Influence of EIF4E and HER2 Protein Expression on the Response to Neoadjuvant Chemotherapy and Trastuzumab in Breast Cancer

Background:Resistance to trastuzumab (TTZ) is still poorly understood. Many proteins implicated in signaling pathways of breast cancer cells have so far been studied as potential markers of TTZ resistance in preclinical models.Method:63 consecutive patients were treated for HER2 + breast cancer with a neoadjuvant chemotherapy regimen containing TTZ between December 2003 and July 2008. This regimen was mostly 4 cycles of FEC 100 (5FU, Epirubicin and Cyclophosphamide) followed by 4 cycles of TTZ – Docetaxel 100mg/m².Immunohistochemistry (IHC) was used to analyse, in the initial biopsy, the expression of HER family receptors (EGFR, HER3, HER4 and HER2), PTEN, cMyc and p27. We also analyzed the expression of two proteins (eIF4E and 4EBP1) involved in translational control of mRNAs. 4EBP1 is a small protein that represses the initiation of protein translation through its association with eIF4E, the mRNA cap-binding subunit of the eIF4F complex. mTOR-dependent phosphorylation of 4E-BP1 decreases the affinity of the protein for eIF4E, which facilitates the formation of eIF4F complex. Furthermore, the expression of eIF4E is elevated in many cancers.We analysed the pathologic response rate (pRR) after chemotherapy + TTZ, and we established correlations between the expression of these markers and pRR.Results:Among the 63 patients, 54 had a valuable pre-chemotherapy biopsy.For those 54 patients, median age was 48 years (range [21;80]), median tumor size was 50 mm clinically (range [20;120]), and 26 mm by ultrasound (range [10;80]). Respectively 63%, 57% and 52% were estrogen receptor (ER) negative, progesterone receptor (PR) negative and ER/PR negative. Histology type was ductal infiltrant carcinoma for 91% of patients. Respectively 28% and 72% were grade SBR (EE) II and III.A pathologic complete response (pCR) (Sataloff TA) was observed on 63% of patients, 28% had a partial response but superior to 50% (Sataloff TB) and 9% had a poor or absent pathologic response (Sataloff TC and TD).This pCR was not statistically linked to any initial clinical characteristics (age, grade, hormonal status and tumoral size).pCR was strongly correlated with weak eIf4E and with percentage of HER2 strong-stained cells (respectively p=0,0114 et 0,0056). 93% of tumors with an eIF4E IRS <7 (n=13/14) had a pCR, and only 5% (1/19) with an incomplete pRR had an eIF4E IRS <7. Moreover, 78% (25/32) of tumors with 100% of tumoral cells harboring a strong intensity of HER2 had a pCR versus 41% (9/22) of tumors with less than 100% of cells expressing HER2 with a strong staining.Conclusion:Our study shows a strong correlation between eIF4E expression or HER2 expression and pRR in patients with HER2 + breast treated with a neoadjuvant TTZ-containing regimen. IHC of eIF4E might be a powerful test to predict sensitivity to TTZ.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2043.

[Horizontal glottectomy according to Calearo-Teatini for the treatment of tumors involving the anterior commissure of the larynx: oncological and functional results]

Among the different surgical options proposed for the treatment of glottic neoplasms involving the anterior commissure is the Horizontal Glottectomy (HG) proposed in 1978 by Calearo and Teatini. This type of laryngectomy is now included with good reason among the reconstructive horizontal laryngectomies in that it calls for the complete removal of the vocal folds and corresponding thyroid cartilage, with reconstruction of the airways by means of a thyrocricopexy. The object of our study was to describe the indications, surgical technique and oncological and functional results on the basis of the experience acquired by the Authors in 21 patients affected by laryngeal carcinoma (juxta-commissural T1a with diffuse hyperkeratosis of the contralateral cord and T1b infiltration to the anterior commissure) who underwent Horizontal Glottectomy (HG) according to the Calearo-Teatinin technique. For 3 of the 21 patients, the follow-up was under 3 years; for 11 patients it was over 5 years; and in 4 cases, it was over 10 years, with a survival rate at 5 years of 91.5%. There were 5 deaths (27.7%), 2 of which were due to non-neoplastic intervening causes, and 1 of which for a recurrence of N (5.5%) a year after surgery. In 3 patients, postoperative RT (radiotherapy) was carried out due to infiltration of the resection borders. With regard to the functional results, the naso-gastric tube was maintained for 8 days on average (min 4, max 12 days), and the tracheal cannula remained in situ an average of 11 days (min 7, max 19 days), while the average hospital stay was 9.3 days. The treatment options currently available for glottic tumors involving the anterior commissure may be divided among radiotherapy (RT), conventional surgery including vertical laryngectomies (Tucker's frontoanterior and Leroux-Robert's frontolateral laryngectomies) and horizontal laryngectomies (Calearo-Teatini's horizontal glottectomy, Majer-Piquet's crico-hyoido-epiglottopexy, and Labayle's crico-hyoidopexy), as well as endoscopic laser surgery. Each procedure is adopted on the basis of the experience and philosophy of the surgeon. For tumors involving the anterior commissure, our treatment protocol prescribes HG to be performed whenever possible, as its oncological and functional result have confirmed the validity of the procedure, as long as the indications are followed carefully. Furthermore, when compared to the frontolateral procedure, it provides similar oncological results, but being a much more economical operation on the vertical plane, it avoids stenotic complications, while, compared to the Majer-Piquet procedure, it allows easier and faster rehabilitation, even in elderly patients.

[Oropharyngeal angiolipoma: a case study]

Angiolipoma is a histological variation of lipoma. It occurs in 17% of the cases of lipoma and the cervico-facial localization is quite rate. Indeed, in the literature 17 cases of angiolipoma have been presented in the head and neck region and none in the oropharygeal area. The present work reports a case of pedunculate angiolipoma in a 44-year-old male: the red-violaceous growth resting on the upper surface of the tongue--was 13 cm long and 1 cm in diameter. The implantation base corresponded to the left posterior-lateral wall of the oropharnyx, 1 cm below the lower tonsilar pole. A serreneoud loop was used to remove the angiolipoma in direct view, the patients mouth held open with an autostatic gag. Histologically it was a non infiltrating variant for which simple removal is curative and recurrences are rare. Viceversa, removal of the infiltrating type requires expanding there section edges to include surrounding tissues in an attempt to preventre currences which are quite frequent (occurring in approximately 50% of the cases).

Class II MHC antigen expression on epithelial cells of salivary glands from patients with Sjögren's syndrome

Class II MHC molecules are two-chain glycoproteins normally expressed only on the membrane of cells involved in the immune response. These molecules are restriction elements for helper T cells. Using indirect immunofluorescence on cryostat sections of biopsied salivary glands we have demonstrated epithelial expression of class II antigens in patients with Sjögren's syndrome. The HLA DR+ epithelial cells were seen in close proximity to lymphocyte infiltrates. The finding that class II molecules are also expressed in salivary glands without focal lymphocytic infiltrates suggests a "modulation" as opposed to "induction" of HLA DR antigens on epithelial cells in Sjögren's syndrome, the distinction being related to the enhancement of low levels of expressions vs. de novo synthesis.