Estrogen receptor mutations and splice variants determined in liquid biopsies from metastatic breast cancer patients. Issue 1 (17th November 2017)

• Record Type: Journal Article
• Authors: Beije, Nick; Sieuwerts, Anieta M.; Kraan, Jaco; Van, Ngoc M.; Onstenk, Wendy; Vitale, Silvia R.; van der Vlugt‐Daane, Michelle; Dirix, Luc Y.; Brouwer, Anja; Hamberg, Paul; de Jongh, Felix E.; Jager, Agnes; Seynaeve, Caroline M.; Jansen, Maurice P. H. M.; Foekens, John A.; Martens, John W. M.; Sleijfer, Stefan
• Is Part Of: Molecular oncology. Volume 12:Issue 1(2018)
• Page Start: 48
• Page End: 57
• Publication Date: 2017-11-17
• Subjects: cell‐free DNA -- circulating tumor cells -- endocrine resistance -- ESR1 mutations; Cancer -- Molecular aspects -- Periodicals; 616.994005
• DOI: 10.1002/1878-0261.12147
• Languages: English
• ISSNs: 1574-7891

Abstract

Abstract : Mutations and splice variants in the estrogen receptor (ER) gene, ESR1, may yield endocrine resistance in metastatic breast cancer (MBC) patients. These putative endocrine resistance markers are likely to emerge during treatment, and therefore, its detection in liquid biopsies, such as circulating tumor cells (CTCs) and cell‐free DNA (cfDNA), is of great interest. This research aimed to determine whether ESR1 mutations and splice variants occur more frequently in CTCs of MBC patients progressing on endocrine treatment. In addition, the presence of ESR1 mutations was evaluated in matched cfDNA and compared to CTCs. CellSearch‐enriched CTC fractions (≥5/7.5 mL) of two MBC cohorts were evaluated, namely (a) patients starting first‐line endocrine therapy ( n = 43, baseline cohort) and (b) patients progressing on any line of endocrine therapy ( n = 40, progressing cohort). ESR1 hotspot mutations (D538G and Y537S/N/C) were evaluated in CTC‐enriched DNA using digital PCR and compared with matched cfDNA ( n = 18 baseline cohort; n = 26 progressing cohort). Expression of ESR1 full‐length and 4 of its splice variants (∆5, ∆7, 36 kDa, and 46 kDa) was evaluated in CTC‐enriched mRNA. It was observed that in the CTCs, the ESR1 mutations were not enriched in the progressing cohort (8%), when compared with the baseline cohort (5%) ( P = 0.66). In the cfDNA, however, ESR1 mutations were more prevalent in the progressing cohort (42%) than in the baseline cohort (11%) ( P = 0.04). Three of the same mutations were observed in both CTCs and cfDNA, 1 mutation in CTCs only, and 11 in cfDNA only. Only the ∆5 ESR1 splice variant was CTC‐specific expressed, but was not enriched in the progressing cohort. In conclusion, sensitivity for detecting ESR1 mutations in CTC‐enriched fractions was lower than for cfDNA. ESR1 mutations detected in cfDNA, rarely present at the start of first‐line endocrine therapy, were enriched at progression, strongly suggesting a role in conferring endocrine resistance in MBC. Abstract : This research investigated whether ESR1 mutations and splice variants were enriched in circulating tumor cells (CTCs) and matched the cell‐free DNA (cfDNA) of metastatic breast cancer (MBC) patients receiving endocrine therapy. Detection of ESR1 mutations was more sensitive in cfDNA than in CTC‐enriched DNA, and ESR1 mutations in cfDNA were enriched upon progression. These results add to the evidence that ESR1 mutations confer endocrine resistance in MBC.