101
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Di Benedetto A, Ercolani C, Pizzuti L, Angelucci D, Sergi D, Marinelli C, Iezzi L, Sperati F, Terrenato I, Mazzotta M, Mariani L, Vizza E, Paoletti G, Tomao S, Maugeri-Saccà M, Barba M, Tinari N, Natoli C, Ciliberto G, Grassadonia A, Vici P. Prognostic relevance of DNA damage and repair biomarkers in elderly patients with hormone-receptor-positive breast cancer treated with neoadjuvant hormone therapy: evidence from the real-world setting. Ther Adv Med Oncol 2019; 11:1758835919853192. [PMID: 31452691 PMCID: PMC6700857 DOI: 10.1177/1758835919853192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/10/2019] [Indexed: 01/06/2023] Open
Abstract
Background: The logic behind the outcome of endocrine therapy in breast cancer has long remained poorly understood. The prognostic role of DNA damage and repair biomarkers (DDR) was explored in postmenopausal, hormone-receptor-positive breast cancer patients treated with neoadjuvant hormone therapy (NAHT). Methods: Data on 55 patients were included. The phosphorylated ataxia-teleangectasia and Rad3-related protein (pATR), phosphorylated ataxia-telangiectasia mutated (ATM) kinase, and phosphorylated H2A Histone Family Member X (γ-H2AX) were evaluated by immunohistochemistry in paired tissues collected at baseline and following NAHT. Biomarkers were considered both singularly and within signatures. Ki-67 percentage change was the primary biomarker endpoint. Classical endpoints were also considered. Results: The most favorable Ki-67 outcome was associated with the γ-H2AX/pATM signature (p = 0.011). In models of Ki-67 reduction, ‘luminal B’ subtype, higher grade of anaplasia, and the γ-H2AX/pATM signature tested as significant (p < 0.05 for all). Results were confirmed in multivariate analysis. No association was observed with pathologic response. An increase of ∆γ-H2AX in paired breast tissues was associated with longer event-free survival (p = 0.027) and overall survival (p = 0.042). In Cox models, both survival outcomes were solely affected by grade of anaplasia, with less favorable prognosis in the highest grades (p < 0.05 for both). Conclusions: We report novel evidence of the prognostic role of DDR biomarkers on important patient outcomes in postmenopausal hormone-receptor-positive breast cancer patients treated with NAHT. If confirmed in future and adequately sized trials, our results may help inform therapeutic decisions and clarify underlying biological mechanisms.
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Affiliation(s)
- Anna Di Benedetto
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Cristiana Ercolani
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Domenico Sergi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Laura Iezzi
- Department of Medical and Oral Science and Biotechnologies, University G. D'Annunzio, Chieti, Italy
| | - Francesca Sperati
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Mazzotta
- Department of Clinical and Molecular Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - Luciano Mariani
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Vizza
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giancarlo Paoletti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Silverio Tomao
- Medical Oncology Unit A, Policlinico Umberto I, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Nicola Tinari
- Department of Medical and Oral Science and Biotechnologies, University G. D'Annunzio, Chieti, Italy
| | - Clara Natoli
- Department of Medical and Oral Science and Biotechnologies, University G. D'Annunzio, Chieti, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonino Grassadonia
- Department of Medical and Oral Science and Biotechnologies, University G. D'Annunzio, Chieti, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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102
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Viale G, Hanlon Newell AE, Walker E, Harlow G, Bai I, Russo L, Dell'Orto P, Maisonneuve P. Ki-67 (30-9) scoring and differentiation of Luminal A- and Luminal B-like breast cancer subtypes. Breast Cancer Res Treat 2019; 178:451-458. [PMID: 31422497 PMCID: PMC6797656 DOI: 10.1007/s10549-019-05402-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/07/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Ki-67 labeling index assessed by immunohistochemical assays has been shown useful in assessing the risk of recurrence for estrogen receptor (ER)-positive HER2-negative breast cancers (BC) and distinguishing Luminal A-like from Luminal B-like tumors. We aimed to assess the performance of the Ventana CONFIRM anti-Ki-67 (30-9) Rabbit Monoclonal Primary Antibody. METHODS We constructed a case-cohort design based on a random sample (n = 679) of all patients operated on for a first primary, non-metastatic, ER-positive, HER2-negative BC at the European Institute of Oncology (IEO) Milan, Italy during 1998-2002 and all additional patients (n = 303) operated during the same period, who developed an event (metastasis in distant organs or death due to BC as primary event) and were not included in the previous subset. Multivariable Cox proportional hazards regression with inverse subcohort sampling probability weighting was used to evaluate the risk of event according to Ki-67 (30-9) and derived intrinsic molecular subtype, using previously defined cutoff values, i.e., respectively 14% and 20%. RESULTS Ki-67 was < 14% in 318 patients (32.4%), comprised between 14 and 19% in 245 patients (24.9%) and ≥ 20 in 419 patients (42.7%). At multivariable analysis, the risk of developing distant disease was 1.88 (95% CI 1.20-2.93; P = 0.006) for those with Ki-67 comprised between 14 and 19%, and 3.06 (95% CI 1.93-4.84; P < 0.0001) for those with Ki-67 ≥ 20% compared to those with Ki-67 < 14%. Patients with Luminal B-like BC had an approximate twofold risk of developing distant disease (HR = 1.91; 95% CI 1.35-2.71; P = 0.0003) than patients with Luminal A-like BC defined using Ki-67 (30-9). CONCLUSIONS Ki-67 evaluation using the 30-9 rabbit monoclonal primary antibody was able to stratify patients with ER-positive HER2-negative BC into prognostically distinct groups. Ki-67 assessment, with strict adherence to the international recommendations, should be included among the clinically useful biological parameters for the best treatment of patients with BC.
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Affiliation(s)
- Giuseppe Viale
- Department of Pathology, IEO European Institute of Oncology IRCCS, Milan, Italy.,University of Milan, Milan, Italy
| | | | | | - Greg Harlow
- Ventana Medical Systems, Inc., Tucson, AZ, USA.
| | - Isaac Bai
- Ventana Medical Systems, Inc., Tucson, AZ, USA
| | - Leila Russo
- Department of Pathology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Patrizia Dell'Orto
- Department of Pathology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, Milan, Italy
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103
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Sato N, Masuda N, Morimoto T, Ueno T, Kanbayashi C, Kaneko K, Yasojima H, Saji S, Sasano H, Morita S, Ohno S, Toi M. Neoadjuvant exemestane or exemestane plus docetaxel and cyclophosphamide tailored by clinicopathological response to 12 weeks' exemestane exposure in patients with estrogen receptor-positive breast cancer: A multicenter, open-label, phase II study. Cancer Med 2019; 8:5468-5481. [PMID: 31361400 PMCID: PMC6745863 DOI: 10.1002/cam4.2423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 12/21/2022] Open
Abstract
Our aim was to investigate the efficacy and safety of initial neoadjuvant endocrine therapy with exemestane alone followed by tailored treatment, either continued exemestane monotherapy or exemestane plus docetaxel–cyclophosphamide (TC) combination therapy, in postmenopausal patients with primary invasive estrogen receptor–positive, human epidermal growth factor receptor 2–negative, stage I‐IIIA breast cancer and Ki67 labeling index ≤30%. In this open‐label phase II study, patients initially received exemestane 25 mg/d for 12 weeks. Responders were defined as patients who achieved complete response (CR), partial response (PR) with Ki67 labeling index ≤5% after treatment, or stable disease with Ki67 labeling index ≤5% both before and after treatment. For the subsequent 12 weeks, exemestane monotherapy was continued for responders (group A), whereas nonresponders received exemestane plus four cycles of TC (docetaxel 75 mg/m2 and cyclophosphamide 600 mg/m2 every 3 weeks) (group B). Clinical response rate (ie the proportion of patients with CR or PR) at 24 weeks was the primary endpoint. Of 64 patients provisionally enrolled between December 2010 and May 2016, 58 (median age 60 years) started the study treatment. Five patients discontinued treatment in the initial exemestane monotherapy period, and 39 completed the study treatment. Clinical response rates at 8‐12 and 24 weeks were 71% (10/14, 95% confidence interval [CI] 41.9%‐91.6%) and 57% (8/14, 95% CI 28.9%‐82.3%), respectively, in group A, and 16% (4/25, 95% CI 4.5%‐36.1%) and 56% (14/25, 95% CI 34.9%‐75.6%), respectively, in group B. Grade ≥3 adverse events were reported in 8% (1/15) and 53% (20/38) in group A and group B, respectively. The tailored treatment maintained the favorable clinical response to exemestane alone in responders and improved clinical response in nonresponders. Trial number UMIN000004752 (UMIN Clinical Trials Registry).
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Affiliation(s)
- Nobuaki Sato
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Norikazu Masuda
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takashi Morimoto
- Department of Breast Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Takayuki Ueno
- Breast Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Chizuko Kanbayashi
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Koji Kaneko
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hiroyuki Yasojima
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | | | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Masakazu Toi
- Department of Surgery (Breast Surgery), Graduate School of Medicine, Kyoto University, Kyoto, Japan
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104
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Orozco JIJ, Grumley JG, Matsuba C, Manughian-Peter AO, Chang SC, Chang G, Gago FE, Salomon MP, Marzese DM. Clinical Implications of Transcriptomic Changes After Neoadjuvant Chemotherapy in Patients with Triple-Negative Breast Cancer. Ann Surg Oncol 2019; 26:3185-3193. [PMID: 31342395 DOI: 10.1245/s10434-019-07567-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pathological response to neoadjuvant chemotherapy (NAC) is critical in prognosis and selection of systemic treatments for patients with triple-negative breast cancer (TNBC). The aim of this study is to identify gene expression-based markers to predict response to NAC. PATIENTS AND METHODS A survey of 43 publicly available gene expression datasets was performed. We identified a cohort of TNBC patients treated with NAC (n = 708). Gene expression data from different studies were renormalized, and the differences between pretreatment (pre-NAC), on-treatment (post-C1), and surgical (Sx) specimens were evaluated. Euclidean statistical distances were calculated to estimate changes in gene expression patterns induced by NAC. Hierarchical clustering and pathway enrichment analyses were used to characterize relationships between differentially expressed genes and affected gene pathways. Machine learning was employed to refine a gene expression signature with the potential to predict response to NAC. RESULTS Forty nine genes consistently affected by NAC were involved in enhanced regulation of wound response, chemokine release, cell division, and decreased programmed cell death in residual invasive disease. The statistical distances between pre-NAC and post-C1 significantly predicted pathological complete response [area under the curve (AUC) = 0.75; p = 0.003; 95% confidence interval (CI) 0.58-0.92]. Finally, the expression of CCND1, a cyclin that forms complexes with CDK4/6 to promote the cell cycle, was the most informative feature in pre-NAC biopsies to predict response to NAC. CONCLUSIONS The results of this study reveal significant transcriptomic changes induced by NAC and suggest that chemotherapy-induced gene expression changes observed early in therapy may be good predictors of response to NAC.
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Affiliation(s)
- Javier I J Orozco
- Cancer Epigenetics Laboratory, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Janie G Grumley
- Margie Petersen Breast Center, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Chikako Matsuba
- Computational Biology Laboratory, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Ayla O Manughian-Peter
- Cancer Epigenetics Laboratory, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Shu-Ching Chang
- Medical Data Research Center, Providence Saint Joseph Health, Portland, OR, USA
| | - Grace Chang
- Hematology and Oncology Department, Providence Saint John's Health Center, Santa Monica, CA, USA
| | | | - Matthew P Salomon
- Computational Biology Laboratory, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
| | - Diego M Marzese
- Cancer Epigenetics Laboratory, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
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105
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Leung SCY, Nielsen TO, Zabaglo LA, Arun I, Badve SS, Bane AL, Bartlett JMS, Borgquist S, Chang MC, Dodson A, Ehinger A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hugh JC, Kos Z, Laenkholm AV, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Sakatani T, Salgado R, Starczynski J, Sugie T, van der Vegt B, Viale G, Hayes DF, McShane LM, Dowsett M. Analytical validation of a standardised scoring protocol for Ki67 immunohistochemistry on breast cancer excision whole sections: an international multicentre collaboration. Histopathology 2019; 75:225-235. [PMID: 31017314 DOI: 10.1111/his.13880] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/19/2019] [Indexed: 01/12/2023]
Abstract
AIMS The nuclear proliferation marker Ki67 assayed by immunohistochemistry has multiple potential uses in breast cancer, but an unacceptable level of interlaboratory variability has hampered its clinical utility. The International Ki67 in Breast Cancer Working Group has undertaken a systematic programme to determine whether Ki67 measurement can be analytically validated and standardised among laboratories. This study addresses whether acceptable scoring reproducibility can be achieved on excision whole sections. METHODS AND RESULTS Adjacent sections from 30 primary ER+ breast cancers were centrally stained for Ki67 and sections were circulated among 23 pathologists in 12 countries. All pathologists scored Ki67 by two methods: (i) global: four fields of 100 tumour cells each were selected to reflect observed heterogeneity in nuclear staining; (ii) hot-spot: the field with highest apparent Ki67 index was selected and up to 500 cells scored. The intraclass correlation coefficient (ICC) for the global method [confidence interval (CI) = 0.87; 95% CI = 0.799-0.93] marginally met the prespecified success criterion (lower 95% CI ≥ 0.8), while the ICC for the hot-spot method (0.83; 95% CI = 0.74-0.90) did not. Visually, interobserver concordance in location of selected hot-spots varies between cases. The median times for scoring were 9 and 6 min for global and hot-spot methods, respectively. CONCLUSIONS The global scoring method demonstrates adequate reproducibility to warrant next steps towards evaluation for technical and clinical validity in appropriate cohorts of cases. The time taken for scoring by either method is practical using counting software we are making publicly available. Establishment of external quality assessment schemes is likely to improve the reproducibility between laboratories further.
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Affiliation(s)
| | | | | | | | - Sunil S Badve
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Anita L Bane
- Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - John M S Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada.,Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - Signe Borgquist
- Division of Oncology and Pathology, Department of Clinical Science, Lund University, Lund, Sweden
| | - Martin C Chang
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Andrew Dodson
- Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, UK
| | - Anna Ehinger
- Department of Clinical Genetics and Pathology, Skane University Hospital, Lund University, Lund, Sweden
| | - Susan Fineberg
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Dongxia Gao
- University of British Columbia, Vancouver, BC, Canada
| | | | - Carolina Gutierrez
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Zuzana Kos
- University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | | | | | | | - Sharon Nofech-Mozes
- University of Toronto Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Kent Osborne
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Tammy Piper
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | | | - Roberto Salgado
- Department of Pathology, GZA-ZNA, Antwerp, Belgium.,Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jane Starczynski
- Birmingham Heart of England, National Health Service, Birmingham, UK
| | | | | | - Giuseppe Viale
- European Institute of Oncology, Milan, Italy.,University of Milan, Milan, Italy
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
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106
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Fabian CJ. Will a Low-Dose Option Improve Uptake of Tamoxifen for Breast Cancer Risk Reduction? J Clin Oncol 2019; 37:1595-1597. [DOI: 10.1200/jco.19.00656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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107
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Leal MF, Haynes BP, MacNeill FA, Dodson A, Dowsett M. Comparison of protein expression between formalin-fixed core-cut biopsies and surgical excision specimens using a novel multiplex approach. Breast Cancer Res Treat 2019; 175:317-326. [PMID: 30796652 PMCID: PMC6533418 DOI: 10.1007/s10549-019-05163-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE We evaluated whether multiplex protein quantification using antibody bar-coding with photocleavable oligonucleotides (NanoString) can be applied to evaluate protein expression in breast cancer FFPE specimens. We also assessed whether diagnostic core-cuts fixed immediately at time of procedures and surgical excision sections from routinely fixed breast cancers are affected by the same fixation related differences noted using immunohistochemistry (IHC). METHODS The expression of 26 proteins was analysed using NanoString technology in 16 pairs of FFPE breast cancer core-cuts and surgical excisions. The measurements yielded were compared with those by IHC on Ki67, PgR and HER2 biomarkers and pAKT and pERK1/2 phosphorylated proteins. RESULTS When considered irrespective of sample type, expression measured by the two methods was strongly correlated for all markers (p < 0.001; ρ = 0.69-0.88). When core-cuts and excisions were evaluated separately, the correlations between NanoString and IHC were weaker but significant except for pAKT in excisions. Surgical excisions showed lower levels of 8/12 phosphoproteins and higher levels of 4/13 non-phosphorylated proteins in comparison to core-cuts (p < 0.01). Reduced p4EBP1, pAMPKa, pRPS6 and pRAF1 immunogenicity in excisions was correlated with tumour size and mastectomy specimens showed lower p4EBP1 and pRPS6 expression than lumpectomy (p < 0.05). CONCLUSIONS Our study supports the validity of the new multiplex approach to protein analysis but indicates that, as with IHC, caution is necessary for the analysis in excisions particularly of phosphoproteins. The specimen type, tumour size and surgery type may lead to biases in the quantitative analysis of many proteins of biologic and clinical interest in excision specimens.
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Affiliation(s)
- Mariana Ferreira Leal
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK.
- Breast Cancer Now Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK.
| | - Ben P Haynes
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK
| | - Fiona A MacNeill
- Breast Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Andrew Dodson
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, 4th Floor Wallace Wing, 203 Fulham Road, London, SW3 6JJ, UK
- Breast Cancer Now Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
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108
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Abstract
Endocrine therapy is essential for the treatment of patients with estrogen receptor positive (ER+) breast cancer, however, resistance and the development of metastatic disease is common. Understanding how ER+ breast cancer metastasizes is critical since the major cause of death in breast cancer is metastasis to distant organs. Results from many studies suggest dysregulation of the estrogen receptor alpha gene (ESR1 ) contributes to therapeutic resistance and metastatic biology. This review covers both pre-clinical and clinical evidence on the spectrum of ESR1 alterations including amplification, point mutations, and genomic rearrangement events driving treatment resistance and metastatic potential of ER+ breast cancer. Importantly, we describe how these ESR1 alterations may provide therapeutic opportunities to improve outcomes in patients with lethal, metastatic breast cancer.
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Affiliation(s)
- Jonathan T Lei
- Interdepartmental Graduate Program in Translational Biology & Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, USA.,Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Xuxu Gou
- Interdepartmental Graduate Program in Translational Biology & Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, USA.,Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sinem Seker
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Matthew J Ellis
- Interdepartmental Graduate Program in Translational Biology & Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, USA.,Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA.,Departments of Medicine and Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
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109
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DeCensi A, Puntoni M, Guerrieri-Gonzaga A, Caviglia S, Avino F, Cortesi L, Taverniti C, Pacquola MG, Falcini F, Gulisano M, Digennaro M, Cariello A, Cagossi K, Pinotti G, Lazzeroni M, Serrano D, Branchi D, Campora S, Petrera M, Buttiron Webber T, Boni L, Bonanni B. Randomized Placebo Controlled Trial of Low-Dose Tamoxifen to Prevent Local and Contralateral Recurrence in Breast Intraepithelial Neoplasia. J Clin Oncol 2019; 37:1629-1637. [PMID: 30973790 PMCID: PMC6601429 DOI: 10.1200/jco.18.01779] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Tamoxifen administered for 5 years at 20 mg/d is effective in breast cancer treatment and prevention, but toxicity has limited its broad use. Biomarker trials showed that 5 mg/d is not inferior to 20 mg/d in decreasing breast cancer proliferation. We hypothesized that a lower dose given for a shorter period could be as effective in preventing recurrence from breast intraepithelial neoplasia but have a lower toxicity than the standard dose. PATIENTS AND METHODS We conducted a multicenter randomized trial of tamoxifen, 5 mg/d or placebo administered for 3 years after surgery in women with hormone-sensitive or unknown breast intraepithelial neoplasia, including atypical ductal hyperplasia and lobular or ductal carcinoma in situ. The primary end point was the incidence of invasive breast cancer or ductal carcinoma in situ. RESULTS Five hundred women 75 years of age or younger were included. After a median follow-up of 5.1 years (interquartile range, 3.9-6.3 years), there were 14 neoplastic events with tamoxifen and 28 with placebo (11.6 v 23.9 per 1,000 person-years; hazard ratio, 0.48; 95% CI, 0.26 to 0.92; P = .02), which resulted in a 5-year number needed to treat of 22 (95% CI, 20 to 27). Tamoxifen decreased contralateral breast events by 75% (three v 12 events; hazard ratio, 0.25; 95% CI, 0.07 to 0.88; P = .02). Patient-reported outcomes were not different between arms except for a slight increase in frequency of daily hot flashes with tamoxifen (P = .02). There were 12 serious adverse events with tamoxifen and 16 with placebo, including one deep vein thrombosis and one stage I endometrial cancer with tamoxifen and one pulmonary embolism with placebo. CONCLUSION Tamoxifen at 5 mg/d for 3 years can halve the recurrence of breast intraepithelial neoplasia with a limited toxicity, which provides a new treatment option in these disorders.
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Affiliation(s)
- Andrea DeCensi
- 1 Ente Ospedaliero Ospedali Galliera, Genoa, Italy.,2 Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | | | - Franca Avino
- 4 Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Laura Cortesi
- 5 Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Cristiana Taverniti
- 6 Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Fabio Falcini
- 8 Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | | | | | - Anna Cariello
- 11 Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy
| | | | | | | | | | | | - Sara Campora
- 1 Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | | | | | - Luca Boni
- 14 Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
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110
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Yu KD, Wu SY, Liu GY, Wu J, Di GH, Hu Z, Hou YF, Chen CM, Fan L, Tang LC, Shen ZZ, Wu KJ, Zhuang ZG, Zhang HW, Shao ZM. Concurrent neoadjuvant chemotherapy and estrogen deprivation in patients with estrogen receptor-positive, human epidermal growth factor receptor 2-negative breast cancer (CBCSG-036): A randomized, controlled, multicenter trial. Cancer 2019; 125:2185-2193. [PMID: 30892700 DOI: 10.1002/cncr.32057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The current randomized, controlled, multicenter clinical trial was conducted to investigate the efficacy of concurrent neoadjuvant chemotherapy (NCT) and estrogen deprivation in patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. METHODS Eligible patients with AJCC stage IIB to stage IIIC, ER-positive, HER2-negative breast cancer were enrolled and randomly assigned to receive NCT with or without estrogen deprivation. The primary endpoint was the objective response rate (ORR). RESULTS A total of 249 patients were assigned to either neoadjuvant chemoendocrine therapy (NCET) (125 patients) or the NCT group (124 patients). In the intention-to-treat analysis, the ORR was found to be significantly higher in the NCET group compared with the NCT group (84.8% vs 72.6%; odds ratio, 2.11 [95% CI, 1.13-3.95; P = .02). The efficacy of NCET was more prominent in tumors with a higher Ki-67 index (>20%), with an ORR of 91.2% reported in the NCET group versus 68.7% in the NCT group (P = .001). The pathologic complete response and pathological response rates did not differ significantly between the 2 groups. Although there was no significant difference with regard to progression-free survival (PFS) between the 2 groups (P = .188), patients with a higher baseline Ki-67 index appeared to derive a greater PFS benefit from NCET (2-year PFS rate of 91.5% in the NCET group vs 76.5% in the NCT group; P = .058). Adding endocrine agents to NCT did not result in significant differences in adverse events (grade 3 or 4; graded according to National Cancer Institute Common Terminology Criteria for Adverse Events [version 3.0]) between the 2 groups. CONCLUSIONS The addition of estrogen deprivation to NCT appears to improve the clinical response in patients with ER-positive, HER2-negative breast cancer, especially for those individuals with a higher Ki-67 index. Patients with a higher Ki-67 index might derive more PFS benefit from concurrent neoadjuvant treatment.
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Affiliation(s)
- Ke-Da Yu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Si-Yu Wu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Guang-Yu Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiong Wu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Gen-Hong Di
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Hu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Feng Hou
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Can-Ming Chen
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Fan
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li-Chen Tang
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen-Zhou Shen
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ke-Jin Wu
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Zhi-Gang Zhuang
- Department of Breast Surgery, the First Maternity and Infant Health Hospital, Tongji University, Shanghai, China
| | - Hong-Wei Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhi-Ming Shao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Plant D, Maciejewski M, Smith S, Nair N, Hyrich K, Ziemek D, Barton A, Verstappen S. Profiling of Gene Expression Biomarkers as a Classifier of Methotrexate Nonresponse in Patients With Rheumatoid Arthritis. Arthritis Rheumatol 2019; 71:678-684. [PMID: 30615300 PMCID: PMC9328381 DOI: 10.1002/art.40810] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/04/2018] [Indexed: 12/16/2022]
Abstract
Objective Approximately 30–40% of rheumatoid arthritis (RA) patients who are initially started on low‐dose methotrexate (MTX) will not benefit from the treatment. To date, no reliable biomarkers of MTX inefficacy in RA have been identified. The aim of this study was to analyze whole blood samples from RA patients at 2 time points (pretreatment and 4 weeks following initiation of MTX), to identify gene expression biomarkers of the MTX response. Methods RA patients who were about to commence treatment with MTX were selected from the Rheumatoid Arthritis Medication Study. Using European League Against Rheumatism (EULAR) response criteria, 42 patients were categorized as good responders and 43 as nonresponders at 6 months following the initation of MTX treatment. Data on whole blood transcript expression were generated, and supervised machine learning methods were used to predict a EULAR nonresponse. Models in which transcript levels were included were compared to models in which clinical covariates alone (e.g., baseline disease activity, sex) were included. Gene network and ontology analysis was also performed. Results Based on the ratio of transcript values (i.e., the difference in log2‐transformed expression values between 4 weeks of treatment and pretreatment), a highly predictive classifier of MTX nonresponse was developed using L2‐regularized logistic regression (mean ± SEM area under the receiver operating characteristic [ROC] curve [AUC] 0.78 ± 0.11). This classifier was superior to models that included clinical covariates (ROC AUC 0.63 ± 0.06). Pathway analysis of gene networks revealed significant overrepresentation of type I interferon signaling pathway genes in nonresponders at pretreatment (P = 2.8 × 10−25) and at 4 weeks after treatment initiation (P = 4.9 × 10−28). Conclusion Testing for changes in gene expression between pretreatment and 4 weeks post–treatment initiation may provide an early classifier of the MTX treatment response in RA patients who are unlikely to benefit from MTX over 6 months. Such patients should, therefore, have their treatment escalated more rapidly, which would thus potentially impact treatment pathways. These findings emphasize the importance of a role for early treatment biomarker monitoring in RA patients started on MTX.
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Affiliation(s)
- Darren Plant
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | - Nisha Nair
- University of Manchester, Manchester, UK
| | | | - Kimme Hyrich
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Anne Barton
- Manchester University NHS Foundation Trust, Manchester, UK
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Ueno T, Saji S, Chiba T, Kamma H, Isaka H, Itoh H, Imi K, Miyamoto K, Tada M, Sasano H, Toi M, Imoto S. Progesterone receptor expression in proliferating cancer cells of hormone-receptor-positive breast cancer. Tumour Biol 2019; 40:1010428318811025. [PMID: 30841783 DOI: 10.1177/1010428318811025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Breast cancer has been suggested to have two distinct driving mechanisms: the hormone receptor and the growth factor receptor pathways. We hypothesized that each driving system produces a different expression pattern of estrogen-regulated genes, such as progesterone receptor, in proliferating cells. Progesterone receptor and Ki67 expressions were assessed by dual-fluorescence immunohistochemistry in estrogen-receptor-positive breast cancer tissues. Two distinct proliferating cell populations were observed: progesterone-receptor-positive and progesterone-receptor-negative. In the training cohort, tissues with progesterone-receptor-positive proliferating cells were associated with lower grade and better disease-free survival (p = 0.0055 and 0.0026, respectively). These associations were confirmed in the validation cohort from the neoadjuvant endocrine trial JFMC34 (p = 0.033 and 0.0003, respectively). In the validation cohort, patients with progesterone-receptor-positive proliferating cells responded better to endocrine therapy and had a lower Oncotype DX Recurrence Score. In the multivariate analysis, progesterone receptor status of proliferating cells, but not progesterone receptor or Ki67 alone, was an independent predictor of disease-free survival in both cohorts (p = 0.0043 and 0.0026). In conclusion, the progesterone receptor status of proliferating cancer cells was associated with histological grade and Recurrence Score, and a potent prognostic factor in estrogen-receptor-positive breast cancers. Results suggest that different driving systems generate different expression patterns of progesterone receptor in proliferating cancer cells. Further studies are warranted to validate the findings.
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Affiliation(s)
- Takayuki Ueno
- 1 Department of Breast Surgery, School of Medicine, Kyorin University, Tokyo, Japan.,2 Department of Breast Surgery, Breast Oncology Center, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shigehira Saji
- 3 Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Tomohiro Chiba
- 4 Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Hiroshi Kamma
- 4 Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Hirotsugu Isaka
- 1 Department of Breast Surgery, School of Medicine, Kyorin University, Tokyo, Japan
| | - Hiroki Itoh
- 1 Department of Breast Surgery, School of Medicine, Kyorin University, Tokyo, Japan
| | - Kentaro Imi
- 1 Department of Breast Surgery, School of Medicine, Kyorin University, Tokyo, Japan
| | - Kaisuke Miyamoto
- 1 Department of Breast Surgery, School of Medicine, Kyorin University, Tokyo, Japan
| | - Manami Tada
- 1 Department of Breast Surgery, School of Medicine, Kyorin University, Tokyo, Japan
| | - Hironobu Sasano
- 5 Department of Pathology, School of Medicine, Tohoku University, Sendai, Japan
| | - Masakazu Toi
- 6 Department of Breast Surgery, School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeru Imoto
- 1 Department of Breast Surgery, School of Medicine, Kyorin University, Tokyo, Japan
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Ueno T, Saji S, Masuda N, Iwata H, Kuroi K, Sato N, Takei H, Yamamoto Y, Ohno S, Yamashita H, Hisamatsu K, Aogi K, Sasano H, Toi M. Changes in Recurrence Score by neoadjuvant endocrine therapy of breast cancer and their prognostic implication. ESMO Open 2019; 4:e000476. [PMID: 30962956 PMCID: PMC6435245 DOI: 10.1136/esmoopen-2018-000476] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/29/2018] [Accepted: 01/11/2019] [Indexed: 01/19/2023] Open
Abstract
Background Neoadjuvant endocrine therapy (NET) can improve surgical outcomes in postmenopausal patients with hormone receptor-positive breast cancer. The Ki67 labelling index after NET has a better prognostic power than that at baseline. However, it remains unknown whether a multigene assay with post-treatment samples could predict the prognosis better than that with pretreatment samples. Methods The prognostic value of the multigene assay Oncotype DX Recurrence Score (RS) was investigated using pretreatment and post-treatment samples from a multicentre NET trial, JFMC34-0601 (UMIN C000000345), where exemestane was given at 25 mg/day for 24 weeks. Results Both pretreatment and post-treatment RSs were significantly associated with disease-free survival (DFS) (p=0.005 and 0.002, respectively). The combination of pretreatment and post-treatment RSs was also a predictor of DFS (p=0.002) and superior to preoperative endocrine prognostic index (PEPI). Furthermore, combined RS was the only independent prognostic factor in the multivariate analysis among the three RSs (p=0.04). In addition, combined RS could differentiate early recurrence in the high-risk group from mid/late recurrence in the intermediate-risk group, suggesting possible differential treatment strategies based on the risk categories indicated by the combined RS. Conclusions The combination of pretreatment and post-treatment RSs could provide pivotal information for predicting DFS and differentiating early recurrence in the high-risk group from mid/late recurrence in the intermediate-risk group in patients with hormone receptor-positive breast cancer. A larger study is required to validate the results.
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Affiliation(s)
- Takayuki Ueno
- Breast Surgical Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Shigehira Saji
- Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Norikazu Masuda
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Katsumasa Kuroi
- Surgery, Tokyo Metropolitan Health and Medical Treatment Cooperation Ebara Hospital, Tokyo, Japan
| | - Nobuaki Sato
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hiroyuki Takei
- Department of Breast Surgery and Oncology, Nippon Medical School, Tokyo, Japan
| | - Yutaka Yamamoto
- Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Hiroko Yamashita
- Department of Breast Surgery, Hokkaido University Hospital, Sapporo, Japan
| | | | - Kenjiro Aogi
- Department of Breast Surgery, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Masakazu Toi
- Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Huang J, Chen X, Fei X, Huang O, Wu J, Zhu L, He J, Chen W, Li Y, Shen K. Changes of Tumor Infiltrating Lymphocytes after Core Needle Biopsy and the Prognostic Implications in Early Stage Breast Cancer: A Retrospective Study. Cancer Res Treat 2019; 51:1336-1346. [PMID: 30744321 PMCID: PMC6790848 DOI: 10.4143/crt.2018.504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/07/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The purpose of this study was to investigate the changes of tumor infiltrating lymphocytes (TILs) between core needle biopsy (CNB) and surgery removed sample (SRS) in early stage breast cancer patients and to identify the correlating factors and prognostic significance of TILs changes. Materials and Methods A retrospective study was carried out on 255 patients who received CNB and underwent surgical resection for invasive breast cancer. Stromal TILs levels of CNB and SRS were evaluated respectively. Tumors with ≥50% stromal TILs were defined as lymphocyte-predominant breast cancer (LPBC). Clinicopathological variables were analyzed to determine whether there were factors associated with TILs changes. Log-rank tests and Cox proportional hazards models were used to analyze the influences of TILs and TILs changes on survival. RESULTS SRS-TILs (median, 10.0%) were significant higher than CNB-TILs (median, 5.0%; p<0.001). Younger age (<60 years, p=0.016) and long surgery time interval (STI, ≥4 days; p=0.003) were independent factors correlating with higher TILs changes. CNB-LPBC patients showed better breast cancer-free interval (BCFI, p=0.021) than CNB-non-LPBC (CNB-nLPBC) patients. Patients were categorized into four groups according to the LPBC change pattern from CNB to SRS: LPBC→LPBC, LPBC→nLPBC, nLPBC→LPBC, and nLPBC→nLPBC, with estimated 5-year BCFI 100%, 100%, 69.7%, and 86.0% (p=0.016). nLPBC→LPBC pattern was an independent prognostic factor of worse BCFI (hazard ratio, 2.19; 95% confidence interval, 1.06 to 4.53; p=0.035) compared with other patterns. CONCLUSION TILs were significantly higher in SRS than in CNB. Higher TILs changes were associated with younger age and long STI. Changing from nLPBC to LPBC after CNB indicated a worse BCFI, which needs further validation.
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Affiliation(s)
- Jiahui Huang
- Comprehensive Breast Health Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaosong Chen
- Comprehensive Breast Health Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ou Huang
- Comprehensive Breast Health Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Comprehensive Breast Health Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhu
- Comprehensive Breast Health Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianrong He
- Comprehensive Breast Health Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiguo Chen
- Comprehensive Breast Health Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yafen Li
- Comprehensive Breast Health Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Comprehensive Breast Health Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ruffalo M, Thomas R, Chen J, Lee AV, Oesterreich S, Bar-Joseph Z. Network-guided prediction of aromatase inhibitor response in breast cancer. PLoS Comput Biol 2019; 15:e1006730. [PMID: 30742607 PMCID: PMC6386390 DOI: 10.1371/journal.pcbi.1006730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 02/22/2019] [Accepted: 12/19/2018] [Indexed: 01/07/2023] Open
Abstract
Prediction of response to specific cancer treatments is complicated by significant heterogeneity between tumors in terms of mutational profiles, gene expression, and clinical measures. Here we focus on the response of Estrogen Receptor (ER)+ post-menopausal breast cancer tumors to aromatase inhibitors (AI). We use a network smoothing algorithm to learn novel features that integrate several types of high throughput data and new cell line experiments. These features greatly improve the ability to predict response to AI when compared to prior methods. For a subset of the patients, for which we obtained more detailed clinical information, we can further predict response to a specific AI drug. Breast cancer is the second most common type of cancer in women, with an incidence rate of over 250,000 cases per year, and breast cancer cases show significant heterogeneity in clinical and omic measures. Estrogen receptor positive (ER+) tumors typically grow in response to estrogen, and in post menopausal women, estrogen is only produced in peripheral tissues via the aromatase enzyme. Inhibition of aromatase is often an effective treatment for ER+ tumors, but aromatase inhibitor therapy is not effective for all tumors, and causes of this heterogeneity in response are largely not known. In this work, we present a feature construction and classification method to predict response to aromatase inhibitor therapy. We use network smoothing techniques to combine tumor omic data into predictive features, which we use as input to standard machine learning algorithms. We train predictive models using clinical data, including high-quality clinical data from UPMC patients, and show that our method outperforms previous approaches in predicting response to aromatase inhibitor therapy.
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Affiliation(s)
- Matthew Ruffalo
- Computational Biology Department, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Roby Thomas
- Women’s Cancer Research Center, Department of Pharmacology and Chemical Biology, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Jian Chen
- Women’s Cancer Research Center, Department of Pharmacology and Chemical Biology, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Adrian V. Lee
- Women’s Cancer Research Center, Department of Pharmacology and Chemical Biology, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Steffi Oesterreich
- Women’s Cancer Research Center, Department of Pharmacology and Chemical Biology, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Ziv Bar-Joseph
- Computational Biology Department, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
- Machine Learning Department, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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116
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Colomer R, Saura C, Sánchez-Rovira P, Pascual T, Rubio IT, Burgués O, Marcos L, Rodríguez CA, Martín M, Lluch A. Neoadjuvant Management of Early Breast Cancer: A Clinical and Investigational Position Statement. Oncologist 2019; 24:603-611. [PMID: 30710068 DOI: 10.1634/theoncologist.2018-0228] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/20/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Neoadjuvant treatment is increasingly one of the preferred therapeutic options for early breast cancer and may have some unique outcomes, such as identifying predictive and prognostic factors of response or increasing the knowledge of individual tumor biology. DESIGN A panel of experts from different specialties reviewed published clinical studies on the neoadjuvant management of breast cancer. Recommendations were made that emphasized the clinical multidisciplinary management and the investigational leverage in early breast cancer. RESULTS Neoadjuvant therapy has equivalent efficacy to adjuvant therapy, and it has some additional benefits that include increasing breast conservation, assessing tumor response, establishing prognosis based on the pathological response, and providing a "second opportunity" for nonresponding patients. Achieving pathological complete remission because of neoadjuvant therapy has been correlated with long-term clinical benefit, particularly in HER2-positive and triple-negative breast cancer. In addition, the neoadjuvant setting is a powerful model for the development of new drugs and the identification of prognostic markers. Finally, neoadjuvant therapy has proven to be cost-effective by reducing nondrug costs, avoiding radical surgery, and reducing hospital stays when compared with other treatment approaches. CONCLUSION Neoadjuvant therapy has clinical benefits in early breast cancer and provides in vivo information of individual breast cancer biology while allowing the investigation of new treatment approaches. Access to neoadjuvant therapy should be an option available to all patients with breast cancer through multidisciplinary tumor management. IMPLICATIONS FOR PRACTICE Neoadjuvant treatment should be strongly considered as a therapeutic option for localized breast cancer and is a powerful tool for understanding breast cancer biology and investigating new treatment approaches.
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Affiliation(s)
- Ramon Colomer
- Department of Medical Oncology, Hospital Universitario La Princesa, Madrid, Spain
| | - Cristina Saura
- Department of Medical Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Tomás Pascual
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
- Translational Genomic and Targeted Therapeutics in Solid Tumors, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Isabel T Rubio
- Department of Breast Surgical Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Octavio Burgués
- Pathology Department, Hospital Clínico Universitario, Valencia, Spain
| | - Lourdes Marcos
- Department of Radiology, Hospital Universitario La Princesa, Madrid, Spain
| | - César A Rodríguez
- Department of Medical Oncology, Hospital Clínico Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Miguel Martín
- Department of Medical Oncology, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - Ana Lluch
- Department of Medical Oncology and Hematology, Hospital Clínico Universitario, University of Valencia-INCLIVA Health Research Institute, CIBERONC, Valencia, Spain
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Vendrell JA, Solassol J, Győrffy B, Vilquin P, Jarlier M, Donini CF, Gamba L, Maudelonde T, Rouanet P, Cohen PA. Evaluating ZNF217 mRNA Expression Levels as a Predictor of Response to Endocrine Therapy in ER+ Breast Cancer. Front Pharmacol 2019; 9:1581. [PMID: 30740056 PMCID: PMC6355665 DOI: 10.3389/fphar.2018.01581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
ZNF217 is a candidate oncogene with a wide variety of deleterious functions in breast cancer. Here, we aimed at investigating in a pilot prospective study the association between ZNF217 mRNA expression levels and the clinical response to neoadjuvant endocrine therapy (ET) in postmenopausal ER-positive (ER+) breast cancer patients. Core surgical biopsy samples before treatment initiation and post-treatment were obtained from 68 patients, and Ki-67 values measured by immunohistochemistry (IHC) were used to identify responders (n = 59) and non-responders (n = 9) after 4 months of ET. We report for the first time that high ZNF217 mRNA expression level measured by RT-qPCR in the initial tumor samples (pre-treatment) is associated with poor response to neoadjuvant ET. Indeed, the clinical positive response rate in patients with low ZNF217 expression levels was significantly higher than that in those with high ZNF217 expression levels (P = 0.027). Additionally, a retrospective analysis evaluating ZNF217 expression levels in primary breast tumor of ER+/HER2-/LN0 breast cancer patients treated with adjuvant ET enabled the identification of poorer responders prone to earlier relapse (P = 0.013), while ZNF217 did not retain any prognostic value in the ER+/HER2-/LN0 breast cancer patients who did not receive any treatment. Altogether, these data suggest that ZNF217 expression might be predictive of clinical response to ET.
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Affiliation(s)
- Julie A Vendrell
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM U1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Jérôme Solassol
- Département de Pathologie et Oncobiologie, Laboratoire de Biologie des Tumeurs Solides, CHU Montpellier, University of Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, University Montpellier, Montpellier, France
| | - Balázs Győrffy
- 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary.,MTA TTK Lendület Cancer Biomarker Research Group, Institute of Enzymology, Budapest, Hungary
| | - Paul Vilquin
- Département de Pathologie et Oncobiologie, Laboratoire de Biologie des Tumeurs Solides, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Marta Jarlier
- Biometrics Unit, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - Caterina F Donini
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM U1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Laurent Gamba
- Département de Pathologie et Oncobiologie, Laboratoire de Biologie des Tumeurs Solides, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Thierry Maudelonde
- Département de Pathologie et Oncobiologie, Laboratoire de Biologie des Tumeurs Solides, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Philippe Rouanet
- Département de Chirurgie Oncologique, Institut du Cancer de Montpellier, University of Montpellier, Montpellier, France
| | - Pascale A Cohen
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM U1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, France
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Johnston S, Puhalla S, Wheatley D, Ring A, Barry P, Holcombe C, Boileau JF, Provencher L, Robidoux A, Rimawi M, McIntosh SA, Shalaby I, Stein RC, Thirlwell M, Dolling D, Morden J, Snowdon C, Perry S, Cornman C, Batten LM, Jeffs LK, Dodson A, Martins V, Modi A, Osborne CK, Pogue-Geile KL, Cheang MCU, Wolmark N, Julian TB, Fisher K, MacKenzie M, Wilcox M, Huang Bartlett C, Koehler M, Dowsett M, Bliss JM, Jacobs SA. Randomized Phase II Study Evaluating Palbociclib in Addition to Letrozole as Neoadjuvant Therapy in Estrogen Receptor-Positive Early Breast Cancer: PALLET Trial. J Clin Oncol 2019; 37:178-189. [PMID: 30523750 DOI: 10.1200/jco.18.01624] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE CDK4/6 inhibitors are used to treat estrogen receptor (ER)-positive metastatic breast cancer (BC) in combination with endocrine therapy. PALLET is a phase II randomized trial that evaluated the effects of combination palbociclib plus letrozole as neoadjuvant therapy. PATIENTS AND METHODS Postmenopausal women with ER-positive primary BC and tumors greater than or equal to 2.0 cm were randomly assigned 3:2:2:2 to letrozole (2.5 mg/d) for 14 weeks (A); letrozole for 2 weeks, then palbociclib plus letrozole to 14 weeks (B); palbociclib for 2 weeks, then palbociclib plus letrozole to 14 weeks (C); or palbociclib plus letrozole for 14 weeks. Palbociclib 125 mg/d was administered orally on a 21-days-on, 7-days-off schedule. Core-cut biopsies were taken at baseline and 2 and 14 weeks. Coprimary end points for letrozole versus palbociclib plus letrozole groups (A v B + C + D) were change in Ki-67 (protein encoded by the MKI67 gene; immunohistochemistry) between baseline and 14 weeks and clinical response (ordinal and ultrasound) after 14 weeks. Complete cell-cycle arrest was defined as Ki-67 less than or equal to 2.7%. Apoptosis was characterized by cleaved poly (ADP-ribose) polymerase. RESULTS Three hundred seven patients were recruited. Clinical response was not significantly different between palbociclib plus letrozole and letrozole groups ( P = .20; complete response + partial response, 54.3% v 49.5%), and progressive disease was 3.2% versus 5.4%, respectively. Median log-fold change in Ki-67 was greater with palbociclib plus letrozole compared with letrozole (-4.1 v -2.2; P < .001) in the 190 evaluable patients (61.9%), corresponding to a geometric mean change of -97.4% versus -88.5%. More patients on palbociclib plus letrozole achieved complete cell-cycle arrest (90% v 59%; P < .001). Median log-fold change (suppression) of cleaved poly (ADP-ribose) polymerase was greater with palbociclib plus letrozole versus letrozole (-0.80 v -0.42; P < .001). More patients had grade 3 or greater toxicity on palbociclib plus letrozole (49.8% v 17.0%; P < .001) mainly because of asymptomatic neutropenia. CONCLUSION Adding palbociclib to letrozole significantly enhanced the suppression of malignant cell proliferation (Ki-67) in primary ER-positive BC, but did not increase the clinical response rate over 14 weeks, which was possibly related to a concurrent reduction in apoptosis.
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Affiliation(s)
- Stephen Johnston
- 1 The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Shannon Puhalla
- 2 Univeristy of Pittsburgh Medical Center Cancer Center, Pittsburgh, PA
| | - Duncan Wheatley
- 3 Royal Cornwall Hospitals National Health Service Foundation Trust, Treliske, United Kingdom
| | - Alistair Ring
- 1 The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Peter Barry
- 1 The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Chris Holcombe
- 4 Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool, United Kingdom
| | | | - Louise Provencher
- 6 Centre Hospitalier Université de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - André Robidoux
- 7 Centre Hospitalier Université de Montréal, Montreal, Quebec, Canada
| | | | | | - Ibrahim Shalaby
- 10 Joe Arrington Cancer Research and Treatment Center, Lubbock, TX
| | - Robert C Stein
- 11 National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
- 12 University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | | | - David Dolling
- 14 The Institute of Cancer Research, London, United Kingdom
| | - James Morden
- 14 The Institute of Cancer Research, London, United Kingdom
| | - Claire Snowdon
- 14 The Institute of Cancer Research, London, United Kingdom
| | - Sophie Perry
- 14 The Institute of Cancer Research, London, United Kingdom
| | - Chester Cornman
- 15 National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA
| | - Leona M Batten
- 14 The Institute of Cancer Research, London, United Kingdom
| | - Lisa K Jeffs
- 14 The Institute of Cancer Research, London, United Kingdom
| | - Andrew Dodson
- 1 The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
- 14 The Institute of Cancer Research, London, United Kingdom
| | - Vera Martins
- 1 The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Arjun Modi
- 1 The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | | | | | | | - Norman Wolmark
- 15 National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA
| | - Thomas B Julian
- 16 Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | - Kate Fisher
- 17 International Drug Development Institute, Brussels, Belgium
| | | | - Maggie Wilcox
- 18 Independent Cancer Patients Voice, London, United Kingdom
| | | | | | - Mitch Dowsett
- 1 The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
- 14 The Institute of Cancer Research, London, United Kingdom
| | - Judith M Bliss
- 14 The Institute of Cancer Research, London, United Kingdom
| | - Samuel A Jacobs
- 15 National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA
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Schuster EF, Gellert P, Segal CV, López-Knowles E, Buus R, Cheang MCU, Morden J, Robertson J, Bliss JM, Smith I, Dowsett M. Genomic Instability and TP53 Genomic Alterations Associate With Poor Antiproliferative Response and Intrinsic Resistance to Aromatase Inhibitor Treatment. JCO Precis Oncol 2019; 3:1800286. [PMID: 32914010 PMCID: PMC7446335 DOI: 10.1200/po.18.00286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although aromatase inhibitor (AI) treatment is effective in estrogen receptor-positive postmenopausal breast cancer, resistance is common and incompletely explained. Genomic instability, as measured by somatic copy number alterations (SCNAs), is important in breast cancer development and prognosis. SCNAs to specific genes may drive intrinsic resistance, or high genomic instability may drive tumor heterogeneity, which allows differential response across tumors and surviving cells to evolve resistance to treatment rapidly. We therefore evaluated the relationship between SCNAs and intrinsic resistance to treatment as measured by a poor antiproliferative response. PATIENTS AND METHODS SCNAs were determined by single nucleotide polymorphism array in baseline and surgery core-cuts from 73 postmenopausal patients randomly assigned to receive 2 weeks of preoperative AI or no AI in the Perioperative Endocrine Therapy-Individualizing Care (POETIC) trial. Fifty-six samples from the AI group included 28 poor responders (PrRs, less than 60% reduction in protein encoded by the MKI67 gene [Ki-67]) and 28 good responders (GdRs, greater than 75% reduction in Ki-67). Exome sequencing was available for 72 pairs of samples. RESULTS Genomic instability correlated with Ki-67 expression at both baseline (P < .001) and surgery (P < .001) and was higher in PrRs (P = .048). The SCNA with the largest difference between GdRs and PrRs was loss of heterozygosity observed at 17p (false discovery rate, 0.08), which includes TP53. Nine of 28 PrRs had loss of wild-type TP53 as a result of mutations and loss of heterozygosity compared with three of 28 GdRs. In PrRs, somatic alterations of TP53 were associated with higher genomic instability, higher baseline Ki-67, and greater resistance to AI treatment compared with wild-type TP53. CONCLUSION We observed that primary tumors with high genomic instability have an intrinsic resistance to AI treatment and do not require additional evolution to develop resistance to estrogen deprivation therapy.
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Affiliation(s)
- Eugene F. Schuster
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
- Eugene F. Schuster, PhD, The Institute of Cancer Research, 237 Fulham Rd, London SW3 6JB, United Kingdom; e-mail:
| | - Pascal Gellert
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
| | - Corrinne V. Segal
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
| | - Elena López-Knowles
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
| | - Richard Buus
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
| | | | - James Morden
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Ian Smith
- Royal Marsden Hospital, London, United Kingdom
| | - Mitch Dowsett
- The Institute of Cancer Research, London, United Kingdom
- Royal Marsden Hospital, London, United Kingdom
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Rani A, Stebbing J, Giamas G, Murphy J. Endocrine Resistance in Hormone Receptor Positive Breast Cancer-From Mechanism to Therapy. Front Endocrinol (Lausanne) 2019; 10:245. [PMID: 31178825 PMCID: PMC6543000 DOI: 10.3389/fendo.2019.00245] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/28/2019] [Indexed: 12/24/2022] Open
Abstract
The importance and role of the estrogen receptor (ER) pathway has been well-documented in both breast cancer (BC) development and progression. The treatment of choice in women with metastatic breast cancer (MBC) is classically divided into a variety of endocrine therapies, 3 of the most common being: selective estrogen receptor modulators (SERM), aromatase inhibitors (AI) and selective estrogen receptor down-regulators (SERD). In a proportion of patients, resistance develops to endocrine therapy due to a sophisticated and at times redundant interference, at the molecular level between the ER and growth factor. The progression to endocrine resistance is considered to be a gradual, step-wise process. Several mechanisms have been proposed but thus far none of them can be defined as the complete explanation behind the phenomenon of endocrine resistance. Although multiple cellular, molecular and immune mechanisms have been and are being extensively studied, their individual roles are often poorly understood. In this review, we summarize current progress in our understanding of ER biology and the molecular mechanisms that predispose and determine endocrine resistance in breast cancer patients.
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Affiliation(s)
- Aradhana Rani
- School of Life Sciences, University of Westminster, London, United Kingdom
- *Correspondence: Aradhana Rani
| | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Georgios Giamas
- Department of Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Brighton, United Kingdom
| | - John Murphy
- School of Life Sciences, University of Westminster, London, United Kingdom
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Liu Y, Huang Y, Han J, Wang J, Li F, Zhou J. Association Between Shear Wave Elastography of Virtual Touch Tissue Imaging Quantification Parameters and the Ki-67 Proliferation Status in Luminal-Type Breast Cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:73-80. [PMID: 29708280 DOI: 10.1002/jum.14663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the association between shear wave elastography parameters using virtual touch tissue imaging quantification (VTIQ) and the Ki-67 index in luminal-type breast cancer. METHODS Eighty-one patients with 82 lesions of pathologic confirmed luminal-type breast cancer underwent virtual touch tissue imaging quantification examination before surgery between December 2015 and June 2016. Patients were divided into 2 groups according to the Ki-67 index (≥14% versus < 14%), which is used to define luminal type B and luminal type A, respectively. The mean shear wave velocity (SWVmean ) and lesion-to-adjacent tissues ratio (SWV ratio) were calculated for each lesion. RESULTS The SWVmean , SWV ratio, histologic grade, axillary lymph node involvement, and lymphovascular invasion showed a significant positive association with a high Ki-67 index (all P < .05). Receiver operating characteristic curve analysis for the differential diagnosis between high (≥14%) and low (<14%) Ki-67 groups displayed that the optimal cutoff value for SWVmean and SWV ratio were 3.99 meters per second and 2.861, with sensitivity 94% and 72%, specificity 40.6% and 56.2%, and area under the receiver operating characteristic curve of 0.689 and 0.651, respectively. Univariate analysis showed that SWVmean (P = .005), SWV ratio (P = .029), histologic grade (P = .011), presence of axillary node involvement (P = .004), and lymphovascular invasion (P = .008) were significantly associated with high Ki-67 status. Multivariable analysis displayed that SWVmean (hazard ratio [HR], 1.459, 95% confidence interval [CI], 1.028-2.072; P = .035), histologic grade (HR, 4.105; 95% CI, 1.142-14.763; P = .031), and presence of axillary node involvement (HR, 3.75; 95% CI, 1.228-11.453; P = .020) maintained significance for predicting high Ki-67 status. CONCLUSIONS The SWVmean using the virtual touch tissue imaging quantification method showed significant correlation with the Ki-67 index, suggesting the potential to assess tumor proliferation status in luminal-type breast cancer with a noninvasive manner.
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Affiliation(s)
- Yubo Liu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
| | - Yini Huang
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
| | - Jing Han
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
| | - Jianwei Wang
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
| | - Fei Li
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
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Adjuvant Endocrine Therapy for Breast Cancer. Breast Cancer 2019. [DOI: 10.1007/978-3-319-96947-3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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123
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Elmi A, McDonald ES, Mankoff D. Imaging Tumor Proliferation in Breast Cancer: Current Update on Predictive Imaging Biomarkers. PET Clin 2018; 13:445-457. [PMID: 30100082 DOI: 10.1016/j.cpet.2018.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Uncontrolled growth is a hallmark of cancer; imaging cell proliferation can provides an early indicator of therapeutic response. This capability is especially well-matched to the emerging cell cycle-specific chemotherapeutics with the goal of identifying patients that benefit from these treatments early in the course of treatment to guide personalized therapy. This article focuses on investigational cell proliferation imaging PET radiotracers to evaluate tumor proliferation in the setting of cell cycle-targeted chemotherapy and endocrine therapy for metastatic breast cancer.
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Affiliation(s)
- Azadeh Elmi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Elizabeth S McDonald
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - David Mankoff
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Wong NS. Primary medical therapy and breast conservation treatment: the medical oncology perspective. Gland Surg 2018; 7:560-575. [PMID: 30687629 DOI: 10.21037/gs.2018.10.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Primary systemic therapy (PST) is a widely adopted strategy for increasing operability and breast conservation rates. Although first generation PST trials failed to demonstrate improvements in disease free and overall survival compared to adjuvant systemic therapy (AST), they did demonstrate a strong association between attainment of pathologic complete response (pCR) and improved survival outcomes, leading to the widespread adoption of pCR as the primary endpoint in subsequent PST trials. First generation trials also showed that preoperative PST can improve breast conservation rates and downstage the axilla. Although individual trials did not demonstrate statistically significant increase in local recurrence with PST when compared to AST, a recent meta-analysis did note an increased in such risk, mainly driven by trials in which surgery was omitted in patients with good response to PST. Successive generations of PST clinical trials have since explored the activity of taxanes, optimization of anthracycline and taxane dose and schedules, incorporation of single and dual anti-HER2 therapy in HER2 overexpressing breast cancer, the use of platinums in triple negative breast cancer, and the role of endocrine therapy in hormone receptor positive breast cancer. While these PST trials have generally found increased pCR rates with the introduction of modern chemotherapy regimens and targeted therapies, they have not consistently demonstrated further improvements in breast conservation rates compared to first generation regimens. The reasons for this are complex and may lie beyond differences in anti-tumour activity between different systemic regimens but rather in other potential confounding factors such as tumour to breast volume ratio, tumour location, multicentricity as well as patient or surgeon preference.
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Affiliation(s)
- Nan Soon Wong
- Oncocare Cancer Centre, Gleneagles Medical Centre, Singapore
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125
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Denduluri N, Miller K, O'Regan RM. Using a Neoadjuvant Approach for Evaluating Novel Therapies for Patients With Breast Cancer. Am Soc Clin Oncol Educ Book 2018; 38:47-55. [PMID: 30231324 DOI: 10.1200/edbk_200719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Preoperative systemic therapy, though primarily used to downstage breast cancers, can offer, using pathologic complete response (pCR) as an endpoint, a rapid assessment of efficacy of a given therapeutic approach, particularly in triple-negative (TNBC) and HER2-positive breast cancers. Recently, this approach resulted in the approval of pertuzumab for HER2-positive cancers, in a considerably quicker timeline than would have been possible with its assessment in the adjuvant setting. However, the use of preoperative systemic therapy remains controversial, as the higher response rates noted with newer approaches have not routinely translated into improved longer-term outcomes, nor have they been confirmed in larger adjuvant trials. Almost all trials have demonstrated that pCR is a robust prognostic marker in patients with TNBC and HER2-positive cancers, so part of this discrepancy may be due to inadequate power in the preoperative trials and/or due to the heterogeneous nature of breast cancers. PCR following preoperative chemotherapy is not prognostic in many hormone receptor (HR)-positive breast cancers, especially those with a luminal A phenotype, which typically has minimal response to chemotherapy. Given this lack of response to chemotherapy, there is considerable interest in the use of neoadjuvant endocrine therapy (NET). The rate of pCR to NET in HR-positive cancers is low, leading to the use of surrogate markers, including changes in Ki-67 and the preoperative endocrine prognostic index (PEPI) score, as biomarkers of efficacy. Overall, the use of neoadjuvant approaches offers a rapid assessment of efficacy of novel therapies and remains a useful research tool for drug evaluation.
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Affiliation(s)
- Neelima Denduluri
- From the Virginia Cancer Specialists, Fairfax, VA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Kathy Miller
- From the Virginia Cancer Specialists, Fairfax, VA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Ruth M O'Regan
- From the Virginia Cancer Specialists, Fairfax, VA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; University of Wisconsin Carbone Cancer Center, Madison, WI
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Kalinsky K, Sparano JA, Zhong X, Andreopoulou E, Taback B, Wiechmann L, Feldman SM, Ananthakrishnan P, Ahmad A, Cremers S, Sireci AN, Cross JR, Marks DK, Mundi P, Connolly E, Crew KD, Maurer MA, Hibshoosh H, Lee S, Hershman DL. Pre-surgical trial of the AKT inhibitor MK-2206 in patients with operable invasive breast cancer: a New York Cancer Consortium trial. Clin Transl Oncol 2018; 20:1474-1483. [PMID: 29736694 PMCID: PMC6222014 DOI: 10.1007/s12094-018-1888-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/26/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The PI3K/AKT/mTOR pathway is an oncogenic driver in breast cancer (BC). In this multi-center, pre-surgical study, we evaluated the tissue effects of the AKT inhibitor MK-2206 in women with stage I-III BC. MATERIALS AND METHODS Two doses of weekly oral MK2206 were administered at days - 9 and - 2 before surgery. The primary endpoint was reduction of pAktSer473 in breast tumor tissue from diagnostic biopsy to surgery. Secondary endpoints included changes in PI3K/AKT pathway tumor markers, tumor proliferation (ki-67), insulin growth factor pathway blood markers, pharmacokinetics (PK), genomics, and MK-2206 tolerability. Paired t tests were used to compare biomarker changes in pre- and post-MK-2206, and two-sample t tests to compare with prospectively accrued untreated controls. RESULTS Despite dose reductions, the trial was discontinued after 12 patients due to grade III rash, mucositis, and pruritus. While there was a trend to reduction in pAKT after MK-2206 (p = 0.06), there was no significant change compared to controls (n = 5, p = 0.65). After MK-2206, no significant changes in ki-67, pS6, PTEN, or stathmin were observed. There was no significant association between dose level and PK (p = 0.11). Compared to controls, MK-2206 significantly increased serum glucose (p = 0.02), insulin (p < 0.01), C-peptide (p < 0.01), and a trend in IGFBP-3 (p = 0.06). CONCLUSION While a trend to pAKT reduction after MK-2206 was observed, there was no significant change compared to controls. However, the accrued population was limited, due to toxicity being greater than expected. Pre-surgical trials can identify in vivo activity in the early drug development, but side effects must be considered in this healthy population.
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Affiliation(s)
- K Kalinsky
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA.
| | - J A Sparano
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA
| | - X Zhong
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | | | - B Taback
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, USA
| | - L Wiechmann
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, USA
| | - S M Feldman
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA
| | | | - A Ahmad
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - S Cremers
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - A N Sireci
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - J R Cross
- Donald B. and Catherine C. Marron Cancer Metabolism Center, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - D K Marks
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
| | - P Mundi
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
| | - E Connolly
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
- Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - K D Crew
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - M A Maurer
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
| | - H Hibshoosh
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, USA
| | - S Lee
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - D L Hershman
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, Room 1069, New York, NY, 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
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Escrivá-de-Romaní S, Arumí M, Zamora E, Bellet M. Neoadjuvant Model as a Platform for Research in Breast Cancer and Novel Targets under Development in this Field. Breast Care (Basel) 2018; 13:251-262. [PMID: 30319327 DOI: 10.1159/000492122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
For decades, the neoadjuvant setting has provided a useful scenario for research in breast cancer. Historically, neoadjuvant clinical trials, either hormone therapy-based or chemotherapy-based, have tried to recapitulate the results of their counterpart adjuvant studies, but with smaller patient numbers, more rapid outcomes (clinical response and/or pathologic complete response (pCR)), together with additional biologic information. As for neoadjuvant chemotherapy trials, the increase in pCR rates has been recently accepted as an appropriate surrogate marker to accelerate drug approval in high-risk breast cancer patients. In this setting, with the exception of luminal A tumors, pCR has been associated with improved long-term outcomes, particularly when the analysis is based on specific trials for each breast cancer subtype. For luminal tumors receiving neoadjuvant endocrine therapy, Ki67 at 2-4 weeks and the preoperative endocrine prognostic index score are the most accepted intermediate markers of efficacy, which will be validated in ongoing larger trials. In this review, we describe the different neoadjuvant designs: from the classical randomized trials in which treatment is delivered for 6 or more months to short non-therapeutic presurgical studies lasting just 2 or 3 weeks. We also review the main neoadjuvant trials, either ongoing or completed, for luminal, triple-negative, and HER2-positive breast cancer. The translational effort and research of biomarkers conducted in these studies will be particularly addressed.
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Affiliation(s)
- Santiago Escrivá-de-Romaní
- Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Miriam Arumí
- Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Esther Zamora
- Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Meritxell Bellet
- Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Liang C, Cheng Z, Huang Y, He L, Chen X, Ma Z, Huang X, Liang C, Liu Z. An MRI-based Radiomics Classifier for Preoperative Prediction of Ki-67 Status in Breast Cancer. Acad Radiol 2018; 25:1111-1117. [PMID: 29428211 DOI: 10.1016/j.acra.2018.01.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/01/2018] [Accepted: 01/01/2018] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES This study aims to investigate the value of a magnetic resonance imaging-based radiomics classifier for preoperatively predicting the Ki-67 status in patients with breast cancer. MATERIALS AND METHODS We chronologically divided 318 patients with clinicopathologically confirmed breast cancer into a training dataset (n = 200) and a validation dataset (n = 118). Radiomics features were extracted from T2-weighted (T2W) and contrast-enhanced T1-weighted (T1+C) images of breast cancer. Radiomics feature selection and radiomics classifiers were generated using the least absolute shrinkage and selection operator regression analysis method. The correlation between the radiomics classifiers and the Ki-67 status in patients with breast cancer was explored. The predictive performances of the radiomics classifiers for the Ki-67 status were evaluated with receiver operating characteristic curves in the training dataset and validated in the validation dataset. RESULTS Through the radiomics feature selection, 16 and 14 features based on T2W and T1+C images, respectively, were selected to constitute the radiomics classifiers. The radiomics classifier based on T2W images was significantly correlated with the Ki-67 status in both the training and the validation datasets (both P < .0001). The radiomics classifier based on T1+C images was significantly correlated with the Ki-67 status in the training dataset (P < .0001) but not in the validation dataset (P = .083). The T2W image-based radiomics classifier exhibited good discrimination for Ki-67 status, with areas under the receiver operating characteristic curves of 0.762 (95% confidence interval: 0.685, 0.838) and 0.740 (95% confidence interval: 0.645, 0.836) in the training and validation datasets, respectively. CONCLUSIONS The T2W image-based radiomics classifier was a significant predictor of Ki-67 status in patients with breast cancer. Thus, it may serve as a noninvasive approach to facilitate the preoperative prediction of Ki-67 status in clinical practice.
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Onishi H, Udagawa C, Kubo M, Nakamura S, Akashi-Tanaka S, Kuwayama T, Watanabe C, Takamaru T, Takei H, Ishikawa T, Miyahara K, Matsumoto H, Hasegawa Y, Momozawa Y, Low SK, Kutomi G, Shima H, Satomi F, Okazaki M, Zaha H, Onomura M, Matsukata A, Sagara Y, Baba S, Yamada A, Shimada K, Shimizu D, Tsugawa K, Shimo A, Hartman M, Chan CW, Lee SC, Endo I, Zembutsu H. A genome-wide association study identifies three novel genetic markers for response to tamoxifen: A prospective multicenter study. PLoS One 2018; 13:e0201606. [PMID: 30161160 PMCID: PMC6116947 DOI: 10.1371/journal.pone.0201606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/19/2018] [Indexed: 01/13/2023] Open
Abstract
Purpose Although association studies of genetic variations with the clinical outcomes of breast cancer patients treated with tamoxifen have been reported, genetic factors which could determine individual response to tamoxifen are not fully clarified. We performed a genome-wide association study (GWAS) to identify novel genetic markers for response to tamoxifen. Experimental design We prospectively collected 347 blood samples from patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative, invasive breast cancer receiving preoperative tamoxifen monotherapy for 14 to 28 days. We used Ki-67 response in breast cancer tissues after preoperative short-term tamoxifen therapy as a surrogate marker for response to tamoxifen. We performed GWAS and genotype imputation using 275 patients, and an independent set of 72 patients was used for replication study. Results The combined result of GWAS and the replication study, and subsequent imputation analysis indicated possible association of three loci with Ki-67 response after tamoxifen therapy (rs17198973 on chromosome 4q34.3, rs4577773 on 6q12, and rs7087428 on 10p13, Pcombined = 5.69 x 10−6, 1.64 x 10−5, and 9.77 x 10−6, respectively). When patients were classified into three groups by the scoring system based on the genotypes of the three SNPs, patients with higher scores showed significantly higher after/before ratio of Ki-67 compared to those with lower scores (P = 1.8 x 10−12), suggesting the cumulative effect of the three SNPs. Conclusion We identified three novel loci, which could be associated with clinical response to tamoxifen. These findings provide new insights into personalized hormonal therapy for the patients with breast cancer.
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Affiliation(s)
- Hiroshi Onishi
- Division of Genetics, National Cancer Center Research Institute, Tokyo, Japan
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Chihiro Udagawa
- Division of Genetics, National Cancer Center Research Institute, Tokyo, Japan
| | - Michiaki Kubo
- RIKEN, Center for Integrative Medical Sciences, Yokohama, Japan
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Sadako Akashi-Tanaka
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Takashi Kuwayama
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Chie Watanabe
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Tomoko Takamaru
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takei
- Department of Breast Surgery, Nippon Medical School, Tokyo, Japan
| | - Takashi Ishikawa
- Department of Breast Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kana Miyahara
- Department of Breast Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Yoshie Hasegawa
- Department of Breast Surgery, Hirosaki Municipal Hospital, Hirosaki, Japan
| | | | - Siew-Kee Low
- RIKEN, Center for Integrative Medical Sciences, Yokohama, Japan
| | - Goro Kutomi
- 1st Department of Surgery, Sapporo Medical University, Sapporo, Japan
| | - Hiroaki Shima
- 1st Department of Surgery, Sapporo Medical University, Sapporo, Japan
| | - Fukino Satomi
- 1st Department of Surgery, Sapporo Medical University, Sapporo, Japan
| | - Minoru Okazaki
- Department of Breast Surgery, Sapporo Breast Surgical Clinic, Sapporo, Japan
| | - Hisamitsu Zaha
- Department of Breast Surgery, Nakagami Hospital, Okinawa, Japan
| | - Mai Onomura
- Department of Breast Surgery, Nakagami Hospital, Okinawa, Japan
| | - Ayami Matsukata
- Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan
| | - Yasuaki Sagara
- Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan
| | - Shinichi Baba
- Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan
| | - Akimitsu Yamada
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuhiro Shimada
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Shimizu
- Department of Breast Surgery, Yokohama Minato Red Cross Hospital, Yokohama, Japan
| | - Koichiro Tsugawa
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Arata Shimo
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Ching-Wan Chan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Soo Chin Lee
- Department of Hematology Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hitoshi Zembutsu
- Division of Genetics, National Cancer Center Research Institute, Tokyo, Japan
- * E-mail:
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Kurozumi S, Matsumoto H, Inoue K, Tozuka K, Hayashi Y, Kurosumi M, Oyama T, Fujii T, Horiguchi J, Kuwano H. Impact of combining the progesterone receptor and preoperative endocrine prognostic index (PEPI) as a prognostic factor after neoadjuvant endocrine therapy using aromatase inhibitors in postmenopausal ER positive and HER2 negative breast cancer. PLoS One 2018; 13:e0201846. [PMID: 30080878 PMCID: PMC6078304 DOI: 10.1371/journal.pone.0201846] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/22/2018] [Indexed: 01/03/2023] Open
Abstract
The preoperative endocrine prognostic index (PEPI) predicts survival after neoadjuvant endocrine therapy (NAE) using aromatase inhibitors (AIs) for women with postmenopausal estrogen receptor (ER)-positive breast cancer irrespective of the human epidermal growth factor receptor 2 (HER2) status. Although the progesterone receptor (PgR) is also a prognostic factor for ER-positive breast cancer, the PgR status was not considered a prognostic factor in the original PEPI scoring system. In this study, we investigated the utility of a modified PEPI including the PgR status (PEPI-P) as a prognostic factor after NAE for postmenopausal patients with ER-positive and HER2-negative breast cancer. We enrolled 107 patients with invasive ER-positive and HER2-negative breast cancer treated with exemestane for ≥4 months as NAE. We initially assessed PEPI and compared survival between the groups. Additionally, we obtained an effective cutoff for PgR through survival analysis. Then, we assessed the survival significance of PEPI-P. A PgR staining rate of 50% was the most significant cutoff for predicting recurrence-free survival (RFS) and cancer-specific survival (CSS). PEPI was a significant prognostic factor; moreover, PEPI-P was the most significant prognostic indicator for RFS and CSS. PEPI-P is a potent prognostic indicator of survival after NAE using AIs for postmenopausal patients with ER-positive and HER2-negative breast cancer. This modified PEPI may be useful for therapeutic decision-making regarding postmenopausal ER-positive and HER2-negative breast cancer after NAE.
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Affiliation(s)
- Sasagu Kurozumi
- Division of Breast Surgery, Saitama Cancer Center, Saitama, Japan
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
- * E-mail:
| | | | - Kenichi Inoue
- Division of Breast Oncology, Saitama Cancer Center, Saitama, Japan
| | - Katsunori Tozuka
- Division of Breast Surgery, Saitama Cancer Center, Saitama, Japan
| | - Yuji Hayashi
- Division of Breast Surgery, Saitama Cancer Center, Saitama, Japan
| | | | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takaaki Fujii
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Jun Horiguchi
- Department of Breast Surgery, International University of Health and Welfare, Chiba, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
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Pernaut C, Lopez F, Ciruelos E. Standard Neoadjuvant Treatment in Early/Locally Advanced Breast Cancer. Breast Care (Basel) 2018; 13:244-249. [PMID: 30319326 PMCID: PMC6170899 DOI: 10.1159/000491759] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Neoadjuvant treatment allows us to improve surgical results and test new drugs. In recent years, there have been significant advances in the field of neoadjuvant treatment, including hormonal neoadjuvant therapy in luminal tumors, double blockade in HER2-positive tumors, and the use of platinum salts in triple-negative tumors.
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Affiliation(s)
- Cristina Pernaut
- Breast Cancer Unit, Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain
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132
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Sato N, Masuda N, Morimoto T, Ueno T, Kanbayashi C, Kaneko K, Yasojima H, Saji S, Sasano H, Morita S, Ohno S, Toi M. Neoadjuvant endocrine therapy with exemestane followed by response-guided combination therapy with low-dose cyclophosphamide in postmenopausal patients with estrogen receptor-positive breast cancer: A multicenter, open-label, phase II study. Cancer Med 2018; 7:3044-3056. [PMID: 29905023 PMCID: PMC6051169 DOI: 10.1002/cam4.1600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/08/2018] [Accepted: 05/12/2018] [Indexed: 01/28/2023] Open
Abstract
Patients with estrogen receptor (ER)‐positive breast cancer are less likely to achieve a pathological complete response (pCR) with neoadjuvant chemotherapy. Neoadjuvant endocrine therapy may be more appropriate than neoadjuvant chemotherapy in these hormone‐sensitive patients. Most patients with ER‐positive breast cancer are postmenopausal, and therefore, generally older and less able to tolerate chemotherapy. We aimed to investigate the efficacy and safety of tailored neoadjuvant endocrine and chemoendocrine therapy for postmenopausal breast cancer patients. Untreated patients with primary invasive ER‐positive, HER2‐negative, stage I‐IIIA breast cancer, and Ki67 index ≤30% were enrolled. Patients received exemestane 25 mg/d for 12 weeks. Based on clinical response and change in Ki67 index, assessed at 8‐12 weeks, patients with complete response (CR), partial response (PR) with Ki67 index ≤5% after treatment, or stable disease (SD) with Ki67 index ≤5% before and after treatment were defined as responders. For the subsequent 24 weeks, responders continued exemestane monotherapy (group A), and nonresponders received exemestane 25 mg/d plus cyclophosphamide 50 mg/d (group B). The primary endpoint was clinical response at weeks 24 and 36. A total of 59 patients (median age, 69 years) started initial exemestane monotherapy. After exclusion of three patients who discontinued during this period, 56 remained enrolled to receive subsequent treatment. Clinical response rates (CR and PR) and 95% CI at weeks 24 and 36 were 85% (12/14; 57.2%‐98.2%) and 71% (10/14; 41.9%‐91.6%), respectively, in group A; and 54% (23/42; 38.7%‐70.2%) and 71% (30/42; 55.4%‐84.3%), respectively, in group B. At week 36, no significant difference was found in median Ki67 index between the groups (3.5% and 4.0%). There were no treatment‐related deaths. We found that clinical response comparable to that of responders was achieved in nonresponders after addition of cyclophosphamide to the initial endocrine therapy.
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Affiliation(s)
- Nobuaki Sato
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Norikazu Masuda
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takashi Morimoto
- Department of Breast Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Takayuki Ueno
- Breast Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Chizuko Kanbayashi
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Koji Kaneko
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hiroyuki Yasojima
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | | | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital, Tokyo, Japan
| | - Masakazu Toi
- Department of Surgery (Breast Surgery), Graduate School of Medicine, Kyoto University, Kyoto, Japan
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133
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Reyal F, Hamy AS, Piccart MJ. Neoadjuvant treatment: the future of patients with breast cancer. ESMO Open 2018; 3:e000371. [PMID: 29862051 PMCID: PMC5976132 DOI: 10.1136/esmoopen-2018-000371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- F Reyal
- Residual Tumor and Response to Treatment Laboratory, RT2Lab, PSL Research University, INSERM, U932 Immunity and Cancer, Institut Curie, Paris, France.,Breast and Gynecologic Cancer and Reconstructive Surgery Team, Institut Curie, Paris, France
| | - A S Hamy
- Breast and Gynecologic Cancer and Reconstructive Surgery Team, Institut Curie, Paris, France
| | - Martine J Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
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134
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LeVasseur N, Gelmon KA. Can We Hang Our Hats on One Percent? Oncologist 2018; 23:642-644. [PMID: 29728470 PMCID: PMC6067937 DOI: 10.1634/theoncologist.2018-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/23/2018] [Indexed: 11/28/2022] Open
Abstract
This commentary discusses the results of a recent study assessing Ki‐67 changes in residual breast cancer after neoadjuvant chemotherapy.
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Affiliation(s)
- Nathalie LeVasseur
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Karen A Gelmon
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
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135
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Ueno T, Masuda N, Kamigaki S, Morimoto T, Akiyama F, Kurosumi M, Tsuda H, Mikami Y, Tanaka S, Morita S, Toi M. A multicenter phase II trial of neoadjuvant letrozole plus low-dose cyclophosphamide in postmenopausal patients with estrogen receptor-positive breast cancer (JBCRG-07): therapeutic efficacy and clinical implications of circulating endothelial cells. Cancer Med 2018; 7:2442-2451. [PMID: 29733541 PMCID: PMC6010720 DOI: 10.1002/cam4.1516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 12/12/2022] Open
Abstract
Neoadjuvant endocrine therapy has been reported to decrease tumor size, which leads to increased breast conservation rates. To improve the clinical response, metronomic chemotherapy with endocrine therapy is a promising strategy. A multicenter phase II single‐arm neoadjuvant trial with letrozole and cyclophosphamide was conducted. Eligibility criteria included postmenopausal status, T2–4 N0–1, and estrogen receptor‐positive breast carcinoma. Letrozole (2.5 mg) plus cyclophosphamide (50 mg) was given orally once a day for 24 weeks. The primary endpoint was the clinical response rate (CRR). To investigate anti‐angiogenic effects, circulating endothelial cells (CECs) were quantified using the CellSearch system. From October 2007 to March 2010, 41 patients were enrolled. The CRR was 67.5% (52.0–80.0%), which was above the prespecified threshold (65%). The conversion rate from total mastectomy to breast‐conserving surgery was 64% (18/28). Grade 3 or greater nonhematological toxicity was not reported. Clinical response was associated with improved disease‐free survival (DFS) (P = 0.020). The increase in CEC counts at 8 weeks was observed in nonresponders (P = 0.004) but not in responders. Patients with higher CEC counts at baseline or post‐treatment showed worse DFS than those with lower counts (P < 0.001 at baseline and = 0.014 post‐treatment). Multivariate analysis showed that post‐treatment CEC counts but not pretreatment counts were independently correlated with DFS (P = 0.046). In conclusion, neoadjuvant letrozole plus cyclophosphamide showed a good clinical response for postmenopausal patients with estrogen receptor‐positive breast cancer. CEC quantification is a promising tool for treatment monitoring and prognostic stratification for metronomic therapy following validation of our results in larger studies. Clinical trial registration number: UMIN000001331 Phase II study of neoadjuvant letrozole combined with low‐dose metronomic cyclophosphamide for postmenopausal women with endocrine‐responsive breast cancer (JBCRG‐07)
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Affiliation(s)
- Takayuki Ueno
- Breast Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Breast Surgery, School of Medicine, Kyorin University, Tokyo, Japan
| | - Norikazu Masuda
- National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | | | | | - Futoshi Akiyama
- Department of Pathology, The Cancer Institute of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College, Saitama, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Sunao Tanaka
- Department of Breast Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
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Wang T, Wang H, Yang S, Guo H, Zhang B, Guo H, Wang L, Zhu G, Zhang Y, Zhou H, Zhang X, Li H, Su H. Association of APEX1 and OGG1 gene polymorphisms with breast cancer risk among Han women in the Gansu Province of China. BMC MEDICAL GENETICS 2018; 19:67. [PMID: 29720094 PMCID: PMC5930440 DOI: 10.1186/s12881-018-0578-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/18/2018] [Indexed: 11/17/2022]
Abstract
Background Genetic variations in key DNA repair genes may influence DNA repair capacity, DNA damage and breast carcinogenesis. The current study aimed to estimate the association of APEX1 and OGG1 polymorphisms with the risk of breast cancer development. Methods A total of 518 patients with histopathologically confirmed breast cancer and 921 region- and age-matched cancer-free controls were genotyped for the APEX1 polymorphisms rs3136817 and rs1130409 and the OGG1 polymorphisms rs1052133 and rs2072668 using a QuantStudio™ 12 K Flex Real-Time PCR System. Results The rs3136817 heterozygous TC genotype along with the rs3136817 dominant model (TC + CC) was strongly associated with breast cancer susceptibility (odds ratio [OR] = 0.670, 95% confidence interval [95% CI]: 0.513 - 0.873, P = 0.003; OR = 0.682, 95% CI: 0.526 - 0.883, P = 0.004, respectively). No significant associations were observed among rs1130409, rs1052133, rs2072668 and breast cancer risk. Furthermore, an allele combination analysis revealed that APEX1 haplotypes containing C-T (alleles rs3136817 and rs1130409) conferred a significantly lower risk (corrected P < 0.001). Conclusion This research is the latest report showing that an APEX1 rs3136817 heterozygous genotype may have a positive influence on DNA repair capacity in patients with breast cancer and thus may have a potential protective effect for Chinese Han women. Electronic supplementary material The online version of this article (10.1186/s12881-018-0578-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tao Wang
- Research Center of Translational Medicine, Gansu Provincial Academic Institute for Medical Research, NO. 2 Xiaoxihu East Street, Lanzhou, Gansu, 730050, People's Republic of China
| | - Haitao Wang
- Research Center of Translational Medicine, Gansu Provincial Academic Institute for Medical Research, NO. 2 Xiaoxihu East Street, Lanzhou, Gansu, 730050, People's Republic of China
| | - Suisheng Yang
- Department of Breast Surgery, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, 730050, People's Republic of China
| | - Hongyun Guo
- Research Center of Translational Medicine, Gansu Provincial Academic Institute for Medical Research, NO. 2 Xiaoxihu East Street, Lanzhou, Gansu, 730050, People's Republic of China
| | - Binming Zhang
- Department of Breast Surgery, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, 730050, People's Republic of China
| | - Huan Guo
- Research Center of Translational Medicine, Gansu Provincial Academic Institute for Medical Research, NO. 2 Xiaoxihu East Street, Lanzhou, Gansu, 730050, People's Republic of China
| | - Lan Wang
- Research Center of Translational Medicine, Gansu Provincial Academic Institute for Medical Research, NO. 2 Xiaoxihu East Street, Lanzhou, Gansu, 730050, People's Republic of China
| | - Gongjian Zhu
- Research Center of Translational Medicine, Gansu Provincial Academic Institute for Medical Research, NO. 2 Xiaoxihu East Street, Lanzhou, Gansu, 730050, People's Republic of China
| | - Yongdong Zhang
- Research Center of Translational Medicine, Gansu Provincial Academic Institute for Medical Research, NO. 2 Xiaoxihu East Street, Lanzhou, Gansu, 730050, People's Republic of China
| | - Haihong Zhou
- Research Center of Translational Medicine, Gansu Provincial Academic Institute for Medical Research, NO. 2 Xiaoxihu East Street, Lanzhou, Gansu, 730050, People's Republic of China
| | - Xiuli Zhang
- Research Center of Translational Medicine, Gansu Provincial Academic Institute for Medical Research, NO. 2 Xiaoxihu East Street, Lanzhou, Gansu, 730050, People's Republic of China
| | - Haining Li
- Research Center of Translational Medicine, Gansu Provincial Academic Institute for Medical Research, NO. 2 Xiaoxihu East Street, Lanzhou, Gansu, 730050, People's Republic of China
| | - Haixiang Su
- Research Center of Translational Medicine, Gansu Provincial Academic Institute for Medical Research, NO. 2 Xiaoxihu East Street, Lanzhou, Gansu, 730050, People's Republic of China.
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Long non-coding RNA HOXA-AS2 promotes proliferation and invasion of breast cancer by acting as a miR-520c-3p sponge. Oncotarget 2018; 8:46090-46103. [PMID: 28545023 PMCID: PMC5542252 DOI: 10.18632/oncotarget.17552] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/01/2017] [Indexed: 11/25/2022] Open
Abstract
The long non-coding RNA (lncRNA) HOXA cluster antisense RNA2 (HOXA-AS2) has recently been shown to be dysregulated and involved in the progression of several cancers. However, the biological role and clinical significance of HOXA-AS2 in the carcinogenesis of breast cancer are still unclear. In the present study, we found that HOXA-AS2 was up-regulated in human breast cancer tissues and cell lines and associated with clinicopathological characteristics. Silencing of HOXA-AS2 inhibited the progression of breast cancer cells in vitro and in vivo. Furthermore, microarray profiling indicated that HOXA-AS2 serves as an endogenous sponge by directly binding to miR-520c-3p and down-regulating miR-520c-3p expression. We demonstrated that HOXA-AS2 controls the expression of miR-520c-3p target genes, TGFBR2 and RELA, in breast cancer cells. Therefore, our study may provide a better understanding of the pathogenesis of breast cancer and suggests that HOXA-AS2 may be a potential prognostic and therapeutic target in breast cancer.
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138
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Reinert T, Gonçalves R, Ellis MJ. Current Status of Neoadjuvant Endocrine Therapy in Early Stage Breast Cancer. Curr Treat Options Oncol 2018; 19:23. [PMID: 29663173 DOI: 10.1007/s11864-018-0538-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OPINION STATEMENT Neoadjuvant endocrine therapy (NET) with Ki67-based response monitoring is a practical, cost-effective approach to the management of clinical stage II and III estrogen receptor-positive (ER+) breast cancer. In addition to marked improvements in rates of breast conservation, the identification of extreme responders on the basis of the preoperative endocrine prognostic index (PEPI) provides a rationale to avoid chemotherapy on the basis of highly favorable prognosis in some patients. Finally, samples accrued from patients treated with neoadjuvant therapy are providing valuable insights into the molecular basis for intrinsic resistance to endocrine therapy and promise a more rational basis and precise approach to the systemic treatment of ER+ breast cancer.
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Affiliation(s)
- Tomás Reinert
- Hospital do Câncer Mãe de Deus, Porto Alegre, Brazil
- Postgraduation Department of Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rodrigo Gonçalves
- Setor de Mastologia, Hospital das Clínicas, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Matthew J Ellis
- Lester and Sue Smith Breast Cancer Center, Baylor College of Medicine, Houston, TX, 77030, USA.
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139
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Affiliation(s)
- Takeshi Kotake
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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140
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Okazaki M, Horimoto Y, Tanabe M, Ichikawa Y, Tokuda E, Arakawa A, Kobayashi T, Saito M. Predictive markers for efficacy of everolimus plus exemestane in patients with luminal HER2-negative metastatic breast cancer. Med Oncol 2018. [PMID: 29520681 DOI: 10.1007/s12032-018-1112-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Metastatic breast cancer (MBC) is essentially incurable despite recent improvements in systemic therapies. We often encounter difficulties in choosing the most appropriate treatments, with optimal timing, for individual patients. Everolimus, one of the mTOR inhibitors, is usually used with endocrine therapy for MBC. Identification of predictive markers for everolimus-based treatment remains a major issue, but to date, no predictive markers have been established. We retrospectively investigated predictive markers for treatments with everolimus plus exemestane in patients with ER-positive and HER2-negative breast cancer. Clinicopathological features of 18 patients, with locally advanced disease or MBC given everolimus plus exemestane treatments, were examined in relation to treatment effects. Also, primary breast cancer specimens, all ER positive and HER2 negative, were immunohistochemically investigated for phospho-S6 (pS6) and PTEN, to evaluate the mTOR and PIK3CA/Akt pathways. Those showing a good clinical response had a significantly lower Ki67 labeling index than the poor responders. A similar trend was observed in pS6 level but without statistical significance. Interestingly, there was no correlation between the Ki67 labeling index and pS6, and when both indexes were low, the good clinical response rate was high. The median progression-free survival was longer in the group showing a low Ki67 labeling index (109 weeks) than in that with high Ki67 (19 weeks). There was no trend between PTEN expression and treatment effects. Our results suggest that the primary tumor in luminal HER2-negative breast cancer patients with a low Ki67 labeling index and pS6 level has the potential to respond well to everolimus plus exemestane.
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Affiliation(s)
- Misato Okazaki
- Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yoshiya Horimoto
- Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Pathology and Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuko Ichikawa
- Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Emi Tokuda
- Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Toshiyuki Kobayashi
- Department of Pathology and Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Mitsue Saito
- Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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141
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Iwamoto T, Katagiri T, Niikura N, Miyoshi Y, Kochi M, Nogami T, Shien T, Motoki T, Taira N, Omori M, Tokuda Y, Fujiwara T, Doihara H, Gyorffy B, Matsuoka J. Immunohistochemical Ki67 after short-term hormone therapy identifies low-risk breast cancers as reliably as genomic markers. Oncotarget 2018; 8:26122-26128. [PMID: 28412725 PMCID: PMC5432244 DOI: 10.18632/oncotarget.15385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 01/31/2017] [Indexed: 01/10/2023] Open
Abstract
Background The purpose of this study was to test whether immunohistochemical (IHC) Ki67 levels after short-term preoperative hormone therapy (post-Ki67) predict similar numbers of patients with favorable prognoses as genomic markers. Results Thirty paired cases (60 samples) were enrolled in this study. Post-Ki67 levels were significantly lower than pre-treatment Ki67 levels (P < 0.001). Post-Ki67 predicted more low-risk cases (83.3%, 25/30) than pre-genomic surrogate signature(GSS) (66.7%: 20/30), but the difference in predictive power was not significant (P = 0.233). Proliferation (MKI67, STK15, Survivin, CCNB1, and MYBL2) and estrogen (ER, PGR, BCL2, and SCUBE2) related signatures were significantly downregulated after therapy (P < 0.001 and 0.041, respectively). Materials and Methods Core needle biopsy specimens of primary breast cancer were collected at Okayama University Hospital from hormone receptor-positive and human epidermal growth factor 2-negative patients that subsequently received two weeks of neoadjuvant hormone therapy. Paired post-treatment specimens from surgical samples were also collected. IHC Ki67 levels and GSS were compared between pre- and post-hormone treatment samples. Changes of gene expression pattern in short-term hormone therapy were also assessed. Conclusions IHC based post-Ki67 levels may have distinct predictive power compared with the naïve IHC Ki67. Future studies with larger cohorts and longer follow-up periods may be needed to validate our results.
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Affiliation(s)
- Takayuki Iwamoto
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.,Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan
| | - Toyomasa Katagiri
- Division of Genome Medicine, Institute for Genome Research, Tokushima University, Tokushima, Japan
| | - Naoki Niikura
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Yuichiro Miyoshi
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Mariko Kochi
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.,Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan
| | - Tomohiro Nogami
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Takayuki Motoki
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.,Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan
| | - Naruto Taira
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Masako Omori
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Yutaka Tokuda
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroyoshi Doihara
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Balazs Gyorffy
- MTA TTK Lendület Cancer Biomarker Research Group, Budapest, Hungary.,nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Junji Matsuoka
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan.,Department of Gastroenterological Surgery, Okayama University Hospital, Okayama, Japan.,Department of Palliative and Supportive Medicine, Okayama University Hospital, Okayama, Japan
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142
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Ueno T, Saji S, Masuda N, Kuroi K, Sato N, Takei H, Yamamoto Y, Ohno S, Yamashita H, Hisamatsu K, Aogi K, Iwata H, Yamanaka T, Sasano H, Toi M. Impact of clinical response to neoadjuvant endocrine therapy on patient outcomes: a follow-up study of JFMC34-0601 multicentre prospective neoadjuvant endocrine trial. ESMO Open 2018. [PMID: 29531841 PMCID: PMC5844383 DOI: 10.1136/esmoopen-2017-000314] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Neoadjuvant endocrine therapy (NET) has been demonstrated to improve breast-conserving rate and is a widely accepted treatment option for postmenopausal patients with hormone receptor-positive breast cancer. There are few reports on the association of NET response and long-term outcomes. Objectives To investigate the prognostic value of clinical response to NET. Methods Long-term outcomes of NET were examined in 107 patients who participated in the multicentre prospective neoadjuvant exemestane study, JFMC34-0601. Patients were treated with 25 mg/day exemestane for 16 weeks followed by an 8-week extension depending on the treatment response. Results Clinical response included partial response (PR) in 58 patients, stable disease in 41 patients and progressive disease (PD) in 8 patients. Clinical response was significantly associated with disease-free survival (DFS), distant disease-free survival (DDFS) and overall survival (OS) (P<0.0001 for all). Especially, patients with PD showed markedly poor outcomes with median DFS=17.8 months (HR (vs PR): 7.7 (95% CI 1.6 to 33)) and median OS=37.7 months (HR (vs PR): 26.3 (95% CI 2.4 to 655)). Preoperative endocrine prognostic index (PEPI) were associated with DFS and marginally with OS (P=0.022 and 0.066, respectively). PEPI=0 indicated an excellent prognosis with 95% 5-year DFS (95% CI 73 to 99). In the multivariate analysis including T stage, nodal status and Ki67, clinical response was an independent prognostic factor for DFS, DDFS and OS (P=0.032, 0.0007 and 0.020, respectively), whereas PEPI was marginally associated with DFS and OS (P=0.079 and 0.068, respectively). Conclusions Clinical response to NET showed an independent prognostic value. Patients with PD had markedly poor prognosis, indicating a need of additional therapy. PEPI=0 indicated an excellent prognosis. The integration of clinical response and PEPI would improve decision-making with regard to treatment options for endocrine-responsive breast cancer when these results are validated in a larger clinical trial. Trial registration number UMIN C000000345.
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Affiliation(s)
- Takayuki Ueno
- Department of Breast Surgery, Breast Oncology Center, The Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Norikazu Masuda
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Katsumasa Kuroi
- Department of Surgery, Tokyo Metropolitan Health and Medical Treatment Cooperation Ebara Hospital, Tokyo, Japan
| | - Nobuaki Sato
- Department of Breast Oncology, Niigata Cancer Center, Niigata, Japan
| | - Hiroyuki Takei
- Department of Breast Surgery, Nippon Medical School, Tokyo, Japan
| | - Yutaka Yamamoto
- Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroko Yamashita
- Department of Breast Surgery, Hokkaido University Hospital, Sapporo, Japan
| | | | - Kenjiro Aogi
- National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Hiroji Iwata
- The department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan, Nagoya, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Masakazu Toi
- Department of Surgery (Breast Surgery), Kyoto University, Kyoto, Japan
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143
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Liu H, Li J, Koirala P, Ding X, Chen B, Wang Y, Wang Z, Wang C, Zhang X, Mo YY. Long non-coding RNAs as prognostic markers in human breast cancer. Oncotarget 2018; 7:20584-96. [PMID: 26942882 PMCID: PMC4991477 DOI: 10.18632/oncotarget.7828] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/18/2016] [Indexed: 02/02/2023] Open
Abstract
Long non-coding RNAs (lncRNAs) have been recently shown to play an important role in gene regulation and normal cellular functions, and disease processes. However, despite the overwhelming number of lncRNAs identified to date, little is known about their role in cancer for vast majority of them. The present study aims to determine whether lncRNAs can serve as prognostic markers in human breast cancer. We interrogated the breast invasive carcinoma dataset of the Cancer Genome Atlas (TCGA) at the cBioPortal consisting of ~ 1,000 cases. Among 2,730 lncRNAs analyzed, 577 lncRNAs had alterations ranging from 1% to 32% frequency, which include mutations, alterations of copy number and RNA expression. We found that deregulation of 11 lncRNAs, primarily due to copy number alteration, is associated with poor overall survival. At RNA expression level, upregulation of 4 lncRNAs (LINC00657, LINC00346, LINC00654 and HCG11) was associated with poor overall survival. A third signature consists of 9 lncRNAs (LINC00705, LINC00310, LINC00704, LINC00574, FAM74A3, UMODL1-AS1, ARRDC1-AS1, HAR1A, and LINC00323) and their upregulation can predict recurrence. Finally, we selected LINC00657 to determine their role in breast cancer, and found that LINC00657 knockout significantly suppresses tumor cell growth and proliferation, suggesting that it plays an oncogenic role. Together, these results highlight the clinical significance of lncRNAs, and thus, these lncRNAs may serve as prognostic markers for breast cancer.
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Affiliation(s)
- Hairong Liu
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA.,Department of Oncology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Juan Li
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA.,Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, Shangdong Province, China
| | - Pratirodh Koirala
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA.,Department of Biochemistry, University of Mississippi Medical Center, Jackson, MS, USA
| | - Xianfeng Ding
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA.,College of Life Science, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, China
| | - Binghai Chen
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA.,Department of Urology, Affiliated Hospital of Jiangsu University, Jiangsu, Zhenjiang, China
| | - Yiheng Wang
- School of Computing, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Zheng Wang
- School of Computing, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Chuanxin Wang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, Shangdong Province, China
| | - Xu Zhang
- Center of Biostatistics and Bioinformatics, Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yin-Yuan Mo
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA.,Department of Pharmacology/Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
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144
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Abstract
In the era of personalized medicine, there has been significant progress regarding the molecular analysis of breast cancer subtypes. Research efforts have focused on how classification of subtypes could provide information on prognosis and influence treatment planning. Although much is known about the impact of different molecular subtypes on disease-specific survival, more recent studies have investigated the role of the different molecular subtypes on local-regional recurrence. This is an area of active study, and in recent years there has been significant progress. This article describes outcomes among disease subtypes to aid in optimal surgical decision-making to improve local-regional control.
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Affiliation(s)
- Simona Maria Fragomeni
- Division of Gynecologic Oncology, Multidisciplinary Breast Center, Catholic University of the Sacred Heart of Rome, L.go Agostino Gemelli 8, 00168 Rome, Italy
| | - Andrew Sciallis
- Division of Anatomic Pathology, Department of Pathology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Jacqueline S Jeruss
- Division of Anatomic Pathology, Department of Pathology, University of Michigan, Ann Arbor, MI 48105, USA; Division of Surgical Oncology, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48105, USA.
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145
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Abstract
Neoadjuvant endocrine therapy (NET) can be effective at downstaging patients with estrogen receptor-positive tumors and identifying those tumors that are endocrine sensitive and resistant. The optimal prognostic markers for stratification are under investigation. Use of NET will allow the identification of patients with estrogen receptor-positive tumors who might benefit from additional treatment and allow better understanding of endocrine resistance.
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Affiliation(s)
- Julie Grossman
- Department of Medicine, Washington University, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Cynthia Ma
- Department of Medicine, Washington University, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Rebecca Aft
- Department of Surgery, Washington University, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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146
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The Evolving Role of Companion Diagnostics for Breast Cancer in an Era of Next-Generation Omics. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:2185-2198. [DOI: 10.1016/j.ajpath.2017.04.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 02/06/2023]
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147
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Gregório AC, Lacerda M, Figueiredo P, Simões S, Dias S, Moreira JN. Therapeutic Implications of the Molecular and Immune Landscape of Triple-Negative Breast Cancer. Pathol Oncol Res 2017; 24:701-716. [PMID: 28913723 DOI: 10.1007/s12253-017-0307-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 09/04/2017] [Indexed: 12/15/2022]
Abstract
Treatment and management of breast cancer imposes a heavy burden on public health care, and incidence rates continue to increase. Breast cancer is the most common female neoplasia and primary cause of death among women worldwide. The recognition of breast cancer as a complex and heterogeneous disease, comprising different molecular entities, was a landmark in our understanding of this malignancy. Valuing the impact of the molecular characteristics on tumor behavior enabled a better assessment of a patient's prognosis and increased the predictive power to therapeutic response and clinical outcome. Molecular heterogeneity is also prominent in the triple-negative breast cancer subtype, and is reflected by the distinct prognostic and patient's sensitivity to treatment, being chemotherapy the only systemic treatment currently available. From a therapeutic perspective, gene expression profiling of triple-negative tumors has notably contributed to the exploration of new druggable targets and brought to light the need to align these patients to the various therapies according to their triple-negative subtype. Additionally, the higher amount of tumor infiltrating lymphocytes, and the prevalence of an increased expression of PD-1 receptor and its ligand, PD-L1, in triple-negative tumors, created a new treatment opportunity with immune checkpoint inhibitors. This manuscript addresses the current knowledge on the molecular and immune profiles of breast cancer, and its impact on the development of targeted therapies, with a particular emphasis on the triple-negative subtype.
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Affiliation(s)
- Ana C Gregório
- CNC - Center for Neuroscience and Cell Biology, Faculty of Medicine (Pólo I), University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- IIIUC - Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
| | - Manuela Lacerda
- IPATIMUP - Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Paulo Figueiredo
- IPOFG-EPE - Portuguese Institute of Oncology Francisco Gentil, Coimbra, Portugal
| | - Sérgio Simões
- FFUC - Faculty of Pharmacy, Pólo das Ciências da Saúde, University of Coimbra, Coimbra, Portugal
| | - Sérgio Dias
- IMM - Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - João Nuno Moreira
- CNC - Center for Neuroscience and Cell Biology, Faculty of Medicine (Pólo I), University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.
- FFUC - Faculty of Pharmacy, Pólo das Ciências da Saúde, University of Coimbra, Coimbra, Portugal.
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148
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Harbeck N, Gluz O, Christgen M, Kates RE, Braun M, Küemmel S, Schumacher C, Potenberg J, Kraemer S, Kleine-Tebbe A, Augustin D, Aktas B, Forstbauer H, Tio J, von Schumann R, Liedtke C, Grischke EM, Schumacher J, Wuerstlein R, Kreipe HH, Nitz UA. De-Escalation Strategies in Human Epidermal Growth Factor Receptor 2 (HER2)–Positive Early Breast Cancer (BC): Final Analysis of the West German Study Group Adjuvant Dynamic Marker-Adjusted Personalized Therapy Trial Optimizing Risk Assessment and Therapy Response Prediction in Early BC HER2- and Hormone Receptor–Positive Phase II Randomized Trial—Efficacy, Safety, and Predictive Markers for 12 Weeks of Neoadjuvant Trastuzumab Emtansine With or Without Endocrine Therapy (ET) Versus Trastuzumab Plus ET. J Clin Oncol 2017; 35:3046-3054. [PMID: 28682681 DOI: 10.1200/jco.2016.71.9815] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Human epidermal growth factor receptor 2 (HER2)–positive/hormone receptor (HR)–positive breast cancer is a distinct subgroup associated with lower chemotherapy sensitivity and slightly better outcome than HER2-positive/HR-negative disease. Little is known about the efficacy of the combination of endocrine therapy (ET) with trastuzumab or with the potent antibody-cytotoxic, anti-HER2 compound trastuzumab emtansine (T-DM1) with or without ET for this subgroup. The West German Study Group trial, ADAPT (Adjuvant Dynamic Marker-Adjusted Personalized Therapy Trial Optimizing Risk Assessment and Therapy Response Prediction in Early Breast Cancer) compares pathologic complete response (pCR) rates of T-DM1 versus trastuzumab with ET in early HER2-positive/HR-positive breast cancer. Patients and Methods In this prospective, neoadjuvant, phase II trial, 375 patients with early breast cancer with HER2-positive and HR-positive status (n = 463 screened) were randomly assigned to 12 weeks of T-DM1 with or without ET or to trastuzumab with ET. The primary end point was pCR (ypT0/is/ypN0). Early response was assessed in 3-week post-therapeutic core biopsies (proliferation decrease ≥ 30% Ki-67 or cellularity response). Secondary end points included safety and predictive impact of early response on pCR. Adjuvant therapy followed national standards. Results Baseline characteristics were well balanced among the arms. More than 90% of patients completed the therapy per protocol. pCR was observed in 41.0% of patients treated with T-DM1, 41.5% of patients treated with T-DM1 and ET, and 15.1% with trastuzumab and ET ( P < .001). Early responders (67% of patients with assessable response) achieved pCR in 35.7% compared with 19.8% in nonresponders (odds ratio, 2.2; 95% CI, 1.24 to 4.19). T-DM1 was associated with a significantly higher prevalence of grade 1 to 2 toxicities, especially thrombocytopenia, nausea, and elevation of liver enzymes. Overall toxicity was low; seventeen therapy-related severe adverse events (T-DM1 arms v trastuzumab plus ET; 5.3% v 3.1%, respectively) were reported. Conclusion The ADAPT HER2-positive/HR-positive trial demonstrates that neoadjuvant T-DM1 (with or without ET) given for only 12 weeks results in a clinically meaningful pCR rate. Thus, a substantial number of patients are spared the adverse effects of systemic chemotherapy.
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Affiliation(s)
- Nadia Harbeck
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Oleg Gluz
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Matthias Christgen
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Ronald Ernest Kates
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Michael Braun
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Sherko Küemmel
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Claudia Schumacher
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Jochem Potenberg
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Stefan Kraemer
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Anke Kleine-Tebbe
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Doris Augustin
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Bahriye Aktas
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Helmut Forstbauer
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Joke Tio
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Raquel von Schumann
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Cornelia Liedtke
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Eva-Maria Grischke
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Johannes Schumacher
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Rachel Wuerstlein
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Hans Heinrich Kreipe
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Ulrike Anneliese Nitz
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
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149
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Gallardo A, Garcia-Valdecasas B, Murata P, Teran R, Lopez L, Barnadas A, Lerma E. Inverse relationship between Ki67 and survival in early luminal breast cancer: confirmation in a multivariate analysis. Breast Cancer Res Treat 2017; 167:31-37. [PMID: 28865009 DOI: 10.1007/s10549-017-4486-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Ki67 is a prognostic marker in early breast cancer, but its real usefulness remains controversial. The standard cut-off values for Ki67 have not been universally accepted and different values may be used depending on the type of biopsy (fine needle biopsy versus surgical specimen biopsy). The objective of this study was to evaluate the prognostic significance of Ki67 and to determine the most accurate prognostic cut-off. MATERIALS AND METHODS 495 tissue samples from patients with luminal tumours who underwent breast surgery between 2005 and 2011 were collected from the Department of Pathology at Hospital de la Santa Creu i Sant Pau, Barcelona. Patients with stage IV, HER2-positive tumours or triple-negative breast carcinoma were excluded from the study. Pathology data including tumour grading and ki67 percentage were obtained retrospectively from clinical records. In all cases, the percentage of ki67 was evaluated in fine needle biopsies. RESULTS In the multivariate analysis, Ki67 as a continuous variable was associated with poor overall survival (OS) and cancer-specific survival (CSS) (OS p = 0.0001, HR 1.037, CI 1.014-1.059; CSS p = 0.0001, HR 1.063, CI 1.031-1.096) (Cox regression model). CSS was poor when associated with a KI67 cut-off point >14% (p = 0.013, HR 14.85; CI 1.074-120.53) (Cox regression model). Disease-free survival (DFS) was not associated with Ki67 CONCLUSIONS: Prognosis of luminal breast carcinoma can be predicted using Ki67 as a continuous variable and a standard cut-off value of 14%. Information about the specimen type used to determine ki67 should be recorded in the pathological report.
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Affiliation(s)
- Alberto Gallardo
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Sant Quinti 87-89, 08041, Barcelona, Spain.
| | | | - Paola Murata
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Rolando Teran
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Sant Quinti 87-89, 08041, Barcelona, Spain
| | - Laura Lopez
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Sant Quinti 87-89, 08041, Barcelona, Spain
| | - Agusti Barnadas
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Enrique Lerma
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Sant Quinti 87-89, 08041, Barcelona, Spain
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150
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Focke CM, Bürger H, van Diest PJ, Finsterbusch K, Gläser D, Korsching E, Decker T. Interlaboratory variability of Ki67 staining in breast cancer. Eur J Cancer 2017; 84:219-227. [PMID: 28829990 DOI: 10.1016/j.ejca.2017.07.041] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/17/2017] [Accepted: 07/25/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Postanalytic issues of Ki67 assessment in breast cancers like counting method standardisation and interrater bias have been subject of various studies, but little is known about analytic variability of Ki67 staining between pathology labs. Our aim was to study interlaboratory variability of Ki67 staining in breast cancer using tissue microarrays (TMAs) and central assessment to minimise preanalytic and postanalytic influences. METHODS Thirty European pathology labs stained serial slides of a TMA set of breast cancer tissues with Ki67 according to their routine in-house protocol. The Ki67-labelling index (Ki67-LI) of 70 matched samples was centrally assessed by one observer who counted all cancer cells per sample. We then tested for differences between the labs in Ki67-LI medians by analysing variance on ranks and in proportions of tumours classified as luminal A after dichotomising oestrogen receptor-positive cancers into cancers showing low (<14%, luminal A) and high (≥14%, luminal B HER2 negative) Ki67-LI using Cochran's Q. RESULTS Substantial differences between the 30 labs were indicated for median Ki67-LI (0.65%-33.0%, p < 0.0001) and proportion of cancers classified as luminal A (17%-57%, p < 0.0001). The differences remained significant when labs using the same antibody (MIB-1, SP6, or 30-9) were analysed separately or labs without prior participation in external quality assurance programs were excluded (p < 0.0001, respectively). CONCLUSION Substantial variability in Ki67 staining of breast cancer tissue was found between 30 routine pathology labs. Clinical use of the Ki67-LI for therapeutic decisions should be considered only fully aware of lab-specific reference values.
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Affiliation(s)
- Cornelia M Focke
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Allendestrasse 30, 17033 Neubrandenburg, Germany; Department of Pathology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Horst Bürger
- Institute of Pathology Paderborn/Höxter, Breast Center Paderborn, Husener Str. 46 a, 33098 Paderborn, Germany
| | - Paul J van Diest
- Department of Pathology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Kai Finsterbusch
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Allendestrasse 30, 17033 Neubrandenburg, Germany
| | - Doreen Gläser
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Allendestrasse 30, 17033 Neubrandenburg, Germany
| | - Eberhard Korsching
- Institute of Bioinformatics, University of Münster, Niels-Stensen-Straße 14, 48149 Münster, Germany
| | - Thomas Decker
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Allendestrasse 30, 17033 Neubrandenburg, Germany
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