Documente Academic
Documente Profesional
Documente Cultură
Research Paper
Pharmacogenetics of response to neoadjuvant paclitaxel
treatment for locally advanced breast cancer
Andric C. Perez-Ortiz1,2, Israel Ramírez1, Juan C. Cruz-López3,*, Cynthia Villarreal-
Garza4,*, Alexandra Luna-Angulo5, Esmeralda Lira-Romero1, Salvador Jiménez-
Chaidez1, José Díaz-Chávez6, Juan A. Matus-Santos6, Laura Sánchez-Chapul5,
Patricia Mendoza-Lorenzo7 and Francisco J. Estrada-Mena1
1
Universidad Panamericana, Escuela de Medicina, Mexico City, Mexico
2
Yale University School of Public Health, Laboratory of Epidemiology and Public Health, New Haven, CT, USA
3
Hospital Regional ISSSTE Puebla and Hospital General Zona Norte SSEP Puebla, Puebla City, Mexico
4
Depto. de Investigacion, Instituto Nacional de Cancerologia, Centro de Cancer de Mama, Tecnologico de Monterrey,
Monterrey, Nuevo León, Mexico
5
Instituto Nacional de Rehabilitación, Mexico City, Mexico
6
Unidad de Investigación Biomédica en Cáncer, Instituto de Investigaciones Biomédicas, UNAM/Instituto Nacional de
Cancerología, Mexico City, Mexico
7
División Académica de Ciencias Básicas, Unidad Chontalpa, Universidad Juárez Autónoma de Tabasco, Tabasco, Mexico
*
These authors contributed equally to this work
Correspondence to: Francisco J. Estrada-Mena, email: festrada@up.edu.mx
Keywords: pharmacogenetics; paclitaxel; breast cancer; genetic markers; single nucleotide polymorphism
Received: July 27, 2017 Accepted: October 27, 2017 Published: November 15, 2017
Copyright: Perez-Ortiz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License
3.0 (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and
source are credited.
ABSTRACT
Locally advanced breast cancer (LABC) cases have a varying five-year survival
rate, mainly influenced by the tumor response to chemotherapy. Paclitaxel activity
(response rate) varies across populations from 21.5% to 84%. There are some
reports on genetic traits and paclitaxel; however, there is still considerable residual
unexplained variability. In this study, we aimed to test the association between
eleven novel markers and tumor response to paclitaxel and to explore if any of them
influenced tumor protein expression. We studied a cohort of 140 women with LABC.
At baseline, we collected a blood sample (for genotyping), fine needle aspirates (for
Western blot), and tumor measurements by imaging. After follow-up, we ascertained
the response to paclitaxel monotherapy by comparing the percent change in the
pre-, post- tumor measurements after treatment. To allocate exposure, we genotyped
eleven SNPs with TaqMan probes on RT-PCR and regressed them to tumor response
using linear modeling. In addition, we compared protein expression, between breast
tumors and healthy controls, of those genes whose genetic markers were significantly
associated with tumor response. After adjusting for multiple clinical covariates,
SNPs on the LPHN2, ROBO1, SNTG1, and GRIK1 genes were significant independent
predictors of poor tumor response (tumor growth) despite paclitaxel treatment.
Moreover, proteins encoded by those genes are significantly downregulated in breast
tumor samples.
in our sample are concurrent with already reported single Differences between genomic DNA and
nucleotide polymorphisms for Mexican population in Hap tumor DNA
Map [16]. Similarly, to provide evidence of bias in our
genotyping, we stratified our results based on response To bolster our approach, we also additionally
status. All our data follows the Hardy-Weinberg expected genotyped ten random breast tumor fine needle aspirates
distribution (Supplementary Table 2). All our experiments to ensure that our results are reproducible in this setting
we had a genotyping call rate greater than 95%. and to confirm that tumor DNA is not varying at these loci.
We computed kappa values and percentages in agreement genotype is significantly associated with tumor growth,
to evidence any genotype mismatch between tumor ~ 66.2% 95% CI (17.1% – 115.4%, p = 0.009) compared
and peripheral blood DNA. These results are shown in to the C/C genotype. Regarding GRIK1, the rs363599
Supplementary Table 3. For all our SNPs, both genomic G/G genotype is significantly associated with ~35%
and tumor DNA are unvarying, i.e. by the same genotyping less tumor burden after paclitaxel monotherapy [95%
methodology, we recorded the same genotypes from two CI (–0.442, –0.267), p < 0.0001]. We observed a similar
distinct tissue samples. effect as with the LPHN2 gene in that the homozygous
A/A is significantly associated with increased tumor size
despite paclitaxel treatment [1.497 95% CI (0.644, 2.351),
Unadjusted effects of a set of genetic p < 0.0001]. The rest of our proposed SNPs had a much
lesser impact on the variability in the tumor response to
markers (SNPs) on tumor response to
monotherapy with paclitaxel and are detailed further in
paclitaxel treatment Supplementary Table 4.
To test if any genetic marker (those listed in Table 2)
had a significant differential tumor response based on Unadjusted effect of baseline demographics
genotypes after paclitaxel, we modeled the relative and clinical data on tumor response after
change in tumor diameter as a function of each single chemotherapy with paclitaxel
nucleotide polymorphism (Supplementary Table 4). All
following effects were analyzed taking the ancestral allele We also identified a set of clinical and
as the reference (intercept) and should be interpreted as histopathological predictors of tumor response to
the unadjusted effect of the alternative or least frequent paclitaxel treatment displayed in Supplementary Table 5.
allele on tumor growth. Assuming a genotypic model We found a bivariate association with menopausal status,
of inheritance, genetic markers in the LPHN2 (also metformin use, tumor histology, neoadjuvant treatment,
known as ADGRL2) and GRIK1 genes explained much TNM staging, and molecular subtype. However, these
of the variability in tumor response (14% and 10.4% features poorly explained the variability in the response as
respectively) in our data. The mean effect of at least evidenced by their adjusted R2 values Supplementary Table
one C allele in the rs371363 SNP (LPHN2 gene) is ~ 5. Notably, women who reported ever been exposed to
25% less tumor burden after paclitaxel (Supplementary either estrogens or hormonal therapies (estrogen/progestin
Table 4). This effect holds true for the homozygous C/C combinations) significantly responded poorly to paclitaxel
[–0.248 95% CI (–0.353, –0.144), p < 0.0001] and the treatment compared to non-users. On average, these
heterozygous C/T [–0.261 95% CI (–0.433, –0.089), women had a ~30% increase in their breast tumor and this
p = 0.003]. Interestingly, our data suggests that the T/T effect could range from 11.2% up to 49.6% ( p = 0.002).
Figure 2: Levels of expression of genes of interest in representative cases of breast cancer (Breast tumor) paired with
normal breast tissues (Breast ctrl). Human skeletal muscle (SkM) shown as internal control. All these depictions were run in the
same electrophoretic gel but were separated for illustration purposes.