Expression of epithelial growth factor receptor and its two ligands, transforming growth factor-alpha and epithelial growth factor, in normal and neoplastic squamous cells in the vulva: an immunohistochemical study

Potential targets for tumor-specific imaging of vulvar squamous cell carcinoma: A systematic review of candidate biomarkers

INTRODUCTION

Vulvar squamous cell carcinoma (VSCC) is a rare malignancy with an increasing incidence, especially in young women. Surgical treatment of VSCC is associated with significant morbidity and high recurrence rates, which is related to the limited ability to distinguish (pre)malignant from healthy tissue. There is a need for new tools for specific real-time detection of occult tumor lesions and localization of cancer margins in patients with VSCC. Several tumor-specific imaging techniques are developed to recognize malignant tissue by targeting tumor markers. We present a systematic review to identify, evaluate, and summarize potential markers for tumor-specific imaging of VSCC.

METHODS

Relevant papers were identified by a systematic cross-database literature search developed with assistance of an experienced librarian. Data were extracted from eligible papers and reported based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. VSCC-specific tumor markers were valued based on a weighted scoring system, in which each biomarker was granted points based on ranked eligibility criteria: I) percentage expression, II) sample size, and III) in vivo application.

RESULTS

In total 627 papers were included of which 22 articles met the eligibility criteria. Twelve VSCC-specific tumor markers were identified and of these 7 biomarkers were considered most promising: EGFR, CD44v6, GLUT1, MRP1, MUC1, CXCR-4 and VEGF-A.

DISCUSSION

This overview identified 7 potential biomarkers that can be used in the development of VSCC-specific tracers for real-time and precise localization of tumor tissue before, during, and after treatment. These biomarkers were identified in a small number of samples, without discriminating for VSCC-specific hallmarks such as HPV-status. Before clinical development, experimental studies should first aim at validation of these biomarkers using immunohistochemistry and cell line-based examination, discriminating for HPV-status and the expression rate in lymph nodes and precursor lesions.

Decorin Expression in Human Vulva Carcinoma: Oncosuppressive Effect of Decorin cDNA Transduction on Carcinoma Cells

The extracellular matrix proteoglycan decorin is well-known for its oncosuppressive activity. Here, decorin expression was examined in human vulva carcinoma tissue samples and in primary and commercial cell lines representing this malignant disease. Furthermore, the effect of adenovirus-mediated decorin cDNA (Ad-DCN) transduction on the viability, proliferation, and the expression and activity of the epidermal growth factor receptor (ErbB/HER) family members of the cell lines were investigated. Using in situ hybridization and immunohistochemistry for decorin, it was demonstrated that malignant cells in human vulva carcinoma tissues lack decorin expression. This result was true independently on tumor stage, grade or human papillomavirus status. RT-qPCR analyses showed that the human vulva carcinoma cell lines used in this study were also negative for decorin expression. Transduction of the cell lines with Ad-DCN caused a marked reduction in cell viability, while the proliferation of the cells was not affected. Experiments examining potential mechanisms behind the oncosuppressive effect of Ad-DCN transduction revealed that ErbB2/HER2 expression and activity in carcinoma cells were markedly downregulated. In conclusion, the results of this study showed that human vulva carcinoma cells lack decorin expression, and that Ad-DCN transduction of these cells induces oncosuppressive activity in part via downregulation of ErbB2/HER2.

Immunohistochemical Expression of p53, Fibroblast Growth Factor-b, and Transforming Growth Factor-α in Feline Vaccine-associated Sarcomas

Fifty feline sarcomas associated with vaccine-site injection were evaluated to determine the immunohistochemical expression of p53 protein, basic fibroblast growth factor (FGF-b), and transforming growth factor-α (TGF-α). Forty-one tumors (82%) were fibrosarcomas (FS), eight (16%) were malignant fibrous histiocytomas (MFH), and one (2%) was a chondrosarcoma (CS). Overexpression of p53 protein was observed in the nuclei of tumor cells in 28 (56%) sarcomas; FGF-b expression was found in the cytoplasm of tumor cells in 40 (80%) feline sarcomas, but the staining was more intense in the spindle-shaped cells of FS than in polygonal or round cells of MFH. The single CS faintly expressed FGF-b. The majority of feline vaccine-associated sarcomas (43 of 50, 86%) expressed moderate or intense staining for TGF-α in the cytoplasm of tumor cells. Heterogeneous immunolabeling for p53, FGF-b, and TGF-α was present in neoplastic, multinucleated giant cells. Intense expression of FGF-b was statistically associated with younger cats ( P < 0.01) and with tumors with nodular growth patterns ( P = 0.02). In addition, sarcomas negative for p53 protein expressed FGF-b more frequently than did p53-positive tumors ( P = 0.04). The frequency of FGF-b immunostaining was significantly higher in sarcomas with intense expression of TGF-α ( P = 0.05). Immunohistochemical detection of p53 protein, FGF-b, and TGF-α suggests that these growth-regulating proteins may play different roles in the development of sarcomas associated with vaccine sites.

Epidermal Growth Factor Receptor Is Involved in the Development of an Invasive Phenotype in Vulvar Squamous Lesions, but Is Not Related to MIB-1 Immunoreactivity

This study investigated the expression of epidermal growth factor receptor (EGFR) and proliferation as determined by MIB-1 labeling indices (proliferation index [PI]) in 82 cases of vulvar tissues consisting of healthy epithelia (HE) (n = 10), vulvar condylomas (VC; n = 24), high-grade vulvar intraepithelial neoplasias (HG-VIN) of warty and basaloid types (n = 26), invasive keratinizing squamous cell carcinomas (SCCs; n = 22), and differentiated VIN adjacent to SCCs (n = 7) by means of a standard immunohistochemical method using monoclonal antibodies to characterize EGFR expression, with an emphasis on neoplastic transformation and progression, and to relate it to proliferation. The EGFR expression was mainly membranous and--to a lesser degree--cytoplasmic; it was scored for intensity and quantity. The MIB-1 reactivity was exclusively nuclear. High EGFR immunoscores were detected on 6% of HG-VIN and 41% of SCCs. The EGFR immunoexpression increased significantly from healthy epithelia to VCs, VINs (HG-VIN and differentiated VIN taken together), and SCCs (P < 0.0001 [chi2 test]), but was not related to stage, grade, or recurrence in SCCs. There was no statistical significance for EGFR immunoscores and PIs in the groups of VCs (P = 0.1923), VINs (P = 0.0951), and SCCs (P = 0.6896). This study shows the upregulation of EGFR expression in a few warty and basaloid HG-VIN cases and in many SCCs of the vulva. The lack of a relationship with PIs suggests that mechanisms other than proliferation are involved in this process.

Treatment of squamous cell vulvar cancer with the anti-EGFR tyrosine kinase inhibitor Tarceva

BACKGROUND

The purpose of this case report is to describe the first experience with erlotinib (Tarceva) in the treatment of locally advanced vulvar cancer.

CASE

Two elderly patients presented with locally advanced vulvar cancer. Surgery was not a suitable method of treatment for either of them because of multiple medical co-morbidities and stage of disease. One patient had disease progression on standard chemoradiation. Erlotinib, an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, was tried in both cases and dramatic responses were observed.

CONCLUSION

Therapy targeted to EGFR may be effective in the treatment of locally advanced vulvar cancer. This new therapeutic approach deserves further evaluation in carefully designed studies.

P63 and EGFR as prognostic predictors in stage IIB radiation-treated cervical squamous cell carcinoma

OBJECTIVES

The purpose of this study was to determine the relation between p63, p53-related gene, epidermal growth factor receptor (EGFR), and spontaneous apoptosis in relation to radiotherapy in patients with FIGO stage IIB cervical carcinoma, who had undergone radiation and concurrent chemotherapy, retrospectively.

METHODS

Eighty-four patients with FIGO stage IIB squamous cell carcinoma (SCC) of the uterine cervix, who were treated with radiotherapy and concurrent chemotherapy between 1991 and 1996, were included in the present study. The clinicopathologic features, patterns of treatment failure, and survival data were compared with the expressions of p63 and EGFR, which were determined by immunohistochemistry and with apoptosis by TUNEL on tissue-arrayed slides. Univariate and multivariate analyses were performed to determine the prognostic factors that influence patient survival.

RESULTS

Overall the indices of the expressions of p63 and EGFR in stage IIB cervical carcinoma were 18.7 and 26.6%, respectively, and these were found to be correlated. EGFR expression was significantly associated with extrapelvic failure (P = 0.03), whereas p63 was associated with locoregional failure (P = 0.03). The spontaneous apoptotic index showed no prognostic value, but the immunoreactivities of p63 and EGFR were associated with a worse prognosis by both univariate (P = 0.01 and 0.04, respectively) and multivariate analysis (95% CI:2.0-4.4, RR:3.2 and 95% CI:4.9-8.7, RR:6.7, respectively).

CONCLUSIONS

The expression of p63 gene is associated with poor survival and locoregional failure, whereas EGFR expression was found to be a prognostic predictor of extrapelvic failure. Both molecules were found to be potent molecular risk factors in patients with FIGO stage IIB SCC of the uterine cervix, who had received radiotherapy and concurrent chemotherapy.