Comparing gene expression in deep infiltrating endometriosis with adenomyosis uteri: evidence for dysregulation of oncogene pathways

BACKGROUND

The pathogenesis of deep infiltrating endometriosis (DIE) is poorly understood. It is considered a benign disease but has histologic features of malignancy, such as local invasion or gene mutations. Moreover, it is not clear whether its invasive potential is comparable to that of adenomyosis uteri (FA), or whether it has a different biological background. Therefore, the aim of this study was to molecularly characterize the gene expression signatures of both diseases in order to gain insight into the common or different underlying pathomechanisms and to provide clues to pathomechanisms of tumor development based on these diseases.

METHODS

In this study, we analyzed formalin-fixed and paraffin-embedded tissue samples from two independent cohorts. One cohort involved 7 female patients with histologically confirmed FA, the other cohort 19 female patients with histologically confirmed DIE. The epithelium of both entities was microdissected in a laser-guided fashion and RNA was extracted. We analyzed the expression of 770 genes using the nCounter expression assay human PanCancer (Nanostring Technology).

RESULTS

In total, 162 genes were identified to be significantly down-regulated (n = 46) or up-regulated (n = 116) in DIE (for log2-fold changes of < 0.66 or > 1.5 and an adjusted p-value of < 0.05) compared to FA. Gene ontology and KEGG pathway analysis of increased gene expression in DIE compared to FA revealed significant overlap with genes upregulated in the PI3K pathway and focal adhesion signaling pathway as well as other solid cancer pathways. In FA, on the other hand, genes of the RAS pathway showed significant expression compared to DIE.

CONCLUSION

DIE and FA differ significantly at the RNA expression level: in DIE the most expressed genes were those belonging to the PI3K pathway, and in FA those belonging to the RAS pathway.

[Relevant mutations in predictive breast cancer pathology]

Whereas predictive immunohistochemistry has represented a core element of breast cancer classification for decades, predictive molecular pathology, with the exception of in situ hybridization for assessment of HER2 amplification, has only recently gained importance because novel drugs have been approved for treatment of metastatic disease. For the use of PARP inhibitors, proof of BRCA1 or BRCA2 mutation is mandatory. When mutation of the catalytic subunit α of the phosphatidylinositol‑4.5‑bisphosphate 3‑kinase gene (PIK3CA) is present, which can be encountered in up to 40% of luminal breast cancers, the option for treatment with the specific inhibitor alpelisib arises. The HER2 -encoded growth factor receptor contributes to neoplastic transformation not only by amplification and overexpression but also by activating the mutation of the kinase domain, which is responsive to tyrosine kinase inhibitors of the tucatinib/neratinib type. Up to 30% of metastatic and endocrine treated luminal breast cancers acquire an activating mutation of the estrogen receptor gene ESR1, resulting in an autocrine and ligand-independent growth stimulation resistant to aromatase inhibitors. Larotrectinib-sensitive mutation of tropomyosinreceptor kinase is present in up to 50% of secretory breast cancers, whereas the other histologic subtypes display an incidence of below 1%. In conclusion, predictive molecular pathology has gained importance in metastatic breast cancer.

Prognostic gene expression signature for high-grade serous ovarian cancer

BACKGROUND

Median overall survival (OS) for women with high-grade serous ovarian cancer (HGSOC) is ∼4 years, yet survival varies widely between patients. There are no well-established, gene expression signatures associated with prognosis. The aim of this study was to develop a robust prognostic signature for OS in patients with HGSOC.

PATIENTS AND METHODS

Expression of 513 genes, selected from a meta-analysis of 1455 tumours and other candidates, was measured using NanoString technology from formalin-fixed paraffin-embedded tumour tissue collected from 3769 women with HGSOC from multiple studies. Elastic net regularization for survival analysis was applied to develop a prognostic model for 5-year OS, trained on 2702 tumours from 15 studies and evaluated on an independent set of 1067 tumours from six studies.

RESULTS

Expression levels of 276 genes were associated with OS (false discovery rate < 0.05) in covariate-adjusted single-gene analyses. The top five genes were TAP1, ZFHX4, CXCL9, FBN1 and PTGER3 (P < 0.001). The best performing prognostic signature included 101 genes enriched in pathways with treatment implications. Each gain of one standard deviation in the gene expression score conferred a greater than twofold increase in risk of death [hazard ratio (HR) 2.35, 95% confidence interval (CI) 2.02-2.71; P < 0.001]. Median survival [HR (95% CI)] by gene expression score quintile was 9.5 (8.3 to -), 5.4 (4.6-7.0), 3.8 (3.3-4.6), 3.2 (2.9-3.7) and 2.3 (2.1-2.6) years.

CONCLUSION

The OTTA-SPOT (Ovarian Tumor Tissue Analysis consortium - Stratified Prognosis of Ovarian Tumours) gene expression signature may improve risk stratification in clinical trials by identifying patients who are least likely to achieve 5-year survival. The identified novel genes associated with the outcome may also yield opportunities for the development of targeted therapeutic approaches.

Gonadoblastoma Y locus genes expressed in germ cells of individuals with dysgenetic gonads and a Y chromosome in their karyotypes include DDX3Y and TSPY

STUDY QUESTION

Which Y genes mapped to the 'Gonadoblastoma Y (GBY)' locus on human Y chromosome are expressed in germ cells of individuals with some Differences of Sexual Development (DSD) and a Y chromosome in their karyotype (DSD-XY groups)?

SUMMARY ANSWER

The GBY candidate genes DDX3Y and TSPY are expressed in the germ cells of DSD-XY patients from distinct etiologies: patients with mixed gonadal dysgenesis (MGD) and sex chromosome mosaics (45,X0/46,XY; 46,XX/46,XY); patients with complete androgen insensitivity (CAIS), patients with complete gonadal dysgenesis (CGD; e.g. Swyer syndrome).

WHAT IS KNOWN ALREADY

A GBY locus was proposed to be present on the human Y chromosome because only DSD patients with a Y chromosome in their karyotype have a high-although variable-risk (up to 55%) for germ cell tumour development. GBY was mapped to the proximal part of the short and long Y arm. TSPY located in the proximal part of the short Y arm (Yp11.1) was found to be a strong GBY candidate gene. It is expressed in the germ cells of DSD-XY patients with distinct etiologies but also in foetal and pre-meiotic male spermatogonia. However, the GBY region extends to proximal Yq11 and therefore includes probably more than one candidate gene.

STUDY DESIGN, SIZE, DURATION

Protein expression of the putative GBY candidate gene in proximal Yq11, DDX3Y, is compared with that of TSPY in serial gonadal tissue sections of 40 DSD-XY individuals from the three DSD patient groups (MGD, Complete Androgen Insensitivity Syndrome [CAIS], CGD) with and without displaying malignancy. Expression of OCT3/4 in the same tissue samples marks the rate of pluripotent germ cells.

PARTICIPANTS/MATERIALS, SETTING, METHOD

A total of 145 DSD individuals were analysed for the Y chromosome to select the DSD-XY subgroup. PCR multiplex assays with Y gene specific marker set score for putative microdeletions in GBY Locus. Immunohistochemical experiments with specific antisera mark expression of the GBY candidate proteins, DDX3Y, TSPY, in serial sections of the gonadal tissue samples; OCT3/4 expression analyses in parallel reveal the pluripotent germ cell fraction.

MAIN RESULTS AND THE ROLE OF CHANCE

Similar DDX3Y and TSPY protein expression patterns were found in the germ cells of DSD-XY patients from each subgroup, independent of age. In CAIS patients OCT3/4 expression was often found only in a fraction of these germ cells. This suggest that GBY candidate proteins are also expressed in the non-malignant germ cells of DSD-XY individuals like in male spermatogonia.

LIMITATIONS, REASONS FOR CAUTION

Variation of the expression profiles of GBY candidate genes in the germ cells of some DSD-XY individuals suggests distinct transcriptional and translational control mechanisms which are functioning during expression of these Y genes in the DSD-XY germ cells. Their proposed GBY tumour susceptibility function to transform these germ cells to pre-malignant GB/Germ Cell Neoplasia in Situ (GB/GCNIS) cells seems therefore to be limited and depending on their state of pluripotency.

WIDER IMPLICATIONS OF THE FINDINGS

These experimental findings are of general importance for each individual identified in the clinic with DSD and a Y chromosome in the karyotype. To judge their risk of germ cell tumour development, OCT3/4 expression analyses on their gonadal tissue section is mandatory to reveal the fraction of germ cells still being pluripotent. Comparative expression analysis of the GBY candidate genes can be helpful to reveal the fraction of germ cells with genetically still activated Y chromosomes contributing to further development of malignancy if at high expression level.

STUDY FUNDING/COMPETING INTEREST(S)

This research project was supported by a grant (01GM0627) from the BMBF (Bundesministerium für Bildung und Forschung), Germany to P.H.V. and B.B. The authors have no competing interests.

Abstract P4-02-08: Statistical modeling of influential variables affecting HER2-positivity in breast cancer: Final analyses from two large, multicenter, noninterventional studies in Germany

Background:

While HER2 testing in breast cancer (BC) has been routine for over a decade, testing quality remains a challenge. Currently, HER2-positivity rate is the only recommended quality indicator. However, the large, observational, prospective NIU HER2 study in Germany quantified the impact of patient- and tumor-related characteristics such as histologic grade, hormone receptor (HR) status, histologic subtype, age, and nodal status on HER2-positivity, indicating that these factors need to be considered when evaluating HER2-positivity as a measure of testing quality (Rüschoff et al. Mod Pathol 2017). We now report the final analyses from the multicenter EPI HER2 BC study (ML29763, NCT02666261) in Germany where we compared NIU and EPI study data, and aimed to validate the NIU study model.

Methods:

Data from eligible patients with invasive BC were collected (HER2 test result; patient- and tumor-related factors) and variables influencing HER2-positivity identified and compared between studies. The NIU study model was validated and its predictive power determined using newly collected data from the EPI study, with cutoff and variable coefficients from the previous NIU analysis. Additional promising variables were explored, and their relative influence investigated, using multiple stepwise logistic regression.

Results:

In total, 14,729 (EPI) and 15,281 (NIU) BC samples were analyzed. Distributions of the main variables were comparable; overall HER2-positivity rates were 13.47% (EPI) and 14.24% (NIU). Fitting the NIU study model to EPI study data demonstrated that all five covariates from the NIU study analyses significantly affected HER2-positivity (p &lt; 0.01); the influence for each covariate differed only slightly between studies (in EPI, histologic grade had most influence followed by histologic subtype, HR status, nodal status, and age). Prediction profiles were used to visualize the relationship between the model-predicted probability of HER2-positivity and the five identified covariates, which showed good comparability between studies. The receiver operating characteristics area under the curve (ROC AUC) of the NIU model used to predict HER2-positivity in the EPI study data was close to that of the model fitted to the NIU data, thus successfully validating the NIU model. To further improve the model, the categorical HR status was replaced by estrogen receptor (ER) and progesterone receptor (PgR) expression. Inclusion of ER and PgR as continuous variables improved the predictive strength of the model (ROC AUC = 0.74; sensitivity = 0.76; specificity = 0.63). Based on this improved model, PgR status had the highest influence on HER2-positivity, followed by histologic grade, histologic subtype, nodal status, ER status, and age.

Conclusions:

Results from our analyses confirm the statistically and clinically significant influence of patient- and tumor-related factors on HER2-positivity, and highlight the necessity to integrate these factors into the quality control assessment of HER2 testing. Implementation of this model in routine practice may assist in addressing issues with interlaboratory variation, and help to identify centers with HER2 testing problems more accurately.

Citation Format: Rüschoff J, Lebeau A, Kreipe H, Sinn P, Schildhaus H-U, Decker T, Ammann J, Künzel C, Koch W, Untch M. Statistical modeling of influential variables affecting HER2-positivity in breast cancer: Final analyses from two large, multicenter, noninterventional studies in Germany [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-02-08.

Abstract P6-03-01: Variables influencing HER2-positivity in breast cancer: Assessment and validation of a statistical model based on two multicenter noninterventional studies in Germany

Background:

HER2 testing in breast cancer (BC), routine for &gt;10 years, allows selection of patients (pts) for HER2-targeted therapy; however, testing quality remains a concern. While guidelines recommend assessment of HER2-positivity rates as a quality indicator, the influence of patient- or tumor-related factors on variability was unknown until we identified the effect (in order of influence) of histologic grade, hormone receptor (HR) status, histologic subtype, age, and nodal status in a large, multicenter, observational study in Germany (NIU HER2 study; Rüschoff et al., Mod Pathol 2017). Based on these variables and the statistical model developed, potential issues with HER2 testing quality in local practice may be identified. We now report interim analyses from a multicenter study in Germany (EPI HER2 BC study; NCT02666261), where data from the NIU and EPI studies were compared and the validity of the NIU study model assessed.

Methods:

Routine HER2 test results and patient- and tumor-related data were collected from eligible pts with BC. Factors influencing HER2-positivity rates in the EPI study were compared with those identified in the NIU study. The predictive power of the NIU study model, fitted to EPI data, was determined and assessments performed using the variable coefficients and cutoff resulting from the NIU study analysis. Attempts were also made to improve the model.

Results:

Analyses included 15281 (NIU) and 6019 (EPI) invasive BC samples. The distribution of relevant variables, including HER2-positivity rate (NIU: 14.4%; EPI: 13.5%), was comparable. When the NIU study model was fitted to EPI study data, all five covariates identified in the NIU analyses had a significant effect on HER2-positivity (p&lt;0.001); the order of influence for covariates differed between studies (EPI [in order of influence]: histologic grading, histologic subtype, HR status, nodal status, and age). The relationship between HER2-positivity rate and the combined influence of covariates, visualized with the NIU study prediction profiler, was reproduced with EPI study data. The NIU study statistical model, with variable coefficients and cut-point determined in the NIU study, was used to predict the HER2-positivity of samples in EPI; if their NIU model-estimated probability of positivity was &gt;0.1407, the resulting sensitivity, specificity, and receiver operating characteristic (ROC) area under the curve (AUC) were 0.7032, 0.6622, and 0.7259, respectively. Thus, initial validation of the NIU study model with EPI data was successful. Semiquantitative estrogen and progesterone receptor expression data were available from EPI only; their inclusion as independent continuous, rather than categorical, variables improved the model (ROC AUC = 0.7533).

Conclusions:

The statistical modeling approach used to analyze data from the NIU study showed that patient- or tumor-related characteristics should be considered when assessing HER2 testing quality. Our present analysis validates and improves upon this statistical model and further highlights the need to assess HER2 testing quality in BC. Comparison of calculated vs actual positivity rates may help identify centers with potential HER2 testing quality issues.

Citation Format: Rüschoff J, Lebeau A, Kreipe H, Gerharz CD, Sinn P, Schildhaus H-U, Tennstedt-Schenk C, Ammann JU, Künzel C, Koch W, Untch M. Variables influencing HER2-positivity in breast cancer: Assessment and validation of a statistical model based on two multicenter noninterventional studies in Germany [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-03-01.

Lean Umbilical Cord - a Case Report

The "lean" umbilical cord (also known as thin-cord syndrome) is a comparatively rare anomaly of the umbilical cord, which has seldom been described in the medical literature. We report on a 35-year-old women who presented to us at 29 + 4 weeks gestation with vaginal bleeding and cervical incompetence subsequently complicated not only by premature rupture of membranes but also acute placental insufficiency requiring emergency caesarean section under general anaesthesia at 31 + 2 weeks gestation. At surgery no obvious cause for the acute placental insufficiency - such as placental abruption, cord prolapse or true knot of the umbilical cord - was found. Other possible causes such as vasa praevia or placenta praevia had previously been excluded sonographically on admission for vaginal bleeding. The only notable intraoperative finding was a macroscopically extremely thin umbilical cord.

Changes in chemotherapy usage and outcome of early breast cancer patients in the last decade

Background

During the last decade, neoadjuvant chemotherapy (NACT) of early breast cancer (EBC) evolved from a therapy intended to enable operability to a standard treatment option aiming for increasing cure rates equivalent to adjuvant chemotherapy (ACT). In parallel, improvements in the quality control of breast cancer care have been established in specialized breast care units.

Patients and methods

This study analyzed chemotherapy usage in patients with EBC treated at the Heidelberg University Breast Unit between January 2003 and December 2014.

Results

Overall, 5703 patients were included in the analysis of whom 2222 (39 %) received chemotherapy, 817 (37 %) as NACT, and 1405 (63 %) as ACT. The chemotherapy usage declined from 48 % in 2003 to 34 % in 2014 of the cohort. Further, the proportion of NACT raised from 42 to 65 % irrespective of tumor subtype. In addition, frequency of pathologic complete response (pCR) defined as no tumor residues in breast and axilla (ypT0 ypN0) at surgery following NACT increased from 12 % in 2003 to 35 % in 2014. The greatest effect was observed in HER2+ breast cancer with an increase in patients achieving pCR from 24 to 68 %.

Conclusions

The results mirror the refined indication for chemotherapy in EBC and its preferred usage as NACT in Germany. The increase in pCR rate over time suggests improvement in outcome accomplished by a multidisciplinary decision-making process and stringent measures for quality control.

Electronic supplementary material

The online version of this article (doi:10.1007/s10549-016-4016-4) contains supplementary material, which is available to authorized users.

Abstract P1-03-05: SPARC expression in primary metastatic breast cancer

Aim: To evaluate the prognostic value of the expression of secreted protein acidic and rich in cysteine (SPARC) in primary metastatic breast cancer (PMBC).

Patients and Methods: Fifty-two patients with PMBC diagnosed between 2005 and 2012 at x German centers were retrospectively analyzed for expression of SPARC in tumor cells using an immunoreactive score (IRS) integrating staining intensity and percentage of positive cells (IRS 0-12), and in stroma based on immunohistochemical (IHC) staining intensity only (IHC 0-3+). Association between SPARC expression, tumor characteristics and progression-free survival (PFS) and overall survival (OS) was analyzed.

Results: Only Her2 expression was associated with expression of SPARC in stroma (p 0.028, OR 13.9 95% 1.3-145.5) but not in tumor cells. SPARC expression in stroma was associated with shorter PFS (hazard ratio (HR) 2.6; 95% confidence interval (CI) 1.2-5.4; p 0.014), but not in tumor cells and shorter OS (HR 4.1; 95% CI 1.04-16; p 0.041) for SPARC expression in stroma of breast tumor. No clear association between expression of SPARC in tumor cells and outcome could be detected.

Conclusion: Only SPARC expression in stroma might be associated with shorter PFS and OS in patients with PMBC. This finding is in line with the known key role of expression of SPARC in the metastastatic process. Confirmation in prospective clinical trials is warranted.

Citation Format: Barinoff J, Brandi C, Thill M, Heinrichs C, Mensah J, Weikel W, Fisseler-Eckhoff A, Sinn P, Meyer A-S, Traut A, Schneeweiss A. SPARC expression in primary metastatic breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-03-05.

Abstract P1-08-07: High tumor CD68 mRNA content (intratumoral macrophages) predicts response to neoadjuvant chemotherapy

Background

Immune cell infiltrates have been shown to play a prominent role with regard to prognosis of node negative breast cancer (Schmidt et al 2008). Moreover, it has been shown that B-cells and T-Cells are of particular importance for the response to chemotherapy (Schmidt et al. 2012). However, the role of macrophages remains unclear. It has been assumed, that tumor-associated macrophages play a role in promoting tumorigenesis. Still their role with regard to therapy prediction is unknown. Here we tested wether the infiltration of macrophages is associated with the response to neoadjuvant chemotherapy.

Materials and Methods

Pretreatment core cut biopsies from n = 100 patients with PBC treated within a randomized phase II trial (1) of anthracyline/taxane based NAC were examined. RNA from formalin-fixed, paraffin embedded (FFPE) routine biopsies were extracted using a bead-based extraction method (STRATIFYER XTRAKT kits). CD68 and ESR1, PGR, HER2, Ki67 as well as CALM2 as a house keeping gene were measured via a multiplex quantitative RT-PCR (RT-qPCR). Correlation analyses and partitioning tests were performed using the SAS JMP® 9.0.0 software.

Results

CD68 mRNA exhibited a normal data distribution (Median expression 40-DCT 34,66) in the core needle biopsies of advanced breast tumors. CD68 mRNA correlated strongly with Ki67 mRNA levels (Spearman r = 0,46; p&lt;0,001), whereas there is virtually no correlation with other classical biomarkers such as ESR1, PGR and HER2. Partitioning analysis revealed that CD68 mRNA levels are superior to the previously and prospectively validated response markers ESR1 mRNA and HER2 mRNA. When using the median mRNA expression as an objective cut-off measurement no tumor having low CD68 mRNA expression did respond to chemotherapy, while 22% of the CD68 positive tumors responded by pathological complete response (ypT0ypN0). Based on molecular subtyping into Luminal, HER2 positive and Triple-Negative with predefined Cut-Off values for ESR1mRNA and HER2 mRNA levels, high CD68 were particularly informative within luminal tumors (22% pCR versus 0% pCR rate) and Triple negative tumors (38% pCR versus 0% pCR rate).

Conclusion

The presence of macrophages indicates tumors being sensitive to chemotherapy beyond the prospectively validated ESR1 and HER2 mRNA determinations (2), both in luminal and triple negative tumors. The mRNA expression levels of CD68 provide additional information beyond conventional subtyping and might therefore be useful for early assessment of non-response to chemotherapy und subsequent treatment planning.

1) Schneeweiss et al, Ann Oncol 2011

2) Denkert et al, Ann Oncol 2013.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-07.

Multigene Assays for Classification, Prognosis, and Prediction in Breast Cancer: a Critical Review on the Background and Clinical Utility

Gene signatures which are based on multigene profiling assays have been developed for the purpose to better define the prognosis and prediction of therapy results in early-stage breast cancer. These assays were designed to be more specific than conventional clinico-pathologic parameters in the selection of patients for (neo-)adjuvant treatment and in effect help to avoid unnecessary cytotoxic treatment. In this review we describe molecular risk scores, for which tests are commercially available (PAM50®, MammaTyper®, MammaPrint®, Oncotype DX®, Endopredict®, Genomic Grade Index®) and IHC risk scores (Mammostrat® and IHC4), and discuss the current evidence of their clinical use.

Abstract P3-06-08: Ki-67 mRNA as a predictor for response to neoadjuvant chemotherapy in primary breast cancer

Background: Pathologic complete response (pCR, ypT0/is) is one of the strongest prognostic factors for primary breast cancer (PBC) in the setting of neoadjuvant chemotherapy (NAC). Factors predictive for response to NAC can help to stratify for an individualized therapy. As chemotherapeutic agents are most active in highly proliferative tumors, it was the aim of the present study to evaluate the potential of Ki-67 as a single proliferation marker, quantitatively measured on the mRNA or protein level, to predict response of PBC to NAC.

Material and methods: Pretreatment core cut biopsies from n=72 patients with PBC treated within a randomized phase II trial (1) of anthracylin/taxane based NAC were examined. Immunohistochemistry was performed for the Ki67 antigen on an automated IHC platform (Dako Techmate 500). Ki-67 were assessed either by visual scoring (vIHC) or by quantitative image analysis (qIHC). For quantitative IHC analysis tumor proliferation was analyzed after tumor stroma segmentation using the Aperio Image Analysis toolbox. RNA was extracted from formalin-fixed, paraffin embedded (FFPE) routine biopsies using a bead-based extraction method (STRATIFYER XTRAKT kits). Ki-67, TOP2A and RACGAP1 as well as CALM2 as a house keeping gene were measured via a multiplex quantitative RT-PCR (qPCR). Kaplan-Meier survival estimates, patitioning test and correlation analyses were performed using the SAS JMP® 9.0.0 software.

Results: There was only a moderate correlation between Ki-67 mRNA or Ki-67 measured by immunohistochemistry (IHC) and histologic grade (Spearman r = 0.52 p &lt; 0.0001; r = 0.23 p = 0.033, respectively). Conventional visual scoring and qIHC correlated well (r = 0,78 p &lt; 0,0001), while qPCR and qIHC correlated moderately (r = 0,50 p &lt; 0,0001). For Ki-67 determined by visual scoring of standard IHC there was an optimal discrimination at a cut-off of 20% stained nuclei with regard to chemotherapy response. Yet, the difference between pCR-rates for high and low Ki-67 on IHC was non-significant, with 16.3% and 12.5% pCRs in the IHC Ki-67 high and low group, respectively. For Ki-67 IHC analysed by quantitative image analysis there was optimal cut-off at 35% stained nuclei resulting in 37,5% versus 8,7% pCR rate and 54% of pCRs classified correctly. For qPCR determination, high Ki-67 mRNA expression was associated with a high pCR-rate of 36.4% as opposed to 5.8% in tumors with low Ki-67 mRNA levels and 82% classified correctly.

Conclusion: High Ki-67 mRNA expression measured by RT-qPCR was predictive for the achievement of pCR to NAC and in this respect was superior to Ki-67 determined by vIHC or qIHC. This is consistent with data on Ki-67 IHC as a predictor of pCR on larger neoadjuvant cohorts (1). RT-qPCR based measurements of Ki-67 mRNA ensures an objective and highly reproducible quantification of proliferative activity from FFPE tissue from routine core cut biopsies. As such it seems to be more robust and meaningful compared to protein-based determination of Ki-67 by IHC, both by visual scoring or quantitative image analysis.

1) Schneeweiss et al, Ann Oncol 2011 2) Fasching et al., BMC Cancer 2011

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-06-08.

Variable expression of the Fragile X Mental Retardation 1 (FMR1) gene in patients with premature ovarian failure syndrome is not dependent on number of (CGG)n triplets in exon 1

BACKGROUND

Increased expression of the Fragile X Mental Retardation 1 (FMR1) gene in blood cells has been claimed to be associated with variable (CGG)(n) triplet numbers in the 5' untranslated region of this gene. Increased CGG triplet numbers, including that of the so-called premutation range (n= 55-200), were shown to have a risk of <26% to impair ovarian reserve leading to primary ovarian insufficiency and premature ovarian failure (POF).

METHODS

DNA and RNA samples were isolated from 74 patients with idiopathic POF to evaluate quantitatively the expression of FMR1 in leukocytes and CGG triplet number on FMR1 gene alleles. mRNA levels were normalized and compared with those of control women. Expression of the encoded protein (FMRP) was analysed by immunohistochemistry on ovarian biopsy tissue sections.

RESULTS

A large variance of the FMR1 transcript level was found in the leukocyte RNA samples, but only in patients with POF, and this variability did not correlate to variance of CGG triplet numbers found on both FMR1 alleles (19 < n > 90). During normal folliculogenesis, FMRP is predominantly expressed in granulosa cells.

CONCLUSIONS

Our data suggest that FMR1 expression during human folliculogenesis is probably a quantitative trait. Proper function of FMRP in granulosa cells seems to depend on an optimal transcript level. All women with CGG triplet numbers outside the range associated with normal folliculogenesis (26 < n > 34) are therefore expected to have a relaxed FMR1 transcription control. FMR1 transcript levels in leukocytes might therefore be diagnostic for altered FMRP levels in granulosa cells, which will affect the process of folliculogenesis.

FGFR4 Arg388 genotype is associated with pathological complete response to neoadjuvant chemotherapy for primary breast cancer

BACKGROUND

A single-nucleotide polymorphism (SNP) in the FGFR4 gene is associated with poor prognosis in solid tumors. A recent study presented the first evidence that FGFR4 Arg388 could predict resistance to adjuvant chemotherapy in breast cancer. The present study evaluates the potential of this SNP to predict response to neoadjuvant chemotherapy (NCT) for primary breast cancer (PBC).

METHODS

As part of a randomized phase II trial, 257 patients received either doxorubicin-cyclophosphamide (AC) or doxorubicin-pemetrexed (AP) followed by docetaxel (Doc; Taxotere) as NCT for T2-4/N0-2/M0 PBC. FGFR4 genotype analyzed on germline DNA was correlated with clinicopathologic variables, clinical response, and pathological complete response (pCR) using univariate and multivariate analyses.

RESULTS

Only axillary lymph node status was associated with FGFR4 Arg388 [odds ratio (OR) 1.82, P = 0.03]. Joint analysis of both treatment arms revealed a correlation of FGFR4 Arg388 with clinical response (OR 2.14, P = 0.03) but not with pCR. In the AC-Doc arm, however, FGFR4 Arg388 was a strong predictor of pCR in the multivariate analysis (OR 3.79, P = 0.03). A significant interaction between FGFR4 genotype and treatment (P = 0.01) was found, indicating a therapy-specific effect.

CONCLUSION

We provide the evidence that FGFR4 388Arg is an independent predictor of pCR following AC-Doc as NCT in PBC.

Association of the fibroblast growth factor receptor-4 (FGFR4) Gly388Arg polymorphism with clinical and pathological response to primary systemic therapy (PST) for early breast cancer (EBC)

525

Background: The FGFR4 Arg388 genotype has recently been shown to be associated with decreased disease free survival after adjuvant systemic therapy for EBC and thus therapy resistance (Harbeck et al, J Clin Oncol. 2006). Primary systemic therapy (PST) for EBC allows in-vivo chemosensitivity testing. Pathological complete response (pCR) in the breast following PST is associated with improved survival. We evaluated the FGFR4 Gly388Arg polymorphism as a predictive factor for response to PST for EBC in the setting of a prospective, randomized phase 2 trial. Methods: Patients (pts, n = 257) with T2–4/N0–2/M0 EBC were randomized to 4 cycles (cy) A 60 mg/m2 + C 600 mg/m2 day (d) 1 every three weeks (q3w) followed by 4 cy D 100 mg/m2 d1 q3w, or 4 cy A 60 mg/m2 + P 500 mg/m2 on d1 q3w followed by 4 cy D 100 mg/m2 d1 q3w, stratified by hormone receptor (HR) status. Surgery was performed after last chemotherapy. Genotyping was performed using a Taqman Genotyping assay. The genotype was confirmed by RFLP-PCR for 50% of samples with 100% congruence. Results: Genotype was available for 252 of 257 pts enrolled into this study. Using Fisher´s Exact Test there was no correlation between genotype and clinical tumour size (cT), HR status, HER2neu status, grading, menopausal status or triple negative phenotype. The G/G genotype correlates significantly with clinically positive axillary lymph nodes before chemotherapy (p = 0.03). Considering all pts the G/G genotype (vs G/A + A/A) is associated with a significantly lower overall response rate (ORR)(OR 0,47; 65% vs 80%; p = 0.03). Separate analysis of treatment arms showed a significant correlation between the G/G genotype (vs other genotypes) and a lower pCR rate (OR 0.33; 12.5% vs 30.4%; p = 0.04), clinical complete response (p = 0.02) and ORR (OR 0.25; p = 0.01) in the AC-D arm, whereas there was no correlation for pts treated with AP-D. Conclusions: This study provides important evidence that the FGFR4 genotype might serve as a valuable predicitve marker for response to PST with AC-D for EBC.

No significant financial relationships to disclose.

HER2 overexpression is associated with shorter disease-free survival (DFS) following neoadjuvant systemic therapy (NST) of primary breast cancer (PBC) patients with gemcitabine (G), epirubicin (E) and docetaxel (Doc)

11087

Background: To evaluate prognostic factors for disease-free survival (DFS) following NST with G, E and Doc of patients with PBC. Methods: From 1/02 to 12/04 113 patients with T2–4 N0–2 M0 PBC received either six cycles of GEDoc (G 800 mg/m2 day (d) 1+8, E 60–90 mg/m2 d 1, Doc 60–75 mg/m2 d 1 every three weeks; 63 patients) or five cycles of GE (1,250 mg/m2 d 1, E 90–100 mg/m2 d 1 every two weeks) sequentially followed by four cycles of Doc (80–100 mg/m2 d 1every two weeks) with prophylactic filgrastim. 71% of tumours were hormone receptor positive, 24% HER2 positive (3+ by immunohistochemistry), 46% grade 3. 28 patients (25%) achieved a pathologic complete response (pCR) defined as no invasive tumour residue in the removed breast tissue at surgery. 9 of these patients had non-invasive cancer residues in the breast, one patient showed persisting axillary lymph node involvement. Results: With a median follow up of 3.2 years there is no statistically significant difference in DFS, distant DFS (DDFS) and overall survival (OS) rates between patients with and without pCR (DFS 79 versus (vs) 81 %, p=0,61; DDFS 82 vs 84 %, p=0.69; OS 86 vs 91%, p=0.33). In a Cox proportional hazards model HER2 3+ before NST (hazard ratio (HR)= 4.7; 95% confidence interval (CI) 1.9 - 11.3; p=0.0006), positive hormone receptors before NST (HR=0.27; 95% CI 0.11 - 0.65; p=0.003) and clinically nodal involvement before NST (HR=3.3; 95% CI 1.2–9.1; p=0.02) were statistically significant prognostic factors for recurrence whereas tumour size and grade before NST, the achievement of pCR, nodal status at surgery and response after 6 weeks of NST did not reach statistical significance. Thus far, in multivariate analysis only Her2 3+ before NST retained its prognostic significance (HR= 2.8; 95% CI 1.03 - 7.5, p=0.04). Conclusions: With a median follow-up of 3.2 years in multivariate analysis only HER2 3+ is associated with shorter DFS following NST containing G, E and Doc for PBC. Thus far, there is no statistically significant prognostic value for pCR.

No significant financial relationships to disclose.

Low-level amplifications of the human telomerase gene (TERC) regularly is associated with vulvar intraepithelial neoplasia

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Background: Invasive squamous carcinomas of the vulva frequently harbor gains on the long arm of chromosome 3, including the human telomerase gene locus (TERC). Vulvar cancer develops from precursor lesions known as vulvar intraepithelial neoplasia (VIN) which frequently occur simultaneously in multiple locations and have a considerable risk or recurrence during follow-up. We investigated TERC gene copy number in a series of vulvar intraepithelial neoplasias to determine the risk of progression in these lesions. Methods: A total of 20 cases of high grade vulvar intraepithelial neoplasias (VIN 3) were analyzed using a two-color fluorescence in situ hybridization (FISH) assay detecting the human telomerase gene locus (3q26) on paraffin embedded tissue sections. Two samples were excluded for technical reasons. Results: In 11 cases, gains of chromosomal material at 3q26 were detected with an average of 1.48 copies per chromosome. In another patient a high level amplification was found. The remaining two cases, four centromere and 3q26 hybridization signals were observed, consistent with a tetraploidy of chromosome 3. No changes in DNA copy number on chromosome 3q were detected only in four lesions. Conclusions: Our findings demonstrate high frequency of gains on chromosome 3q in the majority of high grade vulvar lesions. This suggests an involvement of the human telomerase gene locus in the pathogenesis of vulvar cancer.

No significant financial relationships to disclose.

Characteristics associated with long-term progression-free survival following high-dose chemotherapy in metastatic breast cancer and influence of chemotherapy dose

BACKGROUND

The purpose of this study was to characterize long-term progression-free survivors (LTPFS) of metastatic breast cancer (MBC) following high-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) and to assess the influence of chemotherapy dose in order to identify patients who derive major benefit from this approach.

PATIENTS AND METHODS

We compared patient and tumor characteristics of 16 LTPFS with the characteristics of 118 MBC patients who received HDCT with ASCT at our institution between 1992 and 2000. To estimate the cumulative dose of chemotherapy received, the summation dose intensity product (SDIP) of the different chemotherapy regimens was calculated as recently described by Hryniuk et al. The SDIP of the induction regimens was added to that of the HDCT regimens to yield the total SDIP of the chemotherapy received. Multivariate analysis was performed to describe the influence of the total SDIP and other prognostic factors on progression-free survival (PFS).

RESULTS

LTPFS were mostly < or = 50 years of age and had limited, chemotherapy-sensitive, hormone-responsive MBC. Due to an apparent dose-survival relationship, an increase by 10 units (U) in the SDIP increased the PFS time by 3 months. Independent predictors of an improved PFS were positive estrogen receptors (P = 0.001), positive combined hormone receptors (P = 0.020), and a complete remission/no evidence of disease status after HDCT (P < 0.001). In patients who had a disease-free interval (DFI) >24 months after primary surgery, an SDIP of >55 U was independently associated with a longer PFS [hazard ratio (HR) = 2.73; 95% confidence interval 1.29-5.81; P = 0.009].

CONCLUSION

HDCT can achieve long-term PFS in young MBC patients with limited, hormone-responsive and chemotherapy-sensitive disease. After a DFI >24 months, a longer PFS is associated with a higher chemotherapy dose as measured by SDIP. These retrospective analyses suggest SDIP might be a tool for studying cumulative dose as a determinant of outcome of MBC chemotherapy. Thus far, however, we cannot clearly identify any subgroup of MBC patients in whom HDCT with ASCT is of particular benefit.

Tandem high-dose chemotherapy in high-risk primary breast cancer: a multivariate analysis and a matched-pair comparison with standard-dose chemotherapy

Stem cell-supported high-dose chemotherapy (HDCT) is currently being evaluated in patients with high-risk primary breast cancer (HRPBC), as defined by extensive axillary lymph node involvement. Conclusive results from randomized studies with sufficient patient numbers and follow-up are pending. We retrospectively analyzed 144 HRPBC patients enrolled in a single-arm trial of tandem HDCT at the University of Heidelberg to evaluate the prognostic value of nodal ratio, HER2/neu status, and cytokeratin-positive bone marrow cells and to compare the outcomes of these patients with those of a conventionally treated control group of 91 patients matched by nodal ratio, tumor size, combined hormone-receptor status, and HER2/neu status. The tandem HDCT regimen consisted of 2 cycles of induction chemotherapy followed by 2 cycles of blood stem cell-supported high-dose ifosfamide, 12 g/m2; carboplatin, 900 mg/M2; and epirubicin, 180 mg/m2. Conventionally treated patients received a regimen containing anthracycline without taxanes (52 patients) or CMF (cyclophosphamide, methotrexate, and 5-flurouracil; 39 patients). With a median follow-up of 3.8 years, disease-free, distant disease-free, and overall survival rates were 62%, 65%, and 84%, respectively. In univariate analysis, besides the hormone receptor status (P = .007), HER2/neu overexpression was the strongest predictor of earlier death (P = .017). In multivariate analysis, a nodal ratio of > or =0.8 was found to be the only independent predictor of relapse (relative risk [RR] = 2.09; 95% confidence interval [CI], 1.21-3.60; P = .008) and only the absence of hormone receptors was associated with earlier death (RR = 3.59; 95% CI, 1.45-8.86; P = .006). Despite a trend toward later distant relapse after HDCT compared with standard-dose chemotherapy with a median follow-up of 3 years (P = .059), thus far, matched-pair analysis has not demonstrated significantly better survival rates after HDCT in all matched patients (P = .786) or in the subgroups of anthracycline-treated patients and patients with and without overexpression of HER2/neu. So far, the follow-up time has been too short to draw definite conclusions; however, patients with a nodal ratio of > or =0.8, receptor-negative tumors, or HER2/neu overexpression are at high risk for relapse and death, irrespective of the kind of adjuvant chemotherapy.