Next-generation sequencing to find predictors for chemotherapy response in triple-negative breast cancer (TNBC).

Authors

null

Esther H. Lips

Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, Netherlands

Esther H. Lips , Magali Michaut , Lennart Mulder , Nicolle Besselink , Marlous L. Hoogstraat , Marco J. Koudijs , Emile E. Voest , Rene Bernards , Jelle Wesseling , Lodewyk F. A. Wessels , Sjoerd Rodenhuis

Organizations

Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, Netherlands, Department of Molecular Carcinogenesis, the Netherlands Cancer Institute, Amsterdam, Netherlands, Center for Personalized Cancer Treatment/ Department of Medical Oncology UMC Utrecht, Utrecht, Netherlands, Department of Pathology, the Netherlands Cancer Institute, Amsterdam, Netherlands, Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, Netherlands

Research Funding

No funding sources reported

Background: In TNBC initial response to chemotherapy is often favorable, but relapse and chemotherapy resistance frequently occur in advanced disease. Hence there is an urgent need for targeted treatments in this breast cancer subtype. Methods: To identify biomarkers of chemotherapy resistance and putative directed treatment targets, we performed next generation sequencing (NGS) of 2,000 genes implicated in oncogenesis. DNA from 31 pre-treatment biopsies and matched normal blood was sequenced. Biopsies were derived from patients scheduled to receive neoadjuvant chemotherapy with doxorubicin/cyclophosphamide. For the analysis, the tumors were divided in responders and non-responders, depending on whether or not a pathological complete remission (pCR) was achieved. Two definitions of pCR were employed: either the complete absence of infiltrating tumor cells in the breast (n=18) or a pCR of both the breast and lymph nodes (n=15). Tumors with partial or no responses were grouped in the non-responder category. Results: As a positive control, we verified that all patients with a known germline BRCA1 mutation (n=8) could be detected by the NGS analysis. In further analyses, we focused only on somatic mutations. Overall, the mutation rate was slightly higher in the non-responders (per tumor, average=12, range=[3-25]) than in the responders (average=8, range=[3-19]) (p=0.17). The analysis of individual genes did not reveal significant differences between responders and non-responders. However, pathway analysis showed that mutations in phosphatidylinositol signaling (e.g., PIK3CA, CALML5) were significantly more frequent in the non-responders, with mutations present in 10/13 non-responders and 2/18 responders (adjusted p=0.013). The chemokine and integrin signaling pathways also revealed a significantly higher mutation rate in the non-responders. Conclusions: Mutations in genes of the phosphatidylinositol pathway occur frequently in TNBCs that do not achieve a pCR on a neoadjuvant chemotherapy regimen consisting of doxorubicin and cyclophosphamide. After validation, alternative chemotherapy regimens and targeted agents should be investigated for these tumors.

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Abstract Details

Meeting

2013 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Breast Cancer - Triple-Negative/Cytotoxics/Local Therapy

Track

Breast Cancer

Sub Track

Cytotoxic Chemotherapy

Citation

J Clin Oncol 31, 2013 (suppl; abstr 1010)

DOI

10.1200/jco.2013.31.15_suppl.1010

Abstract #

1010

Poster Bd #

2

Abstract Disclosures