Caractérisation moléculaire de la résistance à l’hormonothérapie et au ciblage de la voie PI3K/mTOR dans des modèles murins de cancers du sein luminaux

Luminal breast cancer (ER+, HER2 negative) accounts for 65-75% of all breast carcinomas. Current guidelines strongly recommend endocrine treatment at both the early and advanced stages. However, more than 20% of early stage patients, and all advanced patients will eventually develop endocrine resistance.As most preclinical models (MCF7, T47D) do not recapitulate tumor biology, we have chosen to develop murine models derived from fresh tumors, hence called patient derived xenografts (PDX). We show that these models, although difficult to generate, faithfully exhibit the morphological and biological features of their parental counterpart, with high long term stability. These models have also been evaluated for their sensitivity to various endocrine treatments.In the next step, we developed from these initially endocrine sensitive models new tumors rendered resistant to endocrine therapies. We show that there is no unique biological pattern associated with endocrine resistance, although ER functional reprogramming appears to be critical. We also show that PI3K/mTOR pathway activation, may not be always related to endocrine resistance, and suggest that fulvestrant, an ER down regulator, may be highly synergistic with everolimus in specific cases.Several PI3KCA inhibitors are currently being evaluated in this setting.Les cancers du sein luminaux, exprimant le récepteur aux œstrogènes (RE) représentent 65-75% des cancers du sein soit environ 35.000 nouvelles patientes par an en France. Les référentiels thérapeutiques en vigueur recommandent une prescription systématique d’hormonothérapie au stade précoce, et quasiment constante au stade avancé. Néanmoins, il est admis que plus de 20% des patientes au stade précoce, et la quasi-totalité au stade avancé, vont échapper au traitement endocrinien, rendant impératif le développement de modèles précliniques permettant d’étudier les mécanismes d’hormonorésistance. Dans un contexte de modèles cellulaires anciens et très imparfaits (MCF7, T47D), et de quasi absence de modèles murins pertinents, nous avons choisi de développer des modèles murins dérivés de tumeurs fraîches, dits PDX (patient derived xenografts). Nous avons montré que ces modèles, difficiles à obtenir, récapitulaient avec une grande fidélité les caractéristiques morphologiques et biologiques des tumeurs d’origine. Les PDX se distinguent également par une grande stabilité de ces caractéristiques lors des passages successifs, les rendant utilisables au long cours. Nous avons également évalué les modèles obtenus pour leur profil de sensibilité à diverses modalités de traitement hormonal.Dans une seconde étape, nous avons développé des modèles résistants à partir des PDX précédemment obtenues. Quatre modèles ont pu être obtenus, qui nous ont permis d’avoir à disposition des modèles rendant compte de situations cliniques variées. Ces 4 modèles ont fait l’objet d’analyses biologiques extensives visant à identifier les caractéristiques moléculaires potentiellement associées à telle modalité de résistance : nos données suggèrent fortement qu’il y a autant de mécanismes de résistance que de situations, rendant illusoire une définition biologique unifiée de l’hormonorésistance. La reprogrammation fonctionnelle du RE semble être au centre de ces mécanismes.La voie PI3K/mTOR est une des plus fréquemment associée à l’hormonorésistance. De manière originale, nous avons mis en évidence que cette voie était activée aussi bien dans les modèles sensibles que dans les modèles résistants. La troisième étape a consisté à évaluer l’efficacité de l’everolimus, agent ciblant mTORC1. Nous avons pu montrer que l’everolimus était hautement actif dans toutes les situations considérées, sans argument pour une synergie entre everolimus et tamoxifène ou exemestane. En revanche, il existe une nette tendance à la synergie avec le fulvestrant, inhibiteur hautement spécifique du RE entraînant sa dégradation, et faisant suggérer des interactions avec la voie non génomique du RE.Nous testons actuellement des inhibiteurs spécifiques de la PI3KCA grâce à diverses collaborations industrielles qui permettront également de mener des analyses génomiques approfondies. De multiples projets académiques sont en cours

A genomic and transcriptomic approach for a differential diagnosis between primary and secondary ovarian carcinomas in patients with a previous history of breast cancer

<p>Abstract</p> <p>Background</p> <p>The distinction between primary and secondary ovarian tumors may be challenging for pathologists. The purpose of the present work was to develop genomic and transcriptomic tools to further refine the pathological diagnosis of ovarian tumors after a previous history of breast cancer.</p> <p>Methods</p> <p>Sixteen paired breast-ovary tumors from patients with a former diagnosis of breast cancer were collected. The genomic profiles of paired tumors were analyzed using the Affymetrix GeneChip^®Mapping 50 K Xba Array or Genome-Wide Human SNP Array 6.0 (for one pair), and the data were normalized with ITALICS (ITerative and Alternative normaLIzation and Copy number calling for affymetrix Snp arrays) algorithm or Partek Genomic Suite, respectively. The transcriptome of paired samples was analyzed using Affymetrix GeneChip^®Human Genome U133 Plus 2.0 Arrays, and the data were normalized with gc-Robust Multi-array Average (gcRMA) algorithm. A hierarchical clustering of these samples was performed, combined with a dataset of well-identified primary and secondary ovarian tumors.</p> <p>Results</p> <p>In 12 of the 16 paired tumors analyzed, the comparison of genomic profiles confirmed the pathological diagnosis of primary ovarian tumor (n = 5) or metastasis of breast cancer (n = 7). Among four cases with uncertain pathological diagnosis, genomic profiles were clearly distinct between the ovarian and breast tumors in two pairs, thus indicating primary ovarian carcinomas, and showed common patterns in the two others, indicating metastases from breast cancer. In all pairs, the result of the transcriptomic analysis was concordant with that of the genomic analysis.</p> <p>Conclusions</p> <p>In patients with ovarian carcinoma and a previous history of breast cancer, SNP array analysis can be used to distinguish primary and secondary ovarian tumors. Transcriptomic analysis may be used when primary breast tissue specimen is not available.</p

Molecular Characterization of Resistance to Endocrine Therapy and PI3K/mTOR Pathway Targeting in Luminal Breast Cancer Patient Derived Xenografts

Les cancers du sein luminaux, exprimant le récepteur aux œstrogènes (RE) représentent 65-75% des cancers du sein soit environ 35.000 nouvelles patientes par an en France. Les référentiels thérapeutiques en vigueur recommandent une prescription systématique d’hormonothérapie au stade précoce, et quasiment constante au stade avancé. Néanmoins, il est admis que plus de 20% des patientes au stade précoce, et la quasi-totalité au stade avancé, vont échapper au traitement endocrinien, rendant impératif le développement de modèles précliniques permettant d’étudier les mécanismes d’hormonorésistance. Dans un contexte de modèles cellulaires anciens et très imparfaits (MCF7, T47D), et de quasi absence de modèles murins pertinents, nous avons choisi de développer des modèles murins dérivés de tumeurs fraîches, dits PDX (patient derived xenografts). Nous avons montré que ces modèles, difficiles à obtenir, récapitulaient avec une grande fidélité les caractéristiques morphologiques et biologiques des tumeurs d’origine. Les PDX se distinguent également par une grande stabilité de ces caractéristiques lors des passages successifs, les rendant utilisables au long cours. Nous avons également évalué les modèles obtenus pour leur profil de sensibilité à diverses modalités de traitement hormonal.Dans une seconde étape, nous avons développé des modèles résistants à partir des PDX précédemment obtenues. Quatre modèles ont pu être obtenus, qui nous ont permis d’avoir à disposition des modèles rendant compte de situations cliniques variées. Ces 4 modèles ont fait l’objet d’analyses biologiques extensives visant à identifier les caractéristiques moléculaires potentiellement associées à telle modalité de résistance : nos données suggèrent fortement qu’il y a autant de mécanismes de résistance que de situations, rendant illusoire une définition biologique unifiée de l’hormonorésistance. La reprogrammation fonctionnelle du RE semble être au centre de ces mécanismes.La voie PI3K/mTOR est une des plus fréquemment associée à l’hormonorésistance. De manière originale, nous avons mis en évidence que cette voie était activée aussi bien dans les modèles sensibles que dans les modèles résistants. La troisième étape a consisté à évaluer l’efficacité de l’everolimus, agent ciblant mTORC1. Nous avons pu montrer que l’everolimus était hautement actif dans toutes les situations considérées, sans argument pour une synergie entre everolimus et tamoxifène ou exemestane. En revanche, il existe une nette tendance à la synergie avec le fulvestrant, inhibiteur hautement spécifique du RE entraînant sa dégradation, et faisant suggérer des interactions avec la voie non génomique du RE.Nous testons actuellement des inhibiteurs spécifiques de la PI3KCA grâce à diverses collaborations industrielles qui permettront également de mener des analyses génomiques approfondies. De multiples projets académiques sont en cours.Luminal breast cancer (ER+, HER2 negative) accounts for 65-75% of all breast carcinomas. Current guidelines strongly recommend endocrine treatment at both the early and advanced stages. However, more than 20% of early stage patients, and all advanced patients will eventually develop endocrine resistance.As most preclinical models (MCF7, T47D) do not recapitulate tumor biology, we have chosen to develop murine models derived from fresh tumors, hence called patient derived xenografts (PDX). We show that these models, although difficult to generate, faithfully exhibit the morphological and biological features of their parental counterpart, with high long term stability. These models have also been evaluated for their sensitivity to various endocrine treatments.In the next step, we developed from these initially endocrine sensitive models new tumors rendered resistant to endocrine therapies. We show that there is no unique biological pattern associated with endocrine resistance, although ER functional reprogramming appears to be critical. We also show that PI3K/mTOR pathway activation, may not be always related to endocrine resistance, and suggest that fulvestrant, an ER down regulator, may be highly synergistic with everolimus in specific cases.Several PI3KCA inhibitors are currently being evaluated in this setting

Métastases cérébrales du cancer du sein HER2 (expérience de l' institut Curie)

L atteinte cérébrale est devenue un évènement de fréquence croissante chez les patientes atteintes de cancer du sein. Les progrès thérapeutiques réalisés ces 20 dernières années en sont la cause principale. Cependant, la survenue de métastases cérébrales constitue toujours un tournant dans l histoire du cancer du sein car le pronostic reste sombre. Nous avons analysé les données de 143 patientes de moins de 65 ans suivies à l Institut Curie (Paris) entre 1980 et 2008 pour des métastases cérébrales d un cancer du sein ne surexprimant pas HER2. L atteinte cérébrale était diagnostiquée après un délai médian de 49,1 mois. Elle était inaugurale de la maladie métastatique pour 28,7% des patientes, plus fréquemment et de manière significative pour des tumeurs triples négatives, de grade élevé et sans envahissement ganglionnaire au stade initial de la maladie.. La survie médiane à partir du diagnostic de métastases est de 23,6 mois. La survie médiane à partir du diagnostic de métastases cérébrales est de 7,1 mois et de 5,9 mois pour les tumeurs triple négative sans que cette différence ne soit significative. L apparition de métastases cérébrales, que ce soit précocement ou tardivement dans l évolution de la maladie, est en soit l événement pronostique principal.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Concurrent use of palbociclib and radiation therapy: single-centre experience and review of the literature

International audiencePalbociclib in combination with endocrine therapy increases progression-free survival in patients with ER-positive, HER2-negative advanced breast cancer (BC). In this study, we retrospectively evaluated safety in the first patient treated with concurrent use of palbociclib and radiation therapy (RT) in the Curie Institute. Between April 2017 and August 2019, 30 women with metastatic BC received locoregional and/or symptomatic irradiation at a metastatic site concurrently with palbociclib. The most common acute toxicities were radiodermatitis and neutropenia. Palbociclib had to be discontinued during RT in three locally treated patients who developed grade 3 radiodermatitis and febrile neutropenia, grade 2 dysphagia and metastatic disease progression, respectively. After a follow-up of at least 6 months, none of the patients had late toxicity. Concomitant administration of palbociclib with RT was reasonably well tolerated in our series of 30 patients. More prospective data with longer follow-up are needed to confirm these results

Quality of life and impact of pain in women treated with aromatase inhibitors for breast cancer. A multicenter cohort study.

Women with hormone-dependent breast cancer are treated with aromatase inhibitors (AI) to slow disease progression by decreasing estrogen levels. However, AI have adverse effects, including pain, with potentially serious impact on quality of life (QOL) and treatment compliance. We evaluated quality of life during the first year of AI treatment, focusing particularly on the impact of pain. In a multicenter cohort study of 135 women with early-stage breast cancer, free of pain at the initiation of AI treatment, quality of life (by the EORTC QLQ-BR23), somatic and psychic symptoms, psychological characters, temperament and coping strategies were assessed at baseline and at each follow-up visit (1, 3, 6 and 12 months). The impact of treatment-induced pain on quality of life during follow-up was determined with repeated-measures regression models. These models were constructed to assess the effects of pain and pain type on quality of life during follow-up, taking into account predictors associated with quality of life at baseline. Prior ganglion resection, taxane treatment and chemotherapy, a high amplification score on the pain catastrophizing scale, and a high harm avoidance score on the personality questionnaire were associated with a significantly lower baseline QOL. Fifty-seven percent of women developed pain of five different types: upper or lower limb joint pain, diffuse pain, neuropathic pain, tendon pain and mixed pain. A significant decrease in QOL was noted in the women with pain, particularly for body image, sexual functioning and future perspectives. Moreover, the impact of pain on QOL depended on the type of pain experienced. In conclusion, women treated with aromatase inhibitors display changes in quality of life and the degree of change in quality of life depends mostly on the type of pain experienced. Oncologists and patients should be aware of painful adverse effects of AI and encouraged to provide or receive earlier and more appropriate management of these effects

A Question Prompt List for Advanced Cancer Patients Promoting Advance Care Planning: A French Randomized Trial

International audienceContext: Advance care planning is essential to enable informed medical decisions to be made and to reduce aggressiveness in end-of-life (EOL) care.Objectives: This study aimed to explore whether a question prompt list (QPL) adapted to French language and culture could promote discussions, particularly on prognosis and EOL issues, among advanced cancer patients attending outpatient palliative care (PC) consultations.Methods: In this multicenter randomized study, patients assigned to the intervention arm received a QPL to help them prepare for the next consultation one month later. The main inclusion criteria were advanced cancer patients referred to the PC team with an estimated life expectancy of less than one year. The primary endpoint was the number of questions raised, globally and by topic. The secondary objectives were the impact of the QPL on psychological symptoms, quality of life, satisfaction with care, and coping styles at two months.Results: Patients (n = 71) in the QPL arm asked more questions (mean 21.8 vs. 18.2, P = 0.03) than patients in the control arm (n = 71), particularly on PC (5.6 vs. 3.7, P = 0.012) and EOL issues (2.2 vs. 1, P = 0.018) but not on prognosis (4.3 vs. 3.6, not specified). At two months, there was no change in anxiety, depression, or quality of life in either arm; patient satisfaction with doctors' technical skills was scored higher (P = 0.024), and avoidance coping responses were less frequent (self-distraction, P = 0.015; behavioral disengagement, P = 0.025) in the QPL arm.Conclusion: Questions on PC and EOL issues in outpatient PC consultations were more frequent, and patient satisfaction was better when a QPL was made available before the consultation

Quantitative CT Extent of Lung Damage in COVID-19 Pneumonia Is an Independent Risk Factor for Inpatient Mortality in a Population of Cancer Patients: A Prospective Study

International audienceBackground: CT lung extent has emerged as a potential risk factor of COVID-19 pneumonia severity with mainly semiquantitative assessment, and outcome was not assessed in the specific oncology setting. The main goal was to evaluate the prognostic role of quantitative assessment of the extent of lung damage for early mortality of patients with COVID-19 pneumonia in cancer patients. Methods: We prospectively included consecutive cancer patients with recent onset of COVID-19 pneumonia assessed by chest CT between March 15, 2020, and April 20, 2020, and followed until May 1, 2020. Demographic, clinical, laboratory test data and imaging findings were recorded. Quantitative chest CT assessment of COVID-19 pneumonia was based on the density distribution of lung lesions using a freely available software recently released (Myrian XP-Lung). The association between extent of lung damage and overall survival was studied by univariate and multivariate Cox analysis. The Uno C-index was used to assess the discriminatory value of the quantitative CT extent of lung damage. Results: Seventy cancer patients with chest CT evidence of COVID-19 were included. After a median follow-up of 25 days, 17 patients (24%) had died. The median quantitative chest CT extent of COVID-19 was 20% (IQR = 14–35, range = 3–59) for non-survivors vs. 10% (IQR = 6–15, range = 2–55) for survivors (p = 0.002). The extent of COVID-19 pneumonia was correlated with inpatient management (p = 0.003) and oxygen therapy requirements (p < 0.001). Independent factors associated with death were performance status (PS) ≥2 (HR = 3.9, 95% CI = [1.1–13.8] p = 0.04) and extent of COVID-19 pneumonia ≥30% (HR = 12.0, 95% CI = [2.2–64.4] p = 0.004). No differences were found regarding the histology of cancer, cancer stage, metastases sites, or type of oncologic treatment between the survivor and non-survivor groups. The cross-validated Uno C-index of the model including PS and extent of COVID-19 pneumonia was 0.83, 95% CI = [0.73–0.93]. Conclusions: The quantitative chest CT extent of COVID-19 pneumonia was a strong independent prognostic factor of early inpatient mortality in a population of cancer patients

Plasma thymidine kinase 1 activity and outcome of ER+ HER2- metastatic breast cancer patients treated with palbociclib and endocrine therapy

International audiencePurpose: Previous cohort studies have reported plasma TK1 activity (pTKa) as a potential prognostic biomarker in estrogen receptor-positive (ER+) HER2-negative (HER2-) metastatic breast cancer (MBC). In this prospective study, we report here the prognostic impact of pTKa in ER+/HER2- MBC patients treated with endocrine therapy and CDK4/6 inhibitor. Experimental design: Patients were included into the prospective, ethics committee-approved ALCINA study (NCT02866149). Eligibility criteria were patients with ER+/HER2- MBC treated at Institut Curie with endocrine therapy and palbociclib. Plasma samples were obtained at baseline and after 4 weeks of treatment. pTKa was quantified by the DiviTum® assay (Biovica, Sweden). Results: From May 2016 to August 2018, 103 patients treated with endocrine therapy and palbociclib were included. Patients had received a median of two prior systemic therapies for MBC (range 0-14). Median follow-up was 13.8 months (range 6-31), with median PFS and OS of 9.6 months (95%CI [7.0-11.3]) and 28 months (95%CI [23-not reached]), respectively. Median baseline pTKa was 292 Du/L (range 20-27,312 Du/L, IQR [89-853]). After adjusting for other prognostic factors, baseline pTKa remained an independent prognostic factor for both PFS (HR = 1.3 95%CI [1.1-1.4], p = 0.0005) and OS (HR = 1.3 95%CI [1.2-1.6], p < 0.0001), and 4-week pTKa was associated with OS (HR = 1.6 95%CI [1.3-2], p < 0.0001). That survival prediction was significantly improved by the addition of baseline pTKa to clinicopathological characteristics. Adding pTKa changes at 4 weeks to baseline pTKa did not further increase survival prediction. Conclusion: This study demonstrates the clinical validity of pTKa as a new circulating prognostic marker in ER+/HER2- MBC patients treated with endocrine therapy and palbociclib

18F]FDG PET/CT for predicting triple-negative breast cancer outcomes after neoadjuvant chemotherapy with or without pembrolizuma

International audiencePurpose: To determine if pretreatment [18F]FDG PET/CT could contribute to predicting complete pathological complete response (pCR) in patients with early-stage triple-negative breast cancer (TNBC) undergoing neoadjuvant chemotherapy with or without pembrolizumab. Methods: In this retrospective bicentric study, we included TNBC patients who underwent [18F]FDG PET/CT before neoadjuvant chemotherapy (NAC) or chemo-immunotherapy (NACI) between March 2017 and August 2022. Clinical, biological, and pathological data were collected. Tumor SUVmax and total metabolic tumor volume (TMTV) were measured from the PET images. Cut-off values were determined using ROC curves and a multivariable model was developed using logistic regression to predict pCR. Results: N = 191 patients were included. pCR rates were 53 and 70% in patients treated with NAC (N = 91) and NACI (N = 100), respectively (p 12.3), and low TMTV (≤ 3.0 cm3) were predictors of pCR in the NAC cohort while tumor staging classification ( 17.2), and low TMTV (≤ 7.3 cm3) correlated with pCR in the NACI cohort. In multivariable analysis, only high tumor SUVmax (NAC: OR 8.8, p < 0.01; NACI: OR 3.7, p = 0.02) and low TMTV (NAC: OR 6.6, p < 0.01; NACI: OR 3.5, p = 0.03) were independent factors for pCR in both cohorts, albeit at different thresholds. Conclusion: High tumor metabolism (SUVmax) and low tumor burden (TMTV) could predict pCR after NAC regardless of the addition of pembrolizumab. Further studies are warranted to validate such findings and determine how these biomarkers could be used to guide neoadjuvant therapy in TNBC patients