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Lindner R, Sullivan C, Offor O, Lezon-Geyda K, Halligan K, Fischbach N, Shah M, Bossuyt V, Schulz V, Tuck DP, Harris LN. Molecular phenotypes in triple negative breast cancer from African American patients suggest targets for therapy. PLoS One 2013; 8:e71915. [PMID: 24260093 PMCID: PMC3832509 DOI: 10.1371/journal.pone.0071915] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 07/04/2013] [Indexed: 12/20/2022] Open
Abstract
Triple negative breast cancer (TNBC) is characterized by high proliferation, poor differentiation and a poor prognosis due to high rates of recurrence. Despite lower overall incidence African American (AA) patients suffer from higher breast cancer mortality in part due to the higher proportion of TNBC cases among AA patients compared to European Americans (EA). It was recently shown that the clinical heterogeneity of TNBC is reflected by distinct transcriptional programs with distinct drug response profiles in preclinical models. In this study, gene expression profiling and immunohistochemistry were used to elucidate potential differences between TNBC tumors of EA and AA patients on a molecular level. In a retrospective cohort of 136 TNBC patients, a major transcriptional signature of proliferation was found to be significantly upregulated in samples of AA ethnicity. Furthermore, transcriptional profiles of AA tumors showed differential activation of insulin-like growth factor 1 (IGF1) and a signature of BRCA1 deficiency in this cohort. Using signatures derived from the meta-analysis of TNBC gene expression carried out by Lehmann et al., tumors from AA patients were more likely of basal-like subtypes whereas transcriptional features of many EA samples corresponded to mesenchymal-like or luminal androgen receptor driven subtypes. These results were validated in The Cancer Genome Atlas mRNA and protein expression data, again showing enrichment of a basal-like phenotype in AA tumors and mesenchymal subtypes in EA tumors. In addition, increased expression of VEGF-activated genes together with elevated microvessel area determined by the AQUA method suggest that AA patients exhibit higher tumor vascularization. This study confirms the existence of distinct transcriptional programs in triple negative breast cancer in two separate cohorts and that these programs differ by racial group. Differences in TNBC subtypes and levels of tumor angiogenesis in AA versus EA patients suggest that targeted therapy choices should be considered in the context of race.
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MESH Headings
- Adult
- Black or African American
- Aged
- Breast Neoplasms/ethnology
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Databases, Genetic
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Middle Aged
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- Neovascularization, Pathologic/ethnology
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/metabolism
- Neovascularization, Pathologic/pathology
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- RNA, Neoplasm/biosynthesis
- RNA, Neoplasm/genetics
- Retrospective Studies
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Affiliation(s)
- Robert Lindner
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Institute of Pharmacy and Molecular Biotechnology, University of Heidelberg, Heidelberg, Germany
| | - Catherine Sullivan
- Medical Oncology, Yale Cancer Center, New Haven, Connecticut, United States of America
| | - Onyinye Offor
- Medical Oncology, Yale Cancer Center, New Haven, Connecticut, United States of America
| | - Kimberly Lezon-Geyda
- Medical Oncology, Yale Cancer Center, New Haven, Connecticut, United States of America
| | - Kyle Halligan
- Medical Oncology, Yale Cancer Center, New Haven, Connecticut, United States of America
| | - Neal Fischbach
- Department of Oncology, Bridgeport Hospital, Bridgeport, Connecticut, United States of America
| | - Mansi Shah
- Department of Oncology, Bridgeport Hospital, Bridgeport, Connecticut, United States of America
| | - Veerle Bossuyt
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Vincent Schulz
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - David P. Tuck
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Lyndsay N. Harris
- Medical Oncology, Yale Cancer Center, New Haven, Connecticut, United States of America
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail:
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