Predictive value of apoptosis, proliferation, HER-2, and topoisomerase IIalpha for anthracycline chemotherapy in locally advanced breast cancer.
OBJECTIVE
Laboratory evidence indicates that tumor growth depends on the balance between cell proliferation and cell death, and many anticancer agents may exert their therapeutic effect by decreasing proliferation and increasing apoptosis. Additionally, clinical observations indicate that overexpression of HER-2 or topoisomerase IIalpha (topo IIalpha) may be predictors of better response to anthracyclines in breast cancer. The objective of this study was to determine if proliferation (Ki-67), apoptosis (TUNEL), and expression of HER-2 and topo IIalpha are affected by anthracycline treatment, and if these molecular markers predict anthracycline responsiveness.


METHODS
Thirty-three women with primary breast tumors > or =3 cm received either doxorubicin (75 mg/m(2)) or epirubicin (120 mg/m(2)) for 4 cycles before surgery. Clinical response was evaluated after 4 cycles of treatment. Changes in molecular markers were assessed from core needle taken before treatment (D0), at 24-48 h (Dl) and on day 7 (D7) while on treatment, and from the surgical specimen excised on day 84 (D84) after the fourth cycle of chemotherapy.


RESULTS
The overall response rate was 51% (17 of 33 patients), with a 12% complete clinical response rate (4 of 33 patients). There were trends for tumors with higher apoptosis and topo IIalpha at baseline (D0) to be more responsive to anthracyclines, p = 0.1 and p = 0.08, respectively. Median apoptosis increased from D0 to Dl (p = 0.06) while median Ki-67 decreased (p = 0.07). Overall, expression of HER-2 remained stable throughout the chemotherapy administration. By Day 84, topo IIalpha had significantly decreased from baseline in responders, while it increased in non-responders, p = 0.03.


CONCLUSIONS
In human primary breast cancer, anthracycline treatment causes an early increase in apoptosis and a decrease in proliferation. In this pilot study, higher apoptosis and topo IIalphaa levels in primary tumors were associated with greater responsiveness to anthracyclines, and topo IIalpha levels declined in responsive tumors.
Arpino
G
G
Breast Care Center, Baylor College of Medicine, 6550 Fannin Street, Houston, TX 77030, USA.
Ciocca
D R
DR
Weiss
H
H
Allred
D C
DC
Daguerre
P
P
Vargas-Roig
L
L
Leuzzi
M
M
Gago
F
F
Elledge
R
R
Mohsin
S K
SK
D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000494:pharmacology* / Q000627:therapeutic use; D000951:Antigens, Neoplasm / Q000096:biosynthesis; D017209:Apoptosis / Q000187:drug effects*; D014408:Biomarkers, Tumor / Q000096:biosynthesis*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D049109:Cell Proliferation / Q000187:drug effects*; D004250:DNA Topoisomerases, Type II / Q000096:biosynthesis; D004268:DNA-Binding Proteins / Q000096:biosynthesis; D004317:Doxorubicin / Q000494:pharmacology* / Q000627:therapeutic use; D015251:Epirubicin / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D018734:Genes, erbB-2 / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D011237:Predictive Value of Tests
D000903:Antibiotics, Antineoplastic; D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; D015251:Epirubicin; D004317:Doxorubicin; D004250:DNA Topoisomerases, Type II