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Mourits MJE, Schröder CP. [Gender pay gap in a large university hospital in the Netherlands]. Ned Tijdschr Geneeskd 2024; 168:D7920. [PMID: 38451168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Differences in payment between men and women are common. The goal of this study was to assess differences in payment in a large Dutch university hospital. METHODS The Human Resource Management & Organizational BehaviorCenter, University of Groningen conducted the study. Anonymous monthly data from UMCG employees from 2012-2020 (13,212 employees with a permanent appointment and a minimum size of 0.2 Full Time Equivalent (FTE)), were used regarding salary, function, leadership position, department, age, gender, FTE, bonuses and allowances. The total salary consisted of gross salary, bonuses and allowances. Medical specialists were further divided in surgical, medical and support groups. RESULTS Female employees earned on average less than their male colleagues throughout the entire period. In 2020, female medical specialists received an average of 6.1% less salary than male colleagues; for non-medical staff this was 3.2%. A breakdown by salary components showed that for the medical specialists the difference in total salary was not due to differences in gross salary (-0.5%), but to the difference in allowances and bonuses. Female medical specialists received up to 7.1% less in bonuses and up to 5.4% less in allowances and for non-medical staff, in addition to a significant difference in gross salary in 2020 (average -1.7%), a similar pattern was seen. Among medical specialists, the difference was greatest for surgical specialists: 9.9%, compared to 3.0% and 0.4% for medical and support specialists respectively. CONCLUSION We showed a gender payment gap within one of the largest university hospitals of the Netherlands, which is systematic, in time and throughout the institution. The most striking differences are due to bonuses and gratifications.
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Affiliation(s)
- Marian J E Mourits
- UMC Groningen-Universiteit van Groningen, afd. Obstetrie en Gynaecologie,Groningen
- Contact:
| | - Carolien P Schröder
- UMC Groningen-Universiteit van Groningen, afd. Medische Oncologie, Groningen
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Zwager MC, Holt-Kedde I, Timmer-Bosscha H, de Bock GH, Werker PMN, Schröder CP, van der Vegt B, Arjaans M. Presence of crown-like structures in breast adipose tissue; differences between healthy controls, BRCA1/2 gene mutation carriers and breast cancer patients. Breast Cancer Res Treat 2024; 204:27-37. [PMID: 38057686 DOI: 10.1007/s10549-023-07169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE Crown-like structures (CLS) in breast adipose tissue are associated with inflammation and a potential factor in breast cancer behaviour. Whether this effect varies between breast cancer subtypes and is influenced by BMI and BRCA mutation status is presently unknown. Therefore, we compared CLS presence between adipose tissue of healthy controls, BRCA1/2 gene mutation carriers and breast cancer patients, and assessed the relation of CLS with clinical outcome in breast cancer patients. METHODS Immunohistochemical staining for CD68 was performed on breast adipose tissue sections of 48 healthy controls, 78 BRCA1/2 gene mutation carriers and 259 breast cancer patients. CLS presence and index (CLS/cm2) were correlated with BMI, BRCA status, tumour presence, intrinsic tumour subtype and tumour characteristics. Associations with clinical outcome were assessed. RESULTS CLS were more often present in breast cancer patients compared to BRCA carriers and healthy controls. CLS presence was associated with the presence of breast cancer and high BMI. CLS were more often present in Luminal-B-like tumours compared to the other subtypes. No correlations between CLS and BRCA status or age was found. In TNBC, CLS were related to lymphovascular invasion. No association with survival was found. CONCLUSION In conclusion, CLS were more frequently present in breast adipose tissue of breast cancer patients compared to BRCA1/2 gene mutation carriers and healthy controls. Furthermore, our study provides evidence of the association between obesity and presence of CLS. The prognostic significance and impact on clinical outcome of differences in CLS numbers should be further assessed in prospective studies.
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Affiliation(s)
- Mieke C Zwager
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Iris Holt-Kedde
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hetty Timmer-Bosscha
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M N Werker
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marlous Arjaans
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Plastic Surgery, OLVG Medical Center, Amsterdam, The Netherlands
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Mileva M, de Vries EGE, Guiot T, Wimana Z, Deleu AL, Schröder CP, Lefebvre Y, Paesmans M, Stroobants S, Huizing M, Aftimos P, Tol J, Van der Graaf WTA, Oyen WJG, Vugts DJ, Menke-van der Houven van Oordt CW, Brouwers AH, Piccart-Gebhart M, Flamen P, Gebhart G. Molecular imaging predicts lack of T-DM1 response in advanced HER2-positive breast cancer (final results of ZEPHIR trial). NPJ Breast Cancer 2024; 10:4. [PMID: 38184611 PMCID: PMC10771456 DOI: 10.1038/s41523-023-00610-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/04/2023] [Indexed: 01/08/2024] Open
Abstract
Efficacy of the human epidermal growth factor receptor (HER)2-targeting trastuzumab emtansine (T-DM1) in breast cancer (BC) relies on HER2 status determined by immunohistochemistry or fluorescence in-situ hybridization. Heterogeneity in HER2 expression, however, generates interest in "whole-body" assessment of HER2 status using molecular imaging. We evaluated the role of HER2-targeted molecular imaging in detecting HER2-positive BC lesions and patients unlikely to respond to T-DM1. Patients underwent zirconium-89 (89Zr) trastuzumab (HER2) PET/CT and [18F]-2-fluoro-2-deoxy-D-glucose (FDG) PET/CT before T-DM1 initiation. Based on 89Zr-trastuzumab uptake, lesions were visually classified as HER2-positive (visible/high uptake) or HER2-negative (background/close to background activity). According to proportion of FDG-avid tumor load showing 89Zr-trastuzumab uptake (entire/dominant part or minor/no part), patients were classified as HER2-positive and HER2-negative, respectively. Out of 265 measurable lesions, 93 (35%) were HER2-negative, distributed among 42 of the 90 included patients. Of these, 18 (19%) lesions belonging to 11 patients responded anatomically (>30% decrease in axial diameter from baseline) after three T-DM1 cycles, resulting in an 81% negative predictive value (NPV) of the HER2 PET/CT. In combination with early metabolic response assessment on FDG PET/CT performed before the second T-DM1 cycle, NPVs of 91% and 100% were reached in predicting lesion-based and patient-based (RECIST1.1) response, respectively. Therefore, HER2 PET/CT, alone or in combination with early FDG PET/CT, can successfully identify BC lesions and patients with a low probability of clinical benefit from T-DM1.
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Affiliation(s)
- Magdalena Mileva
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas Guiot
- Department of Medical Physics, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Zéna Wimana
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Radiopharmacy, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne-Leen Deleu
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Medical Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Yolene Lefebvre
- Department of Radiology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marianne Paesmans
- Data Center, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Manon Huizing
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Philippe Aftimos
- Department of Medical Oncology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jolien Tol
- Department of Internal Medicine, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands
| | - Winette T A Van der Graaf
- Department of Medical Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wim J G Oyen
- Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Danielle J Vugts
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martine Piccart-Gebhart
- Department of Medical Oncology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Flamen
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Géraldine Gebhart
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Chen M, Yu S, van der Sluis T, Zwager MC, Schröder CP, van der Vegt B, van Vugt MATM. cGAS-STING pathway expression correlates with genomic instability and immune cell infiltration in breast cancer. NPJ Breast Cancer 2024; 10:1. [PMID: 38167507 PMCID: PMC10761738 DOI: 10.1038/s41523-023-00609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Genomic instability, as caused by oncogene-induced replication stress, can lead to the activation of inflammatory signaling, involving the cGAS-STING and JAK-STAT pathways. Inflammatory signaling has been associated with pro-tumorigenic features, but also with favorable response to treatment, including to immune checkpoint inhibition. In this study, we aim to explore relations between inflammatory signaling, markers of replication stress, and immune cell infiltration in breast cancer. Expression levels of cGAS-STING signaling components (STING, phospho-TBK1, and phospho-STAT1), replication stress markers (γH2AX and pRPA), replication stress-related proto-oncogenes (Cyclin E1 and c-Myc) and immune cell markers (CD20, CD4, and CD57) are determined immunohistochemically on primary breast cancer samples (n = 380). RNA-sequencing data from TCGA (n = 1082) and METABRIC (n = 1904) are used to calculate cGAS-STING scores. pTBK1, pSTAT1 expression and cGAS-STING pathway scores are all increased in triple-negative breast cancers compared to other subtypes. Expression of γH2AX, pRPA, Cyclin E1, c-Myc, and immune cell infiltration positively correlate with p-STAT1 expression (P < 0.001). Additionally, we observe significant positive associations between expression of pTBK1 and γH2AX, pRPA, c-Myc, and number of CD4+ cells and CD20+ cells. Also, cGAS-STING scores are correlated with genomic instability metrics, such as homologous recombination deficiency (P < 0.001) and tumor mutational burden (P < 0.01). Moreover, data from the I-SPY2 clinical trial (n = 71) confirms that higher cGAS-STING scores are observed in breast cancer patients who responded to immunotherapy combined with chemotherapy. In conclusion, the cGAS-STING pathway is highly expressed in TNBCs and is correlated with genomic instability and immune cell infiltration.
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Affiliation(s)
- Mengting Chen
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Shibo Yu
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tineke van der Sluis
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mieke C Zwager
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Marcel A T M van Vugt
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Schröder CP, van Leeuwen-Stok E, Cardoso F, Linderholm B, Poncet C, Wolff AC, Bjelic-Radisic V, Werutsky G, Abreu MH, Bozovic-Spasojevic I, den Hoed I, Honkoop AH, Los M, Leone JP, Russell NS, Smilde TJ, van der Velden AWG, Van Poznak C, Vleugel MM, Yung RL, Coens C, Giordano SH, Ruddy KJ. Quality of Life in Male Breast Cancer: Prospective Study of the International Male Breast Cancer Program (EORTC10085/TBCRC029/BIG2-07/NABCG). Oncologist 2023; 28:e877-e883. [PMID: 37310797 PMCID: PMC10546813 DOI: 10.1093/oncolo/oyad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/22/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Prospective data about quality of life (QoL) in men with breast cancer (BC) are lacking. A prospective registry (EORTC10085) of men with all BC stages, including a QoL correlative study, was performed as part of the International Male Breast Cancer Program. METHODS Questionnaires at BC diagnosis included the EORTC QLQ-C30 and BR23 (BC specific module), adapted for men. High functioning and global health/QoL scores indicate high functioning levels/high QoL; high symptom-focused measures scores indicate high symptoms/problems levels. EORTC reference data for healthy men and women with BC were used for comparisons. RESULTS Of 422 men consenting to participate, 363 were evaluable. Median age was 67 years, and median time between diagnosis and survey was 1.1 months. A total of 114 men (45%) had node-positive early disease, and 28 (8%) had advanced disease. Baseline mean global health status score was 73 (SD: 21), better than in female BC reference data (62, SD: 25). Common symptoms in male BC were fatigue (22, SD: 24), insomnia (21, SD: 28), and pain (16, SD: 23), for which women's mean scores indicated more burdensome symptoms at 33 (SD: 26), 30 (SD: 32), and 29 (SD: 29). Men's mean sexual activity score was 31 (SD: 26), with less sexual activity in older patients or advanced disease. CONCLUSIONS QoL and symptom burden in male BC patients appears no worse (and possibly better) than that in female patients. Future analyses on impact of treatment on symptoms and QoL over time, may support tailoring of male BC management.
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Affiliation(s)
- Carolien P Schröder
- Department Medical Oncology, Netherlands Cancer Institute Amsterdam and University Medical Center Groningen, The Netherlands
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Barbro Linderholm
- Department of Oncologym, Sahlgrenska University Hospital, Gothenburg, Sweden and Swedish Association of Breast Oncologists (SABO), Sweden
| | - Coralie Poncet
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Antonio C Wolff
- Department of Medical Oncology, Johns Hopkins, Baltimore, MD, USA
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Clinic, Wuppertal, University Witten/Herdecke, Germany
| | | | - Miguel H Abreu
- Department of Medical Oncology, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | | | - Irma den Hoed
- Department of Medical Oncology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Aafke H Honkoop
- Department of Medical Oncology, Isala, Zwolle, The Netherlands
| | - Maartje Los
- Department of Medical Oncology, St. Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Jose P Leone
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Nicola S Russell
- Department of Radiotherapy, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Ziekenhuis’s Hertogenbosch, The Netherlands
| | | | | | - Marije M Vleugel
- Department of Medical Oncology, Waterlandziekenhuis, Purmerend, The Netherlands
| | - Rachel L Yung
- Department of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Sharon H Giordano
- Department of Health Services Research and Department of Breast Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
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de Heer EC, Zois CE, Bridges E, van der Vegt B, Sheldon H, Veldman WA, Zwager MC, van der Sluis T, Haider S, Morita T, Baba O, Schröder CP, de Jong S, Harris AL, Jalving M. Glycogen synthase 1 targeting reveals a metabolic vulnerability in triple-negative breast cancer. J Exp Clin Cancer Res 2023; 42:143. [PMID: 37280675 PMCID: PMC10242793 DOI: 10.1186/s13046-023-02715-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Hypoxia-induced glycogen turnover is implicated in cancer proliferation and therapy resistance. Triple-negative breast cancers (TNBCs), characterized by a hypoxic tumor microenvironment, respond poorly to therapy. We studied the expression of glycogen synthase 1 (GYS1), the key regulator of glycogenesis, and other glycogen-related enzymes in primary tumors of patients with breast cancer and evaluated the impact of GYS1 downregulation in preclinical models. METHODS mRNA expression of GYS1 and other glycogen-related enzymes in primary breast tumors and the correlation with patient survival were studied in the METABRIC dataset (n = 1904). Immunohistochemical staining of GYS1 and glycogen was performed on a tissue microarray of primary breast cancers (n = 337). In four breast cancer cell lines and a mouse xenograft model of triple-negative breast cancer, GYS1 was downregulated using small-interfering or stably expressed short-hairpin RNAs to study the effect of downregulation on breast cancer cell proliferation, glycogen content and sensitivity to various metabolically targeted drugs. RESULTS High GYS1 mRNA expression was associated with poor patient overall survival (HR 1.20, P = 0.009), especially in the TNBC subgroup (HR 1.52, P = 0.014). Immunohistochemical GYS1 expression in primary breast tumors was highest in TNBCs (median H-score 80, IQR 53-121) and other Ki67-high tumors (median H-score 85, IQR 57-124) (P < 0.0001). Knockdown of GYS1 impaired proliferation of breast cancer cells, depleted glycogen stores and delayed growth of MDA-MB-231 xenografts. Knockdown of GYS1 made breast cancer cells more vulnerable to inhibition of mitochondrial proteostasis. CONCLUSIONS Our findings highlight GYS1 as potential therapeutic target in breast cancer, especially in TNBC and other highly proliferative subsets.
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Affiliation(s)
- E C de Heer
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - C E Zois
- Department of Oncology, Weatherall Institute of Molecular Medicine, University of Oxford, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, Oxford, OX3 9DS, UK.
- Department of Radiotherapy and Oncology, School of Health, Democritus University of Thrace, Alexandroupolis, Greece.
- Department of Oncology, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Molecular Oncology Laboratories, Oxford University, Oxford, OX3 9DS, UK.
| | - E Bridges
- Department of Oncology, Weatherall Institute of Molecular Medicine, University of Oxford, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, Oxford, OX3 9DS, UK
| | - B van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - H Sheldon
- Department of Oncology, Weatherall Institute of Molecular Medicine, University of Oxford, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, Oxford, OX3 9DS, UK
| | - W A Veldman
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - M C Zwager
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T van der Sluis
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S Haider
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - T Morita
- Tokushima University Graduate School, 3-18-15, Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - O Baba
- Tokushima University Graduate School, 3-18-15, Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - C P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
- Department of Medical Oncology, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - S de Jong
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - A L Harris
- Department of Oncology, Weatherall Institute of Molecular Medicine, University of Oxford, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, Oxford, OX3 9DS, UK
| | - M Jalving
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
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Voorwerk L, Isaeva OI, Horlings HM, Balduzzi S, Chelushkin M, Bakker NAM, Champanhet E, Garner H, Sikorska K, Loo CE, Kemper I, Mandjes IAM, de Maaker M, van Geel JJL, Boers J, de Boer M, Salgado R, van Dongen MGJ, Sonke GS, de Visser KE, Schumacher TN, Blank CU, Wessels LFA, Jager A, Tjan-Heijnen VCG, Schröder CP, Linn SC, Kok M. PD-L1 blockade in combination with carboplatin as immune induction in metastatic lobular breast cancer: the GELATO trial. Nat Cancer 2023; 4:535-549. [PMID: 37038006 PMCID: PMC10132987 DOI: 10.1038/s43018-023-00542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/08/2023] [Indexed: 04/12/2023]
Abstract
Invasive lobular breast cancer (ILC) is the second most common histological breast cancer subtype, but ILC-specific trials are lacking. Translational research revealed an immune-related ILC subset, and in mouse ILC models, synergy between immune checkpoint blockade and platinum was observed. In the phase II GELATO trial ( NCT03147040 ), patients with metastatic ILC were treated with weekly carboplatin (area under the curve 1.5 mg ml-1 min-1) as immune induction for 12 weeks and atezolizumab (PD-L1 blockade; triweekly) from the third week until progression. Four of 23 evaluable patients had a partial response (17%), and 2 had stable disease, resulting in a clinical benefit rate of 26%. From these six patients, four had triple-negative ILC (TN-ILC). We observed higher CD8+ T cell infiltration, immune checkpoint expression and exhausted T cells after treatment. With this GELATO trial, we show that ILC-specific clinical trials are feasible and demonstrate promising antitumor activity of atezolizumab with carboplatin, particularly for TN-ILC, and provide insights for the design of highly needed ILC-specific trials.
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Affiliation(s)
- Leonie Voorwerk
- Division of Tumor Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Olga I Isaeva
- Division of Tumor Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hugo M Horlings
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sara Balduzzi
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Maksim Chelushkin
- Division of Tumor Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Noor A M Bakker
- Division of Tumor Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Elisa Champanhet
- Division of Tumor Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hannah Garner
- Division of Tumor Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Karolina Sikorska
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Claudette E Loo
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Inge Kemper
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ingrid A M Mandjes
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michiel de Maaker
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jasper J L van Geel
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jorianne Boers
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Maaike de Boer
- Department of Medical Oncology, GROW, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Roberto Salgado
- Department of Pathology, GZA-ZNA hospitals, Antwerp, Belgium
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Marloes G J van Dongen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Karin E de Visser
- Division of Tumor Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
- Department of Immunology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ton N Schumacher
- Oncode Institute, Utrecht, the Netherlands
- Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
| | - Christian U Blank
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Lodewyk F A Wessels
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Sabine C Linn
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marleen Kok
- Division of Tumor Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
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Zwager MC, Bense R, Waaijer S, Qiu SQ, Timmer-Bosscha H, de Vries EGE, Schröder CP, van der Vegt B. Assessing the role of tumour-associated macrophage subsets in breast cancer subtypes using digital image analysis. Breast Cancer Res Treat 2023; 198:11-22. [PMID: 36622544 PMCID: PMC9883348 DOI: 10.1007/s10549-022-06859-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/29/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE The number of M1-like and M2-like tumour-associated macrophages (TAMs) and their ratio can play a role in breast cancer development and progression. Early clinical trials using macrophage targeting compounds are currently ongoing. However, the most optimal detection method of M1-like and M2-like macrophage subsets and their clinical relevance in breast cancer is still unclear. We aimed to optimize the assessment of TAM subsets in different breast cancer subtypes, and therefore related TAM subset numbers and ratio to clinicopathological characteristics and clinical outcome. METHODS Tissue microarrays of 347 consecutive primary Luminal-A, Luminal-B, HER2-positive and triple-negative tumours of patients with early-stage breast cancer were serially sectioned and immunohistochemically stained for the pan-macrophage marker CD68 and the M2-like macrophage markers CD163, CSF-1R and CD206. TAM numbers were quantified using a digital image analysis algorithm. M1-like macrophage numbers were calculated by subtracting M2-like TAM numbers from the total TAM number. RESULTS M2-like markers CD163 and CSF-1R showed a moderate positive association with each other and with CD68 (r ≥ 0.47), but only weakly with CD206 (r ≤ 0.06). CD68 + , CD163 + and CSF-1R + macrophages correlated with tumour grade in Luminal-B tumours (P < 0.001). Total or subset TAM numbers did not correlate with disease outcome in any breast cancer subtype. CONCLUSION In conclusion, macrophages and their subsets can be detected by means of a panel of TAM markers and are related to unfavourable clinicopathological characteristics in Luminal-B breast cancer. However, their impact on outcome remains unclear. Preferably, this should be determined in prospective series.
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Affiliation(s)
- Mieke C. Zwager
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rico Bense
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stijn Waaijer
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Si-Qi Qiu
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Diagnosis and Treatment Center of Breast Diseases, Clinical Research Center, Shantou Central Hospital, Shantou, China
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Shantou University Medical College, Shantou, China
| | - Hetty Timmer-Bosscha
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth G. E. de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P. Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Medical Oncology, Dutch Cancer Institute, Amsterdam, Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
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Noordhoek I, Bastiaannet E, de Glas NA, Scheepens J, Esserman LJ, Wesseling J, Scholten AN, Schröder CP, Elias SG, Kroep JR, Portielje JEA, Kleijn M, Liefers GJ. Validation of the 70-gene signature test (MammaPrint) to identify patients with breast cancer aged ≥ 70 years with ultralow risk of distant recurrence: A population-based cohort study. J Geriatr Oncol 2022; 13:1172-1177. [PMID: 35871138 DOI: 10.1016/j.jgo.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/22/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION When risk estimation in older patients with hormone receptor positive breast cancer (HR + BC) is based on the same factors as in younger patients, age-related factors regarding recurrence risk and other-cause mortality are not considered. Genomic risk assessment could help identify patients with ultralow risk BC who can forgo adjuvant treatment. However, assessment tools should be validated specifically for older patients. This study aims to determine whether the 70-gene signature test (MammaPrint) can identify patients with HR + BC aged ≥70 years with ultralow risk for distant recurrence. MATERIALS AND METHODS Inclusion criteria: ≥70 years; invasive HR + BC; T1-2N0-3M0. EXCLUSION CRITERIA HER2 + BC; neoadjuvant therapy. MammaPrint assays were performed following standardized protocols. Clinical risk was determined with St. Gallen risk classification. Primary endpoint was 10-year cumulative incidence rate of distant recurrence in relation to genomic risk. Subdistribution hazard ratios (sHR) were estimated from Fine and Gray analyses. Multivariate analyses were adjusted for adjuvant endocrine therapy and clinical risk. RESULTS This study included 418 patients, median age 78 years (interquartile range [IQR] 73-83). Sixty percent of patients were treated with endocrine therapy. MammaPrint classified 50 patients as MammaPrint-ultralow, 224 patients as MammaPrint-low, and 144 patients as MammaPrint-high risk. Regarding clinical risk, 50 patients were classified low, 237 intermediate, and 131 high. Discordance was observed between clinical and genomic risk in 14 MammaPrint-ultralow risk patients who were high clinical risk, and 84 patients who were MammaPrint-high risk, but low or intermediate clinical risk. Median follow-up was 9.2 years (IQR 7.9-10.5). The 10-year distant recurrence rate was 17% (95% confidence interval [CI] 11-23) in MammaPrint-high risk patients, 8% (4-12) in MammaPrint-low (HR 0.46; 95%CI 0.25-0.84), and 2% (0-6) in MammaPrint-ultralow risk patients (HR 0.11; 95%CI 0.02-0.81). After adjustment for clinical risk and endocrine therapy, MammaPrint-high risk patients still had significantly higher 10-year distant recurrence rate than MammaPrint-low (sHR 0.49; 95%CI 0.26-0.90) and MammaPrint-ultralow patients (sHR 0.12; 95%CI 0.02-0.85). Of the 14 MammaPrint-ultralow, high clinical risk patients none developed a distant recurrence. DISCUSSION These data add to the evidence validating MammaPrint's ultralow risk threshold. Even in high clinical risk patients, MammaPrint-ultralow risk patients remained recurrence-free ten years after diagnosis. These findings justify future studies into using MammaPrint to individualize adjuvant treatment in older patients.
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Affiliation(s)
- I Noordhoek
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - E Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - N A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Scheepens
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - L J Esserman
- Department of Surgical Oncology, University of California San Francisco, United States of America
| | - J Wesseling
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands; Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A N Scholten
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C P Schröder
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - S G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - M Kleijn
- Department of Medical Affairs, Agendia N.V., Amsterdam, the Netherlands
| | - G J Liefers
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
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Heimovaara JH, Blommaert J, Free J, Bolt RA, Gort EM, Depuydt T, Boso Martinez C, Schoots MH, van Gerwen M, van den Heuvel-Eibrink M, Langendijk JA, Schröder CP, Amant F, Gordijn SJ, Oldehinkel E. Proton therapy of a pregnant patient with nasopharyngeal carcinoma. Clin Transl Radiat Oncol 2022; 35:33-36. [PMID: 35601798 PMCID: PMC9114153 DOI: 10.1016/j.ctro.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background and purpose Radiotherapy during pregnancy is rarely administered due to lack of data and practical challenges. This is the first detailed report of proton therapy as cancer treatment for a pregnant patient with nasopharyngeal carcinoma. Materials and methods Pencil beam scanning proton therapy was prescribed to a pregnant patient to a total dose of 70 Gy (RBE) to the therapeutic CTV and 54.25 Gy to the prophylactic CTV, delivered in 35 fractions with a simultaneous integrated boost technique. Results Phantom measurements showed a thirty-fold decrease in fetal radiation dose when using proton compared to photon therapy, with a total fetal dose of 5.5 mSv for the complete proton treatment, compared to 185 and 298 mSv for the photon treatment with and without lead shielding, respectively. After adminstering proton therapy during pregnancy, at 39 weeks of gestation, a healthy boy with a birthweight on the 83th percentile was delivered. Pediatric follow-up at 2 months of age of the offspring showed normal growth and age-adequate motor development with no signs of neurological problems. MR follow-up of the tumor 3 months after the end of treatment showed complete remission. Conclusion This case demonstrates the potential of proton therapy for treatment during pregnancy.Compared to photon therapy, proton therapy can significantly limit fetal dose, while simultaneously offering a more optimized treatment to the patient.
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Affiliation(s)
- Joosje H. Heimovaara
- Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Gynecologic Oncology, Netherlands Cancer Institute and Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Jeffrey Free
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - René A. Bolt
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Elske M. Gort
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Tom Depuydt
- Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | | | - Mirthe H. Schoots
- Department of Pathology and Medical Biology, Pathology Section, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mathilde van Gerwen
- Department of Gynecologic Oncology, Netherlands Cancer Institute and Amsterdam University Medical Center, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Johannes A. Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carolien P. Schröder
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute and Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Gynecologic Oncology, Netherlands Cancer Institute and Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Gynecologic Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Sanne J. Gordijn
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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De Heer EC, Zois CE, Bridges E, Zwager MC, van der Sluis T, van der Vegt B, Schröder CP, de Jong S, Harris AL, Jalving M. Abstract 5813: Glycogen synthesis as potential novel target in triple negative breast cancer: Glycogen synthase 1 expression in human breast cancers and the impact of downregulation on proliferation of preclinical models. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Triple-negative breast cancer (TNBC) has a poor clinical prognosis and is characterized by a lack of druggable targets and a hypoxic tumor microenvironment. Hypoxia-induced glycogen accumulation and utilization are involved in cancer proliferation and therapy resistance, making modulation of glycogen metabolism of therapeutic interest. Therefore, we studied expression of glycogen synthase 1 (GYS1, the key regulator of glycogen synthesis) and glycogen stores in publicly available expression data and human breast tumors including TNBC. Also, we studied downregulation of GYS1 in preclinical breast cancer models, focusing on TNBC.
Methods: GYS1 mRNA expression and correlations with survival per clinical subtype were assessed in the METABRIC dataset. A tissue micro-array was constructed from primary tumors of 396 breast cancer patients with long-term follow-up, including normal breast control tissue. Triplicate tissue cores were stained immunohistochemically for GYS1, glycogen and the hypoxic marker carbonic anhydrase 9, and with periodic acid-Schiff staining for glycogen. In four TNBC cell lines and an MDA-MB-231 xenograft model, GYS1 protein expression, glycogen content and cell proliferation in normoxia and hypoxia were evaluated +/- GYS1 knockdown by siRNA or shRNA. Sensitivity of shGYS1 cell lines to drugs targeting mitochondria was tested.
Results: In the METABRIC dataset (n = 1904), overexpression of GYS1 mRNA was associated with poor overall survival (HR 1.20 [95% CI 1.05 - 1.38]), which was mainly driven by the TNBC patients (n = 299, HR 1.52 [95% CI 1.09 - 2.14]). Immunohistochemically, most primary breast tumors had elevated GYS1 levels and glycogen content compared to normal breast tissue, with subtype specific analyses ongoing. In all breast cancer cell lines, hypoxia induced GYS1 protein expression and increased glycogen content. Acute siRNA-mediated GYS1 knockdown decreased proliferation of (TN)BC cell lines and MDA-MB-231 spheroids in both hypoxia and normoxia. shGYS1 MDA-MB-231 cells had decreased glycogen levels and shGYS1 MDA-MB-231 xenograft growth was impaired, especially in the first six weeks after inoculation. In control xenografts, immunohistochemical GYS1 expression was most pronounced adjacent to the necrotic tumor core, whereas shGYS1 xenografts lacked GYS1 expression. Finally, shGYS1 MDA-MB-231 cells were more sensitive to inhibitors of mitochondrial protein homeostasis, suggesting a potential synergistic approach to overcome eventual metabolic adaptation.
Conclusions: GYS1 is overexpressed in primary breast tumors and high mRNA levels correlate with poor survival in TNBC. GYS1 downregulation impairs TNBC proliferation in vitro and in vivo, highlighting glycogen synthesis as potential novel therapeutic target in TNBC.
Citation Format: Ellen C. De Heer, Christos E. Zois, Esther Bridges, Mieke C. Zwager, Tineke van der Sluis, Bert van der Vegt, Carolien P. Schröder, Steven de Jong, Adrian L. Harris, Mathilde Jalving. Glycogen synthesis as potential novel target in triple negative breast cancer: Glycogen synthase 1 expression in human breast cancers and the impact of downregulation on proliferation of preclinical models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5813.
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Affiliation(s)
- Ellen C. De Heer
- 1University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Christos E. Zois
- 2Cancer Research UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Esther Bridges
- 2Cancer Research UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Mieke C. Zwager
- 1University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Tineke van der Sluis
- 1University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bert van der Vegt
- 1University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Carolien P. Schröder
- 3University of Groningen, University Medical Center Groningen/Antoni van Leeuwenhoek-Dutch Cancer Institute, Groningen/Amsterdam, Netherlands
| | - Steven de Jong
- 1University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Adrian L. Harris
- 2Cancer Research UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Mathilde Jalving
- 1University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Scholten AN, Schröder CP, Elias SG, Liefers GJ. [Treatment of older breast cancer patients: de-escalation in oncology]. Ned Tijdschr Geneeskd 2021; 165:D5626. [PMID: 34854608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The prognosis of breast cancer patients has greatly improved in recent decades. Innovations in imaging techniques, pathological assessment, optimized surgical and radiotherapy techniques have contributed to this. Much of the improvement is due to the increase of the range of effective systemic treatment and the continual expansion of the indication for this purpose. However, broadening the guidelines for adjuvant systemic treatments, results in a smaller absolute gain. The balance between effectiveness and side-effects could therefore be compromised, which is an incentive to search for possibilities for de-escalation to prevent potential damage, without unnecessarily increasing the risk of recurrence. Currently, in The Netherlands this is being investigated in older breast cancer patients.
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Noordhoek I, Bastiaannet E, Lujinovic E, Esserman L, Wesseling J, Scholten A, Schröder CP, Elias S, de Glas NA, Kroep JR, Portielje JEA, Kleijn M, Liefers GJJ. Abstract PS6-06: The 70-gene signature (MammaPrint) accurately predicts distant breast cancer recurrence risk in patients aged ≥70 years from the population-based observational FOCUS cohort. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps6-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Predicting breast cancer recurrence in patients aged ≥70 years is challenging, as they generally have more indolent tumors and a higher chance of dying of competing causes than younger patients. The 70-gene signature test (MammaPrint) has been shown to accurately predict recurrence in women with early breast cancer and up to 3 positive lymph nodes. Aim To study outcome related to MammaPrint result in patients aged ≥70 years with breast cancer using a population-based cohort. Methods The population-based FOCUS cohort included all 2095 consecutive patients with any stage breast cancer, diagnosed between 1997 and 2004, aged ≥65 years, in the Comprehensive Cancer Center region West, the Netherlands. In the present exploratory sub-study, patients from FOCUS with the following criteria were included: ≥70 years old, T1-2N0-3M0, hormone receptor positive, HER2 negative, no neo-adjuvant treatment and available tumor specimens. MammaPrint is a genomic risk profile based on microarray gene expression analysis, classifying patients as ultralow risk (M-ULR), low (not UL) risk (M-LR) or high risk (M-HR) of developing a recurrence. Patients were considered clinically low risk (C-LR) with T1-2N0 grade 1-2 tumors and clinically high risk (C-HR) with N+ or T2/grade 3 tumors. Primary endpoint was 10-year distant recurrence free interval (DRFi) in relation to genomic risk, estimated from cumulative incidence and Fine and Gray analyses to take competing mortality into account. Results In this study, 422 patients were included. Median age was 78 years, 238 patients (56%) had node negative disease, 235 patients (56%) had T2 tumors and 227 patients (54%) were C-LR. Most patients were treated with endocrine therapy (ET), and 22 patients (5%) were treated with chemotherapy (CT; table 1). Overall, 50 (12%) patients were M-ULR, 226 (53%) were M-LR and 146 (35%) were M-HR. Discrepancies were found between C and M risk groups in 18/50 M-ULR patients with C-HR, and 56/146 M-HR patients with C-LR. Of the 59 patients that experienced a recurrence during 10 years of follow-up, 44 (75%) were distant recurrences. In the M-ULR group, DRFi was 2% (95%CI 0-6) after 10 years of follow-up, this was 8% (95%CI 5-12) in the M-LR group and 17% (95%CI 11-23) in the M-HR group (p<0.001). In the C-HR subgroup, none of the 18 M-ULR patients developed a recurrence, and DRFi was 10% (95%CI 3-16) in M-LR patients and 20% (95%CI 12-28) in M-HR patients (p=0.015). C risk alone was not able to predict distant recurrence risk (C-LR 8%, C-HR 14%, sHR 1.8 [95%CI 0.9-3.2); p=0.060; table 2). Conclusion MammaPrint accurately predicts 10-year DRFi in older patients with breast cancer. Patients classified as ultralow risk by MammaPrint had a very low chance of developing metastatic disease. Even in clinically high-risk patients who were M-ULR, recurrent disease did not occur 10 years after diagnosis. These findings are in line with published results of the STO-3 trial (JAMA Oncol, 2017) and provide foundation for de-escalation of treatment in older patients guided by genomic testing.
Table 1: Baseline characteristics. BCS = breast conserving surgery. RT = radiotherapyM-ULRM-LRM-HRTotal patientsN (%)50 (11.8)226 (53.6)146 (34.6)AgeMedian (IQR)79 (74-85)79 (74-84)77 (74-84)Histological grade [N (%)]I11 (22.0)39 (17.3)5 (3.4)II21 (42.0)92 (40.7)42 (28.8)III1 (2.0)31 (13.7)54 (37.0)Missing17 (34.0)64 (28.3)45 (30.8)T-stage [N (%)]Tis0 (0.0)2 (0.9)0 (0.0)T117 (34.0)111 (49.1)54 (37.0)T233 (66.0)113 (50.0)89 (61.0)Missing0 (0.0)0 (0.0)3 (2.0)N-stage [N (%)]N032 (64.0)140 (61.9)66 (45.2)N117 (34.0)72 (31.9)67 (45.9)N20 (0.0)6 (2.7)6 (4.1)N30 (0.0)2 (0.9)3 (2.1)Missing1 (2.0)6 (2.7)4 (2.7)Clinical risk [N (%)]Low32 (64.0)139 (61.5)56 (38.4)High18 (36.0)87 (38.5)90 (61.6)Local treatment [N (%)]None4 (8.0)5 (2.2)6 (4.1)BCS only3 (6.0)16 (7.1)13 (8.9)BCS + RT9 (18.0)62 (27.4)29 (19.9)Mastectomy34 (68.0)143 (63.3)98 (67.1)Adjuvant ET [N (%)]None24 (48.0)103 (45.6)40 (27.4)Tamoxifen17 (34.0)87 (38.5)80 (54.8)Aromatase inhibitor3 (6.0)11 (4.9)9 (6.2)Unspecified ET6 (12.0)25 (11.1)17 (11.6)Adjuvant CT [N (%)]No46 (92.0)217 (96.0)137 (93.8)Yes4 (8.0)9 (4.0)9 (6.2)
Table 2: Primary endpoint stratified by genomic and clinical risk. sHR=subdistribution hazard ratio.M-ULRM-LRM-HRTotalC-LRN=32 (14%). DRFi=3% (95%CI 0-9). sHR=1 (reference).N=139 (61%). DRFi=7% (95%CI 3-12). sHR=2.1 (95%CI 0.3-16.5).N=56 (25%). DRFi=13% (95%CI 4-21). sHR=4.3 (95%CI 0.5-34.7).N=227. DRFi=8% (95%CI 4-12).C-HRN=18 (9%).DRFi=0% (95%CI 0-0). sHR=N/A (n events=0).N=87 (45%). DRFi=10% (95%CI 3-16). sHR=1 (reference).N=90 (46%). DRFi=20% (95%CI 12-28). sHR=3.0 (95%CI 1.3-6.9).N=195. DRFi=14% (95%CI 9-19).TotalN=50 (12%). DRFi=2% (95%CI 0-6). sHR=1 (reference).N=226 (53%). DRFi=8% (95%CI 5-12). sHR=3.8 (95%CI 0.5-28.2).N=146 (35%). DRFi=17% (95%CI 11-23). sHR=9.8 (95%CI 1.3-72.6).N=422.
Citation Format: Iris Noordhoek, Esther Bastiaannet, Ersan Lujinovic, Laura Esserman, Jelle Wesseling, Astrid Scholten, Carolien P Schröder, Sjoerd Elias, Nienke A de Glas, Judith R Kroep, Johanneke EA Portielje, Miranda Kleijn, Gerrit-Jan J Liefers. The 70-gene signature (MammaPrint) accurately predicts distant breast cancer recurrence risk in patients aged ≥70 years from the population-based observational FOCUS cohort [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-06.
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Affiliation(s)
| | | | | | - Laura Esserman
- 3University of California, San Fransisco, San Fransisco, CA
| | | | | | | | - Sjoerd Elias
- 6University Medical Center Utrecht, Utrecht, Netherlands
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Steenbruggen TG, Steggink LC, Seynaeve CM, van der Hoeven JJM, Hooning MJ, Jager A, Konings IR, Kroep JR, Smit WM, Tjan-Heijnen VCG, van der Wall E, Bins AD, Linn SC, Schaapveld M, Jacobse JN, van Leeuwen FE, Schröder CP, van Tinteren H, de Vries EGE, Sonke GS, Gietema JA. High-Dose Chemotherapy With Hematopoietic Stem Cell Transplant in Patients With High-Risk Breast Cancer and 4 or More Involved Axillary Lymph Nodes: 20-Year Follow-up of a Phase 3 Randomized Clinical Trial. JAMA Oncol 2020; 6:528-534. [PMID: 31999296 DOI: 10.1001/jamaoncol.2019.6276] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Trials of adjuvant high-dose chemotherapy (HDCT) have failed to show a survival benefit in unselected patients with breast cancer, but long-term follow-up is lacking. Objective To determine 20-year efficacy and safety outcomes of a large trial of adjuvant HDCT vs conventional-dose chemotherapy (CDCT) for patients with stage III breast cancer. Design, Setting, and Participants This secondary analysis used data from a randomized phase 3 multicenter clinical trial of 885 women younger than 56 years with breast cancer and 4 or more involved axillary lymph nodes conducted from August 1, 1993, to July 31, 1999. Additional follow-up data were collected between June 1, 2016, and December 31, 2017, from medical records, general practitioners, the Dutch national statistical office, and nationwide cancer registries. Analysis was performed on an intention-to-treat basis. Statistical analysis was performed from February 1, 2018, to October 14, 2019. Interventions Participants were randomized 1:1 to receive 5 cycles of CDCT consisting of fluorouracil, 500 mg/m2, epirubicin, 90 mg/m2, and cyclophosphamide, 500 mg/m2, or HDCT in which the first 4 cycles were identical to CDCT and the fifth cycle was replaced by cyclophosphamide, 6000 mg/m2, thiotepa, 480 mg/m2, and carboplatin, 1600 mg/m2, followed by hematopoietic stem cell transplant. Main Outcomes and Measures Main end points were overall survival and safety and cumulative incidence risk of a second malignant neoplasm or cardiovascular events. Results Of the 885 women in the study (mean [SD] age, 44.5 [6.6] years), 442 were randomized to receive HDCT, and 443 were randomized to receive CDCT. With 20.4 years median follow-up (interquartile range, 19.2-22.0 years), the 20-year overall survival was 45.3% with HDCT and 41.5% with CDCT (hazard ratio, 0.89; 95% CI, 0.75-1.06). The absolute improvement in 20-year overall survival was 14.6% (hazard ratio, 0.72; 95% CI, 0.54-0.95) for patients with 10 or more invoved axillary lymph nodes and 15.4% (hazard ratio, 0.67; 95% CI, 0.42-1.05) for patients with triple-negative breast cancer. The cumulative incidence risk of a second malignant neoplasm at 20 years or major cardiovascular events was similar in both treatment groups (20-year cumulative incidence risk for second malignant neoplasm was 12.1% in the HDCT group vs 16.2% in the CDCT group, P = .10), although patients in the HDCT group more often had hypertension (21.7% vs 14.3%, P = .02), hypercholesterolemia (15.7% vs 10.6%, P = .04), and dysrhythmias (8.6% vs 4.6%, P = .005). Conclusions and Relevance High-dose chemotherapy provided no long-term survival benefit in unselected patients with stage III breast cancer but did provide improved overall survival in very high-risk patients (ie, with ≥10 involved axillary lymph nodes). High-dose chemotherapy did not affect long-term risk of a second malignant neoplasm or major cardiovascular events. Trial Registration ClinicalTrials.gov Identifier: NCT03087409.
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Affiliation(s)
- Tessa G Steenbruggen
- Department of Medical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Lars C Steggink
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Caroline M Seynaeve
- Department of Medical Oncology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Inge R Konings
- Department of Medical Oncology, Amsterdam UMC, location VUmc, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wim M Smit
- Department of Internal Medicine/Medical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adriaan D Bins
- Department of Medical Oncology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Sabine C Linn
- Department of Medical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Michael Schaapveld
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Judy N Jacobse
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Flora E van Leeuwen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Harm van Tinteren
- Department of Biostatistics, the Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
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Suurs FV, Qiu SQ, Yim JJ, Schröder CP, Timmer-Bosscha H, Bensen ES, Santini JT, de Vries EGE, Bogyo M, van Dam GM. Fluorescent image-guided surgery in breast cancer by intravenous application of a quenched fluorescence activity-based probe for cysteine cathepsins in a syngeneic mouse model. EJNMMI Res 2020; 10:111. [PMID: 32990883 PMCID: PMC7524956 DOI: 10.1186/s13550-020-00688-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose The reoperation rate for breast-conserving surgery is as high as 15–30% due to residual tumor in the surgical cavity after surgery. In vivo tumor-targeted optical molecular imaging may serve as a red-flag technique to improve intraoperative surgical margin assessment and to reduce reoperation rates. Cysteine cathepsins are overexpressed in most solid tumor types, including breast cancer. We developed a cathepsin-targeted, quenched fluorescent activity-based probe, VGT-309, and evaluated whether it could be used for tumor detection and image-guided surgery in syngeneic tumor-bearing mice. Methods Binding specificity of the developed probe was evaluated in vitro. Next, fluorescent imaging in BALB/c mice bearing a murine breast tumor was performed at different time points after VGT-309 administration. Biodistribution of VGT-309 after 24 h in tumor-bearing mice was compared to control mice. Image-guided surgery was performed at multiple time points tumors with different clinical fluorescent camera systems and followed by ex vivo analysis. Results The probe was specifically activated by cathepsins X, B/L, and S. Fluorescent imaging revealed an increased tumor-to-background contrast over time up to 15.1 24 h post probe injection. In addition, VGT-309 delineated tumor tissue during image-guided surgery with different optical fluorescent imaging camera systems. Conclusion These results indicate that optical fluorescent molecular imaging using the cathepsin-targeted probe, VGT-309, may improve intraoperative tumor detection, which could translate to more complete tumor resection when coupled with commercially available surgical tools and techniques.
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Affiliation(s)
- Frans V Suurs
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Si-Qi Qiu
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,Diagnosis and Treatment Center of Breast Diseases, Affiliated Shantou Hospital, Sun Yat-Sen University, Shantou, China.
| | - Joshua J Yim
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, USA
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hetty Timmer-Bosscha
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthew Bogyo
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gooitzen M van Dam
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,Department of Nuclear Medicine and Molecular Imaging and Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Guerrero Llobet S, van der Vegt B, Jongeneel E, Bense RD, Zwager MC, Schröder CP, Everts M, Fehrmann RSN, de Bock GH, van Vugt MATM. Cyclin E expression is associated with high levels of replication stress in triple-negative breast cancer. NPJ Breast Cancer 2020; 6:40. [PMID: 32964114 PMCID: PMC7477160 DOI: 10.1038/s41523-020-00181-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/06/2020] [Indexed: 12/15/2022] Open
Abstract
Replication stress entails the improper progression of DNA replication. In cancer cells, including breast cancer cells, an important cause of replication stress is oncogene activation. Importantly, tumors with high levels of replication stress may have different clinical behavior, and high levels of replication stress appear to be a vulnerability of cancer cells, which may be therapeutically targeted by novel molecularly targeted agents. Unfortunately, data on replication stress is largely based on experimental models. Further investigation of replication stress in clinical samples is required to optimally implement novel therapeutics. To uncover the relation between oncogene expression, replication stress, and clinical features of breast cancer subgroups, we immunohistochemically analyzed the expression of a panel of oncogenes (Cyclin E, c-Myc, and Cdc25A,) and markers of replication stress (phospho-Ser33-RPA32 and γ-H2AX) in breast tumor tissues prior to treatment (n = 384). Triple-negative breast cancers (TNBCs) exhibited the highest levels of phospho-Ser33-RPA32 (P < 0.001 for all tests) and γ-H2AX (P < 0.05 for all tests). Moreover, expression levels of Cyclin E (P < 0.001 for all tests) and c-Myc (P < 0.001 for all tests) were highest in TNBCs. Expression of Cyclin E positively correlated with phospho-RPA32 (Spearman correlation r = 0.37, P < 0.001) and γ-H2AX (Spearman correlation r = 0.63, P < 0.001). Combined, these data indicate that, among breast cancers, replication stress is predominantly observed in TNBCs, and is associated with expression levels of Cyclin E. These results indicate that Cyclin E overexpression may be used as a biomarker for patient selection in the clinical evaluation of drugs that target the DNA replication stress response.
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Affiliation(s)
- Sergi Guerrero Llobet
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Evelien Jongeneel
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rico D. Bense
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mieke C. Zwager
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P. Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke Everts
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rudolf S. N. Fehrmann
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcel A. T. M. van Vugt
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Admiraal JM, Hoekstra-Weebers JEHM, Schröder CP, Tuinier W, Hospers GAP, Reyners AKL. Distress, problems, referral wish, and supportive health care use in breast cancer survivors beyond the first year after chemotherapy completion. Support Care Cancer 2020; 28:3023-3032. [PMID: 31511981 PMCID: PMC7256025 DOI: 10.1007/s00520-019-05030-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/06/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE We examined distress levels, problems, referral wish, and supportive health care use in a cross-sectional group of breast cancer survivors at two-time points with a 1-year time interval. Also, factors related to continuing elevated distress were explored. METHODS Breast cancer survivors, 1-5 years after chemotherapy completion, filled in the Dutch Distress Thermometer/Problem List (DT/PL) and questions on background characteristics at study inclusion (T1). DT/PL responses and health care use were discussed during semi-structured interviews. One year later, re-assessment took place (T2). The data were analyzed by descriptive and univariate analyses. Continuing elevated distress was defined as a DT score ≥ 5 at T1 and T2. RESULTS Seventy-three survivors completed all questionnaires (response = 84.6%). Eighteen (25%) experienced continuing elevated distress. Fatigue (T1 N = 48 (66%); T2 N = 41 (56%)) and lack of physical fitness (T1 N = 44 (60%); T2 N = 36 (49%)) were most often reported. Time since diagnosis, health care use, and practical, social, emotional and physical problems were significantly associated with continuing elevated distress. Between diagnosis and T1, N = 49(67%) used supportive healthcare services, mostly a psychologist and/or a physical/lymphedema therapist, and between T1 and T2, 39 (53%) did. At T1, 8 (11%) expressed a referral wish and at T2, 11 (16%) did. CONCLUSIONS Screening and management of distress, problems, and referral wish are important, even years after chemotherapy completion as a substantial proportion of breast cancer survivors continue to report elevated distress and problems. Special attention should be paid to survivors reporting physical problems, especially fatigue and lack of physical fitness, since these problems are most strongly related to continuing elevated distress.
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Affiliation(s)
- J M Admiraal
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - J E H M Hoekstra-Weebers
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, Groningen, The Netherlands
| | - C P Schröder
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - W Tuinier
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - G A P Hospers
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - Anna K L Reyners
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands.
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18
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Qiu SQ, van Rooijen J, Nienhuis HH, van der Vegt B, Timmer-Bosscha H, van Leeuwen-Stok E, Walenkamp AME, van Deurzen CHM, de Bock GH, de Vries EGE, Schröder CP. High hepatocyte growth factor expression in primary tumor predicts better overall survival in male breast cancer. Breast Cancer Res 2020; 22:30. [PMID: 32188473 PMCID: PMC7081628 DOI: 10.1186/s13058-020-01266-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast cancer is rare in men, but management is focused on tumor characteristics commonly found in female breast cancer. The tumor microenvironment of male breast cancer is less well understood, and insight may improve male breast cancer management. The hepatocyte growth factor (HGF)/c-MET axis and the stromal cell-derived factor-1 (CXCL12)/C-X-C chemokine receptor type 4 (CXCR4) axis are prognostic in women with breast cancer. We aimed to investigate these factors in male breast cancer and correlate them with patient survival. METHODS From 841 Dutch males with breast cancer who were enrolled in the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program (NCT01101425) and diagnosed between 1990 and 2010, archival primary tumor samples were collected. Tissue microarrays were constructed with 3 cores per sample and used for immunohistochemical analysis of HGF, c-MET, CXCL12, and CXCR4. Overall survival (OS) of the patients without metastases (M0) was analyzed using the Kaplan-Meier method. The value of the markers regarding OS was determined using univariable and multivariable Cox regression analyses, providing hazard ratios (HRs) and 95% confidence intervals (95% CIs). RESULTS Of 720 out of 841 patients, sufficient tissue was available for analysis; 487 out of 720 patients had M0 disease. Patients with high HGF expression and high CXCL12 expression had a superior OS (low vs high expression of both markers, 7.5 vs 13.0 years, hazard ratio [HR] 0.64, 95% CI 0.49-0.84, P = 0.001 [HGF]; 9.1 vs 15.3 years, HR 0.63, 95% CI 0.45-0.87, P = 0.005 [CXCL12]). Multivariate analysis identified HGF as an independent predictor for OS (HR 0.64, 95% CI 0.47-0.88, P = 0.001). CONCLUSIONS HGF and CXCL12 tumor expression appear to identify male breast cancer patients with a relatively good prognosis. Possibly, this could support male breast cancer-specific management strategies in the future.
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Affiliation(s)
- Si-Qi Qiu
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
- Diagnosis and Treatment Center of Breast Diseases, Affiliated Shantou Hospital, Sun Yat-sen University, Shantou, China
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Johan van Rooijen
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
- Department of Internal Medicine, Martini Hospital Groningen, Groningen, The Netherlands
| | - Hilde H Nienhuis
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hetty Timmer-Bosscha
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | | | - Annemiek M E Walenkamp
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | | | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
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Agahozo MC, Timmermans MAM, Sleddens HFBM, Foekens R, Trapman-Jansen AMAC, Schröder CP, van Leeuwen-Stok E, Martens JWM, N. M. Dinjens W, van Deurzen CHM. Loss of Y-Chromosome during Male Breast Carcinogenesis. Cancers (Basel) 2020; 12:cancers12030631. [PMID: 32182822 PMCID: PMC7139680 DOI: 10.3390/cancers12030631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 01/18/2023] Open
Abstract
Loss of Y-chromosome (LOY) is associated with increased cancer mortality in males. The prevalence of LOY in male breast cancer (BC) is unknown. The aim of this study is to assess the presence and prognostic effect of LOY during male BC progression. We included male BC patients diagnosed between 1989 and 2009 (n = 796). A tissue microarray (TMA) was constructed to perform immunohistochemistry and fluorescent in situ hybridization (FISH), using an X and Y probe. We also performed this FISH on a selected number of patients using whole tissue slides to study LOY during progression from ductal carcinoma in situ (DCIS) to invasive BC. In total, LOY was present in 12.7% (n = 92) of cases, whereby LOY was associated with ER and PR negative tumors (p = 0.017 and p = 0.01). LOY was not associated with the outcome. Using whole slides including invasive BC and adjacent DCIS (n = 22), we detected a concordant LOY status between both components in 17 patients. In conclusion, LOY is an early event in male breast carcinogenesis, which generally starts at the DCIS stage and is associated with ER and PR negative tumors.
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Affiliation(s)
- Marie Colombe Agahozo
- Department of Pathology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (M.C.A.); (H.F.B.M.S.); (W.N.M.D.)
| | - Mieke A. M. Timmermans
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015GD Rotterdam, The Netherlands; (M.A.M.T.); (R.F.); (A.M.A.C.T.-J.); (J.W.M.M.)
| | - Hein F. B. M. Sleddens
- Department of Pathology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (M.C.A.); (H.F.B.M.S.); (W.N.M.D.)
| | - Renée Foekens
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015GD Rotterdam, The Netherlands; (M.A.M.T.); (R.F.); (A.M.A.C.T.-J.); (J.W.M.M.)
| | - Anita M. A. C. Trapman-Jansen
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015GD Rotterdam, The Netherlands; (M.A.M.T.); (R.F.); (A.M.A.C.T.-J.); (J.W.M.M.)
| | - Carolien P. Schröder
- Department of Medical Oncology, University Medical Center Groningen, 9700AB Groningen, The Netherlands
| | - Elise van Leeuwen-Stok
- Dutch Breast Cancer Research Group, BOOG Study Center, 1006 AE Amsterdam, The Netherlands;
| | - John W. M. Martens
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015GD Rotterdam, The Netherlands; (M.A.M.T.); (R.F.); (A.M.A.C.T.-J.); (J.W.M.M.)
| | - Winand N. M. Dinjens
- Department of Pathology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (M.C.A.); (H.F.B.M.S.); (W.N.M.D.)
| | - Carolien H. M. van Deurzen
- Department of Pathology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (M.C.A.); (H.F.B.M.S.); (W.N.M.D.)
- Correspondence: ; Tel.: +31-107043901
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Venema CM, de Vries EFJ, van der Veen SJ, Dorrius MD, van Kruchten M, Schröder CP, Hospers GAP, Glaudemans AWJM. Enhanced pulmonary uptake on 18F-FES-PET/CT scans after irradiation of the thoracic area: related to fibrosis? EJNMMI Res 2019; 9:82. [PMID: 31444658 PMCID: PMC6708021 DOI: 10.1186/s13550-019-0549-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/05/2019] [Indexed: 12/29/2022] Open
Abstract
Rationale The use of 16α-[18F]fluoro-17β-estradiol (FES) positron emission tomography (PET) in clinical dilemmas and for therapy decision-making in lesions expressing estrogen receptors is growing. However, on a considerable number of FES PET scans, previously performed in a research and clinical setting in our institution, FES uptake was noticed in the lungs without an oncologic substrate. We hypothesized that this uptake was related to pulmonary fibrosis as a result of radiation therapy. This descriptive study therefore aimed to investigate whether radiation therapy in the thoracic area is possibly related to enhanced pulmonary, non-tumor FES uptake. Methods All FES-PET/CT scans performed in our institution from 2008 to 2017 were retrospectively analyzed. Scans from patients who had received irradiation in the thoracic area prior to the scan were compared to scans of patients who had never received irradiation in the thoracic area. The primary outcome was the presence of enhanced non-tumor FES uptake in the lungs, defined as visually increased FES uptake in the absence of an oncologic substrate on the concordant (contrast-enhanced) CT scan. All CT scans were evaluated for the presence of fibrosis or oncologic substrates. Results A total of 108 scans were analyzed: 70 scans of patients with previous irradiation in the thoracic area and 38 of patients without. Enhanced non-tumor FES uptake in the lungs was observed in 39/70 irradiated patients (56%), versus in 9/38 (24%) of non-irradiated patients. Fibrosis was present in 37 of the 48 patients with enhanced non-tumor FES uptake (77%), versus in 15 out of 60 (25%) patients without enhanced non-tumor uptake, irrespective of radiotherapy (p < 0.001). Conclusion After irradiation of the thorax, enhanced non-tumor uptake on FES-PET can be observed in the radiation field in a significant proportion of patients. This seems to be related to fibrosis. When observing enhanced FES uptake in the lungs, this should not be interpreted as metastases. Information on recent radiation therapy or history of pulmonary fibrosis should therefore be taken into consideration.
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Affiliation(s)
- C M Venema
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - E F J de Vries
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - S J van der Veen
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M D Dorrius
- Medical Imaging Center, Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M van Kruchten
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - C P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - G A P Hospers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands.
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Jauw YWS, Bensch F, Brouwers AH, Hoekstra OS, Zijlstra JM, Pieplenbosch S, Schröder CP, Zweegman S, van Dongen GAMS, Menke-van der Houven van Oordt CW, de Vries EGE, de Vet HCW, Boellaard R, Huisman MC. Interobserver reproducibility of tumor uptake quantification with 89Zr-immuno-PET: a multicenter analysis. Eur J Nucl Med Mol Imaging 2019; 46:1840-1849. [PMID: 31209514 PMCID: PMC6647131 DOI: 10.1007/s00259-019-04377-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/27/2019] [Indexed: 10/31/2022]
Abstract
PURPOSE In-vivo quantification of tumor uptake of 89-zirconium (89Zr)-labelled monoclonal antibodies (mAbs) with PET provides a potential tool in strategies to optimize tumor targeting and therapeutic efficacy. A specific challenge for 89Zr-immuno-PET is low tumor contrast. This is expected to result in interobserver variation in tumor delineation. Therefore, the aim of this study was to determine interobserver reproducibility of tumor uptake measures by tumor delineation on 89Zr-immuno-PET scans. METHODS Data were obtained from previously published clinical studies performed with 89Zr-rituximab, 89Zr-cetuximab and 89Zr-trastuzumab. Tumor lesions on 89Zr-immuno-PET were identified as focal uptake exceeding local background by a nuclear medicine physician. Three observers independently manually delineated volumes of interest (VOI). Maximum, peak and mean standardized uptake values (SUVmax, SUVpeak and SUVmean) were used to quantify tumor uptake. Interobserver variability was expressed as the coefficient of variation (CoV). The performance of semi-automatic VOI delineation using 50% of background-corrected ACpeak was described. RESULTS In total, 103 VOI were delineated (3-6 days post injection (D3-D6)). Tumor uptake (median, interquartile range) was 9.2 (5.2-12.6), 6.9 (4.0-9.6) and 5.5 (3.3-7.8) for SUVmax, SUVpeak and SUVmean. Interobserver variability was 0% (0-12), 0% (0-2) and 7% (5-14), respectively (n = 103). The success rate of the semi-automatic method was 45%. Inclusion of background was the main reason for failure of semi-automatic VOI. CONCLUSIONS This study shows that interobserver reproducibility of tumor uptake quantification on 89Zr-immuno-PET was excellent for SUVmax and SUVpeak using a standardized manual procedure for tumor segmentation. Semi-automatic delineation was not robust due to limited tumor contrast.
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Affiliation(s)
- Yvonne W S Jauw
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Frederike Bensch
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Otto S Hoekstra
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Simone Pieplenbosch
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sonja Zweegman
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Guus A M S van Dongen
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | | | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marc C Huisman
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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22
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Moek KL, Waaijer SJH, Kok IC, Suurs FV, Brouwers AH, Menke-van der Houven van Oordt CW, Wind TT, Gietema JA, Schröder CP, Mahesh SVK, Jorritsma-Smit A, Lub-de Hooge MN, Fehrmann RSN, de Groot DJA, de Vries EGE. 89Zr-labeled Bispecific T-cell Engager AMG 211 PET Shows AMG 211 Accumulation in CD3-rich Tissues and Clear, Heterogeneous Tumor Uptake. Clin Cancer Res 2019; 25:3517-3527. [PMID: 30745297 DOI: 10.1158/1078-0432.ccr-18-2918] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/28/2018] [Accepted: 02/06/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Biodistribution of bispecific antibodies in patients is largely unknown. We therefore performed a feasibility study in 9 patients with advanced gastrointestinal adenocarcinomas to explore AMG 211 biodistribution (also known as MEDI-565), an approximately 55 kDa bispecific T-cell engager (BiTE®) directed against carcinoembryonic antigen (CEA) on tumor cells and cluster of differentiation 3 (CD3) on T-cells. EXPERIMENTAL DESIGN 89Zr-labeled AMG 211 as tracer was administered alone or with cold AMG 211, for PET imaging before and/or during AMG 211 treatment. RESULTS Before AMG 211 treatment, the optimal imaging dose was 200-μg 89Zr-AMG 211 + 1,800-μg cold AMG 211. At 3 hours, the highest blood pool standardized uptake value (SUV)mean was 4.0, and tracer serum half-life was 3.3 hours. CD3-mediated uptake was clearly observed in CD3-rich lymphoid tissues including spleen and bone marrow (SUVmean 3.2 and 1.8, respectively), and the SUVmean decreased more slowly than in other healthy tissues. 89Zr-AMG 211 remained intact in plasma and was excreted predominantly via the kidneys in degraded forms. Of 43 visible tumor lesions, 37 were PET quantifiable, with a SUVmax of 4.0 [interquartile range (IQR) 2.7-4.4] at 3 hours using the optimal imaging dose. The tracer uptake differed between tumor lesions 5-fold within and 9-fold between patients. During AMG 211 treatment, tracer was present in the blood pool, whereas tumor lesions were not visualized, possibly reflecting target saturation. CONCLUSIONS This first-in-human study shows high, specific 89Zr-AMG 211 accumulation in CD3-rich lymphoid tissues, as well as a clear, inter- and intraindividual heterogeneous tumor uptake.
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Affiliation(s)
- Kirsten L Moek
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stijn J H Waaijer
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Iris C Kok
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Frans V Suurs
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Adrienne H Brouwers
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Thijs T Wind
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Shekar V K Mahesh
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Annelies Jorritsma-Smit
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marjolijn N Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rudolf S N Fehrmann
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Derk Jan A de Groot
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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23
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Bense RD, Qiu SQ, de Vries EGE, Schröder CP, Fehrmann RSN. Considering the biology of late recurrences in selecting patients for extended endocrine therapy in breast cancer. Cancer Treat Rev 2018; 70:118-126. [PMID: 30149225 DOI: 10.1016/j.ctrv.2018.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 02/05/2023]
Abstract
Extended endocrine therapy can reduce recurrences occurring more than 5 years after diagnosis (late recurrences) in estrogen receptor (ER)-positive breast cancer. Given the side effects of endocrine therapy, optimal patient selection for extended treatment is crucial. Enhanced understanding of late recurrence biology could optimize patient selection in this setting. We therefore summarized the current knowledge of late recurrence biology, clinical trials on extended endocrine therapy, and tools for predicting late recurrence and benefit from treatment extension. Extending 5 years of tamoxifen therapy with 5 years of tamoxifen or an aromatase inhibitor (AI) reduces late recurrence risk by 2-5%, but results of extending AI-based therapy are inconsistent. Although several clinicopathological parameters and multigene assays are prognostic for late recurrence, selection tools predicting benefit from extended endocrine therapy are sparse. Therefore, we additionally performed a pooled analysis using 2231 mRNA profiles of patients with ER-positive/human epidermal growth factor receptor 2-negative breast cancer. Gene Set Enrichment Analysis was applied on genes ranked according to their association with early and late recurrence risk. Higher expression of estrogen-responsive genes was associated with a high recurrence risk beyond 5 years after diagnosis when patients had received no systemic therapy. Although 5 years of endocrine therapy reduced this risk, this effect disappeared after treatment cessation. This suggests that late recurrences of tumors with high expression of estrogen-responsive genes are likely ER-driven. Long-term intervention in this pathway by means of extended endocrine therapy might reduce late recurrences in patients with tumors showing high expression of estrogen-responsive genes.
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Affiliation(s)
- Rico D Bense
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Si-Qi Qiu
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudolf S N Fehrmann
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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24
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Qiu SQ, Dorrius MD, de Jongh SJ, Jansen L, de Vries J, Schröder CP, Zhang GJ, de Vries EGE, van der Vegt B, van Dam GM. Micro-computed tomography (micro-CT) for intraoperative surgical margin assessment of breast cancer: A feasibility study in breast conserving surgery. Eur J Surg Oncol 2018; 44:1708-1713. [PMID: 30005963 DOI: 10.1016/j.ejso.2018.06.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/01/2018] [Accepted: 06/20/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE Around 15%-30% of patients receiving breast-conserving surgery (BCS) for invasive breast carcinoma or ductal carcinoma in situ (DCIS) need a reoperation due to tumor-positive margins at final histopathology. Currently available intraoperative surgical margin assessment modalities all have specific limitations. Therefore, we aimed to assess the feasibility and accuracy of micro-computed tomography (micro-CT) as a novel method for intraoperative margin assessment in BCS. METHODS Lumpectomy specimens from 30 consecutive patients diagnosed with invasive breast cancer or DCIS were imaged using a micro-CT. Margin status was assessed on micro-CT images by two investigators who were blinded to the final histopathological margin status. The micro-CT margin status was compared with the histopathological margin status. RESULTS The margin status could be assessed by micro-CT in 29 out of 30 patients. Of these, nine patients had a positive tumor margin and 20 a negative tumor margin at final histopathology. Margin status evaluation by micro-CT took always less than 15 min. The margin status in 25 patients was correctly predicted by micro-CT. There were four false-negative predictions. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of micro-CT in margin status prediction were 86%, 56%, 100%, 100% and 83%, respectively. With micro-CT, the positive margin rate could potentially have been reduced from 31% to 14%. CONCLUSIONS Whole lumpectomy specimen micro-CT scanning is a promising technique for intraoperative margin assessment in BCS. Intraoperative quick feedback on the margin status could potentially lead to a reduction in the number of reoperations.
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Affiliation(s)
- Si-Qi Qiu
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Monique D Dorrius
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Steven J de Jongh
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Liesbeth Jansen
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jakob de Vries
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Guo-Jun Zhang
- Changjiang Scholar's Laboratory of Shantou University Medical College, Guangdong, China; The Cancer Center, Xiang'an Hospital of Xiamen University, Fujian, China
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gooitzen M van Dam
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Nuclear Medicine and Molecular Imaging and Intensive Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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25
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Qiu SQ, Waaijer SJH, Zwager MC, de Vries EGE, van der Vegt B, Schröder CP. Tumor-associated macrophages in breast cancer: Innocent bystander or important player? Cancer Treat Rev 2018; 70:178-189. [PMID: 30227299 DOI: 10.1016/j.ctrv.2018.08.010] [Citation(s) in RCA: 260] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 02/05/2023]
Abstract
Tumor-associated macrophages (TAMs) are important tumor-promoting cells in the breast tumor microenvironment. Preclinically TAMs stimulate breast tumor progression, including tumor cell growth, invasion and metastasis. TAMs also induce resistance to multiple types of treatment in breast cancer models. The underlying mechanisms include: induction and maintenance of tumor-promoting phenotype in TAMs, inhibition of CD8+ T cell function, degradation of extracellular matrix, stimulation of angiogenesis and inhibition of phagocytosis. Several studies reported that high TAM infiltration of breast tumors is correlated with a worse patient prognosis. Based on these findings, macrophage-targeted treatment strategies have been developed and are currently being evaluated in clinical breast cancer trials. These strategies include: inhibition of macrophage recruitment, repolarization of TAMs to an antitumor phenotype, and enhancement of macrophage-mediated tumor cell killing or phagocytosis. This review summarizes the functional aspects of TAMs and the rationale and current evidence for TAMs as a therapeutic target in breast cancer.
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Affiliation(s)
- Si-Qi Qiu
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands; The Breast Center, Cancer Hospital of Shantou University Medical College, Raoping 7, 515041 Shantou, China
| | - Stijn J H Waaijer
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Mieke C Zwager
- Department of Pathology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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26
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van Rooijen JM, Qiu SQ, Timmer-Bosscha H, van der Vegt B, Boers JE, Schröder CP, de Vries EGE. Androgen receptor expression inversely correlates with immune cell infiltration in human epidermal growth factor receptor 2-positive breast cancer. Eur J Cancer 2018; 103:52-60. [PMID: 30208359 DOI: 10.1016/j.ejca.2018.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Although targeting human epidermal growth factor receptor 2 (HER2) is a meaningful treatment in HER2-positive breast cancer, ultimately resistance develops. Androgen receptor (AR) expression and immune cell infiltration are thought to be involved in trastuzumab response and may, therefore, be of interest as additional targets for therapy in HER2-positive breast cancer. AIM To improve insights into the presence among AR expression, immune cell infiltration and HER2, we analysed HER2-positive breast tumours. METHODS Primary tumours of 221 patients treated with trastuzumab for metastatic disease were selected. HER2 status was centrally confirmed. AR, T-cells (CD3 and CD8), programmed cell death protein 1 (PD-1) and PD-1 ligand 1 immunohistochemical staining and M2 tumour-associated macrophages (TAMs; CD68 and CD163) immunofluorescence were performed. Tumour-infiltrating lymphocytes were evaluated by haematoxylin and eosin staining. RESULTS Sufficient tumour material was available for 150 patients. Oestrogen receptor was expressed in 51.3% of the tumours and AR in 81.3% of the tumours. AR expression was inversely correlated with M2 TAM (Pearson's r = -0.361, P < 0.001), CD3+ (r = -0.199, P < 0.030) and CD8+ (r = -0.212, P < 0.021) T-cell infiltration. Clustering analysis showed high immune cell infiltration in AR low-expressing tumours, and low immune cell infiltration in AR-high expressing tumours. CONCLUSION AR expression inversely correlates with immune cell infiltration in HER2-positive breast cancer.
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Affiliation(s)
- Johan M van Rooijen
- Department of Internal Medicine, Martini Hospital Groningen, Van Swietenplein 1, 9728NT, Groningen, The Netherlands; Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Si-Qi Qiu
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands; The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Hetty Timmer-Bosscha
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - James E Boers
- Department of Pathology, Isala Clinics, Dokter van Heesweg 2 8025 AB, Zwolle, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
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Bensch F, Brouwers AH, Lub-de Hooge MN, de Jong JR, van der Vegt B, Sleijfer S, de Vries EGE, Schröder CP. 89Zr-trastuzumab PET supports clinical decision making in breast cancer patients, when HER2 status cannot be determined by standard work up. Eur J Nucl Med Mol Imaging 2018; 45:2300-2306. [PMID: 30058029 PMCID: PMC6208812 DOI: 10.1007/s00259-018-4099-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/17/2018] [Indexed: 12/21/2022]
Abstract
Background Up-to-date information on human epidermal growth factor receptor 2 (HER2) status in breast cancer (BC) is important, as expression can vary during the course of the disease, necessitating anti-HER2 therapy adjustments. Repeat biopsies, however, are not always possible. In this feasibility trial we assessed whether 89Zr-trastuzumab PET could support diagnostic understanding and aid clinical decision making, when HER2 status could not be determined by standard work up. Additionally, HER2 status on circulating tumour cells (CTCs) was assessed. Patients and methods 89Zr-trastuzumab PET was performed in patients if disease HER2 status remained unclear after standard work up (bone scan, 18F-FDG PET, CT and if feasible a biopsy). PET result and central pathologic revision of available tumour biopsies were reported to the referring physician. CTC HER2 status prior to PET was evaluated afterwards and therefore not reported. Diagnostic understanding and treatment decision questionnaires were completed by the referring physicians before, directly after and ≥ 3 months after 89Zr-trastuzumab PET. Results Twenty patients were enrolled: 8 with two primary cancers (HER2-positive and HER2-negative BC or BC and non-BC), 7 with metastases inaccessible for biopsy, 4 with prior HER2-positive and -negative metastases and 1 with primary BC with equivocal HER2 status. 89Zr-trastuzumab PET was positive in 12 patients, negative in 7 and equivocal in 1 patient. In 15/20 patients, 89Zr-trastuzumab PET supported treatment decision. The scan altered treatment of 8 patients, increased physicians’ confidence without affecting treatment in 10, and improved physicians’ disease understanding in 18 patients. In 10/20 patients CTCs were detected; 6/10 showed HER2 expression. CTC HER2 status was not correlated to 89Zr-trastuzumab PET result or treatment decision. Conclusion 89Zr-trastuzumab PET supports clinical decision making when HER2 status cannot be determined by standard work up. The impact of CTC HER2 status needs to be further explored. Electronic supplementary material The online version of this article (10.1007/s00259-018-4099-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frederike Bensch
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands.
| | - A H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M N Lub-de Hooge
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - J R de Jong
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - B van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - E G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
| | - C P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
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Waaijer SJH, Warnders FJ, Stienen S, Friedrich M, Sternjak A, Cheung HK, van Scheltinga AGTT, Schröder CP, de Vries EGE, Lub-de Hooge MN. Molecular Imaging of Radiolabeled Bispecific T-Cell Engager 89Zr-AMG211 Targeting CEA-Positive Tumors. Clin Cancer Res 2018; 24:4988-4996. [PMID: 29980531 DOI: 10.1158/1078-0432.ccr-18-0786] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/28/2018] [Accepted: 07/02/2018] [Indexed: 01/10/2023]
Abstract
Purpose: AMG 211, a bispecific T-cell engager (BiTE) antibody construct, targets carcinoembryonic antigen (CEA) and the CD3 epsilon subunit of the human T-cell receptor. AMG 211 was labeled with zirconium-89 (89Zr) or fluorescent dye to evaluate the tumor-targeting properties.Experimental Design: 89Zr-AMG211 was administered to mice bearing CEA-positive xenograft tumors of LS174T colorectal adenocarcinoma or BT474 breast cancer cells, as well as CEA-negative HL-60 promyelocytic leukemia xenografts. Biodistribution studies with 2- to 10-μg 89Zr-AMG211 supplemented with unlabeled AMG 211 up to 500-μg protein dose were performed. A BiTE that does not bind CEA, 89Zr-Mec14, served as a negative control. 89Zr-AMG211 integrity was determined in tumor lysates ex vivo Intratumoral distribution was studied with IRDye800CW-AMG211. Moreover, 89Zr-AMG211 was manufactured according to Good Manufacturing Practice (GMP) guidelines for clinical trial NCT02760199Results: 89Zr-AMG211 demonstrated dose-dependent tumor uptake at 6 hours. The highest tumor uptake was observed with a 2-μg dose, and the lowest tumor uptake was observed with a 500-μg dose. After 24 hours, higher uptake of 10-μg 89Zr-AMG211 occurred in CEA-positive xenografts, compared with CEA-negative xenografts. Although the blood half-life of 89Zr-AMG211 was approximately 1 hour, tumor retention persisted for at least 24 hours. 89Zr-Mec14 showed no tumor accumulation beyond background level. Ex vivo autoradiography revealed time-dependent disintegration of 89Zr-AMG211. 800CW-AMG211 was specifically localized in CEA-expressing viable tumor tissue. GMP-manufactured 89Zr-AMG211 fulfilled release specifications.Conclusions: 89Zr-AMG211 showed dose-dependent CEA-specific tumor targeting and localization in viable tumor tissue. Our data enabled its use to clinically evaluate AMG 211 in vivo behavior. Clin Cancer Res; 24(20); 4988-96. ©2018 AACR.
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Affiliation(s)
- Stijn J H Waaijer
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Frank J Warnders
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | | | | | | | - Carolien P Schröder
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjolijn N Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands.
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Waaijer SJ, Giesen D, Ishiguro T, Sano Y, Ohishi N, Gianella-Borradori A, Schröder CP, Vries EGD, Hooge MNLD. Abstract 3028: PET imaging with the bispecific 89Zr-antibody ERY974 targeting CD3 and glypican 3 in tumor-bearing mouse models. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: ERY974, a modified monoclonal IgG4 bispecific antibody directed against human CD3 on T cells and glypican 3 (GPC3) on tumor cell, is currently in phase I clinical trial. The oncofetal protein GPC3 is overexpressed in several tumor types. Radiolabeling ERY974 with positron emission tomography (PET) isotope zirconium-89 (89Zr) enables non-invasive molecular imaging of tumor targeting and whole-body distribution. We aimed to evaluate 89Zr-ERY974 tumor targeting and effect of T cells on tumor uptake in mouse models, including a humanized mouse model.
METHODS: ERY974 and two control molecules namely bispecific CD3xkeyhole limpet hemocyanin (KLH) and KLHxKLH antibodies were radiolabeled with 89Zr. Studies were performed in immunodeficient NOD/Shi-SCID/IL-2Rgnull (NOG) as well as human CD34+ hematopoietic stem cell engrafted NOG mice (huNOG), all subcutaneously inoculated with GPC3 overexpressing human hepatocellular carcinoma HepG2 cells. Mice received 10 µg 89Zr-ERY974, 89Zr-CD3xKLH or 89Zr-KLHxKLH intravenously, with subsequent µPET scanning at 24, 72, 120 and 168 h followed by ex vivo biodistribution. Organs of interest were quantified on µPET scans as mean standardized uptake value (SUVmean) and with ex vivo biodistribution as % injected dose/gram of tissue (%ID/g). Tumor, spleen and lymph nodes were analyzed with autoradiography and immunohistochemical CD3 staining.
RESULTS: µPET imaging revealed increased tumor-to-blood ratio (TBR) of 89Zr-ERY974 in NOG over time with maximal TBR of 2.2±0.3 at 168 h post tracer injection (pi). At 168 h, tumor uptake was specific as 89Zr-CD3xKLH and 89Zr-KLHxKLH showed a TBR of only 0.6±0.2 and 0.8±0.3, respectively. In huNOG mice human CD3+ T cells were present in tumor, spleen and lymph nodes. In huNOG mice tumor uptake of 89Zr-ERY974 was higher than in NOG mice as measured on µPET scans (SUVmean at 168 h pi 6.9±2.6 vs 2.9±0.2; P<0.01) and with ex vivo biodistribution (60.9±26.2 %ID/g vs 16.7±2.3 %ID/g; P<0.001), whereas 89Zr-CD3xKLH tumor uptake in both mouse models was lower (P<0.05) but were similar in these mouse models. Autoradiography 168 h following 89Zr-ERY974 administration to huNOG mice showed 89Zr in extensive T cell infiltrate areas in the tumors of huNOG mice, whereas T cell infiltrate was lower in tumors of 89Zr-CD3xKLH and 89Zr-KLHxKLH injected huNOG mice. Spleens of huNOG mice showed CD3+ specific uptake as 89Zr-ERY974 and 89Zr-CD3xKLH uptake were higher than 89Zr-KLHxKLH uptake(P<0.05), whereas spleen uptake in NOG mice of the 3 tracers was similar. Moreover, in huNOG CD3+ mesenteric lymph nodes 89Zr-ERY974 uptake was higher than 89Zr-KLHxKLH uptake (P<0.05)
CONCLUSION: 89Zr-ERY974 demonstrates specific tumor uptake in NOG and huNOG mice, while in huNOG mice tumor uptake colocalized with T cell rich infiltrate and also uptake in in spleen and lymph nodes was observed.
Citation Format: Stijn J. Waaijer, Danique Giesen, Takahiro Ishiguro, Yuji Sano, Norihisa Ohishi, Athos Gianella-Borradori, Carolien P. Schröder, Elisabeth G. de Vries, Marjolijn N. Lub-de Hooge. PET imaging with the bispecific 89Zr-antibody ERY974 targeting CD3 and glypican 3 in tumor-bearing mouse models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3028.
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Affiliation(s)
| | - Danique Giesen
- 1University Medical Center Groningen, Groningen, Netherlands
| | | | - Yuji Sano
- 2Chugai Pharmaceutical Co., Ltd., Japan
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Nienhuis HH, van Kruchten M, Elias SG, Glaudemans AW, de Vries EF, Bongaerts AH, Schröder CP, de Vries EG, Hospers GA. 18F-Fluoroestradiol Tumor Uptake Is Heterogeneous and Influenced by Site of Metastasis in Breast Cancer Patients. J Nucl Med 2018; 59:1212-1218. [DOI: 10.2967/jnumed.117.198846] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 03/21/2018] [Indexed: 01/18/2023] Open
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Qiu SQ, Zhang GJ, Jansen L, de Vries J, Schröder CP, de Vries EGE, van Dam GM. Evolution in sentinel lymph node biopsy in breast cancer. Crit Rev Oncol Hematol 2018; 123:83-94. [PMID: 29482783 DOI: 10.1016/j.critrevonc.2017.09.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/12/2017] [Accepted: 09/19/2017] [Indexed: 02/05/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in clinically node-negative (cN0) breast cancer patients without neoadjuvant chemotherapy (NAC). The application of SLNB in patients receiving NAC has also been explored. Evidence supports its use after NAC in pretreatment cN0 patients. Nonetheless, its routine use in all the pretreatment node-positive patients who become cN0 after NAC is unjustified due to the unacceptably high false-negative rate, which can be improved in a subset of patients. Axillary surgery omission in selected patients with a low risk of ALN metastasis has gained more and more research interest because the SLNs are tumor-free in more than 70% of all patients. To avoid drawbacks of conventional mapping methods, novel techniques for SLN detection have been developed and shown to be highly accurate in patients with early breast cancer. This article reviews the progress in SLNB in patients with breast cancer.
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Affiliation(s)
- Si-Qi Qiu
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands; The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Guo-Jun Zhang
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China; Changjiang Scholar's Laboratory of Shantou University Medical College, Guangdong, China
| | - Liesbeth Jansen
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Jakob de Vries
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Gooitzen M van Dam
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands; Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
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Venema CM, de Vries EFJ, Glaudemans AWJM, Hospers GAP, Schröder CP. Abstract PD2-12: Molecular imaging for early identification of patients who benefit from palbociclib in addition to letrozole. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd2-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Palbociclib plus letrozole has improved both progression free survival and overall response rate in metastatic breast cancer (MBC) patients. For response to palbociclib, the best biomarker is ER expression. 16α-[18F]Fluoro-17β-estradiol (FES) -PET allows whole body ER level assessment, and provides insight in the heterogeneity of ER expression throughout the body. We hypothesized that lesions with low uptake on FES-PET are unlikely to respond to letrozole plus palbociclib. METHODS: Post-menopausal women with ER positive MBC were eligible for this pilot study. All patients were staged with fludeoxyglucose (FDG)-PET and CT scan, and in addition a FES-PET was performed at baseline. After 8 weeks treatment an FDG-PET/CT was used for response evaluation. The primary endpoint was the relation between standard uptake value (SUV) per lesion on FES-PET to response, as measured by RECIST 1.1 criteria in case of measurable disease. In case of non-measurable bone lesions, progression was defined as an increase in SUV on FDG-PET of more than 30% per lesion compared to baseline (based on PERCIST). RESULTS: 15 patients were included of which 14 were evaluable for primary endpoint. Mean age was 50 years (range 35-76). Median number of prior therapies was 1. A total of 280 lesions were detected on conventional imaging of which 50 showed low uptake (SUV<1.5) on FES-PET. 29/50 low uptake lesions showed progression based on diagnostic CT (n=9) or FDG PET (n=20). In contrast, 28/230 FES positive lesions showed progression.
ResponseStable diseaseProgression FES uptake >1.51089428230FES uptake <1.57142950 11510857280
DISCUSSION: this pilot trial indicates negative predictive value of low FES uptake for response to letrozol plus palbociclib in ER positive MBC. The FES-PET may therefore be a biomarker for response for this combination treatment. This will have to be explored further in future clinical trials.
Citation Format: Venema CM, de Vries EFJ, Glaudemans AWJM, Hospers GAP, Schröder CP. Molecular imaging for early identification of patients who benefit from palbociclib in addition to letrozole [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-12.
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Affiliation(s)
- CM Venema
- University Medical Center Groningen, Groningen, Netherlands
| | - EFJ de Vries
- University Medical Center Groningen, Groningen, Netherlands
| | | | - GAP Hospers
- University Medical Center Groningen, Groningen, Netherlands
| | - CP Schröder
- University Medical Center Groningen, Groningen, Netherlands
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Giordano SH, Schröder CP, Poncet C, van Leeuwen-Stok E, Linderholm B, Abreu MH, Rubio I, Van Poznak C, Morganstern D, Cameron D, Vleugel MM, Smilde TJ, Bozovic-Spasojevic I, Korde L, Russell NS, den Hoed IDM, Honkoop AH, van der Velden AWG, van 't Riet M, Dijkstra N, Bogler O, Goulioti T, Hilsenbeck S, Ruddy KJ, Wolff A, van Deurzen CHM, Martens J, Bartlett JMS, Aalders K, Tryfonidis K, Cardoso F. Abstract P5-23-01: Clinical and biological characterization of male breast cancer (BC) EORTC 10085/TBCRC 029/BOOG 2013-02/BIG 2-07: Baseline results from the prospective registry. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-23-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Through the International Male Breast Cancer Program, a prospective registry for male BC was created with the goals of evaluating 1) the clinical and biological features of this disease and 2) assessing feasibility of a prospective therapeutic clinical trial.
METHODS: All men, with any stage histologically proven invasive breast cancer, age 3 18 years, and newly presenting at the participating institutions (within 3 months prior) were eligible. Patients were enrolled for 30 months after activation of the first center, through February 2017. Per the study design, if <100 men enrolled, the study would be considered a failure and therapeutic trials would not be pursued through this network. Epidemiologic data, staging, pathologic features, and BRCA status were collected. Treatment and outcome data collection is ongoing. Optional collection of FFPE tumor samples, blood, and QOL were performed in the US, the Netherlands, and Latin America. Clinical database lock for this report was May 30, 2017. We currently report patient and disease characteristics and will update with patterns of treatment for the presentation. Outcomes and biological samples will be analyzed in the future.
RESULTS: 557 patients were enrolled: 75% in Europe, 20% in United States, 5% in other countries. 6.3% of patients had missing forms. Median age was 67 years (range 26-92). 93% were diagnosed 2010-2017. Among patients with complete data, 79% presented with a breast mass. 88% were M0 and 12% M1. Among M0 patients: 47%, 39%, 2%, and 11% had T1, T2, T3, and T4 disease respectively; 52% were N0. Overall, 98% had ER+ disease and 11% had HER2+ cancer. 14% had grade 1, 56% had grade 2, and 30% had grade 3 tumors. Among 112 men who underwent BRCA1 testing, 1 was positive. Among 118 men who had BRCA2 testing, 18 (15%) were positive. 21% of men had prior or concurrent malignancies, with the following most common sites: prostate, non-melanoma skin, colorectal, and melanoma. The prevalence of previously identified possible risk factors for male breast cancer were: overweight/obesity (72%), former/current smoker (51%), current alcohol 31 drink daily (41%), family history of breast cancer (35%), gynecomastia (16%), history radiation exposure (8%), use of anti-androgens (1%), and use of estrogens (1%).
CONCLUSION: Through an international collaborative effort, we were able to prospectively accrue 557 patients to a male breast cancer registry. These results demonstrate feasibility of pursuing a therapeutic clinical trial in men with breast cancer. In addition, this study shows the relatively low uptake of BRCA testing, high rates of concurrent/prior malignancy, and the rates of potentially modifiable risk factors in this patient population.
Funding from Breast Cancer Research Foundation, Susan G. Komen, Dutch Pink Ribbon Foundation, Swedish Breast Cancer Association (BRO) and EBCC Council.
Citation Format: Giordano SH, Schröder CP, Poncet C, van Leeuwen-Stok E, Linderholm B, Abreu MH, Rubio I, Van Poznak C, Morganstern D, Cameron D, Vleugel MM, Smilde TJ, Bozovic-Spasojevic I, Korde L, Russell NS, den Hoed IDM, Honkoop AH, van der Velden AWG, van 't Riet M, Dijkstra N, Bogler O, Goulioti T, Hilsenbeck S, Ruddy KJ, Wolff A, van Deurzen CHM, Martens J, Bartlett JMS, Aalders K, Tryfonidis K, Cardoso F. Clinical and biological characterization of male breast cancer (BC) EORTC 10085/TBCRC 029/BOOG 2013-02/BIG 2-07: Baseline results from the prospective registry [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-23-01.
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Affiliation(s)
- SH Giordano
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - CP Schröder
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - C Poncet
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - E van Leeuwen-Stok
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - B Linderholm
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - MH Abreu
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - I Rubio
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - C Van Poznak
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - D Morganstern
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - D Cameron
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - MM Vleugel
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - TJ Smilde
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - I Bozovic-Spasojevic
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - L Korde
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - NS Russell
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - IDM den Hoed
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - AH Honkoop
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - AWG van der Velden
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - M van 't Riet
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - N Dijkstra
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - O Bogler
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - T Goulioti
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - S Hilsenbeck
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - KJ Ruddy
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - A Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - CHM van Deurzen
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - J Martens
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - JMS Bartlett
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - K Aalders
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - K Tryfonidis
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - F Cardoso
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
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Admiraal JM, van der Velden AWG, Geerling JI, Burgerhof JGM, Bouma G, Walenkamp AME, de Vries EGE, Schröder CP, Reyners AKL. Web-Based Tailored Psychoeducation for Breast Cancer Patients at the Onset of the Survivorship Phase: A Multicenter Randomized Controlled Trial. J Pain Symptom Manage 2017; 54:466-475. [PMID: 28711750 DOI: 10.1016/j.jpainsymman.2017.07.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/18/2017] [Accepted: 07/06/2017] [Indexed: 12/29/2022]
Abstract
CONTEXT Many breast cancer patients have unmet informational and psychosocial needs after treatment completion. A psychoeducational intervention may be well suited to support these patients. OBJECTIVES The purpose of this multicenter randomized controlled trial was to examine the effectiveness of a web-based tailored psychoeducational program (ENCOURAGE) for breast cancer patients, which aims to empower patients to take control over prevailing problems. METHODS Female breast cancer patients from two hospitals in The Netherlands who recently completed (neo-)adjuvant chemotherapy were randomly assigned to standard care or 12-week access to the ENCOURAGE program providing fully automated information problem-solving strategies, resources, and services for reported problems. At six and 12 weeks, patients completed self-report questions on optimism and control over the future (primary outcome), feelings of being informed, and acceptance of the illness. At baseline and 12 weeks, distress and quality of life questionnaires were completed. RESULTS About 138 patients were included. Almost all patients (67 of 69) visited ENCOURAGE as requested. No differences between the control and intervention group were observed for primary and secondary outcomes. An unplanned subgroup analysis showed that in clinically distressed patients (N = 57 at baseline; 41%), use of the ENCOURAGE program increased optimism and control over the future at 12 weeks more than in patients in the control group (Cohen's d = 0.65). CONCLUSION Although the effectiveness was not demonstrated, a subgroup of women treated for breast cancer can probably be supported by the program. The results of the present study are a starting point for further development and use of the program.
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Affiliation(s)
- Jolien M Admiraal
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette W G van der Velden
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Medical Oncology, Martini Hospital, Groningen, The Netherlands
| | - Jenske I Geerling
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Grietje Bouma
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annemiek M E Walenkamp
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Vermeulen MA, Slaets L, Cardoso F, Giordano SH, Tryfonidis K, van Diest PJ, Dijkstra NH, Schröder CP, van Asperen CJ, Linderholm B, Benstead K, Foekens R, Martens JW, Bartlett JM, van Deurzen CH. Pathological characterisation of male breast cancer: Results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Eur J Cancer 2017; 82:219-227. [DOI: 10.1016/j.ejca.2017.01.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 02/08/2023]
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Bensch F, Lamberts LE, Smeenk MM, Jorritsma-Smit A, Lub-de Hooge MN, Terwisscha van Scheltinga AGT, de Jong JR, Gietema JA, Schröder CP, Thomas M, Jacob W, Abiraj K, Adessi C, Meneses-Lorente G, James I, Weisser M, Brouwers AH, de Vries EGE. 89Zr-Lumretuzumab PET Imaging before and during HER3 Antibody Lumretuzumab Treatment in Patients with Solid Tumors. Clin Cancer Res 2017; 23:6128-6137. [PMID: 28733442 DOI: 10.1158/1078-0432.ccr-17-0311] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/30/2017] [Accepted: 07/18/2017] [Indexed: 01/24/2023]
Abstract
Purpose: We evaluated biodistribution and tumor targeting of 89Zr-lumretuzumab before and during treatment with lumretuzumab, a human epidermal growth factor receptor 3 (HER3)-targeting monoclonal antibody.Experimental Design: Twenty patients with histologically confirmed HER3-expressing tumors received 89Zr-lumretuzumab and underwent positron emission tomography (PET). In part A, 89Zr-lumretuzumab was given with additional, escalating doses of unlabeled lumretuzumab, and scans were performed 2, 4, and 7 days after injection to determine optimal imaging conditions. In part B, patients were scanned following tracer injection before (baseline) and after a pharmacodynamic (PD)-active lumretuzumab dose for saturation analysis. HER3 expression was determined immunohistochemically in skin biopsies. Tracer uptake was calculated as standardized uptake value (SUV).Results: Optimal PET conditions were found to be 4 and 7 days after administration of 89Zr-lumretuzumab with 100-mg unlabeled lumretuzumab. At baseline using 100-mg unlabeled lumretuzumab, the tumor SUVmax was 3.4 (±1.9) at 4 days after injection. SUVmean values for normal blood, liver, lung, and brain tissues were 4.9, 6.4, 0.9 and 0.2, respectively. Saturation analysis (n = 7) showed that 4 days after lumretuzumab administration, tumor uptake decreased by 11.9% (±8.2), 10.0% (±16.5), and 24.6% (±20.9) at PD-active doses of 400, 800, and 1,600 mg, respectively, when compared with baseline. Membranous HER3 was completely downregulated in paired skin biopsies already at and above 400-mg lumretuzumab.Conclusions: PET imaging showed biodistribution and tumor-specific 89Zr-lumretuzumab uptake. Although, PD-active lumretuzumab doses decreased 89Zr-lumretuzumab uptake, there was no clear evidence of tumor saturation by PET imaging as the tumor SUV did not plateau with increasing doses. Clin Cancer Res; 23(20); 6128-37. ©2017 AACR.
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Affiliation(s)
- Frederike Bensch
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Laetitia E Lamberts
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Michaël M Smeenk
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Annelies Jorritsma-Smit
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Marjolijn N Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, the Netherlands.,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | | | - Johan R de Jong
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Marlene Thomas
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
| | - Wolfgang Jacob
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
| | - Keelara Abiraj
- Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Celine Adessi
- Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | | | - Ian James
- A4P Consulting Ltd, Sandwich, United Kingdom
| | - Martin Weisser
- Pharma Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands.
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Schröder CP, Bensch F, Brouwers AH, Lub-de Hooge MN, de Jong JR, van der Vegt B, Sleijfer S, de Vries EG. Abstract P5-03-06: Clinical value of 89Zr-trastuzumab PET in HER2-positive breast cancer patients with a clinical dilemma. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-03-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Information on human epidermal growth factor receptor 2 (HER2) is essential for management of metastatic breast cancer (mBC). In patients suspected of HER2-positive mBC, standard work up may fail to clarify whole body HER2 status. We aimed to assess whether 89Zr-trastuzumab PET can support treatment decisions in patients posing this clinical dilemma.
Methods: 89Zr-trastuzumab PET was performed as described earlier (Gaykema et al, Clin Cancer Res 2014) in patients in whom standard work up with bone scan, FDG PET, CT and if feasible a biopsy, failed to evaluate HER2 status of their disease. 89Zr-trastuzumab PET was defined positive, when at least a dominant part of the tumor load showed substantial tracer uptake (Gebhart et al, Ann Oncol 2015), when tumor tracer uptake in single lesions (except brain) was ≥ normal liver uptake or when brain metastases had a tracer uptake > background. Circulating tumor cell (CTC) analysis prior to tracer injectionwas performed using the CellSearch System (Janssen Diagnostics LLC) and CTC HER2 status was assessed immunofluorescently. Questionnaires about treatment decisions were completed before, directly after and ≥3 months after 89Zr-trastuzumab PET.
Results: Twenty patients were enrolled: 8 with two primary cancers (HER2-positive and HER2-negative BC or BC and non-BC), 7 with metastases inaccessible for biopsy, 4 with prior HER2-positive and HER2-negative metastases, 1 with primary BC with equivocal HER2 status (average 4.23 HER2 gene copies/nucleus). 89Zr-trastuzumab PET was positive in 12 patients, negative in 7 and equivocal in one patient. In 15/20 patients 89Zr-trastuzumab PET supported treatment decision. The scan altered treatment of 8 patients, increased physicians' confidence without affecting treatment in 10, and improved physicians' understanding of disease in 18 patients. Ten patients had 1-99 CTCs, 6 with HER2 expression. There was no correlation between HER2 expression by CTCs and 89Zr-trastuzumab PET results or subsequent treatment decision.
Conclusion: 89Zr-trastuzumab PET, but not CTC analysis, supports clinical decision making in BC patients in whom standard work up fails to evaluate HER2 status. (Funded by the Dutch A Sister's Hope).
Citation Format: Schröder CP, Bensch F, Brouwers AH, Lub-de Hooge MN, de Jong JR, van der Vegt B, Sleijfer S, de Vries EG. Clinical value of 89Zr-trastuzumab PET in HER2-positive breast cancer patients with a clinical dilemma [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-03-06.
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Affiliation(s)
- CP Schröder
- Universital Medical Center Groningen, Groningen, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - F Bensch
- Universital Medical Center Groningen, Groningen, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - AH Brouwers
- Universital Medical Center Groningen, Groningen, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - MN Lub-de Hooge
- Universital Medical Center Groningen, Groningen, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - JR de Jong
- Universital Medical Center Groningen, Groningen, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - B van der Vegt
- Universital Medical Center Groningen, Groningen, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - S Sleijfer
- Universital Medical Center Groningen, Groningen, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - EG de Vries
- Universital Medical Center Groningen, Groningen, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Netherlands
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de Waal EGM, Glaudemans AWJM, Schröder CP, Vellenga E, Slart RHJA. Nuclear medicine imaging of multiple myeloma, particularly in the relapsed setting. Eur J Nucl Med Mol Imaging 2016; 44:332-341. [PMID: 27900520 PMCID: PMC5215256 DOI: 10.1007/s00259-016-3576-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
Multiple myeloma (MM) is characterized by a monoclonal plasma cell population in the bone marrow. Lytic lesions occur in up to 90 % of patients. For many years, whole-body X-ray (WBX) was the method of choice for detecting skeleton abnormalities. However, the value of WBX in relapsing disease is limited because lesions persist post-treatment, which restricts the capacity to distinguish between old, inactive skeletal lesions and new, active ones. Therefore, alternative techniques are necessary to visualize disease activity. Modern imaging techniques such as magnetic resonance imaging, positron emission tomography and computed tomography offer superior detection of myeloma bone disease and extramedullary manifestations. In particular, the properties of nuclear imaging enable the identification of disease activity by directly targeting the specific cellular properties of malignant plasma cells. In this review, an overview is provided of the effectiveness of radiopharmaceuticals that target metabolism, surface receptors and angiogenesis. The available literature data for commonly used nuclear imaging tracers, the promising first results of new tracers, and our pilot work indicate that a number of these radiopharmaceutical applications can be used effectively for staging and response monitoring of relapsing MM patients. Moreover, some tracers can potentially be used for radio immunotherapy.
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Affiliation(s)
- Esther G M de Waal
- Department of Hematology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edo Vellenga
- Department of Hematology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
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Koch M, de Jong JS, Glatz J, Symvoulidis P, Lamberts LE, Adams ALL, Kranendonk MEG, Terwisscha van Scheltinga AGT, Aichler M, Jansen L, de Vries J, Lub-de Hooge MN, Schröder CP, Jorritsma-Smit A, Linssen MD, de Boer E, van der Vegt B, Nagengast WB, Elias SG, Oliveira S, Witkamp AJ, Mali WPTM, Van der Wall E, Garcia-Allende PB, van Diest PJ, de Vries EGE, Walch A, van Dam GM, Ntziachristos V. Threshold Analysis and Biodistribution of Fluorescently Labeled Bevacizumab in Human Breast Cancer. Cancer Res 2016; 77:623-631. [PMID: 27879266 DOI: 10.1158/0008-5472.can-16-1773] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/06/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022]
Abstract
In vivo tumor labeling with fluorescent agents may assist endoscopic and surgical guidance for cancer therapy as well as create opportunities to directly observe cancer biology in patients. However, malignant and nonmalignant tissues are usually distinguished on fluorescence images by applying empirically determined fluorescence intensity thresholds. Here, we report the development of fSTREAM, a set of analytic methods designed to streamline the analysis of surgically excised breast tissues by collecting and statistically processing hybrid multiscale fluorescence, color, and histology readouts toward precision fluorescence imaging. fSTREAM addresses core questions of how to relate fluorescence intensity to tumor tissue and how to quantitatively assign a normalized threshold that sufficiently differentiates tumor tissue from healthy tissue. Using fSTREAM we assessed human breast tumors stained in vivo with fluorescent bevacizumab at microdose levels. Showing that detection of such levels is achievable, we validated fSTREAM for high-resolution mapping of the spatial pattern of labeled antibody and its relation to the underlying cancer pathophysiology and tumor border on a per patient basis. We demonstrated a 98% sensitivity and 79% specificity when using labeled bevacizumab to outline the tumor mass. Overall, our results illustrate a quantitative approach to relate fluorescence signals to malignant tissues and improve the theranostic application of fluorescence molecular imaging. Cancer Res; 77(3); 623-31. ©2016 AACR.
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Affiliation(s)
- Maximilian Koch
- Chair for Biological Imaging, Technical University of Munich, München, Germany.,Institute for Biological and Medical Imaging, Helmholtz Zentrum München, München, Germany
| | - Johannes S de Jong
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jürgen Glatz
- Chair for Biological Imaging, Technical University of Munich, München, Germany.,Institute for Biological and Medical Imaging, Helmholtz Zentrum München, München, Germany
| | - Panagiotis Symvoulidis
- Chair for Biological Imaging, Technical University of Munich, München, Germany.,Institute for Biological and Medical Imaging, Helmholtz Zentrum München, München, Germany
| | - Laetitia E Lamberts
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Arthur L L Adams
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Anton G T Terwisscha van Scheltinga
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Hospital and Clinical Pharmacy, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Michaela Aichler
- Research Unit Analytical Pathology, Helmholtz Zentrum München, München, Germany
| | - Liesbeth Jansen
- Department of Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Jakob de Vries
- Department of Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Marjolijn N Lub-de Hooge
- Hospital and Clinical Pharmacy, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Annelies Jorritsma-Smit
- Hospital and Clinical Pharmacy, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Matthijs D Linssen
- Hospital and Clinical Pharmacy, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Esther de Boer
- Department of Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Wouter B Nagengast
- Department of Gastroenterology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, Cell Biology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sabrina Oliveira
- Department of Biology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willem P T M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elsken Van der Wall
- Department of Medical Oncology, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P Beatriz Garcia-Allende
- Chair for Biological Imaging, Technical University of Munich, München, Germany.,Institute for Biological and Medical Imaging, Helmholtz Zentrum München, München, Germany
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Axel Walch
- Research Unit Analytical Pathology, Helmholtz Zentrum München, München, Germany
| | - Gooitzen M van Dam
- Department of Surgery, University of Groningen, University Medical Center Groningen, the Netherlands.,Department of Nuclear Medicine and Molecular Imaging and Intensive Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Vasilis Ntziachristos
- Chair for Biological Imaging, Technical University of Munich, München, Germany. .,Institute for Biological and Medical Imaging, Helmholtz Zentrum München, München, Germany
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Lamberts LE, Koch M, de Jong JS, Adams ALL, Glatz J, Kranendonk MEG, Terwisscha van Scheltinga AGT, Jansen L, de Vries J, Lub-de Hooge MN, Schröder CP, Jorritsma-Smit A, Linssen MD, de Boer E, van der Vegt B, Nagengast WB, Elias SG, Oliveira S, Witkamp AJ, Mali WPTM, Van der Wall E, van Diest PJ, de Vries EGE, Ntziachristos V, van Dam GM. Tumor-Specific Uptake of Fluorescent Bevacizumab-IRDye800CW Microdosing in Patients with Primary Breast Cancer: A Phase I Feasibility Study. Clin Cancer Res 2016; 23:2730-2741. [PMID: 28119364 DOI: 10.1158/1078-0432.ccr-16-0437] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 10/21/2016] [Accepted: 10/22/2016] [Indexed: 12/22/2022]
Abstract
Purpose: To provide proof of principle of safety, breast tumor-specific uptake, and positive tumor margin assessment of the systemically administered near-infrared fluorescent tracer bevacizumab-IRDye800CW targeting VEGF-A in patients with breast cancer.Experimental Design: Twenty patients with primary invasive breast cancer eligible for primary surgery received 4.5 mg bevacizumab-IRDye800CW as intravenous bolus injection. Safety aspects were assessed as well as tracer uptake and tumor delineation during surgery and ex vivo in surgical specimens using an optical imaging system. Ex vivo multiplexed histopathology analyses were performed for evaluation of biodistribution of tracer uptake and coregistration of tumor tissue and healthy tissue.Results: None of the patients experienced adverse events. Tracer levels in primary tumor tissue were higher compared with those in the tumor margin (P < 0.05) and healthy tissue (P < 0.0001). VEGF-A tumor levels also correlated with tracer levels (r = 0.63, P < 0.0002). All but one tumor showed specific tracer uptake. Two of 20 surgically excised lumps contained microscopic positive margins detected ex vivo by fluorescent macro- and microscopy and confirmed at the cellular level.Conclusions: Our study shows that systemic administration of the bevacizumab-IRDye800CW tracer is safe for breast cancer guidance and confirms tumor and tumor margin uptake as evaluated by a systematic validation methodology. The findings are a step toward a phase II dose-finding study aimed at in vivo margin assessment and point to a novel drug assessment tool that provides a detailed picture of drug distribution in the tumor tissue. Clin Cancer Res; 23(11); 2730-41. ©2016 AACR.
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Affiliation(s)
- Laetitia E Lamberts
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Maximillian Koch
- Technische Universität München & Helmholtz Zentrum, München, Germany
| | - Johannes S de Jong
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arthur L L Adams
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jürgen Glatz
- Technische Universität München & Helmholtz Zentrum, München, Germany
| | - Mariëtte E G Kranendonk
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Anton G T Terwisscha van Scheltinga
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Hospital and Clinical Pharmacy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Liesbeth Jansen
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jakob de Vries
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marjolijn N Lub-de Hooge
- Hospital and Clinical Pharmacy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Annelies Jorritsma-Smit
- Hospital and Clinical Pharmacy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Matthijs D Linssen
- Hospital and Clinical Pharmacy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Esther de Boer
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wouter B Nagengast
- Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sabrina Oliveira
- Division of Cell Biology of the Department of Biology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Willem P Th M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Elsken Van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Gooitzen M van Dam
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Intensive Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Bense RD, Sotiriou C, Piccart-Gebhart MJ, Haanen JBAG, van Vugt MATM, de Vries EGE, Schröder CP, Fehrmann RSN. Relevance of Tumor-Infiltrating Immune Cell Composition and Functionality for Disease Outcome in Breast Cancer. J Natl Cancer Inst 2016; 109:2905892. [PMID: 27737921 DOI: 10.1093/jnci/djw192] [Citation(s) in RCA: 241] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/25/2016] [Indexed: 12/20/2022] Open
Abstract
Background Not all breast cancer patients benefit from neoadjuvant or adjuvant therapy, resulting in considerable undertreatment or overtreatment. New insights into the role of tumor-infiltrating immune cells suggest that their composition, as well as their functionality, might serve as a biomarker to enable optimal patient selection for current systemic therapies and upcoming treatment options such as immunotherapy. Methods We performed several complementary unbiased in silico analyses on gene expression profiles of 7270 unrelated tumor samples of nonmetastatic breast cancer patients with known clinical follow-up. CIBERSORT was used to estimate the fraction of 22 immune cell types to study their relations with pathological complete response (pCR), disease-free survival (DFS), and overall survival (OS). In addition, we used four previously reported immune gene signatures and a CD8+ T-cell exhaustion signature to assess their relationships with breast cancer outcome. Multivariable binary logistic regression and multivariable Cox regression were used to assess the association of immune cell-type fractions and immune signatures with pCR and DFS/OS, respectively. Results Increased fraction of regulatory T-cells in human epidermal growth factor receptor 2 (HER2)-positive tumors was associated with a lower pCR rate (odds ratio [OR] = 0.15, 95% confidence interval [CI] = 0.03 to 0.69), as well as shorter DFS (hazard ratio [HR] = 3.13, 95% CI = 1.23 to 7.98) and OS (HR = 7.69, 95% CI = 3.43 to 17.23). A higher fraction of M0 macrophages in estrogen receptor (ER)-positive tumors was associated with worse DFS (HR = 1.66, 95% CI = 1.18 to 2.33) and, in ER-positive/HER2-negative tumors, with worse OS (HR = 1.71, 95% CI = 1.12 to 2.61). Increased fractions of γδ T-cells in all breast cancer patients related to a higher pCR rate (OR = 1.55, 95% CI = 1.01 to 2.38), prolonged DFS (HR = 0.68, 95% CI = 0.48 to 0.98), and, in HER2-positive tumors, with prolonged OS (HR = 0.27, 95% CI = 0.10 to 0.73). A higher fraction of activated mast cells was associated with worse DFS (HR = 5.85, 95% CI = 2.20 to 15.54) and OS (HR = 5.33, 95% CI = 2.04 to 13.91) in HER2-positive tumors. The composition of relevant immune cell types frequently differed per breast cancer subtype. Furthermore, a high CD8+ T-cell exhaustion signature score was associated with shortened DFS in patients with ER-positive tumors regardless of HER2 status (HR = 1.80, 95% CI = 1.07 to 3.04). Conclusions The main hypothesis generated in our unbiased in silico approach is that a multitude of immune cells are related to treatment response and outcome in breast cancer.
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Affiliation(s)
- Rico D Bense
- Affiliations of authors: Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (RDB, MATMvV, EGEdV, CPS, RSNF); Department of Medical Oncology and Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (CS, MJPG); Division of Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands (JBAGH)
| | - Christos Sotiriou
- Affiliations of authors: Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (RDB, MATMvV, EGEdV, CPS, RSNF); Department of Medical Oncology and Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (CS, MJPG); Division of Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands (JBAGH)
| | - Martine J Piccart-Gebhart
- Affiliations of authors: Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (RDB, MATMvV, EGEdV, CPS, RSNF); Department of Medical Oncology and Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (CS, MJPG); Division of Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands (JBAGH)
| | - John B A G Haanen
- Affiliations of authors: Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (RDB, MATMvV, EGEdV, CPS, RSNF); Department of Medical Oncology and Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (CS, MJPG); Division of Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands (JBAGH)
| | - Marcel A T M van Vugt
- Affiliations of authors: Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (RDB, MATMvV, EGEdV, CPS, RSNF); Department of Medical Oncology and Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (CS, MJPG); Division of Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands (JBAGH)
| | - Elisabeth G E de Vries
- Affiliations of authors: Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (RDB, MATMvV, EGEdV, CPS, RSNF); Department of Medical Oncology and Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (CS, MJPG); Division of Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands (JBAGH)
| | - Carolien P Schröder
- Affiliations of authors: Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (RDB, MATMvV, EGEdV, CPS, RSNF); Department of Medical Oncology and Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (CS, MJPG); Division of Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands (JBAGH)
| | - Rudolf S N Fehrmann
- Affiliations of authors: Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (RDB, MATMvV, EGEdV, CPS, RSNF); Department of Medical Oncology and Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (CS, MJPG); Division of Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands (JBAGH)
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van den Brom RRH, Abdulahad WH, Rutgers A, Kroesen BJ, Roozendaal C, de Groot DJA, Schröder CP, Hospers GAP, Brouwer E. Rapid granulomatosis with polyangiitis induced by immune checkpoint inhibition. Rheumatology (Oxford) 2016; 55:1143-5. [PMID: 27069016 DOI: 10.1093/rheumatology/kew063] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
| | | | | | - Bart-Jan Kroesen
- Department of Medical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Caroline Roozendaal
- Department of Medical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Venema CM, van der Veen SJ, Glaudemans AWJM, Schröder CP, de Vries EFJ, Hospers GAP. Abstract P5-01-07: Radiotherapy may induce enhanced uptake on 18F-fluoroestradiol PET scans. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-01-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Whole body imaging of 18F-fluoroestradiol (FES) uptake combined with positron emission tomography (PET) has been applied for diagnosis and prediction of therapy response in estrogen receptor (ER) positive breast cancer patients. A maximal standardized uptake value (SUVmax) of 1.5 has previously been defined as the optimal threshold for FES uptake to differentiate between ER-positive and negative tumor lesions. FES uptake in healthy tissue differs per anatomic site and can be influenced by extrinsic factors. Previous FES PET studies have suggested that radiotherapy (RTx) may cause heterogeneous enhanced uptake in lungs. The cause of this uptake has not been elucidated yet. This is an exploratory study to evaluate whether patients with RTx prior to FES PET show enhanced FES uptake in tissues in the irradiation field.
Methods: Our FES PET database was screened between 2009 and June 2015 for patients who had RTx ≤6 months before FES PET, independent of location of RTx. Irradiation fields were reconstructed and fused with the FES PET scan. The main outcome was the presence of enhanced FES uptake, defined as visually increased FES uptake above background with a SUVmax >1.5 in the irradiation field in the absence of an oncologic substrate on the concordant (contrast enhanced) CT scan.
Results: A total of 133 patients were identified in the database; 29 were eligible for the study. Mean age at the first FES PET scan was 57 (SD 9) years. 28/29 patients had breast cancer, 2/28 had a concurrent other malignancy. Seventeen patients (59%) showed enhanced uptake in the RTx field. 15/17 patients were irradiated in the thoracic area, and 2/17 at the hip. Enhanced uptake was mostly located at the dorsomedial side of the lungs, or subcutaneously after thoracic- or hip RTx, respectively. Patients with normal FES uptake in the radiation field were irradiated in the pelvic/lumbal spine area (n=5), hip (n=3) or thorax (n=4). Time range between RTx and FES PET did not differ between patients with and without enhanced FES uptake (mean 50.9 days [range 0-156] vs. mean 56.8 days [range 0-178]). Systemic treatment at the time of FES PET did not differ between the patients with and without enhanced uptake. Radiation dosage in gray (Gy) was related to enhanced FES uptake, after RTx in the thoracic area or at the hip.
Conclusion: RTx can induce enhanced uptake in the irradiation field on the FES PET scan in part of the patients. Irradiation-induced FES uptake most frequently occurs in lung tissue. Therefore, physicians should keep the possibility of radiation-induced aspecific enhanced tracer uptake in mind, when interpreting FES PET scan of patients that have recently received RTx.
Citation Format: Venema CM, van der Veen SJ, Glaudemans AWJM, Schröder CP, de Vries EFJ, Hospers GAP. Radiotherapy may induce enhanced uptake on 18F-fluoroestradiol PET scans. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-01-07.
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Affiliation(s)
- CM Venema
- University Medical Center Groningen, Groningen, Netherlands
| | | | | | - CP Schröder
- University Medical Center Groningen, Groningen, Netherlands
| | - EFJ de Vries
- University Medical Center Groningen, Groningen, Netherlands
| | - GAP Hospers
- University Medical Center Groningen, Groningen, Netherlands
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Bense RD, van der Vegt B, de Vries EGE, van Vugt MATM, Schröder CP, Fehrmann RSN. Abstract P6-08-01: Inverse relationships between high somatic copy number load and immune phenotypes in breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-08-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Currently, there is no clear biomarker to predict which breast cancer patient may benefit from immunotherapy. High somatic point mutational load is thought to lead to immune activation and CD8+ T cell activation and infiltration. In addition, pre-existing CD8+ T cells distinctly located at the invasive tumor margin are associated with expression of the PD-1/PD-L1 immune inhibitory axis and may predict response to PD-1 targeted therapy. However, breast tumors are considered copy number-driven rather than mutational-driven cancers. Therefore, in order to identify which breast cancer patients may potentially benefit from immunotherapy, we investigated relations between copy number load and CD8+ T cell abundance, immune pathways and immune activation scores in a large set of publically available breast cancer expression profiles.
Methods
Functional genomic mRNA-profiling (Fehrmann et al., Nat Genet, 2015) was used to capture the downstream effect of somatic copy number alterations on gene expression levels. This method allowed using gene expression profiles to quantify somatic copy number load occurring in tumor samples in a univariate measurement called the copy number load index (CNL-index). Immune activation scores were calculated according to two known gene immune signatures (Teschendorff et al., Genome Biol, 2007 and Desmedt et al., Clin Cancer Res, 2008). Cibersort (Newman et al., Nat Methods, 2015) was applied to estimate CD8+ T cell abundance. Publicly available gene expression profiles of 7,270 primary breast cancer samples were used. The relation between CNL-index, immune activation scores and disease-free survival (DFS), defined as time from diagnosis until distant metastasis development, was assessed by multivariate cox-regression analysis including age, ER and HER2 status, tumor size, lymph node involvement, tumor grade and treatment regimen. Gene set enrichment analysis (GSEA) was applied to assess relations between immune pathways and CNL-index.
Results
In primary breast cancer, low CNL-index was found in 1,796 samples (24.7%) versus 5,474 samples with a high CNL-index (75.3%). Higher CNL-index was correlated with shorter DFS (HR 2.51, P = 1.6x10-4), whereas higher immune activation scores were associated with prolonged DFS (HR 0.199, P = 0.003 and HR 0.347, P = 0.017). CD8+ T cell abundance was negatively correlated with the CNL-index (Spearman R = -0.14, P = 8.11x10-34). GSEA showed enrichment of immune pathways amongst genes that negatively correlated with CNL-index. Subset analysis in 1,555 TNBC samples showed low CNL-index in 287 samples (18.5%) versus high CNL-index in 1,268 samples (81.5%). Similar to the entire breast cancer set, CD8+ T cell abundance and CNL-index were negatively correlated in TNBC (Spearman R = -0.11, P = 4.11x10-05). Immune pathway enrichment in genes in TNBC also negatively correlated to CNL-index.
Conclusion
High CNL-index (i.e. high copy number load) is inversely related to immunoactivation, immune pathways and CD8+ T cell abundance. This implies that in breast cancer, tumors with low CNL-index may be intrinsically sensitive to immune modulation, which warrants further confirmation in prospective trials.
This research was supported by Dutch Cancer Society Grants RUG 2010-4739 and RUG 2013-5960.
Citation Format: Bense RD, van der Vegt B, de Vries EGE, van Vugt MATM, Schröder CP, Fehrmann RSN. Inverse relationships between high somatic copy number load and immune phenotypes in breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-08-01.
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Affiliation(s)
- RD Bense
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - B van der Vegt
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - EGE de Vries
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - MATM van Vugt
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - CP Schröder
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - RSN Fehrmann
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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van den Brom RR, Mäkelburg AB, Schröder CP, de Vries EG, Hospers GA. Vemurafenib-Induced Disseminated Intravascular Coagulation in Metastatic Melanoma. J Clin Oncol 2015; 33:e133-4. [DOI: 10.1200/jco.2013.51.4471] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rob R.H. van den Brom
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anja B.U. Mäkelburg
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carolien P. Schröder
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Geke A.P. Hospers
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Gebhart G, Lamberts LE, Wimana Z, Garcia C, Emonts P, Ameye L, Stroobants S, Huizing M, Aftimos P, Tol J, Oyen WJG, Vugts DJ, Hoekstra OS, Schröder CP, Menke-van der Houven van Oordt CW, Guiot T, Brouwers AH, Awada A, de Vries EGE, Flamen P. Molecular imaging as a tool to investigate heterogeneity of advanced HER2-positive breast cancer and to predict patient outcome under trastuzumab emtansine (T-DM1): the ZEPHIR trial. Ann Oncol 2015; 27:619-24. [PMID: 26598545 DOI: 10.1093/annonc/mdv577] [Citation(s) in RCA: 241] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/17/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Only human epidermal growth factor receptor (HER)2 status determined by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) has been validated to predict efficacy of HER2-targeting antibody-drug-conjugate trastuzumab emtansine (T-DM1). We propose molecular imaging to explore intra-/interpatient heterogeneity in HER2 mapping of metastatic disease and to identify patients unlikely to benefit from T-DM1. PATIENTS AND METHODS HER2-positive mBC patients with IHC3+ or FISH ≥ 2.2 scheduled for T-DM1 underwent a pretreatment HER2-positron emission tomography (PET)/computed tomography (CT) with (89)Zr-trastuzumab. [(18)F]2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT was performed at baseline and before T-DM1 cycle 2. Patients were grouped into four HER2-PET/CT patterns according to the proportion of FDG-avid tumor load showing relevant (89)Zr-trastuzumab uptake (>blood pool activity): patterns A and B were considered positive (>50% or all of the tumor load 'positive'); patterns C and D were considered negative (>50% or all of the tumor load 'negative'). Early FDG-PET/CT was defined as nonresponding when >50% of the tumor load showed no significant reduction of FDG uptake (<15%). Negative (NPV) and positive predictive values (PPV) of HER2-PET/CT, early FDG response and their combination were assessed to predict morphological response (RECIST 1.1) after three T-DM1 cycles and time-to-treatment failure (TTF). RESULTS In the 56 patients analyzed, 29% had negative HER2-PET/CT while intrapatient heterogeneity (patterns B and C) was found in 46% of patients. Compared with RECIST1.1, respective NPV/PPV for HER2-PET/CT were 88%/72% and 83%/96% for early FDG-PET/CT. Combining HER2-PET/CT and FDG-PET/CT accurately predicted morphological response (PPV and NPV: 100%) and discriminated patients with a median TTF of only 2.8 months [n = 12, 95% confidence interval (CI) 1.4-7.6] from those with a TTF of 15 months (n = 25, 95% CI 9.7-not calculable). CONCLUSIONS Pretreatment imaging of HER2 targeting, combined with early metabolic response assessment holds great promise for improving the understanding of tumor heterogeneity in mBC and for selecting patients who will/will not benefit from T-DM1. CLINICALTRIALSGOV IDENTIFIER NCT01565200.
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Affiliation(s)
- G Gebhart
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - L E Lamberts
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Z Wimana
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - C Garcia
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - P Emonts
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - L Ameye
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - M Huizing
- Antwerp University Hospital, Antwerpen, Belgium
| | - P Aftimos
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - J Tol
- Radboud University Medical Center Nijmegen, Nijmegen
| | - W J G Oyen
- Radboud University Medical Center Nijmegen, Nijmegen
| | - D J Vugts
- VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - O S Hoekstra
- VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - C P Schröder
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - T Guiot
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - A H Brouwers
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Awada
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - E G E de Vries
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P Flamen
- Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
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Lamberts LE, Menke-van der Houven van Oordt CW, ter Weele EJ, Bensch F, Smeenk MM, Voortman J, Hoekstra OS, Williams SP, Fine BM, Maslyar D, de Jong JR, Gietema JA, Schröder CP, Bongaerts AHH, Lub-de Hooge MN, Verheul HMW, Sanabria Bohorquez SM, Glaudemans AWJM, de Vries EGE. ImmunoPET with Anti-Mesothelin Antibody in Patients with Pancreatic and Ovarian Cancer before Anti-Mesothelin Antibody-Drug Conjugate Treatment. Clin Cancer Res 2015; 22:1642-52. [PMID: 26589435 DOI: 10.1158/1078-0432.ccr-15-1272] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/20/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Mesothelin (MSLN) is frequently overexpressed in pancreatic and ovarian cancers, making it a potential drug target. We performed an (89)Zr-PET imaging study with MMOT0530A, a MSLN antibody, in conjunction with a phase I study with the antibody-drug conjugate DMOT4039A, containing MMOT0530A bound to MMAE. The aim was to study antibody tumor uptake, whole-body distribution, and relation between uptake, response to treatment, and MSLN expression. EXPERIMENTAL DESIGN Before DMOT4039A treatment, patients received 37 MBq (89)Zr-MMOT0530A followed by PET/CT imaging 2, 4, and 7 days postinjection. Tracer uptake was expressed as standardized uptake value (SUV). MSLN expression was determined with immunohistochemistry (IHC) on archival tumor tissue. RESULTS Eleven patients were included, 7 with pancreatic and 4 with ovarian cancer. IHC MSLN expression varied from absent to strong. Suitable tracer antibody dose was 10 mg MMOT0530A and optimal imaging time was 4 and 7 days postinjection. Tumor tracer uptake occurred in 37 lesions with mean SUVmax of 13.1 (±7.5) on PET 4 days postinjection, with 11.5 (±7.5) in (N= 17) pancreatic and 14.5 (±8.7) in (N= 20) ovarian cancer lesions. Within patients, a mean 2.4-fold (±1.10) difference in uptake between tumor lesions existed. Uptake in blood, liver, kidneys, spleen, and intestine reflected normal antibody distribution. Tracer tumor uptake was correlated to IHC. Best response to DMOT4039A was partial response in one patient. CONCLUSIONS With (89)Zr-MMOT0530A-PET, pancreatic and ovarian cancer lesions as well as antibody biodistribution could be visualized. This technique can potentially guide individualized antibody-based treatment.
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Affiliation(s)
- Laetitia E Lamberts
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Eva J ter Weele
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Frederike Bensch
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Michiel M Smeenk
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Johannes Voortman
- Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Simon P Williams
- Department of Early Clinical Development, Genentech, Inc. South San Francisco, California
| | - Bernard M Fine
- Department of Biomedical Imaging, Genentech, Inc. South San Francisco, California
| | - Daniel Maslyar
- Department of Biomedical Imaging, Genentech, Inc. South San Francisco, California
| | - Johan R de Jong
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alphons H H Bongaerts
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjolijn N Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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van Kruchten M, Glaudemans AWJM, de Vries EFJ, Schröder CP, de Vries EGE, Hospers GAP. Positron emission tomography of tumour [(18)F]fluoroestradiol uptake in patients with acquired hormone-resistant metastatic breast cancer prior to oestradiol therapy. Eur J Nucl Med Mol Imaging 2015; 42:1674-1681. [PMID: 26091705 PMCID: PMC4554736 DOI: 10.1007/s00259-015-3107-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/02/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Whereas anti-oestrogen therapy is widely applied to treat oestrogen receptor (ER) positive breast cancer, paradoxically, oestrogens can also induce tumour regression. Up-regulation of ER expression is a marker for oestrogen hypersensitivity. We, therefore, performed an exploratory study to evaluate positron emission tomography (PET) with the tracer 16α-[(18)F]fluoro-17β-oestradiol ((18)F-FES) as potential marker to select breast cancer patients for oestradiol therapy. METHODS Eligible patients had acquired endocrine-resistant metastatic breast cancer that progressed after ≥2 lines of endocrine therapy. All patients had prior ER-positive histology. Treatment consisted of oestradiol 2 mg, three times daily, orally. Patients underwent (18)F-FES-PET/CT imaging at baseline. Tumour (18)F-FES-uptake was quantified for a maximum of 20 lesions and expressed as maximum standardised uptake value (SUVmax). CT-scan was repeated every 3 months to evaluate treatment response. Clinical benefit was defined as time to radiologic or clinical progression ≥24 weeks. RESULTS (18)F-FES uptake, quantified for 255 lesions in 19 patients, varied greatly between lesions (median 2.8; range 0.6-24.3) and between patients (median 2.5; range 1.1-15.5). Seven (37%) patients experienced clinical benefit of oestrogen therapy, eight progressed (PD), and four were non-evaluable due to side effects. The positive and negative predictive value (PPV/NPV) of (18)F-FES-PET for response to treatment were 60% (95% CI: 31-83%) and 80% (95% CI: 38-96%), respectively, using SUVmax >1.5. CONCLUSION (18)F-FES-PET may aid identification of patients with acquired antihormone resistant breast cancer that are unlikely to benefit from oestradiol therapy.
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Affiliation(s)
- Michel van Kruchten
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
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Lamberts LE, Williams SP, Terwisscha van Scheltinga AG, Lub-de Hooge MN, Schröder CP, Gietema JA, Brouwers AH, de Vries EG. Antibody Positron Emission Tomography Imaging in Anticancer Drug Development. J Clin Oncol 2015; 33:1491-504. [DOI: 10.1200/jco.2014.57.8278] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
More than 50 monoclonal antibodies (mAbs), including several antibody–drug conjugates, are in advanced clinical development, forming an important part of the many molecularly targeted anticancer therapeutics currently in development. Drug development is a relatively slow and expensive process, limiting the number of drugs that can be brought into late-stage trials. Development decisions could benefit from quantitative biomarkers, enabling visualization of the tissue distribution of (potentially modified) therapeutic mAbs to confirm effective whole-body target expression, engagement, and modulation and to evaluate heterogeneity across lesions and patients. Such biomarkers may be realized with positron emission tomography imaging of radioactively labeled antibodies, a process called immunoPET. This approach could potentially increase the power and value of early trials by improving patient selection, optimizing dose and schedule, and rationalizing observed drug responses. In this review, we summarize the available literature and the status of clinical trials regarding the potential of immunoPET during early anticancer drug development.
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Affiliation(s)
- Laetitia E. Lamberts
- Laetitia E. Lamberts, Anton G.T. Terwisscha van Scheltinga, Marjolijn N. Lub-de Hooge, Carolien P. Schröder, Jourik A. Gietema, Adrienne H. Brouwers, and Elisabeth G.E. de Vries, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; and Simon P. Williams, Genentech, South San Francisco, CA
| | - Simon P. Williams
- Laetitia E. Lamberts, Anton G.T. Terwisscha van Scheltinga, Marjolijn N. Lub-de Hooge, Carolien P. Schröder, Jourik A. Gietema, Adrienne H. Brouwers, and Elisabeth G.E. de Vries, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; and Simon P. Williams, Genentech, South San Francisco, CA
| | - Anton G.T. Terwisscha van Scheltinga
- Laetitia E. Lamberts, Anton G.T. Terwisscha van Scheltinga, Marjolijn N. Lub-de Hooge, Carolien P. Schröder, Jourik A. Gietema, Adrienne H. Brouwers, and Elisabeth G.E. de Vries, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; and Simon P. Williams, Genentech, South San Francisco, CA
| | - Marjolijn N. Lub-de Hooge
- Laetitia E. Lamberts, Anton G.T. Terwisscha van Scheltinga, Marjolijn N. Lub-de Hooge, Carolien P. Schröder, Jourik A. Gietema, Adrienne H. Brouwers, and Elisabeth G.E. de Vries, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; and Simon P. Williams, Genentech, South San Francisco, CA
| | - Carolien P. Schröder
- Laetitia E. Lamberts, Anton G.T. Terwisscha van Scheltinga, Marjolijn N. Lub-de Hooge, Carolien P. Schröder, Jourik A. Gietema, Adrienne H. Brouwers, and Elisabeth G.E. de Vries, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; and Simon P. Williams, Genentech, South San Francisco, CA
| | - Jourik A. Gietema
- Laetitia E. Lamberts, Anton G.T. Terwisscha van Scheltinga, Marjolijn N. Lub-de Hooge, Carolien P. Schröder, Jourik A. Gietema, Adrienne H. Brouwers, and Elisabeth G.E. de Vries, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; and Simon P. Williams, Genentech, South San Francisco, CA
| | - Adrienne H. Brouwers
- Laetitia E. Lamberts, Anton G.T. Terwisscha van Scheltinga, Marjolijn N. Lub-de Hooge, Carolien P. Schröder, Jourik A. Gietema, Adrienne H. Brouwers, and Elisabeth G.E. de Vries, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; and Simon P. Williams, Genentech, South San Francisco, CA
| | - Elisabeth G.E. de Vries
- Laetitia E. Lamberts, Anton G.T. Terwisscha van Scheltinga, Marjolijn N. Lub-de Hooge, Carolien P. Schröder, Jourik A. Gietema, Adrienne H. Brouwers, and Elisabeth G.E. de Vries, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; and Simon P. Williams, Genentech, South San Francisco, CA
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