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Conde E, Hernandez S, Rodriguez Carrillo JL, Martinez R, Alonso M, Curto D, Jimenez B, Caminoa A, Benito A, Garrido P, Clave S, Arriola E, Esteban-Rodriguez I, De Castro J, Sansano I, Felip E, Rojo F, Dómine M, Abdulkader I, Garcia-Gonzalez J, Teixido C, Reguart N, Compañ D, Insa A, Mancheño N, Palanca S, Juan-Vidal O, Baixeras N, Nadal E, Cebollero M, Calles A, Martin P, Salas C, Provencio M, Aranda I, Massuti B, Lopez-Vilaro L, Majem M, Paz-Ares L, Lopez-Rios F. RET Fusion Testing in Patients With NSCLC: The RETING Study. JTO Clin Res Rep 2024; 5:100653. [PMID: 38525319 PMCID: PMC10957499 DOI: 10.1016/j.jtocrr.2024.100653] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction RET inhibitors with impressive overall response rates are now available for patients with NSCLC, yet the identification of RET fusions remains a difficult challenge. Most guidelines encourage the upfront use of next-generation sequencing (NGS), or alternatively, fluorescence in situ hybridization (FISH) or reverse transcriptase-polymerase chain reaction (RT-PCR) when NGS is not possible or available. Taken together, the suboptimal performance of single-analyte assays to detect RET fusions, although consistent with the notion of encouraging universal NGS, is currently widening some of the clinical practice gaps in the implementation of predictive biomarkers in patients with advanced NSCLC. Methods This situation prompted us to evaluate several RET assays in a large multicenter cohort of RET fusion-positive NSCLC (n = 38) to obtain real-world data. In addition to RNA-based NGS (the criterion standard method), all positive specimens underwent break-apart RET FISH with two different assays and were also tested by an RT-PCR assay. Results The most common RET partners were KIF5B (78.9%), followed by CCDC6 (15.8%). The two RET NGS-positive but FISH-negative samples contained a KIF5B(15)-RET(12) fusion. The three RET fusions not identified with RT-PCR were AKAP13(35)-RET(12), KIF5B(24)-RET(9) and KIF5B(24)-RET(11). All three false-negative RT-PCR cases were FISH-positive, exhibited a typical break-apart pattern, and contained a very high number of positive tumor cells with both FISH assays. Signet ring cells, psammoma bodies, and pleomorphic features were frequently observed (in 34.2%, 39.5%, and 39.5% of tumors, respectively). Conclusions In-depth knowledge of the advantages and disadvantages of the different RET testing methodologies could help clinical and molecular tumor boards implement and maintain sensible algorithms for the rapid and effective detection of RET fusions in patients with NSCLC. The likelihood of RET false-negative results with both FISH and RT-PCR reinforces the need for upfront NGS in patients with NSCLC.
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Affiliation(s)
- Esther Conde
- Hospital Universitario 12 de Octubre, Madrid, Spain
- Universidad Complutense, Madrid, Spain
- Research Institute Hospital 12 de Octubre (i+12), Madrid, Spain
- Centro de Investigación Biomedica en Red Cancer (CIBERONC), Madrid, Spain
| | - Susana Hernandez
- Hospital Universitario 12 de Octubre, Madrid, Spain
- Research Institute Hospital 12 de Octubre (i+12), Madrid, Spain
| | | | | | - Marta Alonso
- Hospital Universitario 12 de Octubre, Madrid, Spain
- Research Institute Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Daniel Curto
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Pilar Garrido
- Centro de Investigación Biomedica en Red Cancer (CIBERONC), Madrid, Spain
- Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Sergi Clave
- Centro de Investigación Biomedica en Red Cancer (CIBERONC), Madrid, Spain
- Hospital del Mar, Barcelona, Spain
| | - Edurne Arriola
- Centro de Investigación Biomedica en Red Cancer (CIBERONC), Madrid, Spain
- Hospital del Mar, Barcelona, Spain
| | | | - Javier De Castro
- Centro de Investigación Biomedica en Red Cancer (CIBERONC), Madrid, Spain
- Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigacion Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Irene Sansano
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Federico Rojo
- Centro de Investigación Biomedica en Red Cancer (CIBERONC), Madrid, Spain
- Instituto de Investigacion Sanitaria-Fundacion Jimenez Diaz (IIS-FJD), Madrid, Spain
| | - Manuel Dómine
- Instituto de Investigacion Sanitaria-Fundacion Jimenez Diaz (IIS-FJD), Madrid, Spain
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ihab Abdulkader
- Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Cristina Teixido
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Noemi Reguart
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | - Amelia Insa
- Hospital Clinico Universitario, Valencia, Spain
| | - Nuria Mancheño
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - Sarai Palanca
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | | | - Nuria Baixeras
- Hospital Universitari de Bellvitge, L’Hospitalet, Barcelona, Spain
| | - Ernest Nadal
- Catalan Institute of Oncology, L’Hospitalet, Barcelona, Spain
| | - Maria Cebollero
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Antonio Calles
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Paloma Martin
- Centro de Investigación Biomedica en Red Cancer (CIBERONC), Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Clara Salas
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Ignacio Aranda
- Hospital General Universitario Dr. Balmis – Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Bartomeu Massuti
- Hospital General Universitario Dr. Balmis – Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | | | | | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, Madrid, Spain
- Universidad Complutense, Madrid, Spain
- Research Institute Hospital 12 de Octubre (i+12), Madrid, Spain
- Centro de Investigación Biomedica en Red Cancer (CIBERONC), Madrid, Spain
| | - Fernando Lopez-Rios
- Hospital Universitario 12 de Octubre, Madrid, Spain
- Universidad Complutense, Madrid, Spain
- Research Institute Hospital 12 de Octubre (i+12), Madrid, Spain
- Centro de Investigación Biomedica en Red Cancer (CIBERONC), Madrid, Spain
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2
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Hernandez S, Conde E, Molero A, Suarez-Gauthier A, Martinez R, Alonso M, Plaza C, Camacho C, Chantada D, Juaneda-Magdalena L, Garcia-Toro E, Saiz-Lopez P, Rojo F, Abad M, Boni V, Del Carmen S, Regojo RM, Sanchez-Frias ME, Teixido C, Paz-Ares L, Lopez-Rios F. Efficient Identification of Patients With NTRK Fusions Using a Supervised Tumor-Agnostic Approach. Arch Pathol Lab Med 2024; 148:318-326. [PMID: 37270803 DOI: 10.5858/arpa.2022-0443-oa] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 06/06/2023]
Abstract
CONTEXT.— The neurotrophic tropomyosin receptor kinase (NTRK) family gene rearrangements have been recently incorporated as predictive biomarkers in a "tumor-agnostic" manner. However, the identification of these patients is extremely challenging because the overall frequency of NTRK fusions is below 1%. Academic groups and professional organizations have released recommendations on the algorithms to detect NTRK fusions. The European Society for Medical Oncology proposal encourages the use of next-generation sequencing (NGS) if available, or alternatively immunohistochemistry (IHC) could be used for screening with NGS confirmation of all positive IHC results. Other academic groups have included histologic and genomic information in the testing algorithm. OBJECTIVE.— To apply some of these triaging strategies for a more efficient identification of NTRK fusions within a single institution, so pathologists can gain practical insight on how to start looking for NTRK fusions. DESIGN.— A multiparametric strategy combining histologic (secretory carcinomas of the breast and salivary gland; papillary thyroid carcinomas; infantile fibrosarcoma) and genomic (driver-negative non-small cell lung carcinomas, microsatellite instability-high colorectal adenocarcinomas, and wild-type gastrointestinal stromal tumors) triaging was put forward. RESULTS.— Samples from 323 tumors were stained with the VENTANA pan-TRK EPR17341 Assay as a screening method. All positive IHC cases were simultaneously studied by 2 NGS tests, Oncomine Comprehensive Assay v3 and FoundationOne CDx. With this approach, the detection rate of NTRK fusions was 20 times higher (5.57%) by only screening 323 patients than the largest cohort in the literature (0.30%) comprising several hundred thousand patients. CONCLUSIONS.— Based on our findings, we propose a multiparametric strategy (ie, "supervised tumor-agnostic approach") when pathologists start searching for NTRK fusions.
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Affiliation(s)
- Susana Hernandez
- From the Department of Pathology, 12 de Octubre University Hospital, Research Institute 12 de Octubre University Hospital (i+12), Madrid, Spain (Hernandez, Alonso)
| | - Esther Conde
- the Department of Pathology, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Research Institute 12 de Octubre University Hospital (i+12), CIBERONC, Madrid, Spain (Conde, Lopez-Rios)
| | - Aida Molero
- the Department of Pathology, Segovia General Hospital, Segovia, Spain (Molero)
| | - Ana Suarez-Gauthier
- the Department of Pathology, Jimenez Diaz Foundation University Hospital, Madrid, Spain (Suarez-Gauthier)
| | - Rebeca Martinez
- the Department of Pathology, Health Diagnostic-Grupo Quiron Salud, Madrid, Spain (Martinez)
| | - Marta Alonso
- From the Department of Pathology, 12 de Octubre University Hospital, Research Institute 12 de Octubre University Hospital (i+12), Madrid, Spain (Hernandez, Alonso)
| | - Carlos Plaza
- the Department of Pathology, Clinico San Carlos University Hospital, Madrid, Spain (Plaza)
| | - Carmen Camacho
- the Department of Pathology, Insular Materno-Infantil University Hospital, Las Palmas de Gran Canaria, Spain (Camacho)
| | - Debora Chantada
- the Department of Pathology, Alvaro Cunqueiro Hospital, Vigo, Spain (Chantada, Juaneda-Magdalena)
| | - Laura Juaneda-Magdalena
- the Department of Pathology, Alvaro Cunqueiro Hospital, Vigo, Spain (Chantada, Juaneda-Magdalena)
| | - Enrique Garcia-Toro
- the Department of Pathology, Burgos University Hospital, Burgos, Spain (Garcia-Toro, Saiz-Lopez)
| | - Patricia Saiz-Lopez
- the Department of Pathology, Burgos University Hospital, Burgos, Spain (Garcia-Toro, Saiz-Lopez)
| | - Federico Rojo
- the Institute of Health Research-Jimenez Diaz Foundation, CIBERONC, Madrid, Spain (Rojo)
| | - Mar Abad
- the Department of Pathology, Salamanca University Hospital, Salamanca, Spain (Abad)
| | - Valentina Boni
- NEXT Oncology Madrid, Quiron Salud Madrid University Hospital, Madrid, Spain (Boni)
| | - Sofia Del Carmen
- the Department of Pathology, Marques de Valdecilla University Hospital, Santander, Spain (del Carmen)
| | - Rita Maria Regojo
- the Department of Pathology, La Paz University Hospital, Madrid, Spain (Regojo)
| | | | - Cristina Teixido
- the Department of Pathology, Thoracic Oncology Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain (Teixido)
| | - Luis Paz-Ares
- the Department of Oncology, 12 de Octubre University Hospital, Department of Medicine, Universidad Complutense de Madrid, Research Institute 12 de Octubre University Hospital (i+12), CIBERONC, Madrid, Spain (Paz-Ares)
| | - Fernando Lopez-Rios
- the Department of Pathology, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Research Institute 12 de Octubre University Hospital (i+12), CIBERONC, Madrid, Spain (Conde, Lopez-Rios)
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3
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Zazo S, Pérez‐Buira S, Carvajal N, Plaza‐Sánchez J, Manso R, Pérez‐González N, Dominguez C, Prieto‐Potin I, Rubio J, Dómine M, Lozano V, Mohedano P, Carcedo D, Carias R, Rojo F. Actionable mutational profiling in solid tumors using hybrid-capture-based next-generation sequencing in a real-world setting in Spain. Cancer Med 2024; 13:e6827. [PMID: 38213074 PMCID: PMC10905216 DOI: 10.1002/cam4.6827] [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] [Revised: 11/09/2023] [Accepted: 12/08/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE This study aimed to describe the performance of a next-generation sequencing (NGS) panel for the detection of precise genomic alterations in cancer in Spanish clinical practice. The impact of tumor characteristics was evaluated on informative NGS and actionable mutation rates. MATERIALS AND METHODS A cross-sectional study was conducted at the Fundación Jiménez Díaz University Hospital (May 2021-March 2022) where molecular diagnostic of 537 Formalin-Fixed Paraffin-Embedded (FFPE) tissue samples of diverse solid tumors (lung, colorectal, melanoma, gastrointestinal stromal, among others) was performed using AVENIO Tumor Tissue Targeted Kit. A descriptive analysis of the features of all samples was carried out. Multivariable logistic analysis was conducted to assess the impact of sample characteristics on NGS performance defined by informative results rate (for all tumors and for lung tumors), and on actionable mutations rate (for lung tumors only). RESULTS AVENIO performance rate was 75.2% in all tumor samples and 75.3% in lung cancer samples, and the multivariable analysis showed that surgical specimens are most likely to provide informative results than diagnostic biopsies. Regarding the mutational findings, 727 pathogenic, likely pathogenic, or variant of unknown significance mutations were found in all tumor samples. Single nucleotide variant was the most common genomic alteration, both for all tumor samples (85.3% and 81.9% for all solid tumors and lung samples, respectively). In lung tumors, multivariable analysis showed that it is more likely to find actionable mutations from non-smokers and patients with adenocarcinoma, large cell, or undifferentiated histologies. CONCLUSION This is the largest cohort-level study in Spain to profile the analyses of biopsy samples of different tumors using NGS in routine clinical practice. Our findings showed that the use of NGS routinely provides good rates of informative results and can improve tumor characterization and identify a greater number of actionable mutations.
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Affiliation(s)
- Sandra Zazo
- Department of PathologyFundación Jiménez Díaz University HospitalMadridSpain
- IIS‐Fundación Jimenez DiazCenter for Biomedical Network Research on Cancer (CIBERONC)MadridSpain
| | - Sandra Pérez‐Buira
- Department of PathologyFundación Jiménez Díaz University HospitalMadridSpain
| | - Nerea Carvajal
- Department of PathologyFundación Jiménez Díaz University HospitalMadridSpain
| | | | - Rebeca Manso
- Department of PathologyFundación Jiménez Díaz University HospitalMadridSpain
| | | | - Carolina Dominguez
- IIS‐Fundación Jimenez DiazCenter for Biomedical Network Research on Cancer (CIBERONC)MadridSpain
| | - Iván Prieto‐Potin
- Department of PathologyFundación Jiménez Díaz University HospitalMadridSpain
| | - Jaime Rubio
- Medical Oncology DepartmentFundación Jiménez Díaz University HospitalMadridSpain
| | - Manuel Dómine
- IIS‐Fundación Jimenez DiazCenter for Biomedical Network Research on Cancer (CIBERONC)MadridSpain
- Medical Oncology DepartmentFundación Jiménez Díaz University HospitalMadridSpain
| | | | | | | | - Rafael Carias
- Department of PathologyFundación Jiménez Díaz University HospitalMadridSpain
| | - Federico Rojo
- Department of PathologyFundación Jiménez Díaz University HospitalMadridSpain
- IIS‐Fundación Jimenez DiazCenter for Biomedical Network Research on Cancer (CIBERONC)MadridSpain
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4
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Santana-Hernández S, Suarez-Olmos J, Servitja S, Berenguer-Molins P, Costa-Garcia M, Comerma L, Rea A, Perera-Bel J, Menendez S, Arpí O, Bermejo B, Martínez MT, Cejalvo JM, Comino-Méndez I, Pascual J, Alba E, López-Botet M, Rojo F, Rovira A, Albanell J, Muntasell A. NK cell-triggered CCL5/IFNγ-CXCL9/10 axis underlies the clinical efficacy of neoadjuvant anti-HER2 antibodies in breast cancer. J Exp Clin Cancer Res 2024; 43:10. [PMID: 38167224 PMCID: PMC10763072 DOI: 10.1186/s13046-023-02918-4] [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: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The variability in responses to neoadjuvant treatment with anti-HER2 antibodies prompts to personalized clinical management and the development of innovative treatment strategies. Tumor-infiltrating Natural Killer (TI-NK) cells can predict the efficacy of HER2-targeted antibodies independently from clinicopathological factors in primary HER2-positive breast cancer patients. Understanding the mechanism/s underlying this association would contribute to optimizing patient stratification and provide the rationale for combinatorial approaches with immunotherapy. METHODS We sought to uncover processes enriched in NK cell-infiltrated tumors as compared to NK cell-desert tumors by microarray analysis. Findings were validated in clinical trial-derived transcriptomic data. In vitro and in vivo preclinical models were used for mechanistic studies. Findings were analysed in clinical samples (tumor and serum) from breast cancer patients. RESULTS NK cell-infiltrated tumors were enriched in CCL5/IFNG-CXCL9/10 transcripts. In multivariate logistic regression analysis, IFNG levels underlie the association between TI-NK cells and pathological complete response to neoadjuvant treatment with trastuzumab. Mechanistically, the production of IFN-ɣ by CD16+ NK cells triggered the secretion of CXCL9/10 from cancer cells. This effect was associated to tumor growth control and the conversion of CD16 into CD16-CD103+ NK cells in humanized in vivo models. In human breast tumors, the CD16 and CD103 markers identified lineage-related NK cell subpopulations capable of producing CCL5 and IFN-ɣ, which correlated with tissue-resident CD8+ T cells. Finally, an early increase in serum CCL5/CXCL9 levels identified patients with NK cell-rich tumors showing good responses to anti-HER2 antibody-based neoadjuvant treatment. CONCLUSIONS This study identifies specialized NK cell subsets as the source of IFN-ɣ influencing the clinical efficacy of anti-HER2 antibodies. It also reveals the potential of serum CCL5/CXCL9 as biomarkers for identifying patients with NK cell-rich tumors and favorable responses to anti-HER2 antibody-based neoadjuvant treatment.
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Affiliation(s)
| | | | - Sonia Servitja
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Oncology Department, Hospital del Mar, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERonc), Madrid, Spain
| | | | | | - Laura Comerma
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERonc), Madrid, Spain
- Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Anna Rea
- University Pompeu Fabra, Barcelona, Spain
| | - Julia Perera-Bel
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Silvia Menendez
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Oriol Arpí
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Begoña Bermejo
- Centro de Investigación Biomédica en Red de Cáncer (CIBERonc), Madrid, Spain
- Department of Oncology, Hospital Clínico de Valencia, Valencia, Spain
| | | | | | - Iñaki Comino-Méndez
- Centro de Investigación Biomédica en Red de Cáncer (CIBERonc), Madrid, Spain
- Hospitales Universitarios Regional y Virgen de La Victoria, Málaga, Spain
- The Biomedical Research Institute of Málaga, Málaga, Spain
| | - Javier Pascual
- Centro de Investigación Biomédica en Red de Cáncer (CIBERonc), Madrid, Spain
- Hospitales Universitarios Regional y Virgen de La Victoria, Málaga, Spain
- The Biomedical Research Institute of Málaga, Málaga, Spain
| | - Emilio Alba
- Centro de Investigación Biomédica en Red de Cáncer (CIBERonc), Madrid, Spain
- Hospitales Universitarios Regional y Virgen de La Victoria, Málaga, Spain
- The Biomedical Research Institute of Málaga, Málaga, Spain
| | - Miguel López-Botet
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
| | - Federico Rojo
- Centro de Investigación Biomédica en Red de Cáncer (CIBERonc), Madrid, Spain
- Department of Pathology, IIS 'Fundación Jimenez Díaz University Hospital', Madrid, Spain
| | - Ana Rovira
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Oncology Department, Hospital del Mar, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERonc), Madrid, Spain
| | - Joan Albanell
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Oncology Department, Hospital del Mar, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERonc), Madrid, Spain
- University Pompeu Fabra, Barcelona, Spain
| | - Aura Muntasell
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERonc), Madrid, Spain.
- Universitat Autònoma de Barcelona, Hospital del Mar Research Institute (IMIM), Doctor Aiguader, 88, 08003, Barcelona, Spain.
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5
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Sanz-Álvarez M, Luque M, Morales-Gallego M, Cristóbal I, Ramírez-Merino N, Rangel Y, Izarzugaza Y, Eroles P, Albanell J, Madoz-Gúrpide J, Rojo F. Generation and Characterization of Trastuzumab/Pertuzumab-Resistant HER2-Positive Breast Cancer Cell Lines. Int J Mol Sci 2023; 25:207. [PMID: 38203378 PMCID: PMC10779249 DOI: 10.3390/ijms25010207] [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: 11/13/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
The combination of trastuzumab and pertuzumab as first-line therapy in patients with HER2-positive breast cancer has shown significant clinical benefits compared to trastuzumab alone. However, despite initial therapeutic success, most patients eventually progress, and tumors develop acquired resistance and invariably relapse. Therefore, there is an urgent need to improve our understanding of the mechanisms governing resistance in order to develop targeted therapeutic strategies with improved efficacy. We generated four novel HER2-positive cell lines via prolonged exposure to trastuzumab and pertuzumab and determined their resistance rates. Long-term resistance was confirmed by a significant increase in the colony-forming capacity of the derived cells. We authenticated the molecular identity of the new lines via both immunohistochemistry for the clinical phenotype and molecular profiling of point mutations. HER2 overexpression was confirmed in all resistant cell lines, and acquisition of resistance to trastuzumab and pertuzumab did not translate into differences in ER, PR, and HER2 receptor expression. In contrast, changes in the expression and activity of other HER family members, particularly HER4, were observed. In the same vein, analyses of the receptor and effector kinase status of different cellular pathways revealed that the MAPK pathway may be involved in the acquisition of resistance to trastuzumab and pertuzumab. Finally, proteomic analysis confirmed a significant change in the abundance patterns of more than 600 proteins with implications in key biological processes, such as ribosome formation, mitochondrial activity, and metabolism, which could be relevant mechanisms in the generation of resistance in HER2-positive breast cancer. We concluded that these resistant BCCLs may be a valuable tool to better understand the mechanisms of acquisition of resistance to trastuzumab and pertuzumab-based anti-HER2 therapy.
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Affiliation(s)
- Marta Sanz-Álvarez
- Department of Pathology, Fundación Jiménez Díaz University Hospital Health Research Institute (IIS—FJD, UAM)—CIBERONC, 28040 Madrid, Spain; (M.S.-Á.); (M.L.); (M.M.-G.)
| | - Melani Luque
- Department of Pathology, Fundación Jiménez Díaz University Hospital Health Research Institute (IIS—FJD, UAM)—CIBERONC, 28040 Madrid, Spain; (M.S.-Á.); (M.L.); (M.M.-G.)
| | - Miriam Morales-Gallego
- Department of Pathology, Fundación Jiménez Díaz University Hospital Health Research Institute (IIS—FJD, UAM)—CIBERONC, 28040 Madrid, Spain; (M.S.-Á.); (M.L.); (M.M.-G.)
| | - Ion Cristóbal
- Translational Oncology Division, OncoHealth Institute, Fundación Jiménez Díaz University Hospital Health Research Institute (IIS—FJD, UAM)—CIBERONC, 28040 Madrid, Spain;
| | | | - Yamileth Rangel
- Department of Pathology, Infanta Elena University Hospital, 28342 Madrid, Spain;
| | - Yann Izarzugaza
- Department of Medical Oncology, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain;
| | - Pilar Eroles
- Institute of Health Research INCLIVA—CIBERONC, 46010 Valencia, Spain;
- Department of Physiology, University of Valencia, 46010 Valencia, Spain
| | - Joan Albanell
- Cancer Research Program, IMIM (Hospital del Mar Research Institute), 08003 Barcelona, Spain;
- Department of Medical Oncology, Hospital del Mar—CIBERONC, 08003 Barcelona, Spain
- Department of Experimental and Health Sciences, Faculty of Medicine, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Juan Madoz-Gúrpide
- Department of Pathology, Fundación Jiménez Díaz University Hospital Health Research Institute (IIS—FJD, UAM)—CIBERONC, 28040 Madrid, Spain; (M.S.-Á.); (M.L.); (M.M.-G.)
| | - Federico Rojo
- Department of Pathology, Fundación Jiménez Díaz University Hospital Health Research Institute (IIS—FJD, UAM)—CIBERONC, 28040 Madrid, Spain; (M.S.-Á.); (M.L.); (M.M.-G.)
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6
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Tarantino P, Viale G, Press MF, Hu X, Penault-Llorca F, Bardia A, Batistatou A, Burstein HJ, Carey LA, Cortes J, Denkert C, Diéras V, Jacot W, Koutras AK, Lebeau A, Loibl S, Modi S, Mosele MF, Provenzano E, Pruneri G, Reis-Filho JS, Rojo F, Salgado R, Schmid P, Schnitt SJ, Tolaney SM, Trapani D, Vincent-Salomon A, Wolff AC, Pentheroudakis G, André F, Curigliano G. ESMO expert consensus statements (ECS) on the definition, diagnosis, and management of HER2-low breast cancer. Ann Oncol 2023; 34:645-659. [PMID: 37269905 DOI: 10.1016/j.annonc.2023.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [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: 02/05/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023] Open
Abstract
Human epidermal growth factor receptor 2 (HER2)-low breast cancer has recently emerged as a targetable subset of breast tumors, based on the evidence from clinical trials of novel anti-HER2 antibody-drug conjugates. This evolution has raised several biological and clinical questions, warranting the establishment of consensus to optimally treat patients with HER2-low breast tumors. Between 2022 and 2023, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process focused on HER2-low breast cancer. The consensus included a multidisciplinary panel of 32 leading experts in the management of breast cancer from nine different countries. The aim of the consensus was to develop statements on topics that are not covered in detail in the current ESMO Clinical Practice Guideline. The main topics identified for discussion were (i) biology of HER2-low breast cancer; (ii) pathologic diagnosis of HER2-low breast cancer; (iii) clinical management of HER2-low metastatic breast cancer; and (iv) clinical trial design for HER2-low breast cancer. The expert panel was divided into four working groups to address questions relating to one of the four topics outlined above. A review of the relevant scientific literature was conducted in advance. Consensus statements were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This article presents the developed statements, including findings from the expert panel discussions, expert opinion, and a summary of evidence supporting each statement.
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Affiliation(s)
- P Tarantino
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston, USA; Department of Oncology and Hemato-Oncology, University of Milan, Milan
| | - G Viale
- Department of Pathology and Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy
| | - M F Press
- Department of Pathology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
| | - X Hu
- Department of Medical Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - F Penault-Llorca
- Centre de Lutte Contre le Cancer Centre Jean PERRIN, Clermont-Ferrand, France
| | - A Bardia
- Harvard Medical School, Boston, USA; Department of Medical Oncology, Massachusetts General Hospital, Boston, USA
| | - A Batistatou
- Department of Pathology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - H J Burstein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston, USA
| | - L A Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - J Cortes
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quironsalud Group, Barcelona; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - C Denkert
- Philipps-University Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | - V Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes
| | - W Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier University, INSERM U1194, Montpellier, France
| | - A K Koutras
- Division of Oncology, Department of Medicine, University Hospital of Patras, Greece
| | - A Lebeau
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - S Loibl
- German Breast Group/GBG Forschungs GmbH, Neu-Isenburg; Goethe University Frankfurt, Frankfurt, Germany
| | - S Modi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M F Mosele
- Department of Medical Oncology, Institute Gustave Roussy, Villejuif, France
| | - E Provenzano
- Department of Histopathology, Cambridge University NHS Foundation Trust and NIH Cambridge Biomedical Research Centre, Cambridge, UK
| | - G Pruneri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan; Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - J S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - F Rojo
- Department of Pathology, IIS-Fundacion Jimenez Diaz University Hospital-CIBERONC, Madrid, Spain
| | - R Salgado
- Department of Pathology, ZAS, Antwerp, Belgium; Division of Research, Peter Mac Callum Cancer Centre, Melbourne, Australia
| | - P Schmid
- Barts Cancer Institute, Queen Mary University London, London, UK
| | - S J Schnitt
- Harvard Medical School, Boston, USA; Department of Pathology, Brigham and Women's Hospital and Breast Oncology Program, Dana-Farber Cancer Institute, Boston, USA
| | - S M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston, USA
| | - D Trapani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan; European Institute of Oncology, IRCCS, Milan, Italy
| | - A Vincent-Salomon
- Department of Pathology, Diagnostic and Theranostic Medicine Division, Institut Curie, PSL University, Paris, France
| | - A C Wolff
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA
| | | | - F André
- INSERM U981 - Molecular Predictors and New Targets in Oncology, PRISM Center for Precision Medicine, Gustave Roussy, Villejuif, France
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, Milan; European Institute of Oncology, IRCCS, Milan, Italy.
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7
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Robert ME, Rüschoff J, Jasani B, Graham RP, Badve SS, Rodriguez-Justo M, Kodach LL, Srivastava A, Wang HL, Tang LH, Troncone G, Rojo F, Van Treeck BJ, Pratt J, Shnitsar I, Kumar G, Karasarides M, Anders RA. Erratum to High Interobserver Variability Among Pathologists Using Combined Positive Score to Evaluate PD-L1 Expression in Gastric, Gastroesophageal Junction, and Esophageal Adenocarcinoma [Modern Pathology 36(5) (2023) 100154]. Mod Pathol 2023; 36:100238. [PMID: 37327723 DOI: 10.1016/j.modpat.2023.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Marie E Robert
- Yale University School of Medicine, New Haven, Connecticut.
| | | | | | | | - Sunil S Badve
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Hanlin L Wang
- University of California Los Angeles, Los Angeles, California
| | - Laura H Tang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Federico Rojo
- IIS-Fundacion Jimenez Diaz CIBERONC (Madrid), Madrid, Spain
| | | | | | | | | | | | - Robert A Anders
- Johns Hopkins University, Convergence Institute, Baltimore, Maryland; Bloomberg-Kimmel Institute for Cancer Immunotherapy, Baltimore, Maryland.
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Santos A, Cristóbal I, Caramés C, Luque M, Sanz-Álvarez M, Madoz-Gúrpide J, Rojo F, García-Foncillas J. Deregulation of the miR-19b/PPP2R5E Signaling Axis Shows High Functional Impact in Colorectal Cancer Cells. Int J Mol Sci 2023; 24:ijms24097779. [PMID: 37175484 PMCID: PMC10178228 DOI: 10.3390/ijms24097779] [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: 03/03/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
MicroRNA (miR)-19b is deregulated in colorectal cancer (CRC) and locally advanced rectal cancer (LARC), predicting worse outcome and disease progression in CRC patients, and acting as a promising prognostic marker of patient recurrence and pathological response to 5-fluorouracil (5-FU)-based neoadjuvant chemoradiotherapy in LARC. Moreover, there is a strong inverse correlation between miR-19b and PPP2R5E in LARC, and both predict the response to neoadjuvant therapy in LARC patients. However, the functional role of the miR-19b/PPP2R5E axis in CRC cells remains to be experimentally evaluated. Here, we confirm with luciferase assays that miR-19b is a direct negative regulator of PPP2R5E in CRC, which is concordant with the observed decreased PP2A activity levels after miR-19b overexpression. Furthermore, PPP2R5E downregulation plays a key role mediating miR-19b-induced oncogenic effects, increasing cell viability, colonosphere formation ability, and the migration of CRC cells. Lastly, we also confirm the role of miR-19b mediating 5-FU sensitivity of CRC cells through negative PPP2R5E regulation. Altogether, our findings demonstrate the functional relevance of the miR-19b/PPP2R5E signaling pathway in disease progression, and its potential therapeutic value determining the 5-FU response of CRC cells.
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Affiliation(s)
- Andrea Santos
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Ion Cristóbal
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Cristina Caramés
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
- Medical Oncology Department, University Hospital "Fundación Jiménez Díaz", UAM, 28040 Madrid, Spain
| | - Melani Luque
- Pathology Department, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Marta Sanz-Álvarez
- Pathology Department, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Juan Madoz-Gúrpide
- Pathology Department, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Federico Rojo
- Pathology Department, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Jesús García-Foncillas
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
- Medical Oncology Department, University Hospital "Fundación Jiménez Díaz", UAM, 28040 Madrid, Spain
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Cabello P, Torres-Ruiz S, Adam-Artigues A, Forés-Martos J, Martínez MT, Hernando C, Zazo S, Madoz-Gúrpide J, Rovira A, Burgués O, Rojo F, Albanell J, Lluch A, Bermejo B, Cejalvo JM, Eroles P. miR-146a-5p Promotes Angiogenesis and Confers Trastuzumab Resistance in HER2+ Breast Cancer. Cancers (Basel) 2023; 15:cancers15072138. [PMID: 37046799 PMCID: PMC10093389 DOI: 10.3390/cancers15072138] [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] [Received: 12/26/2022] [Revised: 03/17/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Trastuzumab treatment has significantly improved the prognosis of HER2-positive breast cancer patients. Despite this, resistance to therapy still remains the main clinical challenge. In order to evaluate the implication of microRNAs in the trastuzumab response, we performed a microRNA array in parental and acquired trastuzumab-resistant HER2-positive breast cancer cell lines. Our results identified miR-146a-5p as the main dysregulated microRNA. Interestingly, high miR-146a-5p expression in primary tumor tissue significantly correlated with shorter disease-free survival in HER2-positive breast cancer patients. The gain- and loss-of-function of miR-146a-5p modulated the response to trastuzumab. Furthermore, the overexpression of miR-146a-5p increased migration and angiogenesis, and promoted cell cycle progression by reducing CDKN1A expression. Exosomes from trastuzumab-resistant cells showed a high level of miR-146a-5p expression compared with the parental cells. In addition, the co-culture with resistant cells’ exosomes was able to decrease in sensitivity and increase the migration capacities in trastuzumab-sensitive cells, as well as angiogenesis in HUVEC-2 cells. Collectively, these data support the role of miR-146a-5p in resistance to trastuzumab, and demonstrate that it can be transferred by exosomes conferring resistance properties to other cells.
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Affiliation(s)
- Paula Cabello
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- International University of Valencia—VIU, 46002 Valencia, Spain
| | | | | | | | - María Teresa Martínez
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Department of Medical Oncology, University Clinical Hospital of Valencia, 46010 Valencia, Spain
| | - Cristina Hernando
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Department of Medical Oncology, University Clinical Hospital of Valencia, 46010 Valencia, Spain
| | - Sandra Zazo
- Department of Pathology, Jiménez Díaz Foundation, 28040 Madrid, Spain
| | | | - Ana Rovira
- Center for Biomedical Network Research on Cancer (CIBERONC), 28040 Madrid, Spain
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Octavio Burgués
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28040 Madrid, Spain
- Department of Pathology, University Clinical Hospital of Valencia, 46010 Valencia, Spain
| | - Federico Rojo
- Department of Pathology, Jiménez Díaz Foundation, 28040 Madrid, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28040 Madrid, Spain
| | - Joan Albanell
- Center for Biomedical Network Research on Cancer (CIBERONC), 28040 Madrid, Spain
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Ana Lluch
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Department of Medical Oncology, University Clinical Hospital of Valencia, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28040 Madrid, Spain
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Begoña Bermejo
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Department of Medical Oncology, University Clinical Hospital of Valencia, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28040 Madrid, Spain
| | - Juan Miguel Cejalvo
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Department of Medical Oncology, University Clinical Hospital of Valencia, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28040 Madrid, Spain
| | - Pilar Eroles
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28040 Madrid, Spain
- Department of Physiology, University of Valencia, 46010 Valencia, Spain
- Department of Biotechnology, Polytechnic University of Valencia, 46022 Valencia, Spain
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10
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González-Santiago S, Gil-Gil M, Carrasco E, Martínez-Jáñez N, Adamo B, Antolín S, Alonso J, Vethencourt A, Martínez-Vila C, Galve E, Rojo F, Caballero R, Casas M, Cortazar E, McCulloch L, Vedovato JC, Martín M. P006 Randomized Phase II trial evaluating three anti-diarrhoeal prophylaxis strategies in patients with HER2+/HR+ early breast cancer treated with extended adjuvant neratinib (DIANER GEICAM/2018-06). Breast 2023. [DOI: 10.1016/s0960-9776(23)00125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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11
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Rocha P, Sanchez I, Pinto LM, Giner M, Gorro NN, Hoyo AR, Garcia AT, Pérez-Buira S, Torres-Fernandez É, Clave S, Paricio BB, Rojo F, Paz-Ares L, Cubells CM, de la Rosa CA, Casado MI, Garcia-Campelo R, Baez L, Mellén ÁC, Arriola E. 165P SCLC subtypes are associated with distinct dinicopathological features and outcomes: A biomarker analysis from the CANTABRICO study. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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12
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Cristóbal I, Santos A, Rojo F, García-Foncillas J. A complex microRNA regulatory network may control the HCP5/UTP3/c-Myc/VAMP3 signaling axis. Mol Ther 2023; 31:922-923. [PMID: 36933561 PMCID: PMC10124069 DOI: 10.1016/j.ymthe.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/19/2023] Open
Affiliation(s)
- Ion Cristóbal
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain; Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain.
| | - Andrea Santos
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain; Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Federico Rojo
- Pathology Department, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Jesús García-Foncillas
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain; Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain.
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13
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Robert ME, Rüschoff J, Jasani B, Graham RP, Badve SS, Rodriguez-Justo M, Kodach LL, Srivastava A, Wang HL, Tang LH, Troncone G, Rojo F, Van Treeck BJ, Pratt J, Shnitsar I, Kumar G, Karasarides M, Anders RA. High Interobserver Variability among Pathologists Using Combined Positive Score to Evaluate PD-L1 Expression in Gastric, Gastroesophageal Junction and Esophageal Adenocarcinoma. Mod Pathol 2023; 36:100154. [PMID: 36925069 DOI: 10.1016/j.modpat.2023.100154] [Citation(s) in RCA: 6] [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: 10/28/2022] [Revised: 02/17/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Abstract
Reliable, reproducible methods to interpret programmed death ligand-1 (PD-L1) expression on tumor cells (TC) and immune cells (IC) are needed for pathologists to inform decisions associated with checkpoint inhibitor therapies. Our international study compared interpathologist agreement of PD-L1 expression using combined positive score (CPS) under standardized conditions on samples from patients with gastric/gastroesophageal junction/esophageal adenocarcinoma. Tissue sections from 100 adenocarcinoma pre-treatment biopsies were stained in a single laboratory using the PD-L1 IHC 28-8 and 22C3(Agilent) pharmDx immunohistochemical assays. PD-L1 CPS was evaluated by 12 pathologists on scanned whole slide images of these biopsies before and after a 2-hour CPS training session by Agilent. Additionally, pathologists determined PD-L1 positive TC, IC, and total viable TC on a single tissue fragment from 35 of 100 biopsy samples. Scoring agreement among pathologists was assessed using the intraclass correlation coefficient (ICC). Interobserver variability for CPS for 100 biopsies was high with only fair agreement among pathologists both pre- (range 0.45 to 0.55) and post-training (range 0.56 to 0.57) for both assays. For the 35 single biopsy samples, poor/fair agreement was also observed for the total number viable TC (ICC 0.09), number of PD-L1 positive IC (ICC 0.19), number of PD-L1 positive TC (ICC 0.54), and calculated CPS (ICC 0.14), while calculated TC score (positive TC/Total TC) showed excellent agreement (ICC 0.82). Retrospective histologic review of samples with the poorest interpathologist agreement revealed (1) ambiguous identification of positively staining stromal cells, (2) faint or variable intensity of staining, (3) difficulty in distinguishing membranous from cytoplasmic tumor staining, and (4) cautery and crush artifact, as possible confounding factors. These results emphasize the need for objective techniques to standardize the interpretation of PD-L1 expression when using the CPS methodology on gastric/gastroesophageal junction cancer biopsies to accurately identify patients most likely to benefit from immune checkpoint inhibitor therapy.
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Affiliation(s)
| | | | | | | | - Sunil S Badve
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Hanlin L Wang
- University of California Los Angeles, Los Angeles, CA, USA
| | - Laura H Tang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Federico Rojo
- IIS-Fundacion Jimenez Diaz CIBERONC (Madrid), Madrid, Spain
| | | | | | | | | | | | - Robert A Anders
- John Hopkins University,; Convergence Institute,; Bloomberg∼Kimmel Intitute for Cancer Immunotherapy Baltimore, MD, USA.
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Loibl S, Denkert C, Liu Y, Knudsen ES, DeMichele A, Zhang Z, Teply-Szymanski J, Filipits M, Fasching PA, Gnant M, Deng S, Balic M, Rojo F, Watson M, Deshpande C, Turner N, Metzger O, Theall KP, Witkiewicz A, Valota O, Symmans WF, Mayer EL. Abstract PD17-05: Development and Validation of a Composite Biomarker Predictive of Palbociclib + Endocrine Treatment Benefit in Early Breast Cancer: PENELOPE-B and PALLAS Trials. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd17-05] [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: 03/06/2023]
Abstract
Abstract
Background: The PENELOPE-B (NCT01864746) and PALLAS (NCT02513394) trials are large prospective, randomized, phase III trials that evaluated adjuvant palbociclib (PAL) + endocrine treatment (ET) vs ET in patients with hormone receptor–positive/human epidermal growth factor receptor 2–negative (HER2–) early breast cancer (EBC). Both studies did not meet the primary endpoint of improving invasive disease-free survival (iDFS). We conducted biomarker analyses to identify patients who might benefit from PAL + ET in EBC. Methods: Resected tumor tissue was collected from consenting patients. Gene expression analyses were conducted using the HTG EdgeSeq Oncology Biomarker Panel including 2549 genes. Based on 91 genes from the HTG panel, the intrinsic molecular subtypes were calculated using Absolute Intrinsic Molecular Subtyping (AIMS). Potential predictive treatment biomarkers were established in PENELOPE-B (n=906 with resected tissue) as the development set using an outcome-oriented approach based on iDFS with a selection procedure that maximized the log-rank statistic to estimate a standard Z score–based optimal cutoff. Independent validation was conducted on PALLAS (n=2085; PENELOPE-B-like with resected tissue and HTG data). Hazard ratios and corresponding 95% CIs were calculated using the Cox proportional hazards model, and iDFS distributions between treatment arms were compared using the log-rank test. Interaction between treatment and biomarker status was assessed. Results: Patient baseline characteristics were well balanced, with no differences in iDFS between the intent-to-treat set and the biomarker set for both trials. Approximately 73% of patients (PENELOPE-B [n=663] and PALLAS [n=1516]) had luminal A subtypes whereas only 7.1 % (PENELOPE-B [n=64]) and 8.3 % (PALLAS [n=172]) had a luminal B subtype. AIMS subtypes showed overall similar prognostic patterns for iDFS between PENELOPE-B and PALLAS. The biomarker-defined subgroup found in PENELOPE-B with optimal cutoff demonstrated a preferential benefit from PAL + ET (n=364 [96 events]; hazard ratio [95% CI], 0.63 [0.42, 0.95]; P=0.025). Independent validation of the PALLAS subgroup using the pre-defined optimal cutoff confirmed a significant benefit from PAL + ET (n=916 [70 events]; 0.55 [0.34–0.90]; P=0.015) while not in the rest of the patients (interaction p=0.0025). Significant treatment effects remained (0.55 [0.34–0.89]; P=0.015) after adjusting for the randomization stratification factors of PALLAS. Conclusions: The composite predictive biomarker defined from PENELOPE-B was independently validated in a prospectively defined retrospective analysis of a subset of patients selected from PALLAS. The composite biomarker identified a subset of EBC patients deriving benefit from the addition of PAL to ET. This patient stratification approach can potentially be applied to future adjuvant clinical trials for treatment of hormone receptor–positive/HER2– EBC.
Citation Format: Sibylle Loibl, Carsten Denkert, Yuan Liu, Erik S. Knudsen, Angela DeMichele, Zhe Zhang, Julia Teply-Szymanski, Martin Filipits, Peter A. Fasching, Michael Gnant, Shibing Deng, Marija Balic, Federico Rojo, Mark Watson, Chetan Deshpande, Nicholas Turner, Otto Metzger, Kathy Puyana Theall, Agnieszka Witkiewicz, Olga Valota, W. Fraser Symmans, Erica L. Mayer. Development and Validation of a Composite Biomarker Predictive of Palbociclib + Endocrine Treatment Benefit in Early Breast Cancer: PENELOPE-B and PALLAS Trials [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD17-05.
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Affiliation(s)
| | - Carsten Denkert
- 2Institut für Pathologie, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Germany
| | - Yuan Liu
- 3Pfizer Inc, San Diego, California
| | - Erik S. Knudsen
- 4Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | | | | | - Martin Filipits
- 8Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Peter A. Fasching
- 9Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | | | | | - Marija Balic
- 12Divison of Oncology, Department of Internal Medicine, Medical University Graz, Austria
| | | | | | | | | | - Otto Metzger
- 17Dana-Farber Cancer Institute, Boston, Massachusetts
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Novoa SA, Rodríguez CA, Cruz J, López-Tarruella S, Tibau A, Adrover E, Miguel A, Margelí M, Martínez P, Hernández M, Antón A, Rodríguez-Lescure Á, Falo C, Álvarez I, Malón D, Andrés R, Alonso-Romero JL, Gómez C, Illaramendi JJ, Campo R, Miralles JJ, Bezares S, Rojo F, Guerrero-Zotano A. Abstract P4-07-45: Treatment strategies for advanced triple negative breast cancer patients as per routine clinical practice: analysis from the observational study GEICAM/2014-03 (RegistEM). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-07-45] [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: 03/06/2023]
Abstract
Abstract
Background: Triple negative breast cancer (TNBC) is well known for its more aggressive course and poorer prognosis compared to other BC subtypes. RegistEM study provides real world data to understand the distribution of BC subtypes in the advanced setting, being its primary objective. Biological samples collection is part of its procedures. This is a non-interventional cohort study and 1,907 patients (pts) have been enrolled up to now (females and males) with advanced BC (ABC), diagnosed from Jan-2016 to Dec-2019, either after recurrence or as first BC diagnosis, in 38 Spanish sites. These pts will be followed for at least 5 years.
Methods: In the current analysis (cut-off date 08/April/2022, database ongoing), we describe characteristics, treatment patterns and outcomes, including comparison between recurrent and de novo disease, of 157 pts with advanced TNBC included in the RegistEM study. Those pts represent the 10% of pts available in the database at the cut-off date and with ABC diagnosis up to December 2018 (n=1559). The BC clinical subtypes were histologically confirmed on the most recent tumor lesion (metastatic [M] or primary BC) before starting with the 1st-line therapy.
Results: At first ABC diagnosis, 73% pts had recurrent early BC (EBC), 26% de novo MBC and 1% unresectable locally ABC (ULABC). Median age was 57 years (range 30-88), all pts were women, 98% Caucasian and 65% postmenopausal. Family history of BC and/or ovarian cancer was reported in 37% pts, and a hereditary-risk genetic test was performed in 59 of 147 pts. Germline BRCA1/2 and TP53 were the most frequently mutated genes, 21% (6/28) and 47% (8/17) pts, respectively. Visceral involvement was present in 69% pts (similar between recurrent EBC and de novo ABC, although brain metastases were only present in the recurrent EBC group), and ≤ 2 metastatic locations in 59%. In 61% (70/115) pts with recurrent EBC, the subtype was assessed in metastatic lesions, and 39 pts of them also had TN subtype in primary BC. In terms of the most frequent therapies by line: 1) 1st-line: chemotherapy (CT) (60%) and CT/biological therapy (BT) (39%). Of the 87 pts with CT alone, monotherapy was the preferred option in 57% pts (capecitabine 25%, taxanes 16%, and eribulin or vinorelbine, 5% each). Bevacizumab was the most frequent BT (79%) combined with CT (single agent in 56% pts, mostly taxanes and capecitabine). Progressive disease (PD) was reported in 85% pts (similar in pts with both recurrent and de novo MBC or ULABC); 2) 2nd-line: CT (79%) (monotherapy capecitabine, eribulin, taxanes) and CT/BT (17%) (CT-containing bevacizumab 82%). Progression was reported in 92% pts; 3) 3rd-line: CT (90%) (eribulin 33%, platinum-based 25%) and CT/BT (9%) (CT-containing bevacizumab 67%). Progression was reported in 88% pts. At database cut-off date, death was reported in 133 (85%) pts, mainly because of PD. Overall survival (OS) was similar between both groups, recurrent and de novo MBC.
Conclusion: In this population of Spanish TNBC pts with ABC, three quarters had recurrent disease. De novo ABC pts had a higher proportion of non-visceral metastases, with absence of brain involvement at the first diagnosis. Single-agent CT and CT plus bevacizumab were the most frequent therapies, and OS was similar between recurrent and de novo MBC pts, although numerically higher in the later group.
Citation Format: Silvia Antolin Novoa, César A Rodríguez, Josefina Cruz, Sara López-Tarruella, Ariadna Tibau, Encarna Adrover, Ana Miguel, Mireia Margelí, Purificación Martínez, María Hernández, Antonio Antón, Álvaro Rodríguez-Lescure, Catalina Falo, Isabel Álvarez, Diego Malón, Raquel Andrés, José L Alonso-Romero, César Gómez, J. José Illaramendi, Ruth Campo, Juan José Miralles, Susana Bezares, Federico Rojo, Angel Guerrero-Zotano. Treatment strategies for advanced triple negative breast cancer patients as per routine clinical practice: analysis from the observational study GEICAM/2014-03 (RegistEM) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-45.
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Affiliation(s)
- Silvia Antolin Novoa
- 1Complejo Hospitalario Universitario A Coruña (CHUAC). GEICAM Spanish Breast Cancer Group., Spain
| | - César A Rodríguez
- 2Hospital Universitario de Salamanca-IBSAL. GEICAM Spanish Breast Cancer Group., Spain
| | - Josefina Cruz
- 3Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Sara López-Tarruella
- 4Hospital Universitario Gregorio Marañón. CIBERONC-ISCIII. GEICAM Spanish Breast Cancer Group., Spain
| | - Ariadna Tibau
- 5Hospital de la Santa Creu i Sant Pau. GEICAM Spanish Breast Cancer Group, Spain
| | - Encarna Adrover
- 6Complejo Hospitalario Universitario de Albacete. GEICAM Spanish Breast Cancer Group., Spain
| | - Ana Miguel
- 7ALTHAIA Xarxa asistencial de Manresa. GEICAM Spanish Breast Cancer Group., Spain
| | - Mireia Margelí
- 8SOLTI Cancer Research Group. Medical Oncology Department, ICO Badalona, B-ARGO Group. GEICAM Spasnish Breast Cancer Group., Catalonia, Spain
| | | | - María Hernández
- 10Complejo Hospitalario Universitario de Gran Canaria Dr. Negrín. GEICAM Spanish Breast Cancer Group., Spain
| | - Antonio Antón
- 11Hospital Universitario Miguel Servet. GEICAM Spanish Breast Cancer Group., Spain
| | | | - Catalina Falo
- 13ICO Hospitalet. GEICAM Spanish Breast Cancer Group., Spain
| | - Isabel Álvarez
- 14Hospital Universitario Donostia-BioDonostia. GEICAM Spanish Breast Cancer Group., Spain
| | - Diego Malón
- 15Hospital Universitario Fuenlabrada. GEICAM Spanish Breast Cancer Group
| | - Raquel Andrés
- 16Hospital Clínico Universitario Lozano Blesa. GEICAM Spanish Breast Cancer Group., Spain
| | - José L Alonso-Romero
- 17Hospital Clínico Universitario Virgen de la Arrixaca. GEICAM Spanish Breast Cancer Group
| | - César Gómez
- 18Hospital Universitario Infanta Sofía. GEICAM Spanish Breast Cancer Group
| | - J. José Illaramendi
- 19Hospital Universitario de Navarra-Nafarroako Unibertsitate Ospitalea. GEICAM Spanish Breast Cancer Group
| | - Ruth Campo
- 20GEICAM Spanish Breast Cancer Group., Spain
| | | | | | | | - Angel Guerrero-Zotano
- 24Fundación Instituto Valenciano de Oncología (FIVO). GEICAM Spanish Breast Cancer Group., Spain
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Rüschoff J, Penner A, Ellis IO, Hammond MEH, Lebeau A, Osamura RY, Penault-Llorca F, Rojo F, Atkey N, Scheel AH, D´Arrigo C, Schildhaus HU, Moh A, Desai C, Viale G. Abstract HER2-13: HER2-13 Proficiency assessment of HER2-low breast cancer scoring with the Ventana PATHWAY 4B5 and Dako HercepTest HER2 assays and the impact of pathologist training. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-her2-13] [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: 03/06/2023]
Abstract
Abstract
Background: Based on the results of the DESTINY-Breast04 study, the HER2-targeted antibody-drug conjugate trastuzumab deruxtecan (T-DXd) and the Ventana PATHWAY 4B5 companion diagnostic were recently approved by the US Food and Drug Administrated for the treatment and identification of patients with HER2-low (IHC2+/ISH- or IHC1+) (Modi et al. N Engl J Med 2022). The efficacy of T-DXd in HER2-low mBC highlights the need to distinguish lower ranges of HER2 IHC expression, which has been reported to be more challenging than scoring high HER2 expression (Fernandez et al. JAMA Oncol 2022). Here we report on current real-world HER2-low interpretation proficiency and the impact of training for participating pathologists in HER2-low scoring.
Methods: Pathologists from laboratories across the US, EU, Japan, Australia, and Brazil were invited to use a digital pathology platform (Pathotrainer) to interpret HER2 digital images using ASCO/CAP 2018 scoring criteria. Two whole-slide imaging sample sets of representative study cases were compiled for Ventana PATHWAY 4B5 or Dako HercepTest (HcT) stained tumors. Another sample set (n = 25) was developed for a 4 hour virtual training session based on the ASCO/CAP 2018 guideline with some practical considerations. A steering committee (SC) of 8 pathology experts was formed to guide the study. Pathologists’ score was compared with a reference score as determined by independent review of 3 experts in HER2 pathology. Paired study cases (n = 14) considered challenging due to difficult-to-interpret staining patterns were reevaluated by the SC members. Concordance and efficacy of training were measured by Cohen’s weighted kappa (κ) coefficient, overall rater agreement (ORA), and receiver operating characteristic curve statistics. The primary endpoint was real-world concordance and ORA. The secondary endpoints were post-training concordance and ORA and correct identification of HER2 IHC 0 and HER2-low.
Results: Pre-training baseline or real-world scores were taken by 77 pathologists in 14 countries (n = 49 for 4B5, n = 28 for HcT) and 74 pathologists completed post-training scores (n = 48 for 4B5, n = 26 for HcT). HER2 scoring proficiency of pathologists was high for both assays when assessed on ASCO/CAP binary HER2-negative and -positive status, irrespective of training (4B5: κ = 0.96, ORA =98.9.%; HcT: κ = 0.84, ORA = 94.3%) Concordance per ORA for the new 3-tier classification (HER2 IHC 0 vs HER2-low [IHC 2+/ISH- or IHC 1+] vs HER2-positive [IHC 3+ or IHC 2+/ISH+]) was greater than 80% for both assays at baseline and after training (see Table). In a subgroup analysis assessing training effect for 4B5 assay, concordance rates for HER2 IHC 0 were 74.6% at baseline and 89.2% after training (P < 0.001), and for HER2-low, NPA was 80.6% before and 91.1% after training (P < 0.001); there were no statistically significant changes after training for HcT (data not shown).
Conclusions: Results from this real-world global study demonstrate that overall score concordance with a new category of HER2-low was above the 80% ORA benchmark for both 4B5 and HcT and is higher than previously reported (Fernandez et al. JAMA Oncol 2022). These data demonstrate pathologists’ ability to achieve an acceptable level of accuracy for identifying HER2 IHC 0 and HER2-low patients even after short-term training; however, additional training techniques and experience are needed to further improve accuracy.
Acknowledgment
Judy Yu, a former AstraZeneca employee, provided expertise and technical insights to support the study.
Editorial Acknowledgment
Under guidance of the authors, assistance in medical writing and editorial support was provided by Toinette Labuschagné, MSc, of ApotheCom, and was funded by Daiichi Sankyo.
Funding
This study was funded by Daiichi Sankyo and AstraZeneca.
Table. Summary of Pathologist Concordance and Interobserver Variability
Citation Format: Josef Rüschoff, Alexander Penner, Ian O. Ellis, M. Elizabeth H. Hammond, Annette Lebeau, Robert Y. Osamura, Frédérique Penault-Llorca, Federico Rojo, Neil Atkey, Andreas H. Scheel, Corrado D´Arrigo, Hans-Ulrich Schildhaus, Akira Moh, Chirag Desai, Giuseppe Viale. HER2-13 Proficiency assessment of HER2-low breast cancer scoring with the Ventana PATHWAY 4B5 and Dako HercepTest HER2 assays and the impact of pathologist training [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr HER2-13.
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Affiliation(s)
- Josef Rüschoff
- 1Discovery Life Sciences Biomarker Services, Kassel, Germany
| | | | | | - M. Elizabeth H. Hammond
- 4Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Annette Lebeau
- 5University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Y. Osamura
- 6Diagnostic Pathology, Nippon Koukan Hospital, Kawasaki and Keio University School of Medicine, Tokyo, Japan
| | | | | | | | | | - Corrado D´Arrigo
- 11Poundbury Cancer Institute for Personalised Medicine, Dorchester, UK
| | | | - Akira Moh
- 13Daiichi Sankyo, Inc., Basking Ridge, NJ, USA
| | | | - Giuseppe Viale
- 15European Institute of Oncology IRCCS, and University of Milan, Milan, Italy
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López-Tarruella S, Guerrero-Zotano A, Cruz J, Novoa SA, Martínez P, Hernández M, Rodríguez CA, Chacón JI, Tibau A, Falo C, Rodríguez-Lescure Á, Margelí M, Servitja S, Andrés R, Galán-Gramaje M, Adrover E, Miguel A, Villanueva R, Varela S, Campo R, Escudero MJ, Bezares S, Rojo F, Álvarez I. Abstract P4-07-38: Real-world data of Advanced Breast Cancer (ABC) patients with HER2-positivity before the second-line therapy: data from the observational study GEICAM/2014-03 (RegistEM). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-07-38] [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: 03/06/2023]
Abstract
Abstract
Background: Over the last years, the treatment of HER2-positive (HER2+) breast cancer (BC) patients (pts) has been changing because of the development of new anti-HER2 agents. In the current analysis, we describe the features, treatment patterns, progression-free survivall (PFS) and overall survival (OS) outcomes of BC pts with HER2 + (immunohistochemistry [IHC] 3+ or IHC 2+ and in situ hybridization [ISH]+), following ASCO/CAP 2018 guidelines in the most recent tumor lesion before the 2nd-line.
Methods: The RegistEM study is an ongoing BC registry study that is providing prospective data from around 1900 pts diagnosed with advanced BC (ABC) between 01/Jan/2016 and 31/Dec/2019, in 38 Spanish institutions from GEICAM network. In this analysis, 296 HER2+ BC pts have been included, representing the 18% of pts available in the database at the cut-off date (08/Apr/2022), with ABC diagnosis before 2019 (n=1559).
Results: At first ABC diagnosis, 58% (n=173) pts had recurrent disease (>36 months [mo] from initial BC diagnosis in 62%), 41% (n=120) de novo metastatic BC and 1% (n=3) unresectable locally ABC (ULABC); the median age was 58 years, 68% were postmenopausal and there was only 1 male pt. From total 296 pts, 66% had hormone receptor expression [HR+]; the BC subtype was assessed in tumor tissue from the breast (58%) or a metastatic lesion (34%), and in 8% pts, HER2 positivity was observed after the 1st-line. Family history of BC and/or ovarian cancer was reported in 28% pts, and a hereditary-risk genetic test was performed in 26% pts (n=74/282). Germline BRCA1/2 and TP53 genetic testing were reported in 14 and 26 pts respectively, being mutated in 3/14 (21%) and 5/26 (19%) pts. Bone (50%), lymph nodes (49%), liver (35%), lung (31%), soft tissue (8%) and central nervous system (CNS), mostly in brain (8%), were the main metastatic sites. One hundred pts were diagnosed with CNS metastases: 24 at baseline, 48 during the 1st-line and 28 in subsequent lines. Additional data according to HR status and type of ABC are detailed in the table below, showing a worse prognosis in absence of HR expression. In HR- pts, bone metastases were less frequent and lymph nodes metastases more frequent compared to HR+ pts. Visceral disease was present in 69% (66% in HR+ and 74% in HR-; non-statistically significant) pts and ≈80% had ≤3 (54%, ≤2) locations involved. The most common therapies by line were: 1) 1st-line: Chemotherapy (CT) + biological therapy (BT) (38%), CT + BT+ endocrine therapy (ET) (35%), and ET + BT [11%]; 2) 2nd-line: BT (55%), CT + BT (20%) and ET + BT (15%); 3) 3rd-line: CT + BT (49%) and BT (31%). The median (95% confidence interval [CI]) progression-free survival (PFS) on 1st, 2nd and 3rd line was 18 (15-22), 8 (7-9) and 6 (5-8) mo, respectively. The median (95% CI) overall survival (OS) from ABC diagnosis was 43 (40-49) mo. These survival outcomes were higher in HR+ pts, however, the differences were only statistically significant in OS (p=0.006; log-rank). At database cut-off date, death was reported in 47% pts.
Conclusions: In spite of the anti-HER2 therapies administered in the advanced setting, the HR expression is a relevant prognostic factor, with a clinically and statistically significant impact in OS, improving the outcomes of HR+ pts.
Citation Format: Sara López-Tarruella, Angel Guerrero-Zotano, Josefina Cruz, Silvia Antolin Novoa, Purificación Martínez, María Hernández, César A Rodríguez, J. Ignacio Chacón, Ariadna Tibau, Catalina Falo, Álvaro Rodríguez-Lescure, Mireia Margelí, Sonia Servitja, Raquel Andrés, María Galán-Gramaje, Encarna Adrover, Ana Miguel, Rafael Villanueva, Silvia Varela, Ruth Campo, Mª José Escudero, Susana Bezares, Federico Rojo, Isabel Álvarez. Real-world data of Advanced Breast Cancer (ABC) patients with HER2-positivity before the second-line therapy: data from the observational study GEICAM/2014-03 (RegistEM) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-38.
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Affiliation(s)
- Sara López-Tarruella
- 1Hospital Universitario Gregorio Marañón. CIBERONC-ISCIII. GEICAM Spanish Breast Cancer Group., Spain
| | - Angel Guerrero-Zotano
- 2Fundación Instituto Valenciano de Oncología (FIVO). GEICAM Spanish Breast Cancer Group., Spain
| | - Josefina Cruz
- 3Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Silvia Antolin Novoa
- 4Complejo Hospitalario Universitario A Coruña (CHUAC). GEICAM Spanish Breast Cancer Group., Spain
| | | | - María Hernández
- 6Complejo Hospitalario Universitario de Gran Canaria Dr. Negrín. GEICAM Spanish Breast Cancer Group., Spain
| | - César A Rodríguez
- 7Hospital Universitario de Salamanca-IBSAL. GEICAM Spanish Breast Cancer Group., Spain
| | - J. Ignacio Chacón
- 8Hospital Universitario de Toledo. GEICAM Spanish Breast Cancer Group., Spain
| | - Ariadna Tibau
- 9Hospital de la Santa Creu i Sant Pau. GEICAM Spanish Breast Cancer Group, Spain
| | - Catalina Falo
- 10ICO Hospitalet. GEICAM Spanish Breast Cancer Group., Spain
| | | | - Mireia Margelí
- 12SOLTI Cancer Research Group. Medical Oncology Department, ICO Badalona, B-ARGO Group. GEICAM Spasnish Breast Cancer Group., Catalonia, Spain
| | | | - Raquel Andrés
- 14Hospital Clínico Universitario Lozano Blesa. GEICAM Spanish Breast Cancer Group., Spain
| | | | - Encarna Adrover
- 16Complejo Hospitalario Universitario de Albacete. GEICAM Spanish Breast Cancer Group., Spain
| | - Ana Miguel
- 17ALTHAIA Xarxa asistencial de Manresa. GEICAM Spanish Breast Cancer Group., Spain
| | - Rafael Villanueva
- 18Institut Català d’Oncologia. GEICAM Spanish Breast Cancer Group., Spain
| | - Silvia Varela
- 19Hospital Universitario Lucus Augusti. GEICAM Spanish Breast Cancer Group., Spain
| | - Ruth Campo
- 20GEICAM Spanish Breast Cancer Group., Spain
| | | | | | | | - Isabel Álvarez
- 24Hospital Universitario Donostia-BioDonostia. GEICAM Spanish Breast Cancer Group., Spain
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Denkert C, Martín M, Untch M, Bonnefoi HR, Knudsen ES, Im SA, DeMichele A, Witkiewicz A, Van ’t Veer L, Kim SB, Bear HD, McCarthy N, Gelmon K, Marmé F, García-Sáenz JÁ, Turner N, Rojo F, Filipits M, Martin LA, Fasching PA, Schem C, Kelly CM, Reimer T, Toi M, Rugo H, Gnant M, Makris A, Liu Y, Weber K, Rachakonda S, Loibl S. Abstract HER2-06: HER2-06 Outcome analysis of HER2-zero or HER2-low hormone receptor-positive (HR+) breast cancer patients - characterization of the molecular phenotype in combination with molecular subtyping. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-her2-06] [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: 03/06/2023]
Abstract
Abstract
Background: Breast cancer with low HER2 expression (HER2-low) is of high clinical relevance because of new therapeutic options with antibody-drug conjugates. We have recently shown in a large cohort from neoadjuvant clinical trials that HER2-low breast cancer has different molecular characteristics as well as different clinical outcomes compared to HER2-zero. Considering the positive correlation between HER2-low expression and hormone receptor positivity observed consistently in many investigations, we have extended our analysis to HR+ tumors from the post-neoadjuvant PenelopeB trial. In PenelopeB, patients with HR+ breast cancer and residual disease after neoadjuvant chemotherapy (NACT) were randomized to post-neoadjuvant palbociclib versus placebo in addition to endocrine therapy. We evaluated the molecular phenotype and clinical outcomes of HER2-low compared to HER2-zero patients. Methods: A total of 1250 patients were randomized, HER2 status was available for 1151 tumors from pretherapeutic core biopsy, determined mainly by local pathology, and from 1213 tumors from the post-NACT sample, determined as part of central pathology. For 1119 patients a paired HER2-status was both available. HER2-zero was defined as IHC0 and HER2-low-positive was defined as IHC1+ or IHC2+/ISH-. Gene expression analysis of 2549 genes using the HTG oncology biomarker panel was performed in 620 pretherapeutic biopsies and 780 post-NACT residual tumor samples, with 539 paired gene expression samples. Breast cancer subtypes were determined using the AIMS approach. Results: In pretherapeutic biopsies, 695 tumors (60%) were HER2-low and 457 (40%) were HER2-zero. A HER2-low status in the biopsy was significantly linked to improved iDFS (HR 0.76 (0.60-0.96; p=0.02). In residual tumors, 632 tumors (60%) were HER2-low and 581 (40%) were HER2-zero, without any prognostic impact of HER2 low status. In addition, a shift of HER2-low-status comparing core biopsy and residual tumor was observed in 415 (37%) of 1119 tumors. 161 (14%) had a shift from HER2-zero to HER2-low and 254 (23%) shifted from HER2-low to HER2-zero. A shift from HER2-zero to HER2-low in the post-NACT samples was significantly linked to reduced iDFS (HR 1.43 [95%CI 1.01-2.01]), p=0.04), compared to HER2-low group, while a shift from HER2-low to HER2-zero was associated with better iDFS compared to HER2-zero group, although not statistically significant (p=0.17). We did not observe a significant correlation of HER2-low status and AIMS molecular subtypes. In particular, the HER2-enriched (HER2E) subtype was assigned to only 4.3% of HER2-zero and 3.1% of HER2-low tumors. Significant iDFS differences were observed for HER2-low-status in combination with AIMS subtypes (lumB/basal/HER2E vs. lumA/normL; overall p-value < 0.0001) for both pretherapeutic biopsies and residual tumor. Patients with post-NACT HER2-low tumors had an improved survival in the subgroups of aggressive AIMS subtypes (lumB/basal/HER2E), but not in the less aggressive AIMs subtypes (lumA/normL), with a positive test for interaction (p=0.02). For the pre-NACT samples a similar, but non-significant trend was observed. We evaluated a total of 620 core biopsies for differences in gene expression comparing HER2-low and HER2-zero tumors. A total of 417 genes were statistically significantly different, but in a hierarchical clustering there was no clear separation of HER2-low and HER2-zero tumors. Conclusions: In the PenelopeB cohort of HR+ tumors, a HER2-low status in pretherapeutic core biopsies is related to improved disease-free survival, especially for those tumors that have a more aggressive intrinsic subtype. A shift of HER2-low status was observed before and after chemotherapy, indicating an adaptation of the pathway activity to therapy-induced stress, which might become relevant for future diagnostic and therapeutic approaches.
Citation Format: Carsten Denkert, Miguel Martín, Michael Untch, Hervé R. Bonnefoi, Erik S. Knudsen, Seock-Ah Im, Angela DeMichele, Agnieszka Witkiewicz, Laura Van ’t Veer, Sung-Bae Kim, Harry D. Bear, Nicole McCarthy, Karen Gelmon, Frederik Marmé, José Ángel García-Sáenz, Nicholas Turner, Federico Rojo, Martin Filipits, Lesley-Ann Martin, Peter A. Fasching, Christian Schem, Catherine M. Kelly, Toralf Reimer, Masakazu Toi, Hope Rugo, Michael Gnant, Andreas Makris, Yuan Liu, Karsten Weber, Sivaramakrishna Rachakonda, Sibylle Loibl. HER2-06 Outcome analysis of HER2-zero or HER2-low hormone receptor-positive (HR+) breast cancer patients - characterization of the molecular phenotype in combination with molecular subtyping [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr HER2-06.
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Affiliation(s)
- Carsten Denkert
- 1Institut für Pathologie, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Germany
| | - Miguel Martín
- 2Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Hervé R. Bonnefoi
- 4Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U1312, and European Organisation for Research and Treatment of Cancer (EORTC), Bordeaux, France
| | - Erik S. Knudsen
- 5Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Seock-Ah Im
- 6Seoul National University College of Medicine, Seoul, Korea, Republic of (South), Republic of Korea
| | | | | | | | | | - Harry D. Bear
- 11Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia
| | - Nicole McCarthy
- 12Breast Cancer Trials Australia and New Zealand and University of Queensland Australia
| | - Karen Gelmon
- 13BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Frederik Marmé
- 14Med. Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | | | - Nicholas Turner
- 16The Institute of Cancer Research: Royal Cancer Hospital, London, UK
| | | | - Martin Filipits
- 18Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Lesley-Ann Martin
- 19Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK
| | - Peter A. Fasching
- 20Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | | | | | - Toralf Reimer
- 23Breast Center, University of Rostock, Rostock, Germany
| | - Masakazu Toi
- 24Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Hope Rugo
- 25University of California San Francisco, San Francisco, CA
| | - Michael Gnant
- 26Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andreas Makris
- 27Mount Vernon Cancer Centre, Northwood, England, United Kingdom
| | - Yuan Liu
- 28Pfizer Inc, San Diego, California
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Knudsen ES, Rachakonda S, Marmé F, Martín M, Untch M, Bonnefoi HR, Schmitt WD, Kim SB, Bear HD, Witkiewicz A, Im SA, DeMichele A, Van’t Veer L, McCarthy N, Sinn BV, Gelmon K, García-Sáenz JÁ, Kelly CM, Reimer T, Turner N, Rojo F, Filipits M, Fasching PA, Schem C, Martin LA, Liu Y, Toi M, Rugo H, Gnant M, Makris A, Furlanetto J, Weber K, Denkert C, Loibl S. Abstract PD17-06: Immunohistochemical markers and determinants of clinical response in the Penelope-B trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd17-06] [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: 03/06/2023]
Abstract
Abstract
Background: The Penelope-B trial did not show improvement in invasive disease-free survival (iDFS) with the addition of palbociclib to endocrine therapy (ET) in patients with high-risk early breast cancer (BC) after neoadjuvant chemotherapy (NACT). Biomarkers may be able to identify subgroups of patients deriving benefit from Palbociclib and guide future studies. Estrogen-receptor (ER), progesterone-receptor (PgR) and Ki-67 might be helpful in identifying patients benefiting from palbociclib. Concordantly, tumors with elevated expression of Cyclin D1 and phosphorylated retinoblastoma protein (phospho-RB) may harbor more dependency on CDK4/6 and thus higher sensitivity to palbociclib. Methods: The percentage of positive ER and PgR cells and Ki-67 assessed in surgical specimens after NACT were combined to obtain the immunohistochemical score 3 (IHC3, Cuzick et al JCO 2011, low vs high based on the median IHC3 value). Cyclin D1 and phospho-RB Ser 807/811 immunoreactive (phospho-RB) scores were analyzed in residual tumors after NACT (range 0-12 each). Proportional hazard regression model was used to assess the predictive and prognostic value of IHC3 and treatment on iDFS. Subgroup analysis was performed according to BC intrinsic subtypes (luminal-A/normal-like, luminal-B/HER2-enriched/basal) and HER2-status (HER2 0, HER2 low). Cox/Fine-Gray regression was used to define the predictive and prognostic value of CyclinD1 (≤1, >1), phospho-RB (≤2, >2) as dichotomized and continuous variables on iDFS, distant DFS (DDFS), locoregional invasive recurrence-free interval (LRRFI) and overall survival (OS). Multivariate analyses (MVA) were adjusted for age (≤50 vs >50), Ki-67 (≤15 vs >15), region (non-Asian vs Asian), ypN (ypN0-1 vs ypN2-3), risk status (CPS-EG=2 ypN+ vs ≥3), cT (cT1-2 vs cT3-4), ypT (ypT0-2 vs ypT3-4), and grade (G1-2 vs G3). The MVA for IHC3 includes all the covariates above except Ki-67. p< 0.05 was defined as statistically significant. Results: Data for ER, PgR, Ki-67, HER2, Cyclin D1 and phospho-RB were available for 1250 patients. Overall, 98.9% of the patients had ER+ tumors, 75.0% PgR+, 52.2% had HER2 low, 25.5% Ki-67>15, 50% had IHC3 score higher than median, 93.9% had Cyclin D1 >1, 57.8% had phospho-RB >2. Patients with IHC3 score high had a worse iDFS compared to patients with IHC3 score low (MVA HR 2.28 95%CI (1.78-2.91), p< 0.0001). Patients with luminal-A/normal-like tumors and IHC3 low had an improved iDFS with the addition of palbociclib to ET (MVA HR 0.35 95%CI (0.14-0.90), test for interaction p=0.01). No difference was observed according to HER2 status. Cyclin D1>1 has no predictive value but is prognostic for better iDFS (MVA HR 0.62 95%CI (0.41-0.94), p=0.023), LRRFI (MVA HR 0.30 95%CI (0.15-0.63), p=0.001) and OS (MVA HR 0.50 95%CI (0.28-0.89), p=0.019). Similar results were obtained when Cyclin D1 was analysed as a continuous variable. Phospho-RB had neither predictive nor prognostic value. Phospho-RB highly correlates with Ki-67 (p< 0.001, Spearman correlation 0.248). Conclusions: Patients with high Cyclin D1 expression had a favorable prognosis independent of treatment arm, but patients with luminal-A/normal-like tumors and IHC3 low after NACT had an improved outcome when receiving palbociclib in addition to adjuvant ET. Theses exploratory studies suggest specific signatures/phenotypes could predict benefit from Palbociclib in high-risk early breast cancer.
Citation Format: Erik S. Knudsen, Sivaramakrishna Rachakonda, Frederik Marmé, Miguel Martín, Michael Untch, Hervé R. Bonnefoi, Wolfgang D. Schmitt, Sung-Bae Kim, Harry D. Bear, Agnieszka Witkiewicz, Seock-Ah Im, Angela DeMichele, Laura Van’t Veer, Nicole McCarthy, Bruno V. Sinn, Karen Gelmon, José Ángel García-Sáenz, Catherine M. Kelly, Toralf Reimer, Nicholas Turner, Federico Rojo, Martin Filipits, Peter A. Fasching, Christian Schem, Lesley-Ann Martin, Yuan Liu, Masakazu Toi, Hope Rugo, Michael Gnant, Andreas Makris, Jenny Furlanetto, Karsten Weber, Carsten Denkert, Sibylle Loibl. Immunohistochemical markers and determinants of clinical response in the Penelope-B trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD17-06.
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Affiliation(s)
- Erik S. Knudsen
- 1Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Frederik Marmé
- 3Med. Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Miguel Martín
- 4Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Hervé R. Bonnefoi
- 6Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U1312, and European Organisation for Research and Treatment of Cancer (EORTC),, Bordeaux, France
| | - Wolfgang D. Schmitt
- 7Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | | | - Harry D. Bear
- 9Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia
| | | | - Seock-Ah Im
- 11Seoul National University College of Medicine, Seoul, Korea, Republic of Korea
| | | | | | - Nicole McCarthy
- 14Icon Cancer Center, Wesley Medical Centre, Auchenflower, Australia
| | | | - Karen Gelmon
- 16BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Toralf Reimer
- 19Breast Center, University of Rostock, Rostock, Germany
| | - Nicholas Turner
- 20The Institute of Cancer Research: Royal Cancer Hospital, London, UK
| | | | - Martin Filipits
- 22Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Peter A. Fasching
- 23Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | | | - Lesley-Ann Martin
- 25Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK
| | - Yuan Liu
- 26Pfizer Inc, San Diego, California
| | - Masakazu Toi
- 27Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Hope Rugo
- 28University of California San Francisco, San Francisco, CA
| | - Michael Gnant
- 29Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andreas Makris
- 30Mount Vernon Cancer Centre, Northwood, England, United Kingdom
| | | | | | - Carsten Denkert
- 33Institut für Pathologie, Philipps Universität Marburg und Universitätsklinikum Marburg (UKGM), Germany
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20
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Torres-Ruiz S, Tormo E, Garrido-Cano I, Lameirinhas A, Rojo F, Madoz-Gúrpide J, Burgués O, Hernando C, Bermejo B, Martínez MT, Lluch A, Cejalvo JM, Eroles P. High VEGFR3 Expression Reduces Doxorubicin Efficacy in Triple-Negative Breast Cancer. Int J Mol Sci 2023; 24:ijms24043601. [PMID: 36835014 PMCID: PMC9966352 DOI: 10.3390/ijms24043601] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Due to the lack of specific targets, cytotoxic chemotherapy still represents the common standard treatment for triple-negative breast patients. Despite the harmful effect of chemotherapy on tumor cells, there is evidence that treatment could modulate the tumor microenvironment in a way favoring the propagation of the tumor. In addition, the lymphangiogenesis process and its factors could be involved in this counter-therapeutic event. In our study, we have evaluated the expression of the main lymphangiogenic receptor VEGFR3 in two triple-negative breast cancer in vitro models, resistant or not to doxorubicin treatment. The expression of the receptor, at mRNA and protein levels, was higher in doxorubicin-resistant cells than in parental cells. In addition, we confirmed the upregulation of VEGFR3 levels after a short treatment with doxorubicin. Furthermore, VEGFR3 silencing reduced cell proliferation and migration capacities in both cell lines. Interestingly, high VEGFR3 expression was significantly positively correlated with worse survival in patients treated with chemotherapy. Furthermore, we have found that patients with high expression of VEGFR3 present shorter relapse-free survival than patients with low levels of the receptor. In conclusion, elevated VEGFR3 levels correlate with poor survival in patients and with reduced doxorubicin treatment efficacy in vitro. Our results suggest that the levels of this receptor could be a potential marker of meager doxorubicin response. Consequently, our results suggest that the combination of chemotherapy and VEGFR3 blockage could be a potentially useful therapeutic strategy for the treatment of triple-negative breast cancer.
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Affiliation(s)
| | - Eduardo Tormo
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
| | | | - Ana Lameirinhas
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
| | - Federico Rojo
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Pathology, Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Juan Madoz-Gúrpide
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Pathology, Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Octavio Burgués
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Pathology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Cristina Hernando
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Begoña Bermejo
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - María Teresa Martínez
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Ana Lluch
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
- Department of Medicine, Universidad de Valencia, 46010 Valencia, Spain
| | - Juan Miguel Cejalvo
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Pilar Eroles
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Physiology, Universidad de Valencia, 46010 Valencia, Spain
- Department of Biotechnology, Universidad Politécnica de Valencia, 46022 Valencia, Spain
- Correspondence:
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21
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Vázquez JC, Piñero A, de Castro FJ, Lluch A, Martín M, Barnadas A, Alba E, Rodríguez-Lescure Á, Rojo F, Giménez J, Solá I, Quintana MJ, Bonfill X, Urrutia G, Sánchez-Rovira P. The value of sentinel lymph-node biopsy in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy: a systematic review. Clin Transl Oncol 2023; 25:417-428. [PMID: 36153763 DOI: 10.1007/s12094-022-02953-1] [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] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE To conduct a systematic review to analyse the performance of the sentinel lymph-node biopsy (SLNB) in women with node-positive breast cancer at diagnosis and node-negative tumour after neoadjuvant therapy, compared to axillary lymph-node dissection. METHODS The more relevant databases were searched. Main outcomes were false-negative rate (FNR), sentinel lymph-node identification rate (SLNIR), negative predictive value (NPV), and accuracy. We conducted meta-analyses when appropriate. RESULTS Twenty studies were included. The pooled FNR was 0.14 (95% CI 0.11-0.17), the pooled SLNIR was 0.89 (95% CI 0.86-0.92), NPV was 0.83 (95% CI 0.79-0.87), and summary accuracy was 0.92 (95% CI 0.90-0.94). SLNB performed better when more than one node was removed and double mapping was used. CONCLUSIONS SLNB can be performed in women with a node-negative tumour after neoadjuvant therapy. It has a better performance when used with previous marking of the affected node and with double tracer.
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Affiliation(s)
- Juan C Vázquez
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Antonio Piñero
- GEICAM Spanish Breast Cancer Group, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Francisco J de Castro
- Complejo Asistencial de Salamanca, GEICAM Spanish Breast Cancer Group, Salamanca, Spain
| | - Ana Lluch
- Medical Oncology Unit, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Miguel Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Universidad Complutense de Madrid, Madrid, Spain
| | - Agustí Barnadas
- Medical Oncology Unit, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Emilio Alba
- Centro de Investigación Biomédica en Red de Oncología, GEICAM Spanish Breast Cancer Group, UGCI Oncología Médica, Hospitales Regional y Virgen de la Victoria, IBIMA, CIBERONC-ISCIII, Málaga, Spain
| | | | - Federico Rojo
- Centro de Investigación Biomédica en Red de Oncología, GEICAM Spanish Breast Cancer Group, Hospital Universitario Fundacion Jimenez Diaz, CIBERONC-ISCIII, Madrid, Spain
| | - Julia Giménez
- Instituto Valenciano de Oncologia-IVO-GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - Ivan Solá
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Maria J Quintana
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Bonfill
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gerard Urrutia
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pedro Sánchez-Rovira
- Medical Oncology Unit, GEICAM Spanish Breast Cancer Group, Complejo Hospitalario de Jaén, Jaén, Spain
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22
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Asleh K, Lluch A, Goytain A, Barrios C, Wang XQ, Torrecillas L, Gao D, Ruiz-Borrego M, Leung S, Bines J, Guerrero-Zotano Á, García-Sáenz JÁ, Cejalvo JM, Herranz J, Torres R, de la Haba-Rodriguez J, Ayala F, Gómez H, Rojo F, Nielsen TO, Martin M. Triple-Negative PAM50 Non-Basal Breast Cancer Subtype Predicts Benefit from Extended Adjuvant Capecitabine. Clin Cancer Res 2023; 29:389-400. [PMID: 36346687 PMCID: PMC9873250 DOI: 10.1158/1078-0432.ccr-22-2191] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/01/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Predictive biomarkers for capecitabine benefit in triple-negative breast cancer (TNBC) have been recently proposed using samples from phase III clinical trials, including non-basal phenotype and biomarkers related to angiogenesis, stroma, and capecitabine activation genes. We aimed to validate these findings on the larger phase III GEICAM/CIBOMA clinical trial. EXPERIMENTAL DESIGN Tumor tissues from patients with TNBC randomized to standard (neo)adjuvant chemotherapy followed by capecitabine versus observation were analyzed using a 164-gene NanoString custom nCounter codeset measuring mRNA expression. A prespecified statistical plan sought to verify the predictive capacity of PAM50 non-basal molecular subtype and tested the hypotheses that breast tumors with increased expression of (meta)genes for cytotoxic cells, mast cells, endothelial cells, PDL2, and 38 individual genes benefit from adjuvant capecitabine for distant recurrence-free survival (DRFS; primary endpoint) and overall survival. RESULTS Of the 876 women enrolled in the GEICAM/CIBOMA trial, 658 (75%) were evaluable for analysis (337 with capecitabine and 321 without). Of these cases, 553 (84%) were profiled as PAM50 basal-like whereas 105 (16%) were PAM50 non-basal. Non-basal subtype was the most significant predictor for capecitabine benefit [HRcapecitabine, 0.19; 95% confidence interval (CI), 0.07-0.54; P < 0.001] when compared with PAM50 basal-like (HRcapecitabine, 0.9; 95% CI, 0.63-1.28; P = 0.55; Pinteraction<0.001, adjusted P value = 0.01). Analysis of biological processes related to PAM50 non-basal subtype revealed its enrichment for mast cells, extracellular matrix, angiogenesis, and features of mesenchymal stem-like TNBC subtype. CONCLUSIONS In this prespecified correlative analysis of the GEICAM/CIBOMA trial, PAM50 non-basal status identified patients with early-stage TNBC most likely to benefit from capecitabine.
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Affiliation(s)
- Karama Asleh
- Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, Canada.,Interdisciplinary Oncology Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ana Lluch
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain.,Hospital Clínico Universitario de Valencia, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain
| | - Angela Goytain
- Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, Canada
| | - Carlos Barrios
- Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre, Brazil.,LACOG, Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Xue Q. Wang
- Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, Canada
| | - Laura Torrecillas
- LACOG, Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Centro Médico Nacional 20 de Noviembre ISSSTE, CDMX, Mexico
| | - Dongxia Gao
- Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, Canada
| | - Manuel Ruiz-Borrego
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Samuel Leung
- Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, Canada
| | - José Bines
- LACOG, Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,National Cancer Institute (INCA), Brazil
| | - Ángel Guerrero-Zotano
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain.,Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - Jose Ángel García-Sáenz
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain.,Department of Oncology and Instituto de Investigación Sanitaria Hospital Clinico San Carlos (IdISSC), Madrid, Spain
| | - Juan Miguel Cejalvo
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain.,Hospital Clínico Universitario de Valencia, Valencia, Spain.,Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain
| | | | - Roberto Torres
- LACOG, Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Instituto Nacional del Cáncer, Santiago, Chile
| | - Juan de la Haba-Rodriguez
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)–Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain.,Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain
| | - Francisco Ayala
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain.,Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Henry Gómez
- LACOG, Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru.,Universidad Ricardo Palma, Lima, Peru
| | - Federico Rojo
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain.,Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain
| | - Torsten O. Nielsen
- Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, Canada
| | - Miguel Martin
- GEICAM, Spanish Breast Cancer Group, Madrid, Spain.,Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Medicine Department, Universidad Complutense, Madrid, Spain.,Corresponding Author: Miguel Martin, Hospital General Universitario Gregorio Marañón, C. Dr. Esquerdo, 46, 28007 Madrid, Spain. Phone: 349-1659-2870; E-mail:
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23
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Albanell J, Pérez-García JM, Gil-Gil M, Curigliano G, Ruíz-Borrego M, Comerma L, Gibert J, Bellet M, Bermejo B, Calvo L, de la Haba J, Espinosa E, Minisini AM, Quiroga V, Santaballa Bertran A, Mina L, Bellosillo B, Rojo F, Menéndez S, Sampayo-Cordero M, Popa C, Malfettone A, Cortés J, Llombart-Cussac A. Palbociclib Rechallenge for Hormone Receptor-Positive/HER-Negative Advanced Breast Cancer: Findings from the Phase II BioPER Trial. Clin Cancer Res 2023; 29:67-80. [PMID: 36165912 PMCID: PMC9811162 DOI: 10.1158/1078-0432.ccr-22-1281] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 04/21/2022] [Revised: 06/27/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess the efficacy and exploratory biomarkers of continuing palbociclib plus endocrine therapy (ET) beyond progression on prior palbociclib-based regimen in patients with hormone receptor-positive/HER2-negative (HR+/HER2-) advanced breast cancer (ABC). PATIENTS AND METHODS The multicenter, open-label, phase II BioPER trial included women who had experienced a progressive disease (PD) after having achieved clinical benefit on the immediately prior palbociclib plus ET regimen. Palbociclib (125 mg, 100 mg, or 75 mg daily orally for 3 weeks and 1 week off as per prior palbociclib-based regimen) plus ET of physician's choice were administered in 4-week cycles until PD or unacceptable toxicity. Coprimary endpoints were clinical benefit rate (CBR) and percentage of tumors with baseline loss of retinoblastoma (Rb) protein expression. Additional endpoints included safety and biomarker analysis. RESULTS Among 33 patients enrolled, CBR was 34.4% [95% confidence interval (CI), 18.6-53.2; P < 0.001] and 13.0% of tumors (95% CI, 5.2-27.5) showed loss of Rb protein expression, meeting both coprimary endpoints. Median progression-free survival was 2.6 months (95% CI, 1.8-6.7). No new safety signals were reported. A signature that included baseline mediators of therapeutic resistance to palbociclib and ET (low Rb score, high cyclin E1 score, ESR1 mutation) was independently associated with shorter median progression-free survival (HR, 22.0; 95% CI, 1.71-282.9; P = 0.018). CONCLUSIONS Maintaining palbociclib after progression on prior palbociclib-based regimen seems to be a reasonable, investigational approach for selected patients. A composite biomarker signature predicts a subset of patients who may not derive a greater benefit from palbociclib rechallenge, warranting further validation in larger randomized controlled trials.
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Affiliation(s)
- Joan Albanell
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain.,Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Oncología (CIBERONC-ISCIII), Madrid, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,GEICAM, Spain
| | - José Manuel Pérez-García
- International Breast Cancer Center (IBCC), Quironsalud Group, Barcelona, Spain.,Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey
| | - Miguel Gil-Gil
- GEICAM, Spain.,Catalan Institute of Oncology, Breast Cancer Unit, Medical Oncology Department, IDIBELL, Barcelona, Spain
| | - Giuseppe Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milano, Italy.,University of Milano, Department of Oncology and Hemato-Oncology, Milano, Italy
| | | | - Laura Comerma
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Joan Gibert
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Meritxell Bellet
- Vall d´Hebrón University Hospital, Barcelona, Spain.,Vall d´Hebrón Institute of Oncology (VHIO), Barcelona, Spain
| | - Begoña Bermejo
- Centro de Investigación Biomédica en Red de Oncología (CIBERONC-ISCIII), Madrid, Spain.,GEICAM, Spain.,Medical Oncology, Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, Valencia; Medicine Department, Universidad de Valencia, Valencia, Spain
| | - Lourdes Calvo
- GEICAM, Spain.,Complejo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | | | | | | | - Vanesa Quiroga
- Badalona-Applied Research Group in Oncology (B-ARGO Group), Catalan Institute of Oncology, Badalona, Barcelona, Spain
| | | | - Leonardo Mina
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey
| | - Beatriz Bellosillo
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Oncología (CIBERONC-ISCIII), Madrid, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Federico Rojo
- Centro de Investigación Biomédica en Red de Oncología (CIBERONC-ISCIII), Madrid, Spain.,GEICAM, Spain.,IIS-Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Silvia Menéndez
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Miguel Sampayo-Cordero
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey
| | - Crina Popa
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey
| | - Andrea Malfettone
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey
| | - Javier Cortés
- International Breast Cancer Center (IBCC), Quironsalud Group, Barcelona, Spain.,Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey.,Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - Antonio Llombart-Cussac
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey.,Hospital Arnau de Vilanova, Valencia, Spain.,Universidad Catolica, Valencia, Spain.,Corresponding Author: Antonio Llombart-Cussac, Hospital Arnau de Vilanova, Calle de Sant Clement, 12, 46015, Valencia, Spain. Phone: 0034-961-976-060; E-mail:
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24
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Cristóbal I, Santos A, Rojo F, García-Foncillas J. The SMAD3-induced effects in colorectal cancer are orchestrated by a complex network of long noncoding RNAs. J Cell Physiol 2023; 238:3-4. [PMID: 35023150 DOI: 10.1002/jcp.30681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 12/08/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Ion Cristóbal
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jimenez Díaz-UAM, Madrid, Spain.,Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jimenez Díaz-UAM, Madrid, Spain
| | - Andrea Santos
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jimenez Díaz-UAM, Madrid, Spain.,Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jimenez Díaz-UAM, Madrid, Spain
| | - Federico Rojo
- Pathology Department, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Jesús García-Foncillas
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jimenez Díaz-UAM, Madrid, Spain.,Medical Oncology Department, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
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25
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Rincón-Castanedo C, Martín-Ruiz A, Zazo S, Luis Huertas AL, Valenzuela PL, Morán M, Fleck SJ, Santos-Lozano A, Ramírez M, Rojo F, Lucia A, González-Murillo Á, Fiuza-Luces C. Combined exercise intervention in a mouse model of high-risk neuroblastoma: effects on physical, immune, tumor and clinical outcomes. Exerc Immunol Rev 2023; 29:86-110. [PMID: 37358366] [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] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Background Exercise might exert anti-tumoral effects in adult cancers but this question remains open in pediatric tumors, which frequently show a different biology compared to adult malignancies. We studied the effects of an exercise intervention on physical function, immune variables and tumoral response in a preclinical model of a highly aggressive pediatric cancer, high-risk neuroblastoma (HR-NB). Methods 6-8-week-old male mice with orthotopically-induced HR-NB were assigned to a control (N = 13) or exercise (5-week combined [aerobic+resistance]) group (N = 17). Outcomes included physical function (cardiorespiratory fitness [CRF] and muscle strength), as well as related muscle molecular indicators, blood and tumor immune cell and molecular variables, tumor progression, clinical severity, and survival. Results Exercise attenuated CRF decline (p=0.029 for the group-by-time interaction effect), which was accompanied by higher muscle levels of oxidative capacity (citrate synthase and respiratory chain complexes III, IV and V) and an indicator of antioxidant defense (glutathione reductase) in the intervention arm (all p≤0.001), as well as by higher levels of apoptosis (caspase-3, p=0.029) and angiogenesis (vascular endothelial growth factor receptor-2, p=0.012). The proportion of 'hot-like' (i.e., with viable immune infiltrates in flow cytometry analyses) tumors tended to be higher (p=0.0789) in the exercise group (76.9%, vs. 33.3% in control mice). Exercise also promoted greater total immune (p=0.045) and myeloid cell (p=0.049) infiltration within the 'hot' tumors, with a higher proportion of two myeloid cell subsets (CD11C+ [dendritic] cells [p=0.049] and M2-like tumor-associated macrophages [p=0.028]), yet with no significant changes in lymphoid infiltrates or in cirulating immune cells or chemokines/cytokines. No training effect was found either for muscle strength or anabolic status, cancer progression (tumor weight and metastasis, tumor microenvironment), clinical severity, or survival. Conclusions Combined exercise appears as an effective strategy for attenuating physical function decline in a mouse model of HR-NB, also exerting some potential immune benefits within the tumor, which seem overall different from those previously reported in adult cancers.
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Affiliation(s)
| | - Asunción Martín-Ruiz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Biophysics & Systems Biology Group. Department of Biochemistry and Molecular Biology, Complutense University of Madrid (UCM). Madrid, Spain
| | - Sandra Zazo
- Pathology, Fundación Jiménez Díaz University, Hospital Health Research Institute (IIS-FJD, UAM)-CIBERONC, Madrid, Spain
| | - Ana L Luis Huertas
- Servicio de Cirugía Pediátrica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Pedro L Valenzuela
- Physical Activity and Health Research Group ('PAHERG'), Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), Madrid, Spain
- Department of Systems Biology, University of Alcalá, Alcalá de Henares, Spain
| | - María Morán
- Mitochondrial and Neuromuscular Diseases Laboratory, Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), Madrid, Spain
- Spanish Network for Biomedical Research in Rare Diseases (CIBERER), U723, Madrid, Spain
| | - Steven J Fleck
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Alejandro Santos-Lozano
- Physical Activity and Health Research Group ('PAHERG'), Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), Madrid, Spain
- i+HeALTH, Department of Health Sciences, European University Miguel de Cervantes, Valladolid, Spain
| | - Manuek Ramírez
- Unidad de Terapias Avanzadas, Oncología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Fundación de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Federico Rojo
- Pathology, Fundación Jiménez Díaz University, Hospital Health Research Institute (IIS-FJD, UAM)-CIBERONC, Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Physical Activity and Health Research Group ('PAHERG'), Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), Madrid, Spain
| | - África González-Murillo
- Unidad de Terapias Avanzadas, Oncología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Fundación de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Carmen Fiuza-Luces
- Physical Activity and Health Research Group ('PAHERG'), Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), Madrid, Spain
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26
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de la Cruz-Merino L, Gion M, Cruz J, Alonso-Romero JL, Quiroga V, Moreno F, Andrés R, Santisteban M, Ramos M, Holgado E, Cortés J, López-Miranda E, Cortés A, Henao F, Palazón-Carrión N, Rodriguez LM, Ceballos I, Soto A, Puertes A, Casas M, Benito S, Chiesa M, Bezares S, Caballero R, Jiménez-Cortegana C, Sánchez-Margalet V, Rojo F. Pembrolizumab in combination with gemcitabine for patients with HER2-negative advanced breast cancer: GEICAM/2015-04 (PANGEA-Breast) study. BMC Cancer 2022; 22:1258. [PMID: 36463104 PMCID: PMC9719636 DOI: 10.1186/s12885-022-10363-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We evaluated a new chemoimmunotherapy combination based on the anti-PD1 monoclonal antibody pembrolizumab and the pyrimidine antimetabolite gemcitabine in HER2- advanced breast cancer (ABC) patients previously treated in the advanced setting, in order to explore a potential synergism that could eventually obtain long term benefit in these patients. METHODS HER2-negative ABC patients received 21-day cycles of pembrolizumab 200 mg (day 1) and gemcitabine (days 1 and 8). A run-in-phase (6 + 6 design) was planned with two dose levels (DL) of gemcitabine (1,250 mg/m2 [DL0]; 1,000 mg/m2 [DL1]) to determine the recommended phase II dose (RP2D). The primary objective was objective response rate (ORR). Tumor infiltrating lymphocytes (TILs) density and PD-L1 expression in tumors and myeloid-derived suppressor cells (MDSCs) levels in peripheral blood were analyzed. RESULTS Fourteen patients were treated with DL0, resulting in RP2D. Thirty-six patients were evaluated during the first stage of Simon's design. Recruitment was stopped as statistical assumptions were not met. The median age was 52; 21 (58%) patients had triple-negative disease, 28 (78%) visceral involvement, and 27 (75%) ≥ 2 metastatic locations. Progression disease was observed in 29 patients. ORR was 15% (95% CI, 5-32). Eight patients were treated ≥ 6 months before progression. Fourteen patients reported grade ≥ 3 treatment-related adverse events. Due to the small sample size, we did not find any clear association between immune tumor biomarkers and treatment efficacy that could identify a subgroup with higher probability of response or better survival. However, patients that experienced a clinical benefit showed decreased MDSCs levels in peripheral blood along the treatment. CONCLUSION Pembrolizumab 200 mg and gemcitabine 1,250 mg/m2 were considered as RP2D. The objective of ORR was not met; however, 22% patients were on treatment for ≥ 6 months. ABC patients that could benefit of chemoimmunotherapy strategies must be carefully selected by robust and validated biomarkers. In our heavily pretreated population, TILs, PD-L1 expression and MDSCs levels could not identify a subgroup of patients for whom the combination of gemcitabine and pembrolizumab would induce long term benefit. TRIAL REGISTRATION ClinicalTrials.gov and EudraCT (NCT03025880 and 2016-001,779-54, respectively). Registration dates: 20/01/2017 and 18/11/2016, respectively.
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Affiliation(s)
- L. de la Cruz-Merino
- grid.411375.50000 0004 1768 164XDepartment of Medical Oncology, Medicine Department, Virgen Macarena University Hospital, University of Seville, Dr. Fedriani St, No. 3, Seville, 41009 Spain ,grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - M. Gion
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411347.40000 0000 9248 5770Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J. Cruz
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411220.40000 0000 9826 9219Department of Medical Oncology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - JL. Alonso-Romero
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411372.20000 0001 0534 3000Department of Medical Oncology, Hospital Clínico Universitario Virgen de La Arrixaca-IMIB, Murcia, Spain
| | - V. Quiroga
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.418701.b0000 0001 2097 8389Department of Medical Oncology, Badalona Applied Research Group in Oncology (B-ARGO Group), Catalan Institute of Oncology, Badalona, Spain
| | - F. Moreno
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411068.a0000 0001 0671 5785Department of Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - R. Andrés
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411050.10000 0004 1767 4212Department of Medical Oncology, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain
| | - M. Santisteban
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411730.00000 0001 2191 685XDepartment of Medical Oncology, Clínica Universidad de Navarra, Navarra, Spain ,grid.508840.10000 0004 7662 6114IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - M. Ramos
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.418394.3Department of Medical Oncology, Centro Oncológico de Galicia, A Coruña, Spain
| | - E. Holgado
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.414808.10000 0004 1772 3571Department of Medical Oncology, Hospital La Luz, Quironsalud, Madrid, Spain
| | - J. Cortés
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,International Breast Cancer Center (IBCC), Quiron Group, Barcelona and Madrid, Spain ,grid.411083.f0000 0001 0675 8654Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain ,grid.119375.80000000121738416Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - E. López-Miranda
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411347.40000 0000 9248 5770Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A. Cortés
- grid.411347.40000 0000 9248 5770Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F. Henao
- grid.411375.50000 0004 1768 164XDepartment of Medical Oncology, Medicine Department, Virgen Macarena University Hospital, University of Seville, Dr. Fedriani St, No. 3, Seville, 41009 Spain ,grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - N. Palazón-Carrión
- grid.411375.50000 0004 1768 164XDepartment of Medical Oncology, Medicine Department, Virgen Macarena University Hospital, University of Seville, Dr. Fedriani St, No. 3, Seville, 41009 Spain ,grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - L. M. Rodriguez
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411220.40000 0000 9826 9219Department of Medical Oncology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - I. Ceballos
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.411220.40000 0000 9826 9219Department of Medical Oncology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - A. Soto
- grid.411372.20000 0001 0534 3000Department of Medical Oncology, Hospital Clínico Universitario Virgen de La Arrixaca-IMIB, Murcia, Spain
| | - A. Puertes
- grid.411372.20000 0001 0534 3000Department of Medical Oncology, Hospital Clínico Universitario Virgen de La Arrixaca-IMIB, Murcia, Spain
| | - M. Casas
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - S. Benito
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - M. Chiesa
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - S. Bezares
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - R. Caballero
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain
| | - C. Jiménez-Cortegana
- grid.411375.50000 0004 1768 164XMedical Biochemistry and Molecular Biology and Immunology Department, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - V. Sánchez-Margalet
- grid.411375.50000 0004 1768 164XMedical Biochemistry and Molecular Biology and Immunology Department, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - F. Rojo
- grid.430580.aGEICAM Spanish Breast Cancer Group, San Sebastián de los Reyes, Madrid, Spain ,grid.419651.e0000 0000 9538 1950Pathology Department, IIS-Fundación Jiménez Díaz, Madrid, Spain ,CIBERONC-ISCIII, Madrid, Spain
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Pattanayak B, Lameirinhas A, Torres-Ruiz S, Burgués O, Rovira A, Martínez MT, Tapia M, Zazo S, Albanell J, Rojo F, Bermejo B, Eroles P. Role of SALL4 in HER2+ Breast Cancer Progression: Regulating PI3K/AKT Pathway. Int J Mol Sci 2022; 23:13292. [PMID: 36362083 PMCID: PMC9655635 DOI: 10.3390/ijms232113292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/26/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 08/30/2023] Open
Abstract
Treatment for the HER2+ breast cancer subtype is still unsatisfactory, despite breakthroughs in research. The discovery of various new molecular mechanisms of transcription factors may help to make treatment regimens more effective. The transcription factor SALL4 has been related to aggressiveness and resistance therapy in cancer. Its molecular mechanisms and involvement in various signaling pathways are unknown in the HER2+ breast cancer subtype. In this study, we have evaluated the implication of SALL4 in the HER2+ subtype through its expression in patients' samples and gain and loss of function in HER2+ cell lines. We found higher SALL4 expression in breast cancer tissues compared to healthy tissue. Interestingly, high SALL4 expression was associated with disease relapse and poor patient survival. In HER2+ cell lines, transient overexpression of SALL4 modulates PI3K/AKT signaling through regulating PTEN expression and BCL2, which increases cell survival and proliferation while reducing the efficacy of trastuzumab. SALL4 has also been observed to regulate the epithelial-mesenchymal transition and stemness features. SALL4 overexpression significantly reduced the epithelial markers E-cadherin, while it increased the mesenchymal markers β-catenin, vimentin and fibronectin. Furthermore, it has been also observed an increased expression of MYC, an essential transcription factor for regulating epithelial-mesenchymal transition and/or cancer stem cells. Our study demonstrates, for the first time, the importance of SALL4 in the HER2+ subtype and partial regulation of trastuzumab sensitivity. It provides a viable molecular mechanism-driven therapeutic strategy for an important subset of HER2-overexpressing patients whose malignancies are mediated by SALL4 expression.
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Affiliation(s)
| | - Ana Lameirinhas
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
| | | | - Octavio Burgués
- Department of Pathology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
| | - Ana Rovira
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - María Teresa Martínez
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Marta Tapia
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Sandra Zazo
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Pathology, Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Joan Albanell
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain
| | - Federico Rojo
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Pathology, Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Begoña Bermejo
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Pilar Eroles
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Department of Physiology, Universidad de Valencia, 46010 Valencia, Spain
- Department of Biotechnology, Universidad Politécnica de Valencia, 46022 Valencia, Spain
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Santos A, Cristóbal I, Rubio J, Caramés C, Luque M, Sanz-Álvarez M, Zazo S, Madoz-Gúrpide J, Rojo F, García-Foncillas J. MicroRNA-19b Plays a Key Role in 5-Fluorouracil Resistance and Predicts Tumor Progression in Locally Advanced Rectal Cancer Patients. Int J Mol Sci 2022; 23:ijms232012447. [PMID: 36293302 PMCID: PMC9604503 DOI: 10.3390/ijms232012447] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
The standard clinical management of locally advanced rectal cancer (LARC) patients includes neoadjuvant 5-fluorouracil (5-FU)-based chemoradiotherapy (CRT) followed by mesorectal excision. MicroRNA (miR)-19b expression levels in LARC biopsies obtained from initial colonoscopy have recently been identified as independent predictors of both patient outcome and pathological response to preoperative CRT in this disease. Moreover, it has been discovered that this miR increases its expression in 5-FU resistant colon cancer cells after 5-FU exposure. Despite the fact that these observations suggest a functional role of miR-19b modulating 5-FU response of LARC cells, this issue still remains to be clarified. Here, we show that downregulation of miR-19b enhances the antitumor effects of 5-FU treatment. Moreover, ectopic miR-19b modulation was able to restore sensitivity to 5-FU treatment using an acquired resistant model to this compound. Notably, we also evaluated the potential clinical impact of miR-19b as a predictive marker of disease progression after tumor surgery resection in LARC patients, observing that miR-19b overexpression significantly anticipates patient recurrence in our cohort (p = 0.002). Altogether, our findings demonstrate the functional role of miR-19b in the progressively decreasing sensitivity to 5-FU treatment and its potential usefulness as a therapeutic target to overcome 5-FU resistance, as well as its clinical impact as predictor of tumor progression and relapse.
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Affiliation(s)
- Andrea Santos
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, Health Research Institute (IIS)—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
- Translational Oncology Division, Oncohealth Institute, IIS—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
| | - Ion Cristóbal
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, Health Research Institute (IIS)—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
- Translational Oncology Division, Oncohealth Institute, IIS—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
- Correspondence: (I.C.); (J.G.-F.); Tel.: +34-915-504-800 (I.C. & J.G.-F.)
| | - Jaime Rubio
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, Health Research Institute (IIS)—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
- Translational Oncology Division, Oncohealth Institute, IIS—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
- Medical Oncology Department, University Hospital “Fundación Jiménez Díaz”, UAM, 28040 Madrid, Spain
| | - Cristina Caramés
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, Health Research Institute (IIS)—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
- Translational Oncology Division, Oncohealth Institute, IIS—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
- Medical Oncology Department, University Hospital “Fundación Jiménez Díaz”, UAM, 28040 Madrid, Spain
| | - Melani Luque
- Pathology Department, IIS—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
| | - Marta Sanz-Álvarez
- Pathology Department, IIS—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
| | - Sandra Zazo
- Pathology Department, IIS—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
| | - Juan Madoz-Gúrpide
- Pathology Department, IIS—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
| | - Federico Rojo
- Pathology Department, IIS—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
| | - Jesus García-Foncillas
- Translational Oncology Division, Oncohealth Institute, IIS—Fundación Jiménez Díaz—UAM, 28040 Madrid, Spain
- Medical Oncology Department, University Hospital “Fundación Jiménez Díaz”, UAM, 28040 Madrid, Spain
- Correspondence: (I.C.); (J.G.-F.); Tel.: +34-915-504-800 (I.C. & J.G.-F.)
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Laimito KR, Martin M, Rojo F, Gámez-Pozo A, De Castro F, Vegas EF, Viro JC, Martínez JA. 45P In silico transcriptomic mapping of Notch biological pathway in luminal breast cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hernandez S, Rodriguez Carrillo J, Caminoa A, Benito A, Martinez R, Alonso M, Clave S, Arriola E, Esteban-Rodriguez I, De Castro J, Sansano I, Felip E, Abdulkader I, Garcia J, Rojo F, Domine M, Teixido C, Reguart N, Compañ D, Insa A, Mancheño N, Palanca S, Juan O, Baixeras N, Nadal E, Cebollero M, Calles A, Martin P, Salas C, Provencio M, Aranda I, Massuti B, Lopez-Vilaro L, Majem M, Garrido P, Paz-Ares L, Lopez-Rios F, Conde E. P2.07-02 RET Fusion Testing with FISH and Real-Time PCR: a Comparison with RNA-Based Next-Generation Sequencing in RET Positive NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Rubio Perez J, Fernández Ochoa M, Villalba Cuesta P, Avedillo Ruidiaz M, Rojo F, Domine Gomez M. 102P Clinical analysis of patients with different KRAS mutations in NSCLC: Different entities analyzed by NGS. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Garrido‐Cano I, Adam‐Artigues A, Lameirinhas A, Blandez JF, Candela‐Noguera V, Rojo F, Zazo S, Madoz‐Gúrpide J, Lluch A, Bermejo B, Sancenón F, Cejalvo JM, Martínez‐Máñez R, Eroles P. miR-99a-5p modulates doxorubicin resistance via the COX-2/ABCG2 axis in triple-negative breast cancer: from the discovery to in vivo studies. Cancer Commun (Lond) 2022; 42:1412-1416. [PMID: 35997029 PMCID: PMC9759767 DOI: 10.1002/cac2.12352] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/14/2022] [Accepted: 08/05/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Iris Garrido‐Cano
- Biomedical Research Institute INCLIVAValencia46010Spain,Bioengineering, Biomaterials and Nanomedicine Networking Biomedical Research Centre (CIBER‐BBN)Madrid28029Spain
| | | | | | - Juan F. Blandez
- Bioengineering, Biomaterials and Nanomedicine Networking Biomedical Research Centre (CIBER‐BBN)Madrid28029Spain,Interuniversity Research Institute for Molecular Recognition and Technological Development (IDM)Polytechnic University of ValenciaUniversity of ValenciaValencia46010Spain,Joint Unit CIPF‐UPV of Mechanisms of Diseases and Nanomedicine, ValenciaPolytechnic University of ValenciaPrince Felipe Research CenterValencia46012Spain,Joint Research Unit in Nanomedicine and SensorsPolytechnic University of ValenciaMedical Research Institute Hospital La FeValencia46026Spain
| | - Vicente Candela‐Noguera
- Interuniversity Research Institute for Molecular Recognition and Technological Development (IDM)Polytechnic University of ValenciaUniversity of ValenciaValencia46010Spain
| | - Federico Rojo
- Biomedical Research Networking Center in Oncology (CIBERONC)Madrid28029Spain,Department of PathologyFundación Jiménez Díaz University Hospital Health Research InstituteMadrid28040Spain
| | - Sandra Zazo
- Department of PathologyFundación Jiménez Díaz University Hospital Health Research InstituteMadrid28040Spain
| | - Juan Madoz‐Gúrpide
- Department of PathologyFundación Jiménez Díaz University Hospital Health Research InstituteMadrid28040Spain
| | - Ana Lluch
- Biomedical Research Institute INCLIVAValencia46010Spain,Biomedical Research Networking Center in Oncology (CIBERONC)Madrid28029Spain,Department of Clinical OncologyUniversity Clinical Hospital of ValenciaValencia46010Spain,Department of MedicineUniversity of ValenciaValencia46010Spain
| | - Begoña Bermejo
- Biomedical Research Institute INCLIVAValencia46010Spain,Biomedical Research Networking Center in Oncology (CIBERONC)Madrid28029Spain,Department of Clinical OncologyUniversity Clinical Hospital of ValenciaValencia46010Spain
| | - Felix Sancenón
- Bioengineering, Biomaterials and Nanomedicine Networking Biomedical Research Centre (CIBER‐BBN)Madrid28029Spain,Interuniversity Research Institute for Molecular Recognition and Technological Development (IDM)Polytechnic University of ValenciaUniversity of ValenciaValencia46010Spain,Joint Unit CIPF‐UPV of Mechanisms of Diseases and Nanomedicine, ValenciaPolytechnic University of ValenciaPrince Felipe Research CenterValencia46012Spain,Joint Research Unit in Nanomedicine and SensorsPolytechnic University of ValenciaMedical Research Institute Hospital La FeValencia46026Spain
| | - Juan Miguel Cejalvo
- Biomedical Research Institute INCLIVAValencia46010Spain,Biomedical Research Networking Center in Oncology (CIBERONC)Madrid28029Spain,Department of Clinical OncologyUniversity Clinical Hospital of ValenciaValencia46010Spain
| | - Ramón Martínez‐Máñez
- Bioengineering, Biomaterials and Nanomedicine Networking Biomedical Research Centre (CIBER‐BBN)Madrid28029Spain,Interuniversity Research Institute for Molecular Recognition and Technological Development (IDM)Polytechnic University of ValenciaUniversity of ValenciaValencia46010Spain,Joint Unit CIPF‐UPV of Mechanisms of Diseases and Nanomedicine, ValenciaPolytechnic University of ValenciaPrince Felipe Research CenterValencia46012Spain,Joint Research Unit in Nanomedicine and SensorsPolytechnic University of ValenciaMedical Research Institute Hospital La FeValencia46026Spain
| | - Pilar Eroles
- Biomedical Research Institute INCLIVAValencia46010Spain,Biomedical Research Networking Center in Oncology (CIBERONC)Madrid28029Spain,Department of PhysiologyUniversity of ValenciaValencia46010Spain
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Prieto-Potin I, Idrovo F, Suárez-Gauthier A, Díaz-Blázquez M, Astilleros-Blanco de Córdova L, Chamizo C, Zazo S, Carvajal N, López-Sánchez A, Pérez-Buira S, Aúz-Alexandre CL, Manso R, Plaza-Sánchez J, de Lucas-López V, Pérez-González N, Martín-Valle S, Cristóbal I, Casado V, García-Foncillas J, Rojo F. Comprehensive Approach to Genomic and Immune Profiling: Insights of a Real-World Experience in Gynecological Tumors. Diagnostics (Basel) 2022; 12:diagnostics12081903. [PMID: 36010253 PMCID: PMC9406465 DOI: 10.3390/diagnostics12081903] [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: 06/28/2022] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
Gynecological cancer accounts for an elevated incidence worldwide requiring responsiveness regarding its care. The comprehensive genomic approach agrees with the classification of certain tumor types. We evaluated 49 patients with gynecological tumors undergoing high-throughput sequencing to explore whether identifying alterations in cancer-associated genes could characterize concrete histological subtypes. We performed immune examination and analyzed subsequent clinical impact. We found 220 genomic aberrations mostly distributed as single nucleotide variants (SNV, 77%). Only 3% were classified as variants of strong clinical significance in BRCA1 and BRCA2 of ovarian high-grade serous (HGSC) and uterine endometrioid carcinoma. TP53 and BRCA1 occurred in 72% and 28% of HGSC. Cervical squamous cell carcinoma was entirely HPV-associated and mutations occurred in PIK3CA (60%), as well as in uterine serous carcinoma (80%). Alterations were seen in PTEN (71%) and PIK3CA (60%) of uterine endometrioid carcinoma. Elevated programmed death-ligand 1 (PD-L1) was associated with high TILs. Either PD-L1 augmented in deficient mis-matched repair (MMR) proteins or POLE mutated cases when compared to a proficient MMR state. An 18% received genotype-guided therapy and a 4% immunotherapy. The description of tumor subtypes is plausible through high-throughput sequencing by recognizing clinically relevant alterations. Additional concomitant assessment of immune biomarkers identifies candidates for immunotherapy.
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Affiliation(s)
- Iván Prieto-Potin
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Franklin Idrovo
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Ana Suárez-Gauthier
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - María Díaz-Blázquez
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | | | - Cristina Chamizo
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Sandra Zazo
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Nerea Carvajal
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Almudena López-Sánchez
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Sandra Pérez-Buira
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Carmen Laura Aúz-Alexandre
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Rebeca Manso
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Jenifer Plaza-Sánchez
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Virginia de Lucas-López
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Nuria Pérez-González
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Sara Martín-Valle
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Ion Cristóbal
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
- Translational Oncology Division, Oncohealth Institute, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Victoria Casado
- Translational Oncology Division, Oncohealth Institute, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Jesús García-Foncillas
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
- Translational Oncology Division, Oncohealth Institute, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
| | - Federico Rojo
- Department of Pathology, CIBERONC, UAM, Fundación Jiménez Díaz University Hospital Health Research Institute, 28040 Madrid, Spain
- Correspondence:
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Affiliation(s)
- Ion Cristóbal
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain.,Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Andrea Santos
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain.,Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Federico Rojo
- Pathology Department, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Jesús García-Foncillas
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
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Asleh K, Lluch A, Goytain A, Barrios C, Wang XQ, Herranz J, Gao D, Caballero R, Leung S, Rojo F, Nielsen TO, Martin M. Abstract 5271: Correlative analysis of RNA biomarkers for adjuvant capecitabine benefit in the CIBOMA/2004-01phase III clinical trial of triple negative breast cancer patients. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5271] [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
Introduction: Predictive biomarkers for capecitabine benefit in triple negative breast cancer (TNBC) have been recently identified using samples from phase III clinical trials, including immunohistochemical (IHC) non-basal phenotype and RNA biomarkers related to angiogenesis, stroma and capecitabine activation genes. We aimed to validate these findings on the larger phase III CIBOMA clinical trial.
Experimental Design: Tumor tissues from TNBC patients randomized to standard (neo)adjuvant chemotherapy with capecitabine vs. observation were analyzed using a 164 gene NanoString custom nCounter codeset. A prespecified statistical plan sought to verify the predictive capacity of PAM50 non-basal molecular subtype previously found by IHC, and tested the hypotheses that breast tumors with increased expression of (meta)genes for cytotoxic T cells, mast cells, endothelial cells, PDL2 and 38 individual genes benefit from adjuvant capecitabine for distant recurrence free survival (DRFS, primary endpoint) and overall survival. Exploratory analyses investigated (a) predictive capacity of categorical expression of biomarkers, and continuous expression of additional genes included in the codeset; (b) the prognostic capacity of continuous biomarker expression.
Results: Of the 876 women enrolled in the CIBOMA trial, 658 (75%) were evaluable for analysis (337 with capecitabine and 321 without) with similar baseline characteristics relative to the intention-to-treat population. 553 (84%) cases were profiled as PAM50 basal-like while 105 (16%) were PAM50 non-basal. PAM50 non-basal subtype was the most significant predictor for capecitabine benefit (HRcapecitabine=0.19; 95%CI, 0.07-0.54; p=0<0.001) when compared to PAM50 basal-like (HRcapecitabine=0.9; 95%CI, 0.63-1.28; p=0.55) (p-interaction<0.001, adjusted p-value=0.01). Analysis of biological processes related to PAM50 non-basal subtype revealed its enrichment for mast cells, extracellular matrix, angiogenesis and features of the mesenchymal stem-like TNBC subtype. Multivariate analysis showed a significantly lower DRFS on the observation arm for the mast cell metagene (HRobservation=1.35; 95%CI, 1.12-1.62; p=0.002, adjusted p-value=0.006), particularly among PAM50 non-basal tumors (HRobservation=2.70; 95%CI, 0.99-7.35; p=0.01, p-interaction=0.08). Tumors above the median for genes involved in immune response (PDL2, CCR5), capecitabine metabolism (CES1) and angiogenesis (STC1) were significantly associated with favorable survival rates on the capecitabine arm (HRcapecitabine ranged between 0.51-0.60; p=0<0.05).
Conclusions: In this prespecified correlative analysis of the CIBOMA trial, PAM50 non-basal status and the mast cell metagene identified early-stage TNBC patients most likely to benefit from adjuvant capecitabine.
Citation Format: Karama Asleh, Ana Lluch, Angela Goytain, Carlos Barrios, Xue Q. Wang, Jesus Herranz, Dongxia Gao, Rosalia Caballero, Samuel Leung, Federico Rojo, Torsten O. Nielsen, Miguel Martin. Correlative analysis of RNA biomarkers for adjuvant capecitabine benefit in the CIBOMA/2004-01phase III clinical trial of triple negative breast cancer patients [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 5271.
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Affiliation(s)
- Karama Asleh
- 1Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana Lluch
- 2GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Hospital Clínico Universitario de Valencia and Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Oncología ISCIII, Madrid, Spain
| | - Angela Goytain
- 1Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carlos Barrios
- 3Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre, Brazil; LACOG, Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Xue Q. Wang
- 1Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Dongxia Gao
- 1Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Samuel Leung
- 1Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Federico Rojo
- 5GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Pathology Department, IIS-Fundación Jimenez Diaz-CIBERONC, Madrid, Spain
| | - Torsten O. Nielsen
- 1Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Miguel Martin
- 6GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Centro de Investigación Biomédica en Red de Oncología ISCIII, Madrid, Spain
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Adam-Artigues A, Arenas EJ, Martínez-Sabadell A, Brasó-Maristany F, Cervera R, Tormo E, Hernando C, Martínez MT, Carbonell-Asins J, Simón S, Poveda J, Moragón S, Zazo S, Martínez D, Rovira A, Burgués O, Rojo F, Albanell J, Bermejo B, Lluch A, Prat A, Arribas J, Eroles P, Cejalvo JM. Targeting HER2-AXL heterodimerization to overcome resistance to HER2 blockade in breast cancer. Sci Adv 2022; 8:eabk2746. [PMID: 35594351 PMCID: PMC9122332 DOI: 10.1126/sciadv.abk2746] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
Anti-HER2 therapies have markedly improved prognosis of HER2-positive breast cancer. However, different mechanisms play a role in treatment resistance. Here, we identified AXL overexpression as an essential mechanism of trastuzumab resistance. AXL orchestrates epithelial-to-mesenchymal transition and heterodimerizes with HER2, leading to activation of PI3K/AKT and MAPK pathways in a ligand-independent manner. Genetic depletion and pharmacological inhibition of AXL restored trastuzumab response in vitro and in vivo. AXL inhibitor plus trastuzumab achieved complete regression in trastuzumab-resistant patient-derived xenograft models. Moreover, AXL expression in HER2-positive primary tumors was able to predict prognosis. Data from the PAMELA trial showed a change in AXL expression during neoadjuvant dual HER2 blockade, supporting its role in resistance. Therefore, our study highlights the importance of targeting AXL in combination with anti-HER2 drugs across HER2-amplified breast cancer patients with high AXL expression. Furthermore, it unveils the potential value of AXL as a druggable prognostic biomarker in HER2-positive breast cancer.
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Affiliation(s)
| | - Enrique J. Arenas
- Preclinical Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), Madrid 28019, Spain
| | - Alex Martínez-Sabadell
- Preclinical Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
| | - Fara Brasó-Maristany
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona 08036, Spain
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona 08036, Spain
| | | | - Eduardo Tormo
- INCLIVA Biomedical Research Institute, Valencia 46010, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), Madrid 28019, Spain
| | - Cristina Hernando
- INCLIVA Biomedical Research Institute, Valencia 46010, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de València, Valencia 46010, Spain
| | - María Teresa Martínez
- INCLIVA Biomedical Research Institute, Valencia 46010, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de València, Valencia 46010, Spain
| | | | - Soraya Simón
- Department of Medical Oncology, Hospital Clínico Universitario de València, Valencia 46010, Spain
| | - Jesús Poveda
- Department of Medical Oncology, Hospital Clínico Universitario de València, Valencia 46010, Spain
| | - Santiago Moragón
- Department of Medical Oncology, Hospital Clínico Universitario de València, Valencia 46010, Spain
| | - Sandra Zazo
- Department of Pathology, IIS Fundación Jiménez Díaz, Madrid 28040, Spain
| | - Débora Martínez
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona 08036, Spain
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona 08036, Spain
| | - Ana Rovira
- Center for Biomedical Network Research on Cancer (CIBERONC), Madrid 28019, Spain
- Department of Medical Oncology, Hospital del Mar, Barcelona 08003, Spain
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
| | - Octavio Burgués
- INCLIVA Biomedical Research Institute, Valencia 46010, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), Madrid 28019, Spain
- Department of Pathology, Hospital Clínico Universitario de València, Valencia 46010, Spain
| | - Federico Rojo
- Center for Biomedical Network Research on Cancer (CIBERONC), Madrid 28019, Spain
- Department of Pathology, IIS Fundación Jiménez Díaz, Madrid 28040, Spain
| | - Joan Albanell
- Center for Biomedical Network Research on Cancer (CIBERONC), Madrid 28019, Spain
- Department of Medical Oncology, Hospital del Mar, Barcelona 08003, Spain
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
- Pompeu Fabra University (UPF), Barcelona 08002, Spain
| | - Begoña Bermejo
- INCLIVA Biomedical Research Institute, Valencia 46010, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), Madrid 28019, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de València, Valencia 46010, Spain
| | - Ana Lluch
- INCLIVA Biomedical Research Institute, Valencia 46010, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), Madrid 28019, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de València, Valencia 46010, Spain
- Department of Medicine, Universidad de Valencia, Valencia 46010, Spain
| | - Aleix Prat
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona 08036, Spain
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona 08036, Spain
- SOLTI Breast Cancer Research Group, Barcelona 08008, Spain
| | - Joaquín Arribas
- Preclinical Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), Madrid 28019, Spain
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona 08003, Spain
- Department of Biochemistry and Molecular Biology, Universitat Autónoma de Barcelona, Barcelona 08193, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona 08010, Spain
| | - Pilar Eroles
- INCLIVA Biomedical Research Institute, Valencia 46010, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), Madrid 28019, Spain
- Department of Physiology, Universidad de Valencia, Valencia 46010, Spain
| | - Juan Miguel Cejalvo
- INCLIVA Biomedical Research Institute, Valencia 46010, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), Madrid 28019, Spain
- Department of Medical Oncology, Hospital Clínico Universitario de València, Valencia 46010, Spain
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Casadevall D, Hernandez-Prat A, Garc A-Alonso S, Arpi-Llucia O, Menendez S, Qin M, Guardia C, Morancho B, Sanchez-Mart N FJ, Zazo S, Gavilan E, Sabbaghi M, Eroles P, Cejalvo JM, Lluch A, Rojo F, Pandiella A, Rovira A, Albanell J. mTOR inhibition and trastuzumab-emtansine (T-DM1) in HER2-positive breast cancer. Mol Cancer Res 2022; 20:1108-1121. [PMID: 35348729 DOI: 10.1158/1541-7786.mcr-21-0545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/06/2022] [Accepted: 03/23/2022] [Indexed: 12/09/2022]
Abstract
In patients with trastuzumab-resistant HER2-positive breast cancer, the combination of everolimus (mTORC1 inhibitor) with trastuzumab failed to show a clinically significant benefit. However, the combination of mTOR inhibition and the antibody-drug conjugate (ADC) trastuzumab-emtansine (T-DM1) remains unexplored. We tested T-DM1 plus everolimus in a broad panel of HER2-positive breast cancer cell lines. The combination was superior to T-DM1 alone in four cell lines (HCC1954, SKBR3, EFM192A, and MDA-MB-36) and in two cultures from primary tumor cells derived from HER2-positive patient-derived xenografts (PDX), but not in BT474 cells. In the trastuzumab-resistant HCC1954 cell line, we characterized the effects of the combination using TAK-228 (mTORC1 and 2 inhibitor) and knockdown of the different mTOR complex components. T-DM1 did not affect mTOR downstream signaling nor induct autophagy. Importantly, mTOR inhibition increased intracellular T-DM1 levels, leading to increased lysosomal accumulation of the compound. The increased efficacy of mTOR inhibition plus T-DM1 was abrogated by lysosome inhibitors (chloroquine and bafilomycin A1). Our experiments suggest that BT474 are less sensitive to T-DM1 due to lack of optimal lysosomal processing and intrinsic resistance to the DM1 moiety. Finally, we performed several in vivo experiments that corroborated the superior activity of T-DM1 and everolimus in HCC1954 and PDX-derived mouse models. In summary, everolimus in combination with T-DM1 showed strong antitumor effects in HER2-positive breast cancer, both in vitro and in vivo. This effect might be related, at least partially, to mTOR-dependent lysosomal processing of T-DM1, a finding that might apply to other ADCs that require lysosomal processing. Implications: Inhibition of mTOR increases the anti-tumor activity of T-DM1, supporting that the combination of mTOR inhibitors and antibody-drug conjugates warrants clinical evaluation in patients with HER2-positive breast cancer.
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Affiliation(s)
| | | | | | - Oriol Arpi-Llucia
- IMIM (Institut Hospital del Mar d'Investigacions M�diques), Barcelona, Barcelona, Spain
| | | | - Mengjuan Qin
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Cristina Guardia
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Barcelona, Spain
| | | | | | - Sandra Zazo
- IIS-Fundaci�n Jim�nez D�az-CIBERONC, UAM, Madrid, Spain
| | | | | | - Pilar Eroles
- INCLIVA Biomedical Research Institute - University of Valencia, Spain. CIBERONC, Valencia, Valencia, Spain
| | - Juan Miguel Cejalvo
- Biomedical Health Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - Ana Lluch
- University of Valencia - Biomedical Research Institute INCLIVA-Hospital Cl�nico de Valencia-CIBERONC, Valencia, Valencia, Spain
| | - Federico Rojo
- IIS-Fundaci�n Jim�nez D�az-CIBERONC, UAM, Madrid, Spain
| | - Atanasio Pandiella
- Centro de Investigaci�n del C�ncer, CIBERONC and IBSAL, Salamanca, Spain
| | | | - Joan Albanell
- Hospital Del Mar Medical Research Instiiute, Barcelona, Spain
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Rojo F, Conde E, Torres H, Cabezón-Gutiérrez L, Bautista D, Ramos I, Carcedo D, Arrabal N, García JF, Galán R, Nadal E. Clinical and economic impact of 'ROS1-testing' strategy compared to a 'no-ROS1-testing' strategy in advanced NSCLC in Spain. BMC Cancer 2022; 22:292. [PMID: 35303812 PMCID: PMC8933896 DOI: 10.1186/s12885-022-09397-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Detection of the ROS1 rearrangement is mandatory in patients with advanced or metastatic non-small cell lung cancer (NSCLC) to allow targeted therapy with specific inhibitors. However, in Spanish clinical practice ROS1 determination is not yet fully widespread. The aim of this study is to determine the clinical and economic impact of sequentially testing ROS1 in addition to EGFR and ALK in Spain. Methods A joint model (decision-tree and Markov model) was developed to determine the cost-effectiveness of testing ROS1 strategy versus a no-ROS1 testing strategy in Spain. Distribution of ROS1 techniques, rates of testing, positivity, and invalidity of biomarkers included in the analysis (EGFR, ALK, ROS1 and PD-L1) were based on expert opinion and Lungpath real-world database. Treatment allocation depending on the molecular testing results was defined by expert opinion. For each treatment, a 3-states Markov model was developed, where progression-free survival (PFS) and overall survival (OS) curves were parameterized using exponential extrapolations to model transition of patients among health states. Only medical direct costs were included (€ 2021). A lifetime horizon was considered and a discount rate of 3% was applied for both costs and effects. Both deterministic and probabilistic sensitivity analyses were performed to address uncertainty. Results A target population of 8755 patients with advanced NSCLC (non-squamous or never smokers squamous) entered the model. Over a lifetime horizon, the ROS1 testing scenario produced additional 157.5 life years and 121.3 quality-adjusted life years (QALYs) compared with no-ROS1 testing scenario. Total direct costs were increased up to € 2,244,737 for ROS1 testing scenario. The incremental cost-utility ratio (ICUR) was 18,514 €/QALY. Robustness of the base-case results were confirmed by the sensitivity analysis. Conclusions Our study shows that ROS1 testing in addition to EGFR and ALK is a cost-effective strategy compared to no-ROS1 testing, and it generates more than 120 QALYs in Spain over a lifetime horizon. Despite the low prevalence of ROS1 rearrangements in NSCLC patients, the clinical and economic consequences of ROS1 testing should encourage centers to test all advanced or metastatic NSCLC (non-squamous and never-smoker squamous) patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09397-4.
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Affiliation(s)
- Federico Rojo
- Hospital Universitario Fundación Jiménez Diaz - CIBERONC, Madrid, Spain
| | - Esther Conde
- Hospital Universiario 12 de Octubre-CIBERONC, Madrid, Spain
| | - Héctor Torres
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | - David Carcedo
- Hygeia Consulting, S.A, Madrid, Spain. .,Hygeia Consulting, Barcelona, Spain.
| | | | | | | | - Ernest Nadal
- Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Spain
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Luque M, Cristóbal I, Sanz-Álvarez M, Santos A, Zazo S, Eroles P, Arpí O, Rovira A, Albanell J, Madoz-Gúrpide J, García-Foncillas J, Rojo F. CIP2A as a Key Regulator for AKT Phosphorylation Has Partial Impact Determining Clinical Outcome in Breast Cancer. J Clin Med 2022; 11:jcm11061610. [PMID: 35329936 PMCID: PMC8955826 DOI: 10.3390/jcm11061610] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 12/07/2022] Open
Abstract
Together with its reported ability to modulate AKT phosphorylation (p-AKT) status in several tumor types, the oncoprotein CIP2A has been described to induce breast cancer progression and drug resistance. However, the clinical and therapeutic relevance of the CIP2A/AKT interplay in breast cancer remains to be fully clarified. Here, we found high p-AKT levels in 80 out of 220 cases (36.4%), which were associated with negative estrogen receptor expression (p = 0.049) and CIP2A overexpression (p < 0.001). Interestingly, p-AKT determined substantially shorter overall (p = 0.002) and progression-free survival (p = 0.003), and multivariate analyses showed its CIP2A-independent prognostic value. Moreover, its clinical relevance was further confirmed in the triple negative and HER2-positive subgroups after stratifying our series by molecular subtype. Functionally, we confirmed in vitro the role of CIP2A as a regulator of p-AKT levels in breast cancer cell lines, and the importance of the CIP2A/AKT axis was also validated in vivo. Finally, p-AKT also showed a higher predictive value of response to doxorubicin than CIP2A in ex vivo analyses. In conclusion, our findings suggest that CIP2A overexpression is a key contributing event to AKT phosphorylation and highlights the CIP2A/AKT axis as a promising therapeutic target in breast cancer. However, our observations highlight the existence of alternative mechanisms that regulate AKT signaling in a subgroup of breast tumors without altered CIP2A expression that determines its independent value as a marker of poor outcome in this disease.
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Affiliation(s)
- Melani Luque
- Pathology Department, IIS-Fundación Jiménez Diaz-UAM, 28040 Madrid, Spain; (M.L.); (M.S.-Á.); (S.Z.); (J.M.-G.)
| | - Ion Cristóbal
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, ISS-FJD-UAM, 28040 Madrid, Spain;
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Diaz-UAM, 28040 Madrid, Spain;
- Correspondence: (I.C.); (F.R.); Tel.: +34-915-504-800 (I.C. & F.R.)
| | - Marta Sanz-Álvarez
- Pathology Department, IIS-Fundación Jiménez Diaz-UAM, 28040 Madrid, Spain; (M.L.); (M.S.-Á.); (S.Z.); (J.M.-G.)
| | - Andrea Santos
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, ISS-FJD-UAM, 28040 Madrid, Spain;
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Diaz-UAM, 28040 Madrid, Spain;
| | - Sandra Zazo
- Pathology Department, IIS-Fundación Jiménez Diaz-UAM, 28040 Madrid, Spain; (M.L.); (M.S.-Á.); (S.Z.); (J.M.-G.)
| | - Pilar Eroles
- Institute of Health Research INCLIVA, 46010 Valencia, Spain;
| | - Oriol Arpí
- Medical Oncology Department, Hospital del Mar, 08003 Barcelona, Spain; (O.A.); (A.R.); (J.A.)
| | - Ana Rovira
- Medical Oncology Department, Hospital del Mar, 08003 Barcelona, Spain; (O.A.); (A.R.); (J.A.)
| | - Joan Albanell
- Medical Oncology Department, Hospital del Mar, 08003 Barcelona, Spain; (O.A.); (A.R.); (J.A.)
| | - Juan Madoz-Gúrpide
- Pathology Department, IIS-Fundación Jiménez Diaz-UAM, 28040 Madrid, Spain; (M.L.); (M.S.-Á.); (S.Z.); (J.M.-G.)
| | - Jesús García-Foncillas
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Diaz-UAM, 28040 Madrid, Spain;
| | - Federico Rojo
- Pathology Department, IIS-Fundación Jiménez Diaz-UAM, 28040 Madrid, Spain; (M.L.); (M.S.-Á.); (S.Z.); (J.M.-G.)
- Correspondence: (I.C.); (F.R.); Tel.: +34-915-504-800 (I.C. & F.R.)
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Conde E, Rojo F, Gómez J, Enguita AB, Abdulkader I, González A, Lozano D, Mancheño N, Salas C, Salido M, Salido-Ruiz E, de Álava E. Molecular diagnosis in non-small-cell lung cancer: expert opinion on ALK and ROS1 testing. J Clin Pathol 2022; 75:145-153. [PMID: 33875457 PMCID: PMC8862096 DOI: 10.1136/jclinpath-2021-207490] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 02/15/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 01/09/2023]
Abstract
The effectiveness of targeted therapies with tyrosine kinase inhibitors in non-small-cell lung cancer (NSCLC) depends on the accurate determination of the genomic status of the tumour. For this reason, molecular analyses to detect genetic rearrangements in some genes (ie, ALK, ROS1, RET and NTRK) have become standard in patients with advanced disease. Since immunohistochemistry is easier to implement and interpret, it is normally used as the screening procedure, while fluorescence in situ hybridisation (FISH) is used to confirm the rearrangement and decide on ambiguous immunostainings. Although FISH is considered the most sensitive method for the detection of ALK and ROS1 rearrangements, the interpretation of results requires detailed guidelines. In this review, we discuss the various technologies available to evaluate ALK and ROS1 genomic rearrangements using these techniques. Other techniques such as real-time PCR and next-generation sequencing have been developed recently to evaluate ALK and ROS1 gene rearrangements, but some limitations prevent their full implementation in the clinical setting. Similarly, liquid biopsies have the potential to change the treatment of patients with advanced lung cancer, but further research is required before this technology can be applied in routine clinical practice. We discuss the technical requirements of laboratories in the light of quality assurance programmes. Finally, we review the recent updates made to the guidelines for the determination of molecular biomarkers in patients with NSCLC.
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Affiliation(s)
- Esther Conde
- Department of Pathology and Laboratory of Therapeutic Targets & CIBERONC, HM Hospitales, Madrid, Spain
| | - Federico Rojo
- Department of Pathology, Hospital Universitario Fundacion Jiménez Díaz, Madrid, Spain
| | - Javier Gómez
- Department of Pathology, Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain,Instituto de Investigación Sanitaria Valdecilla IDIVAL, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Ana Belén Enguita
- Department of Pathology, Clínica Dermatológica Internacional, Madrid, Spain
| | - Ihab Abdulkader
- Department of Pathology, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Ana González
- Department of Pathology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Dolores Lozano
- Department of Pathology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Nuria Mancheño
- Department of Pathology, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | - Clara Salas
- Department of Pathology, Hospital Universitario Puerta del Hierro Majadahonda, Majadahonda, Madrid, Spain
| | - Marta Salido
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - Eduardo Salido-Ruiz
- Department of Pathology, Hospital Universitario de Canarias, La Laguna, Canarias, Spain
| | - Enrique de Álava
- Department of Pathology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Salas C, Martín-López J, Martínez-Pozo A, Hernández-Iglesias T, Carcedo D, Ruiz de Alda L, García JF, Rojo F. Real-world biomarker testing rate and positivity rate in NSCLC in Spain: Prospective Central Lung Cancer Biomarker Testing Registry (LungPath) from the Spanish Society of Pathology (SEAP). J Clin Pathol 2022; 75:193-200. [PMID: 33722840 PMCID: PMC8862081 DOI: 10.1136/jclinpath-2020-207280] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 11/23/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 01/09/2023]
Abstract
AIM The aim of this study was to describe the testing rate and frequency of molecular alterations observed in the Lung Cancer Biomarker Testing Registry (LungPath). METHODS A descriptive study of NSCLC biomarker determinations collected from March 2018 to January 2019, from 38 Spanish hospitals, was carried out. Only adenocarcinoma and not otherwise specified histologies were included for epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), c-ros oncogene 1 (ROS1) and programmed death ligand-1 (PD-L1) expression. The testing rate and the positivity rate were calculated. Multivariate logistic regression was used to explore the joint relationship between independent explanatory factors and both testing and positivity rates. Two models were adjusted: one with sample type and histology as independent factors, and the other adding the testing rate or the positivity rate of the other biomarkers. RESULTS 3226 patient samples were analysed, where EGFR, ALK, ROS1 and PD-L1 information was collected (a total of 12 904 determinations). Overall, 9118 (71.4%) determinations were finally assessed. EGFR (91.4%) and ALK (80.1%) were the mainly tested biomarkers. Positivity rates for EGFR, ALK, ROS1 and PD-L1 were 13.6%, 3.4%, 2.0% and 49.2%, respectively. Multivariate models showed a lower testing rate for ALK in surgical pieces, fine-needle aspiration or other types of samples versus biopsies. CONCLUSIONS Despite the high testing rate in EGFR and ALK in NSCLC, the real-world evidence obtained from the LungPath demonstrates that ROS1 and PD-L1 were not determined in a significant portion of patients. LungPath provides crucial information to improve the coverage in molecular testing in lung cancer, to monitor the positivity rate and the introduction of new biomarker testing in clinical practice.
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Affiliation(s)
- Clara Salas
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain,External Quality Asessment (GCP) of the Spanish Society of Pathology (SEAP), Madrid, Spain
| | | | - Antonio Martínez-Pozo
- External Quality Asessment (GCP) of the Spanish Society of Pathology (SEAP), Madrid, Spain,Pathology Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | | | | | - Federico Rojo
- External Quality Asessment (GCP) of the Spanish Society of Pathology (SEAP), Madrid, Spain,IIS-Fundacion Jimenez Diaz University Hospital CIBERONC, Madrid, Spain
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Loibl S, Hauke J, Gelmon K, Marmé F, Ernst C, Martin M, Untch M, Bonnefoi H, Knudsen E, Im SA, DeMichele A, Van’t Veer L, Kim SB, Bear H, McCarthy N, Turner N, Witkiewicz A, Rojo F, Fasching PA, García-Sáenz JA, Kelly CM, Reimer T, Toi M, Rugo HS, Denkert C, Gnant M, Makris A, Liu Y, Valota O, Felder B, Weber K, Nekljudova V, Hahnen E. Abstract P5-13-36: Germline BRCA1/2 and other predisposition genes in high-risk early-stage HR+/HER2- breast cancer (BC) patients treated with endocrine therapy (ET) with or without palbociclib: A secondary analysis from the PENELOPE-B study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-13-36] [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: In high-risk hormone-receptor (HR)+/HER2- BC patients germline (g) mutations can be found in approximately 14% in BRCA1/2 and in BRCA1/2 and other BC predisposition genes in 20% (Pohl-Rescigno E, et al. JAMA Oncol 2020). In metastatic BC CDK4/6 inhibitors may have greater activity in patients with a BRCA mutation detected in ctDNA (André F, et al. J Clin Oncol 2020). The PENELOPE-B trial did not to show an improved invasive disease-free survival (iDFS) by adding palbociclib to ET in high-risk HR+/HER2- BC (Loibl S, et al. J Clin Oncol 2021). Methods: Blood samples from 898 of 1250 PENELOPE-B patients were available. 445 patients were sampled following a case-cohort design (220 cases defined as patients with any event during follow-up and 225 randomly selected patients without any event [non-cases]) and analyzed for germline variants in BRCA1/2 and 16 non-BRCA1/2 cancer predisposition genes (ATM, BARD1, BRIP1, CDH1, CHEK2, FANCM, MRE11A, NBN, PALB2, PTEN, RAD50, RAD51C, RAD51D, STK11, TP53, XRCC2) by targeted next generation sequencing (NGS). The primary definition of mutational status was the prevalence of a pathogenic mutation (mt) in one or more analyzed BC predisposition genes. Statistical analyses for time-to-event endpoints (iDFS, distant disease-free survival [DDFS], and overall survival [OS]) were based on inverse probability weighting: weighted Cox proportional hazard models and Kaplan-Meier estimates were used. Results: 442 of 445 patients (placebo arm: 104 cases and 105 non-cases; palbociclib arm: 114 cases and 119 non-cases) were successfully analyzed for mutational status. A total of 42 (9.5%) patients (placebo arm: 9.1%; palbociclib arm: 9.9%) carried any mutation. 15 (3.4%) patients had a gBRCA1/2 mt (one of whom carried a gATM mt and one a gCHEK2 mt in addition to gBRCA2 mt) and 29 (6.6%) had mutations in one of the other BC predisposition genes (n=8 CHEK2, n=7 PALB2, n=5 ATM, n=2 RAD50, n=1 for BARD1, FANCM, MRE11A, RAD51C, RAD51D, TP53 and n=1 both RAD51D and BRIP1). The mutational status with respect to all genes analyzed showed no significant correlation to clinical baseline variables. With regard to gBRCA1 and gBRCA2 genes only, the mutational status significantly correlated with age but not with other clinical variables: all 15 (100%) gBRCA mt carriers were younger than 50 years compared to 238 (56%) wildtype (wt) patients (p=0.002). The iDFS rate after 3 years was 80.9% in patients with any mutation and 79.5% in patients without. Mutational status (mt vs. wt) based on all genes analyzed was not prognostic (iDFS: hazard ratio 1.015, 95%CI 0.558-1.784; DDFS: 0.970, 95%CI 0.521-1.758; OS: 0.768, 95%CI 0.274-1.615). Neither the mutated patients had a benefit from palbociclib treatment (palbociclib vs placebo; iDFS: hazard ratio 0.766, 95%CI 0.263-3.022; DDFS: 0.897, 95%CI 0.275-3.489; OS: 0.666, 95%CI 0.063-5.671) nor the wt patients (iDFS: hazard ratio 0.918, 95%CI 0.650-1.303; DDFS: 0.966, 95%CI 0.679-1.393; OS: 0.901, 95%CI 0.573-1.433); interaction tests for treatment arm/mutational status for all time-to-event endpoints were not statistically significant. Analysis in the subgroups of patients by gBRCA1/2 showed similar results but had less statistical power. Conclusions: In this case-cohort analysis of 442 patients enrolled in the PENELOPE-B trial, the detection of BC predisposition genes was lower than expected with 10%. This is probably due to the low rate of gBRCA1/2 carriers (3.4%), which could be influenced by the selection criteria of the trial. Patients with gBRCA1/2 or other BC disposition genes had a comparable outcome to non-carriers in the PENELOPE-B trial.
Citation Format: Sibylle Loibl, Jan Hauke, Karen Gelmon, Frederik Marmé, Corinna Ernst, Miguel Martin, Michael Untch, Hervé Bonnefoi, Erik Knudsen, Seock-Ah Im, Angela DeMichele, Laura Van’t Veer, Sung-Bae Kim, Harry Bear, Nicole McCarthy, Nicholas Turner, Agnieszka Witkiewicz, Federico Rojo, Peter A Fasching, José A García-Sáenz, Catherine M Kelly, Toralf Reimer, Masakazu Toi, Hope S Rugo, Carsten Denkert, Michael Gnant, Andreas Makris, Yuan Liu, Olga Valota, Bärbel Felder, Karsten Weber, Valentina Nekljudova, Eric Hahnen. Germline BRCA1/2 and other predisposition genes in high-risk early-stage HR+/HER2- breast cancer (BC) patients treated with endocrine therapy (ET) with or without palbociclib: A secondary analysis from the PENELOPE-B study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-13-36.
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Affiliation(s)
| | - Jan Hauke
- Center for Familial Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Frederik Marmé
- Medical Faculty Mannheim, Heidelberg University, University Hospital Mannheim, Mannheim, Germany
| | - Corinna Ernst
- Center for Familial Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Miguel Martin
- Instituto de Investigacion Sanitaria Gregorio Marañon, CIBERONC, Universidad Complutense and Spanish Breast Cancer Group, GEICAM, Madrid, Spain
| | | | - Hervé Bonnefoi
- Institut Bergonié and Université de Bordeaux INSERM U916, Bordeaux, France
| | - Erik Knudsen
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Seock-Ah Im
- Seoul National University Hospital, Seoul National University College of Medicine, and KCSG, Seoul, Korea, Republic of
| | | | | | - Sung-Bae Kim
- Asan Medical Center, University of Ulsan College of Medicine, and KCSG, Seoul, Korea, Republic of
| | - Harry Bear
- Division of Surgical Oncology, Massey Cancer Center, Virginia Commonwealth University, VCU Health, Richmond, VA
| | - Nicole McCarthy
- Breast Cancer Trials Australia and New Zealand and University of Queensland, Newcastle, Australia
| | - Nicholas Turner
- The Institute of Cancer Research: Royal Cancer Hospital, London, United Kingdom
| | | | - Federico Rojo
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - José A García-Sáenz
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Hospital Clinico San Carlos (IdISSC) and GEICAM, Madrid, Spain
| | - Catherine M Kelly
- Mater Misericordiae Hospital, University College Dublin and Cancer Trials, Dublin, Ireland
| | - Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Masakazu Toi
- Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hope S Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Carsten Denkert
- Institute of Pathology, Philipps-Universität Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | - Eric Hahnen
- Center for Familial Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Álvarez I, Guerrero-Zotano Á, Cruz J, Martínez P, Hernández M, Rodríguez CA, Rodríguez-Lescure Á, Antolín S, Adrover E, Andrés R, Falo C, Chacón JI, Miguel A, Servitja S, Gramaje MG, Vila MM, Raposo CG, Echarri MJ, Villanueva R, Martorell ATI, Ferreiro SV, Campo R, Miralles JJ, Bezares S, Rojo F, López-Tarruella S. Abstract P1-15-04: Features of HER2+ metastasic patients (pts) from a prospective registry of advanced breast cancer (ABC), GEICAM/2014-03 (RegistEM). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-15-04] [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: The RegistEM study is a non-interventional study that is providing prospective data from around 1900 ABC pts (females and males) diagnosed with advanced disease between 01/Jan/2016 and 31/Dec/2019, either after recurrence or at 1st diagnosis, in 38 Spanish sites representative of the national territory and whose investigators are GEICAM members. Methods: In the current analysis (cut-off date 10/May/2021, ongoing database), we describe the features of 279 pts included in the RegistEM study, with HER2+ (immunohistochemistry [IHQ] 3+, IHQ 2+ and in situ hybridization [ISH]+) tumors at any time of their ABC (5% after the 1st-line therapy). This subgroup has been evaluated because of the interest from a clinical perspective. Multivariate Cox analysis aiming to identify factors associated with overall survival (OS) were built. Results: 279 pts were identified, representing the 15% pts available in the database at the cut-off date. At first ABC diagnosis, 48% pts had recurrent BC (>12 months [mo] from initial BC diagnosis in 93%), 51% de novo metastatic BC and 1% unresectable locally advanced BC (ULABC). The median age was 59 years, 98% were white , 71% postmenopausal and only 1 male was part of this subset. Considering the BC subtype assessed in the most recent tumor lesion before the 1st-line therapy, 264 pts wereHER2 positive (67% with hormone receptor [HR]+). Family history of BC and/or ovarian cancer was reported in 31% pts, and an hereditary-risk genetic test was performed in 25% (66/267 pts). BRCA1/2 and TP53 mutations were reported in 4/20 and 4/19 pts, respectively, and p53 overexpression in 20/46 pts. Lymph nodes (56%), bone (49%), liver (34%), lung (33%), soft tissue (10%) and brain (8%) were the main metastatic sites. Additional data according to HR status and type of ABC are detailed in the table below. In HR- pts, bone metastases were less frequent and lymph nodes metastases more frequent compared to HR+ pts. Visceral disease was present in 68% pts and ≈75% had ≤3 (47% ≤2) locations involved. The most common therapies by line were: 1) 1st-line: CT + dual anti-HER2 blockade (3%), chemotherapy (CT) (almost in all pts taxane-based)+dual anti-HER2 blockade + endocrine therapy (ET) (mainly aromatase inhibitors) (35%), and ET + anti-HER2 blockade or ET + cyclin-dependent kinases 4/6 inhibitors (11%); 2) 2nd-line: anti-HER2 blockade (56%) [mostly an antibody-drug conjugate (90%)], CT + anti-HER2 blockade (18%) and ET + anti-HER2 blockade (14%); 3) 3rd-line: CT + anti-HER2 blockade (55%) and anti-HER2 blockade (22%). The median time-to-progressions to 1st-, 2nd- and 3rd-line were 14, 5, and 4 mo, respectively. A 4th-line therapy was reported in 52% of pts who received a 3rd-line. At database cut-off date, death was reported in 34% of pts. The median OS of this subset of pts was 41 mo (36-49). In a multivariate Cox regression analysis, the following variables were significantly related with worse survival (from ABC diagnosis): Brain (HR=2.62; 95% CI, 1.02-6.73) and Visceral no Brain involvement (HR=2.15; 95% CI, 1.02-4.53) compare to only soft tissue lesions; early stage at first diagnosis (HR=1.77; 95% CI, 1.15-2.73); HR- (HR=1.70; 95% CI, 1.11-2.60) and age (HR=1.04; 95% CI, 1.02-1.07). Conclusions: In this cohort of HER2+ pts with advanced disease, half of them had de novo ABC which was associated with better OS. The median PFS in 1st- and 3rd-line were slightly better in HR+ pts, and in 2nd-line was similar between HR+ and HR- cohorts.
HR+181 (67%)HR- 91 (33%)Recurrent EBC134 (48%)ULABC or de novo M1 145 (52%)Time to recurrence >12 mo in EBC pts., n8435125NALocation of metastaticsites, nBoneBrainLiverLungLymph nodesSoft tissue104 10 62 57 90 1829 9 3232 64 1059 15 36 47 51 2278 6 59 46 1056Líne123123123123n180935690492613385521446333Deaths, n211112111161715141584Therapies by line, nET/BT261922101910212100ET12441011022323CT/BT/ET935031038305830CT/BT4017307581552182366924CT3572353711211BT6431373651145143385The most frequent therapies, nCT + dual anti-HER2 blockade + ET8623331551CT + single-agent HER2 blockade + ET522CT + dual anti-HER2 blockade3493644391016252CT + single-agent HER2 blockade4825641588211521CT5573354711411ET*22105212162644ET + HER2 blockade1213411662782Anti-HER2 blockade6431073651145143382Median duration of treatment, mo125585310441064TTP (mo), median (range)15(1-47)5(1-32)5(0-18)11(2-38)5(1-27)4(2-12)12 (1-47)5(1-26)4(0-17)17(2-45)7(1-32)4(1-18)Median PFS, mo14561154------HR: hormone receptor; EBC: early breast cancer; ULABC: unresectable locally advanced breast cancer; M1: metastatic; mo: month; ET: endrocrine therapy; BT: biological therapy; CT: chemotherapy; TTP: time-to-progression; PFS: progression-free survival. *ET includes aromatase inhibitors or selective estrogen receptor degraders, as single-agents or combined with cyclin-dependent kinases 4/6 inhibitors.
Citation Format: Isabel Álvarez, Ángel Guerrero-Zotano, Josefina Cruz, Purificación Martínez, María Hernández, César A Rodríguez, Álvaro Rodríguez-Lescure, Silvia Antolín, Encarna Adrover, Raquel Andrés, Catalina Falo, Jose Ignacio Chacón, Ana Miguel, Sonia Servitja, Maria Galán Gramaje, Mireia Margelí Vila, César Gómez Raposo, María Jose Echarri, Rafael Villanueva, Ariadna TIbau Martorell, Silvia Varela Ferreiro, Ruth Campo, Juan Jose Miralles, Susana Bezares, Federico Rojo, Sara López-Tarruella. Features of HER2+ metastasic patients (pts) from a prospective registry of advanced breast cancer (ABC), GEICAM/2014-03 (RegistEM) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-15-04.
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Affiliation(s)
- Isabel Álvarez
- Unidad de Gestión del Cáncer de Guipúzcoa (Osakidetza-OSI Donostialdea_Onkologikoa)-BioDonostia. GEICAM Spanish Breast Cancer Group, San Sebastián, Spain
| | - Ángel Guerrero-Zotano
- Fundación Instituto Valenciano de Oncología (FIVO). GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - Josefina Cruz
- Hospital Universitario de Canarias. GEICAM Spanish Breast Cancer Group, Santa Cruz de Tenerife, Spain
| | | | - María Hernández
- Complejo Hospitalario Universitario de Gran Canaria Doctor Negrín. GEICAM Spanish Breast Cancer Group, Las Palmas de Gran Canaria, Spain
| | - César A Rodríguez
- Hospital Universitario de Salamanca-IBSAL. GEICAM Spanish Breast Cancer Group, Salamanca, Spain
| | | | - Silvia Antolín
- Hospital Clínico Universitario Lozano Blesa. GEICAM Spanish Breast Cancer Group, Zaragoza, Spain
| | - Encarna Adrover
- Hospital General Universitario de Albacete. GEICAM Spanish Breast Cancer Group, Albacete, Spain
| | - Raquel Andrés
- Hospital Clínico Universitario Lozano Blesa. GEICAM Spanish Breast Cancer Group, Zaragoza, Spain
| | - Catalina Falo
- ICO Hospitalet. GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - Jose Ignacio Chacón
- Hospital Virgen de la Salud. GEICAM Spanish Breast Cancer group, Toledo, Spain
| | - Ana Miguel
- ALTHAIA Xarxa asistencial de Manresa. GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - Sonia Servitja
- Hospital del Mar. GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - Maria Galán Gramaje
- Hospital Son Llátzer. GEICAM Spanish Breast Cancer Group, Palma de Mallorca, Spain
| | - Mireia Margelí Vila
- ICO-Badalona.B-ARGO (Badalona Appllied Reasearch Group in Oncology). GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | - César Gómez Raposo
- Hospital Universitario Infanta Sofía. GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - María Jose Echarri
- Hospital Severo Ochoa. GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Rafael Villanueva
- Hospital de Sant Joan Despi Moisés Broggi. GEICAM Spanish Breast Cancer Group, Barcelona, Spain
| | | | | | - Ruth Campo
- GEICAM Spanish Breast Cancer Group, San Sebastián, Spain
| | | | | | - Federico Rojo
- Hospital Universitario Fundación Jiménez Díaz. Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense. GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Sara López-Tarruella
- Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense. CIBERONC-ISCIII- .GEICAM Spanish Breast Cancer Group, Madrid, Spain
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Denkert C, Marmé F, Martin M, Untch M, Bonnefoi H, Kim SB, Bear H, Witkiewicz A, Im SA, DeMichele A, Van’t Veer L, McCarthy N, Stiewe T, Gelmon KA, García-Sáenz JA, Kelly CM, Reimer T, Knudsen E, Turner N, Rojo F, Fasching PA, Teply-Szymanski J, Liu Y, Toi M, Rugo HS, Gnant M, Makris A, Felder B, Weber K, Loibl S. Abstract PD2-04: Molecular plasticity of luminal breast cancer and response to CDK 4/6 inhibition - The biomarker program of the PENELOPE-B trial investigating post-neoadjuvant palbociclib. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd2-04] [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: Molecular plasticity of breast cancer is crucial for the development of therapy-resistant disease. In this investigation, we studied changes in molecular signatures between pretherapeutic (pre-Tx) and post-therapeutic (post-NACT) tumor samples from patients included in the PENELOPE-B (NCT01864746) trial. The phase III PENELOPE-B study did not show a significant benefit from palbociclib in women with centrally confirmed HR+, HER2- primary breast cancer without a pathological complete response after taxane-containing neoadjuvant chemotherapy (NACT) and at high-risk of relapse (CPS-EG score ≥3 or 2 and ypN+) (Loibl et al. JCO 2021). However, first translational investigations showed that a small number of patients with a luminal-B tumor subtype, based on absolute intrinsic molecular subtyping (AIMS, Paquet & Hallet, JNCI 2014) subtyping after NACT, had a numerical benefit from post-NACT palbociclib. We have therefore extended the analysis and included a cohort of paired pre-Tx and post-NACT samples. Methods: We investigated gene expression in pre-Tx (n=259) tumor tissue samples using the HTG EdgeSeq Oncology Biomarker Panel including 2549 genes (HTG Molecular Diagnostics Inc.); for the same patients the same panel on post-NACT residual tumor samples were available. The paired samples were selected based on a case-cohort approach. Based on 91 genes of this panel, the AIMS subtype was calculated. In addition, we performed exploratory biomarker analyses to identify genes and gene signatures with prognostic and predictive relevance. After completion of NACT, PENELOPE-B patients were randomized to palbociclib versus placebo in addition to standard endocrine therapy. Results: The prevalence of AIMS subtypes, in particular LumA vs LumB, changed in pre-Tx and post-NACT tumors. In the pre-Tx samples, 115 (44%) and 123 (47%) of tumors had LumA and LumB subtypes, respectively, as expected from a high-risk cohort. However, in the post-NACT samples, LumA tumors were predominant (n=183, 71%) over LumB (n=30; 12%). 78 (30%) and 6 (2%) tumors switched their subtype from LumB to LumA and LumA to LumB, respectively. For further analyses, we compared the groups of low proliferating (LumA and NormL) and high proliferating subtypes (LumB, BasalL and HER2E). In bivariable Cox regression analysis, the grouped pre-Tx and post-NACT AIMS subtypes were independent prognostic factors for iDFS: HR=1.85 (1.16-2.98, p=0.011) for pre-Tx LumB/BasalL/HER2E vs LumA/NormL and HR=2.18 (1.24-3.84, p=0.007) for post-NACT. Similar results were found when adjusted for prognostic clinical factors and for DDFS and OS endpoints although the pre-Tx subtype did not reach significance. These and further Cox models investigating interaction effects show that patients with tumors developing from high (pre-Tx) to low proliferation (post-NACT) had a higher iDFS risk compared to stable low proliferating tumors but a lower iDFS risk compared to stable high proliferating tumors. Neither in the pre-Tx LumB/BasalL/HER2E nor in the pre-Tx LumA/NormL subgroup a benefit from palbociclib was observed. Based on the results of the AIMS subtyping, we extended the exploratory analysis to identify genes that might be involved in the prognostic and predictive effects as well as genes driving the subtype switch. The analysis is ongoing and the relevant genes will be presented at the conference. Conclusions: Our findings show that the switch from high-risk molecular subtypes (in particular LumB) to low-risk subtypes (in particular LumA) is common in neoadjuvant therapy of luminal tumors. The adaptation of luminal high-risk tumors to therapy-induced stress is crucial for the clinical outcome and the results suggest that molecular defined tumor subtypes might not be as stable as originally thought.
Citation Format: Carsten Denkert, Frederik Marmé, Miguel Martin, Michael Untch, Hervé Bonnefoi, Sung-Bae Kim, Harry Bear, Agnieszka Witkiewicz, Seock-Ah Im, Angela DeMichele, Laura Van’t Veer, Nicole McCarthy, Thorsten Stiewe, Karen A. Gelmon, José A. García-Sáenz, Catherine M. Kelly, Toralf Reimer, Erik Knudsen, Nicholas Turner, Federico Rojo, Peter A. Fasching, Julia Teply-Szymanski, Yuan Liu, Masakazu Toi, Hope S. Rugo, Michael Gnant, Andreas Makris, Bärbel Felder, Karsten Weber, Sibylle Loibl. Molecular plasticity of luminal breast cancer and response to CDK 4/6 inhibition - The biomarker program of the PENELOPE-B trial investigating post-neoadjuvant palbociclib [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD2-04.
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Affiliation(s)
- Carsten Denkert
- Institute of Pathology, Philipps-Universität Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | - Frederik Marmé
- Medical Faculty Mannheim, Heidelberg University, University Hospital Mannheim, Mannheim, Germany
| | - Miguel Martin
- Instituto de Investigacion Sanitaria Gregorio Marañon, CIBERONC, Universidad Complutense and Spanish Breast Cancer Group, GEICAM, Madrid, Spain, Madrid, Spain
| | | | - Hervé Bonnefoi
- Institut Bergonié and Université de Bordeaux INSERM U916, Bordeaux, Bordeaux, France
| | - Sung-Bae Kim
- The Asan Medical Center AMC, Seoul, Seoul, Korea, Republic of
| | - Harry Bear
- Division of Surgical Oncology, Massey Cancer Center, Virginia Commonwealth University, VCU Health, Richmond, Richmond, VA
| | | | - Seock-Ah Im
- Seoul National University Hospital, Seoul National University College of Medicine, and KCSG, Seoul, Seoul, Korea, Republic of
| | - Angela DeMichele
- Penn Medicine Abramson Cancer Center, Philadelphia, Philadelphia, PA
| | | | - Nicole McCarthy
- Breast Cancer Trials Australia and New Zealand and University of Queensland, Newcastle, Australia
| | - Thorsten Stiewe
- Institute of Pathology, Philipps-Universität Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | | | - José A. García-Sáenz
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Hospital Clinico San Carlos (IdISSC) and GEICAM, Madrid, Madrid, Spain
| | - Catherine M. Kelly
- Mater Misericordiae Hospital, University College Dublin and Cancer Trials, Dublin, Ireland, Dublin, Ireland
| | - Toralf Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - Erik Knudsen
- Roswell Park Comprehensive Cancer Center, Buffalo, Buffalo, NY
| | - Nicholas Turner
- The Institute of Cancer Research: Royal Cancer Hospital, London, London, United Kingdom
| | - Federico Rojo
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid, Spain
| | | | - Julia Teply-Szymanski
- Institute of Pathology, Philipps-Universität Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | - Yuan Liu
- Pfizer Inc., San Diego, San Diego, CA
| | - Masakazu Toi
- Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hope S. Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, San Francisco, CA
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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García-Foncillas J, Tejera-Vaquerizo A, Sanmartín O, Rojo F, Mestre J, Martín S, Azinovic I, Mesía R. Update on Management Recommendations for Advanced Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14030629. [PMID: 35158897 PMCID: PMC8833756 DOI: 10.3390/cancers14030629] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 12/02/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, which predominantly occurs on the head and neck. Early detection and treatment of primary tumours is crucial to limit progression and local invasion of deep tissues. While high-risk markers of poor prognosis have been identified, factors predicting regional control or survival remain uncertain. Therefore, diagnosis and management of cSCC should be performed individually, considering patient’s clinicopathological profile and the best available treatment options. Surgical excision, radiotherapy, and/or systemic treatments can be selected depending on patient’s status and tumour stage. Considering that a more comprehensive assessment will be provided by a multidisciplinary team, we aimed to generate a practical document that may assist oncologists and dermatologists on the prognosis, diagnosis, management, and follow-up of patients with advanced cSCC. Abstract Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, the incidence of which has risen over the last years. Although cSCC rarely metastasizes, early detection and treatment of primary tumours are critical to limit progression and local invasion. Several prognostic factors related to patients’ clinicopathologic profile and tumour features have been identified as high-risk markers and included in the stratification scales, but their association with regional control or survival is uncertain. Therefore, decision-making on the diagnosis and management of cSCC should be made based on each individual patient’s characteristics. Recent advances in non-invasive imaging techniques and molecular testing have enhanced clinical diagnostic accuracy. Surgical excision is the mainstay of local treatment, whereas radiotherapy (RT) is recommended for patients with inoperable disease or in specific circumstances. Novel systemic treatments including immunotherapies and targeted therapies have changed the therapeutic landscape for cSCC. The anti-PD-1 agent cemiplimab is currently the only FDA/EMA-approved first-line therapy for patients with locally advanced or metastatic cSCC who are not candidates for curative surgery or RT. Given the likelihood of recurrence and the increased risk of developing multiple cSCC, close follow-up should be performed during the first years of treatment and continued long-term surveillance is warranted.
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Affiliation(s)
- Jesús García-Foncillas
- Departamento de Oncología, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (F.R.); (I.A.)
- Department of Medicine, Faculty of Medicine, Universidad Autónoma de Madrid, 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-900-815-019
| | - Antonio Tejera-Vaquerizo
- Instituto Dermatológico GlobalDerm, Palma del Río, 14700 Cordoba, Spain;
- Unidad de Oncología Cutánea, Hospital San Juan de Dios, 14012 Cordoba, Spain
| | | | - Federico Rojo
- Departamento de Oncología, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (F.R.); (I.A.)
| | - Javier Mestre
- Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | | | - Ignacio Azinovic
- Departamento de Oncología, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (F.R.); (I.A.)
| | - Ricard Mesía
- B-ARGO Group, Medical Oncology Department, Institut Català d’Oncologia (ICO), Badalona, 08908 Barcelona, Spain;
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Martín-López J, Rojo F, Martínez-Pozo A, Hernández-Iglesias T, Carcedo D, de Alda LR, García JF, Salas C. Biomarker testing strategies in non-small cell lung cancer in the real-world setting: analysis of methods in the Prospective Central Lung Cancer Biomarker Registry (LungPath) from the Spanish Society of Pathology (SEAP). J Clin Pathol 2021; 76:327-332. [PMID: 34903610 PMCID: PMC10176377 DOI: 10.1136/jclinpath-2021-208034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022]
Abstract
AIMS The aim of this study is to extend the analysis of the Lung Cancer Biomarker Testing Registry (LungPath), by analysing the techniques used in the determination of epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), c-ros oncogene 1 (ROS1) and programmed death ligand-1 (PD-L1) for the diagnostic of patients with advanced non-small-cell lung cancer (NSCLC). METHODS Information of the technique used for the determination of EGFR, ALK, ROS1 and PD-L1 was recorded from March 2018 to January 2019 from 44 centres, but only 34 centres matched with the 38 centres previously analysed, allowing to analyse the techniques used in 8970 matched determinations of EGFR, ALK, ROS1 and PD-L1. Therefore, a by-centre analysis studied the level of implementation of the techniques in the 44 centres, while a by-determination analysis made it possible to assess the overall frequency of the techniques used on the 9134 matched samples. RESULTS By-centre analysis showed that only 46.5% and 25.6% of the centres used reflex strategies for ALK and ROS1 determination, respectively. By-determination analysis showed that 94.4% of EGFR determinations were performed by PCR, 80.7% of ALK determinations were performed by IHC with clone D5F3, while 55.7% of ROS1 determinations were performed by IHC with clone D4D6. 22C3 were the PD-L1 clone more used (43.5%) followed by SP263 clone (31.1%). CONCLUSIONS The real-world evidence obtained from LungPath shows the effort of Spanish hospitals in performing biomarker determination in NSCLC with different methodologies despite that next-generation sequencing (NGS) utilisation in the year of the analysis was low. Biomarker determination results could be optimised with the incorporation of sequencing methods such as NGS in pathology departments.
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Affiliation(s)
- Javier Martín-López
- Pathology Department, Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain
| | - Federico Rojo
- Pathology Department, Hospital Universitario Fundacion Jimenez Diaz-CIBERONC, Madrid, Spain.,External Quality Asessment (GCP), Spanish Society of Anatomical Pathology, Madrid, Spain
| | - Antonio Martínez-Pozo
- External Quality Asessment (GCP), Spanish Society of Anatomical Pathology, Madrid, Spain.,Pathology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | | | | | - Clara Salas
- Pathology Department, Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain.,External Quality Asessment (GCP), Spanish Society of Anatomical Pathology, Madrid, Spain
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Conde E, Hernandez S, Caminoa A, Benito A, Martinez R, Alonso M, Jimenez B, Boni V, Remon J, Pijuan L, Clave S, Arriola E, Esteban I, De Castro J, Sansano I, Felip E, Abdulkader I, Garcia J, Rojo F, Domine M, Teixido C, Reguart N, Compañ D, Insa A, Mancheño N, Palanca S, Juan O, Baixeras N, Nadal E, Cebollero M, Calles A, Martin P, Salas C, Provencio M, Aranda I, Massuti B, Lopez-Vilaro L, Majem M, Enguita A, Paz-Ares L, Garrido P, Lopez-Rios F. MA14.02 RET Fusion Testing in Advanced Non-Small Cell Lung Carcinoma Patients: the RETING Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cristóbal I, Santos A, Rubio J, Rojo F, García-Foncillas J. Comment on "miR-199b-5p-DDR1-ERK signalling axis suppresses prostate cancer metastasis via inhibiting epithelial-mesenchymal transition". Br J Cancer 2021; 125:618-619. [PMID: 34012034 PMCID: PMC8367958 DOI: 10.1038/s41416-021-01433-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 02/02/2023] Open
Affiliation(s)
- Ion Cristóbal
- grid.476442.7Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jimenez Díaz-UAM, Madrid, Spain ,grid.419651.e0000 0000 9538 1950Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jimenez Díaz-UAM, Madrid, Spain
| | - Andrea Santos
- grid.476442.7Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jimenez Díaz-UAM, Madrid, Spain ,grid.419651.e0000 0000 9538 1950Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jimenez Díaz-UAM, Madrid, Spain
| | - Jaime Rubio
- grid.476442.7Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jimenez Díaz-UAM, Madrid, Spain ,grid.419651.e0000 0000 9538 1950Medical Oncology Department, University Hospital “Fundacion Jimenez Diaz”, Madrid, Spain
| | - Federico Rojo
- grid.419651.e0000 0000 9538 1950Pathology Department, IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Jesús García-Foncillas
- grid.419651.e0000 0000 9538 1950Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jimenez Díaz-UAM, Madrid, Spain ,grid.419651.e0000 0000 9538 1950Medical Oncology Department, University Hospital “Fundacion Jimenez Diaz”, Madrid, Spain
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Guardia C, Bianchini G, Arpí-LLucià O, Menendez S, Casadevall D, Galbardi B, Dugo M, Servitja S, Montero JC, Soria-Jiménez L, Sabbaghi M, Peña R, Madoz-Gúrpide J, Lloveras B, Lluch A, Eroles P, Arribas J, Pandiella A, Gianni L, Rojo F, Rovira A, Albanell J. Preclinical and Clinical Characterization of Fibroblast-derived Neuregulin-1 on Trastuzumab and Pertuzumab Activity in HER2-positive Breast Cancer. Clin Cancer Res 2021; 27:5096-5108. [PMID: 34385295 DOI: 10.1158/1078-0432.ccr-20-2915] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 05/29/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To characterize expression of neuregulin-1 (NRG1), an HER3 ligand, in HER2-positive breast cancer and its relation with the efficacy of trastuzumab with or without pertuzumab. EXPERIMENTAL DESIGN Characterization of NRG1 expression in tumor cell lines, in tumor specimens, and in cancer-associated fibroblasts (CAFs). Patient-derived CAFs were used to investigate NRG1 impact on the activity of trastuzumab with or without pertuzumab in HER2-positive breast cancer cells. The relationship between NRG1 expression and pathologic response to anti-HER2-based neoadjuvant therapy was assessed in a retrospective patient cohort and in the NeoSphere trial. RESULTS NRG1 was expressed in HER2-positive breast cancer-derived fibroblasts at significantly higher levels than in cancer cells. NRG1 and the conditioned media (CM) from CAFs phosphorylated HER3 and AKT in cancer cells and mediated trastuzumab resistance. Stable genetic depletion of NRG1 from CAFs overcame trastuzumab resistance. Pertuzumab effectively suppressed trastuzumab resistance mediated by either NRG1 or CAF's CM. NRG1 engaged an epithelial-to-mesenchymal transition that was prevented by trastuzumab and pertuzumab. In clinical samples, stromal and/or tumor cell expression of NRG1 determined by immunohistochemistry was uncommon (13.2%) yet significantly linked with residual disease following trastuzumab-based neoadjuvant therapy. In the NeoSphere trial, the magnitude of the difference of pathologic complete response rates favoring the pertuzumab arm was higher in the NRG1-high group. CONCLUSIONS CAF-derived NRG1 mediates trastuzumab resistance through HER3/AKT, which might be reverted by pertuzumab. In patients with HER2-positive breast cancer, high expression of NRG1 was associated to poor response to trastuzumab, but not in combination with pertuzumab.
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Affiliation(s)
- Cristina Guardia
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
| | | | - Oriol Arpí-LLucià
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
| | - Silvia Menendez
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
| | - David Casadevall
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
| | - Barbara Galbardi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Matteo Dugo
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Sonia Servitja
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
| | | | - Luis Soria-Jiménez
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
| | - MohammadA Sabbaghi
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
| | - Raul Peña
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Juan Madoz-Gúrpide
- Department of Pathology, IIS-Fundación Jiménez Díaz-CIBERONC, Madrid, Spain
| | - Belen Lloveras
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - Ana Lluch
- INCLIVA Biomedical Research Institute, Hospital Clínico de Valencia-CIBERONC, Universitat de València, Barcelona, Spain
| | - Pilar Eroles
- INCLIVA Biomedical Research Institute, Hospital Clínico de Valencia-CIBERONC, Universitat de València, Barcelona, Spain.,INCLIVA, Biomedical Research Institute, Valencia, Spain
| | - Joaquin Arribas
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Preclinical Research Program, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,CIBERONC, Instituto de Salud Carlos III, Madrid, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Atanasio Pandiella
- Centro de Investigación del Cáncer, IBSAL-CSIC-CIBERONC, Salamanca, Spain
| | | | - Federico Rojo
- Department of Pathology, IIS-Fundación Jiménez Díaz-CIBERONC, Madrid, Spain
| | - Ana Rovira
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
| | - Joan Albanell
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. .,Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
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Garrido P, Hladun R, de Álava E, Álvarez R, Bautista F, López-Ríos F, Colomer R, Rojo F. Multidisciplinary consensus on optimising the detection of NTRK gene alterations in tumours. Clin Transl Oncol 2021; 23:1529-1541. [PMID: 33620682 PMCID: PMC8238709 DOI: 10.1007/s12094-021-02558-0] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/24/2021] [Indexed: 12/21/2022]
Abstract
The recent identification of rearrangements of neurotrophic tyrosine receptor kinase (NTRK) genes and the development of specific fusion protein inhibitors, such as larotrectinib and entrectinib, have revolutionised the diagnostic and clinical management of patients presenting with tumours with these alterations. Tumours that harbour NTRK fusions are found in both adults and children; and they are either rare tumours with common NTRK fusions that may be diagnostic, or more prevalent tumours with rare NTRK fusions. To assess currently available evidence on this matter, three key Spanish medical societies (the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Pathological Anatomy (SEAP), and the Spanish Society of Paediatric Haematology and Oncology (SEHOP) have brought together a group of experts to develop a consensus document that includes guidelines on the diagnostic, clinical, and therapeutic aspects of NTRK-fusion tumours. This document also discusses the challenges related to the routine detection of these genetic alterations in a mostly public Health Care System.
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Affiliation(s)
- P. Garrido
- Sociedad Española de Oncología Médica (SEOM), Departamento de Oncología Médica, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERONC, Madrid, Spain
| | - R. Hladun
- Sociedad Española de Hematología y Oncologías Pediátricas (SEHOP), Departamento de Oncología, Hematología y Trasplante de Progenitores Hematopoyéticos Pediátricos, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - E. de Álava
- Sociedad Española de Anatomía Patológica (SEAP), Departamento de Citología e Histología Normal y Patológica, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Facultad de Medicina, Universidad de Sevilla, CIBERONC, Sevilla, Spain
| | - R. Álvarez
- Sociedad Española de Oncología Médica (SEOM), Departamento de Oncología Médica, Hospital Universitario Gregorio Marañón. Instituto Investigación Sanitaria Gregorio Marañon (IISGM), Madrid, Spain
| | - F. Bautista
- Sociedad Española de Hematología y Oncologías Pediátricas (SEHOP), Oncología Pediátrica, Departamento de Hematología y Trasplante de Células Madre Hematopoyéticas, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | - F. López-Ríos
- Sociedad Española de Anatomía Patológica (SEAP), Departamento de Patología, Laboratorio de Dianas Terapéuticas, Hospital Universitario HM Sanchinarro, CIBERONC, Madrid, Spain
| | - R. Colomer
- Sociedad Española de Oncología Médica (SEOM), Departamento de Oncología Médica, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Cátedra UAM-Fundación Instituto Roche de Medicina Personalizada de Precisión, Madrid, Spain
| | - F. Rojo
- Sociedad Española de Anatomía Patológica (SEAP), Departamento de Patología, IIS-Fundación Universitaria Jiménez Díaz, CIBERONC, Madrid, Spain
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