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Limiting systemic endocrine overtreatment in postmenopausal breast cancer patients with an ultralow classification of the 70-gene signature. Breast Cancer Res Treat 2022; 194:265-278. [PMID: 35587322 PMCID: PMC9239940 DOI: 10.1007/s10549-022-06618-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/30/2022] [Indexed: 11/13/2022]
Abstract
Purpose Guidelines recommend endocrine treatment for estrogen receptor-positive (ER+) breast cancers for up to 10 years. Earlier data suggest that the 70-gene signature (MammaPrint) has potential to select patients that have an excellent survival without chemotherapy and limited or no tamoxifen treatment. The aim was to validate the 70-gene signature ultralow-risk classification for endocrine therapy decision making. Methods In the IKA trial, postmenopausal patients with non-metastatic breast cancer had been randomized between no or limited adjuvant tamoxifen treatment without receiving chemotherapy. For this secondary analysis, FFPE tumor material was obtained of ER+HER2− patients with 0–3 positive lymph nodes and tested for the 70-gene signature. Distant recurrence-free interval (DRFI) long-term follow-up data were collected. Kaplan–Meier curves were used to estimate DRFI, stratified by lymph node status, for the three predefined 70-gene signature risk groups. Results A reliable 70-gene signature could be obtained for 135 patients. Of the node-negative and node-positive patients, respectively, 20% and 13% had an ultralow-risk classification. No DRFI events were observed for node-negative patients with an ultralow-risk score in the first 10 years. The 10-year DRFI was 90% and 66% in the low-risk (but not ultralow) and high-risk classified node-negative patients, respectively. Conclusion These survival analyses indicate that the postmenopausal node-negative ER+HER2− patients with an ultralow-risk 70-gene signature score have an excellent 10-year DRFI after surgery with a median of 1 year of endocrine treatment. This is in line with published results of the STO-3-randomized clinical trial and supports the concept that it is possible to reduce the duration of endocrine treatment in selected patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06618-z.
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Paluch-Shimon S, Cherny NI, de Vries EGE, Dafni U, Piccart MJ, Latino NJ, Cardoso F. Application of the ESMO-Magnitude of Clinical Benefit Scale (V.1.1) to the field of early breast cancer therapies. ESMO Open 2021; 5:e000743. [PMID: 32893189 PMCID: PMC7476474 DOI: 10.1136/esmoopen-2020-000743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/19/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022] Open
Abstract
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Affiliation(s)
| | | | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Urania Dafni
- National and Kapodistrian University of Athens, Athens, Greece; Frontier Science Foundation-Hellas, Athens, Greece
| | - Martine J Piccart
- Université Libre de Bruxelles, Institut Jules Bordet, Bruxelles, Belgium
| | - Nicola Jane Latino
- ESMO-MCBS Working Group, European Society for Medical Oncology, Viganello, Switzerland
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
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3
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Pieper W, Ignatov A, Kalinski T, Haybaeck J, Czapiewski P, Nass N. The predictive potential of Neuronatin for neoadjuvant chemotherapy of breast cancer. Cancer Biomark 2021; 32:161-173. [PMID: 34092612 DOI: 10.3233/cbm-203127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Neuronatin (NNAT) determined by immunohistochemistry is a negative prognostic biomarker for breast cancer, independent of the major clinicopathological markers. OBJECTIVE Here, we investigated whether NNAT is also a predictive biomarker for pathological remission after neoadjuvant chemotherapy. METHODS One hundred and four breast cancer patients, treated with systemic neoadjuvant chemotherapy were included in this retrospective study. NNAT was detected in formaldehyde fixed, paraffin embedded primary cancer tissue by immunohistochemistry and an immuno-reactive score (IRS) determined. Pathological remission was scored according to Sinn and by evaluation of cytopathic effects. NNAT-IRS was correlated with clinicopathological parameters as well as relapse free and overall survival and for pathological remission after neoadjuvant therapy. RESULTS NNAT IRS was an independent prognostic marker for relapse free and overall survival and the time from diagnosis to the "tumor-free" state. NNAT IRS was associated with Luminal-A tumors and correlated slightly negative with age and lymph-node metastasis. There was no significant correlation of NNAT-IRS with Sinn's remission score, but with cytopathic effects of chemotherapy. CONCLUSIONS We confirmed the prognostic impact of NNAT-IRS in an independent cohort of neoadjuvantly treated patients. Additionally, a correlation with a score for pathological remission under systemic neoadjuvant chemotherapy for breast cancer was found.
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Affiliation(s)
- Willi Pieper
- Department of Pathology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Atanas Ignatov
- Department of Obstetrics and Gynecology, Otto von Guericke University, Magdeburg, Germany.,Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Germany
| | - Thomas Kalinski
- Department of Pathology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Johannes Haybaeck
- Department of Pathology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany.,Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Germany.,Department of Pathology, Diagnostic and Research Center for Molecular BioMedicine, Institute of Pathology, Medical University of Graz, Austria
| | - Piotr Czapiewski
- Department of Pathology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany.,Department of Pathology, Dessau Medical Center, Dessau, Germany.,Department of Pathology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Norbert Nass
- Department of Pathology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany.,Department for Internal Medicine I, Dessau Medical Center, Dessau, Germany.,Department of Pathology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
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4
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Beard K, Meaney DF, Issadore D. Clinical Applications of Extracellular Vesicles in the Diagnosis and Treatment of Traumatic Brain Injury. J Neurotrauma 2020; 37:2045-2056. [PMID: 32312151 PMCID: PMC7502684 DOI: 10.1089/neu.2020.6990] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Extracellular vesicles (EVs) have emerged as key mediators of cell-cell communication during homeostasis and in pathology. Central nervous system (CNS)-derived EVs contain cell type-specific surface markers and intralumenal protein, RNA, DNA, and metabolite cargo that can be used to assess the biochemical and molecular state of neurons and glia during neurological injury and disease. The development of EV isolation strategies coupled with analysis of multi-plexed biomarker and clinical data have the potential to improve our ability to classify and treat traumatic brain injury (TBI) and resulting sequelae. Additionally, their ability to cross the blood-brain barrier (BBB) has implications for both EV-based diagnostic strategies and for potential EV-based therapeutics. In the present review, we discuss encouraging data for EV-based diagnostic, prognostic, and therapeutic strategies in the context of TBI monitoring and management.
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Affiliation(s)
- Kryshawna Beard
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David F. Meaney
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Issadore
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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5
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Porsch M, Özdemir E, Wisniewski M, Graf S, Bull F, Hoffmann K, Ignatov A, Haybaeck J, Grosse I, Kalinski T, Nass N. Time resolved gene expression analysis during tamoxifen adaption of MCF-7 cells identifies long non-coding RNAs with prognostic impact. RNA Biol 2019; 16:661-674. [PMID: 30760083 DOI: 10.1080/15476286.2019.1581597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Acquired tamoxifen resistance is a persistent problem for the treatment of estrogen receptor positive, premenopausal breast cancer patients and predictive biomarkers are still elusive. We here analyzed gene expression changes in a cellular model to identify early and late changes upon tamoxifen exposure and thereby novel prognostic biomarkers. Estrogen receptor positive MCF-7 cells were incubated with 4OH-tamoxifen (10 nM) and gene expression analyzed by array hybridization during 12 weeks. Array results were confirmed by nCounter- and qRT-PCR technique. Pathway enrichment analysis revealed that early responses concerned mainly amine synthesis and NRF2-related signaling and evolved into a stable gene expression pattern within 4 weeks characterized by changes in glucuronidation-, estrogen metabolism-, nuclear receptor- and interferon signaling pathways. As a large number of long non coding RNAs was subject to regulation, we investigated 5 of these (linc01213, linc00632 linc0992, LOC101929547 and XR_133213) in more detail. From these, only linc01213 was upregulated but all were less abundant in estrogen-receptor negative cell lines (MDA-MB 231, SKBR-3 and UACC3199). In a web-based survival analysis linc01213 and linc00632 turned out to have prognostic impact. Linc01213 was investigated further by plasmid-mediated over-expression as well as siRNA down-regulation in MCF-7 cells. Nevertheless, this had no effect on proliferation or expression of tamoxifen regulated genes, but migration was increased. In conclusion, the cellular model identified a set of lincRNAs with prognostic relevance for breast cancer. One of these, linc01213 although regulated by 4OH-tamoxifen, is not a central regulator of tamoxifen adaption, but interferes with the regulation of migration.
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Affiliation(s)
- Martin Porsch
- a Insitute of Computer Science , Martin Luther University Halle-Wittenberg , Halle , Germany.,b Institute of Human Genetics , Martin Luther University Halle-Wittenberg , Halle , Germany.,c German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig , Leipzig , Germany
| | - Esra Özdemir
- d Institute of Pathology, Otto von Guericke University Magdeburg , Magdeburg , Germany
| | - Martin Wisniewski
- d Institute of Pathology, Otto von Guericke University Magdeburg , Magdeburg , Germany
| | - Sebastian Graf
- a Insitute of Computer Science , Martin Luther University Halle-Wittenberg , Halle , Germany
| | - Fabian Bull
- a Insitute of Computer Science , Martin Luther University Halle-Wittenberg , Halle , Germany.,b Institute of Human Genetics , Martin Luther University Halle-Wittenberg , Halle , Germany.,c German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig , Leipzig , Germany
| | - Katrin Hoffmann
- b Institute of Human Genetics , Martin Luther University Halle-Wittenberg , Halle , Germany
| | - Atanas Ignatov
- e Department of Obstetrics and Gynecology , Otto von Guericke University Magdeburg , Magdeburg , Germany
| | - Johannes Haybaeck
- d Institute of Pathology, Otto von Guericke University Magdeburg , Magdeburg , Germany.,f Diagnostic and Research Institute of Pathology , Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz , Graz , Austria.,g Department of Pathology , Medical University of Innsbruck , Innsbruck , Austria
| | - Ivo Grosse
- a Insitute of Computer Science , Martin Luther University Halle-Wittenberg , Halle , Germany.,c German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig , Leipzig , Germany
| | - Thomas Kalinski
- d Institute of Pathology, Otto von Guericke University Magdeburg , Magdeburg , Germany
| | - Norbert Nass
- d Institute of Pathology, Otto von Guericke University Magdeburg , Magdeburg , Germany
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6
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Gingery A, Iwaniec UT, Subramaniam M, Turner RT, Pitel KS, McGovern RM, Reid JM, Marler RJ, Ingle JN, Goetz MP, Hawse JR. Skeletal and Uterotrophic Effects of Endoxifen in Female Rats. Endocrinology 2017; 158:3354-3368. [PMID: 28977607 PMCID: PMC5659691 DOI: 10.1210/en.2016-1871] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 07/31/2017] [Indexed: 12/24/2022]
Abstract
Endoxifen, the primary active metabolite of tamoxifen, is currently being investigated as a novel endocrine therapy for the treatment of breast cancer. Tamoxifen is a selective estrogen receptor modulator that elicits potent anti-breast cancer effects. However, long-term use of tamoxifen also induces bone loss in premenopausal women and is associated with an increased risk of endometrial cancer in postmenopausal women. For these reasons, we have used a rat model system to comprehensively characterize the impact of endoxifen on the skeleton and uterus. Our results demonstrate that endoxifen elicits beneficial effects on bone in ovary-intact rats and protects against bone loss following ovariectomy. Endoxifen is also shown to reduce bone turnover in both ovary-intact and ovariectomized rats at the cellular and biochemical levels. With regard to the uterus, endoxifen decreased uterine weight but maintained luminal epithelial cell height in ovariectomized animals. Within luminal epithelial cells, endoxifen resulted in differential effects on the expression levels of estrogen receptors α and β as well as multiple other genes previously implicated in regulating epithelial cell proliferation and hypertrophy. These studies analyze the impact of extended endoxifen exposure on both bone and uterus using a Food and Drug Administration-recommended animal model. Although endoxifen is a more potent breast cancer agent than tamoxifen, the results of the present study demonstrate that endoxifen does not induce bone loss in ovary-intact rats and that it elicits partial agonistic effects on the uterus and skeleton in ovariectomized animals.
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Affiliation(s)
- Anne Gingery
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota 55905
| | - Urszula T. Iwaniec
- Skeletal Biology Laboratory, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331
| | - Malayannan Subramaniam
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota 55905
| | - Russell T. Turner
- Skeletal Biology Laboratory, School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon 97331
| | - Kevin S. Pitel
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota 55905
| | - Renee M. McGovern
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota 55905
| | - Joel M. Reid
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota 55905
- Department of Oncology, Mayo Clinic, Rochester, Minnesota 55905
| | - Ronald J. Marler
- Department of Comparative Medicine, Mayo Clinic, Scottsdale, Arizona 85259
| | - James N. Ingle
- Department of Oncology, Mayo Clinic, Rochester, Minnesota 55905
| | | | - John R. Hawse
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota 55905
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Regan MM, Walley BA, Francis PA, Fleming GF, Láng I, Gómez HL, Colleoni M, Tondini C, Pinotti G, Salim M, Spazzapan S, Parmar V, Ruhstaller T, Abdi EA, Gelber RD, Coates AS, Goldhirsch A, Pagani O. Concurrent and sequential initiation of ovarian function suppression with chemotherapy in premenopausal women with endocrine-responsive early breast cancer: an exploratory analysis of TEXT and SOFT. Ann Oncol 2017; 28:2225-2232. [PMID: 28911092 PMCID: PMC5834112 DOI: 10.1093/annonc/mdx285] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent breast cancer treatment guidelines recommend that higher-risk premenopausal patients should receive ovarian function suppression (OFS) as part of adjuvant endocrine therapy. If chemotherapy is also given, it is uncertain whether to select concurrent or sequential OFS initiation. DESIGN AND METHODS We analyzed 1872 patients enrolled in the randomized phase III TEXT and SOFT trials who received adjuvant chemotherapy for hormone receptor-positive, HER2-negative breast cancer and upon randomization to an OFS-containing adjuvant endocrine therapy, initiated gonadotropin-releasing-hormone-agonist triptorelin. Breast cancer-free interval (BCFI) was compared between patients who received OFS concurrently with chemotherapy in TEXT (n = 1242) versus sequentially post-chemotherapy in SOFT (n = 630). Because timing of trial enrollment relative to adjuvant chemotherapy differed, we implemented landmark analysis re-defining BCFI beginning 1 year after final dose of chemotherapy (median, 15.5 and 8.1 months from enrollment to landmark in TEXT and SOFT, respectively). As a non-randomized treatment comparison, we implemented comparative-effectiveness propensity score methodology with weighted Cox modeling. RESULTS Distributions of several clinico-pathologic characteristics differed between groups. Patients who were premenopausal post-chemotherapy in SOFT were younger on average. The median duration of adjuvant chemotherapy was 18 weeks in both groups. There were 231 (12%) BC events after post-landmark median follow-up of about 5 years. Concurrent use of triptorelin with chemotherapy was not associated with a significant difference in post-landmark BCFI compared with sequential triptorelin post-chemotherapy, either in the overall population (HR = 1.11, 95% CI 0.72-1.72; P = 0.72; 4-year BCFI 89% in both groups), or in the subgroup of 692 women <40 years at diagnosis (HR = 1.13, 95% CI 0.69-1.84) who are less likely to develop chemotherapy-induced amenorrhea. CONCLUSION Based on comparative-effectiveness modeling of TEXT and SOFT after about 5 years median follow-up, with limited statistical power especially for the subgroup <40 years, neither detrimental nor beneficial effect of concurrent administration of OFS with chemotherapy on the efficacy of adjuvant therapy that includes chemotherapy was detected. CLINICALTRIALS.GOV NCT00066690 and NCT00066703.
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Affiliation(s)
- M. M. Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston
- International Breast Cancer Study Group Statistical Center, Boston, USA
| | - B. A. Walley
- University of Calgary and Canadian Cancer Trials Group, Calgary, Canada
| | - P. A. Francis
- Division of Cancer Medicine, Peter MacCallum Cancer Center, St Vincent’s Hospital, University of Melbourne, Melbourne
- Australia & New Zealand Breast Cancer Trials Group and International Breast Cancer Study Group, Melbourne, Australia
| | - G. F. Fleming
- The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, USA
| | - I. Láng
- National Institute of Oncology and International Breast Cancer Study Group, Medical Oncology, Budapest, Hungary
| | - H. L. Gómez
- Division of Medicine, Instituto Nacional de Enfermedades Neoplásicas and International Breast Cancer Study Group, Lima, Peru
| | - M. Colleoni
- Division of Medical Senology, European Institute of Oncology and International Breast Cancer Study Group, Milan
| | - C. Tondini
- Medical Oncology, Ospedale Papa Giovanni XXIII and International Breast Cancer Study Group, Bergamo
| | - G. Pinotti
- Medical Oncology, ASST Sette Laghi-Ospedale di Circolo and Fondazione Macchi and International Breast Cancer Study Group, Varese, Italy
| | - M. Salim
- Allan Blair Cancer Center, Regina, Canada
| | - S. Spazzapan
- Medical Oncology, Centro di Riferimento Oncologico and International Breast Cancer Study Group, Aviano, Italy
| | - V. Parmar
- Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre and International Breast Cancer Study Group, Mumbai, India
| | - T. Ruhstaller
- Breast Center St. Gallen, Swiss Group for Clinical Cancer Research (SAKK) , St. Gallen
- International Breast Cancer Study Group, St. Gallen, Switzerland
| | - E. A. Abdi
- Australia & New Zealand Breast Cancer Trials Group and International Breast Cancer Study Group, The Tweed Hospital, Griffith University Gold Coast, Tweed Heads, Australia
| | - R. D. Gelber
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston
- Harvard T.H. Chan School of Public Health, Frontier Science and Technology Research Foundation, Boston, USA
| | - A. S. Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - A. Goldhirsch
- European Institute of Oncology and International Breast Cancer Study Group, Milan, Italy
| | - O. Pagani
- Oncology Institute of Southern Switzerland, Swiss Group for Clinical Cancer Research (SAKK), Bellinzona
- International Breast Cancer Study Group, Lugano, Viganello, Switzerland
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Tan S, David J, Lalonde L, El Khoury M, Labelle M, Younan R, Patocskai E, Richard J, Trop I. Breast magnetic resonance imaging: are those who need it getting it? Curr Oncol 2017; 24:e205-e213. [PMID: 28680288 PMCID: PMC5486393 DOI: 10.3747/co.24.3441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Indications for breast magnetic resonance imaging (mri), a very sensitive but less-specific tool for breast investigation, remain controversial, and accessibility is limited. The purposes of our study were to determine the proportion of breast mri exams performed for various clinical indications, to assess the wait times for breast mri, and to create a list of evidence-based indications for breast mri. METHODS The indications for breast mri exams performed in September 2013 at our academic centre were audited. A multidisciplinary meeting held in May 2014 established a list of evidence-based indications for breast mri, after which, in September 2014 and 2015, breast mri exams were re-audited for clinical indications, and pending requests were calculated. RESULTS In September 2013, surveillance of women with a prior diagnosis of breast cancer represented 21% of breast mri exams (24 of 113), with preoperative staging representing 18% of exams (20 of 113) and high-risk screening representing 12% (13 of 113). Of pending mri requests, 230 were within the recommended delay period, and 457 exceeded the recommended delay. After elaboration of evidence-based guidelines, repeat audits in September 2014 and September 2015 showed that mri performed for women with a prior breast cancer diagnosis represented 23% (33 of 141) and 7% (10 of 143) of exams respectively, with preoperative staging having declined to 9% (13 of 141) and 11% (16 of 143) of exams, and high-risk screening having increased to 36% (51 of 141) and 46% (66 of 143) of exams. Overall, wait times were improved for all breast mri indications. CONCLUSIONS Through multidisciplinary discussion, we actualized a list of breast mri indications, prioritized requests more adequately, and improved wait times.
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Affiliation(s)
| | | | | | | | | | | | | | - J. Richard
- Department of General Medicine, l’Université de Montréal, Montreal, QC
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9
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Accumulation of the advanced glycation end product carboxymethyl lysine in breast cancer is positively associated with estrogen receptor expression and unfavorable prognosis in estrogen receptor-negative cases. Histochem Cell Biol 2016; 147:625-634. [PMID: 28012130 DOI: 10.1007/s00418-016-1534-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 12/13/2022]
Abstract
Advanced glycation end products (AGEs) accumulate as a result of high concentrations of reactive aldehydes, oxidative stress, and insufficient degradation of glycated proteins. AGEs are therefore accepted biomarkers for aging, diabetes, and several degenerative diseases. Due to the Warburg effect and increased oxidative stress, cancer cells frequently accumulate significant amounts of AGEs. As the accumulation of AGEs may reflect the metabolic state and receptor signaling, we evaluated the potential prognostic and predictive value of this biomarker. We used immunohistochemistry to determine the AGE Nε-carboxymethyl lysine (CML) in 213 mammary carcinoma samples and Western blotting to detect AGEs in cell cultures. Whereas no significant correlation between hormone receptor status and CML was observed in cell lines, CML accumulation in tumors was positively correlated with the presence of estrogen receptor alpha, the postmenopausal state, and age. A negative correlation was found for grade III carcinomas and triple-negative cases. In a retrospective Kaplan-Meier survival analysis, there was a statistical trend that high CML accumulation correlated with a more favorable prognosis (relapse-free survival, RFS) under tamoxifen treatment (p = 0.1). In estrogen receptor-negative cases, the high CML content was significantly correlated with an unfavorable outcome (RFS) of chemotherapy (p = 0.046). CML is a therefore a potentially predictive marker for the treatment of breast cancer patients with tamoxifen or chemotherapy.
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Bellerby R, Smith C, Kyme S, Gee J, Günthert U, Green A, Rakha E, Barrett-Lee P, Hiscox S. Overexpression of Specific CD44 Isoforms Is Associated with Aggressive Cell Features in Acquired Endocrine Resistance. Front Oncol 2016; 6:145. [PMID: 27379207 PMCID: PMC4913094 DOI: 10.3389/fonc.2016.00145] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/27/2016] [Indexed: 12/23/2022] Open
Abstract
While endocrine therapy is the mainstay of ER+ breast cancer, the clinical effectiveness of these agents is limited by the phenomenon of acquired resistance that is associated with disease relapse and poor prognosis. Our previous studies revealed that acquired resistance is accompanied by a gain in cellular invasion and migration and also that CD44 family proteins are overexpressed in the resistant phenotype. Given the association of CD44 with tumor progression, we hypothesized that its overexpression may act to promote the aggressive behavior of endocrine-resistant breast cancers. Here, we have investigated further the role of two specific CD44 isoforms, CD44v3 and CD44v6, in the endocrine-resistant phenotype. Our data revealed that overexpression of CD44v6, but not CD44v3, in endocrine-sensitive MCF-7 cells resulted in a gain in EGFR signaling, enhanced their endogenous invasive capacity, and attenuated their response to endocrine treatment. Suppression of CD44v6 in endocrine-resistant cell models was associated with a reduction in their invasive capacity. Our data suggest that upregulation of CD44v6 in acquired resistant breast cancer may contribute to a gain in the aggressive phenotype of these cells and loss of endocrine response through transactivation of the EGFR pathway. Future therapeutic targeting of CD44v6 may prove to be an effective strategy alongside EGFR-targeted agents in delaying/preventing acquired resistance in breast cancer.
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Affiliation(s)
- Rebecca Bellerby
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University , Cardiff , UK
| | - Chris Smith
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University , Cardiff , UK
| | - Sue Kyme
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University , Cardiff , UK
| | - Julia Gee
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University , Cardiff , UK
| | - Ursula Günthert
- Institute of Pathology, University Hospital of Basel , Basel , Switzerland
| | - Andy Green
- Faculty of Medicine and Health Sciences, University of Nottingham , Nottingham , UK
| | - Emad Rakha
- Faculty of Medicine and Health Sciences, University of Nottingham , Nottingham , UK
| | | | - Stephen Hiscox
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University , Cardiff , UK
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11
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Nass N, Sel S, Ignatov A, Roessner A, Kalinski T. Oxidative stress and glyoxalase I activity mediate dicarbonyl toxicity in MCF-7 mamma carcinoma cells and a tamoxifen resistant derivative. Biochim Biophys Acta Gen Subj 2016; 1860:1272-80. [PMID: 26971627 DOI: 10.1016/j.bbagen.2016.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/25/2016] [Accepted: 03/06/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Acquired tamoxifen resistance is a significant problem in estrogen receptor positive breast cancer. In a cellular model, tamoxifen resistance was associated with increased sensitivity towards toxic dicarbonyls and reduced free sulfhydryl group content. We here analyzed the role of oxidative stress and glyoxalase I activity on dicarbonyl resistance and the significance of glyoxalase I expression for survival. METHODS Reactive oxygen species were determined by 2,7-dihydrochlorofluorescein diacetate. Inhibitors for NADPH-oxidase (diphenyleneiodonium), p38 MAPK (SB203580) and ERK1/2 (UO126) were applied to investigate interactions of these signaling molecules. N-acetyl cysteine was used to evaluate the effect of oxidative stress on cell viability, which was assessed by the resazurin assay. Gene expression was analyzed by real time qRT-PCR. Glyoxalase activity was inhibited by the specific inhibitor CS-0683 and siRNA. The relevance of glyoxalase 1 mRNA abundance on survival of breast cancer patients was evaluated by the KM-plotter web interface. RESULTS α-Oxo-aldehydes caused an immediate increase in reactive oxygen species where the tamoxifen resistant cell line (TamR) responded at lower concentrations than the MCF-7 parental cell line. Inhibitor studies placed ROS production by NADPH-oxidase downstream of p38 MAPK. The antioxidant N-acetyl cysteine (NAC) increased survival, whereas glyoxalase (GLO1) inhibition increased dicarbonyl toxicity. GLO1 mRNA abundance was correlated with unfavorable prognosis of breast cancer patients. CONCLUSIONS Dicarbonyl toxicity was mediated by oxidative stress and GLO1 activity determines aldehyde toxicity in tamoxifen resistant cells. GENERAL SIGNIFICANCE Glyoxalases might be predictive biomarkers for tamoxifen resistance and a putative target for the treatment of tamoxifen resistant breast cancer patients.
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Affiliation(s)
- Norbert Nass
- Otto von Guericke University Magdeburg, Department of Pathology, Leipziger Str. 44, House 28, D-39120 Magdeburg, Germany.
| | - Saadettin Sel
- University of Heidelberg, Department of Ophthalmology, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany
| | - Atanas Ignatov
- Otto von Guericke University Magdeburg, Department of Obstetrics and Gynecology, Gerhart-Hauptmann Str. 35, 39108 Magdeburg, Germany
| | - Albert Roessner
- Otto von Guericke University Magdeburg, Department of Pathology, Leipziger Str. 44, House 28, D-39120 Magdeburg, Germany
| | - Thomas Kalinski
- Otto von Guericke University Magdeburg, Department of Pathology, Leipziger Str. 44, House 28, D-39120 Magdeburg, Germany
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Coory M, Lamb KE, Sorich M. Risk-difference curves can be used to communicate time-dependent effects of adjuvant therapies for early stage cancer. J Clin Epidemiol 2014; 67:966-72. [DOI: 10.1016/j.jclinepi.2014.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/23/2014] [Accepted: 03/18/2014] [Indexed: 11/16/2022]
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Quantitative analysis of estrogen receptor expression shows SP1 antibody is more sensitive than 1D5. Appl Immunohistochem Mol Morphol 2013; 21:139-47. [PMID: 22820659 DOI: 10.1097/pai.0b013e31825d73b2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies comparing rabbit monoclonal SP1 antibody with 1D5 for estrogen receptor (ER) immunohistochemical testing show conflicting results. Here we use a standardized quantitative immunofluorescent (QIF) ER assay to determine the level and significance of discordance between the antibodies. Both antibodies were assessed by QIF on our Index TMA of cell lines and case controls, followed by QIF and immunohistochemical analysis on 2 retrospective cohorts from Yale. On the Index TMA, SP1 displayed stronger signal-to-noise ratio compared with 1D5. On the patient cohorts, the range of discrepancy between the 2 antibodies was 8% to 16.9%, with the majority of discrepant cases being SP1 positive/1D5 negative. Kaplan-Meier analysis of the discrepant cases showed outcomes comparable to those of double-positive cases, suggesting that SP1 is more sensitive than 1D5. A series of cases with high levels of ER-β shows that neither antibody cross-reacts, suggesting equivalent specificity. Future efforts are needed to determine whether response to endocrine therapies show superiority of either antibody as a companion diagnostic test.
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Mittempergher L, Saghatchian M, Wolf DM, Michiels S, Canisius S, Dessen P, Delaloge S, Lazar V, Benz SC, Tursz T, Bernards R, van't Veer LJ. A gene signature for late distant metastasis in breast cancer identifies a potential mechanism of late recurrences. Mol Oncol 2013; 7:987-99. [PMID: 23910573 DOI: 10.1016/j.molonc.2013.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/02/2013] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Breast cancer risk of recurrence is known to span 20 years, yet existing prognostic signatures are best at predicting early recurrences (≤ 5 years). There is a critical need to identify those patients at risk of late-relapse (>5 years), in order to select potential candidates for further treatment and to identify molecular targets for such treatment. METHODS A total of 252 breast primary tumors were selected at the Netherlands Cancer Institute from a retrospective series of ER+, HER2- breast cancer patients with a follow-up of at least 10 years. Gene expression analysis was performed using Agilent 4x44K microarrays. Patients were classified in 3 groups: no relapse (M0); relapse before 5 years (M0-5) or after 5 years (M5-15). We assessed the correlation of clinico-pathological variables with late Distant Metastases (DM). We divided the patient series into a training set of untreated patients (n = 140) and a test set of treated patients (n = 112), to investigate whether a gene-signature or single genes could be identified for predicting late DM. Pathway level late DM correlates were identified using PARADIGM and DAVID. RESULTS Of the clinico-pathologic variables tested, only lymph node status associated with late DM. A 241-gene signature developed on the NKI training set was able to classify M5-15 patients in the test set with a sensitivity of 77% and a specificity of 33% (AUC 0.654). This signature showed enrichment in genes involved in immune response and extracellular matrix. An alternative analysis of individual genes identified CH25H as an independent predictor of distant metastasis in our patient series. CONCLUSIONS We identified a gene signature for late metastasis in breast cancer. Our data are consistent with a model in which suppressed anti-tumoral immunity enables dormant tumor cells to re-enter the cell cycle to form metastases in response to extrinsic events in the microenvironment.
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Affiliation(s)
- Lorenza Mittempergher
- The Netherlands Cancer Institute, Division of Molecular Carcinogenesis, Amsterdam, The Netherlands
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15
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Duffy MJ, Crown J. Companion biomarkers: paving the pathway to personalized treatment for cancer. Clin Chem 2013; 59:1447-56. [PMID: 23656699 DOI: 10.1373/clinchem.2012.200477] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Companion biomarkers are biomarkers that are used in combination with specific therapies and that prospectively help predict likely response or severe toxicity. In this article we review the role of companion biomarkers in guiding treatment in patients with cancer. CONTENT In addition to the established companion biomarkers such as estrogen receptors and HER2 (human epidermal growth factor receptor 2) in breast cancer, several new companion biomarkers have become available in recent years. These include v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations for the selection of patients with advanced colorectal cancer who are unlikely to benefit from anti-epidermal growth factor receptor antibodies (cetuximab or panitumumab), epidermal growth factor receptor (EGFR) mutations for selecting patients with advanced non-small cell lung cancer (NSCLC) for treatment with tyrosine kinase inhibitors (gefitinib or erlotinib), v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutations for selecting patients with advanced melanoma for treatment with anti-BRAF agents (vemurafenib and dabrafenib), and anaplastic lymphoma receptor tyrosine kinase (ALK) translocations for identifying patients with NSCLC likely to benefit from crizotinib. SUMMARY The availability of companion biomarkers should improve drug efficacy, decrease toxicity, and lead to a more individualized approach to cancer treatment.
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Affiliation(s)
- Michael J Duffy
- UCD School of Medicine and Medical Science, Conway Institute, University College Dublin, Ireland
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