Molecular Profiling of Endometrial Malignancies

Molecular profiling of endometrial neoplasms reveals genetic changes in endometrial carcinomas that support the dualistic model, in which type I carcinomas are estrogen-dependent, low grade lesions and type II carcinomas are nonestrogen dependent and high grade. The molecular changes in type I endometrial carcinomas include mutations in PTEN, PIK3CA, KRAS, and β-catenin, along with microsatellite instability, whereas type II endometrial carcinomas are characterized by genetic alterations in p53, HER2/neu, p16, and E-cadherin. For endometrial neoplasms with a malignant mesenchymal component, C-MYC mutations and loss of heterozygosity are frequently seen in carcinosarcomas, and a fusion gene, JAZF1/JJAZ1, is distinctive for endometrial stromal sarcoma. In addition, p53 mutations may play an important role in tumorigenesis of undifferentiated endometrial sarcoma. These molecular changes can help in the diagnosis of endometrial neoplasms, as well as form the basis of molecular targeted therapy

The Background Parenchymal Enhancement in Preoperative Breast MRI: The Effect on Tumor Extent Evaluation

Objective: To evaluate whether the level of background parenchymal enhancement (BPE) on MRI has an effect on the accurate assessment of tumor extent of breast cancer. Methods: This retrospective study included the preoperative MR images from 62 patients, who had been diagnosed with breast cancer and imaged between 2005 and 2014. The BPE was classified into minimal-mild and moderate- marked groups by visual evaluation. The tumor extent was classified into three types (unifocal, multifocal and multicentric). The concordance and discordance of the tumor extent at low and high BPE were evaluated, and compared with the pathological results. Results: Minimal-mild BPE was more common in post-menopausal or older women, while pre-menopausal or younger women had more moderate-marked BPE with statistical significance (p = 0.01). 84% of tumors with minimal-mild level of BPE and 73% of tumors with moderate-marked level of BPE, were accurately evaluated for the tumor extension. There was no significant difference in accuracy of tumor extent between minimal-mild and moderate-marked groups (p = 0.35). Conclusion: The preoperative MRI can evaluate the tumor extent of breast cancer with high accuracy and moderate- marked background enhancement does not affect to the tumor extent assessment

Tumor mutational profile of triple negative breast cancer patients in Thailand revealed distinctive genetic alteration in chromatin remodeling gene

Background Triple negative breast cancer (TNBC) is a breast cancer subtype characterized by absence of both hormonal receptors and human epithelial growth factor receptor 2 (HER2). TNBC accounts for 15–20% of breast cancer. TNBC is associated with more aggressive disease and worse clinical outcome. Though the underlying mechanism of TNBC is currently unclear, the heterogeneity of clinical characteristics in various population may relate to the difference in tumor mutational profile. There were studies on TNBC gene mutations in various ethnic groups but the tumor genome data on Thai TNBC patients is currently unknown. This study aims to investigate mutational profile of Thai TNBC. Methods The patients were Thai individuals who were diagnosed with primary breast carcinoma between 2014 and 2017. All surgically removed primary tumor tissues were carefully examined by pathologists and archived as formalin-fixed paraffin-embedded tumor. TNBC was defined by absence of hormonal receptors and HER2 by immunohistochemistry. Genomic DNA was extracted, enriched and sequenced of all exomes on the Illumina HiSeq. Genomic data were then processed through bioinformatics platform to identify genomic alterations and tumor mutational burden. Results A total of 116 TNBC patients were recruited. Genomic analysis of TNBC samples identified 81,460 variants, of which 5,906 variants were in cancer-associated genes. The result showed that Thai TNBC has higher tumor mutation burden than previously reported data. The most frequently mutated cancer-associated gene was TP53 similar to other TNBC cohorts. Meanwhile KMT2C was found to be more commonly mutated in Thai TNBC than previous studies. Mutational profile of Thai TNBC patients also revealed difference in many frequently mutated genes when compared to other Western TNBC cohorts. Conclusion This result supported that TNBC breast cancer patients from various ethnic background showed diverse genome alteration pattern. Although TP53 is the most commonly mutated gene across all cohorts, Thai TNBC showed different gene mutation frequencies, especially in KMT2C. In particular, the cancer gene mutations are more prevalent in Thai TNBC patients. This result provides important insight on diverse underlying genetic and epigenetic mechanisms of TNBC that could translate to a new treatment strategy for patients with this disease

A Phase I Trial of Liposomal Doxorubicin, Bevacizumab, and Temsirolimus in Patients with Advanced Gynecologic and Breast Malignancies

PURPOSE: Liposomal doxorubicin (D) and bevacizumab (A) are active single agents in gynecologic and breast malignancies which share a resistance mechanism: up-regulation of hypoxia inducible factor (HIF-1α). We therefore added temsirolimus (T), which inhibits HIF-1α, to D and A (DAT). Trial objectives were assessment of safety, preliminary efficacy and identification of biologic response correlates. PATIENTS AND METHODS: Cycle length was 21 days, with IV D, A and T on day 1; T on days 8 and 15 (3+3 dose68 escalation design with expansion cohorts). Mutational assays for PIK3CA, BRAF, KRAS and immunhistochemistry for PTEN loss were performed. RESULTS: This report details 74 patients with gynecologic and breast malignancies who received at least one dose of drug on study. Median patient age: 52, (27-79); prior regimens: 4, (1–11). Responses: 1 (1.4%) complete response (CR), 14 (18.9%) partial responses (PR), and 13 (17.6%) with stable disease (SD) ≥ 6 months (total = 37.9%). The most common grade 1 toxicities were fatigue (27%) and anemia (20.2%). Notable grade 3/4 toxicities: thrombocytopenia (9.5%), mucositis (6.7%) and bowel perforation (2.7%). PIK3CA mutations or PTEN loss were identified in 25/59 (42.3%) of tested patients. Among these, nine (36%) achieved CR/PR and four (16%) had SD ≥ 6 months (CR+PR+SD ≥ 6 months = 52%). CONCLUSIONS: DAT is well tolerated with manageable side effects. Responses observed warrant further evaluation. Mutational analyses were notable for a high percentage of responders with PI3K pathway aberrations