title: O6-methylguanine-DNA methyltransferase as a prognostic and predictive marker for basal-like breast cancer treated with cyclophosphamide-based chemotherapy.
abstract: The O6-methylguanine-DNA methyltransferase (MGMT) protein protects cells from alkylating agents by removing alkyl groups from the O6-position of guanine. However, its effect on DNA damage induced by cyclophosphamide (CPM) is unclear. The present study investigated whether MGMT expression was correlated with prognosis in patients with breast cancer that was managed according to a common therapeutic protocol or treated with CPM-based chemotherapy. The intrinsic subtypes and MGMT protein expression levels were assessed in 635 consecutive patients with breast cancer using immunohistochemistry. In total, 425 (67%) luminal A, 95 (15%) luminal B, 47 (7%) human epidermal growth factor receptor-2+/estrogen receptor-(HER2+/ER-) and 48 (8%) basal-like subtypes were identified. Of these, MGMT positivity was identified in 398 (63%) of 635 breast cancers; 68% of luminal A, 67% of luminal B, 30% of HER2+/ER-and 46% of basal-like subtypes were positive. The overall survival (OS) and disease-free survival (DFS) rates did not significantly differ according to the MGMT status among patients with luminal A, luminal B or HER2+/ER-subtypes, and patients with MGMT-negative basal-like cancers tended to have a longer DFS, but not a significantly longer OS time. CPM-containing chemotherapy was administered to 26%, 40%, 47% and 31% of patients with luminal A, luminal B, HER2+/ER-and basal-like tumors, respectively. Although the MGMT status and clinical outcomes of patients with the luminal A, luminal B or HER2+/ER-subtypes treated with CPM were not significantly correlated, the patients with MGMT-negative basal-like tumors who received CPM exhibited significantly improved DFS and OS compared with the CPM-treated patients with MGMT-positive tumors. MGMT may be a useful prognostic and predictive marker for CPM-containing chemotherapy in basal-like breast cancer.
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Sayuri
authors.initials: S
authors.lastname: Isono
authors.affiliation: Department of Gastroenterological and Breast Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka 583-8588, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Fujishima
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Azumi
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Komoike
authors.affiliation: Department of Breast and Endocrine Surgery, Faculty of Medicine Nara Hospital, Kinki University, Ikoma, Nara 630-0293, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Yukawa
authors.affiliation: Department of Breast and Endocrine Surgery, Faculty of Medicine Nara Hospital, Kinki University, Ikoma, Nara 630-0293, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Watatani
keywords: O6-methylguanine-DNA methyltransferase; basal-like breast cancer; cyclophosphamide; predictive marker