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Dore M, Filoche S, Danielson K, Henry C. Characterisation of Levonorgestrel-Resistant Endometrial Cancer Cells. Cancer Manag Res 2021; 13:7871-7884. [PMID: 34703309 PMCID: PMC8523362 DOI: 10.2147/cmar.s327381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Endometrial cancer (EC) is the most common gynaecologic malignancy in the developed world, and incidence is increasing in premenopausal women. The levonorgestrel intrauterine system (LNG-IUS) is gaining traction as an alternative treatment for hyperplasia and early-stage EC for women who are unable to undergo surgery. Thirty to 60% of the women do not respond to this treatment, making the unknown mechanisms of levonorgestrel (LNG) resistance a critical obstacle for the conservative management of EC. This study aimed to characterise LNG-IUS treatment resistance in early-stage endometrial cancer in cell-line models. Methods LNG-resistant endometrial cancer cell lines (MFE296R and MFE319R) and cultures from three early stage endometrial cancer patients were developed. The behavioural profile of MFE296R and MFE319R was analysed using proliferation, adhesion, migration (wound healing and transwell) and invasion (spheroid) assays. LNG-sensitive cell lines (MFE296S and MFE319S) were compared to LNGR cell lines (MFE296R and MFE319R). A literature search was conducted to identify possible candidate biomarkers of LNG resistance. RT-qPCR was used to analyse the mRNA expression of 17 candidate biomarkers in MFE296R and MFE319R. mRNA expression of the top differentially expressed genes was measured using RT-qPCR in primary cultures. Results LNG resistance did not affect proliferation or invasion in immortalised endometrial cancer cells. Transwell migration was significantly increased in MFE319R cells (p=0.03). Cellular adhesion significantly decreased in both MFE296R cells (p=0.012) and MFE319R cells (p=0.04). mRNA expression of KLF4 and SATB2 was significantly amplified in MFE296R and MFE319R cells. mRNA expression of KLF4 was significantly upregulated LNG-resistant primary cell lines. Conclusion LNG-resistant cells may have more oncogenic potential than their LNG-sensitive counterparts. Significant changes in the mRNA expression of KLF4 and SATB2 of LNG-resistant cells is a promising preliminary result in biomarker discovery for guiding LNG-IUS treatment of early stage endometrial cancer.
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Affiliation(s)
- Molly Dore
- Department of Obstetrics, Gynaecology & Women's Health, University of Otago, Wellington, New Zealand
| | - Sara Filoche
- Department of Obstetrics, Gynaecology & Women's Health, University of Otago, Wellington, New Zealand
| | - Kirsty Danielson
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Claire Henry
- Department of Obstetrics, Gynaecology & Women's Health, University of Otago, Wellington, New Zealand
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Dore M, Filoche S, Danielson K, Henry C. Efficacy of the LNG-IUS for treatment of endometrial hyperplasia and early stage endometrial cancer: Can biomarkers predict response? Gynecol Oncol Rep 2021; 36:100732. [PMID: 33718563 PMCID: PMC7933258 DOI: 10.1016/j.gore.2021.100732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/19/2022] Open
Abstract
Endometrial Cancer (EC) is the most common gynaecologic malignancy in the developed world, and is increasing in premenopausal women. The surgical standard of care for early-stage EC is not possible in women with concurrent comorbidities or women who desire a fertility sparing approach. The Levonorgestrel Intrauterine System (LNG-IUS) is gaining traction as an alternative treatment for endometrial hyperplasia and early stage EC in inoperable women. Whilst early evidence appears promising, predictive biomarkers need to be established to determine non-responders, which make up one in three women. This timely review discusses the current literature around the identification of clinical, molecular and novel biomarkers that show potential to predict response to progesterone treatment, including the LNG-IUS.
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Affiliation(s)
- Molly Dore
- Department of Obstetrics, Gynaecology & Women’s Health, University of Otago Wellington, New Zealand
| | - Sara Filoche
- Head of Department, Obstetrics, Gynaecology & Women’s Health, University of Otago Wellington, New Zealand
| | - Kirsty Danielson
- Department of Surgery and Anaesthesia, University of Otago Wellington, New Zealand
| | - Claire Henry
- Department of Obstetrics, Gynaecology & Women’s Health, University of Otago Wellington, New Zealand
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Baxter E, Brennan DJ, McAlpine JN, Mueller JJ, Amant F, van Gent MDJM, Huntsman DG, Coleman RL, Westin SN, Yates MS, Krakstad C, Quinn MA, Janda M, Obermair A. Improving response to progestin treatment of low-grade endometrial cancer. Int J Gynecol Cancer 2020; 30:1811-1823. [PMID: 32381512 DOI: 10.1136/ijgc-2020-001309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/11/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This review examines how response rates to progestin treatment of low-grade endometrial cancer can be improved. In addition to providing a brief overview of the pathogenesis of low-grade endometrial cancer, we discuss limitations in the current classification of endometrial cancer and how stratification may be refined using molecular markers to reproducibly identify 'low-risk' cancers which may represent the best candidates for progestin therapy. We also discuss constraints in current approaches to progestin treatment of low-grade endometrial cancer and perform a systematic review of predictive biomarkers. METHODS PubMed, ClinicalTrials.gov, and Cochrane Library were searched for studies reporting pre-treatment biomarkers associated with outcome in women with low-grade endometrial cancer or endometrial hyperplasia with an intact uterus who received progestin treatment. Studies of fewer than 50 women were excluded. The study protocol was registered in PROSPERO (ID 152374). A descriptive synthesis of pre-treatment predictive biomarkers reported in the included studies was conducted. RESULTS Of 1908 records reviewed, 19 studies were included. Clinical features such as age or body mass index cannot predict progestin response. Lesions defined as 'low-risk' by FIGO criteria (stage 1A, grade 1) can respond well; however, the reproducibility and prognostic ability of the current histopathological classification system is suboptimal. Molecular markers can be reproducibly assessed, have been validated as prognostic biomarkers, and may inform patient selection for progestin treatment. DNA polymerase epsilon (POLE)-ultramutated tumors and a subset of p53 wild-type or DNA mismatch repair (MMR)-deficient tumors with 'low-risk' features (eg, progesterone and estrogen receptor-positive) may have improved response rates, though this needs to be validated. DISCUSSION Molecular markers can identify cases which may be candidates for progestin treatment. More work is needed to validate these biomarkers and potentially identify new ones. Predictive biomarkers are anticipated to inform future research into progestin treatment of low-grade endometrial cancer and ultimately improve patient outcomes.
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Affiliation(s)
- Eva Baxter
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Donal J Brennan
- Department of Gynaecological Oncology, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.,Systems Biology Ireland, University College Dublin, Dublin, Ireland
| | - Jessica N McAlpine
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, The University of British Columbia, Vancouver, British Columbia, Canada.,BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Jennifer J Mueller
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Flanders, Belgium.,Centre for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek Netherlands Cancer Institute and Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Mignon D J M van Gent
- Centre for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek Netherlands Cancer Institute and Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - David G Huntsman
- BC Cancer Agency, Vancouver, British Columbia, Canada.,Departments of Pathology and Laboratory Medicine and Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert L Coleman
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melinda S Yates
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Camilla Krakstad
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Vestland, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Vestland, Norway
| | | | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Queensland, Australia
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