1. HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ breast cancer
- Author
-
Milana A. Bergamino, Elena López-Knowles, Gabriele Morani, Holly Tovey, Lucy Kilburn, Eugene F. Schuster, Anastasia Alataki, Margaret Hills, Hui Xiao, Chris Holcombe, Anthony Skene, John F. Robertson, Ian E. Smith, Judith M. Bliss, Mitch Dowsett, Maggie C.U. Cheang, Abigail Evans, Adrian Ball, Akhil Johri, Ali Nejim, Alison Jones, Allan Corder, Amanda Thorne, Ambika Anand, Amitabha Chakrabarti, Anne Robinson, Anupam Modi, Ashraf Patel, Ashutosh Kothari, Brendan McFall, Caroline Mortimer, Caroline Lee, Charlie Chan, Charlotte Abson, Christopher Holcombe, Christopher Hinton, Ciaran Hollywood, Claire Murphy, Clare Crowley, Claudia Harding-Mackean, Clive Griffith, Conrad Lewanski, Daniel Rea, David Hwang, Derek Crawford, Dinesh Thekkinkattil, Douglas Ferguson, Douglas Adamson, Duncan Wheatley, Duraisamy Ravichandran, Ed Babu, Elaine Hyett, Fawzia Ashkanani, Fiona Hoar, Frances Kenny, Gary Dyke, Geoffrey Sparrow, null Gilbert, Giles Cunnick, Hafiz Algurafi, Helen Sweetland, Highes-Davies Prof, Hisham Hamed, Ian Smith, Ian Laidlaw, Ilyas Khattak, Jacqueline Newby, Jacqueline Rees-Lee, Jalal Kokan, Jane Barrett, Jay Dolatrai Naik, Jayant Vaidya, Jennifer Forrest, Jitendra Parmar, Jocelyn Adams, John Fox, Jonathan Roberts, Jonathan Dawson, Julie Doughty, Jull Donnelly, Kathleen Dunn, Kian Chin, Kieran Horgan, Kislaya Thakur, Ludger Barthelmes, Lynda Wyld, Madhumita Bhattacharyya, Maher Hadaki, Makam Kishore, Marcus Ornstein, Maria Bramley, Maria Bews-Hair, Marina Parton, Mark Sibbering, Mark Kissin, Mark Churn, Martin Hogg, Mary Quigley, Matthew Hatton, Matthew Winter, Matthew Adelekan, Michael Shere, Michael Carr, Michael Williams, Mohammed Absar, Muhammad Sharif, Muireann Kelleher, Nawaz Walji, Nicholas Williams, Nicholas Gallegos, Nigel Bundred, Olivia Hatcher, Perric Crellin, Peter Crane, Peter Donnelly, Peter Kneeshaw, Philip Walker, Prakash Sinha, Pudhupalayam Bhaskar, Racheal Soulsby, Radha Todd, Raghavan Vidya, Rakesh Mehra, Ramachandran Prasad, Ramsay Cutress, Ravi Sharma, Rebecca Roylance, Rebecca Goranova, Reem Ramzi Salman, Riccardo Bonom, Richard Johnson, Richard Sutton, Rick Linforth, Rob Coleman, Robert Grieve, Robert Leonard, Robert Reichert, Robert Kennedy, Roshan Agarwal, Rozenn Allerton, Russell Burcombe, Ruth Davis, Sankaran Narayanan, Sankaran Chandrasekharan, Sarah Vesty, Seema Seetharam, Serena Ledwidge, Shabana Iqbal, Shamaela Wahee, Shobha Silva, Simon Pain, Simon Holt, Simon Thomson, Simon Smith, Simon Ellenbogen, Siobhan Laws, Stephen Chan, Stephen Johnston, Steve Holt, Steven Thrush, Stuart McIntosh, Sumohan Chatterjee, Susan Cleator, Tamoor Usman, Tayo Johnson, Tibor Kovacs, Tracey Irvine, Urmila Barthkur, Vanessa Pope, Victoria Alexandra Brown, Vummiti Muralikrishna, Walid Samra, William Maxwell, and Zoe Winters
- Subjects
Clinical Trials as Topic ,Ki-67 Antigen ,Receptors, Estrogen ,Aromatase Inhibitors ,Receptor, ErbB-2 ,Biomarkers, Tumor ,Humans ,Breast Neoplasms ,Female ,General Medicine ,Neoplasm Recurrence, Local ,Receptors, Progesterone ,General Biochemistry, Genetics and Molecular Biology - Abstract
Background: oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks’ presurgical AI treatment in ER+/HER2+ BCs. Methods: all available ER+/HER2+ BC baseline tumours (n=342) in the POETIC trial were gene expression profiled using BC360™ (NanoString) covering intrinsic subtypes and 46 key biological signatures. Early response to AI was assessed by changes in Ki67 expression and residual Ki67 at 2 weeks (Ki67 2wk). Time-To-Recurrence (TTR) was estimated using Kaplan-Meier methods and Cox models adjusted for standard clinicopathological variables. New molecular subgroups (MS) were identified using consensus clustering. Findings: HER2-enriched (HER2-E) subtype BCs (44.7% of the total) showed poorer Ki67 response and higher Ki67 2wk (p2wk. Five new MS that were associated with differential response to AI were identified. HER2-E had significantly poorer TTR compared to Luminal BCs (HR 2.55, 95% CI 1.14–5.69; p=0.0222). The new MS were independent predictors of TTR, adding significant value beyond intrinsic subtypes. Interpretation: our results show HER2-E as a standardised biomarker associated with poor response to AI and worse outcome in ER+/HER2+. HRD, TP53 mutational score and immune-tumour tolerance are predictive biomarkers for poor response to AI. Lastly, novel MS identify additional non-HER2-E tumours not responding to AI with an increased risk of relapse. Funding: Cancer Research UK (CRUK/07/015).
- Published
- 2022