Recomendaciones para la determinación de HER2 en cáncer de mama. Consenso Nacional de la Sociedad Española de Anatomía Patológica ( SEAP ) y de la Sociedad Española de Oncología Médica ( SEOM )

La identificación de los carcinomas de mama con amplificación/sobreexpresión de HER2 es crítica en la práctica clínica diaria ya que estas neoplasias requieren un tratamiento específico que incluye el uso de terapias dirigidas. Tanto las técnicas de hibridación in situ como las técnicas inmunohistoquímicas son métodos apropiados para la identificación de cánceres de mama HER2 positivos. Sin embargo, numerosos estudios, incluidos los desarrollados por la Asociación para la Garantía de Calidad en Patología de la SEAP (AGCP) y la experiencia de centros de referencia nacionales en la determinación de HER2 han puesto de manifiesto importantes problemas de reproducibilidad entre laboratorios. Por estos motivos, patólogos expertos en la determinación de HER2 de estos centros de referencia, así como oncólogos médicos con una contrastada actividad en cáncer de mama, en representación de las sociedades respectivas (SEAP y SEOM), han trabajado para debatir y consensuar las recomendaciones nacionales de determinación de HER2. Estas recomendaciones se basan no sólo en la experiencia de los participantes en el consenso, sino también en la experiencia internacional publicada en recientes guías de distintos países, tales como Estados Unidos, Reino Unido y Canadá. En este consenso, se recomiendan los requisitos mínimos que un laboratorio de Anatomía Patológica debe cumplir para garantizar la adecuada determinación de HER2 en la práctica diaria. Aquellos laboratorios que carezcan de los estándares mínimos expuestos en esta guía deberían trabajar en alcanzarlos y durante este proceso remitir a laboratorios de referencia las muestras en las que la determinación de HER2 tenga implicaciones clínicas para las pacientes.Breast cancers with HER2 alterations are critical to identify because such tumors require unique treatment, including the use of targeted therapies. HER2 alterations at the DNA (amplification) and protein (overexpression) level usually occur in concert, and both in situ hybridization and immunohistochemistry can be accurate methods to assess these alterations. However, recent studies including those conducted by the Association for Quality Assessment of the Spanish Society of Pathology and the experience of several national reference centres for HER2 testing have suggested that serious reproducibility issues exist with both techniques. To address this, a joint committee of both the Spanish Society of Pathology and the Spanish Society of Medical Oncology has met to review guidelines for HER2 testing. Consensus recommendation are based not only on panellist’s experience but also in those consensus guidelines previously reported in several countries, such as United Stated, United Kingdom and Canada. These guidelines include minimal requirements that Pathology Department must meet in order to guarantee appropriate HER2 testing in breast cancer. Pathology laboratories that do not meet these standards must put effort to reach them and, in the meantime, send clinical cases to reference [email protected]

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Article accepted. The article will be published here soon. Pending final quality checks

SETBP1 overexpression is a novel leukemogenic mechanism that predicts adverse outcome in elderly patients with acute myeloid leukemia

3 Tables. 7 Figures. The online version of this article contains a data supplement.Acute myeloid leukemias (AMLs) result from multiple genetic alterations in hematopoietic stem cells. We describe a novel t(12;18)(p13;q12) involving ETV6 in a patient with AML. The translocation resulted in overexpression of SETBP1 (18q12), located close to the breakpoint. Overexpression of SETBP1 through retroviral insertion has been reported to confer growth advantage in hematopoietic progenitor cells. We show that SETBP1 overexpression protects SET from protease cleavage, increasing the amount of full-length SET protein and leading to the formation of a SETBP1–SET-PP2A complex that results in PP2A inhibition, promoting proliferation of the leukemic cells. The prevalence of SETBP1 overexpression in AML at diagnosis (n = 192) was 27.6% and was associated with unfavorable cytogenetic prognostic group, monosomy 7, and EVI1 overexpression (P < .01). Patients with SETBP1 overexpression had a significantly shorter overall survival, and the prognosis impact was remarkably poor in patients older than 60 years in both overall survival (P = .015) and event-free survival (P = .015). In summary, our data show a novel leukemogenic mechanism through SETBP1 overexpression; moreover, multivariate analysis confirms the negative prognostic impact of SETBP1 overexpression in AML, especially in elderly patients, where it could be used as a predictive factor in any future clinical trials with PP2A activators.This work was supported by the Ministerio de Educación y Ciencia, Ministerio de Ciencia e Innovación (PI081687, M.D.O.; and SAF2007-61827, C.B.), Departamento de Salud del Gobierno de Navarra (14/2008), ISCIII-RTICC (RD06/0020/0078), and Fundación para la Investigación Médica Aplicada y UTE (Spain).Elizabeth Guruceaga, of the Unit of Proteomics,Genomics and Bioinformatics of Center for Applied Medical Research, for the bioinformatics analysis, and Enrique Andreu for useful discussionPeer reviewe

MicroRNA expression profiling in Imatinib-resistant Chronic Myeloid Leukemia patients without clinically significant ABL1-mutations

The development of Imatinib Mesylate (IM), the first specific inhibitor of BCR-ABL1, has had a major impact in patients with Chronic Myeloid Leukemia (CML), establishing IM as the standard therapy for CML. Despite the clinical success obtained with the use of IM, primary resistance to IM and molecular evidence of persistent disease has been observed in 20-25% of IM treated patients. The existence of second generation TK inhibitors, which are effective in patients with IM resistance, makes identification of predictors of resistance to IM an important goal in CML. In this study, we have identified a group of 19 miRNAs that may predict clinical resistance to IM in patients with newly diagnosed CML

Recomendación para la determinación de HER2 en cáncer de mama : Consenso nacional de la sociedad española de anatomía patológica (SEAP) y de la sociedad española de oncología médica (SEOM)

La identificación de los carcinomas de mama con amplificación/sobreexpresión de HER2 es crítica en la práctica clínica diaria ya que estas neoplasias requieren un tratamiento específico que incluye el uso de terapias dirigidas. Tanto las técnicas de hibridación in situ como las técnicas inmunohistoquímicas son métodos apropiados para la identificación de cánceres de mama HER2 positivos. Sin embargo, numerosos estudios, incluidos los desarrollados por la Asociación para la Garantía de Calidad en Patología de la SEAP (AGCP) y la experiencia de centros de referencia nacionales en la determinación de HER2 han puesto de manifiesto importantes problemas de reproducibilidad entre laboratorios. Por estos motivos, patólogos expertos en la determinación de HER2 de estos centros de referencia, así como oncólogos médicos con una contrastada actividad en cáncer de mama, en representación de las sociedades respectivas (SEAP y SEOM), han trabajado para debatir y consensuar las recomendaciones nacionales de determinación de HER2. Estas recomendaciones se basan no sólo en la experiencia de los participantes en el consenso, sino también en la experiencia internacional publicada en recientes guías de distintos países, tales como Estados Unidos, Reino Unido y Canadá. En este consenso, se recomiendan los requisitos mínimos que un laboratorio de Anatomía Patológica debe cumplir para garantizar la adecuada determinación de HER2 en la práctica diaria. Aquellos laboratorios que carezcan de los estándares mínimos expuestos en esta guía deberían trabajar en alcanzarlos y durante este proceso remitir a laboratorios de referencia las muestras en las que la determinación de HER2 tenga implicaciones clínicas para las pacientes.Breast cancers with HER2 alterations are critical to identify because such tumors require unique treatment, including the use of targeted therapies. HER2 alterations at the DNA (amplification) and protein (overexpression) level usually occur in concert, and both in situ hybridization and immunohistochemistry can be accurate methods to assess these alterations. However, recent studies including those conducted by the Association for Quality Assessment of the Spanish Society of Pathology and the experience of several national reference centres for HER2 testing have suggested that serious reproducibility issues exist with both techniques. To address this, a joint committee of both the Spanish Society of Pathology and the Spanish Society of Medical Oncology has met to review guidelines for HER2 testing. Consensus recommendation are based not only on panellist’s experience but also in those consensus guidelines previously reported in several countries, such as United Stated, United Kingdom and Canada. These guidelines include minimal requirements that Pathology Department must meet in order to guarantee appropriate HER2 testing in breast cancer. Pathology laboratories that do not meet these standards must put effort to reach them and, in the meantime, send clinical cases to reference centres.Vera Sempere, Fco Jose, [email protected] ; Lluch Hernandez, Ana, [email protected]

Frequent and simultaneous epigenetic inactivation of TP53 pathway genes in acute lymphoblastic leukemia

Aberrant DNA methylation is one of the most frequent alterations in patients with Acute Lymphoblastic Leukemia (ALL). Using methylation bead arrays we analyzed the methylation status of 807 genes implicated in cancer in a group of ALL samples at diagnosis (n = 48). We found that 154 genes were methylated in more than 10% of ALL samples. Interestingly, the expression of 13 genes implicated in the TP53 pathway was downregulated by hypermethylation. Direct or indirect activation of TP53 pathway with 5-aza-2'-deoxycitidine, Curcumin or Nutlin-3 induced an increase in apoptosis of ALL cells. The results obtained with the initial group of 48 patients was validated retrospectively in a second cohort of 200 newly diagnosed ALL patients. Methylation of at least 1 of the 13 genes implicated in the TP53 pathway was observed in 78% of the patients, which significantly correlated with a higher relapse (p = 0.001) and mortality (p<0.001) rate being an independent prognostic factor for disease-free survival (DFS) (p = 0.006) and overall survival (OS) (p = 0.005) in the multivariate analysis. All these findings indicate that TP53 pathway is altered by epigenetic mechanisms in the majority of ALL patients and correlates with prognosis. Treatments with compounds that may reverse the epigenetic abnormalities or activate directly the p53 pathway represent a new therapeutic alternative for patients with ALL