Abstract P4-02-16: High miRNA26A1 and Low EZH2 Expression Levels Are Associated with Favorable Outcome to Tamoxifen in Advanced Breast Cancer through Similar Molecular Pathways

Background: We showed that decreased expression levels of EZH2 are associated with a favorable outcome to tamoxifen in advanced breast cancer. Furthermore, EZH2 knockdown in MCF7 cells resulted in estrogen receptor (ER) upregulation and increased sensitivity to anti-estrogens. Recently, EZH2 has been identified as a target of miRNA26A1 and miRNA101.

Objective: To associate miRNA26A1 and miRNA101 expression levels with: A) EZH2 and B) molecular pathways and C) outcome to first-line tamoxifen monotherapy for advanced disease.

Materials & Methods: Expression levels of miRNA26A1, miRNA101, EZH2 and references (miRNA-132 and miRNA-374) were measured using quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) in 235 ER-positive primary breast cancer specimens from patients with advanced disease. The levels of expression were related to clinicopathologic factors and disease outcome. Pathway analysis was performed in a subset of 65 ER-positive tumors with available gene expression microarray data available. Computations were performed with STATA and P-values <0.05 were considered statistically significant.

Results: The miRNA26A1 levels were significantly associated with levels of ER, progesterone (PgR), HER2 and EGFR, whereas miRNA101 levels showed significant relations with PgR expression and menopausal status. The miRNA26A1 and miRNA101 levels showed an inverse relation with EZH2 mRNA levels (Spearman Rank Correlation of -0.21 and -0.15, respectively, P<0.05). As continuous variable in univariate analysis, miRNA26A1 (Hazard Ratio (HR) =0.13, 95 % CI: 0.06-0.28) correlated with Time to Progression (TTP), while miRNA101 did not (HR=0.87, 95% CI: 0.70-1.07). In multivariate analysis including traditional predictive factors, the third with highest miRNA26A1 levels (HR=0.49, 95% CI: 0.34-0.72) alone, or combined with the third with lowest EZH2 levels (HR=0.56, 95% CI: 0.35-0.88) were associated with a favorable TTP independently of traditional factors. Pathway analyses identified 2 overlapping, cell cycle, related pathways with two genes (CCNE1and CDC2) differentially expressed (P<0.05) between tumors with high and low levels of miRNA26A1 and EZH2, respectively. Levels of CCNE1 and CDC2 were tested in the 235 tumors and showed as continuous variables also a significant association with TTP (HR=1.27, 95% CI: 1.12-1.45 and HR=1.53, 95% CI: 0.129-1.81).

Conclusions: The miRNA26A1 and miRNA101 levels have an inverse relation with levels of EZH2, however, only miRNA26A1 has predictive value in advanced breast cancer. Pathways comparison between miRNA26A1 and EZH2 identified 2 overlapping cell cycle related pathways and the genes CCNE1 and CDC2. Low levels of EZH2, CCNE1 and CDC2 and high levels of miRNA26A1 are associated with a favorable outcome to tamoxifen therapy.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-02-16.

Integrated Genomic Profiling of Endocrine Therapy Response in Advanced Breast Cancer

PurposeIn hormone receptor positive breast cancer the response rates for endocrine treatment, i.e. tamoxifen (TAM) or aromatase inhibitors (AIs), are only 50 to 70% in the advanced disease setting. The overall aim of this retrospective study is to identify a molecular signature using integrated genomic profiling to improve prediction of endocrine treatment outcome in the advanced disease setting.ObjectivesA) To compare mRNA expression profiles of TAM- and AI-treated patients and to identify genes and pathways associated with treatment outcome.B) To discover miRNA and mRNA signatures predictive for AI response.Patients and MethodsFresh frozen Estrogen Receptor (ER)-positive primary breast cancer specimens from patients with advanced disease treated with first-line AIs (N=55) or TAM (N=109) were analyzed. Expression profiles of 670 miRNAs and 44K mRNAs were generated using multiplex qRT-PCR and microarrays. Profiles were related to clinical response and time to progression (TTP). Statistical and bio-informatic tools were applied to discover and combine markers into an integrated genomic predictive signature. The nearest centroid prediction method of BRB-ArrayTools (Version3.7.0) was used to assess the predictive value.ResultsThe quality controlled and informative expression profiles of 277 miRNAs and 14112 mRNAs in 50 AI-treated tumors and 10433 mRNAs in 101 TAM-treated tumors were included for further analysis in the discovery phase.Global testing of mRNAs linked to Biocarta pathways demonstrated the involvement of the interferon pathway in endocrine therapy response in both AI- and TAM-treated patients. Using BRB-ArrayTools survival analysis to find genes associated with TTP (P<0.05), we identified 1002 mRNAs in AI-treated and 662 mRNAs in TAM-treated tumors to be significantly related with TTP.The overlap of 40 mRNAs between AI- and TAM-treatment was defined as a mRNA signature for endocrine treatment outcome. In TAM-treated patients this classifier has a 69% accuracy (63% sensitivity, 74% specificity), an odds ratio for clinical benefit of 4.69 (95% CI 1.99-11.05, P<0.001) and a hazard ratio for TTP of 0.17 (95% CI 0.10-0.29, P<0.001). In AI-treated patients, this 40mRNA signature has a performance of 78% accuracy (84% sensitivity, 62% specificity) and significantly predicts clinical benefit (odds ratio = 8.27, 95% CI 2.00-34.3, P=0.004) and TTP (hazard ratio = 0.07, 95% CI 0.02-0.22, P<0.001).After statistical analysis a 16 miRNAs classifier for AI-treatment outcome was identified with a performance of 78% accuracy (89% sensitivity, 46% specificity). This classifier significantly predicts clinical benefit (Odds ratio = 7.07, 95% CI 1.57-31.9, P=0.011) and TTP (hazard ratio = 0.24, 95% CI 0.09-0.61, P=0.003).The genomic mRNA and miRNA signatures are currently integrated and validated in additional samples as well as “in silico” on tumors treated with neo-adjuvant AI (Miller et al, JCO 2009).ConclusionThis is the first study that combines miRNA and mRNA profiling in an attempt to define an integrated genomic signature for endocrine treatment outcome. Additional prospective multicenter studies are needed to confirm the predictive value of this signature.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3029.

Down Regulation of EZH2 Is Associated with ESR1 Upregulation and Response to Endocrine Therapy in Breast Cancer

Background: We have previously identified a gene signature for resistance to first-line tamoxifen therapy in advanced breast cancer. One of these genes is Enhancer of Zeste Homolog 1 (EZH1), a member of the EZH family of which EZH2 has been identified as being prognostic. Both genes are involved in transcriptional control and epigenetic memory maintenance and act as polycomb repressors. The aim of this study is to investigate these genes for their predictive value and, if associated with clinical outcome, to evaluate the functional role in treatment response in vitro.Experimental design: Expression levels of EZH1 and EZH2 expression were measured using quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) in primary breast cancer specimens and related to clinicopathologic factors and disease outcome. Functional studies were done in MCF7, a human estrogen sensitive breast cancer cell line. Expression levels of EZH2 were downregulated with siRNAs, and changes in cell numbers were determined treating with (the anti-estrogen) ICI164.384. In addition, alterations in expression levels of putative downstream genes, including the estrogen receptor (ESR1), were measured.Results: When analysed as continuous variable in univariate analysis, only EZH2 was significantly associated with therapy resistance and a shorter Progression Free Survival (PFS) in 278 patients with advanced disease treated with first-line tamoxifen monotherapy. In univariate analysis the tertile with highest EZH2 levels was associated with clinical benefit (OR=0.48, 95%CI: 0.26-0.89; P=0.02) and with PFS (HR=1.80, 95%CI: 1.32-2.46;P<0.001). In multivariate analysis including traditional predictive factors, highest EZH2 levels were independently related with a shorter PFS (HR=1.58, 95%CI: 1.10-2.26; P=0.01). Despite, EZH2 mRNA levels were not significantly correlated with metastasis free survival (HR=1.14, 95%CI: 0.98-1.32; P=0.10) in 688 lymph node negative patients who did not receive adjuvant systemic therapy.EZH2 silencing in MCF7 caused a significant decrease in cell numbers (38%, range 17-53%, N=3) whereas ICI164.384 treatment resulted in decrease of 25% (range 12-30%, N=3) compared to controls. Combining EZH2 silencing with ICI-treatment reduced cell numbers with 67% (range 54-75%, N=3, P<0.001). Interestingly, downregulation of EZH2 was associated with an almost 2-fold upregulation of ESR1 (N=6, P=0.001). This inverse relation has been confirmed in additional “in silico” analyses.Conclusion: High levels of EZH2 are associated with poor clinical outcome for tamoxifen therapy of advanced breast cancer. EZH2 silencing in MCF7 cells inhibits cell proliferation, it upregulates ESR1 levels and increases sensitivity to ICI164.384. Further validation is needed to confirm that silencing of EZH2 leads to an upregulation of the ESR1 and as a consequence to a better response to anti-estrogens. This finding sheds new light on the involvement of EZH2 in anti-estrogen treatment offering possibilities for novel management strategies.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5131.

Decreased expression of EZH2 is associated with ESR1 upregulation and response to anti-estrogens

Abstract #6127

Background: In prostate and breast cancer high levels of Enhancer of Zeste Homolog 2 (EZH2) are associated with tumor progression. EZH2, a histone H3 methyl transferase, is part of the polycomb complex. Together with histone deacetylases (HDACs) EZH2 regulates “genome wide” gene transcription silencing. The aims of this study are a) to correlate EZH2 expression with endocrine therapy response in patients with recurrent disease treated with first-line tamoxifen monotherapy and b) to determine the role of EZH2 in endocrine therapy response using in vitro cell line models.
 Material and Methods: EZH2 mRNA levels were measured with quantitative real-time PCR (qRT-PCR) in 297 retrospectively collected hormone receptor positive (HR+) primary breast tumor specimens of patients with recurrent disease who did respond (N=110) or were resistant (N=187) to first-line tamoxifen monotherapy. In vitro, EZH2 and estrogen receptor (ESR1) expression was downregulated with siRNAs in the human breast cancer cell line MCF7 and assessed for their sensitivity to the selective estrogen receptor degrader ICI164.384 after 96hrs treatment (N=3). To establish therapy response in vitro, cell number counts were determined. All p-values are two-sided and significant if P<0.05.
 Results: In 297 HR+ breast tumors, EZH2 as continuous variable, associated significantly with poor response (OR= 0.67 [0.49-0.91]; P=0.001) and a shorter progression-free survival (PFS) (HR=1.28 [1.11-1.47], P<0.001). In the multivariate model with traditional predictive factors, the tertile with highest EZH2 levels was independently related with response (OR= 0.50 [0.26-0.98]; P=0.045) and PFS (HR=1.82 [1.33-2.49], P<0.001).
 In vitro, EZH2 downregulation in MCF7 with siRNAs showed a significant decrease in cell number compared to the mock silenced cell line (40%). Moreover, ICI treatment of EZH2 silenced MCF7 cells resulted in a 70% cell number decrease versus 23% decrease in the controls (P<0.001). In addition, EZH2 downregulation is associated with a twofold upregulation with ESR1 (P<0.001). Conversely, silencing of ESR1 in MCF7 resulted did not alter EZH2 levels but, as expected, increases HER2 protein levels.
 Conclusion: In primary breast tumors, high EZH2 mRNA levels are associated with poor outcomes after tamoxifen therapy. These results suggest that EZH2 may identify patients at risk for tamoxifen therapy failure. In vitro studies show that downregulation of EZH2 inhibits cell proliferation and on the other hand results in upregulation of ESR1 levels. The latter may explain the increased sensitivity to ICI164.384 of EZH2 silenced cells.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6127.