Influence of Androgen Deprivation Therapy on the Development of Sarcopenia in Patients with Prostate Cancer: A Systematic Review

The changes in body composition during androgen deprivation therapy (ADT) in patients suffering from prostate cancer (PCa) are recognized by professionals more often as biomarker for effective treatment. The aim of this study was to investigate the impact of ADT on the sarcopenia development in PCa. The following databases were used: PubMed, Embase, Web of Science and Scopus databases. Out of 2183 studies, 7 were included in this review. The fixed-effect model was used in the meta-analysis. A significant increase in SATI (Subcutaneous Adipose Tissue Index) of 0.32 (95% CI: 0.13-0.51) p = 0.001, decrease in SMI (Skeletal Muscle Index) of -0.38 (95% CI: -0.57 to -0.19) p < 0.0001, and SMD (Skeletal Muscle Density) of -0.46 (95% CI: -0.69 to -0.24) p < 0.0001 were observed. No statistical association was visible between ADT and changes in BMI (Body Mass Index), 0.05 (95% CI: -0.18-0.28), p = 0.686, and VATI (Visceral Adipose Tissue Index): 0.17 (95% CI: -0.02 to 0.37), p = 0.074. In conclusion, the ADT significantly contributes to the body composition changes and sarcopenia development.

Cardiac Safety and Efficacy of SB3 Trastuzumab Biosimilar for ERBB2-Positive Early Breast Cancer: Secondary Analysis of a Randomized Clinical Trial

Importance

Trastuzumab has been the standard of care for the treatment of patients with ERBB2-positive breast cancer; however, cardiac events have been reported. This long-term follow-up study provides clinical evidence supporting the similarity of a trastuzumab biosimilar (SB3) to reference trastuzumab (TRZ).

Objective

To compare cardiac safety and efficacy between SB3 and TRZ for patients with ERBB2-positive early or locally advanced breast cancer after up to 6 years of follow-up.

Design, Setting, and Participants

This prespecified secondary analysis of a randomized clinical trial, conducted from April 2016 to January 2021, included patients with ERBB2-positive early or locally advanced breast cancer from a multicenter double-blind, parallel-group, equivalence phase 3 randomized clinical trial of SB3 vs TRZ with concomitant neoadjuvant chemotherapy who completed neoadjuvant and adjuvant treatment.

Interventions

In the original trial, patients were randomized to either SB3 or TRZ with concomitant neoadjuvant chemotherapy for 8 cycles (4 cycles of docetaxel followed by 4 cycles of fluorouracil, epirubicin, and cyclophosphamide). After surgery, patients continued SB3 or TRZ monotherapy for 10 cycles of adjuvant treatment per previous treatment allocation. Following neoadjuvant and adjuvant treatment, patients were monitored for up to 5 years.

Main Outcomes and Measures

The primary outcomes were the incidence of symptomatic congestive heart failure and asymptomatic, significant decrease in left ventricular ejection fraction (LVEF). The secondary outcomes were event-free survival (EFS) and overall survival (OS).

Results

A total of 538 female patients were included (median age, 51 years [range, 22-65 years]). Baseline characteristics were comparable between the SB3 and TRZ groups. Cardiac safety was monitored for 367 patients (SB3, n = 186; TRZ, n = 181). Median follow-up was 68 months (range, 8.5-78.1 months). Asymptomatic, clinically significant LVEF decreases were rarely reported (SB3, 1 patient [0.4%]; TRZ, 2 [0.7%]). No patient experienced symptomatic cardiac failure or death due to a cardiovascular event. Survival was evaluated for the 367 patients in the cardiac safety cohort and an additional 171 patients enrolled after a protocol amendment (538 patients [SB3, n = 267; TRZ, n = 271]). No difference was observed in EFS or OS between treatment groups (EFS: hazard ratio [HR], 0.84; 95% CI, 0.58-1.20; P = .34; OS: HR, 0.61; 95% CI, 0.36-1.05; P = .07). Five-year EFS rates were 79.8% (95% CI, 74.8%-84.9%) in the SB3 group and 75.0% (95% CI, 69.7%-80.3%) in the TRZ group, and OS rates were 92.5% (95% CI, 89.2%-95.7%) in the SB3 group and 85.4% (95% CI, 81.0%-89.7%) in the TRZ group.

Conclusions and Relevance

In this secondary analysis of a randomized clinical trial, SB3 demonstrated cardiac safety and survival comparable to those of TRZ after up to 6 years of follow-up in patients with ERBB2-positive early or locally advanced breast cancer.

Trial Registration

ClinicalTrials.gov Identifier: NCT02771795.

Androgen Deprivation Therapy for Prostate Cancer Influences Body Composition Increasing Risk of Sarcopenia

Computed tomography (CT) scans used in treatment response assessment in prostate cancer (PCa) patients are a useful tool for nutritional status evaluation. The aim of this study was to assess the nutritional status, including sarcopenia development based on CT scans, in PCa patients and its association with progression-free survival (PFS). Sixty-four PCa patients were included (group 1: 34 patients undergoing androgen deprivation therapy (ADT) with docetaxel due to newly diagnosed, hormone-sensitive, metastatic PCa and group 2: 30 patients with castration-resistant metastatic PCa continuing ADT therapy with enzalutamide or abiraterone acetate). Nutritional status was evaluated with anthropometrical parameters, Nutritional Risk Score (NRS), and CT scans at the L3 vertebrae. Survival analyses were performed. According to NRS, nutritional status was significantly related to PFS. In both groups, there was a significant reduction in muscle tissue (total muscle tissue and skeletal muscle index). A significant increase in the distribution of adipose tissue (subcutaneous fat, visceral fat, subcutaneous adipose tissue index, and visceral adipose tissue index) in group one was observed. Sarcopenia was diagnosed in patients but with no influence on PFS. Significant reduction in muscle mass and increase in fat mass was observed in patients treated for PCa with no impact on PFS. The NRS was related to PFS in PCa patients and associated with body composition, assessed by CT after the castration therapy. Long-term castration combined with abiraterone therapy with prednisone or enzalutamide significantly influenced muscle tissue and may lead to sarcopenia development.

Abstract P2-23-06: Estrogen receptor-negative progesterone receptor-positive breast cancer is a molecularly distinct group characterized by the down-regulation of genes controlled by ESR1 and SUZ12

Background: Single hormone receptor-positive breast cancers (BCs) display two distinct phenotypes: ER+/PgR– and ER–/PgR+ further stratified by their HER2 status. Their molecular features are not well defined. Our study aimed to identify differentially expressed genes in ER–/PgR+ BCs compared to other phenotypes. Methods: Our cohort comprised 15 ER+/PgR–/HER2–, 11 ER+/PgR–/HER2+, 17 ER–/PgR+/HER2–, 9 ER–/PgR+/HER2+, 5 ER+/PgR+/HER2–, and 5 ER–/PgR–/HER2– invasive BCs collected from 9 Polish and 2 Hungarian centers. The cases were selected from a larger cohort after being matched according to grade, HER2 status, lymph nodes, and distant metastasis status. ER–/PgR+ group was thoroughly validated via immunohistochemistry [Kunc et al. 2022]. The expression of 776 genes was profiled with nCounter® Breast Cancer 360™ Panel in archival formalin-fixed paraffin-embedded tissue samples. A gene was defined as differentially expressed between groups if it met the following criteria: the log2 fold-change in the expression of &gt;1 or ←1 and the p-value &lt; 0.05 (Mann-Whitney U test). Additionally, weighted correlation network analysis (WGCNA) was performed to identify modules of at least 15 highly correlated genes. Subsequently, the association between gene modules and PgR status in ER– subgroup was performed. Identified mRNAs were subjected to functional annotation analysis to determine the top enriched pathways. Results: ER–/PgR+ BCs were characterized by significantly lower expression of ESR1 compared to double-positive (p&lt; 0.001) and ER+/PgR– tumors (p&lt; 0.001), whereas PGR expression was higher compared to ER+/PgR– (p&lt; 0.001), and no significantly different from ER+/PgR+ BCs (p=0.14). Triple-negative BCs had no detectable PGR mRNA. Four genes (MIA, ID4, FOXC1, CDC20) were consistently up-regulated and six genes (FAM214A, MLPH, NFKBIZ, FOS, SLC44A4, SPDEF) were down-regulated in ER–/PgR+/HER2– tumors compared to other HER2– subgroups. Compared to ER+/HER2– BCs, ER–/PgR+/HER2– cases showed up-regulation of 15 genes associated with response to vitamin D, response to ketone, and regulation of transcription, and downregulation of 33 genes involved in response to estrogen, negative regulation of cell population proliferation, regulation of epithelial-mesenchymal transition, and controlled by ESR1 and SUZ12. In WGCNA analysis of the ER– subgroup, PgR status was negatively correlated with 4 gene modules and positively correlated with 1 gene module. In line with differential gene expression analysis, genes negatively correlated with ER–/PgR+ status are regulated by ESR1 and SUZ12 and are involved in the regulation of cell proliferation, extracellular matrix organization, and NOTCH1 signaling. Genes positively correlated with ER–/PgR+ status are regulated by E2F4, FOXM1, SIN3A, NFYB, E2F1, FOS, IRF1, ZMIZ1, and UBTF and participate in cell cycle, regulation of mitosis, and microtubule cytoskeleton regulation. Conclusions: ER–/PgR+ BCs display a distinct mRNA expression profile characterized by the down-regulation of genes controlled by ESR1 and SUZ12. The latter as a part of Polycomb Repressive Complex 2 contributes to chromatin silencing, and some previous studies suggested its role in the regulation of steroid hormone receptors expression. Additionally, ER–/PgR+ BCs overexpress FOXC1 which is linked to more aggressive, high-grade, and treatment-resistant breast cancers. Our data indicate the need to unravel the mechanism of epigenetic regulation of PGR expression, especially its methylation status, in ER–/PgR+ breast cancer.

Citation Format: Michał Kunc, Marta Popęda, Michał Bieńkowski, Marcin Braun, Aleksandra Łacko, Barbara Radecka, Joanna Pikiel, Maria Litwiniuk, Katarzyna Pogoda, Magdalena Niemira, Anna Szałkowska, Ewa Iżycka-Świeszewska, Gabor Cserni, Wojciech Biernat, Elżbieta Senkus. Estrogen receptor-negative progesterone receptor-positive breast cancer is a molecularly distinct group characterized by the down-regulation of genes controlled by ESR1 and SUZ12 [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 P2-23-06.

Coping with cancer and a history of health-related events

Background

Cancer is a source of stress related to the resulting change in lifestyle. The processes which take place when a patient is coping with a disease may be explained in terms of the transactional concept of psychological stress (Lazarus, Folkman) and the critical life events model (Filipp). These two complementary theoretical approaches set the direction and aim of the study which was to determine the role played by earlier events responsible for health loss due to a chronic, serious disease in the course of a stress transaction in cancer patients.

Materials and methods

The study involved 121 patients with either breast or colorectal cancer undergoing chemotherapy as part of their treatment. They were asked to complete a purpose-designed set of questionnaires which included Revised Illness Perception Questionnaire (IPQ-R), the Mini-Mental Adjustment to Cancer (Mini-MAC) questionnaire, the Hospital Anxiety and Depression Scale (HADS), Acceptance of Illness Scale (AIS). The interdependencies between variables were determined using difference significance tests (Mann-Whitney, Kruskal-Wallis) and the Dunn's correction test. The significance level (alpha) of 0.05 was assumed appropriate for the study.

Results

Patients with previous health-related events were found to expect the struggle with cancer to be a greater and more serious challenge. Those patients had suffered loss of health prior to getting cancer and their emotional reactions were heightened. This finding allowed the identification of patients more prone to creating a negative view of their disease.

Conclusions

When planning a psychological treatment of patients with cancer, an account must be taken of their past life events and earlier experiences of being ill, in order to implement appropriate psychological intervention aimed at reducing their emotional stress.

miRNA signatures of prognostic significance in single hormone receptor-positive breast cancer

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Background: Single hormone receptor-positive breast cancer – ER+/PgR– and ER–/PR+, is a distinct entity with vastly undiscovered biology. This study aimed at exploring miRNA profiles of primary tumors of single hormone receptor-positive phenotype and their association with overall survival (OS). Methods: The study group comprised 32 breast cancer patients, collected at 3 Polish centers, with single hormone receptor-positive phenotype, including 14 ER+/PgR– and 18 ER–/PR+ cases, thoroughly characterized for ER (clones: 1D5, EP1 and SP1) and PgR (clone: 636) expression. Expression of 798 miRNAs was profiled using nCounter Human v3 miRNA Expression Assay (NanoString) in each primary tumor sample (FFPE), data available at NCBI GEO (GSE155362). Normalized miRNAs counts were analyzed for the association with OS. Gene targets of miRNAs showing prognostic significance were identified using miRNET 2.0, while their annotation with Gene Ontology Biological Processes was determined with DAVID Bioinformatics Resources 6.8 tool. The results were validated using MINDACT trial dataset [Cardoso et al. 2016]: single hormone receptor-positive (central assessment) cases of ductal histology (including 392 ER+/PgR– and 15 ER–/PR+ cases) where analysed for the prognostic value of gene expression of the identified miRNAs targets. Results: In our cohort, 7 miRNAs showed an association with OS (log-rank test): positive for four: hsa-miR-25-3p (p=0.013), hsa-miR-150-5p (p=0.015), hsa-miR-148a-3p (p=0.038) and hsa-miR-497-5p (p=0.044); and negative for three: hsa-miR-517c-3p (p=0.017), hsa-miR-4284 (p=0.018) and hsa-miR-301a-5p (p=0.029). According to miRNET 2.0, the 4 and 3 prognostic miRNAs have 3801 and 544 gene targets, respectively. The genes targeted by positively associated miRNAs were involved in transcription regulation, vesicle-mediated transport and protein stabilization, while the targets of negatively associated miRNAs were related with mRNA polyadenylation, DNA replication and regulation of DNA-templated transcription. Next, genes targeted by most of miRNAs from either group were identified: 11 targets of positive miRNAs (CANX, CBX5, HIPK1, PDE4DIP, PPM1A, REL, SETD5, SP1, XYLT2, ZMAT3, ZNF460) and 6 targets of negative miRNAs (ARL10, DNAJC28, MTHFD1L, PRPF6, RHOF, TSPAN6). The genes were tested for the association with OS in single hormone receptor-positive subgroup of the MINDACT cohort, with the following significant findings in multivariate analysis including N stage and Ki67 status: PDE4DIP (HR=2.84, p=0.011), CBX5 (HR=2.08, p=0.026) and PRPF6 (HR=0.44, p=0.045). Conclusions: This study identifies 7 miRNAs and their gene targets with a potential prognostic significance in single hormone receptor-positive breast cancer. Thus, several miRNA-mRNA axes merit further investigation both at molecular level and in a separate patient cohort to validate their clinical utility.

Abstract P2-13-04: Final survival analysis of a phase 3 study comparing SB3 (trastuzumab biosimilar) and reference trastuzumab in HER2-positive early or locally advanced breast cancer

Background: SB3 (trastuzumab-dttb) is a biosimilar approved globally based on its similarity with reference trastuzumab (TRZ) demonstrated by thorough comparability exercises in analytical, biological, and clinical studies. In a randomized, double-blind, multicenter Phase 3 study of 875 patients with HER2-positive early or locally advanced breast cancer in the neoadjuvant setting, equivalent efficacy, similar safety, pharmacokinetics, and immunogenicity between SB3 and TRZ were shown. However, when quality attributes of TRZ were examined, downward drifts in antibody-dependent cell-mediated cytotoxicity activities (ADCC) were observed in the TRZ lots with expiry dates ranging from Aug 2018 to Dec 2019. Some of these lots of the reference product were found to be used in the Phase 3 study. After completing the Phase 3 study, patients from select countries were included in a follow-up observational study to monitor cardiac safety and survival. Here, we report the final survival results, including post-hoc subgroup analysis based on ADCC status, at a median follow-up of 68 months. Methods: During the follow-up observational study, the protocol was amended to include additional patients who originally were enrolled in the Phase 3 study but had not been followed in the observational study, in order to collect a larger sample of survival data. For these additional patients, medical records from the last assessment in the Phase 3 study through the date of enrollment in the follow-up study were collected retrospectively. As post-hoc analysis, patients in the TRZ arm were stratified into two subgroups: patients who received during neoadjuvant treatment at least one vial of TRZ with downward drift in ADCC as “Drifted TRZ”, and the others as “Non-drifted TRZ”. Event-free survival (EFS) and overall survival (OS) were assessed. Results: Of 875 patients randomized in the Phase 3 study, 538 patients (SB3, N=267; TRZ, N=271) were enrolled in the follow-up observational study: 367 patients were initially enrolled in the follow-up study, and 171 patients were additionally enrolled following the protocol amendment. The median follow-up duration was 68 months from randomization in the Phase 3 study. 54 events (20.2%) in the SB3 arm, and 67 events (24.7%) in the TRZ arm were reported (HR 0.84 [0.58, 1.20], p=0.335). 22 deaths (8.2%) and 38 deaths (14%) were reported in SB3 and TRZ arms, respectively (HR 0.61 [0.36, 1.05], p=0.073). In post-hoc analysis, of 271 patients in TRZ arm, 107 patients were grouped as “Non-drifted TRZ”, and 164 patients as “Drifted TRZ”. 19 events (17.8%) in the Non-drifted TRZ group and 48 (29.3%) events in the Drifted TRZ group occurred (HR 2.57 [1.28, 5.14], p=0.008). 9 deaths (8.4%) in the Non-drifted TRZ group and 29 deaths (17.7%) in the Drifted TRZ group were reported (HR 3.87 [1.37, 10.93], p=0.011). No difference was observed between SB3 arm and Non-drifted TRZ group in terms of EFS (HR 1.28 [0.73, 2.22], p=0.391) and OS (HR 0.99 [0.42, 2.31], p=0.975). Conclusions: Comparable long-term efficacy results in EFS and OS were shown at 68 months of follow-up, further supporting biosimilarity of SB3 to the reference product. Currently, these follow-up results represent the longest monitoring data of patients treated with a trastuzumab biosimilar for HER2-positive early or locally advanced breast cancer.

Citation Format: Xavier Pivot, Mark D Pegram, Javier Cortes, Diana Lüftner, Gary H Lyman, Giuseppe Curigliano, Igor M Bondarenko, Mikhail Dvorkin, Jin Hee Ahn, Seock-Ah Im, Maria Litwiniuk, Yaroslav V Shparyk, Gwo Fuang Ho, Nikolay V Kislov, Marek Wojtukiewicz, Tomasz Sarosiek, Yee Soo Chae, Jin Seok Ahn, Hyerin Jang, Sujung Kim, Jiwon Lee, Soo Young Lee, Ye Chan Yoon. Final survival analysis of a phase 3 study comparing SB3 (trastuzumab biosimilar) and reference trastuzumab in HER2-positive early or locally advanced breast cancer [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 P2-13-04.

Abstract P4-11-30: Breast cancer follow-up. Patients expectations versus reality

Background: Breast cancer is the most common malignancy among women. The increased incidence and better treatment results lead to an increased number of breast cancer survivors. Polish and international guidelines clearly specify the rules for the tests performed in the follow-up. The only mandatory test is annual mammography. Our aim was to evaluate patients expectations and knowledge regarding follow-up visits. Methods: 188 patients after breast cancer radical treatment completed anonymous questionnaires about their knowledge and preferences of the follow-ups. Results: Median age of the respondents was 64. Median time from the breast cancer diagnosis was 6 years (2-34). 82% of the patients claimed that they were informed by the oncologist about the rules of follow-up visits, 78% knew recommendations about healthy lifestyle and diet. At the same time - 78% would prefer to have more tests done than it’s recommended (abdominal ultrasound - 58 patients (31%), CA 15-3 level- 27 patients (14%), chest x-ray- 18 patients (10%), PET scan - 5 patients (3%), other tests (bone scyntygraphy, brain scan, liver MRI) - 13 patients (7%). Many patients would like to have multiple tests done. When asked if they would prefer to have follow-up visits with their family doctor or in the oncological centre - 94% would prefer to be controlled in the cancer centre. Conclusions: There is a need to educate both oncologists, family doctors and patients, about the rules of follow-up in breast cancer. Patients feel safer if they have more tests done, even though the guidelines recommend only annual mammography. Patients prefer to be controlled in the cancer centres, where they were treated. Because the recommendations were made many years ago, it seems advisable to conduct new studies on possible modifications to these guidelines, due to tremendous advances in breast cancer treatment and the fact that breast cancer is now divided into a numer od biological subtypes. There is a strong need to perform studies to evaluate the role of liquid biopsy, ctDNA and PET-scan in breast cancer follow-up.

Citation Format: Joanna Zaluska-Kusz, Maria Litwiniuk. Breast cancer follow-up. Patients expectations versus reality [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 P4-11-30.

High expression of progesterone receptor may be an adverse prognostic factor in oestrogen receptor-negative/progesterone receptor-positive breast cancer: results of comprehensive re-evaluation of multi-institutional case series

Oestrogen receptor (ER)-negative (-) progesterone receptor (PgR)-positive (+) is the least common combination of steroid receptor expression observed in breast cancer. There are many controversies regarding the actual existence of ER-/PgR+ phenotype. In the current study, we aimed to perform comprehensive immunohistochemical re-evaluation of ER-/PgR+ breast cancers from multiple institutions. A total of 135 cases of ER-/PgR+ breast cancer were collected from 11 institutions from the period 2006-2020 and subsequently stained with three clinically validated anti-ER antibody clones: SP1 (Roche), 1D5 (Dako), and EP1 (Dako), and two anti-PgR antibody clones: 636 (Dako), and 1E2 (Roche). Clinicopathological characteristics of confirmed and re-categorised cases were analysed. Seventy-six cases retained the original ER-/PgR+ phenotype, including 21 HER2+ and 55 HER2- tumours. Forty-seven cases were ER+ with at least one anti-ER antibody, and 12 cases were re-categorised as double-negatives across all anti-ER and anti-PgR antibodies. No significant differences in survival were observed between groups in the HER2+ category. In the HER2- cohort, confirmed ER-/PgR+, ER+ tumours with discrepant ER staining, and triple negatives had inferior overall survival compared to concordant ER+ cases. Progesterone receptor expression in >20% of cells was identified as an adverse prognostic factor in ER-/PgR+/HER2- breast cancer in a multivariable model adjusted by stage (HR 5.0, 95% CI 1.3-19.2, p=0.019). We performed one of the largest validation studies so far on ER-/PgR+ breast cancer and confirmed the existence of this subgroup. Moreover, we identified high PgR expression as an adverse prognostic factor.

Cancer patients and internal medicine patients attitude towards COVID-19 vaccination in Poland

BACKGROUND

The initial approval of the Pfizer/BioNTech and Moderna vaccines by the European Medicines Agency (EMA) and Food and Drug Administration (FDA) marked a milestone in the fight against the COVID-19 pandemic. The increased public debate about the vaccine development process and vaccine side effects has activated the anti-vaccine community, which has begun to spread conspiracy theories about vaccine safety.

OBJECTIVES

Our study is the first to investigate the awareness of Polish patients suffering from various chronic diseases, mainly cancer, about vaccination against SARS-CoV-2.

MATERIAL AND METHODS

An anonymous survey was made available from November 2020 to February 2021 to representatives of patient organizations through social media (Facebook) and to patients in the Chemotherapy Department of the Clinical Hospital in Poznań. The survey was completed by 836 patients. The majority of the survey respondents had cancer (77%, n = 644), and almost 1/5 of the respondents indicated hypertension (15.7%, n = 131) as well as depression and/or anxiety disorders (11.1%, n = 93).

RESULTS

Less than half of the respondents (43.5%, n = 364) believed that SARS-CoV-2 vaccines were safe (40.4%, n = 260, among cancer patients; 53.9%, n = 104, among patients with other medical conditions). More than half of the respondents (60.5%, n = 506) intended to be vaccinated against SARS-CoV-2 (58.8%, n = 378, among cancer patients; 66.3%, n = 128, among patients with other medical conditions). Fear of vaccine complications and lack of belief in vaccine effectiveness were prevalent among both cancer patients and patients with other medical conditions.

CONCLUSIONS

The vast majority of cancer and medical patients wanted to be vaccinated against COVID-19. More than half of the respondents did not believe that the COVID-19 vaccine would be safe for them. Education of cancer and medical patients on the safety and effectiveness of the vaccine, as well as the use of additional protective measures against infection, is an extremely important element of prevention during the COVID-19 pandemic.

Awareness of breast cancer patients in Poland about clinical trials as available treatment options

BACKGROUND

Breast cancer is the most common cancer in women in Poland and worldwide. Due to growing morbidity and mortality, patients are looking for new therapeutic options. Clinical trials give cancer patients a chance to access innovative treatment often not available in the national healthcare system. Patient awareness of clinical trials is an essential element for the development of the clinical trials market.

OBJECTIVE

The purpose of this survey was to obtain information from breast cancer patients about their knowledge of clinical trials.

METHODS

One hundred people were invited to take part in the study, and were recruited into two groups: 50 patients diagnosed with breast cancer less than 40 years of age, and 50 patients with the same disease over 40 years of age. The survey was completed by female patients online.

RESULTS

Most of the subjects correctly understood the assumptions of the clinical trial; most often, both groups of subjects obtained information about medical experiments from the Internet. According to the respondents, the most important motivating factor to participate in the clinical trial was the proposed study drug and their current state of health. Patients would more frequently decide to participate in a clinical trial at the time of cancer progression compared to immediately after diagnosis. Commuting to the research center made recruitment of older patients more difficult (40% of older patients versus 16% of younger patients, p = 0.008).

CONCLUSION

Patients with breast cancer are aware of clinical trials and decide to participate in them based on the proposed study drug and their current state of health. Progression of the disease is a factor that increases the willingness to participate in clinical trials.

The impact of chemotheraphy and supervised high-intensity interval physical activity on left ventricle strain and myocardial work parameters – SPORT NATHY TRIAL pilot study results

Introduction

Cardiotoxic effect of chemotheraphy represents known and challenging problem, thus search for potentially cardioprotective factors plays a key role in the contemporary cardio-oncology. Physical activity may allievate side effects of chemotheraphy and improve quality of live. Myocardial Work is a novel echocardiographic technique and promising tool for cancer patients assesement.

Purpose

The aim of this randomised pilot study was to assess left ventricle function using speckle tracking myocardial strain (2D STE) with Myocardial Work (MW) module in young women undergoing neoadjuvant chemotheraphy due to breast cancer and the impact of supervised high-intensity interval physical activity on these echocardiographic parameters.

Material and methods

We evaluated 24 women aged 27–41 (mean 34±4 yrs) with invasive breast cancer undergoing standard neoadjuvant chemotheraphy and randomized them into two groups: control - (CG, 15 pts) and experimental - with 6 months of supervised high-intensity interval exercise (SHIIEG, 9 pts). Every patient underwent echocardiographic examination 2D STE and MW before chemotheraphy and at 6 months follow-up. The following parameters were evaluated: Global Longitudinal Strain (GLS), Global Work Index (GWI), Global Constructive Work (GCW), Global Work Efficiency (GWE), Global Waste Work (GWW).

Results

Following parameters significantly decreased after chemotherapy: EF (65.4±5.7 vs 60.5±7.0%; p=0.003), GLS (20.4±2.5 vs 18.4±2.0%; p=0.001), GWI (1835.4±206.9 vs 1594.1±228.3 mmHg%; p=0.0004), GCW (2240.5±270.8 vs 1884.9±241.3 mmHg%; p=0.0001), GWE (95.9±1.5 vs 94.9±1.7%; p=0.02). No signifficant changes in GWW (78.6±36.4 vs 80.5±32.2 mmHg%; p=0.7) were found.

The comparison of control (CG) and experimental group (SHIIEG) at 6 months follow-up revealed no signifficant differences in the following parameters: GLS (p=0.9), GWI (p=0.3), GCW (p=0.2), GWE (p=0.3) and GWW (p=0.5). However analysis of relative percentage change from baseline in GLS and GWW (Δ%GLS, Δ%GWW) almost reached statistical significance [for CG and SHIIEG respectively: Δ%GLS (−15.6 vs −4.4; p=0.07), Δ%GWW (+39.4 vs −7.3; p=0.06)].

Conclusions

Neoadjuvant chemotherapy administered in young women with invasive breast cancer impaires the function of left ventricle after 6 month of theraphy, resulting in decrease of GLS, GWI, GCW and GWE. The supervised high-intensity interval physical activity impacts the relative change of GLS (Δ%GLS) and GWW (Δ%GWW), therefore may have cardioprotective effect on left ventricle function.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Greater Poland Cancer Centre, Poznan, Poland

microRNA Expression Profile in Single Hormone Receptor-Positive Breast Cancers is Mainly Dependent on HER2 Status-A Pilot Study

Estrogen (ER) and progesterone (PgR) receptors and HER2 are crucial in the assessment of breast cancer specimens due to their prognostic and predictive significance. Single hormone receptor-positive breast cancers are less common and their clinical course is less favorable than ER(+)/PgR(+) tumors. Their molecular features, especially microRNA (miRNA) profiles, have not been investigated to date. Tumor specimens from 36 chemonaive breast cancer patients with known ER and PgR status (18 ER(+)/PgR(−) and 18 ER(−)/PgR(+) cases) were enrolled to the study. The expression of 829 miRNAs was evaluated with nCounter Human v3 miRNA expression Assay (NanoString). miRNAs differentiating between ER/PgR/HER2 phenotypes were selected based on fold change (FC) calculated for the mean normalized counts of each probe in compared groups. The differences were estimated with Student’s t-test or Two-Way ANOVA (considering also the HER2 status). The results were validated using The Cancer Genome Atlas (TCGA) dataset. Following quality control of raw data, fourcases were excluded due to low sample quality, leaving 14 ER(+)/PgR(−) and 18 ER(−)/PgR(+) cases. After correction for multiple comparisons, we did not find miRNA signature differentiating between ER(−)/PgR(+) and ER(+)/PgR(−) breast cancers. However, a trend for differing expression (p-value ≤ 0.05; FDR > 0.2; ANOVA) in eight miRNAs was observed. The ER(+)/PgR(−) group demonstrated elevated levels of four miRNAs—miR-30a-5p, miR-29c-3p, miR-141-3p and miR-423-5p—while the ER(−)/PgR(+) tumors were enriched in another four miRNAs—miR-514b-5p, miR-424-5p, miR-495-3p, and miR-92a-3p. For one of the miRNAs—miR-29c-3p—the association with the ER(+)/PgR(−) phenotype was confirmed in the TCGA cohort (p-value = 0.024; t-test). HER2 amplification/overexpression in the NanoString cohort was related to significant differences observed in 33 miRNA expression levels (FDR ≤ 0.2; ANOVA). The association with HER2 status was confirmed in the TCGA cohort for four miRNAs (miR-1180-3p, miR-223-3p, miR-30d-5p, and miR-195-5p). The main differences in miRNA expression amongst single hormone receptor-positive tumors were identified according to their HER2 status. However, ER(+)/PgR(−) cases tended to express higher levels of miRNAs associated with ER-positivity (miR-30a-5p, miR-29c-3p, miR-141-3p), whereas ER(−)/PgR(+) cancers showed elevated levels of miRNAs characteristic for double- and triple-negative tumors (miR-92a-3p, miR-424-5p). Further studies are necessary to comprehensively analyze miRNA signatures characteristic of ER(−)/PgR(+) and ER(+)/PgR(−) tumors.

ER-/PgR+ breast cancer is a separate entity characterized by distinct phenotype: Comprehensive reevaluation of cases from Polish and Hungarian centers

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Background: ER negative (-)/PgR positive (+) breast cancer (BC) is very uncommon and questioned by many experts. We comprehensively reevaluated ER-/PgR+ BCs in the large cohort from Polish and Hungarian centers. Methods: FFPE blocks from 105 ER-/PgR+ tumors (45 breast biopsies and 64 post-operative samples from tumors not exposed to systemic therapy) were collected from 10 Polish and 3 Hungarian centers. In 60 cases available original slides with ER/PgR staining underwent reevaluation by 3 pathologists (MK, RP, WB) for ER and PgR expression by ASCO/CAP criteria. Subsequently, all samples were stained with 3 antibodies against ER (Dako monoclonal (MC) mouse anti-ERα, clone 1D5; Dako MC rabbit anti-ERα, clone EP1; VENTANA Roche MC rabbit anti-ERα, clone SP1), and PgR (Dako MC mouse anti-PgR, clone 636). If available, > 1 tissue block was used (av. 2.04 blocks/case, range 1-6). In 5 cases ESR1/PGR/ERBB2/MKi67 mRNA was measured by the Xpert® Breast Cancer STRAT4 (Cepheid, Sunnyvale, CA, USA). Results: 13 cases were excluded from immunohistochemical steps of the study due to insufficient amount of tissue and 8 - due to misdiagnosis after ER/PgR reevaluation of original slides. After re-staining, 42 cases (41.5%) retained the original phenotype, in 34 (33.67%) the ER status was corrected to ER+, and 16 (15.84%) tumors were ER/PgR-double-negative. The general agreement between anti-ER clones was moderate (Fleiss’ κ = 0.54). There were 56 ER- and 16 ER+ cases across all three assays. Five cases showed ER positivity with 2 antibodies (either SP1/EP1 or SP1/1D5), 5 tumors reacted exclusively with SP1 clone, and 2 - with 1D5 clone. Xpert Breast Cancer STRAT4 confirmed the ER-/PgR+ phenotype in 4 of 5 analyzed cases. The confirmed ER-/PgR+ BCs were characterized by lower percentage of PgR+ cells (median 5%) than BCs reclassified to ER+ (median 70%) (p = 0.022) and higher Ki67 expression than ER+ cases (median 54.5% vs 25%, respectively; p = 0.003). 39 (92.85%) ER-/PgR+ BCs presented with grade 3. Besides “conventional” high-grade cancers, we identified two distinct morphologies of ER-/PgR+ BC: resembling apocrine carcinoma (n = 5, 11.9%) and carcinoma with central acellular zone (n = 4, 9.5%). Conclusions: ER-/PgR+ BCs confirmed in the current study were defined by high-grade histology, high proliferation index and low percentage of PgR+ cells. We postulate ER-/PgR+ BC is a real albeit rare entity, and its diagnosis should be made cautiously, utilizing retesting with an alternative tissue block and anti-ER antibody.

The Preventive role of Regular Physical Training in Ventricular Remodeling, Serum Cardiac Markers, and Exercise Performance Changes in Breast Cancer in Women Undergoing Trastuzumab Therapy-An REH-HER Study

Cardiotoxicity is known as a severe clinical problem in oncological practice that reduces the options for cancer therapy. Physical exercise is recognized as a well-established protective measure for many heart and cancer diseases. In our study, we hypothesized that supervised and moderate-intensity exercise training would prevent heart failure and its consequences induced by trastuzumab therapy. The aim of this study was to examine the effect of physical training on ventricular remodeling, serum cardiac markers, and exercise performance in women with human epidermal growth receptor 2 (HER2+) breast cancer (BC) undergoing trastuzumab therapy. This was a prospective, randomized, clinical controlled trial. Forty-six BC women were randomized into either an intervention group (IG) or a control group (CG). An exercise program (IG) was performed after 3–6 months of trastuzumab therapy at 5 d/week (to 80% maximum heart rate (HRmax)) for 9 weeks. We then evaluated their cardiac function using echocardiography, a 6-Minute Walk Test (6MWT), and plasma parameters (C-reactive protein (CRP), myoglobin (MYO), interleukin-6 (IL-6), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase (CK)). After the physical training program, we did not observe any significant changes in the left ventricular (LV) ejection fraction (LVEF) and 6MWT (p > 0.05) in the IG compared to the CG (decrease p < 0.05). The differences in the blood parameters were not significant (p < 0.05). To conclude, moderate-intensity exercise training prevented a decrease in the LVEF and physical capacity during trastuzumab therapy in HER2+ BC. Further research is needed to validate our results.

Abstract P4-14-10: Supervised high intensity interval physical exercise of young women with breast cancer during neoadjuvant chemotherapy has also a positive impact on the control group (SPORT NATHY trial)

Introduction:Physical activity during cancer treatment may reduce resulting side effects(e.g. fatigue) and improve the quality of patient’s life. It is not known, however, which typevof exercise would be the best or what the optimal duration and intensity of training should be. Neoadjuvant chemotherapy enables to evaluate the intervention effects. Young breast cancer patients are more willing to engage in intensive training than older ones. This randomised pilot study (SPORT NATHY TRIAL) evaluates the feasibility and the safety of high intensity interval physical activity during neoadjuvant chemotherapy administered to young women with breast cancer. Possible impact on treatment efficacy will be also evaluated. Methods:Young breast cancer patients (18-40 years old) were randomized to standard neoadjuvant chemotherapy (usual care - UC) or to neoadjuvant chemotherapy with 6 months of supervised high-intensity interval exercise (SHIIE). SHIIE: 2 times per week circuit on uphill treadmill walking/running, cycle ergometry, elliptical trainer from 5 × 1:15 (1st mth), 5 × 1:30 (2nd mth), 5 × 1:45 (3-4th mth) 5 × 2 min (5-6th mth) with 80%-95% HRpeak with 4 min active rest between sets; 10 min warm-up (50-60 % HRpeak) and 5 min cool-down; total time of to 40 min. Additionally once a week 45 min preferred activity (walk, run, cycling, rollerblading) 60-70 % HRpeak. Each time during training max 5 persons SHIIE groups were supervised by a physiotherapist. UC - 90 min (3 × 30min) walks per week (60% HRpeak) and patient physical therapy rules education.Each participant was monitored at all times by Polar activity monitor to measure: the number of steps, calories burnt, length of sleep, general daily heart rate with special attention placed to monitoring the heart rate during training.A biochemical analysis, bone density, cardiovascular evaluation (Digital ECG and transthoracic echocardiography, treadmill exercise test with RAMP protocol designed individually based on the score during 6 min walk test) were performed on all participants before chemotherapy and upon completion of the treatment.Specialized questionnaires and forms were used to estimate emotional status and sexual functioning.Results:We have already enrolled 22 patients. Median age was 35 in both groups. Number of trainings per week was in UC 2,5 and in SHIIE 3,1. All patients in SHIIE participated in min. 90% of supervised trainings.We were surprised to note that patients from the UC group, following the example of SHIIE group patients, increased their activity significantly. This observation was possible thanks to continuous monitoring of all patients with Polar activity monitors.Conclusions:High intensity interval physical activity may be recommended to young breast cancer patients during neoadjuvant chemotherapy and could be part of a valuable support care strategy. Hospital supervised training encourages other patients to be more physically active as well.

Citation Format: Joanna Kufel-Grabowska, Slawomir Marszalek, Maciej Gorecki, Marta Malinowska, Maciej Lesiak, Ewa Straburzynska-Migaj, Wiktoria Suchorska, Janusz Dos, Piotr Nowaczyk, Alicja Nowak, Agnieszka Bartczak-Rutkowska, Magdalena Dudek, Andrzej Marszalek, Maria Litwiniuk. Supervised high intensity interval physical exercise of young women with breast cancer during neoadjuvant chemotherapy has also a positive impact on the control group (SPORT NATHY trial) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-14-10.

The influence of amniotic membrane extracts on cell growth depends on the part of membrane and childbirth mode selected: a proof-of-concept study

OBJECTIVE

The amniotic membrane (AM) is a rich source of biologically active factors, important for wound healing and is widely used in various clinical applications, including tissue engineering, reconstructive surgery and wound management. The aim of the present proof-of-concept study was to assess the influence of amniotic membrane extracts on in vitro proliferation of main cells involved in tissue regeneration. The assessment was done in regards to the content of selected biologically active factors in amniotic membrane extracts.

METHOD

The quantitative analysis of EGF, TGF-β and TIMP-1 in tested samples was assayed by enzyme-linked immunosorbent assay (ELISA) tests. The influence of amniotic membrane extracts on proliferation of keratinocytes (HaCaT), fibroblasts (Wi-38) and endothelial cell lines (HECa-10) was assessed using a colorimetric tetrazolium salt reduction assay.

RESULTS

In all of the amnion samples high amounts of EGF, TGF-β and TIMP-1 were detected. However, the content of these factors varied between placental and cervical portions of the same membrane. Moreover, various concentrations of biologically active factors between physiological at-term delivery and caesarean section-derived membranes were also observed. All of the assessed amnion extracts stimulated proliferation of HaCaT and Wi-38 cells, although samples prepared from caesarean section-derived cervical portion of amniotic membrane stimulated more proliferation of keratinocytes than of fibroblasts. In contrast to HaCaT and Wi-38 cells, proliferation of HECa-10 cell line was inhibited by all tested extracts.

CONCLUSION

The results of our proof-of-concept study confirm that biological dressings prepared from amniotic membrane, especially its placental portion, since they stimulated both fibroblasts and keratinocytes, may provide relevant support for wound healing. On the other hand, dressings prepared from caesarean section-derived cervical portion of amniotic membrane, since they stimulate mainly epidermal cells, may be suitable for some specific applications, where more selective action is required, such as in ocular surgery. However, verification of this observation requires further studies.

Breast cancer in young women

Breast cancer (BC) in young women is rare, affecting only 4-6% of women under the age of 40. Regardless, BC remains the most common malignancy among younger patients. Recently, a significant increase in BC rates has been observed among pre-menopausal subjects. Breast cancer in young women requires special attention due to its specific morphologic and prognostic characteristics and unique aspects, including fertility preservation and psychosocial issues (e.g. its impact on family life and career). Young women are more likely to have tumors with higher incidence of negative clinicopathologic features (higher histological grade, more lymph node positivity, lower estrogen receptor (ER) positivity, higher rates of Her2/neu overexpression). Also, they tend to be diagnosed at more advanced stages of the disease. That, in turn, contributes to less favorable prognosis as compared to older women. Young women are generally treated similarly to older patients. Surgical management includes mastectomy or breast-conserving surgery, followed by radiation therapy (younger women have higher local recurrence rates than older women, especially after breast-conserving therapy). Although the basics of chemotherapy are the same for patients of all ages, younger women have some special considerations. It is important to consider options for fertility preservation before starting systemic treatment. Patients should have access to genetic testing as their results may affect the choice of therapy. Younger women and their families should receive adequate psychological support and counselling.

A Case-Matched Gender Comparison Transcriptomic Screen Identifies eIF4E and eIF5 as Potential Prognostic Markers in Male Breast Cancer

Purpose: Breast cancer affects both genders, but is understudied in men. Although still rare, male breast cancer (MBC) is being diagnosed more frequently. Treatments are wholly informed by clinical studies conducted in women, based on assumptions that underlying biology is similar.Experimental Design: A transcriptomic investigation of male and female breast cancer was performed, confirming transcriptomic data in silico Biomarkers were immunohistochemically assessed in 697 MBCs (n = 477, training; n = 220, validation set) and quantified in pre- and posttreatment samples from an MBC patient receiving everolimus and PI3K/mTOR inhibitor.Results: Gender-specific gene expression patterns were identified. eIF transcripts were upregulated in MBC. eIF4E and eIF5 were negatively prognostic for overall survival alone (log-rank P = 0.013; HR = 1.77, 1.12-2.8 and P = 0.035; HR = 1.68, 1.03-2.74, respectively), or when coexpressed (P = 0.01; HR = 2.66, 1.26-5.63), confirmed in the validation set. This remained upon multivariate Cox regression analysis [eIF4E P = 0.016; HR = 2.38 (1.18-4.8), eIF5 P = 0.022; HR = 2.55 (1.14-5.7); coexpression P = 0.001; HR = 7.04 (2.22-22.26)]. Marked reduction in eIF4E and eIF5 expression was seen post BEZ235/everolimus, with extended survival.Conclusions: Translational initiation pathway inhibition could be of clinical utility in MBC patients overexpressing eIF4E and eIF5. With mTOR inhibitors that target this pathway now in the clinic, these biomarkers may represent new targets for therapeutic intervention, although further independent validation is required. Clin Cancer Res; 23(10); 2575-83. ©2016 AACR.

[Liposomal doxorubicin in patients with breast cancer and concomitant cardiovascular diseases - interdisciplinary expert opinion]

The use of liposomal doxorubicin in place of conventional form can significantly reduce the risk of clinically important cardiovascular complications of chemotherapy. The use of liposomal doxorubicin-containing regimen seems to be the most justified in treatment of breast cancer patients with coexisting cardiovascular diseases. The document defines the possible clinical scenarios for the use of chemotherapy with liposomal doxorubicin and presents the optimal cardiac monitoring of this therapy.

Brain Metastasis Prediction by Transcriptomic Profiling in Triple-Negative Breast Cancer

BACKGROUND

Triple-negative breast cancer (TNBC) lacks expression of steroid hormone receptors (estrogen receptor α and progesterone) and epidermal growth factor receptor type 2. This phenotype shows high metastatic potential, with particular predilection to lungs and brain. Determination of TNBC transcriptomic profiles associated with high risk of brain metastasis (BM) might identify patients requiring alternative, more aggressive, or specific preventive and therapeutic approaches.

PATIENTS AND METHODS

Using a cDNA-mediated annealing, selection, extension, and ligation assay, we investigated expression of 29,369 gene transcripts in primary TNBC tumor samples from 119 patients-71 in discovery cohort A and 48 in independent cohort B-that included best discriminating genes. Expression of mRNA was correlated with the occurrence of symptomatic BM.

RESULTS

In cohort A, the difference at the noncorrected P < .005 was found for 64 transcripts (P = .23 for global test), but none showed significant difference at a preset level of false-discovery rate of < 10%. Of the 30 transcripts with the largest differences between patients with and without BM in cohort A, none was significantly associated with BM in cohort B.

CONCLUSION

Analysis based on the primary tumor gene transcripts alone is unlikely to predict BM development in advanced TNBC. Despite its negative findings, the study adds to the knowledge on the biology of TNBC and paves the way for future projects using more advanced molecular assays.

Abstract P2-15-02: HER2 discordant results in local vs. central testing in the phase 3 nelipepimut-S trial and implementation of Leica Bond Oracle HER2 Immunohistochemistry (IHC) System for low and intermediate levels (1+, 2+) of HER2 protein expression as a companion diagn

Background : The distinction between HER2-positive (IHC 3+ or 2+ with FISH ratio &gt;/= 2) and not overexpressing HER2 has been the focus of many diagnostic tests over the past years in association with development of HER2-targeted therapies. The paucity of therapies developed for the low to intermediate HER2 protein expression populations has resulted in limited attention to their diagnostic precision and accuracy. The development of NeuVaxTM (nelipepimut-S; Galena Biopharma, Inc.) in the defined population requires a HER2 IHC 1+/2+ diagnostic that precisely and accurately ensures identification of targeted patients. We describe discordance rates between local and central testing performed to identify tumors with HER2 IHC 1+/2+ expression that supports the development of a method to validate HER2 1+ and 2+ (FISH &lt; 2.2) patients who receive nelipepimut-S adjuvant therapy.

Methods : The Prevention of Recurrence in Early Stage, Node-Positive Breast Cancer with Low to Intermediate HER2 Expression with NeuVaxTM  Treatment (PRESENT) study, is a multicenter, multinational, prospective, randomized, double-blind, controlled Phase 3 study assessing efficacy and safety of the peptide vaccine nelipepimut-S, in HLA A2 or A3 positive patients with early stage, node positive breast cancer expressing low and intermediate levels (IHC 1+/2+) of HER2 protein. PRESENT 2-step screening includes HLA testing and central lab confirmation of HER2 1+ or 2+ expression using the DAKO HercepTest.

Results : As of 2 June 2014, 1454 patients underwent central IHC testing for HER2 and had a quantifiable result of 0, 1+, 2+, or 3+ for both local and central test. Per local testing, 61% (HER2 1+, n=612; HER2 2+, n=275) were eligible and 39% (HER2 0, n=468; HER2 3+, n=99) were ineligible. Of those eligible by local testing, 67.5% (n=599) were confirmed as eligible per central testing for a discordance rate of 32.5% (n=288). Of the 288 discordant samples tested centrally, 73.6% (n=212) and 26.4% (n=76) were reported as HER2 0 and 3+, respectively. 8.7% (76/877) of patients found to be HER2 1+ or 2+ by local testing were determined to be HER2+ (IHC3+) by central testing.

Conclusions : Current tests for HER2 expression are defined by their ability to determine 3+ positivity, yet significant discordance still occurs with nearly 9% false negative rate in this trial. Similarly, marked discordance exists between local and central laboratory test results for HER2 by IHC at 1+/2+ levels of expression. The relatively high discordance rate observed may be due, in part, to the lack of a validated IHC assay for low-to-intermediate expression of HER2 (0, 1+, and 2+). In order to improve accuracy of testing and to develop a companion diagnostic for nelipepimut-S, the Leica Bond Oracle HER2 IHC System has been validated to determine samples across the IHC spectrum (0, 1+, 2+ and 3+) and is now incorporated into HER2 screening for the PRESENT trial as a companion diagnostic to increase accuracy, precision, and specificity in discerning HER2 1+ and 2+ patients.

Citation Format: Michelle Melisko, Elizabeth A Mittendorf, Sufia Safina, Michael Schenker, Murray A Brunt, Maria Litwiniuk, John Mackey, Katarina Petrakova, Svitiana Alieva, Lacey Chance, Gavin S Choy, Mark Ahn, Adamm Hamm, Sonia Kumar, Hope S Rugo. HER2 discordant results in local vs. central testing in the phase 3 nelipepimut-S trial and implementation of Leica Bond Oracle HER2 Immunohistochemistry (IHC) System for low and intermediate levels (1+, 2+) of HER2 protein expression as a companion diagn [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-15-02.

Total antioxidant status in plasma of breast cancer patients in relation to ERβ expression

AIM OF THE STUDY

The aim of this pilot study was to evaluate the plasma total antioxidant capacity (TAS) in breast cancer patients in relation to ERβ expression.

MATERIAL AND METHODS

The study group consisted of newly diagnosed consecutive female breast cancer patients (n = 41) and controls (n = 28) randomly selected from women with benign breast disease. TAS was determined with the ABTS reagent. Immunostaining for ERβ was performed using polyclonal antibodies. ERα, PgR and HER-2 were measured routinely (immunostaining for ERα and PgR with monoclonal antibodies and EnVision detection system; immunohistochemical method/FISH for HER-2 expression).

RESULTS

The plasma TAS was significantly decreased in the breast cancer patients in comparison to the controls independently of hormonal and lymph node status. The TAS level was not significantly different between breast cancer subgroups either in relation to the ERβ expression (ERβ+ vs. ERβ-) or considering the steroid receptor status (ERα+, ERβ+, Pg+ vs. ERα+, ERβ-, Pg+) even in the selected lymph node negative subgroup. Similarly, HER-2 expression did not significantly affect the TAS concentration. A tendency towards higher TAS level in all ERβ negative breast cancer subgroups was observed.

CONCLUSIONS

The results might confirm enhanced consumption of plasma antioxidants in breast cancer patients. The determination of ERβ isoforms along with parameters of redox status might enable better understanding of their mutual influence.

Abstract P2-10-31: Correlation of quantitative p95HER2 and total HER2 levels with clinical outcomes in a combined analysis of two cohorts of trastuzumab-treated metastatic breast cancer patients

Background: Expression of p95HER2 (p95), a truncated form of HER2 also known as p110 or M611-CTF, is a possible trastuzumab resistance mechanism and has been associated with poor prognosis in trastuzumab-treated HER2-positive metastatic breast cancer (MBC). Previously we reported on optimal clinical cutoffs for quantitative p95 (Clin Cancer Res, 16:4226, 2010) and quantitative HER2 protein expression (H2T) by HERmark® (Cancer, 116:5168, 2010) that defined patient subsets with different progression-free survival (PFS). These cutoffs were confirmed in an independent trastuzumab-treated MBC cohort (ASCO 2011, #586). Here, using individual patient data, we performed an analysis on the combined data set of 243 cases from the discovery and validation cohorts to derive optimal cutoffs for quantitative p95 and H2T.

Methods: Both quantitative H2T (HERmark, Monogram Biosciences) and p95 assays employed the VeraTag® method to quantify protein expression in formalin-fixed, paraffin-embedded tumor samples from two cohorts of 101 and 142 cases of trastuzumab-treated MBC with 7.4 and 9.2 months median PFS, respectively. All analyses were stratified by hormone receptor status, tumor grade (3 vs. 1+2) and cohort. H2T measurements were compared to pre-specified cutoffs for HERmark negative (H2T&lt;10.5 Relative Fluorescence/mm2 tumor [RF/mm2]) and HERmark positive (H2T&gt;17.8 RF/mm2), derived from the &lt;5th percentile of centrally determined HER2-positives and the &gt;95th percentile of centrally determined HER2-negatives, respectively, within a reference database of 1,090 breast cancer patient samples.

Results: Patients classified as HERmark-positive had longer PFS than those classified as HERmark-negative (HR = 0.52; p = 0.0006; medians 10.0 and 5.9 months). The previously determined optimal H2T cutoff of 13.8 RF/mm2 in the center of the HERmark-equivocal zone, gave a similar result (HR = 0.54; p = 0.0005). This was close to the optimal cutoff of 12.75 RF/mm2 (HR = 0.48; p &lt; 0.0001, unadjusted) for the combined data set. The PFS for the small group of patients in the HERmark-equivocal zone (n = 20) was more similar to the HERmark-negatives (equivocal vs. negative: HR=0.98; p = 0.9) than the HERmark-positives (positive vs. equivocal: HR=0.57; p = 0.057). The pre-specified p95 cutoff at 2.8 RF/mm2 separated the 174 HERmark-positive cases into two groups of longer (p95&lt;2.8 RF/mm2) vs. shorter PFS (HR = 1.9; p = 0.0014; medians 13.1 and 7.4 months). Increasing continuous p95 also correlated with shorter PFS (HR = 1.9/log; p = 0.022) in the HERmark-positive subset. An optimal p95 cutoff was identified at 2.7 RF/mm2 (HR = 2.0; p = 0.0009, unadjusted), although a slightly higher local HR maximum was found at 1.55 RF/mm2 (HR = 2.3; p = 0.0004, unadjusted).

Conclusions: HERmark positive and negative categories, defined by analytical comparison with centrally determined HER2 status, were confirmed to have significantly different PFS in trastuzumab-treated MBC patients. The optimal H2T clinical cutoff for this combined analysis was centered in the HERmark analytical equivocal zone. An optimal p95 clinical cutoff of 2.7 RF/mm2 derived from this combined analysis was nearly identical to the previously established cutoff of 2.8 RF/mm2.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-10-31.

Abstract P3-12-09: The risk of brain metastases according to expression of selected immunohistochemical markers in primary breast cancers

Background: About 10–30% of breast cancer patients will develop brain metastases.

In untreated patients with brain metastases the median survival is 1–2 months, and in those undergoing palliative radiotherapy — 3–6 months. The mechanism of brain metastases remains largely unknown. The identification of molecular markers might help in selecting high risk patients, and enable active surveillance, prevention and early treatment. The aim of this study was to analyze predictive value of expression of selected tumor proteins for the risk of brain metastases in breast cancer patients.

Material and methods: This study included 198 advanced breast cancer patients treated between 2001 and 2007 in 11 oncology centers in Poland, including 96 woman with and 102 without overt brain metastases, respectively. The median age at diagnosis in these two groups was 52 and 60 years, respectively, with 52% and 32% of patients being premenopausal. Stage at diagnosis was similar in both groups and ductal carcinoma was a dominant histological type (76% and 86% of cases, respectively). Immunohistochemistry was performed on formalin-fixed paraffin embedded microarray cores derived from the primary tumor. Expression analysis included ER, PR, HER2, Ki67, CK5/6, EGFR, HER3, CXCR4, RAD51, E-cadherin, and claudin 3 and 4. Cox regression model was used to estimate the relative risk of brain metastases.

Results: Expression of HER2, CK5/6, EGFR, RAD51 (both cytoplasmatic and nuclear staining), CXCR4 (cytoplasmatic staining) and Ki67 ≥14%, as well as ER or PR negativity was associated with increased risk of brain metastases in the univariate analysis (Table 1). Of those, Ki67 ≥14% (HR 2.76 [95%CI 1.70–4.48]; p &lt; 0.001), cytoplasmatic expression of double strand DNA repair gene RAD51 (HR 1.87 [95%CI 1.14–3.08]; p = 0.014) and ER negativity (HR 1.72 [95%CI 0.36–0.94]; p = 0.029) were found to be significantly related to the risk of brain relapse in the multivariate analysis. Four molecular profiles composed of the latter three markers were created, of which a profile including ER, Ki67 and RAD51 was associated with the highest risk of brain metastases (HR 4.43 [95%CI 2.69–7.27]; p &lt; 0.001). Molecular subtype analysis showed the highest risk of BM in the ER/PR/ HER2-negative (triple negative) subset (HR 1.21 [95%CI 1.11–1.32]; p &lt; 0.001).

Conclusion: Expression of proteins related to high tumor proliferation, DNA repair and ER negativity is associated with increased risk of brain metastases in breast cancer patients.

Correlation between quantitative HER-2 protein expression and risk for brain metastases in HER-2+ advanced breast cancer patients receiving trastuzumab-containing therapy

BACKGROUND

Patients with human epidermal growth factor receptor (HER)-2+ breast cancer are at particularly high risk for brain metastases; however, the biological basis is not fully understood. Using a novel HER-2 assay, we investigated the correlation between quantitative HER-2 expression in primary breast cancers and the time to brain metastasis (TTBM) in HER-2+ advanced breast cancer patients treated with trastuzumab.

METHODS

The study group included 142 consecutive patients who were administered trastuzumab-based therapy for HER-2+ metastatic breast cancer. HER-2/neu gene copy number was quantified as the HER-2/centromeric probe for chromosome 17 (CEP17) ratio by central laboratory fluorescence in situ hybridization (FISH). HER-2 protein was quantified as total HER-2 protein expression (H2T) by the HERmark® assay (Monogram Biosciences, Inc., South San Francisco, CA) in formalin-fixed, paraffin-embedded tumor samples. HER-2 variables were correlated with clinical features and TTBM was measured from the initiation of trastuzumab-containing therapy.

RESULTS

A higher H2T level (continuous variable) was correlated with shorter TTBM, whereas HER-2 amplification by FISH and a continuous HER-2/CEP17 ratio were not predictive (p = .013, .28, and .25, respectively). In the subset of patients that was centrally determined by FISH to be HER-2+, an above-the-median H2T level was significantly associated with a shorter TTBM (hazard ratio, [HR], 2.4; p = .005), whereas this was not true for the median HER-2/CEP17 ratio by FISH (p = .4). Correlation between a continuous H2T level and TTBM was confirmed on multivariate analysis (HR, 3.3; p = .024).

CONCLUSIONS

These data reveal a strong relationship between the quantitative HER-2 protein expression level and the risk for brain relapse in HER-2+ advanced breast cancer patients. Consequently, quantitative assessment of HER-2 protein expression may inform and facilitate refinements in therapeutic treatment strategies for selected subpopulations of patients in this group.

P2-12-05: Correlation between Quantitative HER2 Protein Expression and Risk of Brain Metastases in HER2−Positive Advanced Breast Cancer Patients Receiving Trastuzumab-Containing Therapy

Background. Patients with HER2−positive breast cancer are at particularly high risk for brain metastases; however, the biological basis is not fully understood. Within HER2−positive breast cancer tumors, it is possible to resolve a ∼1.5-log range of HER2 protein expression using a novel quantitative HER2 assay (HERmark®). We investigated the correlation between quantitative HER2 protein expression in primary breast cancers and the time to brain metastases (TTBM) in HER2−positive advanced breast cancer patients treated with trastuzumab.

Methods. The study group included 142 consecutive patients who were administered trastuzumab-based therapy for HER2−positive metastatic breast cancer, defined as 3+ categorical staining by immunohistochemistry (IHC). HER-2/neu gene copy number was subsequently quantified as HER2/CEP17 ratio by central laboratory fluorescence in situ hybridization (FISH). HER2 protein was quantified as total HER2 protein expression (H2T) by the HERmark assay in formalin-fixed, paraffin-embedded primary tumor samples. HER2 variables were correlated with clinical features and TTBM measured from the initiation of trastuzumab-containing therapy.

Results. H2T level (continuous variable) was correlated with shorter TTBM (HR=2.3; p=0.013), whereas HER2 gene amplification by FISH (p=0.28) and continuous HER2/CEP17 ratio (p=0.25) had no significant prognostic impact. The correlation between continuous H2T level and TTBM was confirmed in a multivariate analysis (HR=3.2; p=0.021). Controlling for the competing risk of death from causes other than brain metastases, continuous H2T remained a strong correlate of TTBM (HR=2.7; p=0.0009). In the subset of patients that was centrally-determined HER2 positive by FISH (117 patients), above-median H2T level was significantly associated with shorter TTBM (HR=2.4; p=0.005), whereas this was not true for median FISH/CEP17 ratio (p=0.4). In a multivariate analysis of this subset, continuous H2T (p=0.021) and a time dependent covariate capturing time to non-brain metastases (p=0.0044) were prognostic for TTBM, whereas FISH/CEP17, ER, PgR and grade were not.

Conclusions. These data reveal a strong relationship between quantitative HER2 protein expression levels and the risk of brain relapse in HER2−positive advanced breast cancer patients. Consequently, quantitative assessment of HER2 protein expression may inform and facilitate refinements in therapeutic treatment strategies for selected subpopulations of patients in this group.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-05.

P5-01-06: Gene Copy Number and Expression of TYMP and TYMS Are Predictive of Outcome in Breast Cancer Patients Treated with Capecitabine

Background: The efficacy of the pro-drug capecitabine (C) may be affected by the expression of thymidylate synthase (TYMS) and thymidine phosphorylase (TYMP), respectively the target and the activating enzyme of C, as well as dihydrofolate reductase (DHFR) that provides a key intermediate.

Method: In this retrospective study, expression and gene copy number (GCN) of the above enzymes were assessed and correlated with time-to progression (TTP) and progression-free survival (PFS) of adult female patients with pathologically confirmed breast cancer and locally advanced or metastatic disease treated with C 1000 mg/m2 BID days 1–14 of a 21-day cycle. TYMS, TYMP and DHFR GCN were scored using custom made FISH probes (Dako, Denmark) in at least 60 morphologically intact non-overlapping nuclei. FISH markers dichotomized as high/low by the median were correlated with TTP and PFS using Cox proportional hazard models in 65, 57 and 24 patients for TYMS, TYMP and DHFR probes respectively. Gene expression was analyzed using the whole genome cDNA-mediated annealing, selection extension and ligation (DASL) platform on total RNA extracted from FFPE tissue samples and correlated with TTP and PFS using Cox models in 75 patients. Correlations between GCN and expression were measured using both Pearson's and Spearman's correlation coefficients.

Results: Our interim results (ASCO 2011) showed that higher TYMS GCN was significantly associated with both decreased TTP (HR 1.76, 95% CI 1.07 to 2.90, p=0.026) and PFS (HR 1.86, 95% CI 1.14 to 3.04, p=0.036) in the overall patient population. We now observe 1) a statistically significant positive correlation between TYMS GCN and expression (Pearson 0.26, p=0.049; Spearman 0.25, p=0.056); 2) a trend towards worse outcome with higher TYMS expression in a) the overall population (TTP-HR 1.23, 95% CI 0.93 to 1.64, p=0.148), b) in ER+ patients (TTP-HR 1.46, 95% CI 0.97 to 2.19, p=0.07) as well as in c) HER2− patients (TTP-HR 1.17, 95% CI 0.85 to 1.61, p=0.343), 3) a statistically significant association between higher TYMP expression and longer PFS, but not TTP in ER+ and HER2− patients (table).

A comparative biomarker study of 514 matched cases of male and female breast cancer reveals gender-specific biological differences

Male breast cancer remains understudied despite evidence of rising incidence. Using a co-ordinated multi-centre approach, we present the first large scale biomarker study to define and compare hormone receptor profiles and survival between male and female invasive breast cancer. We defined and compared hormone receptor profiles and survival between 251 male and 263 female breast cancers matched for grade, age, and lymph node status. Tissue microarrays were immunostained for ERα, ERβ1, -2, -5, PR, PRA, PRB and AR, augmented by HER2, CK5/6, 14, 18 and 19 to assist typing. Hierarchical clustering determined differential nature of influences between genders. Luminal A was the most common phenotype in both sexes. Luminal B and HER2 were not seen in males. Basal phenotype was infrequent in both. No differences in overall survival at 5 or 10 years were observed between genders. Notably, AR-positive luminal A male breast cancer had improved overall survival over female breast cancer at 5 (P = 0.01, HR = 0.39, 95% CI = 0.26-0.87) but not 10 years (P = 0.29, HR = 0.75, 95% CI = 0.46-1.26) and both 5 (P = 0.04, HR = 0.37, 95% CI = 0.07-0.97) and 10 years (P = 0.04, HR = 0.43, 95% CI = 0.12-0.97) in the unselected group. Hierarchical clustering revealed common clusters between genders including total PR-PRA-PRB and ERβ1/2 clusters. A striking feature was the occurrence of ERα on distinct clusters between genders. In female breast cancer, ERα clustered with PR and its isoforms; in male breast cancer, ERα clustered with ERβ isoforms and AR. Our data supports the hypothesis that breast cancer is biologically different in males and females suggesting implications for clinical management. With the incidence of male breast cancer increasing this provides impetus for further study.

[Influence of oncological treatment on fertility of women and pregnancy outcome]

Advances in cancer treatment of young patients have resulted in markedly improved survival rates and quality of life. However infertility remains to be one of adverse effects of anticancer therapy. Female patients who receive high-dose abdominal and/or pelvic irradiation or chemotherapy based on alkylating agents are at highest risk of developing ovarian failure. Among women whose fertility was not impaired during oncologic treatment, there is a significantly increased number of premature labors. High-dose irradiation also predisposes to low-birthweight infants. Neither chemotherapy nor radiotherapy increase a risk of congenital malformations.

Comparative Biomarker Analysis in 523 Matched Male and Female Breast Cancers

Incidence rates of male breast cancer (MBC) are rising. MBC etiology is poorly understood with most of our current knowledge regarding its biology, natural history and treatment extrapolated from our knowledge of female breast cancer (FBC). Retrospective studies on MBC have suffered from small numbers of cases available from any one centre thus a significant problem in studying this disease is accruing sufficiently large numbers to allow comparative analysis of possible prognostic markers. Using a co-ordinated multi-centre approach, the aim of this study was to conduct the first large scale study to address the relevance of the expression of recognised biomarkers in FBC in the same disease in males. Five hundred and twenty three cases were obtained retrospectively and assimilated into TMAs, including 260 MBCs and 263 cases of stage-matched FBCs. MBC comprised 21 grade 1, 121 grade 2, 68 grade 3, 50 unknown, mean age 67 (range 39-90) with 167 ductal, 4 lobular, 10 papillary, 10, mucinous, 4 DCIS, 1 mixed and 64 unknown. FBC comprised 29 grade 1, 140 grade 2, 94 grade, mean age 58 (range 27-92) with 220 ductal, 23 lobular, 14 mixed and 6 unknown. Four µm TMA sections were analysed using the following biomarkers: hormone receptors (ERα, ERβ1, ERβ2, ERβ5, total PR, PRA, PRB, AR), apoptosis markers (p53, bcl2), basal (CK5/6, CK14) and luminal epithelial markers (CK18, CK19), E-cadherin and HER2. Biomarkers were scored according to published criteria; for ERβ isoforms both nuclear and cytoplasmic immunoreactivity was determined Statistical analysis was conducted using SPSS. Luminal A (ERα+, and/or PR+, HER2-) was seen in 93% of MBC vs. 84% of FBC, Luminal B (ERα+, and/or PR+, HER2+) or HER2 subgroup (ERα-, PR-, HER2+) was not seen in MBC but found in 6% and 2% of FBC, respectively. Basal-like tumours (ERα-, PR-, HER2-, CK5/6+) were infrequent (MBC 2%, FBC 1%) and in MBC these tumours also expressed ERβ isoforms. No differences were observed in grade, stage or LN status between genders. Univariate analysis showed ERα, ERβ1, ERβ5, PRA, AR, p53 were significantly associated with FBC while cytoplasmic ERβ2, bcl2 and e-cadherin were associated with MBC (all P&lt;0.001). Although membranous HER2 was not seen in MBC, many cases displayed nuclear staining. Biomarker profile with respect to clinical outcome is on-going. This work has shown the luminal A phenotype is common in MBC and that gender-specific biomarkers are expressed. As MBC is becoming more common, this information may be useful in identifying biomarkers which might affect outcome.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2109.

[Lymphoma of the thyroid in a patient with autoimmune thyroiditis and Sjögren's syndrome--case report]

We present the case of a 74 year old patient suffering from primary Non Hodgkin's lymphoma of the thyroid and Sjogren's syndrome. A massively enlarging goitre, causing breathlessness in a female patient previously treated for autoimmune inflammation of the thyroid (Hashimoto's disease) and Sjogren's syndrome, indicated the need for a fine needle aspiration biopsy (FNA) of the thyroid gland. Non Hodgkin's lymphoma of the thyroid was diagnosed and chemotherapy was begun. After 10 months of cytostatic treatment clinical tests and imaging indicated complete local regression. However, two months after cessation of chemotherapy the patient suffered a relapse of the disease owing to infiltration of the central nervous system. During the course of palliative radiotherapy the patient died. The main purpose for presenting this case was to describe the problem of primary lymphoma of the thyroid in cases of autoimmune disease. As many years of immunisation may lead to carcinogenesis it is important to raise awareness among medical staff with regard to cases of chronic autoimmune disease. In cases of Hashimoto's autoimmune disease of the thyroid, monitoring of the anti-thyroid antibodies is indicated, at least annually, as an increase in the concentration of these antibodies over a period of at least seven years would suggest further development of autoimmune disease. If such conditions are accompanied by tumours of the thyroid, surgery should be considered. It is worth keeping in mind that the thyroid can be a site for extra-lymphatic lymphoma.

I171V germline mutation in the NBS1 gene significantly increases risk of breast cancer

Nijmegen Breakage Syndrome (NBS) is a rare autosomal, recessive disease caused by homozygous mutations in the NBS1 gene. The most common deletion of 5 bp (657del5) in exon 6, which affects mostly the population of Central Europe is observed. Among the typical features of this disorder is that NBS patients experience a high incidence of lymphoid malignancies as well. An increased risk of solid tumors development for 657del5 carriers was the reason to investigate the role of NBS1 gene as a susceptible one for the breast cancer. The purpose of this work is to identify mutations in all 16 exons of the NBS1 gene in the group of the patients with diagnosed breast cancer and the control group of healthy individuals. In the group of 270 women with breast cancer, seven cases of mutated NBS1 gene were revealed. In the subgroup presenting mutated NBS1 gene, the mutation I171V in 5th exon occurred in five cases. It is the first such a discovery concerning breast cancer patients because this mutation had been previously observed only in the course of lymphoid or hematological malignancies. The rate of I171V mutation in the group of breast cancer patients was significantly higher than in the controls (OR: 9.42; 95% CI: 1.09-81.05; P = 0.02). The conclusion is that heterozygous germline mutation I171V in NBS1 gene is a significant risk factor for breast cancer development. It concerns especially the women whose first degree relatives had a previously diagnosed breast cancer (OR: 6.00; 95% CI: 0.98-38.07; P = 0.04). The histopathological and clinical features of breast cancer with I171V mutation suggest accumulation of the negative prognostic factors. The treatment's results however were unexpectedly satisfactory, that is why further investigations are necessary to assess the role of I171V mutation in NBS1 gene as a prognostic and predictive factor for breast cancer.

Steroid hormone status and HER2/neu expression in pregnancy-associated breast cancer

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Background: Breast cancer occurring during pregnancy or within the first year after delivery is considered to be a pregnancy-associated breast cancer. Some studies have shown a decreased estrogen receptor-positive and progesterone receptor-positive status in pregnant patients with breast cancer, others, however, have not. Moreover, little information is available about the expression of HER2/neu and about the other human estrogen receptor, estrogen receptor beta (ERbeta) in pregnancy-associated breast cancers. The aim of this work was to determine the extent of the expression of ER alpha and beta, progesterone receptor (PgR) and HER2/neu in pregnancy- associated breast cancer. Material and Methods: Formalin-fixed, paraffin embedded tissues from 16 patients with pregnancy- associated breast cancer were used in this study. Immunostaining for ERalpha, ERbeta and PgR was performed using monoclonal antibodies against ERalpha, PgR (DakoCytomation) and against ERbeta (CHEMICON). The EnVision detection system was applied. Tumors were considered to be expressing receptors if a positive reaction (regardless of intensity) could be identified in at least 10% of cells. The HER-2 status was analyzed using HercepTest TM (IHC), and IHC 2+ results were confirmed with FISH test. Results: 44% of the tumors (7/16) were ERalpha and PgR positive. The expression of ERbeta protein was observed in 94% of pregnancy-associated breast cancers. As many as 50% of ERbeta positive tumors showed no expression of ERalpha. Further, 31% (5 of 16) of breast cancers were HER2/neu positive. Conclusions: This frequent expression of ERbeta in pregnancy-associated breast cancer may result from their prodifferentiative functions which increase during pregnancy and lactation.

No significant financial relationships to disclose.