
- Taylor Technology, Princeton, New Jersey, United States of America
| | - Jeff Trent
- Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Steve Horvath
- Department of Biostatistics and Human Genetics, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Paul S Mischel
- Department of Pathology and Laboratory Medicine, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Molecular and Medical Pharmacology, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Ingo K Mellinghoff
- Department of Molecular and Medical Pharmacology, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Charles L Sawyers
- Department of Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * To whom correspondence should be addressed. E-mail:
| |
Collapse
|
467
|
Guix M, Granja NDM, Meszoely I, Adkins TB, Wieman BM, Frierson KE, Sanchez V, Sanders ME, Grau AM, Mayer IA, Pestano G, Shyr Y, Muthuswamy S, Calvo B, Krontiras H, Krop IE, Kelley MC, Arteaga CL. Short preoperative treatment with erlotinib inhibits tumor cell proliferation in hormone receptor-positive breast cancers. J Clin Oncol 2008; 26:897-906. [PMID: 18180460 DOI: 10.1200/jco.2007.13.5939] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To administer the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor erlotinib to patients with operable untreated breast cancer during the immediate preoperative period and to measure an antiproliferative and/or a proapoptotic effect in the post-therapy specimen and determine a biomarker profile associated with evidence of erlotinib-mediated cellular activity. PATIENTS AND METHODS Newly diagnosed patients with stages I to IIIA invasive breast cancer were treated with erlotinib 150 mg/d orally for 6 to 14 days until the day before surgery. Erlotinib plasma levels were measured by tandem mass spectrometry the day of surgery. Drug-induced changes in tumor cell proliferation and apoptosis were assessed by Ki67 immunohistochemistry and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling analysis, respectively, in biopsies from the pretherapy and surgical specimens. Biopsies were also evaluated for P-EGFR, P-HER-2, P-MAPK, P-Akt, P-S6, and S118 P-ER alpha. RESULTS In drug-sensitive PC9 xenografts, 5 days of treatment with erlotinib were enough to induce a maximal inhibition of cell proliferation and induction of apoptosis. Forty-one patients completed preoperative treatment with erlotinib. Grade <or= 2 rash and diarrhea were the main toxicities. Erlotinib inhibited tumor cell proliferation (Ki67), P-EGFR, and P-HER-2. The inhibition of proliferation occurred in estrogen receptor (ER) -positive but not in human epidermal growth factor receptor 2 (HER-2) -positive or triple-negative cancers. Treatment was associated with a significant reduction of P-MAPK, P-Akt, P-S6, and S118 P-ER alpha in hormone receptor-positive cancers. CONCLUSION A presurgical approach to evaluate cellular responses to new drugs is feasible in breast cancer. EGFR inhibitors are worthy of testing against ER-positive breast cancers but are unlikely to have clinical activity against HER-2-positive or triple-negative breast cancers.
Collapse
Affiliation(s)
- Marta Guix
- Department of Medicine, Vanderbilt-Ingram Comprehensive Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232-6307, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
468
|
|
469
|
Boughey JC, Buzdar AU, Hunt KK. Recent Advances in the Hormonal Treatment of Breast Cancer. Curr Probl Surg 2008; 45:13-55. [DOI: 10.1067/j.cpsurg.2007.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
470
|
Dowsett M, Salter J, Hills M, Detre S, A'Hern R, Smith IE. Short-term presurgical treatment for all? Breast Cancer Res 2007. [PMCID: PMC2230521 DOI: 10.1186/bcr1811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
471
|
|
472
|
Faratian D, Moodie SL, Harrison DJ, Goryanin I. Dynamic computational modeling in the search for better breast cancer drug therapy. Pharmacogenomics 2007; 8:1757-61. [DOI: 10.2217/14622416.8.12.1757] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Breast cancer is an excellent disease paradigm for systems biology. At the time of writing, a simple PubMed search for ‘breast cancer’ returns nearly 99,000 hits, compared with 51,000 or 16,000 for lung and colon cancer respectively, even though in terms of mortality lung and colon cancers are responsible for four-times more deaths per annum in the UK. These figures reflect the effort and money invested in breast cancer research. It is because breast cancer research is data-rich, crowded and competitive (often perceived as a negative for clinical and basic scientific researchers) that it is such an appealing area of research for systems biologists. For systems biologists, data is currency, and they scavenge diverse and multilayered datasets, from biochemical through genomics and transcriptomics to proteomics, in order to populate computational models. We discuss how dynamic modeling can be used as a tool for predicting responses to new and existing drugs, and what needs to be done to make systems biology a useful tool in the clinic.
Collapse
Affiliation(s)
- Dana Faratian
- Edinburgh Breakthrough Research Unit and Pathology, Cancer Research Centre, Crewe Road South, Edinburgh, EH4 2XR, UK
| | - Stuart L Moodie
- University of Edinburgh, Computational Systems Biology Group, Centre for Systems Biology at Edinburgh, Darwin Building, The King’s Buildings, Edinburgh, EH9 3JZ, UK
| | - David J Harrison
- Edinburgh Breakthrough Research Unit and Pathology, Cancer Research Centre, Crewe Road South, Edinburgh, EH4 2XR, UK
| | - Igor Goryanin
- University of Edinburgh, Computational Systems Biology Group, Centre for Systems Biology at Edinburgh, Darwin Building, The King’s Buildings, Edinburgh, EH9 3JZ, UK
| |
Collapse
|
473
|
Mackay A, Urruticoechea A, Dixon JM, Dexter T, Fenwick K, Ashworth A, Drury S, Larionov A, Young O, White S, Miller WR, Evans DB, Dowsett M. Molecular response to aromatase inhibitor treatment in primary breast cancer. Breast Cancer Res 2007; 9:R37. [PMID: 17555561 PMCID: PMC1929101 DOI: 10.1186/bcr1732] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 04/26/2007] [Accepted: 06/07/2007] [Indexed: 11/10/2022] Open
Abstract
Background Aromatase inhibitors such as anastrozole and letrozole are highly effective suppressants of estrogen synthesis in postmenopausal women and are the most effective endocrine treatments for hormone receptor positive breast cancer in such women. Little is known of the molecular effects of these agents on human breast carcinomas in vivo. Methods We randomly assigned primary estrogen receptor positive breast cancer patients to treatment with anastrozole or letrozole for 2 weeks before surgery. Expression profiling using cDNA arrays was conducted on pretreatment and post-treatment biopsies. Sample pairs from 34 patients provided sufficient RNA for analysis. Results Profound changes in gene expression were seen with both aromatase inhibitors, including many classical estrogen-dependent genes such as TFF1, CCND1, PDZK1 and AGR2, but also many other genes that are likely to represent secondary responses; decrease in the expression of proliferation-related genes were particularly prominent. Many upregulated genes are involved in extracellular matrix remodelling, including collagens and members of the small leucine-rich proteoglycan family (LUM, DCN, and ASPN). No significant differences were seen between letrozole and anastrozole in terms of molecular effects. The gene changes were integrated into a Global Index of Dependence on Estrogen (GIDE), which enumerates the genes changing by at least twofold with therapy. The GIDE varied markedly between tumours and related significantly to pretreatment levels of HER2 and changes in immunohistochemically detected Ki67. Conclusion Our findings identify the transcriptional signatures associated with aromatase inhibitor treatment of primary breast tumours. Larger datasets using this approach should enable identification of estrogen-dependent molecular changes, which are the determinants of benefit or resistance to endocrine therapy.
Collapse
Affiliation(s)
- Alan Mackay
- The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
| | - Ander Urruticoechea
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | | | - Tim Dexter
- The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
| | - Kerry Fenwick
- The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
| | - Alan Ashworth
- The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
| | - Suzanne Drury
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Alexey Larionov
- The Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Oliver Young
- The Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Sharon White
- The Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - William R Miller
- The Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | | | - Mitch Dowsett
- The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
- Academic Department of Biochemistry, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| |
Collapse
|
474
|
Ellis M. What have we gained from the application of biological ‘rationales’? EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70027-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
475
|
Abstract
Aromatase inhibitors are now considered to be part of the endocrine treatment for most hormone receptor-positive breast cancer in post-menopausal women for both early and advanced disease. Despite the impressive efficacy of these agents, up to 50% of treated patients exhibit de novo or intrinsic resistance to aromatase inhibitors and hence identification of response predictors is essential to allow treatment to be directed towards responsive populations and for alternative or additional therapies to be offered to resistant patients. Emerging data seem to suggest a role for the conventional tumour markers of oestrogen receptor and progesterone receptor as possible predictors of response but, particularly in the adjuvant setting, the extent to which these are useful has not been fully elucidated. Data from both the neo-adjuvant and advanced disease settings suggest that response to aromatase inhibitors does not appear to be adversely affected by HER-2 overexpression. Within neo-adjuvant aromatase inhibitor studies, the proliferation marker Ki67 has shown a significant correlation with relapse-free survival, suggesting a role in prediction for measurement of Ki67 and other dynamic markers of response. Analysis of multiple gene expression changes over a short treatment period may also have potential clinical utility for prediction of response.
Collapse
Affiliation(s)
- Helen Anderson
- Academic Department of Biochemistry, Royal Marsden Hospital, London SW3 6JJ, UK.
| | | | | | | |
Collapse
|
476
|
Dowsett M, Smith IE. Response: Re: Prognostic Value of Ki67 Expression After Short-Term Presurgical Endocrine Therapy for Primary Breast Cancer. J Natl Cancer Inst 2007. [DOI: 10.1093/jnci/djm020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
477
|
Hrushesky WJM, Retsky M, Baum M, Demicheli R. Re: Prognostic value of Ki67 expression after short-term presurgical endocrine therapy for primary breast cancer. J Natl Cancer Inst 2007; 99:1053; author reply 1053-4. [PMID: 17596578 DOI: 10.1093/jnci/djm019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
MESH Headings
- Antineoplastic Agents, Hormonal/therapeutic use
- Biomarkers, Tumor
- Biopsy, Needle
- Breast Neoplasms/chemistry
- Breast Neoplasms/drug therapy
- Breast Neoplasms/immunology
- Breast Neoplasms/surgery
- Chemotherapy, Adjuvant
- Data Interpretation, Statistical
- Disease-Free Survival
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Ki-67 Antigen/analysis
- Ki-67 Antigen/metabolism
- Middle Aged
- Neoadjuvant Therapy/methods
- Neoplasms, Hormone-Dependent/chemistry
- Neoplasms, Hormone-Dependent/drug therapy
- Neoplasms, Hormone-Dependent/immunology
- Neoplasms, Hormone-Dependent/surgery
- Time Factors
Collapse
|
478
|
Smith IE, Arnedos M. The evolution of adjuvant endocrine therapy: Developments since St Gallen 2005. Breast 2007; 16 Suppl 2:S4-9. [PMID: 17764939 DOI: 10.1016/j.breast.2007.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The most recent Oxford Overview analysis shows that tamoxifen remains a highly effective adjuvant endocrine therapy with continuing benefit for at least 15 years. The aromatase inhibitors (AIs) achieve a further small reduction in recurrence in postmenopausal women either as first-line treatment or sequentially after 2-3 years tamoxifen but so far usually without survival benefit. Differences in side effects are minor and specifically there is no evidence for significant differences in cardiovascular side effects. Extended adjuvant therapy with an AI after 5 years tamoxifen gives important additional protection to women with higher risk cancers. The relative benefits of first-line vs. sequential AIs after 2-3 years tamoxifen await the outcome of current trials. The major outstanding questions include duration of endocrine therapy, the value of ovarian suppression in premenopausal women in addition to other treatments, and the selection of patients who require endocrine therapy alone without additional chemotherapy.
Collapse
Affiliation(s)
- Ian E Smith
- Breast Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
| | | |
Collapse
|