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Hussein Hameedi B, Hussain Mahdi AAA, Shalash Sultan A. Estimation of Epidermal growth factor (EGF), HER2, CA15-3 and Acid phosphatase in Iraqi breast cancer women. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.03.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Breast cancer is one of frequent cancer that affects millions of people worldwide. Delayed diagnosis of these cancers has raised mortality and morbidity. Cancer biomarkers have tremendously increased the efficacy of treatment and the effectiveness of detection. This study aimed to investigate some biomarkers, including EGF, HER2, CA15-3, and Acid phosphatase, associated with early breast cancer (BC) diagnosis in Iraqi women. Carried on 90 Samples, the patients attended the Center for Early Detection of Breast Tumor at an oncology teaching hospital in Medical City. The study was conducted between 15/February (2021) and 20/July (2021). The consultant medical personnel made the diagnosis based on a Triple Assessment Technique, including physical breast examination, ultrasonography, with or without mammography and fine needle aspiration cytology. Female patients were divided into three groups (Benign, malignant and control). Benign B(34 patients) was split into subgroups, including. Benign premenopausal group B1(17 patients) Benign post-menopausal group B2(17patients) and malignant M(34 patients), malignant premenopausal group M1(17 patients) and malignant post-menopausal group M2(17 patients), and control group C include (11) premenopausal stage C1and (11) post-menopausal group C2. The value of EGF in Malignant cancer M1 (179.80 ±19.07) and M2(130.59 ±18.59)shows a highly significant (P≤0>05) increase in comparison with benign cancer and B2 and healthy control C1and C2 groups, respectively but B1 and B2 shows high significant (P≤0>05)decrease in comparison with C1 and C2 respectively. The values of HER2 show in B2(1.377±0.10); M1(11.76±0.10), and M2(11.79±0.09) increased significantly(P≤0.05) in comparison with C1, C2, B1 respectively. The values of CA-15-3 in M1 and M2 increase significantly(P≤0.05) compared with C1, C2, B1, and B2. The values of acid phosphatase in pre-and post-menopausal males in M1 and M2 increased significantly (p<0.05) compared with C1andC2.
Keywords: Epidermal growth factor, breast cancer, Acid phosphatase, HER2, CA15-3
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Affiliation(s)
- Ban Hussein Hameedi
- 1 Department of Biology, College of Science, Mustansiriyah University, Baghdad, Iraq University of Baghdad, College of Nursing, Department of Basic Science, Iraq, Baghdad
| | | | - Ali Shalash Sultan
- Department of Science, College of Basic Education, Mustansiriyah University, Baghdad, Iraq
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2
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Alataki A, Dowsett M. Human epidermal growth factor receptor-2 and endocrine resistance in hormone-dependent breast cancer. Endocr Relat Cancer 2022; 29:R105-R122. [PMID: 35613334 PMCID: PMC9254309 DOI: 10.1530/erc-21-0293] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 12/27/2022]
Abstract
Endocrine therapies are the main treatment strategies for the clinical management of hormone-dependent breast cancer. Despite prolonged time to recurrence in the adjuvant setting and the initial clinical responses in the metastatic setting, many patients eventually encounter tumour relapse due to acquired resistance to these agents. Other patients experience a lack of tumour regression at the beginning of treatment indicating de novo resistance that significantly limits its efficacy in the clinic. There is compelling evidence that human epidermal growth factor receptor-2 (HER2) overexpression contributes to resistance to endocrine therapies in oestrogen receptor-positive (ER+) breast cancer. ER+/HER2+ tumours comprise about 10% of all breast cancer cases and about 60% of the whole set of HER2+ tumours. Most patients with primary ER+/HER2+ disease will receive antibody-based HER2-targeted therapy, but this is generally for no more than one year while endocrine treatment is usually for at least 5 years. A number of HER2-kinase inhibitors are also now in clinical use or in clinical trials, and the interaction of these with endocrine treatment may differ from that of antibody treatment. In this review article, we aim to summarise knowledge on molecular mechanisms of breast cancer resistance to endocrine therapies attributable to the impact of HER2 signalling on endocrine sensitivity, to discuss data from clinical trials addressing the role of HER2 in the development of endocrine resistance in the metastatic, neoadjuvant and adjuvant settings and to explore rational new therapeutic strategies.
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Affiliation(s)
- Anastasia Alataki
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital and The Institute of Cancer Research, London, UK
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
- Correspondence should be addressed to A Alataki:
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital and The Institute of Cancer Research, London, UK
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
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3
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The Precise Detection of HER-2 Expression in Breast Cancer Cell via Au25 Probes. NANOMATERIALS 2022; 12:nano12060923. [PMID: 35335736 PMCID: PMC8950386 DOI: 10.3390/nano12060923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022]
Abstract
Triple-negative breast cancer (TNBC) accounts for nearly one-quarter of all breast cancer cases, but effective targeted therapies for this disease remain elusive because TNBC cells lack the expression of the most common three receptors seen in other subtypes of breast cancers. The medium-term diagnosis of breast cancers is essential for development and prognosis. According to reports, patients with TNBC may be converted to a positive epidermal growth factor receptor 2(HER-2) after chemotherapy, and trastuzumab treatment will have a better prognosis. Therefore, it is important to accurately quantify the expression of HER-2 in breast cancer cells. Herein, we design a red fluorescent Au25 probe synthesized with BSA-biotin as the ligand, which is accurately quantified by HER-2 primary antibody-biotin using the avidin system. The quantitative detection of the expression of HER-2 in breast cancers is helpful for the companion diagnostic of breast cancer treatment and provides follow-up treatment.
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Seale KN, Tkaczuk KHR. Circulating Biomarkers in Breast Cancer. Clin Breast Cancer 2021; 22:e319-e331. [PMID: 34756687 DOI: 10.1016/j.clbc.2021.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/22/2021] [Accepted: 09/19/2021] [Indexed: 12/11/2022]
Abstract
Breast cancer management has progressed immensely over the decades, but the disease is still a major source of morbidity and mortality worldwide. Even with enhanced imaging detection and tissue biopsy capabilities, disease can progress on an ineffective treatment before additional information is obtained through standard methods of response evaluation, including the RECIST 1.1 criteria, widely used for assessment of treatment response and benefit from therapy.6 Circulating biomarkers have the potential to provide valuable insight into disease progression and response to therapy, and they can serve to identify actionable mutations and tumor characteristics that can direct therapy. These biomarkers can be collected at higher frequencies than imaging or tissue sampling, potentially allowing for more informed management. This review will evaluate the roles of circulating biomarkers in breast cancer, including the serum markers Carcinoembryonic antigen CA15-3, CA27-29, HER2 ECD, and investigatory markers such as GP88; and the components of the liquid biopsy, including circulating tumor cells, cell free DNA/DNA methylation, circulating tumor DNA, and circulating microRNA.
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Affiliation(s)
- Katelyn N Seale
- University of Maryland, School of Medicine, Marlene and Stewart Greenebaum Comprehensive Cancer Center, 22 South Greene Street, S9D12, Baltimore, MD 21201
| | - Katherine H R Tkaczuk
- University of Maryland, School of Medicine, Marlene and Stewart Greenebaum Comprehensive Cancer Center, 22 South Greene Street, S9D12, Baltimore, MD 21201.
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5
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Tao Q, Wu X, Lin Q, Zheng H, Yang W, Liu D, Yang CJ, Ji T. Portable detection of serum HER-2 in breast cancer by a pressure-based platform. Anal Bioanal Chem 2018; 410:7489-7498. [DOI: 10.1007/s00216-018-1364-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/24/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
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6
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The extracellular domain of Her2 in serum as a biomarker of breast cancer. J Transl Med 2018; 98:696-707. [PMID: 29491426 DOI: 10.1038/s41374-018-0033-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/13/2017] [Accepted: 12/20/2017] [Indexed: 11/08/2022] Open
Abstract
Breast cancer is a major health problem worldwide. In ~15% of breast cancers, the epidermal growth factor receptor HER2, a transmembrane protein, is overexpressed. This HER2 overexpression is associated with an aggressive form of the disease and a poor clinical prognosis. The extracellular domain (ECD) of HER2 is released into the blood by a proteolytic mechanism known as "ECD shedding". This proteolytic shedding leaves a constitutively active truncated receptor in the membrane that is 10-100-fold more oncogenic than the full-length receptor and promotes the growth and survival of cancer cells. Shedding of the HER2 ECD is increased during metastasis: whereas 15% of primary breast cancer patients have elevated levels of serum HER2 ECD (sHER2 ECD), the levels reach 45% in patients with metastatic disease. Thus, sHER2 ECD has been proposed as a promising biomarker for cancer recurrence and for monitoring the disease status of patients overexpressing HER2. Nevertheless, in 2016, the American Society of Clinical Oncology advises clinicians not to use soluble HER2 levels to guide their choice of adjuvant therapy for patients with HER2-positive breast cancer, because the evidence was considered not strong enough. Currently, biomarkers such as carcinoembryonic antigen and cancer antigen 15-3 are widely used to monitor metastatic breast cancer disease even if the level of evidence of clinical impact of this monitoring is poor. In this article, we review the evidence that sHER2 ECD might be used in some situations as a biomarker for breast cancer. Although this serum biomarker will not replace the direct measurement of tumor HER2 status for diagnosis of early-stage tumors; it might be especially useful in metastatic disease for prognosis, as an indicator of cancer progression and of therapy response, particularly to anti-HER2 therapies. Owing to these data, sHER2 ECD should be considered as a promising biomarker to detect cancer recurrence and metastasis.
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Schwartz MK, Smith C, Schwartz DC, Dnistrian A, Neiman I. Monitoring Therapy by Serum HER-2/Neu. Int J Biol Markers 2018; 15:324-9. [PMID: 11192828 DOI: 10.1177/172460080001500409] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We have evaluated the performance of the Bayer Immuno 1™ serum HER-2/neu assay. The precision is excellent and varied between 1.7% and 2.1% at values of HER-2/neu ranging from 16.8 ng/mL to 108.6 ng/mL. In normal women who were followed on a monthly basis the average deviation was 6%. The concentration (mean ± SD) in normal women was 8.7 ± 3.2 ng/mL. There was no difference between pre and postmenopausal women. The normal/abnormal cutoff was defined as greater than 15 ng/mL. In normal women and those with benign disease the specificity varied between 95% and 100%. In women with breast cancer the sensitivity was 1.7% in stage I disease, 3.0% in stage II, 16.7 in stage III and 35.5% in stage IV. There were 56 elevations (14.7%) in the total group of 285 women with breast cancer. There was an excellent correlation with a microtitre plate method (r=0.9944). Longitudinal studies showed clearly that women who expressed HER-2/neu in their tissue had elevated serum levels and these levels reflected the clinical course of the patient. More extensive control studies are required to establish the role of HER-2/neu assays in the management of women with breast cancer.
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Affiliation(s)
- M K Schwartz
- Department of Clinical Laboratories, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
c-erbB-2 is an oncoprotein which is overexpressed in some breast cancers. Recently it has been established that the extracellular domain of c-erbB-2 is shed into the serum of patients with breast cancer. There appears to be no association between tumor stage and extracellular domain of c-erbB-2 (c-erbB-2/ECD): c-erbB-2/ECD seems to correlate with patient prognosis whatever the stage of disease. The data also suggest that c-erbB-2/ECD may be useful in monitoring for tumor recurrence and in predicting resistance to hormonal therapy, but not as useful in predicting response to chemotherapy. This may relate to the power of this marker to reflect disease burden, which has an overwhelmingly negative impact on outcome.
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Affiliation(s)
- L Harris
- Department of Hematology/Oncology, Duke University, Durham, North Carolina, USA
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Nunes RA, Li X, Kang SP, Burstein H, Roberts L, Carney W, Blackwell K, Ryan P, Borges V, Iglehart JD, Friedman P, Harris LN. Circulating Tumor Cells in HER-2 Positive Metastatic Breast Cancer Patients Treated with Trastuzumab and Chemotherapy. Int J Biol Markers 2018; 24:1-10. [DOI: 10.1177/172460080902400101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The detection of circulating tumor cells (CTCs) in peripheral blood may have important prognostic and predictive implications in breast cancer treatment. A limitation in this field has been the lack of a validated method of accurately measuring CTCs. While sensitivity has improved using RT-PCR, specificity remains a major challenge. The goal of this paper is to present a sensitive and specific methodology of detecting CTCs in women with HER-2-positive metastatic breast cancer, and to examine its role as a marker that tracks disease response during treatment with trastuzumab-containing regimens. The study included patients with HER-2-positive metastatic breast cancer enrolled on two different clinical protocols using a trastuzumab-containing regimen. Serial CTCs were measured at planned time points and clinical correlations were made. Immunomagnetic selection of circulating epithelial cells was used to address the specificity of tumor cell detection using cytokeratin 19 (CK19). In addition, the extracellular domain of the HER-2 protein (HER-2/ECD) was measured to determine if CTCs detected by CK19 accurately reflect tumor burden. The presence of CTCs at first restaging was associated with disease progression. We observed an association between CK19 and HER-2/ECD. The association of HER-2/ECD with clinical response followed a similar pattern to that seen with CK19. Finally, the absence of HER-2/ECD at best overall response and a change of HER-2/ECD from positive at baseline to negative at best overall response was associated with favorable treatment response. Our study supports the prognostic and predictive role of the detection of CTCs in treatment of HER-2-positive metastatic breast cancer patients. The association between CK19 and markers of disease burden is in line with the concept that CTCs may be a reliable measure of tumor cells in the peripheral blood of patients with metastatic breast cancer. The association of CTCs at first restaging with treatment failure indicates that CTCs may have a role as surrogate markers to monitor treatment response.
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Affiliation(s)
- Raquel A. Nunes
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Xiaochun Li
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Soonmo Peter Kang
- Section of Medical Oncology, Yale University School of Medicine/Yale Cancer Center, New Haven, CT - USA
| | - Harold Burstein
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Walter Carney
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kimberly Blackwell
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Paula Ryan
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Virginia Borges
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - J. Dirk Iglehart
- Department of Cancer Biology/Adult Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Lyndsay N. Harris
- Section of Medical Oncology, Yale University School of Medicine/Yale Cancer Center, New Haven, CT - USA
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10
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Lee MH, Jung SY, Kang SH, Song EJ, Park IH, Kong SY, Kwon YM, Lee KS, Kang HS, Lee ES. The Significance of Serum HER2 Levels at Diagnosis on Intrinsic Subtype-Specific Outcome of Operable Breast Cancer Patients. PLoS One 2016; 11:e0163370. [PMID: 27706242 PMCID: PMC5051717 DOI: 10.1371/journal.pone.0163370] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose This study evaluated the association of serum HER2 (sHER2) levels at diagnosis with clinicopathologic parameters and disease free survival (DFS) in operable breast cancer patients according to intrinsic subtype. Methods The sHER2 levels were measured using a chemiluminescence immunoassay. The HER2 status in all tumor tissues was determined by immunohistochemistry, and confirmed in equivocal cases by fluorescence in situ. Results There were 436 consecutive stage I-III breast cancer patients with sHER2 result at diagnosis between Nov 2004 and Dec 2011. High sHER2 levels (≥ 15 ng/ml) were reported in 52 patients (11.9%) and HER2 overexpression in tumor tissue was observed in 111 patients (25.5%). High sHER2 levels were associated significantly with advanced stage (P < 0.001), mastectomy (P = 0.012), neoadjuvant chemotherapy (P < 0.001), anti-HER2 therapy (P < 0.001) and hormone therapy (P = 0.022). The patients with high sHER2 levels had a worse DFS (P < 0.001). In multivariate analysis, high sHER2 levels were associated significantly with worse DFS (HR = 2.25, 95% CI 1.27–3.99, P = 0.005). High sHER2 levels were associated with worse DFS in the HR+/HER2-, HR+/HER2+ and HR-/HER2+ subtypes (P = 0.043, 0.003 and 0.041, respectively). Conclusions These results show that the sHER2 level at diagnosis is a useful prognostic factor in patients with operable breast cancer, especially in the HR+/HER2-, HR+/HER2+ and HR-/HER2+ subtypes.
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Affiliation(s)
- Moo Hyun Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - So-Youn Jung
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Sun Hee Kang
- Department of Surgery, Keimyung University, School of Medicine, Daegu, Republic of Korea
| | - Eun Jin Song
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - In Hae Park
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Sun-Young Kong
- Department of Laboratory Medicine, Center for Diagnostic Oncology, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Young Mee Kwon
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Keun Seok Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Han-Sung Kang
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
| | - Eun Sook Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea
- * E-mail:
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Advani PP, Crozier JA, Perez EA. HER2 testing and its predictive utility in anti-HER2 breast cancer therapy. Biomark Med 2015; 9:35-49. [PMID: 25605454 DOI: 10.2217/bmm.14.95] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Breast cancer treatment is dependent on accurate pathologic diagnosis. HER2 testing is now universally recommended as part of evaluation of invasive breast cancer. HER2 testing is available via various slide and non-slide based assays, and interpretation of results continues to evolve. Herein we review these testing modalities and their incorporation into the 2013 ASCO/CAP guidelines. Once accurate HER2 status has been established the proper treatment based on recent clinical trials can be instituted.
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Affiliation(s)
- Pooja P Advani
- Division of Hematology & Oncology, Mayo Clinic, 4500 San Pablo Road S., Jacksonville, FL 32224, USA
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Campos LC, Silva JO, Santos FS, Araújo MR, Lavalle GE, Ferreira E, Cassali GD. Prognostic significance of tissue and serum HER2 and MUC1 in canine mammary cancer. J Vet Diagn Invest 2015; 27:531-5. [PMID: 26179096 DOI: 10.1177/1040638715592445] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The aim of our study was to compare serum levels and protein tissue of human epidermal growth factor receptor-2 proto-oncogene (HER2) and mucin 1 (MUC1) using an antigen-capture enzyme-linked immunosorbent assay and immunohistochemistry (IHC) in canine mammary carcinomas and investigate how the 2 markers correlate with dogs with metastasis and without metastasis to a regional lymph node. Forty-eight female dogs were selected, including 14 with non-metastatic cancer, 14 with lymph node metastasis, and 20 healthy animals. Serum samples were collected from all the animals and tissues from 28 dogs with malignant mammary tumor with or without metastasis for evaluated HER2 and MUC1 expression. Tissue sample were evaluated for MUC1 and HER2 immunoexpression by IHC. The results showed measurable serum levels of MUC1 and HER2 in all groups. While serum MUC1 levels were significantly higher in animals with metastasis than the other 2 groups, no increase was observed in HER2 serum levels. The MUC1 IHC results showed that only membrane immunostaining was significantly different between the groups. Statistically, there was an association between immunostaining and the serum HER2 levels. Our results indicate that serum concentrations of HER2 and the IHC staining pattern for HER2 in primary tumor do not correlate with the presence of regional metastasis. However, increased concentrations of MUC1 in the serum of dogs with mammary cancer are associated with the presence of metastasis to regional lymph nodes. A membrane pattern of IHC staining for MUC1 in the primary tumor suggests that metastases to regional lymph node are present.
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Affiliation(s)
- Liliane C Campos
- Department of General Pathology, Institute of Biological Sciences (Campos, Silva, Santos, Araújo, Ferreira, Cassali), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilVeterinary School, Veterinary Hospital (Lavalle), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana O Silva
- Department of General Pathology, Institute of Biological Sciences (Campos, Silva, Santos, Araújo, Ferreira, Cassali), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilVeterinary School, Veterinary Hospital (Lavalle), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fabiana S Santos
- Department of General Pathology, Institute of Biological Sciences (Campos, Silva, Santos, Araújo, Ferreira, Cassali), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilVeterinary School, Veterinary Hospital (Lavalle), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marina R Araújo
- Department of General Pathology, Institute of Biological Sciences (Campos, Silva, Santos, Araújo, Ferreira, Cassali), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilVeterinary School, Veterinary Hospital (Lavalle), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gleidice E Lavalle
- Department of General Pathology, Institute of Biological Sciences (Campos, Silva, Santos, Araújo, Ferreira, Cassali), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilVeterinary School, Veterinary Hospital (Lavalle), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Enio Ferreira
- Department of General Pathology, Institute of Biological Sciences (Campos, Silva, Santos, Araújo, Ferreira, Cassali), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilVeterinary School, Veterinary Hospital (Lavalle), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Geovanni D Cassali
- Department of General Pathology, Institute of Biological Sciences (Campos, Silva, Santos, Araújo, Ferreira, Cassali), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilVeterinary School, Veterinary Hospital (Lavalle), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Di Gioia D, Dresse M, Mayr D, Nagel D, Heinemann V, Stieber P. Serum HER2 in combination with CA 15-3 as a parameter for prognosis in patients with early breast cancer. Clin Chim Acta 2014; 440:16-22. [PMID: 25444743 DOI: 10.1016/j.cca.2014.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 11/01/2014] [Accepted: 11/01/2014] [Indexed: 01/17/2023]
Abstract
AIM HER2 in breast cancer tissue is a marker of high prognostic and predictive relevance. Soluble HER2, the extracellular domain of the HER2/neu receptor (HER2 ECD), which is shed into the blood, has been suggested to be a helpful tumor marker. We investigated the relationship between the concentrations of HER2 ECD, CEA and CA 15-3, the association of these markers with clinicopathological features and the impact of HER2 ECD alone and in combination with known prognostic factors on disease free survival (DFS) and cancer specific survival (CSS) in untreated early breast cancer patients. PATIENTS AND METHODS HER2 ECD (ADVIA, Bayer), CEA (AxSYM, Abbott) and CA 15-3 (Elecsys, Roche) were measured at time of primary diagnosis in the pre-therapeutic (pre-operative) sera of 241 breast cancer patients and were correlated with clinicopathological parameters and outcome. RESULTS Higher HER2 ECD levels were significantly correlated with postmenopausal status (p=0.016) and tissue HER2-overexpression (p<0.0001). Higher serum levels of CA 15-3 were associated with larger tumor size (p=0.019), positive lymph nodes (p=0.019), UICC stage III (p<0.01), positive tissue HER2-overexpression (p<0.05) and negative hormone receptor status (p=0.016). In multivariate analysis, serum HER2 ECD levels, CA 15-3 levels, large tumor size and negative hormonal status were independent prognostic factors in DFS. Patients with both high levels of HER2 ECD (>15 ng/mL) and high serum levels of CA 15-3 (>24 U/mL) had the poorest prognosis with a DFS after 3 years of 50.0%. Patients without elevated serum levels had a better outcome with a DFS of 91.2%. CONCLUSIONS In our retrospective analysis, HER2 ECD and CA 15-3 were independent and better prognostic tools than HER2 in tissue. Prospective validation is necessary to confirm their usefulness in clinical practice.
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Affiliation(s)
- Dorit Di Gioia
- Department of Internal Medicine III, Ludwig-Maximilians-University of Munich, Campus Großhadern, 81377 Munich, Germany.
| | - Marie Dresse
- Institute of Laboratory Medicine, Ludwig-Maximilians-University of Munich, Campus Großhadern, 81377 Munich, Germany
| | - Doris Mayr
- Department of Pathology, Ludwig-Maximilians-University of Munich, 80337 Munich, Germany
| | - Dorothea Nagel
- Institute of Laboratory Medicine, Ludwig-Maximilians-University of Munich, Campus Großhadern, 81377 Munich, Germany
| | - Volker Heinemann
- Department of Internal Medicine III, Ludwig-Maximilians-University of Munich, Campus Großhadern, 81377 Munich, Germany
| | - Petra Stieber
- Institute of Laboratory Medicine, Ludwig-Maximilians-University of Munich, Campus Großhadern, 81377 Munich, Germany
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Di Gioia D, Dresse M, Mayr D, Nagel D, Heinemann V, Kahlert S, Stieber P. Serum HER2 supports HER2-testing in tissue at the time of primary diagnosis of breast cancer. Clin Chim Acta 2014; 430:86-91. [PMID: 24412321 DOI: 10.1016/j.cca.2013.12.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 12/13/2013] [Accepted: 12/25/2013] [Indexed: 10/25/2022]
Abstract
AIM HER2 in tissue is of high prognostic value. Soluble HER2, the extracellular domain (ECD), has been suggested to be a helpful biomarker. We investigated whether there is a relationship between HER2 ECD and HER2 in tissue and whether this relationship could be used for diagnostic purposes. METHODS HER2 ECD was measured in healthy individuals (N=283, 184 females, 99 males), in patients with history of breast cancer (BC) with no evidence of disease (N=249) as well as in BC patients before any treatment (N=565). HER2 in tissue was determined by immunohistochemistry and HER2 ECD was analyzed by immunoassay. RESULTS HER2 ECD levels were higher in healthy men than in healthy women (medians 12.9 ng/mL vs. 9.9 ng/mL, p<0.001). We observed an age dependency in women that means the older the women the higher the HER2 ECD level. In treated BC patients there was only a weak difference between younger and older women. For patients without distant metastases as well as patients with metastatic disease we observed a correlation of HER2 in serum and tissue. The median concentrations of HER2 ECD were 11.7 ng/mL (13.2 ng/mL) for the HER2-negative (HER2-positive) patients in the non-metastatic-group (p<0.001) and 11.9 ng/mL (16.0 ng/mL) in the metastatic-group (p=0.01). Using a cut-off of 30 ng/mL the HER2 in tissue was always positive, corresponding to a specificity of 99.8% and a sensitivity of 10.3%. CONCLUSIONS There is a strong correlation between HER2 ECD and HER2 in tissue. HER2 ECD supports the HER2 testing in tissue and may reveal false-negative tissue findings.
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Affiliation(s)
- Dorit Di Gioia
- Medical Department III, Klinikum Großhadern, University Hospital, Munich, Germany.
| | - Marie Dresse
- Institute of Clinical Chemistry, Klinikum Großhadern, University Hospital, Munich, Germany
| | - Doris Mayr
- Institute of Pathology, Klinikum Großhadern, University Hospital, Munich, Germany
| | - Dorothea Nagel
- Institute of Clinical Chemistry, Klinikum Großhadern, University Hospital, Munich, Germany
| | - Volker Heinemann
- Medical Department III, Klinikum Großhadern, University Hospital, Munich, Germany
| | - Steffen Kahlert
- Gynecological Department, Klinikum Großhadern, University Hospital, Munich, Germany
| | - Petra Stieber
- Institute of Clinical Chemistry, Klinikum Großhadern, University Hospital, Munich, Germany
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15
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Lam L, Czerniecki BJ, Fitzpatrick E, Xu S, Schuchter L, Xu X, Zhang H. Interference-Free HER2 ECD as a Serum Biomarker in Breast Cancer. ACTA ACUST UNITED AC 2013; 4:151. [PMID: 25089226 PMCID: PMC4114390 DOI: 10.4172/2155-9929.1000151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Over-expression of the HER2/neu receptor occurs in 20 to 30 percent of breast tumors and is linked to poorer prognosis. The HER2/neu expression status determines whether or not patient will receive trastuzumab-based treatment. In clinical practice, over-expression of HER2/neu is routinely identified using Immunohistochemistry (IHC) or Fluorescence in Situ Hybridization (FISH), both of which are invasive approaches requiring tissue samples. Serum assays for the Extra Cellular Domain of HER2/neu receptor (HER2 ECD) have been reported but the use is very limited due to serum interference factors (e.g. human anti-animal immunoglobulin antibodies) that lead to false test results and inconsistency with tissue Her2 status. We have developed an ELISA based approach using an MBB buffer to eliminate false results and to obtain more accurate assessment of HER2 ECD levels. Using this refined assay we retroactively measured HER2/neu levels from breast cancer patients and controls. Abnormal HER2 ECD levels were detected in about 32% of invasive breast cancer patients but not in controls or patients with benign diseases. In addition, we also showed that patients with elevated serum HER2 levels appeared to have worse survival regardless of treatments. In a small group of 12 Ductal Carcinoma in situ (DCIS) patients who received HER2/neu peptide vaccination and surgery, only one patient showed constantly rising HER2 levels after treatment and this patient had recurrence of HER2 positive tumor within 5 years. Our studies indicate that once the serum interference issue is resolved, serum HER2 ECD can have potential clinical utility to supplement the tissue based tests.
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Affiliation(s)
- Lian Lam
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, U.S.A
| | - Brian J Czerniecki
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Elizabeth Fitzpatrick
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Shuwen Xu
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Lynn Schuchter
- Division of Hematology-Oncology, HUP, 16 Penn Tower, Philadelphia, U.S.A
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, U.S.A
| | - Hongtao Zhang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, U.S.A
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16
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Lam L, McAndrew N, Yee M, Fu T, Tchou JC, Zhang H. Challenges in the clinical utility of the serum test for HER2 ECD. Biochim Biophys Acta Rev Cancer 2012; 1826:199-208. [PMID: 22521738 DOI: 10.1016/j.bbcan.2012.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 03/28/2012] [Indexed: 01/08/2023]
Abstract
Approximately 15-30% of breast cancers over-express the HER2/neu receptor. Historically, over-expression of HER2/neu has been identified using IHC or FISH, both of which are invasive approaches requiring tissue samples. Recent evidence has shown that some tumors identified as "negative" using these methods can respond to HER2/neu targeted therapy. Shedding of the extracellular domain (ECD) of the receptor into the circulation has led to the development of a serum test of HER2 ECD as an additional approach to probe HER2/neu overexpression. The serum test will be able to monitor the dynamic changes of HER2 status over the course of disease progression. Some studies further suggest that the serum HER2 ECD level and its change may serve as a biomarker to reflect patients' response to therapy. Yet more than 10years after the first serum HER2 ECD test was approved by the FDA, serum HER2 testing has yet to be widely used in clinical practice. In this article we will review the progress of the serum HER2 ECD test and discuss some obstacles impeding its incorporation into broad clinical practice. We will also discuss recent improvements in the sensitivity and specificity of the assay that offer some hope for the future of serum HER2 test.
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Affiliation(s)
- Lian Lam
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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17
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Breast cancer expression of YKL-40 correlates with tumour grade, poor differentiation, and other cancer markers. Br J Cancer 2011; 105:1203-9. [PMID: 21934681 PMCID: PMC3208489 DOI: 10.1038/bjc.2011.347] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Serum levels of a secreted glycoprotein YKL-40 are elevated in patients with a wide range of cancers including breast, colorectal, and ovarian cancers. Furthermore, these increased levels correlate with poorer survival of cancer patients, suggesting that serum levels of YKL-40 might be a prognostic biomarker. However, the tissue expression of YKL-40 and its relationship with clinical outcomes and other potential markers are poorly understood. Methods: Tissue samples from invasive breast cancers, breast ductal carcinoma in situ (DCIS), and cancer-free reduction mammoplasty were enrolled. YKL-40 expression was measured using immunohistochemistry and evaluated by a semi-quantification assay. Statistical analyses explored the relationship of YKL-40 with clinical outcome and other breast cancer biomarkers. Results: Breast ductal carcinoma in situ expressed low and moderate levels of YKL-40. In the subset of 203 patients with invasive cancer, YKL-40 levels were positively correlated with tumour grade (P<0.0001) and Her2/neu (P<0.01), but negatively correlated with oestrogen (P<0.0001) and progesterone receptor (P<0.0001). YKL-40 levels were inversely correlated with expressions of GATA3 (P=0.0137) and E-cadherin (P=0.0417). Conclusion: These data demonstrate that expression levels of YKL-40 are associated with tumour grade, poor differentiation, and other breast cancer markers, highlighting that tissue levels of YKL-40 serve as a valuable biomarker for breast cancer diagnosis and prognosis.
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18
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Leyland-Jones B, Smith BR. Serum HER2 testing in patients with HER2-positive breast cancer: the death knell tolls. Lancet Oncol 2011; 12:286-95. [PMID: 21376291 DOI: 10.1016/s1470-2045(10)70297-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Determination of the human epidermal growth factor receptor 2 (HER2; also known as ERBB2) status of breast tumours is emphasised in various national guidelines as a necessary step for the diagnosis of breast cancer. As an alternative to tissue-based diagnostic methods, there has been substantial interest in the establishment of an easily accessible serum-based alternative that could be used for prognosis and diagnosis. Detection of serum-soluble-HER2 extracellular domain (ECD) and establishment of its potential clinical usefulness has created much debate. We assessed whether identification of circulating concentrations of HER2 ECD have clinical usefulness for management of patients with HER2-positive breast cancer. We examined data from 63 studies of patients with breast cancer. Prevalence of increased concentrations varied greatly between studies. Some studies showed significant associations between raised concentrations and poor prognosis, poor response to treatments including trastuzumab, or tumour characteristics associated with aggressive disease, whereas others did not. Examination of existing data showed that concentrations of HER2 ECD are not consistently related to patient outcomes; therefore, there is insufficient evidence to support the clinical use of serum HER2 ECD testing. Design and execution of future large-scale trials to investigate the clinical use of HER2 ECD testing, in view of the progressive non-supportive evidence, is not recommended. Oncologists should continue to adhere to national guidelines for determining HER2 status. Furthermore, oncologists should continue to use clinical parameters when making decisions about initiation, continuation, and discontinuation of HER2-targeted treatments.
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19
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Tan LD, Xu YY, Yu Y, Li XQ, Chen Y, Feng YM. Serum HER2 level measured by dot blot: a valid and inexpensive assay for monitoring breast cancer progression. PLoS One 2011; 6:e18764. [PMID: 21533253 PMCID: PMC3076436 DOI: 10.1371/journal.pone.0018764] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 03/17/2011] [Indexed: 11/25/2022] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) is one of the most important
prognostic and predictive factors for breast cancer patients. Recently, serum
HER2 ECD level of patients detected by enzyme-linked immunoabsorbent assay
(ELISA) has been shown to predict tumor HER2 status and reveal its association
with tumor progression, recurrence and poor prognosis. In this study, we
established a new method, dot blot assay, to measure the serum HER2 level in
breast cancer patients and further to evaluate the clinical value for monitoring
breast cancer progression. We found that the serum HER2 level measured by dot
blot assay was significantly correlated with tissue HER2 status in breast cancer
patients (P = 0.001), and also
significantly correlated with HER2 level measured by ELISA
(P = 1.06×10−11).
Compared with ELISA method, the specificity and sensitivity of dot blot assay
were 95.3% and 65.0%, respectively. The serum HER2 levels of
patients with grade III or ER-negative were higher than those with grade
I–II (P = 0.004) and ER-positive
(P = 0.033), respectively. Therefore,
the novel dot blot method to detect serum HER2 level is a valid and inexpensive
assay with potential application in monitoring breast cancer progression in
clinical situations.
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Affiliation(s)
- Li-Duan Tan
- Department of Biochemistry and Molecular
Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin,
China
| | - Yuan-Yuan Xu
- Department of Biochemistry and Molecular
Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin,
China
| | - Yue Yu
- Department of Biochemistry and Molecular
Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin,
China
| | - Xiao-Qing Li
- Department of Biochemistry and Molecular
Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin,
China
- Key Laboratory of Breast Cancer Prevention and
Treatment of the Ministry of Education, Tianjin Medical University Cancer
Institute and Hospital, Tianjin, China
| | - Ying Chen
- Clinical Laboratory, Tianjin Medical
University Cancer Institute and Hospital, Tianjin, China
| | - Yu-Mei Feng
- Department of Biochemistry and Molecular
Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin,
China
- Key Laboratory of Breast Cancer Prevention and
Treatment of the Ministry of Education, Tianjin Medical University Cancer
Institute and Hospital, Tianjin, China
- * E-mail:
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20
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Mathelin C, Croce S, Rault S, Gharbi M, Eichler F, Gairard B, Coumaros G, Koehl C. Doit-on doser le marqueur circulant ECD/HER-2 chez les patientes atteintes d’un cancer mammaire ? Presse Med 2011; 40:126-37. [DOI: 10.1016/j.lpm.2010.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Accepted: 10/01/2010] [Indexed: 02/08/2023] Open
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22
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Gutteridge E, Agrawal A, Nicholson R, Cheung KL, Robertson J, Gee J. The effects of gefitinib in tamoxifen-resistant and hormone-insensitive breast cancer: a phase II study. Int J Cancer 2010; 126:1806-1816. [PMID: 19739079 DOI: 10.1002/ijc.24884] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Estrogen receptor (ER)-positive acquired tamoxifen-resistant (TAM-R) MCF-7 breast cancer cell lines exhibit epidermal growth factor receptor (EGFR) expression/signaling and are growth-inhibited by gefitinib (IRESSA). We examined the effect of gefitinib on ER-positive TAM-R and ER-negative hormone-insensitive breast cancer in a Phase II study. Fifty-four patients with breast cancer [ER-positive/acquired TAM-R (n = 28); ER-negative (n = 26)] received oral gefitinib 500 mg/day. Tumor biopsies were taken pre- (n = 28) and 8 weeks post-treatment (n = 14 matched samples). Gefitinib was well tolerated and the clinical benefit rate (objective response or stable disease >24 weeks) was 33.3% overall (n = 18/54), and 53.6 and 11.5% in ER-positive/TAM-R and ER-negative patients, respectively. Pretreatment ER and progesterone receptor-positivity were associated with response (p < 0.001 and 0.016, respectively) and longer progression-free survival (PFS; p= 0.001 and 0.013, respectively). All patients expressed EGFR, but high pretreatment levels predicted poorer outcome (p = 0.005) and shorter PFS (p = 0.012) with gefitinib. In patients with clinical benefit, reduced Ki67 staining during treatment (p = 0.024) was commonly observed, and those with >10% decline in EGFR phosphorylation demonstrated parallel decreases in ERK1/2 MAPK phosphorylation. Acquired tamoxifen resistance appears in part mediated through EGFR signaling and can be blocked with gefitinib.
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Affiliation(s)
- Eleanor Gutteridge
- Professorial Unit of Surgery, Nottingham City Hospital, Nottingham, United Kingdom
| | - Amit Agrawal
- Professorial Unit of Surgery, Nottingham City Hospital, Nottingham, United Kingdom
| | - Robert Nicholson
- Tenovus Centre for Cancer Research, Welsh School of Pharmacy, Cardiff University, Cardiff, United Kingdom
| | - Kwok Leung Cheung
- Professorial Unit of Surgery, Nottingham City Hospital, Nottingham, United Kingdom
| | - John Robertson
- Professorial Unit of Surgery, Nottingham City Hospital, Nottingham, United Kingdom
| | - Julia Gee
- Tenovus Centre for Cancer Research, Welsh School of Pharmacy, Cardiff University, Cardiff, United Kingdom
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23
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Kang SH, Cho J, Ha JS, Kwon SY. Evaluation of Serum HER-2/neu Extracelluar Domain in Breast Cancer Patients: Correlation with Tissue HER-2/neu Status and Clinicopathological Factors. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.78.5.271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sun Hee Kang
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Jihyoung Cho
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Jung Sook Ha
- Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sun Young Kwon
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
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24
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Leary AF, Hanna WM, van de Vijver MJ, Penault-Llorca F, Rüschoff J, Osamura RY, Bilous M, Dowsett M. Value and Limitations of Measuring HER-2 Extracellular Domain in the Serum of Breast Cancer Patients. J Clin Oncol 2009; 27:1694-705. [DOI: 10.1200/jco.2008.17.3989] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The human epidermal receptor-2 (HER-2) is overexpressed or amplified in 15% to 25% of breast cancers. Determination of HER-2 tumor status offers clinically useful information, as it selects patients who may benefit from treatment with trastuzumab, the monoclonal antibody against HER-2. Currently approved methods for HER-2 testing include immunohistochemistry or fluorescent in situ hybridization using tumor tissue. A fragment of HER-2 composed of its extracellular domain (ECD) can also be detected in the serum of some patients with breast cancer. As an easily accessible tumor marker, it could offer additional useful prognostic or predictive information. This review will briefly address the biology of the circulating HER-2 ECD and discuss the evidence to support the role, if any, for measuring HER-2 ECD levels in women with breast cancer. In particular, we focus on the value and limitations of serum ECD in both early and advanced breast cancer in the following clinical contexts: as a marker of HER-2 tumor tissue status; clinical implications of raised levels in women who have a tumor not overexpressing HER-2; as a prognostic indicator and as a predictor of response to treatment; and as a monitoring tool for early recurrence. On the basis of our review of the literature, we conclude that there is currently insufficient evidence to support the use of serum HER-2 ECD in the routine management of individual patients with breast cancer. This conclusion is in agreement with the 2007 American Society of Clinical Oncology guidelines on the use of biomarkers in breast cancer.
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Affiliation(s)
- Alexandra F. Leary
- From the Royal Marsden Hospital, London, United Kingdom; Sunnybrook and Women's College, Health Science Center, Toronto, Canada; Netherlands Cancer Institute, Amsterdam, the Netherlands; Centre Jean Perrin, Clermont-Ferrand, France; Klinikum Kassel, Kassel, Germany; Tokai University School of Medicine, Kanagawa, Japan; and Westmead Hospital, Westmead, New South Wales, Australia
| | - Wedad M. Hanna
- From the Royal Marsden Hospital, London, United Kingdom; Sunnybrook and Women's College, Health Science Center, Toronto, Canada; Netherlands Cancer Institute, Amsterdam, the Netherlands; Centre Jean Perrin, Clermont-Ferrand, France; Klinikum Kassel, Kassel, Germany; Tokai University School of Medicine, Kanagawa, Japan; and Westmead Hospital, Westmead, New South Wales, Australia
| | - Marc J. van de Vijver
- From the Royal Marsden Hospital, London, United Kingdom; Sunnybrook and Women's College, Health Science Center, Toronto, Canada; Netherlands Cancer Institute, Amsterdam, the Netherlands; Centre Jean Perrin, Clermont-Ferrand, France; Klinikum Kassel, Kassel, Germany; Tokai University School of Medicine, Kanagawa, Japan; and Westmead Hospital, Westmead, New South Wales, Australia
| | - Frederique Penault-Llorca
- From the Royal Marsden Hospital, London, United Kingdom; Sunnybrook and Women's College, Health Science Center, Toronto, Canada; Netherlands Cancer Institute, Amsterdam, the Netherlands; Centre Jean Perrin, Clermont-Ferrand, France; Klinikum Kassel, Kassel, Germany; Tokai University School of Medicine, Kanagawa, Japan; and Westmead Hospital, Westmead, New South Wales, Australia
| | - Josef Rüschoff
- From the Royal Marsden Hospital, London, United Kingdom; Sunnybrook and Women's College, Health Science Center, Toronto, Canada; Netherlands Cancer Institute, Amsterdam, the Netherlands; Centre Jean Perrin, Clermont-Ferrand, France; Klinikum Kassel, Kassel, Germany; Tokai University School of Medicine, Kanagawa, Japan; and Westmead Hospital, Westmead, New South Wales, Australia
| | - Robert Y. Osamura
- From the Royal Marsden Hospital, London, United Kingdom; Sunnybrook and Women's College, Health Science Center, Toronto, Canada; Netherlands Cancer Institute, Amsterdam, the Netherlands; Centre Jean Perrin, Clermont-Ferrand, France; Klinikum Kassel, Kassel, Germany; Tokai University School of Medicine, Kanagawa, Japan; and Westmead Hospital, Westmead, New South Wales, Australia
| | - Michael Bilous
- From the Royal Marsden Hospital, London, United Kingdom; Sunnybrook and Women's College, Health Science Center, Toronto, Canada; Netherlands Cancer Institute, Amsterdam, the Netherlands; Centre Jean Perrin, Clermont-Ferrand, France; Klinikum Kassel, Kassel, Germany; Tokai University School of Medicine, Kanagawa, Japan; and Westmead Hospital, Westmead, New South Wales, Australia
| | - Mitch Dowsett
- From the Royal Marsden Hospital, London, United Kingdom; Sunnybrook and Women's College, Health Science Center, Toronto, Canada; Netherlands Cancer Institute, Amsterdam, the Netherlands; Centre Jean Perrin, Clermont-Ferrand, France; Klinikum Kassel, Kassel, Germany; Tokai University School of Medicine, Kanagawa, Japan; and Westmead Hospital, Westmead, New South Wales, Australia
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25
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Ross JS, Slodkowska EA, Symmans WF, Pusztai L, Ravdin PM, Hortobagyi GN. The HER-2 receptor and breast cancer: ten years of targeted anti-HER-2 therapy and personalized medicine. Oncologist 2009; 14:320-68. [PMID: 19346299 DOI: 10.1634/theoncologist.2008-0230] [Citation(s) in RCA: 836] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The human epidermal growth factor receptor (HER-2) oncogene encodes a transmembrane tyrosine kinase receptor that has evolved as a major classifier of invasive breast cancer and target of therapy for the disease. The validation of the general prognostic significance of HER-2 gene amplification and protein overexpression in the absence of anti-HER-2 targeted therapy is discussed in a study of 107 published studies involving 39,730 patients, which produced an overall HER-2-positive rate of 22.2% and a mean relative risk for overall survival (OS) of 2.74. The issue of HER-2 status in primary versus metastatic breast cancer is considered along with a section on the features of metastatic HER-2-positive disease. The major marketed slide-based HER-2 testing approaches, immunohistochemistry, fluorescence in situ hybridization, and chromogenic in situ hybridization, are presented and contrasted in detail against the background of the published American Society of Clinical Oncology-College of American Pathologists guidelines for HER-2 testing. Testing issues, such as the impact of chromosome 17 polysomy and local versus central HER-2 testing, are also discussed. Emerging novel HER-2 testing techniques, including mRNA-based testing by real-time polymerase chain reaction and DNA microarray methods, HER-2 receptor dimerization, phosphorylated HER-2 receptors, and HER-2 status in circulating tumor cells, are also considered. A series of biomarkers potentially associated with resistance to trastuzumab is discussed with emphasis on the phosphatase and tensin homologue deleted on chromosome ten/Akt and insulin-like growth factor receptor pathways. The efficacy results for the more recently approved small molecule HER-1/HER-2 kinase inhibitor lapatinib are also presented along with a more limited review of markers of resistance for this agent. Additional topics in this section include combinations of both anti-HER-2 targeted therapies together as well as with novel agents including bevacizumab, everolimus, and tenespimycin. A series of novel HER-2-targeting agents is also presented, including pertuzumab, ertumaxomab, HER-2 vaccines, and recently discovered tyrosine kinase inhibitors. Biomarkers predictive of HER-2 targeted therapy toxicity are included, and the review concludes with a consideration of HER-2 status in the prediction of response to non-HER-2 targeted treatments including hormonal therapy, anthracyclines, and taxanes.
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Affiliation(s)
- Jeffrey S Ross
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY 12208, USA.
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26
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Abstract
A fundamental mechanism of genetic alteration is amplification of entire gene sequences that results in overexpression of a gene product or protein. If the amplified gene is a member of the oncogene family and/or a regulator of DNA replication or cell cycle progression, overexpression of this oncoprotein may result in enhanced growth advantages for these cells. Amplification of one such oncogene, HER2 (neu, erbB-2), in up to 35% of human breast cancers is associated with a poor prognosis but may predict response to various therapeutic modalities. FDA-approved assays are available to detect the HER2 protein receptor or the HER2 gene sequence to determine eligibility for Herceptin treatment or adriamycin treatment in node positive patients, respectively. As testing for HER2 is becoming more common in the clinical laboratory, we provide an overview of the biology, diagnostic methods, and emerging clinical value of HER2 gene amplification.
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Affiliation(s)
- G J Tsongalis
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT 06102, USA.
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27
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Changes over time of extracellular domain of HER2 (ECD/HER2) serum levels have prognostic value in metastatic breast cancer. Breast Cancer Res Treat 2008; 114:503-11. [DOI: 10.1007/s10549-008-0033-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Accepted: 04/16/2008] [Indexed: 11/26/2022]
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28
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Lee JS, Min WK, Park EH, Lim WS, Choi SL, Son BH, Kim SB, Ahn JH, Ahn SH. Correlation between the Her-2/neu Status as Determined by Immunohistochemical Analysis and the Serum Her-2/neu Concentration as Determined by the Use of ADVIA Cencaur® Automated Immunoassay in Breast Cancer Patients. J Breast Cancer 2008. [DOI: 10.4048/jbc.2008.11.3.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jung-Sun Lee
- Department of Surgery, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Won Ki Min
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Eun Hwa Park
- Department of Surgery, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Woo-Sung Lim
- Department of Surgery, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Sung-Lim Choi
- Department of Surgery, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Byung-Ho Son
- Department of Surgery, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Sung-Bae Kim
- Department of Oncology, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jin-Hee Ahn
- Department of Oncology, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Sei-Hyun Ahn
- Department of Surgery, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
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29
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Harris L, Fritsche H, Mennel R, Norton L, Ravdin P, Taube S, Somerfield MR, Hayes DF, Bast RC. American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol 2007; 25:5287-312. [PMID: 17954709 DOI: 10.1200/jco.2007.14.2364] [Citation(s) in RCA: 1539] [Impact Index Per Article: 90.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To update the recommendations for the use of tumor marker tests in the prevention, screening, treatment, and surveillance of breast cancer. METHODS For the 2007 update, an Update Committee composed of members from the full Panel was formed to complete the review and analysis of data published since 1999. Computerized literature searches of MEDLINE and the Cochrane Collaboration Library were performed. The Update Committee's literature review focused attention on available systematic reviews and meta-analyses of published tumor marker studies. In general, significant health outcomes (overall survival, disease-free survival, quality of life, lesser toxicity, and cost-effectiveness) were used for making recommendations. Recommendations and CONCLUSIONS Thirteen categories of breast tumor markers were considered, six of which were new for the guideline. The following categories showed evidence of clinical utility and were recommended for use in practice: CA 15-3, CA 27.29, carcinoembryonic antigen, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, urokinase plasminogen activator, plasminogen activator inhibitor 1, and certain multiparameter gene expression assays. Not all applications for these markers were supported, however. The following categories demonstrated insufficient evidence to support routine use in clinical practice: DNA/ploidy by flow cytometry, p53, cathepsin D, cyclin E, proteomics, certain multiparameter assays, detection of bone marrow micrometastases, and circulating tumor cells.
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Imoto S, Wada N, Hasebe T, Ochiai A, Kitoh T. Serum c-erbB-2 protein is a useful marker for monitoring tumor recurrence of the breast. Int J Cancer 2006; 120:357-61. [PMID: 17044019 DOI: 10.1002/ijc.22166] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
C-erbB-2 oncogene protein (ErbB-2/HER-2) overexpression is a prognostic marker of breast carcinoma. The purpose of this study was to evaluate serum ErbB-2 for monitoring tumor recurrence of operable breast carcinoma patients. The subjects were 86 breast carcinoma patients with stage I-IIIB. Sera were collected at preoperative and postoperative periods from 1996 to 2000. The cutoff value was set at 5.4 ng/ml for preoperative patients and at 6.5 ng/ml for postoperative patients. Twenty-nine patients (34%) had higher preoperative serum ErbB-2 levels (>or=5.4 ng/ml). A higher preoperative serum ErbB-2 was associated with higher clinical stage, larger tumor size, nodal metastasis, higher histologic grade and lymphatic invasion, but not with vascular invasion, hormonal receptor status or other tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 15-3 (CA15-3). As of April 2005, 27 patients (31%) had recurrence and 18 (62%) of them had a higher preoperative serum ErbB-2. Seventeen patients died of tumor progression. The recurrence-free survival rates at 7 years after breast surgery were 84% in 57 patients with a normal preoperative serum ErbB-2 and 41% in 29 patients with a higher preoperative serum ErbB-2 (p < 0.0001). The overall survival rates at 7 years were 93% and 55% (p < 0.0001), respectively. A multivariate analysis revealed that preoperative serum ErbB-2 was an independent prognostic factor for recurrence-free survival and overall survival in breast carcinoma patients. The specificities and sensitivities of postoperative tumor markers (CEA, CA15-3 and ErbB-2) were 91%, 100% and 85%, and 40%, 30% and 70%, respectively. Serum ErbB-2 is a preoperative prognostic marker and may be useful for monitoring tumor recurrence of the breast.
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Affiliation(s)
- Shigeru Imoto
- Breast Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan.
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De Laurentiis M, Arpino G, Massarelli E, Ruggiero A, Carlomagno C, Ciardiello F, Tortora G, D'Agostino D, Caputo F, Cancello G, Montagna E, Malorni L, Zinno L, Lauria R, Bianco AR, De Placido S. A meta-analysis on the interaction between HER-2 expression and response to endocrine treatment in advanced breast cancer. Clin Cancer Res 2005; 11:4741-8. [PMID: 16000569 DOI: 10.1158/1078-0432.ccr-04-2569] [Citation(s) in RCA: 264] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Experimental data suggest a complex cross-talk between HER-2 and estrogen receptor, and it has been hypothesized that HER-2-positive tumors may be less responsive to certain endocrine treatments. Clinical data, however, have been conflicting. We have conducted a meta-analysis on the interaction between the response to endocrine treatment and the overexpression of HER-2 in metastatic breast cancer. EXPERIMENTAL DESIGN Studies have been identified by searching the Medline, Embase, and American Society of Clinical Oncology abstract databases. Selection criteria were (a) metastatic breast cancer, (b) endocrine therapy (any line of treatment), and (c) evaluation of HER-2 expression (any method). For each study, the relative risk for treatment failure for HER-2-positive over HER-2-negative patients with 95% confidence interval was calculated as an estimate of the predictive effect of HER-2. Pooled estimates of the relative risk were computed by the Mantel-Haenszel method. RESULTS Twelve studies (n = 2,379 patients) were included in the meta-analysis. The overall relative risk was 1.42 (95% confidence interval, 1.32-1.52; P < 0.00001; test for heterogeneity = 0.380). For studies involving tamoxifen, the pooled relative risk was 1.33 (95% confidence interval, 1.20-1.48; P < 0.00001; test for heterogeneity = 0.97); for studies involving other hormonal drugs, a pooled relative risk of 1.49 (95% confidence interval, 1.36-1.64; P < 0.00001; test for heterogeneity = 0.08) was estimated. A second meta-analysis limited to tumors that were either estrogen receptor positive, estrogen receptor unknown, or estrogen receptor negative/progesterone receptor positive yielded comparable results. CONCLUSIONS HER-2-positive metastatic breast cancer is less responsive to any type of endocrine treatment. This effect holds in the subgroup of patients with positive or unknown steroid receptors.
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Affiliation(s)
- Michele De Laurentiis
- Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Università Federico II, Napoli, Italy.
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Müller V, Witzel I, Lück HJ, Köhler G, von Minckwitz G, Möbus V, Sattler D, Wilczak W, Löning T, Jänicke F, Pantel K, Thomssen C. Prognostic and Predictive Impact of the HER-2/neu Extracellular Domain (ECD) in the Serum of Patients Treated with Chemotherapy for Metastatic Breast Cancer. Breast Cancer Res Treat 2004; 86:9-18. [PMID: 15218357 DOI: 10.1023/b:brea.0000032919.83803.48] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The extracellular domain of the HER-2/neu -receptor (ECD) is shed from the receptor protein and can be detected in serum. However, the clinical implication of HER-2/neu ECD measurement must be further evaluated. METHODS In patients with metastatic breast cancer participating in a trial on first-line chemotherapy, the association of serum HER-2/neu ECD with progression-free interval, survival, and response was studied. Blood samples of patients receiving epirubicin and either cyclophosphamide (EC) or paclitaxel (ET) were collected before (n = 103) and in addition, after three courses of therapy (n = 46). RESULTS HER-2/neu ECD levels correlate with HER-2/neu overexpression of corresponding primary tumors determined by immunohistochemistry (antibody CB11, p = 0.018) with an optimized cut-off at 15 ng/mL. Elevated serum levels of HER-2/neu ECD before chemotherapy were correlated with shorter overall survival (p = 0.0097), but not with reduced progression-free survival and response to chemotherapy. In subgroup analyses, patients with elevated pretherapeutic HER-2/neu ECD levels treated with EC showed shorter overall survival (p = 0.0092); no difference was seen in the ET group. With regard to progression-free survival, patients with elevated HER-2/neu ECD levels tended to benefit from ET (p = 0.0341), in patients with low levels no difference was observed between EC and ET. A decrease of HER-2/neu ECD levels after three courses of therapy was associated with response to therapy (p = 0.006). CONCLUSION In our group of metastatic breast cancer patients, elevated HER-2/neu ECD levels are associated with decreased overall survival. With regard to progression-free survival, particularly patients with high HER-2/neu ECD levels seem to benefit from taxane-containing chemotherapy.
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Affiliation(s)
- Volkmar Müller
- Department of Gynecology, University Hospital Hamburg-Eppendorf, Germany
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Ross JS, Fletcher JA, Bloom KJ, Linette GP, Stec J, Symmans WF, Pusztai L, Hortobagyi GN. Targeted therapy in breast cancer: the HER-2/neu gene and protein. Mol Cell Proteomics 2004; 3:379-98. [PMID: 14762215 DOI: 10.1074/mcp.r400001-mcp200] [Citation(s) in RCA: 207] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The HER-2/neu oncogene, a member of the epidermal growth factor receptor or erb gene family, encodes a transmembrane tyrosine kinase receptor that has been linked to prognosis and response to therapy with the anti-HER-2-humanized monoclonal antibody, trastuzumab (Herceptin, Genentech, South San Francisco, CA) in patients with advanced metastatic breast cancer. HER-2/neu status has also been tested for its ability to predict the response of breast cancer to other therapies including hormonal therapies, topoisomerase inhibitors, and anthracyclines. This review includes an analysis of 80 published studies encompassing more than 25,000 patients designed to consider the relative advantages and disadvantages of the various methods of measuring HER-2/neu in clinical breast cancer specimens. Southern blotting, PCR amplification detection, and fluorescence in situ hybridization assays designed to detect HER-2/neu gene amplification are compared with HER-2/neu protein overexpression assays performed by immunohistochemical techniques applied to frozen and paraffin-embedded tissues and enzyme immunoassays performed on tumor cytosols. The significance of HER-2/neu overexpression in ductal carcinoma in situ and the HER-2/neu status in uncommon female breast conditions and male breast cancer are also considered. The role of HER-2/neu testing for the prediction of response to trastuzumab therapy in breast cancer is reviewed along with the current studies designed to test whether HER-2/neu status can predict the response to standard and newer hormonal therapies, cytotoxic chemotherapy, and radiation. The review will also evaluate the status of serum-based testing for circulating HER-2/neu receptor protein and its ability to predict disease outcome and therapy response.
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Affiliation(s)
- Jeffrey S Ross
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY 12208, USA.
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Carney WP, Neumann R, Lipton A, Leitzel K, Ali S, Price CP. Potential clinical utility of serum HER-2/neu oncoprotein concentrations in patients with breast cancer. Clin Chem 2003; 49:1579-98. [PMID: 14500583 DOI: 10.1373/49.10.1579] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The HER-2/neu oncogene and its p185 receptor protein are indicators of a more aggressive form of breast cancer. HER-2/neu status guides Herceptin therapy, specifically directed to the extracellular domain (ECD) of the HER-2/neu oncoprotein. The HER-2/neu ECD is shed from cancer cells into the circulation and is measurable by immunoassay. METHODS We performed a systematic review of the peer-reviewed literature on circulating ECD with respect to prevalence, prognosis, prediction of response to therapy, and monitoring of breast cancer. RESULTS The prevalence of increased ECD in patients with primary breast cancer varied between 0% and 38% (mean, 18.5%), whereas in metastatic disease the range was from 23% to 80% (mean, 43%). Some women with HER-2/neu-negative tumors by tissue testing develop increased ECD concentrations in metastatic disease. Increased ECD has been correlated with indicators of poor prognosis, e.g., overall survival and disease-free survival. Increased ECD predicts a poor response to hormone therapy and some chemotherapy regimens but can predict improved response to combinations of Herceptin and chemotherapy. Many studies support the value of monitoring ECD during breast cancer progression because serial increases precede the appearance of metastases and longitudinal ECD changes parallel the clinical course of disease. CONCLUSIONS The monitoring of circulating HER-2/neu ECD provides a tool for assessing prognosis, for predicting response to therapy, and for earlier detection of disease progression and timely intervention with appropriate therapy.
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Affiliation(s)
- Walter P Carney
- Oncogene Science, Bayer HealthCare, Cambridge, MA 02142, USA.
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Rampaul RS, Pinder SE, Gullick WJ, Robertson JFR, Ellis IO. HER-2 in breast cancer--methods of detection, clinical significance and future prospects for treatment. Crit Rev Oncol Hematol 2003; 43:231-44. [PMID: 12270780 DOI: 10.1016/s1040-8428(01)00207-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Human Epidermal Growth Factor (HER-2) oncogene encodes a transmembrane tyrosine kinase receptor with extensive homology to the Epidermal Growth Factor Receptor (EGFR) which is the prototypal member of this family of receptor tyrosine kinases. HER-2 gene amplification is found in 20-30% of breast cancers. Various methods such as immunohistochemistry, southern and slot blotting, enzyme immunoassays and fluorescence in situ hybridization have all been employed to evaluate HER-2 gene and protein abnormalities. Of these immunohistochemistry is the most frequently employed but there are valid indications for the other avaliable methods. However, it is prudent that whichever methods employed are standardized, especially those that possess may have a degree of subjectivity in their assesment.
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Affiliation(s)
- R S Rampaul
- Department of Surgery, Nottingham City Hospital, Nottingham, UK
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Köstler WJ, Zielinski CC. Her-2/neu as Predictive Marker for Endocrine Therapy and Chemotherapy in Patients with Metastatic Breast Cancer. Breast Cancer Res Treat 2003. [DOI: 10.1023/a:1026329109327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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37
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Ross JS, Fletcher JA, Linette GP, Stec J, Clark E, Ayers M, Symmans WF, Pusztai L, Bloom KJ. The Her-2/neu gene and protein in breast cancer 2003: biomarker and target of therapy. Oncologist 2003; 8:307-25. [PMID: 12897328 DOI: 10.1634/theoncologist.8-4-307] [Citation(s) in RCA: 395] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The HER-2/neu oncogene encodes a transmembrane tyrosine kinase receptor with extensive homology to the epidermal growth factor receptor. In this review, the association of HER-2/neu gene and protein abnormalities with prognosis and response to therapy with trastuzumab and to other therapies in breast cancer is presented. By considering a series of 80 published studies encompassing more than 25,000 patients, the relative advantages and disadvantages of Southern blotting, polymerase chain reaction amplification, and fluorescence in situ hybridization assays designed to detect HER-2/neu gene amplification are compared with HER-2/neu protein overexpression assays performed by immunohistochemical techniques applied to frozen and paraffin-embedded tissues and enzyme immunoassays performed on tumor cytosols. The significance of HER-2/neu overexpression in ductal carcinoma in situ and the HER-2/neu status in uncommon female breast conditions and male breast cancer are also considered. The role of HER-2/neu testing for the prediction of response to trastuzumab therapy in breast cancer is presented as well as its potential impact on responses to standard and newer hormonal therapies, cytotoxic chemotherapy, and radiation. The review also evaluates the status of serum-based testing for circulating HER-2/neu receptor protein and its ability to predict disease outcome and therapy response.
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MESH Headings
- Adult
- Age Distribution
- Aged
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Biomarkers, Tumor/analysis
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Breast Neoplasms, Male/genetics
- Breast Neoplasms, Male/mortality
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/therapy
- Combined Modality Therapy
- Education, Medical, Continuing
- Female
- Gene Expression Regulation, Neoplastic
- Genes, erbB-2/genetics
- Genetic Predisposition to Disease
- Humans
- Incidence
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Risk Assessment
- Sensitivity and Specificity
- Survival Analysis
- Trastuzumab
- Treatment Outcome
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Affiliation(s)
- Jeffrey S Ross
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York 12208, USA.
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Zilembo N, Mariani L, Martinetti A, Miceli R, Seregni E, Bichisao E, La Torre I, Pozzi P, Ferrari L, De Candis D, Longarini VR, Bajetta E, Bombardieri E. c-erbB 2 Serum level as prognostic factor in hormonally treated advanced breast cancer patients. Breast 2002; 11:286-94. [PMID: 14965684 DOI: 10.1054/brst.2002.0416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2001] [Revised: 10/11/2001] [Accepted: 01/16/2002] [Indexed: 11/18/2022] Open
Abstract
To investigate whether c-erbB 2 serum levels may be predictive of clinical response, progression-free and overall survival in postmenopausal women with advanced breast cancer hormonally treated, 265 patients enrolled in previous clinical trials were evaluated. C-erbB 2 serum levels were assessed before the start of treatment and in a subgroup of patients also at the first response evaluation. In addition, serum CA 15.3 levels were determined. The role of c-erbB 2 was investigated by means of multiple regression models in which both c-erbB 2 and CA 15.3 values were modelled as continuous variables together with other known prognostic factors. The failure probability tended to be higher in the presence of high c-erbB 2 levels, but the trend was not statistically significant; in contrast, significant results were obtained for progression-free survival (PFS,P <0.001) and overall survival (OS, P=0.014). The within-patient c-erbB 2 variation significantly predicted PFS (P=0.006) and OS (P=0.040). It is worth noting that c-erbB 2 and CA 15.3 baseline levels were significantly correlated and that the prognostic effect of c-erbB 2 tended to disappear in the presence of high CA 15.3 levels for PFS and OS.
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Affiliation(s)
- N Zilembo
- Medical Oncology Unit B, Istituto Nazionale per lo Studio e la Cura dei Tumori, via Venezian 1, 20133 Milan, Italy
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Perez EA, Geeraerts L, Suman VJ, Adjei AA, Baron AT, Hatfield AK, Maihle N, Michalak JC, Kuross SA, Kugler JW, Lafky JM, Ingle JN. A randomized phase II study of sequential docetaxel and doxorubicin/cyclophosphamide in patients with metastatic breast cancer. Ann Oncol 2002; 13:1225-35. [PMID: 12181246 DOI: 10.1093/annonc/mdf222] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Docetaxel has yielded promising response rates as a component of doxorubicin-based combination schedules in patients with metastatic breast cancer, including docetaxel/doxorubicin and docetaxel/doxorubicin/cyclophosphamide (AC). This randomized two-stage phase II study was conducted to evaluate sequential treatment with docetaxel and AC as first-line treatment in patients with recurrent or metastatic breast cancer previously untreated with chemotherapy for metastatic disease. PATIENTS AND METHODS Thirty-three patients were randomized to either docetaxel (100 mg/m(2)) on day 1 of a 21-day cycle for three cycles followed by AC (60/600 mg/m(2)) on day 1 of a 21-day cycle for three cycles (n = 17) or vice-versa (n = 16), without prophylactic granulocyte colony-stimulating factor support. In addition, we compared pre-treatment serum sErbB1 and sErbB2 protein concentrations with that of an age- and menopausal status-matched group of healthy women, and examined changes in serum sErbB1 and sErbB2 protein concentrations in these two treatment schedules. Data from each one of the two arms of the trial (docetaxel then AC, or AC and then docetaxel) were analyzed separately. RESULTS Enrollment was suspended after the first-stage of accrual, based on statistical design. Confirmed objective response rates after six cycles of treatment were 35% [95% confidence interval (CI) 14% to 62%] with docetaxel then AC and 38% (95% CI 15% to 65%) with AC then docetaxel. Dose reductions were frequent and mostly due to grade 4 neutropenia. Median survival time was 2.5 years in the docetaxel then AC group, and 1.1 years in the AC then docetaxel group. Serum sErbB1 concentrations were not significantly different between the study patients and healthy women, and did not change significantly after three and six cycles of treatment. In contrast, serum sErbB2 concentrations were significantly higher in the study patients compared with healthy women and tended to decrease after three and six cycles of treatment. CONCLUSIONS Response rates at the end of six cycles of treatment, which led to termination of accrual after the first stage using either the sequence of docetaxel first or docetaxel after AC chemotherapy, were lower than anticipated. However, median survival times and median progression-free survival times are similar to those reported in other studies. These data further suggest that additional studies to assess whether serum sErbB2 concentrations are useful predictors of responsiveness to chemotherapy are warranted.
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Affiliation(s)
- E A Perez
- Mayo Clinic and Mayo Foundation, Rochester, MN, USA.
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Nunes RA, Harris LN. The HER2 extracellular domain as a prognostic and predictive factor in breast cancer. Clin Breast Cancer 2002; 3:125-35; discussion 136-7. [PMID: 12123536 DOI: 10.3816/cbc.2002.n.017] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The HER2/neu proto-oncogene encodes a 185-kd transmembrane receptor with tyrosine kinase activity. Amplification of HER2 with overexpression of the p185HER2 receptor occurs in 20%-30% of breast cancers and has been established as an independent prognostic factor in numerous studies. Increasing evidence suggests that HER2 may be a predictive marker for response to chemotherapy and hormonal therapy. HER2 overexpression has provided a new target in breast cancer therapy, as evidenced by the development of trastuzumab (Herceptin(R)), a monoclonal antibody targeted against HER2. Detection of HER2 in the clinical setting is performed by immunohistochemistry or fluorescence in situ hybridization in tissue, and by detection of the shed extracellular domain in serum or plasma. Differences in methodology, reagents, and scoring systems have led to varying results in different patient cohorts, contributing to the debate on the role of HER2 as a prognostic and predictive factor. This review focuses on the prognostic and predictive value of serum HER2 detection in the management of HER2-positive breast cancer.
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Abstract
c-erbB-2 amplification and/or overexpression occurs in 20% to 30% of breast cancers and appear to be associated with a more aggressive phenotype. Detecting abnormalities in c-erbB-2 might provide important clinical information for breast cancer patients. However, several of the potential clinical uses of c-erbB-2 remain unproven. Many variables influence c-erbB-2 results, including selection and characteristics of test populations and methods of analysis. Current literature suggests two roles for c-erbB-2, either as a pure prognostic factor with no association with therapy or as a factor predictive of benefit from specific types of systemic treatments. c-erbB-2 appears to be only a weak prognostic factor, although some individual studies suggest greater prognostic importance. c-erbB-2 abnormalities appear to predict for relative, but not absolute, resistance to endocrine therapy in estrogen receptor (ER)-positive women. When adjuvant chemotherapy is indicated, some studies have indicated that patients with c-erbB-2-positive cancers (by immunohistochemistry [IHC] or fluoresence in situ hybridization [FISH]) receive more benefit from anthracycline-containing regimens as compared to alkylating agents. c-erbB-2 testing appears critical for selecting patients with metastatic disease who should receive the anti-c-erbB-2 antibody, trastuzumab. Prospective randomized clinical trials of trastuzumab as adjuvant therapy are underway. Well-designed, prospective, randomized clinical trials (designed to test the value of c-erbB-2) or formal meta-analyses will help to better establish the predictive role of c-erbB-2 in breast cancer.
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Affiliation(s)
- Daniel F Hayes
- University of Michigan Comprehensive Cancer Center, Department of Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
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Lipton A, Ali SM, Leitzel K, Demers L, Chinchilli V, Engle L, Harvey HA, Brady C, Nalin CM, Dugan M, Carney W, Allard J. Elevated serum Her-2/neu level predicts decreased response to hormone therapy in metastatic breast cancer. J Clin Oncol 2002; 20:1467-72. [PMID: 11896093 DOI: 10.1200/jco.2002.20.6.1467] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the effect of elevation of serum HER-2/neu on response to hormone therapy. PATIENTS AND METHODS Seven hundred nineteen metastatic patients with estrogen receptor-positive (ER(+)), progesterone receptor-positive, or both or ER status unknown breast cancer were randomized in three independent clinical trials to receive second-line hormone therapy with either megestrol acetate or an aromatase inhibitor (fadrozole or letrozole). An automated enzyme-linked immunosorbent assay specific for the extracellular domain of the HER-2/neu (c-erbB-2) oncoprotein product was used to detect serum levels. RESULTS Two hundred nineteen patients (30%) had elevated serum HER-2/neu protein levels, using the mean + 2 SD (15 ng/mL) from the serum of healthy women as an upper limit. Response to treatment was available for 711 patients. The response rate (complete responses plus partial responses plus stable disease) to endocrine therapy was 45% in 494 patients with non-elevated and 23% in 217 patients with elevated serum HER-2/neu levels (P <.0001). Median duration of treatment response (using the time to progression [TTP] variable for patients who responded) was shorter in the group with elevated serum HER-2/neu levels (11.7 months) compared with the patient group with non-elevated levels (17.4 months). TTP, time to treatment failure, and median survival (17.2 months v 29.6 months) were also significantly shorter in the patients with elevated serum HER-2/neu levels (P <.0001). CONCLUSION Patients with ER(+) and serum HER-2/neu-positive metastatic breast cancer are less likely to respond to hormone treatment and have a shorter duration of response than ER(+) and serum HER-2/neu-negative patients. Their survival duration is also shorter.
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Affiliation(s)
- Allan Lipton
- Department of Hematology and Oncology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
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Yamauchi H, Stearns V, Hayes DF. When is a tumor marker ready for prime time? A case study of c-erbB-2 as a predictive factor in breast cancer. J Clin Oncol 2001; 19:2334-56. [PMID: 11304787 DOI: 10.1200/jco.2001.19.8.2334] [Citation(s) in RCA: 212] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE c-erbB-2 (HER-2, c-neu) might play a role as a predictive factor in breast cancer. However, the clinical utility of the marker in this disease is still not established. We conducted a critical analysis of the literature, in which we reviewed the factors that contribute to the lack of acceptance of c-erbB-2 for clinical use and attempted to determine the predictive role of c-erbB-2 for response to specific therapies. METHODS We conducted a MEDLINE literature search using the keywords c-erbB-2, HER2, neu, and breast cancer, reviewed the references included in each publication, and reviewed abstracts that have been reported in the 1997-2000 proceedings to the American Association of Cancer Research and American Society for Clinical Oncology annual meetings. RESULTS The preclinical and clinical data reported to date suggest that amplification or overexpression of c-erbB-2 is a weak to moderate negative pure prognostic factor. c-erbB-2 seems to be a weak to moderate negative predictive factor for response to endocrine therapy. The marker is also a moderate negative predictive factor for response to alkylating agents and a moderate positive predictive factor for response to anthracyclines. The data regarding response to taxanes or radiotherapy are not sufficient to make recommendations regarding treatment decision making. Finally, c-erbB-2 is a strong predictive factor for response to trastuzumab. CONCLUSION We conclude that, in the adjuvant setting, c-erbB-2 status should not be used to determine whether a woman should receive adjuvant systemic therapy (weak prognostic factor). In addition, c-erbB-2 status should not be used to determine whether a patient should receive endocrine therapy. When adjuvant chemotherapy is recommended, anthracycline-based therapy should be the preferred regimen for c-erbB-2-positive patients. However, when anthracyclines are contraindicated, alkylating agent-based therapy should not be withheld. To determine the true predictive role and strength of the marker for response to each therapy, prospective randomized clinical trials or formal meta-analyses are required.
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MESH Headings
- Antibiotics, Antineoplastic/pharmacology
- Antibiotics, Antineoplastic/therapeutic use
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Alkylating/pharmacology
- Antineoplastic Agents, Alkylating/therapeutic use
- Antineoplastic Agents, Hormonal/pharmacology
- Antineoplastic Agents, Hormonal/therapeutic use
- Biomarkers, Tumor/analysis
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Chemotherapy, Adjuvant
- Female
- Gene Expression Regulation, Neoplastic
- Genes, erbB-2/genetics
- Humans
- Patient Care Planning
- Predictive Value of Tests
- Prognosis
- Receptor, ErbB-2/analysis
- Receptor, ErbB-2/biosynthesis
- Receptor, ErbB-2/genetics
- Survival Analysis
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Affiliation(s)
- H Yamauchi
- Breast Cancer Program, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
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Blackshear PE. Genetically engineered rodent models of mammary gland carcinogenesis: an overview. Toxicol Pathol 2001; 29:105-16. [PMID: 11215674 DOI: 10.1080/019262301301418919] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Breast cancer is a multifactorial disease that develops as a result of interactions among genetic, environmental, and hormonal factors. Multiple genetic derangements are believed to be involved in the pathogenesis of breast cancer, including the inactivation of tumor suppressor genes and/or the disregulation of proto-oncogenes. Age, hormones, and environmental factors further influence these genetic derangements. Spontaneous and chemically induced animal models of breast cancer have been limited in their usefulness. The advent of targeted gene mutations has allowed for a more specific exploration of the pathogenesis of breast cancer by creating mouse models that mimic single or multiple gene alterations found in human mammary tumors. The genes targeted in these models include mouse mammary tumor integration sites and genes that encode for growth regulators, signal transduction proteins, cell cycle proteins, and cell matrix proteinases. In this review, I summarize tumor morphology and the relevance of each model to the pathogenesis and progression of human breast cancer. These models have great potential for elucidating the multistep process of mammary gland carcinogenesis and for contributing to the identification of novel therapeutic targets.
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Affiliation(s)
- P E Blackshear
- Schering-Plough Research Institute, Lafayette, New Jersey 07848, USA.
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45
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Ardizzoni A, Cafferata MA, Paganuzzi M, Filiberti R, Marroni P, Neri M, Fontana V, Nicol� G, Perdelli L, Stampino CG, Rosso R, Puntoni R. Study of pretreatment serum levels of HER-2/neu oncoprotein as a prognostic and predictive factor in patients with advanced nonsmall cell lung carcinoma. Cancer 2001. [DOI: 10.1002/1097-0142(20011001)92:7<1896::aid-cncr1707>3.0.co;2-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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46
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Rovelon P. A practical guide to HER2 testing. Eur J Oncol Nurs 2000; 4:18-23. [PMID: 12849613 DOI: 10.1054/ejon.2000.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nurses are becoming increasingly involved in providing information about the full range of medical care to patients. With the identification of increasing numbers of prognostic factors in cancer, this role is extending to include testing for these factors. HER2 status has prognostic and predictive value in breast cancer and the receptor is a target for specific therapies. To identify patients who might benefit from more aggressive treatment regimens or new therapeutic options, it is vital that HER2 abnormalities are accurately measured. A variety of techniques have been developed to measure HER2 overexpression or amplification, including fluorescence in situ hybridization, immunohistochemistry, polymerase chain reaction and enzyme-linked immunosorbent assay. To date, no one test has been accepted as standard and pathology laboratories are using different tests. This has implications for the interpretation of results, which in turn has implications for the widespread use of HER2 testing. This article describes the various tests available for the measurement of HER2, identifies the features of the ideal HER2 test and which test currently best fits these criteria, and considers whether HER2 status should be a routine part of the clinical evaluation of breast cancer patients. Important information that nurses should consider when providing information on HER2 testing to patients is highlighted.
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Affiliation(s)
- P Rovelon
- Institut Gustave Roussy Service Herault, 39, rue Camille Desmoulin, F-9400 Villejuif, France
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Hennig EM, Kvinnsland S, Holm R, Nesland JM. Significant difference in p53 and p21 protein immunoreactivity in HPV 16 positive and HPV negative breast carcinomas. Acta Oncol 1999; 38:931-8. [PMID: 10606422 DOI: 10.1080/028418699432617] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Human papillomavirus (HPV) 16 has previously been found in 19/41 breast carcinomas (46%) in women with a history of HPV 16 positive CIN III lesions. There was no significant difference in distribution of histological subtypes, mean or median tumour diameter or number of regional lymph node metastases in the HPV positive and HPV negative breast carcinoma groups. P53, p21 and c-erbB-2 proteins were analysed by immunohistochemistry in the HPV 16 positive and HPV negative breast carcinomas. There was a significant difference in p53 and p21 protein immunoreactivity between HPV 16 positive and HPV negative breast carcinomas (p = 0.0091 and p = 0.0040), with a significant less detectable p53 and p21 protein immunoreactivity in the HPV 16 positive cases. There was also a significant difference in the coexpression of p53/p21 between the HPV 16 positive and HPV 16 negative breast carcinomas (p = 0.002). No significant difference in immunostaining for c-erbB-2 protein in the two groups was found (p = 0.15), or for the coexpression of p53/c-erbB-2 (p = 0.19). The significantly lower expression of p53 and p21 proteins in HPV 16 positive than in HPV 16 negative breast carcinomas supports the hypothesis of inactivation and degradation of wild-type p53 proteins by HPV 16 E6 and that p53 mutation is not necessary for transformation in the HPV 16 positive cases.
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Affiliation(s)
- E M Hennig
- University of Oslo, Faculty of Medicine, Blindern, Norway
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Imoto S, Kitoh T, Hasebe T. Serum c-erB-2 levels in monitoring of operable breast cancer patients. Jpn J Clin Oncol 1999; 29:336-9. [PMID: 10470658 DOI: 10.1093/jjco/29.7.336] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Various methods and criteria are used to determine protein overexpression of c-erbB-2 and the clinical utility of c-erbB-2 is under investigation. We have reported previously that the levels of cytosol c-erbB-2 in breast cancer were significantly different between the clinical stages. METHODS The levels of c-erbB-2 protein were determined in sera from 210 breast cancer patients using a sandwich enzyme immunoassay between November 1996 and March 1998. The cut-off level was set at 5.4 ng/ml for healthy female blood donors. RESULTS First, serum c-erbB-2 levels were analyzed in 73 preoperative breast cancer patients with stage I-IIIB disease. The range and median values were 2.3-32.3 and 4.8 ng/ml, respectively. The positive rate was 38%. Overexpression of serum c-erbB-2 was significantly associated with tumor size, clinical stage, histological grade, lymphatic invasion, nodal status and overexpression of cytosol c-erbB-2, but not with hormonal receptor status and other clinico-pathological factors. Second, c-erbB-2, CEA and CA15-3 in sera were examined in 157 postoperative breast cancer patients. In the 137 disease-free patients, specificities of c-erbB-2, CEA and CA15-3 were 72, 93 and 99%, respectively, but in the 20 first recurrent patients, these sensitivities were 80, 25 and 25%, respectively. CONCLUSIONS These results suggest that serum c-erbB-2 protein is a useful marker for predicting aggressive behavior and first recurrence of breast cancer.
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Affiliation(s)
- S Imoto
- Division of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
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Ross JS, Fletcher JA. The HER-2/neu oncogene: prognostic factor, predictive factor and target for therapy. Semin Cancer Biol 1999; 9:125-38. [PMID: 10202134 DOI: 10.1006/scbi.1998.0083] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The HER-2/neu oncogene encodes a transmembrane tyrosine kinase receptor with extensive homology to the epidermal growth factor receptor. HER-2/neu has been widely studied in breast cancer. The potential value of HER-2/neu status for the prediction of disease outcome and response to therapy in breast cancer is presented in the light of a series of recently published studies showing a range of impact on the outcome of patients treated with hormonal, cytotoxic and radiation therapies. This review includes the application of serum-based HER-2/neu testing and the use of antibody-based therapies directed against the HER-2/neu protein and their potential to become a new modality for breast cancer treatment.
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Affiliation(s)
- J S Ross
- Department of Pathology and Laboratory Medicine, Albany Medical College, 47 New Scotland Avenue, Albany, MA, NY 12208, USA
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Stearns V, Yamauchi H, Hayes DF. Circulating tumor markers in breast cancer: accepted utilities and novel prospects. Breast Cancer Res Treat 1999; 52:239-59. [PMID: 10066086 DOI: 10.1023/a:1006137619153] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Detecting and/or monitoring changes in circulating tumor markers might assist in evaluating cancer risk, diagnosis, prognosis, or response to treatment. Several categories of circulating tumor markers have been investigated in breast cancer. These categories include classical tumor-associated antigens, such as CEA and CA 15-3, markers of tumor biology, including markers of angiogenesis, adhesion, and invasion, and antibody response to tumor-associated antigens such as HER2/neu and p53. We used a recently proposed Tumor Marker Utility Grading System to evaluate the use of several circulating tumor markers for different clinical utilities in breast cancer. While there are no tumor markers with established clinical utilities for most uses, tumor-associated antigens can be used for monitoring patients with metastatic disease. In addition, markers of tumor biology such as the circulating extracellular domain of HER2/neu might be useful in determining not only prognosis, but also response to specific treatments. However, further investigations are required to further assess the utility of individual tumor markers for specific clinical uses.
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Affiliation(s)
- V Stearns
- Breast Cancer Program, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
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