Pathologic and biologic response to preoperative endocrine therapy in patients with ER-positive ductal carcinoma in situ

Abstract Background Endocrine therapy is commonly recommended in the adjuvant setting for patients as treatment for ductal carcinoma in situ (DCIS). However, it is unknown whether a neoadjuvant (preoperative) anti-estrogen approach to DCIS results in any biological change. This study was undertaken to investigate the pathologic and biomarker changes in DCIS following neoadjuvant endocrine therapy compared to a group of patients who did not undergo preoperative anti-estrogenic treatment to determine whether such treatment results in detectable histologic alterations. Methods Patients (n = 23) diagnosed with ER-positive pure DCIS by stereotactic core biopsy were enrolled in a trial of neoadjuvant anti-estrogen therapy followed by definitive excision. Patients on hormone replacement therapy, with palpable masses, or with histologic or clinical suspicion of invasion were excluded. Premenopausal women were treated with tamoxifen and postmenopausal women were treated with letrozole. Pathologic markers of proliferation, inflammation, and apoptosis were evaluated at baseline and at three months. Biomarker changes were compared to a cohort of patients who had not received preoperative treatment. Results Median age of the cohort was 53 years (range 38–78); 14 were premenopausal. Following treatment, predominant morphologic changes included increased multinucleated histiocytes and degenerated cells, decreased duct extension, and prominent periductal fibrosis. Two postmenopausal patients had ADH only with no residual DCIS at excision. Postmenopausal women on letrozole had significant reduction of PR, and Ki67 as well as increase in CD68-positive cells. For premenopausal women on tamoxifen treatment, the only significant change was increase in CD68. No change in cleaved caspase 3 was found. Two patients had invasive cancer at surgery. Conclusion Preoperative therapy for DCIS is associated with significant pathologic alterations. These changes may be clinically significant. Further work is needed to identify which women may be the best candidates for such treatment for DCIS, and whether best responders may safely avoid surgical intervention. Trial Registration ClinicalTrials.gov NCT0029074

Responsible Research and Innovation and the Governance of Human Enhancement

This article aims to explore the debate on human enhancement (HE) from the perspective of the evolutions of responsibility paradigms, and in particular from the perspective of the so-called Responsible Research and Innovation (RRI) ap- proach. The aim is not to explore the arguments pro or contra the ethical legitimacy and/or techni- cal feasibility of human enhancement, but rather exploring if, and how, the RRI perspective can shape the debate on human enhancement (and vice versa). In particular, the human enhancement debate will be read through the lenses of four main responsibility par- adigms that we sketch by examining both, the historical and conceptual evolution of the responsibility idea and the dynamics of its ascription. In order to provide a useful scheme for interpreting human enhancement, RRI will be characterised as a distinctive responsibility model that can subsequently be used to frame the debate on HE with a particular emphasis on its normative implications, as well as on its social and political significance