DNA methylation profiling in doxorubicin treated primary locally advanced breast tumours identifies novel genes associated with survival and treatment response

<p>Abstract</p> <p>Background</p> <p>Breast cancer is the most frequent cancer in women and consists of a heterogeneous collection of diseases with distinct histopathological, genetic and epigenetic characteristics. In this study, we aimed to identify DNA methylation based biomarkers to distinguish patients with locally advanced breast cancer who may benefit from neoadjuvant doxorubicin treatment.</p> <p>Results</p> <p>We investigated quantitatively the methylation patterns in the promoter regions of 14 genes (<it>ABCB1</it>, <it>ATM</it>, <it>BRCA1</it>, <it>CDH3</it>, <it>CDKN2A</it>, <it>CXCR4</it>, <it>ESR1</it>, <it>FBXW7</it>, <it>FOXC</it>1, <it>GSTP1</it>, <it>IGF2</it>, <it>HMLH1</it>, <it>PPP2R2B</it>, and <it>PTEN</it>) in 75 well-described pre-treatment samples from locally advanced breast cancer and correlated the results to the available clinical and molecular parameters. Six normal breast tissues were used as controls and 163 unselected breast cancer cases were used to validate associations with histopathological and clinical parameters.</p> <p>Aberrant methylation was detected in 9 out of the 14 genes including the discovery of methylation at the <it>FOXC1 </it>promoter. Absence of methylation at the <it>ABCB1 </it>promoter correlated with progressive disease during doxorubicin treatment. Most importantly, the DNA methylation status at the promoters of <it>GSTP1</it>, <it>FOXC1 </it>and <it>ABCB1 </it>correlated with survival, whereby the combination of methylated genes improved the subdivision with respect to the survival of the patients. In multivariate analysis <it>GSTP1 </it>and <it>FOXC1 </it>methylation status proved to be independent prognostic markers associated with survival.</p> <p>Conclusions</p> <p>Quantitative DNA methylation profiling is a powerful tool to identify molecular changes associated with specific phenotypes. Methylation at the <it>ABCB1 </it>or <it>GSTP1 </it>promoter improved overall survival probably due to prolonged availability and activity of the drug in the cell while <it>FOXC1 </it>methylation might be a protective factor against tumour invasiveness. <it>FOXC1 </it>proved to be general prognostic factor, while <it>ABCB1 </it>and <it>GSTP1 </it>might be predictive factors for the response to and efficacy of doxorubicin treatment. Pharmacoepigenetic effects such as the reported associations in this study provide molecular explanations for differential responses to chemotherapy and it might prove valuable to take the methylation status of selected genes into account for patient management and treatment decisions.</p