Hacia la personalización en el tratamiento del cáncer de mama Qué aportan los biomarcadoresen la actualidad?

Transcripción

1 Hacia la personalización en el tratamiento del cáncer de mama Qué aportan los biomarcadoresen la actualidad? Segunda Parte Federico Rojo XVI Jornada sobre el Cáncer de Mama: Personalización en el Cáncer de Mama Barcelona, 22 Febrero 2013

2 Proliferation (Ki67) and prognosis in breast cancer A limited prognostic use Urruticoechea, A. et al. J ClinOncol2005

3 Proliferation in breast cancer: Strong evidence for prognostication? Aleskandarany, MA. Breast Cancer Res 2012

4 Importance of biomarker assays in breast cancer: Current molecular assays to select patients for targeted therapies 20% of patients 75% of patients HER2 + 3+/amplified HER2 - ER + ER % response to anti-her2 therapy NO BENEFIT 40-60% response to anti-oestrogen therapy NO BENEFIT Predictive value of a positive test result is modest

5 Resistance mechanisms to endocrine therapy in breast cancer: emerging efficacy biomarkers Beelen, K. et al. Nat. Rev. Clin. Oncol. 2012

6 Resistance mechanisms to anti-her2 therapy in breast cancer Constitutively active truncated HER2 Epitope masking by MUC4 or CD44/ polymeric hyaluronan complex Failure to trigger immune-mediated mechanisms Upregulation of HER2 downstream signaling pathways Signaling through an alternate receptor and/or pathway

7 Resistance mechanisms to anti-her2 therapy in breast cancer: emerging efficacy biomarkers Mechanismof resistance PI3K pathway Level of evidence Role in intrinsec resistance Role in acquired resistance Frequency in HER2 breast cancer p95her2 IIB Yes Unknown ~25% PTEN loss IIB Yes Unknown ~35% PI3KCA mutations IIB Yes Possible ~25% AKT amplification In vitro Yes Unknown Unknown PDK1 overexpression In vitro Yes Unknown Unknown Alternative signaling HER3 III Yes Unknown Unknown IGF1R III Yes Unknown Unknown EGFR IIB Yes Yes Unknown MET In vitro Yes Unknown Unknown Epitope masking VEGFR In vitro Yes Unknown Unknown MUC4 III Yes Unknown Unknown HSP90 In vitro Yes Unknown Unknown CD44 In vitro Yes Unknown Unknown Immune mechanisms In vitro Yes Unknown Unknown

8 New approaches in the therapy of patients with HER2 breast cancer

9 Efectos de la doxorubicina en cáncer de mama a nivel transcripcional Doxorubicina 5uM (IC50), 24h Affymetrix Human Genome U133 Array Análisis de resultados mediante IPA Inhibición Sobre-expresión N=305

10 El control de la señalización mediada por las MAPK: Las MKP (DUSP) Factoresde crecimiento Estrésdel ambiente Inflamación RAS RAC CDC42 RHOI MAP3K RAF LZK MLK SEKK TAK1 MEKK TAO1 ASK1 DLK MAP2K MEK1 MEK2 MKK4 MKK7 MKK3 MKK6 MKK2 MKK5 MAPK ERK1/2 JNK p38 ERK5 MKP ERK JNK p38 ERK5 MKP MSK1/2 MNK1/2 PPARgETS SRF TCF API API STAT ATF2 ELK RSK EGR1ATF1 FOS MYC PAX6 SP1 p53 JUN MEF2 Transcripción Proliferación Diferenciación Adhesión Motilidad Superviviencia

11 Resultados VIII: Efectos de la modulación de MKP-1 sobre la sensibilidad a la doxorubicina MDA-MB-231 BT-474 MCF Doxorubicina(uM) Doxorubicina(uM) Doxorubicina(uM) Doxorubicina(uM) Doxorubicina(uM) Doxorubicina(uM) Control pcmv-ha-mkp-1 RO [10uM] MTS, 48h

12 Expresión de MKP1 en parénquima mamario y carcinoma de mama 300 Hscore(0-300) Sobreexpresión 0 Normal Hiperplasia ductal Carcinoma in 67 situ Carcinoma infiltrante Supervivencia libre de enfermedad (probabilidad) p=0.001 MKP-1 sobre-expresada MKP-1 no sobre-expresada Años

13 Asociación de MKP-1 y las MAPK en cáncer de mama MKP-1 p-erk1/2 p-jnk p-p38 Cluster#1 MKP-1 p-erk1/2 p-jnk p-p38 Cluster#2 MKP-1 p-erk1/2 p-jnk p-p38 Cluster#3 MKP-1 p-erk1/2 p-jnk p-p38 Cluster#4 MKP-1 p-erk1/2 p-jnk p-p38 Sobre-expresión Supervivencia libre de enfermedad (probabilidad) p=0.022 Cluster#1 Cluster#2 Cluster#3 Cluster#4 Años

14 Regulación de MKP-1 y MAPK en cáncer de mama: efecto sobre quimiosensibilidad ERK Otros factores NF-kB Estrés celular Acetilación H3 MKP1 Lys57 Ser295/323 Degradación proteasoma Actividad fosfatasa Cys258 MKP Estabilización HuR NF90 Ser359/364 Estabilidad MKP1 mrna Traducción HuR NF90 ERK proliferación p38 apoptosis JNK apoptosis

15 Regulación de MKP-1 y MAPK en cáncer de mama: efecto sobre quimiosensibilidad ERK Otros factores NF-kB Estrés celular Acetilación H3 MKP1 Lys57 Ser295/323 Degradación proteasoma Actividad fosfatasa Cys258 MKP Estabilización HuR NF90 Ser359/364 Estabilidad MKP1 mrna Traducción HuR NF90 ERK proliferación p38 apoptosis JNK apoptosis

16 Regulación de MKP-1 y MAPK en cáncer de mama: efecto sobre quimiosensibilidad ERK Otros factores NF-kB Estrés celular Acetilación H3 MKP1 MKP1 mrna Estabilización Traducción HuR HuR NF90 NF90 RTK KRAS Lys57 Ser295/323 Degradación proteasoma Actividad fosfatasa Cys258 MKP Ser359/364 Estabilidad BRAF ERK p38 proliferación JNK apoptosis apoptosis

17 A new paradigm in breast cancer management Massive target profiling

18 Molecular classification in breast cancer: The intrinsec subtypes Sorlie, T et al. PNAS, 2001 Perou, CM et al. Nature, 2000 Perreard, L et al. BreastCancerRes, 2006

19 Clinico-pathological features of intrinsic subtypes Reis-Filho, JS & Pusztai, L. Lancet 2011

20 Main features of commercially available multigene signatures in breast cancer Prat, A. et al. Nat Rev ClinOncol 2011

21 Prediction Analysis of Microarray(PAM) 50 Intrinsec subtypes are predictors in breast cancer Paclitaxel, fluorouracil, doxorubicinand cyclophosphamide response in neoadjuvant therapy Tamoxifen response in adjuvant therapy Parker, JS et al. J ClinOncol2009

22 Mammaprint Breast Cancer Assay Prognostic test on frozen tissue 70-gene expression profile (Agilent-based) related to angiogenesis, invasiveness, cell cycle and signaling Independent prognostic factor in retrospective studies for tumor size <5cm, 0-3 positive lymph nodes, stage I-II ER+/- Define a poor prognosis signature candidate to adjuvant chemotherapy 91% sensitivity, 73% specificity 85±4.3% 95±2.6% 51±4.5% 55±4.4%

23 Oncotype Dx Recurrence Score in ER+, N-, Tam+ patients Lower likelihood of recurrence Greater magnitude of TAM benefit Minimal, if any, chemotherapy benefit Greater likelihood of recurrence Lower magnitude of TAM benefit Clear chemotherapy benefit

24 Limitations of 1 st generation of multigene predictors in breast cancer: ER and proliferation genes Reis-Filho, JS. AACR 2012 Weigelt, B. et al. BreastCan Res 2010 Lee, JK. et al. ClinCancerRes 2010

25 Limitations of 1 st generation of multigene predictors in breast cancer: Lack of concordance between platforms Reis-Filho, JS. AACR 2012 Haibe-Kains, B. et al. JNCI 2012 Fan, C. et al. BMC MedGenomics2011 Weigelt, B. et al. BreastCan Res 2010

26 Systematic bias in genomic classification due to non-neoplastic cell proportion in breast cancer Elloumi, F. et al. BMC MedGenomics 2011

27 Limitations of 1 st generation of multigene predictors in breast cancer: Phenotype in breast intrinsic subtypes Prat, A & Perou, CM. Mol Oncol2011

28 Highlights of the St Gallen International Expert Consensus on early breast cancer 2011: Strategies for subtypes Goldhirsch, A. et al. Ann Oncol2011

29 Highlights of the St Gallen International Expert Consensus on early breast cancer 2011: Strategies for subtypes Goldhirsch, A. et al. Ann Oncol2011

30 Potential role for biomarker-based diagnostics Patient Histopathology Preclinical screens Repeat biopsy Biopsy Prognostic biomarker Targeted drugs Resistance mechanisms Tumor Predictive biomarker Tumor match Efficacy biomarker