Classificatie en moleculaire diagnostiek van mammatumoren

Transcription

1 Classificatie en moleculaire diagnostiek van mammatumoren Marc van de Vijver Academisch Medisch Centrum Amsterdam

2 Disclosure belangen spreker Marc van de Vijver (potentiële) belangenverstrengeling Voor bijeenkomst mogelijk relevante relaties met bedrijven Sponsoring onderzoek Pathology Advisory Board Scientific Advisory Board Co-inventor (patent) Zie hieronder Bedrijfsnamen Hoffmann La Roche Hoffmann La Roche Genomic Health 70 gene prognosis profile (Agendia)

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5 Histologic grade 3 2 1

6 ER

7 Transmembrane structure of HER2 monomer Extracellular domain (632 amino acids) Ligand-binding site Plasma membrane Cytoplasm Intracellular domain (22 amino acids) Intracellular domain (580 amino acids) Tyrosine kinase activity

8 HER2 gene amplification HER2 mrna over-replication + selection of cells with growth advantage HER2 protein normal amount HER2 mrna HER2 protein elevated amount

9 Normal HER2 expression

10 HER2 amplification leads to HER2 overexpression

11 HER2 overexpression leads to tumour proliferation

12 Binding of Herceptin to HER2

13 HER2 testing algorithm Patient Tumor Sample IHC FISH/ FISH/ Herceptin Therapy Herceptin Therapy - + Herceptin Therapy Bilous et al., Mod Pathol. 16, 2003; Review on national testing guidelines

14 IHC scoring: semi-quantitative interpretation of HER2 expression 0 (negative) 1+ (negative) 2+ (equivocal) 3+ (positive)

15 Fluorescent or Bright Field In Situ Hybridzation HER2 gene amplification

16 Brightfield dual color ISH (BDISH, Ventana) Normal HER2 Gene Amplified HER2 Gene HER2 Gene Chromosome 17 Centromere

17 Analysis of gene expression in breast cancer Microarray: expression pattern of all 23,000 genes in the human genome

18 Unsupervised hierarchical cluster analysis

19 Classification based on immunohistochemistry ER+/PR+/HER2-40% ER+/PR-/HER2-30% ER+/PR+/HER2+ 3% ER+/PR-/HER2+ 2% ER-/PR-/HER2+ 10% ER-/PR-/HER2-15%

20 Supervised Classification for Prognosis 78 breast tumors patients < 55 years tumorsize < 5 cm lymphnode negative (LN0) Prognosis Reporter Genes distant metastasis < 5 years (n=34) no distant metastasis > 5 years (n=44)

21 Supervised Classification Prognosis Leave-one-out cross-validation 70 significant prognosis genes 78 tumors good signature threshold poor signature threshold set with 10% false negatives 91 % sensitivity, 73% specificity

22 RASTER study MicroarRAy prognostication in breast cancer Technology introduction program for 70 gene prognosis profile T1/2 N0 patients <60 years 16 participating hospitals

23 Standardizing methods to obtain tumor for gene expression profiling RNA later

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26 E-cadherin inactivation LOH 16q LCIS well diff DCIS invasive lobular carcinoma invasive ductal carc. grade 1 common precursor? BRCA1/2 germline mutation moder diff DCIS p53 mut., HER2 gene amplif. poorly diff DCIS invasive ductal carc. grade 2 invasive ductal carc. grade 3 inactivation of BRCA1/2 wildtype allele? invasive ductal carc. grade 3

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29 The landscape of driver mutations in breast cancer. PJ Stephens et al. Nature 000, 1-5 (2012) doi: /nature11017

30 sequence analysis in breast cancer Shah et al, Nature 2009, 1 metastasis of invasive lobular carcinoma, whole exome sequence Ding et al, Nature 2010, 1 basal like breast carcinoma, whole genome sequence Stephens et al, Nature 2012,100 primary breast carcinomas, whole exome sequence The Cancer Genome Atlas Network, Nature 2012, 507 breast carcinomas, whole exome sequence Nik-Zainal et al, Cell 2012, 21 primary breast carcinomas, whole genome sequence Shah et al, Nature 2012, 104 triple negative breast carcinomas, RNA/whole exome sequence Ellis et al, Nature 2012, 77 ER+ breast carcinomas, whole genome (46), exome (31) sequence Banerji et al, Nature 2012, 103 breast carcinomas, whole exome sequence

31 Driver mutations in >10% of breast carcinomas TP53 PIK3CA GATA3

32 Amplifications from Nik-Zainal et al. (Cell, 2012) ERBB2 CCND1 MYC MDM2 ZNF217 ZNF703

33 ESR1 ligand-binding domain mutations in hormone-resistant breast cancer Weiyi Toy, Yang Shen, Helen Won, Bradley Green, Rita A Sakr, Marie Will, Zhiqiang Li, Kinisha Gala, Sean Fanning, Tari A King, Clifford Hudis, David Chen, Tetiana Taran, Gabriel Hortobagyi, Geoffrey Greene, Michael Berger, José Baselga & Sarat Chandarlapaty 80 patients with ER-positive metastatic breast cancer Comprehensive genetic analysis:14 tumors harbour ESR1 gene mutations in the ligand-binding domain (LBD)

34 Activating ESR1 mutations in hormone-resistant metastatic breast cancer Dan R Robinson, Yi-Mi Wu, Pankaj Vats, Fengyun Su, Robert J Lonigro, Xuhong Cao, Shanker Kalyana-Sundaram, Rui Wang, Yu Ning, Lynda Hodges, Amy Gursky, Javed Siddiqui, Scott A Tomlins, Sameek Roychowdhury, Kenneth J Pienta, Scott Y Kim, J Scott Roberts, James M Rae, Catherine H Van Poznak, Daniel F Hayes, Rashmi Chugh, Lakshmi P Kunju, Moshe Talpaz, Anne F Schott & Arul M Chinnaiyan 11 patients with ER-positive metastatic breast cancer Whole-exome and transcriptome analysis: 6 cases harbored mutations of ESR1 affecting its ligand-binding domain (LBD)

35 Standaard Diameter Classificatie van mammacarcinoom Histologisch type Histologische graad ER status, HER2 status In ontwikkeling Prognose tests (mrna expressie profielen, genetische veranderingen) Predictieve tests (mrna expressie profielen, genetische veranderingen)