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  • 1
    In: Cancers, MDPI AG, Vol. 11, No. 2 ( 2019-02-18), p. 238-
    Abstract: Liquid biopsy analytes such as cell-free DNA (cfDNA) and circulating tumor cells (CTCs) exhibit great potential for personalized treatment. Since cfDNA and CTCs are considered to give additive information and blood specimens are limited, isolation of cfDNA and CTC in an “all from one tube” format is desired. We investigated whether cfDNA variant sequencing from CTC-depleted blood (CTC-depl. B; obtained after positive immunomagnetic isolation of CTCs (AdnaTest EMT-2/Stem Cell Select, QIAGEN)) impacts the results compared to cfDNA variant sequencing from matched whole blood (WB). Cell-free DNA was isolated using matched WB and CTC-depl. B from 17 hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2−) metastatic breast cancer patients (QIAamp MinElute ccfDNA Kit, QIAGEN). Cell-free DNA libraries were constructed (customized QIAseq Targeted DNA Panel for Illumina, QIAGEN) with integrated unique molecular indices. Sequencing (on the NextSeq 550 platform, Illumina) and data analysis (Ingenuity Variant Analysis) were performed. RNA expression in CTCs was analyzed by multimarker quantitative PCR. Cell-free DNA concentration and size distribution in the matched plasma samples were not significantly different. Seventy percent of all variants were identical in matched WB and CTC-depl. B, but 115/125 variants were exclusively found in WB/CTC-depl. B. The number of detected variants per patient and the number of exclusively detected variants per patient in only one cfDNA source did not differ between the two matched cfDNA sources. Even the characteristics of the exclusively detected cfDNA variants in either WB or CTC-depl. B were comparable. Thus, cfDNA variants from matched WB and CTC-depl. B exhibited no relevant differences, and parallel isolation of cfDNA and CTCs from only 10 mL of blood in an “all from one tube” format was feasible. Matched cfDNA mutational and CTC transcriptional analyses might empower a comprehensive liquid biopsy analysis to enhance the identification of actionable targets for individual therapy strategies.
    Type of Medium: Online Resource
    ISSN: 2072-6694
    Language: English
    Publisher: MDPI AG
    Publication Date: 2019
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  • 2
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    American Association for Cancer Research (AACR) ; 2020
    In:  Cancer Research Vol. 80, No. 16_Supplement ( 2020-08-15), p. 5366-5366
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 80, No. 16_Supplement ( 2020-08-15), p. 5366-5366
    Abstract: Background: We recently demonstrated great differences in the RNA profiles of matched circulating tumor cells (CTCs) and extracellular vesicles (EVs) in HER2 negative (HER2-) hormone receptor positive (HR+) metastatic breast cancer (MBC) patients. To elucidate the clinical utility of CTC and EV RNA profiling, we here a) tested the RNA profiles of another MBC subgroup, namely the HER2 positive (HER2+) patients, and b) compared the profiles in the two cohorts. Patients and methods: Blood was collected from 25 HER2+ (HR+ and HR-) and 35 HER2- (only HR+) MBC patients at the time of disease progression and at two consecutive staging time points. CTCs were isolated from 5 ml blood by positive immunomagnetic selection targeting EpCAM, EGFR and HER2 (AdnaTest EMT2/StemCell Select). EVs were isolated from 4 ml pre-filtered plasma by affinity-based binding to a spin column (exoRNeasy). The mRNA was purified by Oligo-dT beads and reverse transcribed (AdnaTest EMT2/StemCell Detect). Pre-amplified cDNA was analyzed by multimarker qPCR assays (AdnaTest TNBC Panel prototype) for 18 genes (including AKT2, ALK, AR, AURKA, BRCA1, KIT, MET, EGFR, ERCC1, ERBB2, ERBB3, KRT5, mTOR, NOTCH1, PARP1, PIK3CA, SRC, GAPDH). Consumables: QIAGEN, Germany. Results: In the HER2+ cohort, transcripts involved in the PI3K pathway were significantly more prevalent in CTCs compared to EVs and were found in more than 50% of these patients. In contrast, NOTCH1 and PARP1 were significantly more prominent in EVs as compared to their matched CTCs and EV PARP1 and EV AURKA overexpression signals were detected in more than 50% of patients. ERCC1 and SRC signals were present in CTCs as well as EVs in the majority of patients. ERCC1 signals in CTCs and EVs showed a significantly higher frequency in the HER2+ compared to the HER2-HR+ cohort. However, ERCC1 signals in CTCs of the HER2-HR+ cohort correlated with shorter survival time after first diagnosis of metastasis (p=0.011). In general, the overexpression signal prevalence was similar in both cohorts and both blood analytes. A small overlap of identical signals in CTCs and EVs of 15%/5% in the HER2+/HER2-HR+ cohort was observed. Interestingly, ERBB2 signals were only found in CTCs, not EVs, and in both cohorts with a similar prevalence (36%/40%). ERBB3 overexpression signals in CTCs significantly correlated with non-response only in the HER2-HR+ cohort (p=0.021). However, in HER2+ patients ERBB3 signals were only present at the time of progressive disease, but not at the time point of stable disease. Conclusions: RNA profiling indicated great differences in CTCs and EVs in both subgroups. Moreover, data emphasize the immense diversity between HER2+ versus HER2-HR+ MBC patients, revealing the need for blood analyte specific and subgroup specific multimarker panel for therapy management based on liquid biopsies in the future. Citation Format: Corinna Keup, Siegfried Hauch, Mitra Tewes, Hans-Christian Kolberg, Oliver Hoffmann, Rainer Kimmig, Sabine Kasimir-Bauer. Metastatic breast cancer subgroup specific mRNA profiles of circulating tumor cells and extracellular vesicles [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5366.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
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  • 3
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 81, No. 4_Supplement ( 2021-02-15), p. PS2-24-PS2-24
    Abstract: Background: Extensive knowledge about the molecular complexity could benefit therapy management in metastatic breast cancer (MBC). Consequently, we isolated and analyzed mRNA from circulating tumor cells (CTCs), mRNA from extracellular vesicles (EVs), and cell-free DNA (cfDNA) from a minimized blood volume and aimed to assess the dynamics of these analytes to elucidate the relevance of multi-parametric liquid biopsies for therapy monitoring and therapeutic decision-making by studying them at various points in time during the course of the therapy. Methods: 2x 9 ml of EDTA blood was drawn from 35 MBC patients with hormone receptor-positive and HER2 negative primary tumors at the time of disease progression and at two consecutive staging time points. CTCs and their mRNA were isolated using the AdnaTest EMT2/StemCell Select/Detect. Plasma from CTC-depleted blood was used for cfDNA isolation, while mRNA from EVs was isolated using exoRNeasy and the remaining blood. mRNA purified from CTCs and EVs was analyzed by a multimarker qPCR panel targeting 17 transcripts. cfDNA was analyzed with a customized QIAseq Targeted DNA Panel (targeting 17 genes) for Illumina with unique molecular indices. Consumables: QIAGEN, Germany. Results: Data from 35 patients at three time points (105 samples) and 51 parameters [results of 17 genes in three analytes (CTCs, EVs, and cfDNA)] were correlated with therapy outcomes defined by visual staging to examine their value for monitoring. Among the top 15 parameters with the best sensitivity and specificity - regardless of whether or not sensitivity and specificity were jointly examined - most parameters originated from the analysis of CTCs. Among these parameters, a two-tailed Fisher’s exact test revealed ERBB3 CTC signals (96% spec; 22% sens; p=0.022) or a combination of ERBB3 CTC signals or ERBB2 CTC signals (87% spec; 37% sens; p=0.008) to be highly correlated with the time of disease progression. Interestingly, an evaluation of the development of signals during the therapy resulted in EV parameters having the best sensitivity and specificity. The appearance of signals associated with resistance (ERCC1) in EVs was significantly correlated with worse therapy outcomes reaching a specificity of 98% (24% sens; p=0.007). A visualization of all results from seven index patients demonstrated the diversity within CTC signals and the dynamics of EV signals during treatment. Some of the CTC signals and their matched EVs (e.g. BRCA1 signals) showed opposed behavior during the treatment for a given patient. PIK3CA and ESR1 variants, known to be associated with resistance, were frequently found in those index patients receiving anti-hormonal treatment. Allele frequencies of PIK3CA variants in cfDNA and PIK3CA CTC signals showed a similar reduction after successful chemotherapy. In contrast, a switch to chemotherapy induced ERCC1 CTC signals in two cases. In three other cases, ERCC1 CTC signals persisted despite the patients having successfully responded to the chemotherapy administered. In individual patients, only signals from a single analyte were particularly prominent at all time points. Conclusion: Among the parameters tested for the purposes of monitoring, most of the top 15 originated from the analysis of CTCs and therefore, underscore their salience in the field of liquid biopsy. Additionally, the dynamic development of overexpression signals in EVs during the course of therapy proved to be an important indicator of disease progression and might therefore also be useful for therapy monitoring. Combination of these results with the analysis of cfDNA variants over time, as done with our index patients, underlines the usefulness of this multimodal liquid biopsy approach for therapeutic decision-making in the future. Citation Format: Sabine Kasimir-Bauer, Markus Storbeck, Peter Hahn, Siegfried Hauch, Markus Sprenger-Haussels, Oliver Hoffmann, Rainer Kimmig, Corinna Keup. Dynamics of a multi-parametric liquid biopsy, including CTCs, EVs, and cfDNA, during therapy in metastatic breast cancer patients provide useful insights for therapy management [abstract] . In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS2-24.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2021
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  • 4
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 79, No. 13_Supplement ( 2019-07-01), p. 1369-1369
    Abstract: Background: Blood analytes derived from liquid biopsies are discussed as useful tools for therapy stratification and for monitoring of clonal evolution. To gain comprehensive insights into the genomic and transcriptomic complexity in metastatic breast cancer (MBC) useful for therapy management, we aimed to isolate and analyze mRNA and gDNA from circulating tumor cells (CTCs), mRNA from extracellular vesicles (EVs) and cell-free DNA (cfDNA) from the same blood sample with minimized volume in a condensed workflow. Patients and Methods: EDTA blood (2x 9 ml) was drawn from 35 MBC patients with hormone receptor positive and HER2 negative primary tumor at time of disease progression and at two further consecutive staging time points. CTCs were isolated in duplicate from 5ml blood by immunomagnetic selection (AdnaTest EMT2/StemCell Select, QIAGEN). Plasma (4 ml) of the CTC-depleted blood was used for cfDNA isolation (QIAamp MinElute ccfDNA Kit, QIAGEN), plasma (4 ml) from the blood not used for CTC/cfDNA isolation was applied for EV isolation (exoRNeasy, QIAGEN). The mRNA purified from CTCs and EVs was analyzed by qPCR panel (AdnaPanel TNBC prototype, QIAGEN), while cfDNA was analyzed with a customized QIAseq Targeted DNA Panel for Illumina (QIAGEN) with unique molecular indices. We are working on a workflow to isolate gDNA from CTCs, starting from mRNA-depleted CTC lysates and analyzing the gDNA with a customized QIAseq Targeted DNA Panel. Isolation and mutation analysis of CTC gDNA was shown to be feasible in spiking experiments. Results: Isolation of mRNA and gDNA from CTCs, mRNA from EVs and cfDNA was successfully established in a parallel workflow. CTC and EV mRNA profiles showed substantial differences synergizing with regard to their clinical relevance. Whereas overexpression of mTOR was related to therapy responsiveness in CTCs, mTOR signals in EVs related to therapy failure. ERBB2 overexpressing CTCs were found in one third of all MBC patients enabling new therapeutic options. Matched cfDNA revealed the appearance of pathogenic mutations (e.g. PIK3CA H1047R) across treatment indicating underlying resistance mechanisms. Moreover, we identified significant correlations of therapy outcome with the overexpression of transcripts/ presence of mutations in each of the isolated liquid biopsy analytes. Comparison of CTC gDNA and cfDNA is further conducted. Conclusions: We were able to describe a complete workflow for parallel CTC mRNA, CTC gDNA, EV mRNA and cfDNA isolation from a minimized blood volume. In this research study each analyte showed synergistic potential for therapy management, thus the comprehensive picture of the genomic and transcriptomic complexity might in future enable to identify the most suitable therapy regiment in each individual patient. Citation Format: Corinna Keup, Markus Storbeck, Peter Hahn, Siegfried Hauch, Markus Sprenger-Haussels, Ann-Kathrin Bittner, Oliver Hoffmann, Mitra Tewes, Rainer Kimmig, Sabine Kasimir-Bauer. Establishment of a workflow for analysis of mRNA and gDNA from circulating tumor cells, extracellular vesicles and cell-free DNA from the same blood sample to mirror the genomic and transcriptomic complexity in metastatic breast cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1369.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2019
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  • 5
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 77, No. 13_Supplement ( 2017-07-01), p. 3777-3777
    Abstract: Background: Blood analytes, as liquid biopsies, are discussed to be surrogate markers for therapy stratification of metastatic breast cancer (MBC) patients. Repeated analysis is enabled by the minimal invasive nature of blood draw. Analysis of RNA enclosed in circulating tumor cells (CTCs) or extracellular vesicles (EVs) may be sensitive enough to detect disease progression earlier than contemporary visual staging methods. A prediction of the ideal therapy strategy via characterization of CTCs or EVs would be even more beneficial. Here we compare RNA profiles of CTCs and EVs in MBC patients to get insight into their feasibility for therapy stratification. Patients and methods: Blood was collected from 10 MBC patients at the time of disease progression (T0) and at two consecutive clinical staging time points (T1 and T2) during therapy. Two cohorts were separated according to RECIST criteria a) Overall Responder showed response at T1 and T2 and b) Late Non-Responder displayed stable disease or partial remission at T1, but showed progressive disease at T2. CTCs were isolated from 5 ml blood by positive immunomagnetic selection targeting EpCAM, EGFR and HER2 (AdnaTest EMT2/StemCell Select TM, QIAGEN, Germany). EVs were isolated from 4 ml pre-filtered plasma by affinity-based binding to a spin column (exoRNeasy, QIAGEN, Germany). mRNA bound to Oligo-dT beads was purified and reverse transcribed (AdnaTest EMT2/StemCell Detect TM, QIAGEN, Germany). Pre-amplified cDNA was analysed by a multimarker qPCR (AdnaPanel TNBC, QIAGEN, Germany). RNA profiles of 18 genes (including AKT2, ALK, AR, AURKA, BRCA1, cKIT, cMET, EGFR, ERCC1, HER2, HER3, KRT5, mTOR, NOTCH1, PARP1, PI3K, SRC1, GAPDH) were normalized by data of healthy donors (n=20) and CD45 served as leukocyte control in the CTC preparation. Results: In general, data analysis showed great differences in RNA profiles of EVs and CTCs. However, PI3K and SRC1 signals were found in similar frequencies in the EV and CTC fraction. HER2, HER3, cKIT or cMET signals significantly correlated with disease progression by analysis of either CTCs or EVs (p=0.001). In EVs, BRCA1 signals positively indicated response, while AR and KRT5 signals were related to a negative response. No marker was exclusively found in CTCs to correlate to the therapy-response course. In CTCs and EVs, however, similar signal courses for PI3K and cMET were found across all time points, revealing PI3K as potential positive response marker and cMET as potential negative response marker in both blood analytes. Conclusions: Expression profiling in CTCs as well as in EVs is enabled by the described workflows. Preliminary data indicated great differences in RNA profiles of EVs and CTCs. The amount of included patients is continuously increased to validate the preliminary results obtained until now. Citation Format: Corinna Keup, Siegfried Hauch, Linda Plappert, Markus Sprenger-Haussels, Pawel Mach, Mitra Tewes, Bahriye Aktas, Hans-Christian Kolberg, Rainer Kimmig, Sabine Kasimir-Bauer. RNA profiles of circulating tumor cells and extracellular vesicles for therapy stratification of metastatic breast cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3777. doi:10.1158/1538-7445.AM2017-3777
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2017
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  • 6
    In: Genome Medicine, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2021-12)
    Abstract: Single liquid biopsy analytes (LBAs) have been utilized for therapy selection in metastatic breast cancer (MBC). We performed integrative statistical analyses to examine the clinical relevance of using multiple LBAs: matched circulating tumor cell (CTC) mRNA, CTC genomic DNA (gDNA), extracellular vesicle (EV) mRNA, and cell-free DNA (cfDNA). Methods Blood was drawn from 26 hormone receptor-positive, HER2-negative MBC patients. CTC mRNA and EV mRNA were analyzed using a multi-marker qPCR. Plasma from CTC-depleted blood was utilized for cfDNA isolation. gDNA from CTCs was isolated from mRNA-depleted CTC lysates. CTC gDNA and cfDNA were analyzed by targeted sequencing. Hierarchical clustering was performed within each analyte, and its results were combined into a score termed Evaluation of multiple Liquid biopsy analytes In Metastatic breast cancer patients All from one blood sample (ELIMA.score), which calculates the contribution of each analyte to the overall survival prediction. Singular value decomposition (SVD), mutual information calculation, k-means clustering, and graph-theoretic analysis were conducted to elucidate the dependence between individual analytes. Results A combination of two/three/four LBAs increased the prevalence of patients with actionable signals. Aggregating the results of hierarchical clustering of individual LBAs into the ELIMA.score resulted in a highly significant correlation with overall survival, thereby bolstering evidence for the additive value of using multiple LBAs. Computation of mutual information indicated that none of the LBAs is independent of the others, but the ability of a single LBA to describe the others is rather limited—only CTC gDNA could partially describe the other three LBAs. SVD revealed that the strongest singular vectors originate from all four LBAs, but a majority originated from CTC gDNA. After k-means clustering of patients based on parameters of all four LBAs, the graph-theoretic analysis revealed CTC ERBB2 variants only in patients belonging to one particular cluster. Conclusions The additional benefits of using all four LBAs were objectively demonstrated in this pilot study, which also indicated a relative dominance of CTC gDNA over the other LBAs. Consequently, a multi-parametric liquid biopsy approach deconvolutes the genomic and transcriptomic complexity and should be considered in clinical practice.
    Type of Medium: Online Resource
    ISSN: 1756-994X
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 7
    In: Breast Care, S. Karger AG, Vol. 15, No. 5 ( 2020), p. 470-480
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Despite the assumption of breast cancer (BC) as a cold, non-immunogenic tumor, immune checkpoint inhibitor (ICI) therapy is favorable for a subgroup of patients. Immunohistochemical assessment of the programmed cell death ligand 1 (PD-L1) is the only approved companion diagnostic for anti-PD-L1 therapy in metastatic triple-negative BC; however, challenges regarding the standardization of PD-L1 scoring in tumor tissue still remain. Consequently, to select patients most likely to respond to ICI, blood-based biomarkers are urgently needed. 〈 b 〉 〈 i 〉 Summary and Key Messages: 〈 /i 〉 〈 /b 〉 Liquid biopsy, comprising circulating immune cells, circulating tumor cells and extracellular vesicles, as well as their surface proteins, is of high potential, and these analytes were already shown to be molecular correlates or regulators of the evasion from antitumoral immune reaction. Liquid biopsy, also enabling the evaluation of tumor mutational burden (TMB), microsatellite instability, and the T-cell receptor repertoire, allows serial sampling for monitoring purposes and reflects intra-tumoral heterogeneity which qualifies as marker for immunogenicity. Only a very few studies have already elucidated the potential of these analytes as biomarkers under ICI therapy. Nonetheless, the topic is of growing interest and has high relevance for the future. However, for clinical implementation, these multifarious analytes first need to pass robust standardization and validation procedures.
    Type of Medium: Online Resource
    ISSN: 1661-3791 , 1661-3805
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
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  • 8
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 80, No. 4_Supplement ( 2020-02-15), p. P4-01-11-P4-01-11
    Abstract: Background: Triple negative breast cancer (TNBC) is known for its aggressive behavior and poor prognosis since treatment options are limited. Specific biomarkers are urgently needed to treat patients (pts) accordingly. In this regard, circulating tumor cells (CTCs) are discussed to be an ideal surrogate marker for individualized treatment options. We here comprehensively analyzed mRNA profiles of CTCs from TNBC pts before and after neoadjuvant chemotherapy including the expression of prostate related genes [androgen receptor (AR), its splice variant ARV7, the prostate specific antigen (PSA) and the prostate specific membrane antigen (PSMA)] to further elucidate these markers as targets for personalized treatment. Methods: 2 × 5 ml blood of 34 TNBC pts before and 22 pts after therapy were analyzed for CTCs applying positive immunomagnetic selection using the AdnaTest EMT-2/Stem Cell Select (QIAGEN, Germany). Subsequently, cDNA was pre-amplified for specific genes using TaqMan PreAmp Master Mix according to in house designed assays. A 19 gene qPCR panel was pe rformed including AKT2, ALK, AR, AURKA, BRCA1, EGFR, ERCC1, ERBB2, ERBB3, KIT, KRT5, MET, MTOR, NOTCH1, PARP1, PIK3CA, SRC, CD45 (leucocyte control) and GAPDH (housekeeping gene) as well as an internal reference. The cutoff was calculated, taking the false positive rate in healthy donors into account, and defined as Ct (cutoff) - Ct (sample) - [Ct (CD45cutoff) - Ct (CD45sample)]. Using the AdnaPanel Prostate Cancer (QIAGEN, Germany), cDNA was further analyzed for the expression profile of AR, ARV7, PSA and PSMA, respectively. Results: Before therapy, at least one of the prostate related genes was detected in 50% of the pts, resulting in the expression of AR in 35%, ARV7 in 24%, PSMA in 18%, and PSA in 15% of cases, respectively. Notably, in 75% of AR-positive cases, ARV7 was also expressed on CTCs. After therapy, prostate related genes were only detected in two pts, expressing AR, ARV7 and PSA (n=1) and AR (n=1), respectively. Before therapy, the presence of PSMA-positive CTCs alone (p=0.026) or in combination with ARwildtype/ARV7-positive CTCs (p=0.014) significantly correlated with early relapse. Interestingly, this expression pattern was highly related to the expression of genes belonging to the ERBB family (EGFR, ERBB2, ERBB3; p=0.034). Either ERRB family or PSMA expression on CTCs in TNBC was detected in about 70% of the cases analyzed with 90% relapses predicted. Conclusion: Although AR and its splice variant were detected on CTCs in one third of the pts before therapy, these markers do not seem to be relevant with regard to be considered as targets for additional treatment options. In contrast, although expressed in a minority of pts, PSMA-positive CTCs at primary diagnosis indicated worse outcome and should be included in CTC-multimarker panel analysis to identify pts at higher risk for relapse. This study is ongoing and the analysis of more pts will finally show whether these results can be confirmed. Citation Format: Sabine Kasimir-Bauer, Corinna Keup, Oliver Hoffmann, Siegfried Hauch, Rainer Kimmig, Ann-Kathrin Bittner. Circulating tumor cells expressing the prostate specific membrane antigen PSMA indicate worse outcome in triple-negative breast cancer patients at primary diagnosis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-01-11.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
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  • 9
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    American Association for Cancer Research (AACR) ; 2022
    In:  Cancer Research Vol. 82, No. 4_Supplement ( 2022-02-15), p. P5-13-33-P5-13-33
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 82, No. 4_Supplement ( 2022-02-15), p. P5-13-33-P5-13-33
    Abstract: Background: CDK4/6 inhibitors represent a new treatment option for metastatic (M), hormone receptor-positive/HER2-negative (HR+/HER2-) breast cancer (BC) patients. However, predictive markers have not been defined to decide who will benefit from CDK4/6 inhibitors. Circulating tumor cells (CTCs) represent the tumoral heterogeneity in real time and are available for molecular characterization via minimal-invasive sequential blood sampling. Here, we aim to identify biomarkers of resistance to Palbociclib by conducting transcriptional profiling of CTCs before therapy initiation (baseline) and after six months under treatment. Methods: Blood of 50 HR+/HER2-MBC patients drawn at baseline of Palbociclib plus endocrine treatment and blood of 20 HR+/HER2-MBC patients drawn before initiation of endocrine monotherapy, as well as blood samples of these 70 patients after six months under treatment will be analyzed. Patients with progressive disease within the first six months of treatment were defined as non-responders. Isolation of CTCs was conducted using positive immunomagnetic selection targeting EpCAM, EGFR and HER2 (AdnaTest EMT2/StemCell Select). cDNA was analyzed by a new multimarker qPCR panel utilizing QuantiNova LNA Probe assays targeting 25 genes. qPCR data was normalized to CD45 to substract the effect of contaminating leukocytes. Additionally, data was normalized to 20 healthy female donor controls to identify BC specific overexpression signals with a specificity of & gt;90% for all targets. Consumables: QIAGEN, Germany. Results: We successfully established the multimarker qPCR according to the MIQE guidelines. Up to now, the binary mRNA overexpression signals of 25 targets in CTCs isolated at baseline were analyzed in 40 of the total 70 planned MBC patients. In detail, 24 of those 40 patients were treated with Palbociclib plus endocrine therapy, including seven responders and 15 non-resonders, while the 16 other patients were treated with endocrine therapy alone (seven non-responders and nine responders). In the entire cohort, STAT1 signals were significantly related to a decreased overall survival (p=0.0034) and NFKB1 signals correlated significantly with an increased progression free survival (PFS; p=0.027). In the Palbociclib group, CDK2, WWTR1 and YAP1 overexpression signals were more common in non-responders compared with responders. MLH1 and NFKB1 signals were more common in responders than in non-responders. In this cohort, MLH3 overexpression at baseline was significantly correlated with prolonged PFS (p=0.047) and the patient with the longest PFS (35 months) was the only patient with detectable ERBB4, JUN, CETN2 and TEAD2 signals. In the control group treated with endocrine therapy alone, signal prevalence of CXCR4 and STAT1 were increased in the non-responders versus responders and ABCC2, ESR1, FAT4 and FGFR1 signals were more frequently detected in the responders. Conclusion: Transcriptional profiling of CTCs represents a real-time snapshot of the disease complexity. Characterization of the CTCs isolated from blood drawn at baseline is promising for the identification of urgently needed predictive markers (here MLH3 overexpression), while characterization of CTCs isolated under treatment can elucidate the transcriptional dynamics and might be used as monitoring marker by differentiation of non-responders and responders. We will finalize CTC analysis of the entire cohort and will continue blood sampling of additional Palbociclib treated patients, also in the follow-up of the disease, to validate CTC MLH3 overexpression as predictive biomarker for CDK4/6 inhibitor treatment and moreover, to find further overexpression signals in CTCs relevant for MBC therapy management. Citation Format: Sabine Kasimir-Bauer, Charlotte Gruber, Oliver Hoffmann, Rainer Kimmig, Corinna Keup. Longitudinal transcriptional profiling of CTCs in metastatic breast cancer patients receiving the CDK4/6 inhibitor Palbociclib to predict therapy response [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-13-33.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
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  • 10
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 83, No. 7_Supplement ( 2023-04-04), p. 2140-2140
    Abstract: Background: Resistance to CDK4/6 inhibitors (CDK4/6i), like Palbociclib and Ribociclib, plus endocrine therapy (TX) is an omnipresent topic for metastatic (M), hormone receptor-positive/HER2-negative (HR+/HER2-) breast cancer (BC) patients (pts). Circulating tumor cells (CTCs) represent the oncogenic heterogeneity in real time. Here, we aim to identify markers of resistance to CDK4/6i by mRNA profiling of CTCs. Methods: Blood of 90 HR+/HER2-MBC pts drawn before CDK4/6i plus endocrine TX (baseline: n=57 pts first line; n=33 second or more line pts), 19 HR+/HER2-MBC pts receiving endocrine monoTX (control group) and matched samples of 78/62 of these 109 pts after six months of TX/at progression (PD) were analyzed. Isolation of CTCs was conducted using the AdnaTest EMT2/StemCell Select. Expression profiling was conducted with preamplified cDNA utilizing QuantiNova LNA Probe assays targeting 25 genes. qPCR data were normalized to CD45 and data of 20 healthy female donors. Consumables: QIAGEN, Germany. Only results with Benjamini Hochberg corrected p & lt;0.05 in univariate Cox regression and multivariate Cox regression with non-adjusted p & lt;0.05 are demonstrated. Results: At baseline, in pts treated with CDK4/6i in the first line, CETN2 (HR 3.6)/MLH3 (HR 4)/E2F1 (HR 5.3) overexpression signals in CTCs correlated significantly with shorter progression-free survival (PFS) and shorter overall survival [(baseline to death, OS) (HR 8.3/HR 4.9/HR 3.8)], whereas ESR1 signals correlated with a shorter OS (HR 4.4). After six months of TX, in CDK4/6i treated pts, CXCR4 and CETN2 signals correlated with a shorter PFS and the signal dynamics from baseline to six months of CXCR4, CETN2 and PCNA also correlated with a shorter PFS. At PD, STAT1 signals were identified as potential Ribociclib specific resistance markers and Hippo pathway inhibition as a potential new approach for postCDK4/6i TX, because TEAD2 and WWTR1 correlated with shorter remaining time to death. Conclusion: We identified overexpression of transcripts involved in DNA damage response mechanisms (CETN2, MLH3 and/or PCNA) at baseline to have predictive and/or prognostic value in first line CDK4/6i treated pts while signal dynamics of CETN2 and PCNA to six months of TX could serve as monitoring marker in these pts. Currently, further longitudinal blood sampling over the course of treatment is underway to give a deeper insight in resistance development under CDK4/6i treatment. Citation Format: Corinna Keup, Charlotte Gruber, Stefanos Ioannis Moukas, Mitra Tewes, Hans-Christian Kolberg, Rainer Kimmig, Sabine Kasimir-Bauer. DNA damage response in circulating tumor cells shows predictive value for metastatic breast cancer patients receiving CDK4/6 inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2140.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2023
    detail.hit.zdb_id: 2036785-5
    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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