Abstract. Breast cancer patients who are positive for estrogen receptor (ER) are usually treated with anti-estrogen drugs, such as tamoxifen (Tam). However, a great majority of such patients eventually develop resistance to Tam. In this study, MCF-7 cells (with de novo and/or acquired resistance to Tam) as well as T47D cells (acquired resistance to Tam) models were used to investigate the effect of treatment with cisplatin plus tumor necrosis factor-related apoptosis-inducing ligand (TRAIL). The results in the two cell types treated with cisplatin plus TRAIL showed significantly increased cell death compared to that in the untreated control cells. A similar treatment had a minimal effect on normal breast cells, the increased cell death appeared to be caused by the activation of caspases and, inhibition of the activity of caspases (using relatively specific inhibitors) reduced the cell death caused by cisplatin plus TRAIL treatment. Taken together, the results suggested that cisplatin plus TRAIL treatment has the potential to provide a novel treatment strategy to improve the treatment outcome in anti-estrogen-resistant breast cancer patients.
IntroductionHormonal influence on breast tissue and in breast cancer development has long been recognized. Examinations of ~70% of breast cancer patients have been found to be positive for estrogen receptor (ER)/progesterone (PR) receptor (1,2). Additionally, the receptor status has been used as a biomarker for therapy and prognosis. Currently, ER/PR + breast cancer patients are treated with anti-estrogen drugs, such as tamoxifen (Tam) or aromatase inhibitors (AIs) (3,4). Tam binds to ER, thereby preventing the binding of estrogen and subsequent activation of ER. Aromatase inhibitors (AI) suppress the activity of aromatase enzyme and thus, the production of estrogen. Although these inhibitors were shown to be effective, some patients develop resistance and do not respond to Tam therapy or other targeted endocrine therapies. The de novo resistance appears to be due to the up-regulation/overexpression of the HER2 receptor and/or Akt protein. Clinical and in vitro studies have also suggested that overexpression of the HER2 receptor is associated with resistance to hormone therapy (5-7). In addition, the majority of breast cancer patients with ER expression initially respond to endocrine therapy but, develop 'acquired' resistance over a period of time (8). MCF-7 and T47D breast cancer cell lines have been used as experimental models to investigate the mechanism(s) involved in acquired resistance to Tam (5,9,10). The results from such studies reported by our and other research groups have shown that drug resistance in these cells can be acquired through various mechanisms, including: i) loss of ERα expression, ii) altered activity of co-regulators, iii) cross-talk between the ERα and growth factor signaling pathways and, iv) overexpression of PKCα or PKCδ (3,5,11). These anti-estrogen-resistant models are also useful for the identification of other 'potential' therapeutic agents ...