title: Short preoperative treatment with erlotinib inhibits tumor cell proliferation in hormone receptor-positive breast cancers.
abstract: OBJECTIVE
  To administer the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor erlotinib to patients with operable untreated breast cancer during the immediate preoperative period and to measure an antiproliferative and/or a proapoptotic effect in the post-therapy specimen and determine a biomarker profile associated with evidence of erlotinib-mediated cellular activity.
  
  
  METHODS
  Newly diagnosed patients with stages I to IIIA invasive breast cancer were treated with erlotinib 150 mg/d orally for 6 to 14 days until the day before surgery. Erlotinib plasma levels were measured by tandem mass spectrometry the day of surgery. Drug-induced changes in tumor cell proliferation and apoptosis were assessed by Ki67 immunohistochemistry and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling analysis, respectively, in biopsies from the pretherapy and surgical specimens. Biopsies were also evaluated for P-EGFR, P-HER-2, P-MAPK, P-Akt, P-S6, and S118 P-ER alpha.
  
  
  RESULTS
  In drug-sensitive PC9 xenografts, 5 days of treatment with erlotinib were enough to induce a maximal inhibition of cell proliferation and induction of apoptosis. Forty-one patients completed preoperative treatment with erlotinib. Grade <or= 2 rash and diarrhea were the main toxicities. Erlotinib inhibited tumor cell proliferation (Ki67), P-EGFR, and P-HER-2. The inhibition of proliferation occurred in estrogen receptor (ER) -positive but not in human epidermal growth factor receptor 2 (HER-2) -positive or triple-negative cancers. Treatment was associated with a significant reduction of P-MAPK, P-Akt, P-S6, and S118 P-ER alpha in hormone receptor-positive cancers.
  
  
  CONCLUSIONS
  A presurgical approach to evaluate cellular responses to new drugs is feasible in breast cancer. EGFR inhibitors are worthy of testing against ER-positive breast cancers but are unlikely to have clinical activity against HER-2-positive or triple-negative breast cancers.
authors.affiliation: Department of Medicine, Vanderbilt-Ingram Comprehensive Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232-6307, USA.
authors.forename: Marta
authors.initials: M
authors.lastname: Guix
authors.forename: Nara de Matos
authors.initials: Nde M
authors.lastname: Granja
authors.forename: Ingrid
authors.initials: I
authors.lastname: Meszoely
authors.forename: Theresa B
authors.initials: TB
authors.lastname: Adkins
authors.forename: Bobbye M
authors.initials: BM
authors.lastname: Wieman
authors.forename: Kerek E
authors.initials: KE
authors.lastname: Frierson
authors.forename: Violeta
authors.initials: V
authors.lastname: Sanchez
authors.forename: Melinda E
authors.initials: ME
authors.lastname: Sanders
authors.forename: Ana M
authors.initials: AM
authors.lastname: Grau
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Mayer
authors.forename: Gary
authors.initials: G
authors.lastname: Pestano
authors.forename: Yu
authors.initials: Y
authors.lastname: Shyr
authors.forename: Senthil
authors.initials: S
authors.lastname: Muthuswamy
authors.forename: Benjamin
authors.initials: B
authors.lastname: Calvo
authors.forename: Helen
authors.initials: H
authors.lastname: Krontiras
authors.forename: Ian E
authors.initials: IE
authors.lastname: Krop
authors.forename: Mark C
authors.initials: MC
authors.lastname: Kelley
authors.forename: Carlos L
authors.initials: CL
authors.lastname: Arteaga
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000970:Antineoplastic Agents / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D049109:Cell Proliferation / Q000187:drug effects; D017024:Chemotherapy, Adjuvant; D066246:ErbB Receptors / Q000378:metabolism; D000069347:Erlotinib Hydrochloride; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D019394:Ki-67 Antigen / Q000378:metabolism; D051379:Mice; D008819:Mice, Nude; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D047428:Protein Kinase Inhibitors / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D011799:Quinazolines / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D015398:Signal Transduction / Q000187:drug effects; D053719:Tandem Mass Spectrometry; D016896:Treatment Outcome; D023041:Xenograft Model Antitumor Assays
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D066246:ErbB Receptors; D000069347:Erlotinib Hydrochloride; D019394:Ki-67 Antigen; D047428:Protein Kinase Inhibitors; D011505:Protein-Tyrosine Kinases; D011799:Quinazolines; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human