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Boscolo Bielo L, Trapani D, Nicolò E, Valenza C, Guidi L, Belli C, Kotteas E, Marra A, Prat A, Fusco N, Criscitiello C, Burstein HJ, Curigliano G. The evolving landscape of metastatic HER2-positive, hormone receptor-positive Breast Cancer. Cancer Treat Rev 2024; 128:102761. [PMID: 38772169 DOI: 10.1016/j.ctrv.2024.102761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/05/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
Therapeutic agents targeting Human Epidermal Growth Factor Receptor 2 (HER2) demonstrated to positively impact the prognosis of HER2-positive breast cancer. HER2-positive breast cancer can present either as hormone receptor-negative or positive, defining Triple-positive breast cancer (TPBC). TPBC demonstrate unique gene expression profiles, showing reduced HER2-driven gene expression, as recapitulated by a higher proportion of Luminal-type intrinsic subtypes. The different molecular landscape of TPBC dictates distinctive clinical features, including reduced chemotherapy sensitivity, different patterns of recurrence, and better overall prognosis. Cross-talk between HER2 and hormone receptor signaling seems to be critical to determine resistance to HER2-directed agents. Accordingly, superior outcomes have been achieved with the use of endocrine therapy, representing the first subtype-specific pharmacological intervention unique to this subgroup. Additional targeted agents capable to tackle resistance mechanisms to anti-HER2, hormone agents, or both might further improve the efficacy of treatments, such as PI3K/AKT/mTOR inhibitors, particularly in a biomarker-enriched setting, and CDK4/6-inhibitors, with preliminary data suggesting a role of PAM50 subtyping to predict higher benefits in luminal tumors. Finally, the distinct biology of triple-positive tumors may yield the rationale for considering combinations within antibody-drug conjugate regimens. Accordingly, in this review, we summarized the current evidence and rationale for considering TPBC as a different entity, in which distinct therapeutical approaches leveraging on the different biological profile of TPBC may result in superior anticancer regimens and improved patient-centric outcomes.
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Affiliation(s)
- Luca Boscolo Bielo
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Dario Trapani
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Eleonora Nicolò
- Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Carmine Valenza
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lorenzo Guidi
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Carmen Belli
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy
| | - Elias Kotteas
- Oncology Unit, Sotiria General Hospital, 3rd Dept of Internal Medicine, Athens School of Medicine, Greece
| | - Antonio Marra
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy
| | - Aleix Prat
- Department of Medical Oncology and Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Carmen Criscitiello
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Harold J Burstein
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
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Cai Y, Zheng H, Xu D, Xie J, Wang W, Liu Z, Zheng Z. M6A RNA Methylation-Mediated Dysregulation of AGAP2-AS1 Promotes Trastuzumab Resistance of Breast Cancer. Pharmacology 2024; 109:282-292. [PMID: 38744264 DOI: 10.1159/000539202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Trastuzumab is commonly used to treat human epidermal growth factor receptor-2-positive (HER2+) breast cancer, but its efficacy is often limited by chemotherapy resistance. Recent studies have indicated that long non-coding RNAs (lncRNAs) play important roles in tumor progression and response to therapy. However, the regulatory mechanisms associating lncRNAs and trastuzumab resistance remain unknown. METHODS Quantitative polymerase chain reaction was performed to detect the expression of related genes. Western blot and immunofluorescence assays were used to evaluate protein expression levels. A series of gain- or loss-of-function assays confirmed the function of AGAP2-AS1 in trastuzumab resistance, both in vitro and in vivo. RNA immunoprecipitation and pull-down analyses were conducted to verify the interaction between METTL3/YTHDF2 and lncRNA AGAP2-AS1. RESULTS AGAP2-AS1 was upregulated in trastuzumab-resistant cells and SKBR-3R-generated xenografts in nude mice. Silencing AGAP2-AS1 significantly decreased trastuzumab-induced cytotoxicity both in vitro and in vivo. Furthermore, m6A methylation of AGAP2-AS1 was reduced in trastuzumab-resistant cells compared to that in parental cells. In addition, METTL3 increased m6A methylation of AGAP2-AS1, which finally induced the suppressed AGAP2-AS1 expression. Moreover, YTHDF2 was essential for METTL3-mediated m6A methylation of AGAP2-AS1. Functionally, AGAP2-AS1 regulated trastuzumab resistance by inducing autophagy and increasing ATG5 expression. CONCLUSION we demonstrated that METTL3/YTHDF2-mediated m6A methylation increased the expression of AGAP2-AS1, which could promote trastuzumab resistance in breast cancer. AGAP2-AS1 regulates trastuzumab resistance by inducing autophagy. Therefore, AGAP2-AS1 may be a promising predictive biomarker and therapeutic target in patients with breast cancer.
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MESH Headings
- Humans
- Drug Resistance, Neoplasm/genetics
- Drug Resistance, Neoplasm/drug effects
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Trastuzumab/pharmacology
- Trastuzumab/therapeutic use
- RNA, Long Noncoding/genetics
- RNA, Long Noncoding/metabolism
- Animals
- Female
- Mice, Nude
- Mice
- Methyltransferases/genetics
- Methyltransferases/metabolism
- Methylation/drug effects
- Cell Line, Tumor
- RNA-Binding Proteins/metabolism
- RNA-Binding Proteins/genetics
- Gene Expression Regulation, Neoplastic/drug effects
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Adenosine/analogs & derivatives
- Adenosine/pharmacology
- Xenograft Model Antitumor Assays
- Mice, Inbred BALB C
- Up-Regulation/drug effects
- RNA Methylation
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Affiliation(s)
- Yangjun Cai
- Department of Thyroid and Breast Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Haihong Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Dong Xu
- Department of Thyroid and Breast Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Jingjing Xie
- Department of Oncology and Hematology, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Weiwen Wang
- Department of Thyroid and Breast Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Zhiwei Liu
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Zhongqiu Zheng
- Department of Thyroid and Breast Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
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Franco AFDV, Malinverni ACM, Waitzberg AFL. Immunoexpression of HER2 pathway related markers in HER2 invasive breast carcinomas treated with trastuzumab. Pathol Res Pract 2023; 252:154917. [PMID: 37977031 DOI: 10.1016/j.prp.2023.154917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE We evaluated the immunoexpression of potential markers involved in the HER2 pathway in invasive breast carcinoma with HER2 amplification treated with trastuzumab. METHODS Samples of ninety patients diagnosed and treated at two public Brazilian hospitals with overexpressed invasive carcinoma between 2009 and 2018 were included. Several markers (Bcl-2, CDK4, cyclin D1, EGFR, IGF1, IGF-1R, MDM2, MUC4, p16, p21, p27, p53, PTEN, RA, TNFα, and VEGF) were immune analyzed in the tumor by immunohistochemistry and then correlated with clinicopathological variables. RESULTS Tumor sample expression results determined potential markers of good prognosis with statistically significant values: cyclin D1 with a nuclear grade, and recurrence; IGF-1 with tumor size, and death; p16 with a response after treatment; PTEN with a response after treatment, and death. Markers of poor prognosis: p53 with histological, and nuclear grade; IGF-1R with a compromised lymph node. The treatment resistance rate after trastuzumab was 40%; the overall survival was 4.13 years (95% CI 5.1-12.5) and the disease-free survival was 3.6 years (95% CI 5.1-13.1). CONCLUSIONS The tumor samples profile demonstrated that cyclin D1, IGF-1, p16, and PTEN presented the potential for a good prognosis and p53 and IGF-1R for worse.
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Affiliation(s)
- Andreia Fabiana do Vale Franco
- Pathology Department, Universidade Federal de São Paulo, Escola Paulista, de Medicina, Botucatu Street, 740, 1st Floor Vila Clementino, São Paulo, SP, Brazil; Laboratory of Molecular and Experimental Pathology, Universidade Federal, de São Paulo, Escola Paulista de Medicina, Pedro de Toledo Street, 781, 5th Floor - Vila Clementino, São Paulo, SP, Brazil.
| | - Andrea Cristina Moraes Malinverni
- Pathology Department, Universidade Federal de São Paulo, Escola Paulista, de Medicina, Botucatu Street, 740, 1st Floor Vila Clementino, São Paulo, SP, Brazil; Laboratory of Molecular and Experimental Pathology, Universidade Federal, de São Paulo, Escola Paulista de Medicina, Pedro de Toledo Street, 781, 5th Floor - Vila Clementino, São Paulo, SP, Brazil
| | - Angela Flavia Logullo Waitzberg
- Pathology Department, Universidade Federal de São Paulo, Escola Paulista, de Medicina, Botucatu Street, 740, 1st Floor Vila Clementino, São Paulo, SP, Brazil; Laboratory of Molecular and Experimental Pathology, Universidade Federal, de São Paulo, Escola Paulista de Medicina, Pedro de Toledo Street, 781, 5th Floor - Vila Clementino, São Paulo, SP, Brazil
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Vinod R, Mahran R, Routila E, Leivo J, Pettersson K, Gidwani K. Nanoparticle-Aided Detection of Colorectal Cancer-Associated Glycoconjugates of Extracellular Vesicles in Human Serum. Int J Mol Sci 2021; 22:ijms221910329. [PMID: 34638669 PMCID: PMC8508761 DOI: 10.3390/ijms221910329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Extracellular vesicles (EVs) are found in all biological fluids, providing potential for the identification of disease biomarkers such as colorectal cancer (CRC). EVs are heavily glycosylated with specific glycoconjugates such as tetraspanins, integrins, and mucins, reflecting the characteristics of the original cell offering valuable targets for detection of CRC. We report here on europium-nanoparticle (EuNP)-based assay to detect and characterize different surface glycoconjugates of EVs without extensive purification steps from five different CRC and the HEK 293 cell lines. The promising EVs candidates from cell culture were clinically evaluated on small panel of serum samples including early-stage (n = 11) and late-stage (n = 11) CRC patients, benign condition (n = 11), and healthy control (n = 10). The majority of CRC cell lines expressed tetraspanin sub-population and glycovariants of integrins and conventional tumor markers. The subpopulation of CD151 having CD63 expression (CD151CD63) was significantly (p = 0.001) elevated in early-stage CRC (8 out of 11) without detecting any benign and late-stage samples, while conventional CEA detected mostly late-stage CRC (p = 0.045) and with only four early-stage cases. The other glycovariant assays such as CEACon-A, CA125WGA, CA 19.9Ma696, and CA 19.9Con-A further provided some complementation to the CD151CD63 assay. These results indicate the potential application of CD151CD63 assay for early detection of CRC patients in human serum.
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Affiliation(s)
- Rufus Vinod
- Department of Life Technologies, University of Turku, 20520 Turku, Finland; (R.V.); (R.M.); (E.R.); (J.L.); (K.P.)
| | - Randa Mahran
- Department of Life Technologies, University of Turku, 20520 Turku, Finland; (R.V.); (R.M.); (E.R.); (J.L.); (K.P.)
- Tropical Health and Parasitology Department, High Institute of Public Health, Alexandria University, Alexandria 21617, Egypt
| | - Erica Routila
- Department of Life Technologies, University of Turku, 20520 Turku, Finland; (R.V.); (R.M.); (E.R.); (J.L.); (K.P.)
| | - Janne Leivo
- Department of Life Technologies, University of Turku, 20520 Turku, Finland; (R.V.); (R.M.); (E.R.); (J.L.); (K.P.)
| | - Kim Pettersson
- Department of Life Technologies, University of Turku, 20520 Turku, Finland; (R.V.); (R.M.); (E.R.); (J.L.); (K.P.)
| | - Kamlesh Gidwani
- Department of Life Technologies, University of Turku, 20520 Turku, Finland; (R.V.); (R.M.); (E.R.); (J.L.); (K.P.)
- Correspondence:
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Qian X, Qu H, Zhang F, Peng S, Dou D, Yang Y, Ding Y, Xie M, Dong H, Liao Y, Han M. Exosomal long noncoding RNA AGAP2-AS1 regulates trastuzumab resistance via inducing autophagy in breast cancer. Am J Cancer Res 2021; 11:1962-1981. [PMID: 34094664 PMCID: PMC8167703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/13/2021] [Indexed: 03/11/2023] Open
Abstract
Trastuzumab has been widely used for treatment of HER-2-positive breast cancer patients, however, the clinical response has been restricted due to emergence of resistance. Recent studies indicate that long noncoding RNA AGAP2-AS1 (lncRNA AGAP2-AS1) plays an important role in cancer resistance. However, the precise regulatory function and therapeutic potential of AGAP2-AS1 in trastuzumab resistance is still not defined. In this study, we sought to reveal the essential role of AGAP2-AS1 in trastuzumab resistance. Our results suggest that AGAP2-AS1 disseminates trastuzumab resistance via packaging into exosomes. Exosomal AGAP2-AS1 induces trastuzumab resistance via modulating ATG10 expression and autophagy activity. Mechanically, AGAP2-AS1 is associated with ELAVL1 protein, and the AGAP2-AS1-ELAVL1 complex could directly bind to the promoter region of ATG10, inducing H3K27ac and H3K4me3 enrichment, which finally activates ATG10 transcription. AGAP2-AS1-targeting antisense oligonucleotides (ASO) substantially increased trastuzumab-induced cytotoxicity. Clinically, increased expression of serum exosomal AGAP2-AS1 was associate with poor response to trastuzumab treatment. In conclusion, exosomal AGAP2-AS1 increased trastuzumab resistance via promoting ATG10 expression and inducing autophagy. Therefore, AGAP2-AS1 may serve as predictive biomarker and therapeutic target for HER-2+ breast cancer patients.
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Affiliation(s)
- Xueke Qian
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University Zhengzhou 450052, China
| | - Hongbo Qu
- Department of Breast and Thyroid Surgery, The First People's Hospital of Chenzhou City Hunan 423000, China
| | - Fan Zhang
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University Haikou 570311, China
| | - Shujia Peng
- Department of General Surgery, Tangdu Hospital, The Fourth Military Medical University Xi'an 710038, Shaanxi, China
| | - Dongwei Dou
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University Zhengzhou 450052, China
| | - Yunqing Yang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University Zhengzhou 450052, China
| | - Yichao Ding
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University Haikou 570311, China
| | - Mingwei Xie
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University Haikou 570311, China
| | - Huaying Dong
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University Haikou 570311, China
| | - Yue Liao
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University Haikou 570311, China.,Department of Obstetrics and Gynecology, University Hospital, LMU Munich Marchioninistr 15, Munich 81377, Germany
| | - Mingli Han
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University Zhengzhou 450052, China
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Han J, Qu H, Han M, Ding Y, Xie M, Hu J, Chen Y, Dong H. MSC-induced lncRNA AGAP2-AS1 promotes stemness and trastuzumab resistance through regulating CPT1 expression and fatty acid oxidation in breast cancer. Oncogene 2020; 40:833-847. [PMID: 33273726 DOI: 10.1038/s41388-020-01574-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/22/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022]
Abstract
Trastuzumab resistance has been becoming a major obstacle for treatment of HER-2-positive breast cancer patients. Increasing evidence suggests that mesenchymal stem cells (MSCs) play critical roles during the formation of drug resistance, however, the underlying mechanism is not well known. In this study, mass spectrometry, RNA pulldown and RNA immunoprecipitation assays were performed to verify the direct interactions among AGAP2-AS1 and other associated targets, such as human antigen R (HuR), miR-15a-5p, and carnitine palmitoyl transferase 1 (CPT1). In vitro and in vivo experimental assays were done to clarify the functional role of AGAP2-AS1 in trastuzumab resistance, stemness, and fatty acid oxidation (FAO). The results showed that MSC co-culture induced trastuzumab resistance. AGAP2-AS1 was upregulated in MSC-cultured cells, and knockdown of AGAP2-AS1 reversed the MSC-mediated trastuzumab resistance. Furthermore, MSC culture-induced AGAP2-AS1 regulates stemness and trastuzumab resistance via activating FAO. Mechanistically, AGAP2-AS1 is associated with HuR, and the AGAP2-AS1-HuR complex could directly bind to the CPT1, increasing its expression via improving RNA stability. In addition, AGAP2-AS1 could serve as ceRNA via sponging miR-15a-5p and releasing CPT1 mRNA. Clinically, increased expression of serum AGAP2-AS1 predicts poor response to trastuzumab treatment in breast cancer patients. In conclusion, MSC culture-induced AGAP2-AS1 caused stemness and trastuzumab resistance via promoting CPT1 expression and inducing FAO. Our results provide new insight of the role of MSCs in trastuzumab resistance and AGAP2-AS1 could be promising predictive biomarker and therapeutic target for HER-2+ breast cancer patients.
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Affiliation(s)
- Jing Han
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, 570311, Haikou, China
| | - Hongbo Qu
- Department of Breast and Thyroid Surgery, The First People's Hospital of Chenzhou City, 423000, Hunan, China
| | - Mingli Han
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Yichao Ding
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, 570311, Haikou, China
| | - Mingwei Xie
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, 570311, Haikou, China
| | - Jianguo Hu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, 400010, Chongqing, China
| | - Yuanwen Chen
- Department of General Surgery, Chongqing Renji Hospital, University of Chinese Academy of Science, Chongqing, China, 400062, Chongqing, China
| | - Huaying Dong
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, 570311, Haikou, China.
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Harnan S, Tappenden P, Cooper K, Stevens J, Bessey A, Rafia R, Ward S, Wong R, Stein RC, Brown J. Tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer: a systematic review and economic analysis. Health Technol Assess 2020; 23:1-328. [PMID: 31264581 DOI: 10.3310/hta23300] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Breast cancer and its treatment can have an impact on health-related quality of life and survival. Tumour profiling tests aim to identify whether or not women need chemotherapy owing to their risk of relapse. OBJECTIVES To conduct a systematic review of the effectiveness and cost-effectiveness of the tumour profiling tests oncotype DX® (Genomic Health, Inc., Redwood City, CA, USA), MammaPrint® (Agendia, Inc., Amsterdam, the Netherlands), Prosigna® (NanoString Technologies, Inc., Seattle, WA, USA), EndoPredict® (Myriad Genetics Ltd, London, UK) and immunohistochemistry 4 (IHC4). To develop a health economic model to assess the cost-effectiveness of these tests compared with clinical tools to guide the use of adjuvant chemotherapy in early-stage breast cancer from the perspective of the NHS and Personal Social Services. DESIGN A systematic review and health economic analysis were conducted. REVIEW METHODS The systematic review was partially an update of a 2013 review. Nine databases were searched in February 2017. The review included studies assessing clinical effectiveness in people with oestrogen receptor-positive, human epidermal growth factor receptor 2-negative, stage I or II cancer with zero to three positive lymph nodes. The economic analysis included a review of existing analyses and the development of a de novo model. RESULTS A total of 153 studies were identified. Only one completed randomised controlled trial (RCT) using a tumour profiling test in clinical practice was identified: Microarray In Node-negative Disease may Avoid ChemoTherapy (MINDACT) for MammaPrint. Other studies suggest that all the tests can provide information on the risk of relapse; however, results were more varied in lymph node-positive (LN+) patients than in lymph node-negative (LN0) patients. There is limited and varying evidence that oncotype DX and MammaPrint can predict benefit from chemotherapy. The net change in the percentage of patients with a chemotherapy recommendation or decision pre/post test ranged from an increase of 1% to a decrease of 23% among UK studies and a decrease of 0% to 64% across European studies. The health economic analysis suggests that the incremental cost-effectiveness ratios for the tests versus current practice are broadly favourable for the following scenarios: (1) oncotype DX, for the LN0 subgroup with a Nottingham Prognostic Index (NPI) of > 3.4 and the one to three positive lymph nodes (LN1-3) subgroup (if a predictive benefit is assumed); (2) IHC4 plus clinical factors (IHC4+C), for all patient subgroups; (3) Prosigna, for the LN0 subgroup with a NPI of > 3.4 and the LN1-3 subgroup; (4) EndoPredict Clinical, for the LN1-3 subgroup only; and (5) MammaPrint, for no subgroups. LIMITATIONS There was only one completed RCT using a tumour profiling test in clinical practice. Except for oncotype DX in the LN0 group with a NPI score of > 3.4 (clinical intermediate risk), evidence surrounding pre- and post-test chemotherapy probabilities is subject to considerable uncertainty. There is uncertainty regarding whether or not oncotype DX and MammaPrint are predictive of chemotherapy benefit. The MammaPrint analysis uses a different data source to the other four tests. The Translational substudy of the Arimidex, Tamoxifen, Alone or in Combination (TransATAC) study (used in the economic modelling) has a number of limitations. CONCLUSIONS The review suggests that all the tests can provide prognostic information on the risk of relapse; results were more varied in LN+ patients than in LN0 patients. There is limited and varying evidence that oncotype DX and MammaPrint are predictive of chemotherapy benefit. Health economic analyses indicate that some tests may have a favourable cost-effectiveness profile for certain patient subgroups; all estimates are subject to uncertainty. More evidence is needed on the prediction of chemotherapy benefit, long-term impacts and changes in UK pre-/post-chemotherapy decisions. STUDY REGISTRATION This study is registered as PROSPERO CRD42017059561. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Sue Harnan
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul Tappenden
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katy Cooper
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Stevens
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alice Bessey
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rachid Rafia
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sue Ward
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ruth Wong
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert C Stein
- University College London Hospitals Biomedical Research Centre, London, UK.,Research Department of Oncology, University College London, London, UK
| | - Janet Brown
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Han M, Qian X, Cao H, Wang F, Li X, Han N, Yang X, Yang Y, Dou D, Hu J, Wang W, Han J, Zhang F, Dong H. lncRNA ZNF649-AS1 Induces Trastuzumab Resistance by Promoting ATG5 Expression and Autophagy. Mol Ther 2020; 28:2488-2502. [PMID: 32735773 DOI: 10.1016/j.ymthe.2020.07.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/06/2020] [Accepted: 07/10/2020] [Indexed: 12/26/2022] Open
Abstract
The regulatory mechanism of long non-coding RNAs (lncRNAs) in trastuzumab resistance is not well established to date. In this research, we identified differentially expressed lncRNA and investigated its regulatory role in trastuzumab resistance of breast cancer. HiSeq sequencing and quantitative real-time PCR were performed to identify the dysregulated lncRNAs. Mass spectrometry, RNA fluorescence in situ hybridization (RNA-FISH), and immunoprecipitation assays were performed to identify the direct interactions between ZNF649-AS1 and other associated targets, such as polypyrimidine tract binding protein 1 (PTBP1) and autophagy related 5 (ATG5). Our results showed that ZNF649-AS1 was more highly expressed in trastuzumab-resistant cells compared to sensitive cells. Increased expression of ZNF649-AS1 was associated with a poorer response and shorter survival time of breast cancer patients. ZNF649-AS1 was upregulated by H3K27ac modification at the presence of trastuzumab treatment, and knockdown of ZNF649-AS1 reversed trastuzumab resistance via modulating ATG5 expression and autophagy. Mechanically, ZNF649-AS1 was associated with PTBP1 protein, which further promoted the transcription activity of the ATG5 gene. In conclusion, we demonstrated that H3K27ac modification-induced upregulation of ZNF649-AS1 could cause autophagy and trastuzumab resistance through associating with PTBP1 and promoting ATG5 transcription.
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Affiliation(s)
- Mingli Han
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
| | - Xueke Qian
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hui Cao
- Department of Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Fang Wang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiangke Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Na Han
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xue Yang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yunqing Yang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Dongwei Dou
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jianguo Hu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Wei Wang
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, China
| | - Jing Han
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, China
| | - Fan Zhang
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, China
| | - Huaying Dong
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, China.
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9
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Kurilov R, Haibe-Kains B, Brors B. Assessment of modelling strategies for drug response prediction in cell lines and xenografts. Sci Rep 2020; 10:2849. [PMID: 32071383 PMCID: PMC7028927 DOI: 10.1038/s41598-020-59656-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/23/2020] [Indexed: 12/20/2022] Open
Abstract
Data from several large high-throughput drug response screens have become available to the scientific community recently. Although many efforts have been made to use this information to predict drug sensitivity, our ability to accurately predict drug response based on genetic data remains limited. In order to systematically examine how different aspects of modelling affect the resulting prediction accuracy, we built a range of models for seven drugs (erlotinib, pacliatxel, lapatinib, PLX4720, sorafenib, nutlin-3 and nilotinib) using data from the largest available cell line and xenograft drug sensitivity screens. We found that the drug response metric, the choice of the molecular data type and the number of training samples have a substantial impact on prediction accuracy. We also compared the tasks of drug response prediction with tissue type prediction and found that, unlike for drug response, tissue type can be predicted with high accuracy. Furthermore, we assessed our ability to predict drug response in four xenograft cohorts (treated either with erlotinib, gemcitabine or paclitaxel) using models trained on cell line data. We could predict response in an erlotinib-treated cohort with a moderate accuracy (correlation ≈ 0.5), but were unable to correctly predict responses in cohorts treated with gemcitabine or paclitaxel.
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Affiliation(s)
- Roman Kurilov
- Division of Applied Bioinformatics, German Cancer Research Center, Heidelberg, Germany. .,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany.
| | - Benjamin Haibe-Kains
- Princess Margaret Cancer Centre, Toronto, Ontario, M5G 1L7, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, M5G 1L7, Canada.,Department of Computer Science, University of Toronto, Toronto, Ontario, M5T 3A1, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, M5G 1L7, Canada
| | - Benedikt Brors
- Division of Applied Bioinformatics, German Cancer Research Center, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany
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10
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Han M, Hu J, Lu P, Cao H, Yu C, Li X, Qian X, Yang X, Yang Y, Han N, Dou D, Zhang F, Ye M, Yang C, Gu Y, Dong H. Exosome-transmitted miR-567 reverses trastuzumab resistance by inhibiting ATG5 in breast cancer. Cell Death Dis 2020; 11:43. [PMID: 31969559 PMCID: PMC6976584 DOI: 10.1038/s41419-020-2250-5] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 02/06/2023]
Abstract
Trastuzumab is commonly used in the treatment of human epidermal growth factor receptor-2 positive (HER-2+) breast cancer, but its efficacy is often limited by the emergence of chemoresistance. Recent studies indicate that exosomes act as vehicles for exchange of genetic cargo between heterogeneous populations of tumor cells, engendering a transmitted drug resistance for cancer development and progression. However, the specific contribution of breast cancer-derived exosomes is poorly understood. In this study, publicly available expression profiling data from breast cancer and bioinformatics analyses were used to screen potential miRNAs in trastuzumab resistance. A series of gain- or loss-functional assays were performed to define the function of miR-567 and ATG5 in trastuzumab resistance and autophagy, both in vitro and in vivo. Our results showed that miR-567 was significantly decreased in trastuzumab-resistant patients compared with responding patients. Moreover, miR-567 was also downregulated in trastuzumab-resistant cells compared with parental cells. Overexpression of miR-567 reversed chemoresistance, whereas silence of miR-567 induced trastuzumab resistance, both in vitro and in vivo. In addition, enhanced miR-567 could be packaged into exosomes, incorporated into receipt cells, suppressing autophagy and reversed chemoresistance by targeting ATG5. To conclude, exosomal miR-567 plays a key role in reversing trastuzumab resistance via regulating autophagy, indicating it may be a promising therapeutic target and prognostic indicator for breast cancer patients.
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Affiliation(s)
- Mingli Han
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jianguo Hu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Pengwei Lu
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Hui Cao
- Department of Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Chao Yu
- Department of General Surgery, University-Town Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiangke Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xueke Qian
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xue Yang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yunqing Yang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Na Han
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Dongwei Dou
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Fan Zhang
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Mulin Ye
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Changcheng Yang
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou, 570102, China
| | - Yuanting Gu
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Huaying Dong
- Department of General Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China.
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11
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Wang J, Xu B. Targeted therapeutic options and future perspectives for HER2-positive breast cancer. Signal Transduct Target Ther 2019; 4:34. [PMID: 31637013 PMCID: PMC6799843 DOI: 10.1038/s41392-019-0069-2] [Citation(s) in RCA: 200] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 12/12/2022] Open
Abstract
Over the past 2 decades, there has been an extraordinary progress in the regimens developed for the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer. Trastuzumab, pertuzumab, lapatinib, and ado-trastuzumab emtansine (T-DM1) are commonly recommended anti-HER2 target agents by the U.S. Food and Drug Administration. This review summarizes the most significant and updated research on clinical scenarios related to HER2-positive breast cancer management in order to revise the guidelines of everyday clinical practices. In this article, we present the data on anti-HER2 clinical research of neoadjuvant, adjuvant, and metastatic studies from the past 2 decades. We also highlight some of the promising strategies that should be critically considered. Lastly, this review lists some of the ongoing clinical trials, findings of which may soon be available.
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Affiliation(s)
- Jiani Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, 100021 Beijing, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, 100021 Beijing, China
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, 100021 Beijing, China
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12
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Sperinde J, Huang W, Vehtari A, Chenna A, Kellokumpu-Lehtinen PL, Winslow J, Bono P, Lie YS, Petropoulos CJ, Weidler J, Joensuu H. p95HER2 Methionine 611 Carboxy-Terminal Fragment Is Predictive of Trastuzumab Adjuvant Treatment Benefit in the FinHer Trial. Clin Cancer Res 2018. [PMID: 29535130 DOI: 10.1158/1078-0432.ccr-17-3250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Expression of p95HER2 (p95), a truncated form of the HER2 receptor, which lacks the trastuzumab binding site but retains kinase activity, has been reported as a prognostic biomarker for poor outcomes in patients with trastuzumab-treated HER2-positive metastatic breast cancer. The impact of p95 expression on trastuzumab treatment efficacy in early HER2-positive breast cancer is less clear. In the current study, p95 was tested as a predictive marker of trastuzumab treatment benefit in the HER2-positive subset of the FinHer adjuvant phase III trial.Experimental Design: In the FinHer trial, 232 patients with HER2-positive early breast cancer were randomized to receive chemotherapy plus 9 weeks of trastuzumab or no trastuzumab treatment. Quantitative p95 protein expression was measured in formalin-fixed paraffin-embedded samples using the p95 VeraTag assay (Monogram Biosciences), specific for the M611 form of p95. Quantitative HER2 protein expression was measured using the HERmark assay (Monogram Biosciences). Distant disease-free survival (DDFS) was used as the primary outcome measure.Results: In the arm receiving chemotherapy only, increasing log10(p95) correlated with shorter DDFS (HR, 2.0; P = 0.02). In the arm receiving chemotherapy plus trastuzumab (N = 95), increasing log10(p95) was not correlated with a shorter DDFS. In a combined analysis of both treatment arms, high breast tumor p95 content was significantly correlated with trastuzumab treatment benefit in multivariate models (interaction P = 0.01).Conclusions: A high p95HER2/HER2 ratio identified patients with metastatic breast cancer with poor outcomes on trastuzumab-based therapies. Further investigation of the p95HER2/HER2 ratio as a potential prognostic or predictive biomarker for HER2-targeted therapy is warranted. Clin Cancer Res; 24(13); 3046-52. ©2018 AACR.
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Affiliation(s)
- Jeff Sperinde
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California.
| | - Weidong Huang
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Aki Vehtari
- Helsinki Institute for Information Technology HIIT, Department of Computer Science, Aalto University, Finland
| | - Ahmed Chenna
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | | | - John Winslow
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Petri Bono
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Yolanda S Lie
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Christos J Petropoulos
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Jodi Weidler
- Monogram Biosciences, currently Cepheid, Sunnyvale, California
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Hospital & Helsinki University, Helsinki, Finland
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13
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Kang CC, Ward TM, Bockhorn J, Schiffman C, Huang H, Pegram MD, Herr AE. Electrophoretic cytopathology resolves ERBB2 forms with single-cell resolution. NPJ Precis Oncol 2018; 2:10. [PMID: 29872719 PMCID: PMC5871910 DOI: 10.1038/s41698-018-0052-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 02/10/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022] Open
Abstract
In addition to canonical oncoproteins, truncated isoforms and proteolysis products are implicated in both drug resistance and disease progression. In HER2-positive breast tumors, expression of truncated HER2 isoforms resulting from alternative translation and/or carboxy-terminal fragments (CTFs) resulting from proteolysis (collectively, t-erbB2) have been associated with shortened progression-free survival of patients. Thus, to advance clinical pathology and inform treatment decisions, we developed a high-selectivity cytopathology assay capable of distinguishing t-erbB2 from full-length HER2 expression without the need for isoform-specific antibodies. Our microfluidic, single-cell western blot, employs electrophoretic separations to resolve full-length HER2 from the smaller t-erbB2 in each ~28 pL single-cell lysate. Subsequently, a pan-HER2 antibody detects all resolved HER2 protein forms via immunoprobing. In analysis of eight breast tumor biopsies, we identified two tumors comprised of 15% and 40% t-erbB2-expressing cells. By single-cell western blotting of the t-erbB2-expressing cells, we observed statistically different ratios of t-erbB2 proteins to full-length HER2 expression. Further, target multiplexing and clustering analyses scrutinized signaling, including ribosomal S6, within the t-erbB2-expressing cell subpopulation. Taken together, cytometric assays that report both protein isoform profiles and signaling state offer cancer classification taxonomies with unique relevance to precisely describing drug resistance mechanisms in which oncoprotein isoforms/fragments are implicated.
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Affiliation(s)
- Chi-Chih Kang
- 1Department of Bioengineering, University of California Berkeley, Berkeley, CA 94720 USA
| | - Toby M Ward
- 2Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, CA 94305 USA
| | - Jessica Bockhorn
- 2Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, CA 94305 USA
| | - Courtney Schiffman
- 3Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA 94720 USA
| | - Haiyan Huang
- 4Department of Statistics, University of California Berkeley, Berkeley, CA 94720 USA
| | - Mark D Pegram
- 2Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, CA 94305 USA
| | - Amy E Herr
- 1Department of Bioengineering, University of California Berkeley, Berkeley, CA 94720 USA
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14
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Chumsri S, Sperinde J, Liu H, Gligorov J, Spano JP, Antoine M, Moreno Aspitia A, Tan W, Winslow J, Petropoulos CJ, Chenna A, Bates M, Weidler JM, Huang W, Dueck A, Perez EA. High p95HER2/HER2 Ratio Associated With Poor Outcome in Trastuzumab-Treated HER2-Positive Metastatic Breast Cancer NCCTG N0337 and NCCTG 98-32-52 (Alliance). Clin Cancer Res 2018. [PMID: 29530935 DOI: 10.1158/1078-0432.ccr-17-1864] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: p95HER2 is a truncated form of HER2 that confers resistance to trastuzumab in vitro, but clinical results have been conflicting to date. Given that p95HER2 levels correlate with total HER2 expression levels, which confer better outcomes, we sought to evaluate the p95HER2/HER2 ratio in the North Central Cancer Treatment Group N0337 and N98-32-52 trials.Experimental Design: The HERmark assay and VeraTag technology (Monogram Biosciences) were used to measure total HER2 and p95HER2 expression levels in 91 patient samples.Results: In the multivariate model, increasing total HER2 level was significantly associated with longer (OS; HR, 0.33; P = 0.002) and decreasing p95HER2 level was significantly associated with longer OS (HR, 4.2; P = 0.01). Total HER2 expression level was significantly associated with longer progression-free survival (PFS) (HR, 0.57; P = 0.04), whereas p95HER2 level was not (HR, 1.7; P = 0.25). However, there was a positive association between p95HER2 and total HER2 expression levels (R2 = 0.48; P < 0.001). Consistent with our hypothesis, the ratio of p95HER2/HER2 was significantly associated with worsening PFS (HR, 1.7; P = 0.04) and OS (HR, 2.8; P = 0.002). Patients with the highest tertile of p95HER2/HER2 values had significantly less favorable PFS (HR, 1.8; P = 0.06) and OS (HR, 2.3; P = 0.02).Conclusions: A high p95HER2/HER2 ratio identified patients with metastatic breast cancer with poor outcomes on trastuzumab-based therapies. Further investigation of the p95HER2/HER2 ratio as a potential prognostic or predictive biomarker for HER2-targeted therapy is warranted. Clin Cancer Res; 24(13); 3053-8. ©2018 AACR.
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Affiliation(s)
- Saranya Chumsri
- Center for Breast Health, Mayo Clinic, Jacksonville, Florida.
| | - Jeff Sperinde
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Heshan Liu
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Winston Tan
- Center for Breast Health, Mayo Clinic, Jacksonville, Florida
| | - John Winslow
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Christos J Petropoulos
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Ahmed Chenna
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | | | | | - Weidong Huang
- Monogram Biosciences, Inc., Laboratory Corporation of America Holdings, South San Francisco, California
| | - Amylou Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, Arizona
| | - Edith A Perez
- Center for Breast Health, Mayo Clinic, Jacksonville, Florida
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15
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Siravegna G, Geuna E, Mussolin B, Crisafulli G, Bartolini A, Galizia D, Casorzo L, Sarotto I, Scaltriti M, Sapino A, Bardelli A, Montemurro F. Genotyping tumour DNA in cerebrospinal fluid and plasma of a HER2-positive breast cancer patient with brain metastases. ESMO Open 2017; 2:e000253. [PMID: 29067216 PMCID: PMC5640139 DOI: 10.1136/esmoopen-2017-000253] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Central nervous system (CNS) involvement contributes to significant morbidity and mortality in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (mBC) and represents a major challenge for clinicians. Liquid biopsy of cerebrospinal fluid (CSF)-derived circulating tumour DNA (ctDNA) harbours clinically relevant genomic alterations in patients with CNS metastases and could be effective in tracking tumour evolution. METHODS In a HER2-positive mBC patient with brain metastases, we applied droplet digital PCR (ddPCR) and next-generation whole exome sequencing (WES) analysis to measure ctDNA dynamic changes in CSF and plasma collected during treatment. RESULTS Baseline CSF-derived ctDNA analysis revealed TP53 and PIK3CA mutations as well as ERBB2 and cMYC amplification. Post-treatment ctDNA analysis showed decreased markers level in plasma, consistent with extra-CNS disease control, while increased in the CSF, confirming poor treatment benefit in the CNS. DISCUSSION Analysis of ctDNA in the CSF of HER2-positive mBC is feasible and could represent a useful companion for clinical management of brain metastases.
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Affiliation(s)
| | - Elena Geuna
- Investigative Clinical Oncology (INCO), Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | | | - Giovanni Crisafulli
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy.,Department of Oncology, University of Torino, Candiolo, Italy
| | | | - Danilo Galizia
- Investigative Clinical Oncology (INCO), Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Laura Casorzo
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Ivana Sarotto
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Maurizio Scaltriti
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New Jersey, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anna Sapino
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy.,Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alberto Bardelli
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy.,Department of Oncology, University of Torino, Candiolo, Italy
| | - Filippo Montemurro
- Investigative Clinical Oncology (INCO), Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
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16
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Gingras I, Gebhart G, de Azambuja E, Piccart-Gebhart M. HER2-positive breast cancer is lost in translation: time for patient-centered research. Nat Rev Clin Oncol 2017; 14:669-681. [PMID: 28762384 DOI: 10.1038/nrclinonc.2017.96] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
No biomarker beyond HER2 itself, which suffers from a low positive predictive value, has demonstrated clinical utility in breast cancer, despite numerous attempts to improve treatment tailoring for the growing number of anti-HER2 targeted therapies. This prompted us to examine the body of evidence, using a systematic approach, to identify putative predictive biomarkers in HER2-positive breast cancer, and discuss the hitherto failure to address the needs of patients. In the future, it is hoped immune-based biomarkers will predict benefit from anti-HER2 treatments in the neoadjuvant and adjuvant settings. In advanced-stage disease, the quantification of tumour heterogeneity using molecular-imaging technology has generated informative data on the success or failure of the antibody-drug conjugate T-DM1. Treatment tailoring remains a high priority, in cost-constrained health-care systems, but such tailoring will require a dramatic shift in the way translational research is being conducted, with the establishment of large, easily accessible, and well-annotated databases of candidate predictive biomarkers. Single-centre biomarker research should become a thing of the past.
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Affiliation(s)
- Isabelle Gingras
- Department of Hematology and Oncology, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, H4J 1C5, Montreal, Quebec, Canada
| | - Géraldine Gebhart
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B), 1, rue Heger-Bordet, 1000 Brussels, Belgium
| | - Evandro de Azambuja
- Medical Support Team of the Academic Promoting Team (APT), Institut Jules Bordet, Université Libre de Bruxelles (U.L.B), 1, rue Heger-Bordet, 1000 Brussels, Belgium
| | - Martine Piccart-Gebhart
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B), 1, rue Heger-Bordet, 1000 Brussels, Belgium
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17
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Kourie HR, El Rassy E, Clatot F, de Azambuja E, Lambertini M. Emerging treatments for HER2-positive early-stage breast cancer: focus on neratinib. Onco Targets Ther 2017; 10:3363-3372. [PMID: 28744140 PMCID: PMC5513878 DOI: 10.2147/ott.s122397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Over the last decades, a better understanding of breast cancer heterogeneity provided tools for a biologically based personalization of anticancer treatments. In particular, the overexpression of the human epidermal growth factor receptor 2 (HER2) by tumor cells provided a specific target in these HER2-positive tumors. The development of the monoclonal antibody trastuzumab, and its approval in 1998 for the treatment of patients with metastatic disease, radically changed the natural history of this aggressive subtype of breast cancer. These findings provided strong support for the continuous research in targeting the HER2 pathway and implementing the development of new anti-HER2 targeted agents. Besides trastuzumab, a series of other anti-HER2 agents have been developed and are currently being explored for the treatment of breast cancer patients, including those diagnosed with early-stage disease. Among these agents, neratinib, an oral tyrosine kinase inhibitor that irreversibly inhibits HER1, HER2, and HER4 at the intracellular level, has shown promising results, including when administered to patients previously exposed to trastuzumab-based treatment. This article aims to review the available data on the role of the HER2 pathway in breast cancer and on the different targeted agents that have been studied or are currently under development for the treatment of patients with early-stage HER2-positive disease with a particular focus on neratinib.
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Affiliation(s)
- Hampig Raphael Kourie
- Department of Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elie El Rassy
- Department of Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Florian Clatot
- Department of Medical Oncology and IRON/U1245, Centre Henri Becquerel, Rouen, France.,Breast Cancer Translational Research Laboratory
| | - Evandro de Azambuja
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Matteo Lambertini
- Breast Cancer Translational Research Laboratory.,Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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18
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Shi H, Zhang W, Zhi Q, Jiang M. Lapatinib resistance in HER2+ cancers: latest findings and new concepts on molecular mechanisms. Tumour Biol 2016; 37:10.1007/s13277-016-5467-2. [PMID: 27726101 DOI: 10.1007/s13277-016-5467-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/23/2016] [Indexed: 12/12/2022] Open
Abstract
In the era of new and mostly effective molecular targeted therapies, human epidermal growth factor receptor 2 positive (HER2+) cancers are still intractable diseases. Lapatinib, a dual epidermal growth factor receptor (EGFR) and HER2 tyrosine kinase inhibitor, has greatly improved breast cancer prognosis in recent years after the initial introduction of trastuzumab (Herceptin). However, clinical evidence indicates the existence of both primary unresponsiveness and secondary lapatinib resistance, which leads to the failure of this agent in HER2+ cancer patients. It remains a major clinical challenge to target the oncogenic pathways with drugs having low resistance. Multiple pathways are involved in the occurrence of lapatinib resistance, including the pathways of receptor tyrosine kinase, non-receptor tyrosine kinase, autophagy, apoptosis, microRNA, cancer stem cell, tumor metabolism, cell cycle, and heat shock protein. Moreover, understanding the relationship among these mechanisms may contribute to future tumor combination therapies. Therefore, it is of urgent necessity to elucidate the precise mechanisms of lapatinib resistance and improve the therapeutic use of this agent in clinic. The present review, in the hope of providing further scientific support for molecular targeted therapies in HER2+ cancers, discusses about the latest findings and new concepts on molecular mechanisms underlying lapatinib resistance.
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Affiliation(s)
- Huiping Shi
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China
| | - Weili Zhang
- Department of Gastroenterology, Xiangcheng People's Hospital, Suzhou, Jiangsu Province, 215131, China
| | - Qiaoming Zhi
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China.
| | - Min Jiang
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China.
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19
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Fabi A, Malaguti P, Vari S, Cognetti F. First-line therapy in HER2 positive metastatic breast cancer: is the mosaic fully completed or are we missing additional pieces? JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2016; 35:104. [PMID: 27357210 PMCID: PMC4928292 DOI: 10.1186/s13046-016-0380-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 06/20/2016] [Indexed: 12/17/2022]
Abstract
The discovery of human epidermal growth factor receptor 2 (HER2) and its role in the biology of breast cancer and the subsequent development of HER2-targeted therapies, have dramatically improved clinical outcomes for women with early-stage and advanced HER2-positive breast cancer (BC). HER-2 targeted therapies represent a major step forward in achieving the goal of delivering individualized targeted therapy for BC, and trastuzumab was the first anti-HER-2 strategy to be approved for treatment of HER-2 positive BC. This review discusses the treatment of metastatic HER2-positive BC and describes efficacy and safety of novel anti-HER2 target therapies in first-line metastatic settings and the future challenges include refining such treatments, reducing toxicity and simultaneously developing innovative therapies. Furthermore, combinations of trastuzumab and drugs targeting the downstream pathway are described. In the next future will be possible to use an ample armamentarium of combination therapies directed against HER2 and key signaling components integrated in the HER network. This approach will allow clinicians to tailor the management of the individual patient on the basis of tumor- specific biomarker profiles. There is an urgent need for prospective biomarker-driven trials to identify patients for whom targeting is cost-effective.
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Affiliation(s)
- Alessandra Fabi
- Division of Medical Oncology 1, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Paola Malaguti
- Division of Medical Oncology 1, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Sabrina Vari
- Division of Medical Oncology 1, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Francesco Cognetti
- Division of Medical Oncology 1, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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20
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Nuciforo P, Thyparambil S, Aura C, Garrido-Castro A, Vilaro M, Peg V, Jimenez J, Vicario R, Cecchi F, Hoos W, Burrows J, Hembrough T, Ferreres JC, Perez-Garcia J, Arribas J, Cortes J, Scaltriti M. High HER2 protein levels correlate with increased survival in breast cancer patients treated with anti-HER2 therapy. Mol Oncol 2016; 10:138-147. [PMID: 26422389 PMCID: PMC4968773 DOI: 10.1016/j.molonc.2015.09.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/24/2015] [Accepted: 09/02/2015] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Current methods to determine HER2 (human epidermal growth factor receptor 2) status are affected by reproducibility issues and do not reliably predict benefit from anti-HER2 therapy. Quantitative measurement of HER2 may more accurately identify breast cancer (BC) patients who will respond to anti-HER2 treatments. METHODS Using selected reaction monitoring mass spectrometry (SRM-MS), we quantified HER2 protein levels in formalin-fixed, paraffin-embedded (FFPE) tissue samples that had been classified as HER2 0, 1+, 2+ or 3+ by immunohistochemistry (IHC). Receiver operator curve (ROC) analysis was conducted to obtain optimal HER2 protein expression thresholds predictive of HER2 status (by standard IHC or in situ hybridization [ISH]) and of survival benefit after anti-HER2 therapy. RESULTS Absolute HER2 amol/μg levels were significantly correlated with both HER2 IHC and amplification status by ISH (p < 0.0001). A HER2 threshold of 740 amol/μg showed an agreement rate of 94% with IHC and ISH standard HER2 testing (p < 0.0001). Discordant cases (SRM-MS-negative/ISH-positive) showed a characteristic amplification pattern known as double minutes. HER2 levels >2200 amol/μg were significantly associated with longer disease-free survival (DFS) and overall survival (OS) in an adjuvant setting and with longer OS in a metastatic setting. CONCLUSION Quantitative HER2 measurement by SRM-MS is superior to IHC and ISH in predicting outcome after treatment with anti-HER2 therapy.
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Affiliation(s)
- Paolo Nuciforo
- Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra (Cerdanyola del Vallès), Spain
| | - Sheeno Thyparambil
- OncoPlex Diagnostics (Division of NantOmics, LLC), 9600 Medical Center Drive, Suite 300, Rockville, MD 20850, USA
| | - Claudia Aura
- Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Ana Garrido-Castro
- Department of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Marta Vilaro
- Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Vicente Peg
- Department of Pathology, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - José Jimenez
- Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Rocio Vicario
- Preclinical Research Program, Vall d'Hebron Institute of Oncology, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Fabiola Cecchi
- OncoPlex Diagnostics (Division of NantOmics, LLC), 9600 Medical Center Drive, Suite 300, Rockville, MD 20850, USA
| | - William Hoos
- OncoPlex Diagnostics (Division of NantOmics, LLC), 9600 Medical Center Drive, Suite 300, Rockville, MD 20850, USA
| | - Jon Burrows
- OncoPlex Diagnostics (Division of NantOmics, LLC), 9600 Medical Center Drive, Suite 300, Rockville, MD 20850, USA
| | - Todd Hembrough
- OncoPlex Diagnostics (Division of NantOmics, LLC), 9600 Medical Center Drive, Suite 300, Rockville, MD 20850, USA
| | - Juan Carles Ferreres
- Department of Pathology, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - José Perez-Garcia
- Department of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Joaquin Arribas
- Preclinical Research Program, Vall d'Hebron Institute of Oncology, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Spain
| | - Javier Cortes
- Department of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Maurizio Scaltriti
- Human Oncology & Pathogenesis Program (HOPP), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 20, New York, NY 10065, USA
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21
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Rahmatpanah FB, Jia Z, Chen X, Char JE, Men B, Franke AC, Jones FE, McClelland M, Mercola D. A class of genes in the HER2 regulon that is poised for transcription in breast cancer cell lines and expressed in human breast tumors. Oncotarget 2015; 6:1286-301. [PMID: 25428913 PMCID: PMC4359233 DOI: 10.18632/oncotarget.2676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/04/2014] [Indexed: 01/06/2023] Open
Abstract
HER2-positive breast cancer accounts for 25% of all cases and has a poor prognosis. Although progress has been made in understanding signal transduction, little is known of how HER2 achieves gene regulation. We performed whole genome expression analysis on a HER2+ and HER2− breast cancer cell lines and compared these results to expression in 812 primary tumors stratified by their HER2 expression level. Chip-on-chip with anti-RNA polymerase II was compared among breast cancer cell lines to identify genes that are potentially activated by HER2. The expression levels of these HER2-dependent POL II binding genes were determined for the 812 HER2+/− breast cancer tissues. Genes differentially expressed between HER2+/− cell lines were generally regulated in the same direction as in breast cancer tissues. We identified genes that had POLII binding in HER2+ cell lines, but without significant gene expression. Of 737 such genes “poised” for expression in cell lines, 113 genes were significantly differentially expressed in breast tumors in a HER2-dependent manner. Pathway analysis of these 113 genes revealed that a large group of genes were associated with stem cell and progenitor cell control as indicated by networks centered on NANOG, SOX2, OCT3/4. HER2 directs POL II binding to a large number of genes in breast cancer cells. A “poised” class of genes in HER2+ cell lines with POLII binding and low RNA expression but is differentially expressed in primary tumors, strongly suggests a role of the microenvironment and further suggests a role for stem cells proliferation in HER2-regulated breast cancer tissue.
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Affiliation(s)
- Farah B Rahmatpanah
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA
| | - Zhenyu Jia
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA.,Department of Statistics, University of Akron, Akron, Ohio, USA.,Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Xin Chen
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA
| | - Jessica E Char
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA
| | - Bozhao Men
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA
| | - Anna-Clara Franke
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA
| | - Frank E Jones
- Department of Cell and Molecular Biology, Tulane University, New Orleans, Louisiana, USA
| | - Michael McClelland
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA.,Department of Microbiology and Molecular Genetics, University of California, Irvine, CA, USA
| | - Dan Mercola
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA
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22
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Carey LA, Berry DA, Cirrincione CT, Barry WT, Pitcher BN, Harris LN, Ollila DW, Krop IE, Henry NL, Weckstein DJ, Anders CK, Singh B, Hoadley KA, Iglesia M, Cheang MCU, Perou CM, Winer EP, Hudis CA. Molecular Heterogeneity and Response to Neoadjuvant Human Epidermal Growth Factor Receptor 2 Targeting in CALGB 40601, a Randomized Phase III Trial of Paclitaxel Plus Trastuzumab With or Without Lapatinib. J Clin Oncol 2015; 34:542-9. [PMID: 26527775 DOI: 10.1200/jco.2015.62.1268] [Citation(s) in RCA: 296] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Dual human epidermal growth factor receptor 2 (HER2) targeting can increase pathologic complete response rates (pCRs) to neoadjuvant therapy and improve progression-free survival in metastatic disease. CALGB 40601 examined the impact of dual HER2 blockade consisting of trastuzumab and lapatinib added to paclitaxel, considering tumor and microenvironment molecular features. PATIENTS AND METHODS Patients with stage II to III HER2-positive breast cancer underwent tumor biopsy followed by random assignment to paclitaxel plus trastuzumab alone (TH) or with the addition of lapatinib (THL) for 16 weeks before surgery. An investigational arm of paclitaxel plus lapatinib (TL) was closed early. The primary end point was pCR in the breast; correlative end points focused on molecular features identified by gene expression-based assays. RESULTS Among 305 randomly assigned patients (THL, n = 118; TH, n = 120; TL, n = 67), the pCR rate was 56% (95% CI, 47% to 65%) with THL and 46% (95% CI, 37% to 55%) with TH (P = .13), with no effect of dual therapy in the hormone receptor-positive subset but a significant increase in pCR with dual therapy in those with hormone receptor-negative disease (P = .01). The tumors were molecularly heterogeneous by gene expression analysis using mRNA sequencing (mRNAseq). pCR rates significantly differed by intrinsic subtype (HER2 enriched, 70%; luminal A, 34%; luminal B, 36%; P < .001). In multivariable analysis treatment arm, intrinsic subtype, HER2 amplicon gene expression, p53 mutation signature, and immune cell signatures were independently associated with pCR. Post-treatment residual disease was largely luminal A (69%). CONCLUSION pCR to dual HER2-targeted therapy was not significantly higher than single HER2 targeting. Tissue analysis demonstrated a high degree of intertumoral heterogeneity with respect to both tumor genomics and tumor microenvironment that significantly affected pCR rates. These factors should be considered when interpreting and designing trials in HER2-positive disease.
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Affiliation(s)
- Lisa A Carey
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom.
| | - Donald A Berry
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Constance T Cirrincione
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - William T Barry
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Brandelyn N Pitcher
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Lyndsay N Harris
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - David W Ollila
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Ian E Krop
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Norah Lynn Henry
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Douglas J Weckstein
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Carey K Anders
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Baljit Singh
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Katherine A Hoadley
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Michael Iglesia
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Maggie Chon U Cheang
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Charles M Perou
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Eric P Winer
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
| | - Clifford A Hudis
- Lisa A. Carey, David W. Ollila, Carey K. Anders, Katherine A. Hoadley, Michael Iglesia, and Charles M. Perou, University of North Carolina Chapel Hill, Chapel Hill; Constance T. Cirrincione and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Donald A. Berry, Alliance Statistics and Data Center, MD Anderson, Houston, TX; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Ian E. Krop and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Lyndsay N. Harris, University Hospitals of Cleveland, Cleveland, OH; Norah Lynn Henry, University of Michigan, Ann Arbor, MI; Douglas J. Weckstein, New Hampshire Hematology-Oncology, Hooksett, NH; Baljit Singh, New York University; Clifford A. Hudis, Memorial Sloan-Kettering Cancer Center, New York, NY; and Maggie Chon U. Cheang, Clinical Trials and Statistics Unit, Institute of Cancer Research, Belmont, United Kingdom
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Non-HER2 signaling pathways activated in resistance to anti-HER2 therapy in breast cancer. Breast Cancer Res Treat 2015; 153:493-505. [PMID: 26400847 DOI: 10.1007/s10549-015-3578-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/16/2015] [Indexed: 01/21/2023]
Abstract
HER2 receptor is overexpressed approximately in 20 % of human breast cancer (BC) and is a poor prognostic factor. Although therapies targeting this receptor have improved the prognosis of this cancer, up to 62 % patients treated with these drugs experiment progression during the first year of treatment. Some molecular mechanisms have been proposed to be responsible for this resistance, such as activation of alternative signaling pathways (through ERBB receptors and non-ERBB receptors or increased expression of ligands and alterations in HER2 signaling components). In this article, we will review the influence of genetic markers in non-HER2 signaling pathways investigated to date as cause of resistance to HER2-targeted drugs in HER2-positive BC patients. GRB7, included in the 17q12 amplicon, has been associated to poor prognosis in BC patients. Biomarkers like EPHAR and SRC, have demonstrated clinical relevance and prognostic value in HER2-positive BC patients. Non-invasive biomarkers, such as elevated IGF1 serum levels have been revealed as interesting biomarkers to be considered as predictors of trastuzumab clinical outcomes in BC patients. However, the prognostic value of most of the biomarkers investigated to date, such as HER3, IGF1R, PIK3CA, or AKT1 cannot be fully established yet, since results have not been conclusive.
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Segovia-Mendoza M, González-González ME, Barrera D, Díaz L, García-Becerra R. Efficacy and mechanism of action of the tyrosine kinase inhibitors gefitinib, lapatinib and neratinib in the treatment of HER2-positive breast cancer: preclinical and clinical evidence. Am J Cancer Res 2015; 5:2531-2561. [PMID: 26609467 PMCID: PMC4633889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 07/13/2015] [Indexed: 06/05/2023] Open
Abstract
An increasing number of tumors, including breast cancer, overexpress proteins of the epidermal growth factor receptor (EGFR) family. The interaction between family members activates signaling pathways that promote tumor progression and resistance to treatment. Human epidermal growth factor receptor type II (HER2) positive breast cancer represents a clinical challenge for current therapy. It has motivated the development of novel and more effective therapeutic EGFR family target drugs, such as tyrosine kinase inhibitors (TKIs). This review focuses on the effects of three TKIs mostly studied in HER2- positive breast cancer, lapatinib, gefitinib and neratinib. Herein, we discuss the mechanism of action, therapeutic advantages and clinical applications of these TKIs. To date, TKIs seem to be promising therapeutic agents for the treatment of HER2-overexpressing breast tumors, either as monotherapy or combined with other pharmacological agents.
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Affiliation(s)
- Mariana Segovia-Mendoza
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránAvenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, Tlalpan 14080, México, D. F., México
- Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Circuito Interior, Cuidad UniversitariaAv. Universidad 3000, Coyoacán 04510, México D. F, México
| | - María E González-González
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránAvenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, Tlalpan 14080, México, D. F., México
| | - David Barrera
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránAvenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, Tlalpan 14080, México, D. F., México
| | - Lorenza Díaz
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránAvenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, Tlalpan 14080, México, D. F., México
| | - Rocío García-Becerra
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránAvenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, Tlalpan 14080, México, D. F., México
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Madrid-Paredes A, Cañadas-Garre M, Sánchez-Pozo A, Calleja-Hernández MÁ. De novo resistance biomarkers to anti-HER2 therapies in HER2-positive breast cancer. Pharmacogenomics 2015; 16:1411-26. [PMID: 26257318 DOI: 10.2217/pgs.15.88] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Therapies targeting HER2 receptor, overexpressed in 20% breast cancer (BC), improved prognosis, however ~62% patients experiment progression during the first year. Molecular mechanisms proposed to be responsible for this de novo resistance include HER2 modifications, defects in the antibody dependent cellular cytotoxicity or in cell arrest and apoptosis or alterations in HER2 signaling components. This article will review the influence of genetic markers investigated to date as cause of de novo resistance to HER2-targeted drugs in HER2-positive BC patients. Biomarkers like p95HER2, CCND1 and CDC25A have demonstrated clinical relevance and prognostic value in HER2-positive BC patients. However, the prognostic value of most biomarkers investigated to date, such as PIK3CA or AKT1, cannot be fully established yet.
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Affiliation(s)
- Adela Madrid-Paredes
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain.,Department of Biochemistry & Molecular Biology II, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain
| | - Marisa Cañadas-Garre
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain
| | - Antonio Sánchez-Pozo
- Department of Biochemistry & Molecular Biology II, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain.,Department of Pharmacology, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n; 18071 Granada, Spain
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Trastuzumab in metastatic breast cancer after complete remission: How long is enough? Med Oncol 2015; 32:211. [DOI: 10.1007/s12032-015-0648-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
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Diver EJ, Foster R, Rueda BR, Growdon WB. The Therapeutic Challenge of Targeting HER2 in Endometrial Cancer. Oncologist 2015; 20:1058-68. [PMID: 26099744 DOI: 10.1634/theoncologist.2015-0149] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/12/2015] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED Endometrial cancer is the most common gynecologic cancer in the United States, diagnosed in more than 50,000 women annually. While the majority of women present with low-grade tumors that are cured with surgery and adjuvant radiotherapy, a significant subset of women experience recurrence and do not survive their disease. A disproportionate number of the more than 8,000 annual deaths attributed to endometrial cancer are due to high-grade uterine cancers, highlighting the need for new therapies that target molecular alterations specific to this subset of tumors. Numerous correlative scientific investigations have demonstrated that the HER2 (ERBB2) gene is amplified in 17%-33% of carcinosarcoma, uterine serous carcinoma, and a subset of high-grade endometrioid endometrial tumors. In breast cancer, this potent signature has directed women to anti-HER2-targeted therapies such as trastuzumab and lapatinib. In contrast to breast cancer, therapy with trastuzumab alone revealed no responses in women with recurrent HER2 overexpressing endometrial cancer, suggesting that these tumors may possess acquired or innate trastuzumab resistance mechanisms. This review explores the literature surrounding HER2 expression in endometrial cancer, focusing on trastuzumab and other anti-HER2 therapy and resistance mechanisms characterized in breast cancer but germane to endometrial tumors. Understanding resistance pathways will suggest combination therapies that target both HER2 and key oncogenic escape pathways in endometrial cancer. IMPLICATIONS FOR PRACTICE This review summarizes the role of HER2 in endometrial cancer, with a focus on uterine serous carcinoma. The limitations to date of anti-HER2 therapy in this disease site are examined, and mechanisms of drug resistance are outlined based on the experience in breast cancer. Potential opportunities to overcome inherent resistance to anti-HER2 therapy in endometrial cancer are detailed, offering opportunities for further clinical study with the goal to improve outcomes in this challenging disease.
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Affiliation(s)
- Elisabeth J Diver
- Vincent Center for Reproductive Biology and Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Rosemary Foster
- Vincent Center for Reproductive Biology and Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Bo R Rueda
- Vincent Center for Reproductive Biology and Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Whitfield B Growdon
- Vincent Center for Reproductive Biology and Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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28
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Hsieh A, Pittman K, Patterson WK, Townsend A. Can maintenance trastuzumab be stopped in patients with HER2-positive metastatic breast cancer? BMJ Case Rep 2015; 2015:bcr-2014-207750. [PMID: 26040825 DOI: 10.1136/bcr-2014-207750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Trastuzumab has significantly improved the median survival of patients with HER2-positive breast cancer. In metastatic disease, maintenance trastuzumab is usually given after tumour response has been achieved with the combination of chemotherapy and trastuzumab, with the aim of prolonging time to disease progression. We report a case where a durable complete response (CR) was achieved without maintenance trastuzumab. In the absence of consensus guidelines, it is difficult to recommend which HER2-positive patients with metastatic breast cancer after CR will benefit from withdrawing maintenance trastuzumab therapy and when this could be considered.
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Affiliation(s)
- Amy Hsieh
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Ken Pittman
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | | | - Amanda Townsend
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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29
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Nuciforo P, Radosevic-Robin N, Ng T, Scaltriti M. Quantification of HER family receptors in breast cancer. Breast Cancer Res 2015; 17:53. [PMID: 25887735 PMCID: PMC4389676 DOI: 10.1186/s13058-015-0561-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The clinical success of trastuzumab in breast cancer taught us that appropriate tumor evaluation is mandatory for the correct identification of patients eligible for targeted therapies. Although HER2 protein expression by immunohistochemistry (IHC) and gene amplification by fluorescence in situ hybridization (FISH) assays are routinely used to select patients to receive trastuzumab, both assays only partially predict response to the drug. In the case of epidermal growth factor receptor (EGFR), the link between the presence of the receptor or its amplification and response to anti-EGFR therapies could not be demonstrated. Even less is known for HER3 and HER4, mainly due to lack of robust and validated assays detecting these proteins. It is becoming evident that, besides FISH and IHC, we need better assays to quantify HER receptors and categorize the patients for individualized treatments. Here, we present the current available methodologies to measure HER family receptors and discuss the clinical implications of target quantification.
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Affiliation(s)
- Paolo Nuciforo
- Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Passeig Vall d'Hebron 119-129, Barcelona, 08035, Spain.
- Universitat Autònoma de Barcelona, Barcelona, 08035, Spain.
| | - Nina Radosevic-Robin
- ERTICa Research Group, University of Auvergne EA4677, 63000, Clermont-Ferrand, France.
- Biopathology, Jean Perrin Comprehensive Cancer Center, 58 rue Montalembert, 63011, Clermont-Ferrand, France.
| | - Tony Ng
- Richard Dimbleby Department of Cancer Research, Randall Division of Cell and Molecular Biophysics and Division of Cancer Studies, King's College London, London, SE1 1UL, UK.
- UCL Cancer Institute, Paul O'Gorman Building, University College London, London, WC1E 6DD, UK.
- Breakthrough Breast Cancer Research Unit, Department of Research Oncology, Guy's Hospital King's College London School of Medicine, London, SE1 9RT, UK.
| | - Maurizio Scaltriti
- Human Oncology and Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 20, New York, NY, 10065, USA.
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Scaltriti M, Nuciforo P, Bradbury I, Sperinde J, Agbor-Tarh D, Campbell C, Chenna A, Winslow J, Serra V, Parra JL, Prudkin L, Jimenez J, Aura C, Harbeck N, Pusztai L, Ellis C, Eidtmann H, Arribas J, Cortes J, de Azambuja E, Piccart M, Baselga J. High HER2 expression correlates with response to the combination of lapatinib and trastuzumab. Clin Cancer Res 2015; 21:569-76. [PMID: 25467182 DOI: 10.1158/1078-0432.ccr-14-1824] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Expression of p95HER2 has been associated with resistance to trastuzumab-based therapy in patients with metastatic breast cancer. Conversely, high levels of HER2 have been linked with increased clinical benefit from anti-HER2 therapy. In this work, we aimed to investigate whether the levels of p95HER2 and HER2 can predict response to anti-HER2 therapy in patients with breast cancer. EXPERIMENTAL DESIGN We measured p95HER2 and HER2 by VeraTag and HERmark, respectively, in primary tumors of patients enrolled in the neoadjuvant phase III study NeoALTTO and correlated these variables with pathologic complete response (pCR) and progression-free survival (PFS) following lapatinib (L), trastuzumab (T), or the combination of both agents (L+T). RESULTS A positive correlation between p95HER2 and HER2 levels was found in the 274 cases (60%) in which quantification of both markers was possible. High levels of these markers were predictive for pCR, especially in the hormone receptor (HR)-positive subset of patients. High HER2 expression was associated with increased pCR rate upon L+T irrespective of the HR status. To examine whether the levels of either p95HER2 or HER2 could predict for PFS in patients treated with lapatinib, trastuzumab or L+T, we fit to the PFS data in Cox models containing log2(p95HER2) or log2(HER2). Both variables correlated with longer PFS. CONCLUSIONS Increasing HER2 protein expression correlated with increased benefit of adding lapatinib to trastuzumab. HER2 expression is a stronger predictor of pCR and PFS than p95HER2 for response to lapatinib, trastuzumab and, more significantly, L+T.
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Affiliation(s)
- Maurizio Scaltriti
- Human Oncology and Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Paolo Nuciforo
- Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Ian Bradbury
- Frontier Science (Scotland) Ltd., Inverness-shire, Scotland
| | - Jeff Sperinde
- Clinical Research, Monogram Biosciences, Inc., South San Francisco, California
| | | | | | - Ahmed Chenna
- Clinical Research, Monogram Biosciences, Inc., South San Francisco, California
| | - John Winslow
- Clinical Research, Monogram Biosciences, Inc., South San Francisco, California
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Josep Lluis Parra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Ludmila Prudkin
- Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - José Jimenez
- Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Claudia Aura
- Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology, and CCC LMU, University of Munich, Munich, Germany
| | - Lajos Pusztai
- Genetics and Genomics Program, Yale School of Medicine, New Haven, Connecticut
| | | | - Holger Eidtmann
- Department of Gynecology and Midwifery, University Hospital Kiel, Kiel, Germany
| | - Joaquin Arribas
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain. Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Javier Cortes
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | - José Baselga
- Human Oncology and Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, New York, New York. Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Vici P, Pizzuti L, Natoli C, Gamucci T, Di Lauro L, Barba M, Sergi D, Botti C, Michelotti A, Moscetti L, Mariani L, Izzo F, D'Onofrio L, Sperduti I, Conti F, Rossi V, Cassano A, Maugeri-Saccà M, Mottolese M, Marchetti P. Triple positive breast cancer: a distinct subtype? Cancer Treat Rev 2014; 41:69-76. [PMID: 25554445 DOI: 10.1016/j.ctrv.2014.12.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/11/2014] [Accepted: 12/11/2014] [Indexed: 01/23/2023]
Abstract
Breast cancer is a heterogeneous disease, and within the HER-2 positive subtype this is highly exemplified by the presence of substantial phenotypical and clinical heterogeneity, mostly related to hormonal receptor (HR) expression. It is well known how HER-2 positivity is commonly associated with a more aggressive tumor phenotype and decreased overall survival and, moreover, with a reduced benefit from endocrine treatment. Preclinical studies corroborate the role played by functional crosstalks between HER-2 and estrogen receptor (ER) signaling in endocrine resistance and, more recently, the activation of ER signaling is emerging as a possible mechanism of resistance to HER-2 blocking agents. Indeed, HER-2 positive breast cancer heterogeneity has been suggested to underlie the variability of response not only to endocrine treatments, but also to HER-2 blocking agents. Among HER-2 positive tumors, HR status probably defines two distinct subtypes, with dissimilar clinical behavior and different sensitivity to anticancer agents. The triple positive subtype, namely, ER/PgR/Her-2 positive tumors, could be considered the subset which most closely resembles the HER-2 negative/HR positive tumors, with substantial differences in biology and clinical outcome. We argue on whether in this subgroup the "standard" treatment may be considered, in selected cases, i.e., small tumors, low tumor burden, high expression of both hormonal receptors, an overtreatment. This article review the existing literature on biologic and clinical data concerning the HER-2/ER/PgR positive tumors, in an attempt to better define the HER-2 subtypes and to optimize the use of HER-2 targeted agents, chemotherapy and endocrine treatments in the various subsets.
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Affiliation(s)
- Patrizia Vici
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Laura Pizzuti
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Clara Natoli
- Department of Experimental and Clinical Sciences, University "G. d'Annunzio", V dei Vestini, 29, 66100 Chieti, Italy.
| | - Teresa Gamucci
- Medical Oncology Unit ASL Frosinone, V Armando Fabi, 03100 Frosinone, Italy.
| | - Luigi Di Lauro
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Maddalena Barba
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy; Scientific Direction, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Domenico Sergi
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Claudio Botti
- Department of Surgery, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Andrea Michelotti
- Oncology Unit I, Azienda Ospedaliera Universitaria Pisana, V Roma 67, 56126 Pisa, Italy.
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology, Belcolle Hospital, ASL Viterbo, Strada S. Martinese, 01100 Viterbo, Italy.
| | - Luciano Mariani
- Department of Gynecologic Oncology, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy; HPV Unit, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Fiorentino Izzo
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Loretta D'Onofrio
- Department of Medical Oncology, University Campus Bio-Medico, V Álvaro del Portillo 21, 00128 Rome, Italy.
| | - Isabella Sperduti
- Biostatistics Unit, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Francesca Conti
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Valentina Rossi
- Division of Medical Oncology, Ospedale Civile di Saluzzo, V Spielberg 58, 12100 Saluzzo (CN), Italy.
| | - Alessandra Cassano
- Division of Medical Oncology, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy.
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology B, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy; Scientific Direction, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Marcella Mottolese
- Department of Pathology, "Regina Elena" National Cancer Institute, V Elio Chianesi 53, 00144 Rome, Italy.
| | - Paolo Marchetti
- Oncology Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, V Grottarossa 1035/1039, 00189 Rome, Italy.
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Ihnenfeld Arciénega I, Imesch P, Fink D, Dedes KJ. Prolonged complete remission of metastatic HER2-positive breast cancer after continuous trastuzumab treatment: a case report and review of the literature. Target Oncol 2014; 10:297-301. [PMID: 25511015 DOI: 10.1007/s11523-014-0350-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/03/2014] [Indexed: 01/06/2023]
Abstract
Metastatic breast cancer is considered an incurable disease. Targeted treatments against the human epidermal growth factor receptor 2 (HER2), however, significantly improve survival in patients with metastatic HER2-positive breast cancer. Some patients may respond with prolonged complete remission. Evidence on safety of long-term trastuzumab and risk of relapse after trastuzumab cessation is limited. We present a case of an 81-year-old patient with HER2-amplified metastatic breast cancer (MBC) in the liver. Following taxane-based chemotherapy in combination with trastuzumab after local treatment resulted in a complete radiological remission after 21 months of trastuzumab maintenance therapy. The patient remains in complete remission 6 years later and continues to receive trastuzumab as maintenance therapy. Prolonged remission in cases with complete response under trastuzumab-based regimens for metastatic HER2-positive breast cancer can be observed in some patients. Reviewing the few available cases published in the literature, these patients share some common characteristics: hormone receptor negative disease and metastases to the liver. There is no evidence that trastuzumab maintenance treatment can be safely interrupted after a certain time period.
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Affiliation(s)
- Isabel Ihnenfeld Arciénega
- Division of Gynecology, University Hospital of Zurich, Frauenklinistrasse, CH-8091, Zurich, Switzerland,
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Kotoula V, Bobos M, Alexopoulou Z, Papadimitriou C, Papadopoulou K, Charalambous E, Tsolaki E, Xepapadakis G, Nicolaou I, Papaspirou I, Aravantinos G, Christodoulou C, Efstratiou I, Gogas H, Fountzilas G. Adjusting breast cancer patient prognosis with non-HER2-gene patterns on chromosome 17. PLoS One 2014; 9:e103707. [PMID: 25098819 PMCID: PMC4123879 DOI: 10.1371/journal.pone.0103707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/30/2014] [Indexed: 12/27/2022] Open
Abstract
Background HER2 and TOP2A gene status are assessed for diagnostic and research purposes in breast cancer with fluorescence in situ hybridization (FISH). However, FISH probes do not target only the annotated gene, while chromosome 17 (chr17) is among the most unstable chromosomes in breast cancer. Here we asked whether the status of specifically targeted genes on chr17 might help in refining prognosis of early high-risk breast cancer patients. Methods Copy numbers (CN) for 14 genes on chr17, 4 of which were within and 10 outside the core HER2 amplicon (HER2- and non-HER2-genes, respectively) were assessed with qPCR in 485 paraffin-embedded tumor tissue samples from breast cancer patients treated with adjuvant chemotherapy in the frame of two randomized phase III trials. Principal Findings HER2-genes CN strongly correlated to each other (Spearman’s rho >0.6) and were concordant with FISH HER2 status (Kappa 0.6697 for ERBB2 CN). TOP2A CN were not concordant with TOP2A FISH status (Kappa 0.1154). CN hierarchical clustering revealed distinct patterns of gains, losses and complex alterations in HER2- and non-HER2-genes associated with IHC4 breast cancer subtypes. Upon multivariate analysis, non-HER2-gene gains independently predicted for shorter disease-free survival (DFS) and overall survival (OS) in patients with triple-negative cancer, as compared to luminal and HER2-positive tumors (interaction p = 0.007 for DFS and p = 0.011 for OS). Similarly, non-HER2-gene gains were associated with worse prognosis in patients who had undergone breast-conserving surgery as compared to modified radical mastectomy (p = 0.004 for both DFS and OS). Non-HER2-gene losses were unfavorable prognosticators in patients with 1–3 metastatic nodes, as compared to those with 4 or more nodes (p = 0.017 for DFS and p = 0.001 for OS). Conclusions TOP2A FISH and qPCR may not identify the same pathology on chr17q. Non-HER2 chr17 CN patterns may further predict outcome in breast cancer patients with known favorable and unfavorable prognosis.
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Affiliation(s)
- Vassiliki Kotoula
- Department of Pathology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
- * E-mail:
| | - Mattheos Bobos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Zoi Alexopoulou
- Department of Biostatistics, Health Data Specialists Ltd, Athens, Greece
| | - Christos Papadimitriou
- Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens School of Medicine, Athens, Greece
| | - Kyriaki Papadopoulou
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Elpida Charalambous
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Eleftheria Tsolaki
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | | | - Irene Nicolaou
- Department of Histopathology, “Agii Anagriri” Cancer Hospital, Athens, Greece
| | | | - Gerasimos Aravantinos
- Second Department of Medical Oncology, “Agii Anargiri” Cancer Hospital, Athens, Greece
| | | | | | - Helen Gogas
- First Department of Medicine, “Laiko” General Hospital, University of Athens, Medical School, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
- Department of Medical Oncology, “Papageorgiou” Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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Tural D, Akar E, Mutlu H, Kilickap S. P95 HER2 fragments and breast cancer outcome. Expert Rev Anticancer Ther 2014; 14:1089-96. [DOI: 10.1586/14737140.2014.929946] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Trastuzumab is one of the most important agents that target human epidermal growth factor receptor 2, but its cardiotoxic effect limits to use it. The mechanism of cardiac dysfunction-related trastuzumab is still unclear. In literature, there is no definite information about the cumulative dose of trastuzumab for cardiotoxicity. In presented case, we reported a breast cancer patient who has been receiving long-term trastuzumab. We have not found any cardiac problems for duration of over four years. According to our case and literature review, we may say that trastuzumab is safely used with periodically echocardiographic control in patients with breast cancer.
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Affiliation(s)
- Hasan Mutlu
- Department of Medical Oncology, Akdeniz University, Antalya, Turkey
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Montemurro F, Prat A, Rossi V, Valabrega G, Sperinde J, Peraldo-Neia C, Donadio M, Galván P, Sapino A, Aglietta M, Baselga J, Scaltriti M. Potential biomarkers of long-term benefit from single-agent trastuzumab or lapatinib in HER2-positive metastatic breast cancer. Mol Oncol 2014; 8:20-6. [PMID: 24075779 PMCID: PMC5528507 DOI: 10.1016/j.molonc.2013.08.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/27/2013] [Accepted: 08/29/2013] [Indexed: 01/06/2023] Open
Abstract
In 2009 a prospective, randomized Phase II trial (NCT00842998) was initiated to evaluate the activity of HER2-targeting agents without chemotherapy (CT) in HER2-positive metastatic breast cancer (MBC) patients. The primary tumors of the patients enrolled in this study offered a unique opportunity to identify biomarkers that could predict durable clinical benefit from CT-free anti-HER2 therapy. Patients with HER2-positive MBC were randomized to trastuzumab or lapatinib as first-line therapy. CT was added to anti-HER2 therapy in patients failing to achieve tumor regression at the 8-week evaluation and in those progressing at any time. Expression analysis of 105 selected genes was performed from formalin-fixed paraffin-embedded primary tumor samples. The research-based PAM50 intrinsic subtypes were also identified. Additionally, quantitative HER2 (H2T) and p95HER2 (p95) protein expression were evaluated by HERmark® and VeraTag® assay, respectively. Predictors of persistence on protocol (PP) were studied by Cox univariate and multivariate analysis. Nineteen patients were enrolled. Median overall survival was 43 months and median PP was 3.8 months (0.8-38.8+), with 4 patients (21.1%) persisting on single agent trastuzumab or lapatinib for longer than 12 mo (14.9-38.8 + mo). Seventeen patients were evaluable for PP. Gene expression analysis revealed that high expression of the 17q12-21 amplicon genes HER2 and GRB7, and the PAM50 HER2-enriched intrinsic profile, were significantly associated with longer PP. Conversely, high expression of luminal-related genes such as PGR, MDM2 or PIK3CA, or the PAM50 luminal intrinsic profile correlated with reduced PP. Moreover, increasing H2T/p95 ratio was found to be significantly associated with longer PP (HR 0.56 per 2-fold increase in H2T/p95, P = 0.0015). Our data suggest that patients belonging to the "HER2-enriched" subtype and/or having high H2T/p95 protein expression ratio are exquisitely sensitive to anti-HER2 agents. MBC patients with these tumors could be candidates for studies aimed at establishing chemotherapy-free regimens.
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Affiliation(s)
- Filippo Montemurro
- Unit of Investigative Clinical Oncology (INCO), Fondazione del Piemonte per l'Oncologia, Institute of Candiolo (IRCCs), Str. Provinciale 142, 10060 Candiolo, Italy; Division of Medical Oncology, Fondazione del Piemonte per l'Oncologia, Institute of Candiolo (IRCCs), Str. Provinciale 142, 10060 Candiolo, Italy
| | - Aleix Prat
- Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Valentina Rossi
- Unit of Investigative Clinical Oncology (INCO), Fondazione del Piemonte per l'Oncologia, Institute of Candiolo (IRCCs), Str. Provinciale 142, 10060 Candiolo, Italy
| | - Giorgio Valabrega
- Division of Medical Oncology, Fondazione del Piemonte per l'Oncologia, Institute of Candiolo (IRCCs), Str. Provinciale 142, 10060 Candiolo, Italy
| | - Jeff Sperinde
- Clinical Research, Monogram Biosciences, Inc., 345 Oyster Point Blvd., South San Francisco, CA, USA
| | - Caterina Peraldo-Neia
- Laboratory of Cell Therapy, Fondazione del Piemonte per l'Oncologia, Institute of Candiolo (IRCCs), Candiolo, Italy
| | - Michela Donadio
- A.O. Città della Salute e della Scienza di Torino - sede Molinette, C.so Bramante 88/90, 10126 Torino, Italy
| | - Patricia Galván
- Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Anna Sapino
- Department of Biological Sciences and Human Oncology, Universita di Torino, Str. Provinciale 142, 10060 Candiolo, Italy
| | - Massimo Aglietta
- Division of Medical Oncology, Fondazione del Piemonte per l'Oncologia, Institute of Candiolo (IRCCs), Str. Provinciale 142, 10060 Candiolo, Italy
| | - José Baselga
- Human Oncology & Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 20, New York, NY 10065, USA
| | - Maurizio Scaltriti
- Human Oncology & Pathogenesis Program (HOPP), Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 20, New York, NY 10065, USA.
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