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《Expert review of anticancer therapy》2013,13(12):1579-1589
Approaches to treatment for many patients with advanced breast cancer are based on the expression of specific receptors. Treatments targeting the hormone receptor (typically the estrogen receptor) are used to reduce signaling through these receptors and thereby inhibit proliferation of breast cancer cells expressing these receptors. Although these treatments are effective for many patients, resistance to treatment is common. Recent clinical trials suggest that using multiple agents targeting the same pathway is not sufficient to overcome resistance. New treatment approaches are needed for these patients. Inhibition of the mTOR signaling pathway, a key point of confluence for multiple signaling cascades, offers a promising approach to restoring sensitivity to endocrine therapy in breast cancer. This article reviews the current data from studies of mTOR inhibitors everolimus and temsirolimus in combination with endocrine therapies to overcome treatment resistance in patients with advanced breast cancer. 相似文献
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Knowlden JM Gee JM Barrow D Robertson JF Ellis IO Nicholson RI Hutcheson IR 《Breast cancer research : BCR》2011,13(5):R93
Introduction
Recently we reported that insulin receptor substrate 1 (IRS-1), classically an adaptor protein for the insulin-like growth factor type I receptor (IGF-IR), associates with the epidermal growth factor receptor in oestrogen receptor (ER)-positive (ER+) tamoxifen-resistant breast cancer cells. In this study, we examined whether IRS-1 also associates with another erbB receptor family member, erbB3, and what impact this might have on IGF-IR signalling in three ER+ breast cancer cell lines. 相似文献4.
Endocrine therapy for breast cancer was introduced more than 100 years ago. In the last 30 years, it has been demonstrated that tamoxifen significantly improves outcomes for patients with hormone-responsive breast tumors. Aromatase inhibitors, which suppress the production of estrogen, are recognized today as an effective alternative for estrogen-receptor-positive breast cancer in postmenopausal women. However, despite an initial response to treatment, many tumors eventually recur or progress. When selecting subsequent endocrine therapy, it is helpful to understand the mechanisms of hormone resistance, consider the goals of treatment, and evaluate the clinical potential of each available drug. The objective of this article was to review the underlying mechanisms of action and resistance for each type of hormone therapy, evaluate the most recent data regarding the use of endocrine agents after disease progression or recurrence, and explore potential combinations of hormone therapies with novel molecules that target key growth factor signaling pathways. 相似文献
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内分泌治疗作为雌激素受体(estrogen receptor,ER)阳性乳腺癌的主要治疗方案被广泛应用。他莫西芬(tamoxifen,Tam)是乳腺癌内分泌治疗最常用的药物,它通过与雌激素竞争性结合ERα来降低雌激素的生物学活性,抑制细胞的增殖,从而治疗乳腺癌。然而,肿瘤细胞所表现出的原发性或获得性的他莫西芬耐药使得其临床应用受到了限制,寻找克服他莫西芬耐药的治疗策略已经刻不容缓。目前为止,他莫西芬耐药的相关机制已部分明确,但仍需进一步研究。有证据表明ERα、生长因子受体信号通路及microRNA的表达异常等多种机制均与他莫西芬耐药有关。本文对他莫西芬耐药的相关机制进行了具体分析,以期为ER阳性乳腺癌的治疗提供新思路。 相似文献
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Hei Jason Chan Haiqing Li Zheng Liu Yate-Ching Yuan Joanne Mortimer Shiuan Chen 《Oncotarget》2015,6(28):25815-25827
Of all breast cancer patients, about 70% are ER+ and 10% are ER+/HER2+. The ER+/HER2+ patients have a worse outcome compared to ER+/HER2- patients. Currently there is a lack of effective prognosis biomarkers for the prediction of outcome in ER+/HER2+ patients. Genome-wide differences in ER binding between the endocrine-responsive and endocrine-resistant cells were discovered using ChIP-seq, and combined with gene expression microarray data to identify direct ER target genes. These genes were correlated to survival outcome using publicly available breast cancer patient cohorts. We found the expression of the gene SERPINA1 to have a significant predictive value for the overall survival (OS) of ER+ patients in the TCGA cohort, and validated this finding in the Curtis cohort. SERPINA1 also has a significant predictive value for the OS of ER+/HER2+ patients in the TCGA cohort, with validation in the Bild cohort. The expression of SERPINA1 can be suppressed by fulvestrant and HER2 siRNA. Our results indicate that ER is constitutively activated, resulting in an E2-independent ER binding to the SERPINA1 gene and upregulation of SERPINA1 expression. Importantly, results of survival correlation suggests that high expression of SERPINA1 could be predictive for a better clinical outcome of ER+ and ER+/HER2+ patients. 相似文献
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Biological effects of fulvestrant on estrogen receptor positive human breast cancer: short,medium and long‐term effects based on sequential biopsies 下载免费PDF全文
Amit Agrawal John F.R. Robertson Kwok L. Cheung Eleanor Gutteridge Ian O. Ellis Robert I. Nicholson Julia M.W. Gee 《International journal of cancer. Journal international du cancer》2016,138(1):146-159
We report the first study of the biological effect of fulvestrant on ER positive clinical breast cancer using sequential biopsies through to progression. Thirty‐two locally/systemically advanced breast cancers treated with first‐line fulvestrant (250 mg/month) were biopsied at therapy initiation, 6 weeks, 6 months and progression and immunohistochemically‐analyzed for Ki67, ER, EGFR and HER2 expression/signaling activity. This series showed good fulvestrant responses (duration of response [DoR] = 25.8 months; clinical benefit = 81%). Ki67 fell (p < 0.001) in 79% of tumours by 6 months and lower Ki67 at all preprogression time‐points predicted for longer DoR. ER and PR significantly decreased in all tumours by 6 months (p < 0.001), with some declines in ER (serine 118) phosphorylation and Bcl‐2 (p = 0.007). There were modest HER2 increases (p = 0.034, 29% tumours) and loss of any detectable EGFR phosphorylation (p = 0.024, 50% tumours) and MAP kinase (ERK1/2) phosphorylation (p = 0.019, 65% tumours) by 6 months. While ER remained low, there was some recovery of Ki67, Bcl‐2 and (weakly) EGFR/MAPK activity in 45–67% patients at progression. Fulvestrant's anti‐proliferative impact is related to DoR, but while commonly downregulating ER and indicators of its signaling and depleting EGFR/MAPK signaling in some patients, additional elements must determine response duration. Residual ER at fulvestrant relapse explains reported sensitivity to further endocrine therapies. Occasional modest treatment‐induced HER2 and weakly detectable EGFR/HER2/MAPK signaling at relapse suggests targeting of such activity might have value alongside fulvestrant in some patients. However, unknown pathways must drive relapse in most. Ki67 has biomarker potential to predict fulvestrant outcome and as a quantitative measure of response. 相似文献
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Mothaffar F. Rimawi Priya B. Shetty Heidi L. Weiss Rachel Schiff C. Kent Osborne Gary C. Chamness Richard M. Elledge 《Cancer》2010,116(5):1234-1242
BACKGROUND:
Epidermal growth factor receptor (EGFR) expression is associated with aggressive phenotypes in preclinical breast cancer models, but in clinical studies, EGFR has been inconsistently linked to poor outcome. We hypothesized that EGFR expression in human breast tumors, when centrally and uniformly assessed, is associated with an aggressive phenotype and resistance to systemic therapy.METHODS:
In a database of 47,286 patients with breast cancer, EGFR status was known on 2567 tumors. EGFR levels were measured centrally by ligand binding assay, and tumors with ≥10 fmol/mg were prospectively deemed positive. Clinical and biological features of EGFR‐positive and EGFR‐negative tumors were compared. Clinical outcomes were assessed by systemic therapy status.RESULTS:
Of 2567 tumors, 475 (18%) were EGFR positive. EGFR‐positive tumors were more common in younger and in black women, were larger, had a higher S‐phase fraction, and were more likely to be aneuploid. EGFR‐positive tumors were more likely to be HER2‐positive (26% vs 16%, P < .0001), but less likely to be estrogen receptor‐positive (60% vs 88%, P < .0001) or progesterone receptor‐positive (26% vs 65%, P < .0001). In multivariate analyses, EGFR expression independently correlated with worse disease‐free survival (hazard ratio [HR] = 1.66; 95% confidence interval [CI], 1.4‐2.41, P = .007) and overall survival (HR = 1.98, 95% CI, 1.36‐2.88, P = .0004) in treated patients, but not in untreated patients.CONCLUSIONS:
EGFR expression is more common in breast tumors in younger and black women. It is associated with lower hormone receptor levels, higher proliferation, genomic instability, and HER2 overexpression. It is correlated with higher risk of relapse in patients receiving adjuvant treatment. Blocking EGFR may improve outcome in selected patients. Cancer 2010. © 2010 American Cancer Society. 相似文献12.
Shuying Liu Xiaolong Meng Huiqin Chen Wenbin Liu Todd Miller Mandi Murph Yiling Lu Fan Zhang Mihai Gagea Carlos L. Arteaga Gordon B. Mills Funda Meric-Bernstam Ana M. González-Angulo 《Oncotarget》2014,5(19):9049-9064
Despite numerous therapies that effectively inhibit estrogen signaling in breast cancer, a significant proportion of patients with estrogen receptor (ER)-positive malignancy will succumb to their disease. Herein we demonstrate that long-term estrogen deprivation (LTED) therapy among ER-positive breast cancer cells results in the adaptive increase in ER expression and subsequent activation of multiple tyrosine kinases. Combination therapy with the ER down-regulator fulvestrant and dasatinib, a broad kinase inhibitor, exhibits synergistic activity against LTED cells, by reduction of cell proliferation, cell survival, cell invasion and mammary acinar formation. Screening kinase phosphorylation using protein arrays and functional proteomic analysis demonstrates that the combination of fulvestrant and dasatinib inhibits multiple tyrosine kinases and cancer-related pathways that are constitutively activated in LTED cells. Because LTED cells display increased insulin receptor (InsR)/insulin-like growth factor 1 receptor (IGF-1R) signaling, we added an ant-IGF-1 antibody to the combination with fulvestrant and dasatinib in an effort to further increase the inhibition. However, adding MK0646 only modestly increased the inhibition of cell growth in monolayer culture, but neither suppressed acinar formation nor inhibited cell migration in vitro and invasion in vivo. Therefore, combinations of fulvestrant and dasatinib, but not MK0646, may benefit patients with tyrosine-kinase-activated, endocrine therapy-resistant breast cancer. 相似文献
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Expression patterns and predictive value of phosphorylated AKT in early-stage breast cancer. 总被引:1,自引:0,他引:1
F Andre R Nahta R Conforti T Boulet M Aziz L X H Yuan F Meslin M Spielmann G Tomasic L Pusztai G N Hortobagyi S Michiels S Delaloge F J Esteva 《Annals of oncology》2008,19(2):315-320
BACKGROUND: AKT phosphorylation is a critical step in the activation of growth factor receptors and can mediate tumor resistance to anthracyclines. We evaluated the expression patterns and predictive value of phosphorylated AKT (pAKT) in breast cancer tissues. PATIENTS AND METHODS: pAKT expression was assessed by immunohistochemistry in 823 tumors from patients with early breast cancer enrolled in two randomized trials. The distribution of pAKT expression was correlated with HER2 and epidermal growth factor receptor (EGFR) expression. The predictive value of pAKT for the efficacy of adjuvant chemotherapy was determined by test for interaction. RESULTS: pAKT, EGFR, and HER2 were expressed in 119 of 781 (15%), 118 of 758 (16%), and 99 of 775 (13%) assessable tumors. Staining was positive for pAKT in 28 of 99 (28%) and 90 of 676 (13%) HER2+ and HER2- tumors (P < 0.001). pAKT was expressed in 15 of 94 (16%) and 75 of 563 (13%) HER2-/EGFR+ and HER2-/EGFR- tumors, respectively (P = 0.49). A positive staining for pAKT did not correlate with prognosis (P = 0.94), and did not predict the resistance to anthracyclines (test for interaction, P = 0.70). CONCLUSIONS: AKT phosphorylation is associated with HER2 expression but not EGFR expression in patients with early breast cancer. pAKT is not predictive for the efficacy of anthracycline-based adjuvant chemotherapy. 相似文献
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Approximately 70−75% of breast cancers express the estrogen receptor (ER), indicating a level of dependence on estrogen for growth. Endocrine therapy is an important class of target-directed therapy that blocks the growth-promoting effects of estrogen via ER. Although endocrine therapy continues to be the cornerstone of effective treatment of ER-positive (ER+) breast cancer, many patients with advanced ER+ breast cancer encounter de novo or acquired resistance and require more aggressive treatment such as chemotherapy. Novel approaches are needed to augment the benefit of existing endocrine therapies by prolonging time to disease progression, preventing or overcoming resistance, and delaying the use of chemotherapy. 相似文献
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目的:研究PI3K/AKT信号转导通路中PTEN、PI3K、AKT蛋白在乳腺癌中的表达及其与疾病发生发展、预后的关系。方法用免疫组化SP法检测45例乳腺癌患者病理组织(观察组)和其中15例患者癌旁正常组织(对照组)中PTEN、PI3K、AKT表达情况,采用单因素回归分析对PTEN、PI3K、AKT蛋白在乳腺癌组织中阳性表达的相关因素进行分析。结果 PI3K、AKT在乳腺癌中的表达率分别为73.3%、75.5%,高于癌旁正常乳腺组织的33.3%、40%,差异具有统计学意义(P﹤0.05);PTEN在乳腺癌中表达率为22.2%,低于癌旁正常乳腺组织的53.3%,但差异无统计学意义(P﹥0.05);单因素回归分析结果显示,患者发病年龄对PTEN、PI3K、AKT在乳腺癌组织中阳性表达无关(P﹥0.05);组织学分级、临床分期、存在淋巴结转移是PTEN、PI3K、AKT在乳腺癌组织中的阳性表达的相关因素(P﹤0.05)。结论 PI3K/AKT信号通路可能参与了乳腺癌的发生与发展,PTEN蛋白表达缺失导致AKT、PI3K蛋白的过度表达,PI3K、PTEN、AKT蛋白表达的检测可能有助于预测乳腺癌的预后。 相似文献
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Endocrine therapy agents (the selective estrogen receptor (ER) modulators such as tamoxifen or the selective ER down-regulators such as ICI 182,780) are key treatment regimens for hormone receptor-positive breast cancers. While these drugs are very effective in controlling ER-positive breast cancer, many tumors that initially respond well to treatment often acquire drug resistance, which is a major clinical problem. In clinical practice, hormonal therapy agents are commonly used in combination or sequence with radiation therapy. Tamoxifen treatment and radiotherapy improve both local tumor control and patient survival. However, tamoxifen treatment may render cancer cells less responsive to radiation therapy.Only a handful of data exist on the effects of radiation on cells resistant to hormonal therapy agents. These scarce data show that cells that were resistant to tamoxifen were also resistant to radiation. Yet, the existence and mechanisms of cross-resistance to endocrine therapy and radiation therapy need to be established.Here, we for the first time examined and compared radiation responses of MCF-7 breast adenocarcinoma cells (MCF-7/S0.5) and two antiestrogen resistant cell lines derived from MCF-7/S0.5: the tamoxifen resistant MCF-7/TAMR-1 and ICI 182,780 resistant MCF-7/182R-6 cell lines. Specifically, we analyzed the radiation-induced changes in the expression of genes involved in DNA damage, apoptosis, and cell cycle regulation. We found that the tamoxifen-resistant cell line in contrast to the parental and ICI 182,780-resistant cell lines displayed a significantly less radiation-induced decrease in the expression of genes involved in DNA repair. Furthermore, we show that MCF-7/TAMR-1 and MCF-7/182R-6 cells were less susceptible to radiation-induced apoptosis as compared to the parental line. These data indicate that tamoxifen-resistant breast cancer cells have a reduced sensitivity to radiation treatment. The current study may therefore serve as a roadmap to the future analysis of the mechanisms of cross-resistance between hormonal therapy and radiation. 相似文献
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Soonmyoung Paik Dan Paul Hartmann Robert B. Dickson Marc E. Lippman 《Breast cancer research and treatment》1994,31(2-3):301-307
Summary Acquisition of the antiestrogen resistance by breast cancer cellsin vivo may result from a variety of mechanisms. The main pathway appears to involve loss of estrogen receptor (ER) expression or selection for ER negative cells among heterogenous population of tumor cells. However, clinical data suggest that, in about 30% of the cases, antiestrogen resistance arises even in the presence of estrogen receptors. Postulated mechanisms leading to the latter phenotype include selection for variant receptor forms during treatment, development of novel metabolic pathways for the drug, loss of nuclear co-factors, or activation of signal transduction pathway that cross activate ER signals. We have used anin vitro experimental system utilizing LY-2 cell line, an ER positive and antiestrogen resistant MCF-7 cell variant, to study the mechanism of antiestrogen resistance in the presence of functional ER. Result from a complementation experiment suggests that LY-2 phenotype is a recessive trait. Cloning of the genetic defect in the LY-2 cells would provide further insight for the mechanism of antiestrogen resistance in ER positive breast cancer cells. 相似文献
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