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Askoxylakis V, Ferraro GB, Kodack DP, Badeaux M, Shankaraiah RC, Seano G, Kloepper J, Vardam T, Martin JD, Naxerova K, Bezwada D, Qi X, Selig MK, Brachtel E, Duda DG, Huang P, Fukumura D, Engelman JA, Jain RK. Preclinical Efficacy of Ado-trastuzumab Emtansine in the Brain Microenvironment. J Natl Cancer Inst 2016; 108:djv313. [PMID: 26547932 PMCID: PMC4862418 DOI: 10.1093/jnci/djv313] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 05/27/2015] [Accepted: 09/28/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Central nervous system (CNS) metastases represent a major problem in the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer because of the disappointing efficacy of HER2-targeted therapies against brain lesions. The antibody-drug conjugate ado-trastuzumab emtansine (T-DM1) has shown efficacy in trastuzumab-resistant systemic breast cancer. Here, we tested the hypothesis that T-DM1 could overcome trastuzumab resistance in murine models of brain metastases. METHODS We treated female nude mice bearing BT474 or MDA-MB-361 brain metastases (n = 9-11 per group) or cancer cells grown in organotypic brain slice cultures with trastuzumab or T-DM1 at equivalent or equipotent doses. Using intravital imaging, molecular techniques and histological analysis we determined tumor growth, mouse survival, cancer cell apoptosis and proliferation, tumor drug distribution, and HER2 signaling. Data were analyzed with one-way analysis of variance (ANOVA), Kaplan-Meier analysis, and Coefficient of Determination. All statistical tests were two-sided. RESULTS T-DM1 delayed the growth of HER2-positive breast cancer brain metastases compared with trastuzumab. These findings were consistent between HER2-driven and PI3K-driven tumors. The activity of T-DM1 resulted in a survival benefit (median survival for BT474 tumors: 28 days for trastuzumab vs 112 days for T-DM1, hazard ratio = 6.2, 95% confidence interval = 6.1 to 85.84, P < .001). No difference in drug distribution or HER2-signaling was revealed between the two groups. However, T-DM1 led to a statistically significant increase in tumor cell apoptosis (one-way ANOVA for ApopTag, P < .001), which was associated with mitotic catastrophe. CONCLUSIONS T-DM1 can overcome resistance to trastuzumab therapy in HER2-driven or PI3K-driven breast cancer brain lesions due to the cytotoxicity of the DM1 component. Clinical investigation of T-DM1 for patients with CNS metastases from HER2-positive breast cancer is warranted.
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MESH Headings
- Ado-Trastuzumab Emtansine
- Animals
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/pharmacology
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/pharmacology
- Apoptosis/drug effects
- Biomarkers, Tumor/analysis
- Blotting, Western
- Brain Neoplasms/chemistry
- Brain Neoplasms/drug therapy
- Brain Neoplasms/secondary
- Breast Neoplasms/chemistry
- Breast Neoplasms/pathology
- Cell Proliferation/drug effects
- Drug Administration Schedule
- Drug Resistance, Neoplasm
- Female
- Gene Expression Profiling
- Kaplan-Meier Estimate
- Maytansine/administration & dosage
- Maytansine/analogs & derivatives
- Maytansine/pharmacology
- Mice
- Mice, Nude
- Microarray Analysis
- Microscopy, Electron
- Odds Ratio
- Receptor, ErbB-2/analysis
- Trastuzumab
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Vasileios Askoxylakis
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Gino B Ferraro
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - David P Kodack
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Mark Badeaux
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Ram C Shankaraiah
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Giorgio Seano
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Jonas Kloepper
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Trupti Vardam
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - John D Martin
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Kamila Naxerova
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Divya Bezwada
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Xiaolong Qi
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Martin K Selig
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Elena Brachtel
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Dan G Duda
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Peigen Huang
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Dai Fukumura
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Jeffrey A Engelman
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Rakesh K Jain
- : Edwin L. Steele Laboratories, Department of Radiation Oncology (VA, GBF, DPK, MB, RCS, GS, JK, TV, JDM, KN, DB, XQ, DGD, PH, DF, RKJ), Department of Pathology (MKS, EB), and Department of Medicine, Cancer Center (JAE), Massachusetts General Hospital and Harvard Medical School, Boston MA.
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