Background Observational and experimental data support a potential breast cancer chemopreventive effect of green tea. Methods We conducted an ancillary study using archived blood/urine from a phase IB randomised, placebo-controlled dose escalation trial of an oral green tea extract, Polyphenon E (Poly E), in breast cancer patients. Using an adaptive trial design, women with stage I–III breast cancer who completed adjuvant treatment were randomised to Poly E 400 mg (n = 16), 600 mg (n = 11) and 800 mg (n = 3) twice daily or matching placebo (n = 10) for 6 months. Blood and urine collection occurred at baseline, and at 2, 4 and 6 months. Biological endpoints included growth factor [serum hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF)], lipid (serum cholesterol, triglycerides), oxidative damage and inflammatory biomarkers. Results From July 2007-August 2009, 40 women were enrolled and 34 (26 Poly E, eight placebo) were evaluable for biomarker endpoints. At 2 months, the Poly E group (all dose levels combined) compared to placebo had a significant decrease in mean serum HGF levels (−12.7% versus +6.3%, P = 0.04). This trend persisted at 4 and 6 months but was no longer statistically significant. For the Poly E group, serum VEGF decreased by 11.5% at 2 months (P = 0.02) and 13.9% at 4 months (P = 0.05) but did not differ compared to placebo. At 2 months, there was a trend toward a decrease in serum cholesterol with Poly E (P = 0.08). No significant differences were observed for other biomarkers. Conclusions Our findings suggest potential mechanistic actions of tea polyphenols in growth factor signalling, angiogenesis and lipid metabolism.
Background: Observational studies have correlated green tea intake with reduced breast cancer risk. In preclinical studies, the main polyphenol of green tea, epigallocatechin-3-gallate (EGCG), inhibits growth factors, such as vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF), which influence tumor cell growth, migration, and invasion. We conducted an ancillary study using archived serum and urine from a completed phase IB randomized, placebo-controlled dose escalation trial of an oral green tea extract, Polyphenon E (Poly E), in women with hormone receptor (HR)-negative breast cancer. The objective was to understand the effects of Poly E on potential biomarkers of breast cancer risk. Methods: Forty women with stage I-III HR-negative breast cancer who completed adjuvant treatment were randomized using an adaptive trial design to Poly E 400 mg (n = 16), 600 mg (n = 11), 800 mg (n = 3) twice daily or matching placebo (n = 10) for 6 months. Blood and urine collection occurred at baseline, 2, 4, and 6 months. Biologic endpoints included oxidative damage (urine 8-oxoG and isoprostane, plasma carbonyls), inflammatory (serum C-reactive protein [CRP], urine prostaglandin E2 metabolite [PGE-M]), growth factor (serum VEGF, HGF), and lipid (total cholesterol, triglycerides) biomarkers, as well as total urinary tea polyphenols. Results: From July 2007 to Sept 2009, 40 women were enrolled from 4 sites. During the intervention, 5 women developed a dose-limiting toxicity which required stopping study drug, 4 were lost to follow-up, and complete biomarker data was available for 34 participants (26 Poly E, 8 placebo). Concentration of total urinary tea polyphenol metabolites increased from baseline by an average of 10-fold in the Poly E group (all dose levels combined) compared to placebo (p = 0.001). Within the Poly E group, the mean decrease from baseline in serum VEGF was statistically significant at months 2 (11.5%, p = 0.02) and 4 (13.9%, p = 0.04). However, these changes were not significant when compared to placebo. At 2 months, mean serum HGF levels decreased by 12.6% for Poly E compared to a 6.3% increase for placebo (p = 0.04). This trend persisted at 4 and 6 months, but was no longer statistically significant. With Poly E treatment, there was a non-significant trend toward a decrease from baseline in serum cholesterol at 2, 4, and 6 months. No significant differences were observed in the biomarkers of oxidative damage (urine 8-oxoG and isoprostane, plasma carbonyls) or inflammation (serum CRP, urine PGE-M) after treatment with Poly E compared to placebo. Discussion: We demonstrated a significant reduction in serum HGF and a favorable decline in serum VEGF and total cholesterol during a 6-month intervention of Poly E in women with breast cancer. Given the small sample size and lack of adjustment for multiple comparisons, these results need to be confirmed in a larger study. Nevertheless, these findings are consistent with published results from short-term intervention trials of Poly E. This suggests potential mechanisms of action of green tea in angiogenesis, growth factor signaling, and metabolic pathways. Citation Format: Katherine D. Crew, Kimberly A. Ho, Powel Brown, Heather Greenlee, Therese B. Bevers, Banu Arun, Clifford Hudis, Heather L. McArthur, Jenny Chang, Mothaffar Rimawi, Lana Vornik, Terri L. Cornelison, James Cardelli, Regina M. Santella, Antai Wang, Scott M. Lippman, Dawn L. Hershman. Biomarker effects of an oral green tea extract, Polyphenon E, in women with a history of hormone receptor-negative breast cancer. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B65.
Breast cancer care in the developing world is limited by access to quality ER and HER2 IHC diagnostic assays needed to justify hormone and HER2 therapeutics. Shipping pathology specimens to a central testing site often out of country delays therapy and is costly. The Xpert Breast Cancer Stratifier assay makes quantitative measurements of ESR1, PGR, ERBB2, and MKi67 mRNAs from FFPE specimens in <2 hours on an easy-to-use automated diagnostic platform, the GeneXpert (GX). 10,000 GX machines are currently in use in 182 countries offering the possibility of a point-of-care solution. We compared concordance in tumor samples between IHC and mRNA intending to challenge the limits of the GX mRNA assay. 83 breast tumor samples were chosen including those with low cellularity, small volume disease, unusual subtypes, ER- tumors with surrounding benign epithelium, and low level HER2+ tumors. mRNA, IHC and FISH assays were performed. Slides were tested following macrodissection of invasive carcinoma and as non-macrodissected whole sections. GX measurements for Ki67 were compared with mitotic rate as an alternative to Ki67 IHC. Overall percent agreement following macrodissection was 95% for ER, 89% for HER2, 76% for PR, and 80% for Ki67 (>20% positive cut), and using whole section, 99% for ER, 80% for PR, 92% for HER2, and 73% for Ki67. Concordance was 92% for both macrodissection and whole section using mitotic rate to assess proliferation. Ignoring HER2 2+ calls which represented low level amplified tumors by FISH, the concordance rates were 95% for macrodissection and 99% for whole section. Discordance when testing long-term stored 4μm sections was resolved in a number of cases by using a fresh cut from the FFPE block. Half the ER discrepancies were in very small volume tumors ≤25mm2 and 75% were classified as ER-ve by IHC, and positive by Stratifier. 80% of ER IHC- cases were appropriately identified as ER- by the Stratifier in the presence of benign breast epithelium. HER2+ DCIS adjacent to HER2- invasive tumor resulted in a discrepant HER2 mRNA result even with macrodissection. No ER or HER2 discrepancies occurred in low cellularity tumors (≤30% cellularity) nor in lobular and mucinous subtypes. In a study intended to challenge an mRNA breast biomarker assay, concordance between mRNA results and IHC was high for ER and HER2, the two most important prognostic markers needed for therapeutic decision making. Use of whole sections rather than tumor macrodissection did not decrease concordance. Discrepant ER cases were more prevalent when analyzing low volumes of tumor and in this setting were seen in ER IHC- tumors surrounded by ER+ normal epithelium, or with weak IHC expression, highlighting predictable limitations of the assay. Concordance was better between Ki67 mRNA and mitotic rate than with IHC. Re-test data suggested that a fresh cut of the FFPE block yields the best results by GX, perhaps due to mRNA degradation in stored 4μm sections. The Xpert Breast Cancer Stratifier may provide a rapid, cost-effective solution to the problem of obtaining accurate diagnostic results at the point-of-care in low resource settings, and deserves further evaluation in developing countries. Citation Format: Brock JE, Milner DA, Ho K, Natalie W, Victor C, Annaliza R, Teresa B, Kathryn G-F, Edwin LW, Jodi W, Wendy W, Michael B. Comparison of the Xpert breast cancer stratifier mRNA assay with central ER, PR, HER2, and Ki67 immunohistochemistry (IHC) for rapid biomarker analysis in developing countries [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-07.
Background: Numerous epidemiologic studies and experimental data support potential anti-tumor effects of green tea and its main component, epigallocatechin-3-gallate (EGCG), in breast cancer. However, there is limited data on the effects of tea catechins on breast cancer in human intervention trials. The purpose of this study is to evaluate tumor proteomic changes after short-term pre-surgical administration of an oral green tea extract, Polyphenon E (Poly E), in women with operable breast cancer using reverse phase protein array (RPPA). Methods: This is a phase II single-arm open-label trial of oral Poly E 800 mg daily for 2-4 weeks in women with histologically-confirmed breast cancer on core biopsy who were scheduled for surgical resection. Formalin-fixed paraffin-embedded (FFPE) tumor tissue from the diagnostic core biopsy (pre-treatment) and surgical resection (post-treatment) were analyzed for expression of the Ki-67 proliferation index, estrogen receptor (ER), progesterone receptor (PR), and HER2 by immunohistochemistry (IHC). Protein was extracted for RPPA analysis of 161 proteins, including components of the PI3K/AKT and MAPK pathways. Women were matched by age, breast cancer stage, ER/PR/HER2 status, and time interval between breast biopsy and surgery to untreated historical controls. Paired t-test was used to calculate changes in protein markers before and after Poly E treatment and 2-sample t-test to compare biomarker changes in the treatment and no treatment groups. All statistical analyses were 2-sided and performed using SAS version 9.1. Results: From Feb 2008 to Sept 2009, 25 women were enrolled and 21 were evaluable. Median age: 50 years (range, 33-71); White/Hispanic/Black (%): 44/48/7; Stage 0/I/II/III (%): 11/48/30/11; hormone receptor +/- (%): 85/15. Mean duration on Poly E was 20 days (range, 13-36). We demonstrated significant correlations between RPPA and IHC for Ki-67 (0.46, P<0.0001), ER (0.45, P=0.0017), PR (0.46, P=0.0014), and a trend for HER2 (0.28, P=0.0923). Poly E treatment did not cause a significant decrease in Ki-67 compared to untreated controls (mean absolute change, -0.5% vs. +2.6%, P=0.83). In the Poly E-treated group, the RPPA results showed significant modulation of apoptosis and PI3K/AKT pathway proteins (P<0.05). After Bonferroni correction to adjust for multiple comparisons (P<0.00031), 11 markers remained statistically significant comparing change from baseline with Poly E treatment: up-regulation of MEK1, JNK2, and p38-MAPK; down-regulation of CDK4, HER2-pY1248, MAPK-pT202-Y204, MIG-6, mTOR-pS2448, PRAS40-pT246, Src-pY416, and Scr-pY527. Compared to untreated controls, the Poly E group had significant changes from baseline in 10 proteins: up-regulation of IRS1, p38-MAPK, Notch1, and YAP; down-regulation of ERCC1, MIG-6, p90RSK-pT359-S363, PRAS40-pT246, Smad3, and Src-pY416 (P<0.05). Conclusions: Short-term administration of Poly E did not significantly decrease proliferation in breast tumor tissue; however, our RPPA data suggests that Poly E may act on alternative signaling pathways. The changes we observed in CDK4, HER2, Src, MAPK, and JNK expression are consistent with preclinical studies of EGCG. This is one of the first human intervention trials to demonstrate the biologic effects of Poly E on growth factor signaling pathways in breast cancer. Citation Format: Kimberly A. Ho, Davida Kornreich, James A. Cardelli, Jerry McLarty, Dawn L. Hershman, Matthew Maurer, Kevin Kalinsky, Bret Taback, Hanina Hibshoosh, Tao Su, Susan F. Refice, Katherine D. Crew. Evaluating tissue biomarker effects of an oral green tea extract, polyphenon E, using reverse phase protein array in women with operable breast cancer. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A73.
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