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Matoba Y, Devins KM, Milane L, Manning WB, Mazina V, Yeku OO, Rueda BR. High-Grade Endometrial Cancer: Molecular Subtypes, Current Challenges, and Treatment Options. Reprod Sci 2024:10.1007/s43032-024-01544-5. [PMID: 38658487 DOI: 10.1007/s43032-024-01544-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
Although many recent advancements have been made in women's health, perhaps one of the most neglected areas of research is the diagnosis and treatment of high-grade endometrial cancer (EnCa). The molecular classification of EnCa in concert with histology was a major step forward. The integration of profiling for mismatch repair deficiency and Human Epidermal Growth Factor 2 (HER2) overexpression, can further inform treatment options, especially for drug resistant recurrent disease. Recent early phase trials suggest that regardless of subtype, combination therapy with agents that have distinct mechanisms of action is a fruitful approach to the treatment of high-grade EnCa. Unfortunately, although the importance of diagnosis and treatment of high-grade EnCa is well recognized, it is understudied compared to other gynecologic and breast cancers. There remains a tremendous need to couple molecular profiling and biomarker development with promising treatment options to inform new treatment strategies with higher efficacy and safety for all who suffer from high-grade recurrent EnCa.
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Affiliation(s)
- Yusuke Matoba
- Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 60 Blossom St, 02114, Boston, MA, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 02115, Boston, MA, USA
| | - Kyle M Devins
- Department of Pathology, Massachusetts General Hospital, 021151, Boston, MA, USA
| | - Lara Milane
- Department of Pharmaceutical Sciences, Bouvé College of Health Sciences, Northeastern University, 02115, Boston, MA, USA
| | - William B Manning
- Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 60 Blossom St, 02114, Boston, MA, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 02115, Boston, MA, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 02114, Boston, MA, USA
| | - Varvara Mazina
- Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 60 Blossom St, 02114, Boston, MA, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 02115, Boston, MA, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 02114, Boston, MA, USA
| | - Oladapo O Yeku
- Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 60 Blossom St, 02114, Boston, MA, USA
- Cancer Center, Massachusetts General Hospital, 55 Fruit St, 02114, Boston, MA, USA
| | - Bo R Rueda
- Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 60 Blossom St, 02114, Boston, MA, USA.
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 02115, Boston, MA, USA.
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Zhang H, Finkelman BS, Ettel MG, Velez MJ, Turner BM, Hicks DG. HER2 evaluation for clinical decision making in human solid tumours: pearls and pitfalls. Histopathology 2024. [PMID: 38443321 DOI: 10.1111/his.15170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/23/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024]
Abstract
The significant clinical benefits of human epidermal growth factor receptor 2 (HER2)-targeted therapeutic agents have revolutionized the clinical treatment landscape in a variety of human solid tumours. Accordingly, accurate evaluation of HER2 status in these different tumour types is critical for clinical decision making to select appropriate patients who may benefit from life-saving HER2-targeted therapies. HER2 biomarker scoring criteria is different in different organ systems, and close adherence to the corresponding HER2 biomarker testing guidelines and their updates, if available, is essential for accurate evaluation. In addition, knowing the unusual patterns of HER2 expression is also important to avoid inaccurate evaluation. In this review, we discuss the key considerations when evaluating HER2 status in solid tumours for clinical decision making, including tissue handling and preparation for HER2 biomarker testing, as well as pathologist's readout of HER2 testing results in breast carcinomas, gastroesophageal adenocarcinomas, colorectal adenocarcinomas, gynaecologic carcinomas, and non-small cell lung carcinomas.
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Affiliation(s)
- Huina Zhang
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Brian S Finkelman
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Mark G Ettel
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Moises J Velez
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Bradley M Turner
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - David G Hicks
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
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Hashem S, Zare SY, Fadare O. HER2 Status Assessment in Endometrial Serous Carcinoma: Comparative Analysis of Two Proposed Testing and Interpretation Algorithms. Int J Gynecol Pathol 2024; 43:4-14. [PMID: 37406350 DOI: 10.1097/pgp.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
HER2 status is now routinely assessed in endometrial serous carcinoma (ESC) due to the reported predictive value of HER2 protein overexpression and/or gene amplification. Herein the authors compare 2 proposed testing and interpretation guidelines for HER2 in ESC. Forty-three consecutive cases of ESC that had been dually tested by both HER2 immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) were interpreted using 2 sets of guidelines. Guideline set 1 (GS1) is the 2018 American Society of Clinical Oncology/College of American Pathologists guidelines for breast cancer. Guideline set 2 (GS2) is a recent proposal that is a slight modification of the enrollment criteria for the clinical trial (NCT01367002) that demonstrated a survival benefit for anti-HER2 therapy in ESC. By IHC, GS1 and GS2, respectively classified 39.5% (17/43) and 28% (12/43) of ESC as HER2-negative, 37.2% (16/43) and 53.4% (23/43) as HER2 equivocal, and 23.2% (10/43) and 18.6% (8/43) as HER2-positive ( P > 0.05 for all). IHC and FISH were highly concordant at the extremes using either set of guidelines, as no cases were found to be IHC3+/FISH-negative or IHC 0-1+/FISH-positive. GS1 and GS2 were comparable regarding the proportion of IHC equivocal cases that were HER2 amplified by FISH (19% vs 23% respectively; [ P = 0.71]). GS1 and GS2 displayed 98% (42/43) concordance regarding the final (IHC and/or FISH-based) classification of tumors as being HER2-positive or negative, and the same 13 cases were ultimately classified as HER2 amplified using either GS1 or GS2. One "discordant" case was classified as HER2-positive using GS2 but HER2-negative using GS1 (HER2 IHC score 2+ using both guidelines, HER2:CEP17 signal ratio of 3, HER2 signal number of 3.4). Six (14%) of the 43 cases (FISH Groups: 2, 3, and 4) would require IHC results to interpret the FISH findings using GS1. Because GS1 requires that the HER2 IHC staining be observed within a homogeneous and contiguous invasive cell population, and this is not a requirement in GS2, GS2 may be better suited for ESC given its frequently heterogeneous staining pattern. Additional studies may be required on the optimal interpretation of problematic dual-probe FISH scenarios in GS2 and the necessity for IHC correlation in such scenarios. Using either set of guidelines, our findings support a reflex testing strategy of restricting FISH testing to cases that are IHC equivocal.
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Navarro Sanchez JM, Finkelman BS, Turner BM, Katerji H, Wang X, Varghese S, Wang T, Peng Y, Hicks DG, Zhang H. HER2 in uterine serous carcinoma: Current state and clinical perspectives. Am J Clin Pathol 2023; 160:341-351. [PMID: 37267036 DOI: 10.1093/ajcp/aqad056] [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: 03/03/2023] [Accepted: 04/21/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES Uterine cancer has the highest incidence and the second-highest mortality rate among gynecologic malignancies in the United States. Although uterine serous carcinoma (USC) represents less than 10% of endometrial carcinomas, it accounts for a disproportionate 50% of tumor relapses and 40% of endometrial cancer deaths. Over the past decade, clinical trials have focused on finding better treatments for this aggressive subtype of endometrial cancer, especially HER2-targeted therapy. METHODS We conducted a literature search in PubMed to expand the understanding of HER2 in USC. RESULTS HER2 has been established as an important biomarker with prognostic and therapeutic implications in USC. Intratumoral heterogeneity and lateral/basolateral membranous staining of HER2 as well as high discordance between HER2 immunohistochemistry and in situ hybridization are more common in USC than in breast carcinoma. Therefore, a universal HER2 testing and scoring system more suitable to endometrial cancer is needed and currently under investigation. CONCLUSIONS This review discusses the clinical perspective of HER2 overexpression/gene amplification in USC, the distinct HER2 staining pattern and the evaluation of HER2 in USC, the resistance mechanisms of HER2-targeted therapy in HER2-positive cancers, and likely areas of future investigation.
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Affiliation(s)
| | - Brian S Finkelman
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, US
| | - Bradley M Turner
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, US
| | - Hani Katerji
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, US
| | - Xi Wang
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, US
| | - Sharlin Varghese
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, US
| | - Tiannan Wang
- Department of Pathology, University of Southern California, Los Angeles, CA, US
| | - Yan Peng
- Department of Pathology and Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, US
| | - David G Hicks
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, US
| | - Huina Zhang
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, US
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Androutsopoulos G, Styliara I, Zarogianni E, Lazurko N, Valasoulis G, Michail G, Adonakis G. The ErbB Signaling Network and Its Potential Role in Endometrial Cancer. EPIGENOMES 2023; 7:24. [PMID: 37873809 PMCID: PMC10594534 DOI: 10.3390/epigenomes7040024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
Endometrial cancer (EC) is the second most common malignancy of the female reproductive system worldwide. The updated EC classification emphasizes the significant role of various signaling pathways such as PIK3CA-PIK3R1-PTEN and RTK/RAS/β-catenin in EC pathogenesis. Some of these pathways are part of the EGF system signaling network, which becomes hyperactivated by various mechanisms and participates in cancer pathogenesis. In EC, the expression of ErbB receptors is significantly different, compared with the premenopausal and postmenopausal endometrium, mainly because of the increased transcriptional activity of ErbB encoding genes in EC cells. Moreover, there are some differences in ErbB-2 receptor profile among EC subgroups that could be explained by the alterations in pathophysiology and clinical behavior of various EC histologic subtypes. The fact that ErbB-2 receptor expression is more common in aggressive EC histologic subtypes (papillary serous and clear cell) could indicate a future role of ErbB-targeted therapies in well-defined EC subgroups with overexpression of ErbB receptors.
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Affiliation(s)
- Georgios Androutsopoulos
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, School of Medicine, University of Patras, 26504 Rion, Greece
- Department of Obstetrics and Gynaecology, School of Medicine, University of Patras, 26504 Rion, Greece; (I.S.); (E.Z.); (N.L.); (G.M.); (G.A.)
| | - Ioanna Styliara
- Department of Obstetrics and Gynaecology, School of Medicine, University of Patras, 26504 Rion, Greece; (I.S.); (E.Z.); (N.L.); (G.M.); (G.A.)
| | - Evgenia Zarogianni
- Department of Obstetrics and Gynaecology, School of Medicine, University of Patras, 26504 Rion, Greece; (I.S.); (E.Z.); (N.L.); (G.M.); (G.A.)
| | - Nadia Lazurko
- Department of Obstetrics and Gynaecology, School of Medicine, University of Patras, 26504 Rion, Greece; (I.S.); (E.Z.); (N.L.); (G.M.); (G.A.)
| | - George Valasoulis
- Department of Obstetrics and Gynaecology, Medical School, University of Thessaly, 41334 Larisa, Greece;
- Hellenic National Public Health Organization—ECDC, 15123 Athens, Greece
| | - Georgios Michail
- Department of Obstetrics and Gynaecology, School of Medicine, University of Patras, 26504 Rion, Greece; (I.S.); (E.Z.); (N.L.); (G.M.); (G.A.)
| | - Georgios Adonakis
- Department of Obstetrics and Gynaecology, School of Medicine, University of Patras, 26504 Rion, Greece; (I.S.); (E.Z.); (N.L.); (G.M.); (G.A.)
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Ross DS, Devereaux KA, Jin C, Lin DY, Zhang Y, Marra A, Makker V, Weigelt B, Ellenson LH, Chui MH. Histopathologic features and molecular genetic landscape of HER2-amplified endometrial carcinomas. Mod Pathol 2022; 35:962-971. [PMID: 34972830 PMCID: PMC9990080 DOI: 10.1038/s41379-021-00997-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022]
Abstract
HER2 is an established therapeutic biomarker in advanced or recurrent endometrial serous carcinoma. Current clinical guidelines recommend HER2 testing exclusively in this endometrial carcinoma (EC) subtype; however, the full spectrum of ECs harboring HER2 amplification remains ill-defined. The present study characterizes the clinicopathologic and molecular features of HER2-amplified ECs across all histologic subtypes. Retrospective analysis of our institutional cohort of 2,042 ECs subjected to targeted clinical massively parallel sequencing identified 77 (3.8%) cases with HER2 amplification, a group comprised of serous (n = 29), endometrioid (low-grade, n = 2, high-grade, n = 1) and clear cell (n = 4) carcinomas, carcinosarcomas (n = 18) and high-grade ECs with ambiguous features (HGEC, n = 23). A co-existing TP53 mutation was identified in 94% (72/77) of HER2-amplified ECs. Other recurrent genetic alterations included amplification of CCNE1 (22%) and ERBB3 (10%), FBXW7 mutations or deletions (13%), and mutations in PIK3CA (40%) and PPP2R1A (13%). The HER2 immunohistochemistry score was 2+ or 3+ for all evaluable cases (n = 61). Apart from carcinosarcomas, which often showed lower HER2 expression, particularly in the sarcomatous component, HER2 immunohistochemical staining pattern and intensity were similar across EC subtypes. Intratumor heterogeneity in HER2 expression was common and correlated with genetic heterogeneity as detected by fluorescence in-situ hybridization. These results demonstrate the frequent co-occurrence of HER2 amplification with TP53 mutation and high-grade histology, rather than being specific to serous carcinoma, per se. Overall, these findings suggest that HER2 targeted therapy may be more broadly applicable to all high-grade EC histotypes and consideration should be given to expanding therapeutic eligibility.
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Affiliation(s)
- Dara S Ross
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kelly A Devereaux
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Cao Jin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David YunTe Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yanming Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Antonio Marra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vicky Makker
- Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lora H Ellenson
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Herman Chui
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Tymon-Rosario J, Siegel ER, Bellone S, Harold J, Adjei N, Zeybek B, Mauricio D, Altwerger G, Menderes G, Ratner E, Clark M, Andikyan V, Huang GS, Azodi M, Schwartz PE, Fader AN, Santin AD. Trastuzumab tolerability in the treatment of advanced (stage III-IV) or recurrent uterine serous carcinomas that overexpress HER2/neu. Gynecol Oncol 2021; 163:93-99. [PMID: 34372971 DOI: 10.1016/j.ygyno.2021.07.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Due to previously reported trastuzumab safety concerns and the scant data available in endometrial cancer patients, we sought to assess the safety, tolerability and toxicity profile of trastuzumab in patients with advanced/recurrent uterine serous carcinoma (USC) that overexpress HER2/neu in our multicenter randomized phase II trial. METHODS Patients were randomized 1:1 to receive carboplatin/paclitaxel (C/P) for 6 cycles ± trastuzumab (T) with the experimental arm continuing to receive single agent trastuzumab maintenance treatment until disease progression/toxicity. Progression-free-survival was the primary endpoint; overall-survival and toxicity were secondary endpoints. Adverse events (AEs) were compared between treatment arms. RESULTS There were 28 patients in the C/P arm and 32 patients in the experimental (C/P + T) arm. Fifty-eight patients (97%) experienced 977 treatment-related AEs of which 875 (89.6%) were low-grade (grade 1-2) and 102 (10.4%) were high-grade (grade 3-5). The mean ± standard deviation of AEs per patient was 15.5 ± 16.3 in the C/P arm and 17.0 ± 16.0 in the C/P + T arm. Gastrointestinal AEs were the most common in both arms (n = 155, 15.7%) of which 94.2% were low-grade (n = 146). Importantly, no significant difference between treatment arms was detected in any system-organ class of AE including cardiac AE. Five (17%) of 29 patients who received prolonged trastuzumab maintenance therapy had no sign of cumulative toxicity after an average (range) of 5.1 (4.2-6.3) years. CONCLUSIONS Trastuzumab appears to be safe and has a manageable toxicity profile both when used in combination with chemotherapy and when used for single agent maintenance in patients with HER2/neu positive USC. This safety profile is reassuring given the proven efficacy of trastuzumab in advanced/recurrent HER2/neu positive USC.
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Affiliation(s)
- Joan Tymon-Rosario
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stefania Bellone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Justin Harold
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Naomi Adjei
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Burak Zeybek
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Dennis Mauricio
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Gary Altwerger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Gulden Menderes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Elena Ratner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Mitchell Clark
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Vaagn Andikyan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Gloria S Huang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Masoud Azodi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA
| | | | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, CT 06520, USA.
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HER-2 Amplification in Uterine Serous Carcinoma and Serous Endometrial Intraepithelial Carcinoma. Am J Surg Pathol 2021; 45:708-715. [PMID: 33739786 DOI: 10.1097/pas.0000000000001682] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Human epidermal growth factor receptor 2 (HER-2) targeted therapy shows promising results in HER-2-positive uterine serous carcinoma (USC). HER-2 scoring criteria for USC and its associated noninvasive lesion, serous endometrial intraepithelial carcinoma (SEIC), are not well-established. Here, we compare the breast and gastric (GI) HER-2 immunohistochemistry (IHC) scoring criteria for HER-2 with HER-2/neu fluorescence in situ hybridization (FISH) in 68 tumors (17 USC with SEIC, 30 USC, 18 SEIC, 3 metastatic USC). The majority (97%) of lesions displayed intratumoral HER-2 IHC heterogeneity. Breast or GI IHC scoring criteria were performed equivalently. The breast and GI IHC criteria classified 51% and 47% USC as HER-2 negative (IHC 0/1+), 40% and 45% as equivocal (IHC 2+), and 9% each as HER-2 positive (IHC 3+). A quarter of USC classified as HER-2 negative or positive with the breast (25%, n=7/28) or GI IHC criteria (23%, n=6/26) was discordant by FISH. Specifically, 13% to 14% of IHC 0/1+ USC were FISH amplified; 50% of IHC 3+ USC were FISH negative. The majority (77% to 83%) of SEIC were HER-2 IHC 0/1+, and no SEIC was HER-2 IHC 3+. A minority (4% to 7%) of IHC 0/1+ SEIC were FISH positive. Discordant HER-2 status was observed between half (47%,bn=7/15) of synchronous SEIC and USC. In conclusion, USC displays HER-2 intratumoral heterogeneity, a high IHC/FISH discordance rate, and variation in HER-2 status between the SEIC and invasive components. Caution is required when evaluating HER-2 in small biopsies, which should be repeated on excisions. Both IHC and FISH should be performed on USC until clinical trials correlate HER-2 status with clinical response to HER-2-targeted therapy.
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Robinson CL, Harrison BT, Ligon AH, Dong F, Maffeis V, Matulonis U, Nucci MR, Kolin DL. Detection of ERBB2 amplification in uterine serous carcinoma by next-generation sequencing: an approach highly concordant with standard assays. Mod Pathol 2021; 34:603-612. [PMID: 33077919 DOI: 10.1038/s41379-020-00695-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 01/29/2023]
Abstract
Uterine serous carcinoma is an aggressive subtype of endometrial cancer that accounts for fewer than 10% of endometrial carcinomas but is responsible for about half of deaths. A subset of cases has HER2 overexpression secondary to ERBB2 gene amplification, and these patients may benefit from anti-HER2 therapies, such as trastuzumab. HER2 protein overexpression is currently assessed by immunohistochemistry (IHC) and ERBB2 gene amplification by fluorescence in situ hybridization (FISH). Targeted next-generation sequencing (NGS) is increasingly used to routinely identify predictive and prognostic molecular abnormalities in endometrial carcinoma. To investigate the ability of a targeted NGS panel to detect ERBB2 amplification, we identified cases of uterine serous carcinoma (n = 93) and compared HER2 expression by IHC and copy number assessed by FISH with copy number status assessed by NGS. ERBB2 copy number status using a combination of IHC and FISH was interpreted using the 2018 ASCO/CAP guidelines for breast carcinoma. ERBB2 amplification by NGS was determined by the relative number of reads mapping to ERBB2 in tumor DNA compared to control nonneoplastic DNA. Cases with copy number ≥6 were considered amplified and copy number <6 were non-amplified. By IHC, 70 specimens were classified as negative (0 or 1+), 19 were classified as equivocal (2+), and 4 were classified as positive (3+). Using combined IHC/FISH, ERBB2 amplification was observed in 8 of 93 cases (9%). NGS identified the same 8 cases with copy number ≥6; all 85 others had copy number <6. In this series, NGS had 100% concordance with combined IHC/FISH in identifying ERBB2 amplification. NGS is highly accurate in detecting ERBB2 amplification in uterine serous carcinoma and provides an alternative to measurement by IHC and FISH.
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Affiliation(s)
| | - Beth T Harrison
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Azra H Ligon
- Department of Pathology, Division of Clinical Cytogenetics, Brigham and Women's Hospital, Boston, MA, USA
| | - Fei Dong
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Valeria Maffeis
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | | | - Marisa R Nucci
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - David L Kolin
- Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, MA, USA.
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10
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Randomized Phase II Trial of Carboplatin–Paclitaxel Compared with Carboplatin–Paclitaxel–Trastuzumab in Advanced (Stage III–IV) or Recurrent Uterine Serous Carcinomas that Overexpress Her2/Neu (NCT01367002): Updated Overall Survival Analysis. Clin Cancer Res 2020; 26:3928-3935. [DOI: 10.1158/1078-0432.ccr-20-0953] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 12/30/2022]
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11
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Bonazzoli E, Cocco E, Lopez S, Bellone S, Zammataro L, Bianchi A, Manzano A, Yadav G, Manara P, Perrone E, Haines K, Espinal M, Dugan K, Menderes G, Altwerger G, Han C, Zeybek B, Litkouhi B, Ratner E, Silasi DA, Huang GS, Azodi M, Schwartz PE, Santin AD. PI3K oncogenic mutations mediate resistance to afatinib in HER2/neu overexpressing gynecological cancers. Gynecol Oncol 2019; 153:158-164. [PMID: 30630630 DOI: 10.1016/j.ygyno.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Aberrant expression of HER2/neu and PIK3CA gene products secondary to amplification/mutations are common in high-grade-serous-endometrial (USC) and ovarian-cancers (HGSOC). Because scant information is currently available in the literature on the potential negative effect of PIK3CA mutations on the activity of afatinib, in this study we evaluate for the first time the role of oncogenic PIK3CA mutations as a potential mechanism of resistance to afatinib in HGSOC and USC overexpressing HER2/neu. METHODS We used six whole-exome-sequenced primary HGSOC/USC cell-lines and three xenografts overexpressing HER2/neu and harboring mutated or wild-type PIK3CA/PIK3R1 genes to evaluate the role of PI3K-mutations as potential mechanism of resistance to afatinib, an FDA-approved pan-c-erb-inhibitor in clinical trials in USC. Primary-USC harboring wild-type-PIK3CA gene was transfected with plasmids encoding oncogenic PIK3CA-mutations (H1047R/E545K). The effect of afatinib on HER2/PI3K/AKT/mTOR pathway was evaluated by immunoblotting. RESULTS We found PI3K wild-type cell-lines to be significantly more sensitive (lower IC50) than PI3K-mutated cell-lines p = 0.004). In vivo, xenografts of primary cell-line USC-ARK2, transfected with the PIK3CA-H1047R or E545K hotspot-mutations, exhibited significantly more rapid tumor growth when treated with afatinib, compared to mice harboring ARK2-tumors transfected with wild-type-PIK3CA (p = 0.041 and 0.001, respectively). By western-blot, afatinib effectively reduced total and phospho-HER2 proteins in all cell-lines. However, H1047R/E545K-PIK3CA-transfected-ARK2-cells demonstrated a greater compensatory increase in phosphorylated-AKT proteins after afatinib exposure when compared to controls ARK2. CONCLUSIONS Oncogenic PI3K mutations may represent a major mechanism of resistance to afatinib. Combinations of c-erb with PIK3CA, AKT or mTOR inhibitors may be necessary to more efficiently block the PIK3CA/AKT/mTOR pathway.
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Affiliation(s)
- Elena Bonazzoli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Emiliano Cocco
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA; Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro 88100, Italy
| | - Stefania Bellone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Luca Zammataro
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Anna Bianchi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Aranzazu Manzano
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Ghanshyam Yadav
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Paola Manara
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Emanuele Perrone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Kaitlin Haines
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Mariana Espinal
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Katherine Dugan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Gulden Menderes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Gary Altwerger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Chanhee Han
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Burak Zeybek
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Babak Litkouhi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Elena Ratner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Dan-Arin Silasi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Gloria S Huang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Masoud Azodi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA.
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Fader AN, Roque DM, Siegel E, Buza N, Hui P, Abdelghany O, Chambers SK, Secord AA, Havrilesky L, O'Malley DM, Backes F, Nevadunsky N, Edraki B, Pikaart D, Lowery W, ElSahwi KS, Celano P, Bellone S, Azodi M, Litkouhi B, Ratner E, Silasi DA, Schwartz PE, Santin AD. Randomized Phase II Trial of Carboplatin-Paclitaxel Versus Carboplatin-Paclitaxel-Trastuzumab in Uterine Serous Carcinomas That Overexpress Human Epidermal Growth Factor Receptor 2/neu. J Clin Oncol 2018; 36:2044-2051. [PMID: 29584549 DOI: 10.1200/jco.2017.76.5966] [Citation(s) in RCA: 268] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose Uterine serous carcinoma is a rare, aggressive variant of endometrial cancer. Trastuzumab is a humanized monoclonal antibody that targets human epidermal growth factor receptor 2 (HER2)/neu, a receptor overexpressed in 30% of uterine serous carcinoma. This multicenter, randomized phase II trial compared carboplatin-paclitaxel with and without trastuzumab in patients with advanced or recurrent uterine serous carcinoma who overexpress HER2/neu. Methods Eligible patients had primary stage III or IV or recurrent HER2/neu-positive disease. Participants were randomly assigned to receive carboplatin-paclitaxel (control arm) for six cycles with or without intravenous trastuzumab (experimental arm) until progression or unacceptable toxicity. The primary end point was progression-free survival, which was assessed for differences between treatment arms via one-sided log-rank tests. Results From August 2011 to March 2017, 61 patients were randomly assigned. Forty progression-free survival-related events occurred among 58 evaluable participants. Among all patients, median progression-free survival was 8.0 months (control) versus 12.6 months (experimental; P = .005; hazard ratio [HR], 0.44; 90% CI, 0.26 to 0.76). Similarly, median progression-free survival was 9.3 (control) versus 17.9 (experimental) months among 41 patients with stage III or IV disease undergoing primary treatment ( P = .013; HR, 0.40; 90% CI, 0.20 to 0.80) and 6.0 (control) versus 9.2 months (experimental), respectively, among 17 patients with recurrent disease ( P = .003; HR, 0.14; 90% CI, 0.04 to 0.53). Toxicity was not different between treatment arms, and no unexpected safety signals emerged. Conclusion Addition of trastuzumab to carboplatin-paclitaxel was well tolerated and increased progression-free survival. These encouraging results deserve further investigation to determine their impact on overall survival in patients with advanced or recurrent uterine serous carcinoma who overexpress HER2/neu.
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Affiliation(s)
- Amanda N Fader
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Dana M Roque
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Eric Siegel
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Natalia Buza
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Pei Hui
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Osama Abdelghany
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Setsuko K Chambers
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Angeles Alvarez Secord
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Laura Havrilesky
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - David M O'Malley
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Floor Backes
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Nicole Nevadunsky
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Babak Edraki
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Dirk Pikaart
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - William Lowery
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Karim S ElSahwi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Paul Celano
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Stefania Bellone
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Masoud Azodi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Babak Litkouhi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Elena Ratner
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Dan-Arin Silasi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Peter E Schwartz
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Alessandro D Santin
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
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Le Gallo M, Lozy F, Bell DW. Next-Generation Sequencing. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 943:119-148. [DOI: 10.1007/978-3-319-43139-0_5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Longoria TC, Eskander RN. Immunotherapy in endometrial cancer - an evolving therapeutic paradigm. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2015; 2:11. [PMID: 27231571 PMCID: PMC4881063 DOI: 10.1186/s40661-015-0020-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/27/2015] [Indexed: 12/17/2022]
Abstract
Endometrial cancer is the only gynecologic malignancy with a rising incidence and mortality. While cure is routinely achieved with surgery alone or in combination with adjuvant pelvic radiotherapy when disease is confined to the uterus, patients with metastatic or recurrent disease exhibit limited response rates to cytotoxic chemotherapy, targeted agents, or hormonal therapy. Given the unmet clinical need in this patient population, exploration of novel therapeutic approaches is warranted, and attention is turning to immunomodulation of the tumor microenvironment. Existing evidence suggests that endometrial cancer is sufficiently immunogenic to be a reasonable candidate for active and/or passive immunotherapy. In this review, we critically examine what is known about the microenvironment in endometrial cancer and what has been learned from preliminary immunotherapy trials that enrolled endometrial cancer patients, encouraging further attempts at immunomodulation in the treatment of aggressive forms of this disease.
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Affiliation(s)
- Teresa C. Longoria
- University of California, Irvine Medical Center, 101 The City Drive South, Bldg 56, Ste 800, Orange, CA 92868 USA
| | - Ramez N. Eskander
- University of California, Irvine Medical Center, 101 The City Drive South, Bldg 56, Ste 800, Orange, CA 92868 USA
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15
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Omar N, Yan B, Salto-Tellez M. HER2: An emerging biomarker in non-breast and non-gastric cancers. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.pathog.2015.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Zhang Y, Zhao D, Gong C, Zhang F, He J, Zhang W, Zhao Y, Sun J. Prognostic role of hormone receptors in endometrial cancer: a systematic review and meta-analysis. World J Surg Oncol 2015; 13:208. [PMID: 26108802 PMCID: PMC4511445 DOI: 10.1186/s12957-015-0619-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 06/10/2015] [Indexed: 12/19/2022] Open
Abstract
Background The aim of this study was to summarize the global predicting role of hormone receptors for survival in endometrial cancer. Methods Eligible studies were identified and assessed for quality through multiple search strategies. Data were collected from studies comparing overall survival (OS), cancer-specific survival (CSS), or progression-free survival (PFS) in patients with elevated levels of estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2) with those in patients with lower levels. The combined hazard ratios of ER, PR, and HER2 for survival were calculated. Results A total of 98 studies were included for meta-analysis (44 for ER, 38 for PR, and 16 for HER2). Higher levels of either ER or PR could significantly indicate better survival. The pooled hazard ratios (HRs) of ER for OS, CSS, and PFS were 0.75 (95 % CI, 0.68–0.83), 0.45 (95 % CI, 0.33–0.62), and 0.66 (95 % CI, 0.52–0.85), respectively. The combined HRs of PR for OS, CSS, and PFS reached 0.63 (95 % CI, 0.56–0.71), 0.62 (95 % CI, 0.42–0.93), and 0.45 (95 % CI, 0.30–0.68), respectively. In contrast, elevated levels of HER2 could predict worse outcome with a HR of 1.98 (95 % CI, 1.49–2.62) for OS, and a HR of 2.26 (95 % CI, 1.57–3.25) for PFS. Conclusions In patients with endometrial cancer, higher level of ER and PR predicted favorable survival, and increased level of HER2 was associated with poorer survival. All of the three hormone receptors had prognostic value for survival.
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Affiliation(s)
- Yanli Zhang
- Department of Minimally Invasive Gynecologic Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Changle Road #536, Shanghai, 200040, People's Republic of China.
| | - Dong Zhao
- Department of Minimally Invasive Gynecologic Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Changle Road #536, Shanghai, 200040, People's Republic of China.
| | - Changguo Gong
- Institutes for Advanced Interdisciplinary Research, East China Normal University, Shanghai, People's Republic of China.
| | - Fengmei Zhang
- Institutes for Advanced Interdisciplinary Research, East China Normal University, Shanghai, People's Republic of China.
| | - Jing He
- Institutes for Advanced Interdisciplinary Research, East China Normal University, Shanghai, People's Republic of China.
| | - Wei Zhang
- Institutes for Advanced Interdisciplinary Research, East China Normal University, Shanghai, People's Republic of China.
| | - Yulan Zhao
- School of Life Science, East China Normal University, North Zhongshan Road #3663, Shanghai, People's Republic of China.
| | - Jing Sun
- Department of Minimally Invasive Gynecologic Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Changle Road #536, Shanghai, 200040, People's Republic of China.
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Sanguedolce F, Bufo P. HER2 assessment by silver in situ hybridization: where are we now? Expert Rev Mol Diagn 2015; 15:385-98. [PMID: 25578771 DOI: 10.1586/14737159.2015.992416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
HER2 testing in breast and gastric cancer is critical not only as a prognostic tool but also as a predictive marker for response to the humanized monoclonal antibody trastuzumab. Currently, HER2 status is assessed on histological and cytological specimens by conventional validated methods such as immunohistochemistry and FISH, while bright-field in situ hybridization techniques, such as silver in situ hybridization and chromogenic in situ hybridization, may offer performance benefits over FISH. The major points are first, technical issues, advantages and disadvantages relevant to each methods, and their clinical implications and second, the well-known genetic heterogeneity of HER2, and the occurrence of polysomy of chromosome 17. This review aims to summarize the growing body of literature on the accuracy of bright-field in situ techniques, notably silver in situ hybridization, in assessing HER2 status, and to discuss the role of such methods in pathology practice.
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18
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Comprehensive profiling of EGFR/HER receptors for personalized treatment of gynecologic cancers. Mol Diagn Ther 2014; 18:137-51. [PMID: 24403167 DOI: 10.1007/s40291-013-0070-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The primary gynecologic cancers include cancers of the endometrium, ovary, and cervix. Worldwide, cervical cancer is the most common gynecologic cancer, whereas endometrial cancer is the most common in the US. Ovarian cancer is the fifth most deadly cancer in women, with 5-year survival rates for advanced disease at only 27 %. As such, there is an urgent need for reliable screening tools and novel targeted therapeutic regimens for these malignancies. The epidermal growth factor receptor (EGFR)/human EGFR (HER) family of receptors has been associated with the development and progression of many solid tumors. Despite clear roles for these receptors in other cancers, the expression of HER family members in gynecologic cancers and their relationship with disease stage, grade, and response to treatment remain controversial. In this review, we describe the existing evidence for the use of HER family members as diagnostic and prognostic indicators as well as their potential as therapeutic targets in gynecologic cancers.
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Wang HY, Kim S, Park S, Kim S, Jung D, Park KH, Lee H. Evaluation of a quantitative RT-PCR assay to detect HER2 mRNA overexpression for diagnosis and selection of trastuzumab therapy in breast cancer tissue samples. Exp Mol Pathol 2014; 97:368-74. [PMID: 25236569 DOI: 10.1016/j.yexmp.2014.09.011] [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: 08/17/2014] [Accepted: 09/12/2014] [Indexed: 11/19/2022]
Abstract
Breast cancer patients who have a positive result for HER2 overexpression are commonly treated with Herceptin, a HER2-targeted therapy. In the present study, the BrightGen HER2 RT-qDx (Syantra, Calgary, Canada), which is based on a one-tube nested RT-qPCR method that detects HER2 mRNA overexpression, was clinically evaluated in a total of 237 formalin-fixed paraffin-embedded (FFPE) tissue samples from breast cancer patients. Among the 38 HER2 positive samples, which were determined via IHC/FISH methods, 13 samples out of 16 (81.3%) that were IHC2+/FISH+ and 22 samples out of 22 (100%) that were IHC3+ have been decided positive for HER2 expression via the RT-qPCR method. The true positivity and false positivity results for the RT-qPCR were 92% (35/38) and 2% (1/65), respectively. The concordance between RT-qPCR and IHC results and RT-qPCR and IHC/FISH was 87.2% and 92.1%, respectively. Conclusively, the BrightGen HER2 RT-qDx may be a reliable and convenient method that can supplement traditional IHC and FISH methods for efficient use of trastuzumab.
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Affiliation(s)
- Hye-Young Wang
- M&D, Inc., Wonju Eco Environmental Technology Center, Wonju, Gangwon, Republic of Korea
| | - Sunghyun Kim
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, Republic of Korea; Institute for Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Sangjung Park
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, Republic of Korea; Department of Clinical Laboratory Science, College of Medical Science, Daegu Haany University, Daegu, Republic of Korea
| | - Seungil Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dongju Jung
- Department of Biomedical Laboratory Science, College of Natural Sciences, Hoseo University, Chungnam, Republic of Korea
| | - Kwang Hwa Park
- Department of Pathology, Wonju College of Medicine, Yonsei University, Wonju, Gangwon, Republic of Korea.
| | - Hyeyoung Lee
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Gangwon, Republic of Korea.
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The expression of HER-2/neu (c-erbB2), survivin and cycline D1 in serous ovarian neoplasms: their correlation with clinicopathological variables. J Mol Histol 2014; 45:679-87. [DOI: 10.1007/s10735-014-9591-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/29/2014] [Indexed: 11/25/2022]
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21
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Groeneweg JW, Hall TR, Zhang L, Kim M, Byron VF, Tambouret R, Sathayanrayanan S, Foster R, Rueda BR, Growdon WB. Inhibition of gamma-secretase activity impedes uterine serous carcinoma growth in a human xenograft model. Gynecol Oncol 2014; 133:607-15. [DOI: 10.1016/j.ygyno.2014.03.560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 01/22/2023]
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Buza N, Roque DM, Santin AD. HER2/neu in Endometrial Cancer: A Promising Therapeutic Target With Diagnostic Challenges. Arch Pathol Lab Med 2014; 138:343-50. [PMID: 24576030 DOI: 10.5858/arpa.2012-0416-ra] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT In the era of targeted cancer therapy, there is growing interest in developing novel therapeutic strategies against endometrial carcinoma, especially its most biologically aggressive variant, serous adenocarcinoma. Several publications have demonstrated that a significant proportion of uterine serous carcinomas show HER2 overexpression and/or amplification, suggesting that HER2 may be a promising therapeutic target. Case reports have already shown clinical response to trastuzumab, a humanized monoclonal immunoglobulin (Ig) G1 antibody against HER2, and patients are currently being enrolled in a multi-institutional prospective randomized trial to evaluate the therapeutic efficacy of trastuzumab. OBJECTIVE To review current data on HER2 testing and targeted therapy against HER2/neu in endometrial carcinoma. DATA SOURCES Review of the literature and personal experience of the authors. CONCLUSIONS Parallel to the clinical studies, there is a need to develop standardized criteria for HER2 testing in endometrial carcinoma that reflect the unique biological and pathogenetic features of these tumors and correlate with clinical response to therapy. This article presents a comprehensive review of the current state of HER2-based therapy and HER2 testing in endometrial carcinoma.
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Affiliation(s)
- Natalia Buza
- From the Departments of Pathology (Dr Buza) and Obstetrics, Gynecology, and Reproductive Sciences (Drs Roque and Santin), Yale University School of Medicine, New Haven, Connecticut; and the Gynecologic Oncology Program, Yale Cancer Center, New Haven, Connecticut (Dr Santin)
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Chou WC, Cheng AL, Brotto M, Chuang CY. Visual gene-network analysis reveals the cancer gene co-expression in human endometrial cancer. BMC Genomics 2014; 15:300. [PMID: 24758163 PMCID: PMC4234489 DOI: 10.1186/1471-2164-15-300] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 04/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background Endometrial cancers (ECs) are the most common form of gynecologic malignancy. Recent studies have reported that ECs reveal distinct markers for molecular pathogenesis, which in turn is linked to the various histological types of ECs. To understand further the molecular events contributing to ECs and endometrial tumorigenesis in general, a more precise identification of cancer-associated molecules and signaling networks would be useful for the detection and monitoring of malignancy, improving clinical cancer therapy, and personalization of treatments. Results ECs-specific gene co-expression networks were constructed by differential expression analysis and weighted gene co-expression network analysis (WGCNA). Important pathways and putative cancer hub genes contribution to tumorigenesis of ECs were identified. An elastic-net regularized classification model was built using the cancer hub gene signatures to predict the phenotypic characteristics of ECs. The 19 cancer hub gene signatures had high predictive power to distinguish among three key principal features of ECs: grade, type, and stage. Intriguingly, these hub gene networks seem to contribute to ECs progression and malignancy via cell-cycle regulation, antigen processing and the citric acid (TCA) cycle. Conclusions The results of this study provide a powerful biomarker discovery platform to better understand the progression of ECs and to uncover potential therapeutic targets in the treatment of ECs. This information might lead to improved monitoring of ECs and resulting improvement of treatment of ECs, the 4th most common of cancer in women.
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Affiliation(s)
| | | | | | - Chun-Yu Chuang
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan.
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24
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Fader AN, Boruta D, Olawaiye AB, Gehrig PA. Updates on uterine papillary serous carcinoma. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Buza N, English DP, Santin AD, Hui P. Toward standard HER2 testing of endometrial serous carcinoma: 4-year experience at a large academic center and recommendations for clinical practice. Mod Pathol 2013; 26:1605-12. [PMID: 23765245 DOI: 10.1038/modpathol.2013.113] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/08/2013] [Accepted: 05/11/2013] [Indexed: 01/28/2023]
Abstract
HER2 overexpression and/or amplification have been reported in endometrial serous carcinoma, suggesting that HER2 may be a promising therapeutic target. However, there is considerable variation in the reported rates of HER2 overexpression and amplification, likely--at least in part--resulting from variability in the testing methods, interpretation, and scoring criteria used. Unlike in breast and gastric cancer, currently there are no established guidelines for HER2 testing in endometrial carcinoma. A total of 108 endometrial carcinoma cases--85 pure serous carcinomas and 23 mixed endometrial carcinomas with serous component--were identified over a 4-year period. All H&E and HER2 immunohistochemical slides were reviewed and HER2 FISH results (available on 52 cases) were retrieved from pathology reports. HER2 immunohistochemical scores were assigned according to the FDA criteria and the current breast ASCO/CAP scoring criteria. Clinical information was retrieved from the patients' medical records. Thirty-eight cases (35%) showed HER2 overexpression and/or gene amplification, 20 of which (53%) had significant heterogeneity of protein expression by immunohistochemistry. Lack of apical membrane staining resulting in a lateral/basolateral staining pattern was observed in the majority of HER2-positive tumors. Five of the HER2-positive cases (13%) demonstrated discrepant immunohistochemical scores when using the FDA versus ASCO/CAP scoring system. The overall concordance rate between HER2 immunohistochemistry and FISH was 75% (39/52) when using the FDA criteria, compared with 81% (42/52) by the ASCO/CAP scoring system. In conclusion, in this largest comprehensive study, 35% of endometrial serous carcinoma harbors HER2 protein overexpression and/or gene amplification, over half of which demonstrate significant heterogeneity of protein expression. The current breast ASCO/CAP scoring criteria provide the highest concordance between immunohistochemistry and FISH. Assessment of HER2 immunohistochemistry on multiple tumor sections or sections with large tumor areas is recommended, due to the significant heterogeneity of HER2 protein expression.
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Affiliation(s)
- Natalia Buza
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
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Thanapprapasr D, Cheewakriangkrai C, Likittanasombut P, Thanapprapasr K, Mutch DG. Targeted endometrial cancer therapy as a future prospect. ACTA ACUST UNITED AC 2013; 9:189-99. [PMID: 23477324 DOI: 10.2217/whe.13.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Among female-specific cancers worldwide, endometrial cancer is the third most common after breast cancer and cervical cancer. In addition, it is the most common gynecological cancer in the USA and Europe. The incidence of this disease appears to be increasing. The cause of this increase is multifactorial, but a few possible factors involved are increasing obesity, an aging population leading to more postmenopausal women and greater tamoxifen use. Surgery is generally the primary treatment of this disease and postoperative radiation therapy in some patients with high or intermediate risk may prevent locoregional recurrences. Adjuvant chemotherapy improves progression-free survival in advanced or recurrent cancer. However, overall survival in patients with advanced disease is poor. Hence, better therapy is needed and targeted molecular therapies are emerging as possible treatment candidates. These include molecules that target VEGF, mTOR, tyrosine kinases, human EGF receptors and FGF receptors. Therapies targeting specific molecular features should be evaluated in future strategies in the treatment of endometrial cancer.
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Affiliation(s)
- Duangmani Thanapprapasr
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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27
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Kim MA, Jung JE, Lee HE, Yang HK, Kim WH. In situ analysis of HER2 mRNA in gastric carcinoma: comparison with fluorescence in situ hybridization, dual-color silver in situ hybridization, and immunohistochemistry. Hum Pathol 2013; 44:487-94. [DOI: 10.1016/j.humpath.2012.06.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 06/21/2012] [Accepted: 06/27/2012] [Indexed: 12/30/2022]
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28
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Androutsopoulos G, Adonakis G, Liava A, Ravazoula P, Decavalas G. Expression and potential role of ErbB receptors in type II endometrial cancer. Eur J Obstet Gynecol Reprod Biol 2013; 168:204-8. [PMID: 23395558 DOI: 10.1016/j.ejogrb.2013.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 10/26/2012] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Endometrial cancer is the most common malignancy of the female genital tract. Based on clinical and pathological features, endometrial cancer is classified into two types. The aim of our study was to describe the expression and the potential clinical role of ErbB receptors in Greek patients with type II endometrial cancer. STUDY DESIGN Between 1991 and 2008, 10 women with histologically confirmed type II endometrial cancer were referred to the Department of Gynecologic Oncology of the University of Patras Medical School. Tissue specimens from endometrial lesions were immunostained for EGFR, ErbB-2, ErbB-3 and ErbB-4. RESULTS For EGFR, 5 cases were positive (50%) and 5 cases were negative. For ErbB-2, 9 cases were positive (90%) and 1 case was negative. For ErbB-3, all cases were positive. For ErbB-4, 7 cases were positive (70%) and 3 cases were negative. Also for all ErbB receptors, 5 cases were positive (50%). During follow up, 3 patients died from their disease. All of them had papillary serous endometrial cancer and 2 of them were positive for all ErbB receptors. CONCLUSION Although our study was based on a small number of cases, it is obvious that we had high expression levels of ErbB receptors in patients with type II endometrial cancer. Also the majority of patients with dismal outcome were positive for all ErbB receptors. This is very important, as ErbB-targeted therapies may be clinically active as adjuvant therapy in well-defined subgroups of type II EC patients with EGFR and ErbB-2 overexpression.
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Affiliation(s)
- Georgios Androutsopoulos
- Department of Obstetrics and Gynecology, University of Patras, Medical School, Rion 26500, Greece.
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Abstract
PURPOSE OF REVIEW Endometrial cancer is the most common gynaecological malignancy in the western world. Two clinicopathological subtypes are recognized: type I (endometrioid) and type II (nonendometrioid) carcinomas. This review describes the molecular alterations in endometrial cancer and how this knowledge is leading to the development of novel treatments in this area. RECENT FINDINGS Molecularly targeted agents have entered clinical trials in endometrial cancer. So far, mechanistic target of rapamycin (mTOR) inhibitors and antiangiogenic agents appear promising and are being pursued further in addition to other targeted approaches. SUMMARY The clinicopathological and molecular heterogeneity of endometrial cancer needs to be taken into account in the design of future clinical trials as well as the incorporation of robust biomarkers for the success of therapeutic strategies in endometrial cancer.
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del Carmen MG, Birrer M, Schorge JO. Uterine papillary serous cancer: a review of the literature. Gynecol Oncol 2012; 127:651-61. [PMID: 23000148 DOI: 10.1016/j.ygyno.2012.09.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/09/2012] [Accepted: 09/13/2012] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Uterine papillary serous carcinoma (UPSC) represents a distinct subtype of endometrial cancer. UPSC is less common than endometrioid carcinoma (ECC) but accounts for a disproportionate number of uterine cancer related deaths. This article critically reviews the literature pertinent to the pathology, pathogenesis, diagnosis, management, and outcome of patients with UPSC. METHODS MEDLINE was searched for all research articles published in English between January 1, 1967-January 1, 2012 which reported on patients diagnosed with UPSC. Given the rarity of this tumor, studies were not limited by design or number of reported patients. RESULTS UPSC represents a histologically aggressive subtype of endometrial cancer. It commonly presents with extra uterine disease involvement which can be identified by comprehensive surgical staging. Optimal cytoreduction and systemic platinum/taxane-based adjuvant therapy appear to confer a survival advantage. CONCLUSIONS UPSC is a biologically distinct entity, different from ECC. Future studies should explore the role of targeted therapies in the management of UPSC.
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Affiliation(s)
- Marcela G del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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El-Sahwi KS, Schwartz PE, Santin AD. Development of targeted therapy in uterine serous carcinoma, a biologically aggressive variant of endometrial cancer. Expert Rev Anticancer Ther 2012; 12:41-9. [PMID: 22149431 DOI: 10.1586/era.11.192] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Endometrial cancer (EC) is the most common female genital malignancy in the USA. Most carcinomas arising from the uterus are estrogen dependent and are associated with obesity and hypertension. They are designated type I ECs and typically, due to their early diagnosis secondary to postmenopausal bleeding, have a good prognosis. By contrast, type II ECs develop in older patients, are not hormone dependent and are responsible for most recurrences and deaths from EC. Uterine serous cancer constitutes up to 10% of all endometrial tumors, and represents the most biologically aggressive variant of type II EC. This article will describe the most salient molecular markers that have been identified in uterine serous cancer, thus far with emphasis on the use of erbB2 (HER2/neu) as the first of a series of therapeutic markers for the treatment of this highly-aggressive subset of ECs.
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Affiliation(s)
- Karim S El-Sahwi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, CT, USA
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Togami S, Sasajima Y, Oi T, Ishikawa M, Onda T, Ikeda SI, Kato T, Tsuda H, Kasamatsu T. Clinicopathological and prognostic impact of human epidermal growth factor receptor type 2 (HER2) and hormone receptor expression in uterine papillary serous carcinoma. Cancer Sci 2012; 103:926-32. [PMID: 22329832 DOI: 10.1111/j.1349-7006.2012.02240.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/02/2012] [Accepted: 02/02/2012] [Indexed: 01/22/2023] Open
Abstract
Uterine papillary serous carcinoma (UPSC) is a rare and aggressive variant of endometrial carcinoma. Little is known about the pathological and biological features of this tumor. Human epidermal growth factor receptor 2 (HER2) and hormone receptor (HR) expression have an important role in tumor behavior and clinical outcome, but their relevance in UPSC is not clear. In the present study, the immunohistochemical expression of HER2 and HR was assessed in 27 patients with Stage I disease, 13 with Stage II disease, 25 with Stage III disease, and 6 with Stage IV disease. Correlations between HER2 and HR expression and the clinicopathological parameters of UPSC were evaluated using Cox's univariate and multivariate analyses. For all patients, the 5-year recurrence-free survival (RFS) and overall survival (OS) rates were 51% and 66%, respectively; in patients with Stage I, II, III and IV disease, the RFS and OS were 67%/81%, 59%/77%, 43%/54% and 0%/0%, respectively. Of all 71 patients, 14% (10/71) were positive for HER2 and 52% (37/71) were positive for HR. Overexpression of HER2 was correlated with lower OS (P = 0.01), whereas HR overexpression was correlated with higher OS (P = 0.008). In multivariate models, HER2, HR, and histologic subtype were identified as independent prognostic indicators for RFS (P = 0.022, P = 0.018, and P = 0.01, respectively), but HR was the only independent factor associated with OS (P = 0.044). Thus, HER2 and HR are prognostic variables in UPSC, with HR an independent prognostic factor for OS.
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Affiliation(s)
- Shinichi Togami
- Division of Gynecology, National Cancer Center Hospital, Tokyo, Japan.
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O'Hara AJ, Bell DW. The genomics and genetics of endometrial cancer. ADVANCES IN GENOMICS AND GENETICS 2012; 2012:33-47. [PMID: 22888282 PMCID: PMC3415201 DOI: 10.2147/agg.s28953] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Most sporadic endometrial cancers (ECs) can be histologically classified as endometrioid, serous, or clear cell. Each histotype has a distinct natural history, clinical behavior, and genetic etiology. Endometrioid ECs have an overall favorable prognosis. They are typified by high frequency genomic alterations affecting PIK3CA, PIK3R1, PTEN, KRAS, FGFR2, ARID1A (BAF250a), and CTNNB1 (β-catenin), as well as epigenetic silencing of MLH1 resulting in microsatellite instability. Serous and clear cell ECs are clinically aggressive tumors that are rare at presentation but account for a disproportionate fraction of all endometrial cancer deaths. Serous ECs tend to be aneuploid and are typified by frequent genomic alterations affecting TP53 (p53), PPP2R1A, HER-2/ERBB2, PIK3CA, and PTEN; additionally, they display dysregulation of E-cadherin, p16, cyclin E, and BAF250a. The genetic etiology of clear cell ECs resembles that of serous ECs, but it remains relatively poorly defined. A detailed discussion of the characteristic patterns of genomic alterations that distinguish the three major histotypes of endometrial cancer is reviewed herein.
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Affiliation(s)
- Andrea J O'Hara
- National Human Genome Research Institute, Cancer Genetics Branch, National Institutes of Health, Bethesda, MD, USA
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Dewdney SB, Kizer NT, Andaya AA, Babb SA, Luo J, Mutch DG, Schmidt AP, Brinton LA, Broaddus RR, Ramirez NC, Huettner PC, McMeekin DS, Darcy K, Ali S, Judson PL, Mannel RS, Lele SB, O'Malley DM, Goodfellow PJ. Uterine serous carcinoma: increased familial risk for lynch-associated malignancies. Cancer Prev Res (Phila) 2012; 5:435-43. [PMID: 22246618 DOI: 10.1158/1940-6207.capr-11-0499] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Serous uterine cancer is not a feature of any known hereditary cancer syndrome. This study evaluated familial risk of cancers for patients with serous uterine carcinoma, focusing on Lynch syndrome malignancies. Fifty serous or mixed serous endometrial carcinoma cases were prospectively enrolled. Pedigrees were developed for 29 probands and tumors were assessed for DNA mismatch repair (MMR) abnormalities. Standardized incidence ratios for cancers in relatives were estimated. A second-stage analysis was undertaken using data from Gynecologic Oncology Group (GOG)-210. Incidence data for cancers reported in relatives of 348 patients with serous and mixed epithelial and 624 patients with endometrioid carcinoma were compared. Nineteen of 29 (65.5%) patients in the single-institution series reported a Lynch-related cancer in relatives. Endometrial and ovarian cancers were significantly overrepresented and a high number of probands (6 of 29, 20.7%) reported pancreatic cancers. None of the probands' tumors had DNA MMR abnormalities. There was no difference in endometrial or ovarian cancer incidence in relatives of serous and endometrioid cancer probands in the case-control study. Pancreatic cancers were, however, significantly more common in relatives of patients with serous cancer [OR, 2.39; 95% confidence interval (CI), 1.06-5.38]. We identified an excess of endometrial, ovarian, and pancreatic cancers in relatives of patients with serous cancer in a single-institution study. Follow-up studies suggest that only pancreatic cancers are overrepresented in relatives. DNA MMR defects in familial clustering of pancreatic and other Lynch-associated malignancies are unlikely. The excess of pancreatic cancers in relatives may reflect an as yet unidentified hereditary syndrome that includes uterine serous cancers.
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Affiliation(s)
- Summer B Dewdney
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 660 South Euclid, St. Louis, MO 63110, USA
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erbB2 Overexpression in Uterine Serous Cancer: A Molecular Target for Trastuzumab Therapy. Obstet Gynecol Int 2011; 2011:128295. [PMID: 21876697 PMCID: PMC3159302 DOI: 10.1155/2011/128295] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 06/27/2011] [Accepted: 06/27/2011] [Indexed: 11/18/2022] Open
Abstract
Endometrial cancer is the most common female genital tract malignancy in the United States. Type I endometrial cancer is usually diagnosed at an early stage, and has a good prognosis. Type II is very aggressive, and is responsible for most uterine cancer relapses and deaths. Uterine serous adenocarcinomas (USC) constitute the majority of Type II variants. They have a higher propensity for lymph node and distant metastases. They are frequently aneuploid and associated with p53 mutations. erbB2 overexpression in USC has been described. The incidence, which is higher in African Americans, ranges from 18-80%. erbB2 overexpression was found to be associated with higher stage, chemoresistance, and worse survival. Trastuzumab a humanized mAb was approved by the FDA for treatment of breast cancers that overexpress erbB2 in combination with standard chemotherapy. Evidence of trastuzumab activity in USC has been reported in vitro, as well as in case reports of advanced and recurrent cases. Promising results were obtained in these heavily pretreated patients either with trastuzumab alone or in combination with chemotherapy. This supports the hypothesis that trastuzumab may very well be an attractive and viable treatment option for advanced stage USC tumors that overexpress the erbB2, and is worthy of further study.
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Assessing the Impact of Polysomy-17 on HER2 Status and the Correlations of HER2 Status With Prognostic Variables (ER, PR, p53, Ki-67) in Epithelial Ovarian Cancer. Int J Gynecol Pathol 2011; 30:372-9. [DOI: 10.1097/pgp.0b013e31820c9ff3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tsai WC, Lee MY, Chen FL, Wang PH, Lin WL, Ruan A, Li YJ, Wang SC, Chiang H, Han CP. The HER2 gene copies per tumor cell either before or after correction for chromosome-17 correlated significantly with HER2 IHC results in epithelial ovarian cancer in a tissue microarray study. Arch Gynecol Obstet 2010; 284:721-9. [PMID: 21046136 DOI: 10.1007/s00404-010-1708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 08/24/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND HER2 gene amplification and HER2 protein overexpression are important factors in predicting clinical sensitivity to anti-HER2 monoclonal antibody therapy in breast cancer patients. The purpose of this study is to evaluate the correlation between HER2 protein expressions and the HER2 gene copies per tumor cell either before or after chromosome-17 correction in epithelial ovarian cancer (EOC). METHODS Adopting 2007 ASCO/CAP guideline recommendations for HER2 testing, 27 tissue microarray (TMA) samples from EOC patients were analyzed by immunohistochemistry (IHC) using Dako, c-erb-B2 antibody and subsequently examined by fluorescence in situ hybridization (FISH) using Abbott/Vysis, PathVysion HER2 DNA Probe Kit. RESULTS The overall concordance revealed 81.5% between HER2 IHC and HER2 FISH results. Additionally, HER2 gene copies prior to chromosome-17 correction increased significantly in a stepwise order through the negative, equivocal, and positive IHC result categories (P = 0.026), as did the HER2 gene copies after chromosome-17 correction (P = 0.028). On the other hand, HER2 IHC results correlated significantly with both chromosome-17 uncorrected HER2 gene copy numbers (ρ = 0.430, P = 0.025) and chromosome-17 corrected HER2 gene copy numbers (ρ = 0.524, P = 0.027). CONCLUSION We demonstrated that both chromosome-17 corrected and uncorrected HER2 gene copies correlated significantly with HER2 IHC result categories; and tests for the HER2 gene copies per tumor cell either before or after correction for chromosome-17 can be applied as a potentially valuable tool in analyzing the HER2 status in EOC.
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Affiliation(s)
- Wen-Chih Tsai
- Department of Obstetrics and Gynecology, Po-Jen General Hospital, Taipei, Taiwan
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Rauh-Hain JA, Growdon WB, Schorge JO, Goodman A, Boruta DM, McCann C, Horowitz NS, del Carmen MG. Prognostic determinants in patients with stage IIIC and IV uterine papillary serous carcinoma. Gynecol Oncol 2010; 119:299-304. [DOI: 10.1016/j.ygyno.2010.07.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/07/2010] [Accepted: 07/11/2010] [Indexed: 01/22/2023]
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40
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Rauh-Hain JA, Del Carmen MG. Treatment for advanced and recurrent endometrial carcinoma: combined modalities. Oncologist 2010; 15:852-61. [PMID: 20660059 DOI: 10.1634/theoncologist.2010-0091] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Women with recurrent or advanced endometrial cancer constitute a heterogeneous group of patients. Depending on previous treatment, women with recurrent endometrial cancer may be appropriate candidates for surgery, radiation therapy, hormonal therapy, or chemotherapy. Women with advanced stage disease at presentation may also be appropriate candidates for systemic and local therapies. We review the treatment options available to treat recurrent and locally advanced endometrial cancer. Treatment choice depends largely on the localization of disease, the patient's performance status and previous treatment history, as well the tumor's hormonal receptor status. Radiation therapy is appropriate for isolated vaginal recurrences in patients with no previous history of radiation therapy. Patients with recurrent low-grade tumors overexpressing estrogen and progesterone receptors may be treated with progestin therapy. Systemic therapy is appropriate for patients with disseminate recurrences or advanced stage disease at presentation, or for those with receptor-negative tumors. We review all these different treatment strategies available to patients with advanced or recurrent endometrial cancer.
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Affiliation(s)
- J Alejandro Rauh-Hain
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9 E, Boston, MA 02114, USA
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Abstract
PURPOSE OF REVIEW Uterine papillary serous carcinoma (UPSC) is a rare but aggressive subtype of endometrial cancer. Although it represents only 10% of all endometrial cancer cases, UPSC accounts for up to 40% of all endometrial cancer-related recurrences and subsequent deaths. The present article reviews the literature concerning the epidemiology, molecular pathogenesis and recent updates on management of UPSC. RECENT FINDINGS Women most often present with postmenopausal vaginal bleeding but may also be diagnosed by vaginal cytology. In women diagnosed with metastatic disease, ascites, omental implants or a pelvic mass may be present. Pelvic and extrapelvic recurrences occur frequently, with extrapelvic relapses being observed most commonly. Although few prospective trials exist, several retrospective series have demonstrated that optimal cytoreduction and adjuvant platinum/taxane-based chemotherapy with or without radiotherapy appears to improve survival. In addition, another approach to UPSC management may lie in targeted therapy. SUMMARY Women diagnosed with UPSC should undergo comprehensive surgical staging and an attempt at optimal cytoreduction. Platinum/taxane-based adjuvant chemotherapy should be considered in the treatment of both early and advanced-stage patients. Careful long-term surveillance is indicated as many of these women will recur. Prospective studies are needed to define the optimal treatment regimens and to study the role of targeted therapies in UPSC.
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42
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Gul AE, Keser SH, Barisik NO, Kandemir NO, Cakir C, Sensu S, Karadayi N. The relationship of cerb B 2 expression with estrogen receptor and progesterone receptor and prognostic parameters in endometrial carcinomas. Diagn Pathol 2010; 5:13. [PMID: 20167054 PMCID: PMC2837627 DOI: 10.1186/1746-1596-5-13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 02/18/2010] [Indexed: 11/15/2022] Open
Abstract
Background Endometrial carcinoma (EC) is the most common malignancy of the female genital tract. Gene alterations and overexpression of various oncogenes are important in tumor development. The human HER 2 neu (c-erbB-2) gene product is a transmembrane receptor with an intracellular tyrosine kinase that plays an important role in coordinating the endometrial growth factor receptor signaling network. The aim of this study was to investigate the expression of c-erbB-2 in endometrial cancer, to study its correlation to established prognostic parameters and estrogen receptor (ER) and progesterone receptor (PR) status. Methods Immunohistochemical (IHC) analyses of ER, PR and c-erbB-2 were performed in 72 EC cases. Results We detected a positive staining with c erbB 2 in 18.1% of the cases and determined a statistically significant relation between c-erbB-2 and PR. We could not find a statistically significant relation between c-erbB-2 staining and ER. There was not a statistically significant difference between c-erbB-2 and histological grade. The highest level of c-erbB-2 was found in grade 2 cases. There was not any statistically significant relation between c-erbB-2 and menstrual status, myometrial invasion, lymph node status, stage and survival. Conclusions Although our study provides additional evidence of the potential prognostic role of c-erbB-2, further prospective and controlled studies are required to validate their clinical usefulness.
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Affiliation(s)
- Aylin Ege Gul
- Pathology Department, Dr, Lütfi Kirdar Kartal Educational and Research Hospital, Istanbul, Turkey.
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Current World Literature. Curr Opin Obstet Gynecol 2010; 22:87-93. [DOI: 10.1097/gco.0b013e328335462f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Xu M, Schwartz P, Rutherford T, Azodi M, Santin A, Silasi D, Martel M, Hui P. HER-2/neu receptor gene status in endometrial carcinomas: a tissue microarray study. Histopathology 2010; 56:269-73. [DOI: 10.1111/j.1365-2559.2009.03464.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Management of women with uterine papillary serous cancer: A Society of Gynecologic Oncology (SGO) review. Gynecol Oncol 2009; 115:142-153. [DOI: 10.1016/j.ygyno.2009.06.011] [Citation(s) in RCA: 212] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 06/05/2009] [Accepted: 06/08/2009] [Indexed: 11/22/2022]
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Abstract
Endometrial cancer is the most frequent gynecological cancer and the fourth most common cancer in women in the developed world. Over the last decade, immunotherapy has been the focus of intense investigation as a form of cancer treatment whereby the treatment initiates a host immune response ultimately eradicating the tumor. It has been suggested that in endometrial cancer and many other forms of cancer, immunosuppression poses a significant obstacle at inducing antitumor immunity by immunotherapy. This review will look at the different studies that have identified immunomodulation of T cells, cytokines and macrophages, and regulation of apoptotic and angiogenic factors in endometrial cancer patients that may contribute to the inefficiency of immunotherapy.
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Affiliation(s)
- Nicole Brooks
- School of Medical Sciences, RMIT University, Bundoora, Victoria, Australia
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Brown L. Pathology of uterine malignancies. Clin Oncol (R Coll Radiol) 2008; 20:433-47. [PMID: 18499412 DOI: 10.1016/j.clon.2008.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 04/22/2008] [Indexed: 01/17/2023]
Abstract
This overview covers epithelial, stromal and mesenchymal malignancies of the body of the uterus, excluding the cervix. The distinction of type I and type II endometrial adenocarcinoma with the morphological variants of this tumour is discussed and some molecular aspects are explored. The concept of carcinosarcoma representing a metaplastic adenocarcinoma of the endometrium that behaves more like a carcinoma than a sarcoma is explained. Some types of mixed epithelial and stromal neoplasm are described and contrasted with carcinosarcoma. The concept of stromal sarcoma and high-grade uterine sarcoma is described and an outline of malignant smooth muscle tumours of the uterus includes a description of smooth muscle tumours of uncertain malignant potential and worrying benign smooth muscle lesions.
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Affiliation(s)
- L Brown
- Department of Histopathology, Leicester Royal Infirmary, Infirmary Square, Leicester, UK.
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