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Dowling RJO, Niraula S, Chang MC, Done SJ, Ennis M, Hood N, McCready DR, Leong W, Escallon JM, Reedijk M, Goodwin PJ, Stambolic V. Abstract PD03-05: Analysis of tumour cell signaling in response to neoadjuvant metformin in women with early stage breast cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-pd03-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The anti-diabetic drug metformin, commonly used to treat type 2 diabetes due to its ability to reduce circulating glucose and insulin, has emerged as a potential anti-cancer agent. Observational studies have reported decreased cancer incidence and mortality in diabetics receiving metformin. Metformin's ability to reduce insulin may be particularly important for breast cancer (BC) because hyperinsulinemia is an adverse prognostic factor and most cells express the insulin receptor (IR). The anti-cancer effects of metformin are associated with both direct (insulin-independent) and indirect (insulin-dependent) actions. Direct effects are linked to activation of AMPK and an inhibition of mTOR signalling, while indirect effects are mediated by reductions in circulating insulin levels, leading to reduced IR-activated PI3K signalling. We conducted a neoadjuvant, single arm, “window of opportunity” trial examining the clinical and biological effects of metformin on thirty-nine locoregional BC patients awaiting definitive surgery.
Methods: Non-diabetic women with newly diagnosed, untreated BC were given metformin 500 mg tid for ≥2 weeks post diagnostic core biopsy until surgery. Fasting blood and tumour samples were collected at diagnosis and surgery. Blood glucose and insulin were assayed to assess the physiologic effects of metformin, while IHC analysis of tumours was used to characterize cellular markers before and after metformin. Specifically, IR levels and the phosphorylation status of proteins involved in AMPK and PI3K/AKT/mTOR signalling, including AMPK (T172) and AKT (S473), were examined.
Results: 39 patients with a mean age of 51 years received metformin for a median of 18 days (range 13–40) with minor GI toxicities. The clinical effects (previously reported) included significant (p < 0.05) decreases in body mass index (−0.5 kg/m2), weight (−1.2 kg), glucose (−0.14 mM) and HOMA (an estimate of insulin resistance, −0.21), and a decrease in insulin (−4.7 pmol/L) that approached significance (p = 0.0686). Ki67 staining in tumour tissue decreased significantly and TUNEL increased significantly. Levels of IR expression decreased significantly (from 4.39 to 3.82, p = 0.0375) as did the phosphorylation status of AKT (S473) and AMPK (T172) (from 9.82 to 7.08, p = <0.0001; from 6.2 to 5.1, p = 0.0034, respectively).
Conclusions: Metformin impact was consistent with beneficial anti-cancer effects. Reduced AKT phosphorylation, coupled with decreased insulin and IR levels, suggest insulin-dependent effects are important in the clinical setting. Assessment of additional factors in BC cells, including OCT1 expression (required for metformin uptake), and the phosphorylation of ACC (a marker of AMPK activation), is underway and will be reported. Integrated analysis of these factors combined with the physiological and molecular data described above will further enhance understanding of metformin action in the clinical setting.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD03-05.
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Affiliation(s)
- RJO Dowling
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
| | - S Niraula
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
| | - MC Chang
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
| | - SJ Done
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
| | - M Ennis
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
| | - N Hood
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
| | - DR McCready
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
| | - W Leong
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
| | - JM Escallon
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
| | - M Reedijk
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
| | - PJ Goodwin
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
| | - V Stambolic
- Ontario Cancer Institute, University Health Network, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; Mt. Sinai Hospital, Toronto, ON, Canada; Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, Toronto, ON, Canada
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Hsu T, Ennis M, Hood N, Goodwin PJ. PD04-09: Self-Reported Cognitive Attributes and Fatigue Improve over Long-Term Follow-Up in Breast Cancer Survivors; Some Cognitive Attributes Are Worse in Breast Cancer Survivors Than in Non-Cancer Controls. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-pd04-09] [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: Cognitive deficits and fatigue have been reported in breast cancer (BC) patients undergoing a variety of treatments, including chemotherapy; in some studies these concerns persist after completion of treatment. We examined these factors over time (median 11 yrs) in a longitudinal study of BC patients and compared the status of long-term BC survivors to non-BC controls.
Methods: 535 T1-3, N0-1, M0 BC patients were enrolled 1989–96; 260 women survived without metastases to participate in long-term follow-up (LTFU) measurements in 2006–8. 161 controls without BC were enrolled 2007–8. Questionnaires examined a range of QOL attributes; here we focus on items related to cognition and fatigue including: EORTC QLQ C30 (cognitive functioning, fatigue), Profile of Mood States (POMS — confusion/bewilderment, fatigue/inertia, vigor/activity), Fatigue Symptom Inventory (FSI — average fatigue past week, total disruption index), Everyday Problems (EDP — forgetfulness, difficulty concentrating, easily distracted). 166 of the BC patients had also completed EORTC and POMS at diagnosis and 1 year, and change in items on these questionnaires was calculated. Age and income adjusted differences between BC (LTFU) and controls were analyzed. Clinical significance was defined as ≥5% of the scale range or an effect size of ≥0.2 and statistical significance as P≤ 0.05.
Results: BC cases were older than controls (62.3 vs 59.1 yr), had lower education (24.6 vs 10.2% high school only) and family income (38.2 vs 19.8% < $60,000 annually) (all P<0.01). Cognitive attributes: BC patients showed clinically and statistically significant improvements between diagnosis and LTFU on POMS confusion/bewilderment but not EORTC cognitive functioning. Comparing BC (LTFU) to controls, in multivariate analyses adjusted for age and income, EORTC cognitive functioning (81.5 vs 87.4) and EDP forgetfulness (0.9 vs 0.6) were clinically and statistically significantly worse in BC patients than controls. In contrast, POMS confusion/bewilderment, EDP difficulty concentrating and EDP easily distracted scores were similar in BC patients at LTFU and controls. Fatigue: BC patients showed clinically and statistically significant improvements between diagnosis and LTFU on EORTC fatigue, POMS fatigue/inertia and POMS vigor/activity. After adjustment for age and income there were no clinically and statistically significant differences between BC (LTFU) and controls on any fatigue items.
Conclusions: Fatigue items, as well as some cognitive items, improved over time in BC patients and scores were comparable to scores in non-BC controls at LTFU. However, scores on some cognitive items were worse in LTFU BC patients than in non-BC controls raising concerns that BC diagnosis and treatment may be associated with long-term adverse effects on some aspects of self-reported cognitive attributes.
(Funded by The Breast Cancer Research Foundation)
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD04-09.
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Affiliation(s)
- T Hsu
- 1University of Toronto, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Mount Sinai and Princess Margaret Hospitals, Samuel Lunenfeld Research Institue, University of Toronto, Toronto, ON, Canada
| | - M Ennis
- 1University of Toronto, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Mount Sinai and Princess Margaret Hospitals, Samuel Lunenfeld Research Institue, University of Toronto, Toronto, ON, Canada
| | - N Hood
- 1University of Toronto, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Mount Sinai and Princess Margaret Hospitals, Samuel Lunenfeld Research Institue, University of Toronto, Toronto, ON, Canada
| | - PJ Goodwin
- 1University of Toronto, Toronto, ON, Canada; Applied Statistician, Markham, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Mount Sinai and Princess Margaret Hospitals, Samuel Lunenfeld Research Institue, University of Toronto, Toronto, ON, Canada
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Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Hood N. Association of young age and chemotherapy with psychosocial distress and health-related quality of life (HRQOL) during the first year after breast cancer (BC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8014] [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: 11/20/2022] Open
Affiliation(s)
- P. J. Goodwin
- Samuel Lunenfeld Research Institute, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Sunnybrook & Womens Health Sciences Centre, Toronto, ON, Canada; St Michaels Hospital, Toronto, ON, Canada
| | - M. Ennis
- Samuel Lunenfeld Research Institute, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Sunnybrook & Womens Health Sciences Centre, Toronto, ON, Canada; St Michaels Hospital, Toronto, ON, Canada
| | - K. I. Pritchard
- Samuel Lunenfeld Research Institute, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Sunnybrook & Womens Health Sciences Centre, Toronto, ON, Canada; St Michaels Hospital, Toronto, ON, Canada
| | - M. E. Trudeau
- Samuel Lunenfeld Research Institute, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Sunnybrook & Womens Health Sciences Centre, Toronto, ON, Canada; St Michaels Hospital, Toronto, ON, Canada
| | - J. Koo
- Samuel Lunenfeld Research Institute, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Sunnybrook & Womens Health Sciences Centre, Toronto, ON, Canada; St Michaels Hospital, Toronto, ON, Canada
| | - N. Hood
- Samuel Lunenfeld Research Institute, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Sunnybrook & Womens Health Sciences Centre, Toronto, ON, Canada; St Michaels Hospital, Toronto, ON, Canada
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