Post-treatment breast cancer prognosis
The disclosure includes the identification and use of gene expression profiles, or patterns, with clinical relevance to extended treatment and cancer-free survival in a patient. In particular, the disclosure includes the identities of genes that are expressed in correlation with benefit in a switch in endocrine therapy used to treat a patient. The levels of gene expression are disclosed as a molecular index for predicting clinical outcome, and so prognosis, for the patient. The disclosure further includes methods for predicting cancer recurrence, and/or predicting occurrence of metastatic cancer, after initial treatment with an anti-estrogen agent. The disclosure further includes methods for determining or selecting the treatment of a subject based upon the likelihood of life expectancy, cancer recurrence, and/or cancer metastasis.
1 . A method of treating breast cancer in a subject who has undergone removal of hormone receptor positive (HR+) node-negative breast cancer and has been treated with a first endocrine therapy comprising a selective estrogen receptor modulator (SERM), a selective estrogen receptor down-regulator (SERD), or an aromatase inhibitor (AI), the method comprising:
preparing or having prepared cDNA from nucleic acids in a breast cancer sample from the subject,
measuring or having measured the subject's expression levels of HoxB13, IL17BR, Bub1B, CENPA, NEK2, RACGAP1, and RRM2 from the cDNA,
calculating or having calculated a ratio of the subject's expression levels of HoxB13:IL17BR (“H:I ratio”),
normalizing or having normalized the subject's expression levels of Bub1B, CENPA, NEK2, RACGAP1, and RRM2,
calculating or having calculated a Molecular Grade Index (“MGI”) for the subject comprising summing the subject's normalized expression levels of Bub1B, CENPA, NEK2, RACGAP1, and RRM2,
calculating or having calculated a breast cancer index (BCI) prognostic value for the subject by combining or having combined the subject's H:I ratio and MGI,
comparing or having compared the subject's BCI prognostic value to a cut-off value that is or has been determined by the BCI values for a dataset comprising HR+ node-negative breast cancer subjects that did not have cancer recurrence and HR+ node-negative breast cancer subjects that did have cancer recurrence; and
treating the subject with a second endocrine therapy if the subject's BCI prognostic value is above the cut-off value.
2 . The method of claim 1 , wherein the subject's expression levels of Bub1B, CENPA, NEK2, RACGAP1, and RRM2 are normalized or have been normalized to the subject's expression levels of ACTB, HBMS, SDHA, and UBC.
3 . The method of claim 1 , wherein the cDNA is prepared or has been prepared using reverse-transcription polymerase chain reaction (PCR) or quantitative PCR.
4 . The method of claim 1 , wherein the second endocrine therapy comprises a SERM, SERD, or Al.
5 . The method of claim 1 , wherein the second endocrine therapy comprises a different SERM, SERD, or Al relative to the first endocrine therapy.
6 . The method of claim 1 , wherein the first endocrine therapy comprises tamoxifen.
7 . The method of claim 1 , wherein the first endocrine therapy comprises tamoxifen and the second endocrine therapy comprises letrozole.
8 . The method of claim 1 , wherein the HR+ breast cancer comprises estrogen receptor positive (ER+) breast cancer.
9 . The method of claim 1 , wherein the HR+ breast cancer comprises ductal carcinoma in situ (DCIS).
10 . The method of claim 1 , further comprising building or having built a continuous risk model based on the dataset of HR+ node-negative breast cancer subjects by calculating or having calculated the dataset's BCI values.
11 . The method of claim 10 , wherein the continuous risk model is a Cox regression model.