San Antonio Breast Cancer Symposium

San Antonio Breast Cancer Symposium

Perspective from Leif W. Ellisen, MD, PhD
December 11, 2015
4 min read
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Triple-negative breast cancers may differ based on BRCA1/2 status

Perspective from Leif W. Ellisen, MD, PhD
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SAN ANTONIO — Multiplatform tumor profiling indicated the molecular makeup of triple-negative breast cancers may differ between patients who are BRCA1/2 negative and positive, according to study results presented at the San Antonio Breast Cancer Symposium.

“Triple-negative breast cancer is negative for the three receptors: ER, PR and HER-2. So, there is no targeted therapy for this disease yet, and that’s why it remains a challenge,” Elias Obeid, MD, MPH, assistant professor in the departments of clinical genetics and medical oncology at Fox Chase Cancer Center, told HemOnc Today. “We understand that there are differences within triple-negative breast cancers, and it is not just one disease. Ideally, we are trying to improve our understanding of the disease and trying to find different targets that we can identify with molecular profiling to improve outcomes.”

Obeid and colleagues conducted multiplatform profiling (Molecular Intelligence, Caris Life Sciences) — which included next generation gene sequencing, protein expression by immunohistochemistry, and gene amplification by fluorescence or chromogenic in situ hybridization — on primary and metastatic specimens from 386 patients with triple-negative breast cancer. Researchers sought to identify differences in BRCA1/2 mutated and non-mutated profiles to inform targeted treatment options.

Overall, 63 patients (16.3%) harbored BRCA1/2 mutations, whereas 83.7% did not.

Proteins with the greatest expression in BRCA1/2 mutated and non-mutated specimens included TOPO1 (63.5% and 63.4%), EGFR (65.2% and 67.4%) and PD-1 (65.1% and 61.9%).

A greater proportion of BRCA1/2 non-mutated specimens harbored immunohistochemistry differences in androgen receptor expression (22% vs. 11.1%) and PTEN (59.6% vs. 47.6%), but this trend did not reach statistical significance.

“There is now an interest in the androgen receptor, and our results in the triple-negative cases demonstrated a trend for a difference between androgen receptor expression in the BRCA-mutated vs. non-mutated tumors,” Obeid said. “This is just preliminary data — it doesn’t tell us anything about the treatment yet — but in the future, that could be considered.”

Based on data from next generation sequencing, TP53 occurred at the highest frequency among gene mutations in BRCA1/2-mutated and non-mutated specimens (80.6% vs. 73.1%).

APC occurred in a greater proportion of BRCA1/2-mutated tumors (6.3% vs. 1.9%), whereas PIK3CA occurred in significantly more BRCA1/2 non-mutated tumors (25.8% vs. 11.1%; P = .0137).

“There were more likely to be mutations in the PI3-kinase pathway in the BRCA1/2 non-mutated tumors, and this could lend to the possibility of exploring mTOR inhibitors or other targets in this pathway,” Obeid said.

“Like some other exploratory analyses, this uncovers more questions that we need to ask, but it also will help us design the next generation of clinical trials so we can understand more who is going to respond to treatment as opposed to just giving treatments to patients without understand the basics of it,” he added. – by Alexandra Todak

Reference:

Arguello D, et al. Abstract P3-07-30. Presented at: San Antonio Breast Cancer Symposium; Dec. 8-12, 2015; San Antonio.

Disclosure: Obeid reports no relevant financial disclosures. Other researchers report employment with Caris Life Sciences.