The human epidermal growth factor receptor 2 (HER2) in the breast cancer : from measurement to targeted treatment

Authors: Furrer, Daniela
Advisor: Diorio, Caroline
Abstract: The overexpression of the human epidermal growth factor receptor 2 (HER2) and/or HER2 gene amplification are predictive factors in breast cancer. Following the HER2-targeted treatment with trastuzumab, the reliable evaluation of HER2 has become essential. Unfortunately, up to 50% of HER2-positive breast cancer patients develop resistance towards this drug. The objectives were: 1). To determine the most reliable and economical method to evaluate HER2 status (cohort of 521 consecutive breast cancer cases); 2). To examine the association between tobacco and alcohol consumption, and two HER2 polymorphisms (Ile655Val and Ala1170Pro), and the response to trastuzumab (cohort of 236 HER2-positive breast cancer patients treated with trastuzumab). Moreover, in a pilot study, we explored the association between genome-wide DNA methylation patterns in breast cancer tissues and the response to trastuzumab (cohort of 12 breast cancer patients treated with trastuzumab). HER2 status was evaluated by immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and TaqMan assay. We compared HER2 status determined by FISH on whole tissue (WT, one tissue per slide) section and tissue microarray (TMA, 60 tissues per slide) section, and HER2 status evaluated by IHC and FISH on the block used for diagnostic (diagnostic block) and on a randomly chosen additional block (random block). Clinicopathological information were assessed by review of medical records, tobacco and alcohol consumption by an administered validated questionnaire. DNA methylation patterns were evaluated using the Illumina Infinium HumanMethylation450 BeadChip. Overall concordance between HER2 status determined by FISH on WT and TMA sections was 98.2% and that between diagnostic and random blocks was 98.0% for FISH and 93.6% for IHC. Tobacco consumption and the Val allele were associated with a worse response, whereas alcohol consumption was associated with a better response. Methylation pattern in tumor tissues of HER2-positive breast cancer patients who acquired resistance to trastuzumab treatment differed from that of HER2-positive breast cancer patients who responded to trastuzumab treatment. However, this observation seemed to depend upon the method of bioinformatics analysis used. We conclude that FISH performed on TMA section represents a reliable and economical method for the evaluation of HER2. Results obtained by FISH, but not those obtained by IHC, fulfill the recommendations of the College of American Pathologists of concordance greater than 95% between the reference method and the new method. Tobacco use, alcohol consumption and Ile655Val HER2 polymorphism might influence the response to trastuzumab treatment.
Document Type: Thèse de doctorat
Issue Date: 2017
Open Access Date: 29 November 2019
Grantor: Université Laval
Collection:Thèses et mémoires

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