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La mise au point de modèles de laboratoire est d’une importance cruciale pour comprendre la biologie du cancer de la prostate, ainsi que pour évaluer les nouveaux traitements. Le développement de tels modèles est particulièrement difficile et reste à ce jour insuffisant car la majorité de ces modèles est d’origine métastatique ou obtenu in vitro d’une façon artificielle. C’est pourquoi, nous avons entrepris au laboratoire, l’établissement de nouveaux modèles à partir d’un cancer primaire de prostate tumorale et obtenu la lignée IGR-CaP1. La lignée IGR-CaP1 constitue un modèle adapté pour étudier les étapes précoces de la cancérogenèse prostatique. De plus, sa tumoroginicité et sa capacité à induire des métastases osseuses de nature mixtes ostéoblastiques et ostéolytiques font de ce modèles un outil potentiellement intéressant pour étudier les mécanismes métastatiques et rechercher de nouvelles cibles thérapeutiques. Depuis 2004, le traitement de référence des cancers de la prostate métastatiques hormono-résistants est une chimiothérapie par le Docetaxel. Cependant, malgré le bénéfice de survie obtenu, presque la moitié des patients traités par le Docetaxel développent une résistance à la chimiothérapie. Il est donc urgent d’identifier un biomarqueur prédictif pour sélectionner les patients qui vont bénéficier de cette chimiothérapie afin de contourner cette résistance. Dans le but d’étudier les mécanismes de résistance au Docetaxel dans le cancer de la prostate, nous avons établi plusieurs clones résistants au Docetaxel à partir de la lignée IGR-CaP1. Ces clones résistants nous ont permis de réaliser une analyse génomique à haut-débit par microarray comparant l’expression génique entre la lignée sensible et les clones résistants et d’identifier une signature de gènes potentiellement impliqués dans la résistance au Docetaxel. Parmi les gènes identifiés, nous nous sommes focalisés sur le gène LZTS1 sous-exprimé dans tous les clones résistants. LZTS1 est un suppresseur de tumeur qui contrôle le cycle cellulaire en interagissant avec la cycline Cdc25C. Nos résultats suggèrent que la déplétion de LZTS1 est potentiellement impliquée dans le mécanisme de résistance au Docetaxel. La finalité de notre projet est de valider nos résultats par immunohistochimie à partir des prélèvements tumoraux obtenus dans l’essai de phase III GETUG12. Nous espérons que notre étude permettra aux cliniciens de sélectionner les sous-groupes de patients susceptibles de profiter d’un traitement par Docetaxel. / One of the major hindrances in the study of the biology of prostate cancer is the limited number of laboratory models. Most of these models have been obtained from prostate tumor metastases or have been artificially established in vitro.We recently developed one new cell line (IGR-CaP1) derived from patients with clinically localized prostate cancer. In contrast to previously established models from metastases tissues, IGR-CaP1 may be a suitable model to study molecular pathways implicated in the early steps of the oncogenic development of prostate cancer. Furthermore, its high tumorigenic properties and its ability to induce mixed bone lesions, make it as a potential model for both tumor progression and drug assessment in animals.Docetaxel is the standard treatment for metastatic castration-resistant prostate cancer (CRPC) since 2004. In spite of a benefit in survival, drug resistance is often observed. Therefore, it is crucial to identify predictive markers to select patients who will respond to docetaxel. In order to investigate mechanisms of docetaxel resistance, we derived docetaxel-resistant variants from the IGR-CaP1 human prostate cancer cell line. A microarray genomic analysis comparing chemo-resistant versus sensitive prostate cell lines was used to identify a signature of genes potentially implicated in docetaxel resistance. Among these genes, we focused on LZTS1 wich is underexpressed in IGR-CaP1 resistant variants. LZTS1 is a tumor suppressor that controls the cell cycle by interacting with Cdc25C. Our data suggest that depletion of LZTS1 is potentially involved in the mecanism of docetaxel resistance. Finally, an immunohistochemical analysis will be done on human biopsies from the phase III GETUG12 trial patients. Ultimately, our study could help to improve selection of patients that could benefit from docetaxel chemotherapy.

Le cancer de la prostate est le cancer le plus fréquent chez l’homme et représente la troisième cause de mortalité par cancer en France. Depuis 2004, le docetaxel est le traitement de référence du cancer de la prostate métastatique résistant à la castration (mCRPC). Cependant, malgré le bénéfice de survie obtenu, près de la moitié des patients traités développent une résistance à la chimiothérapie. L’objectif de mon projet de thèse consiste à identifier un prédicteur moléculaire permettant de sélectionner les patients qui vont répondre à la chimiothérapie par docetaxel. Par l’étude du mécanisme moléculaire associé avec le développement de la résistance, mon second objectif est d’identifier de nouvelles cibles thérapeutiques afin de contourner cette résistance.Dans ce but, les profils d’expression de gènes et de microARNs différentiellement exprimés dans plusieurs modèles cellulaires de cancer de prostate résistants au docetaxel ont été établis. L’intégration des données issues de ces analyses haut-débit a suggéré que la transition épithélio-mésenchymateuse (EMT) intervenait dans le mécanisme de résistance au docetaxel. La dissection du mécanisme d’EMT observé dans les modèles cellulaires a permis d’identifier SHISA3 comme une nouvelle protéine régulatrice de ce processus. Le gène SHISA3, alors jamais décrit chez l’Homme, est fortement sous-exprimé dans les modèles résistants au docetaxel présentant un phénotype mésenchymateux, mais également dans de multiples tumeurs humaines. L’inhibition de SHISA3 dans les modèles cellulaires sensibles induit une EMT complète, caractérisée par la perte des jonctions cellulaires, l’expression des facteurs de transcription mésenchymateux et l’augmentation des capacités migratoires. L’étude du mécanisme d’action de SHISA3 nous a permis de mettre en évidence l’interaction de SHISA3 avec le TGFβRII. Nous avons montré dans les cellules résistantes au docetaxel que l’inhibition pharmacologique de la voie du TGFβ provoque une sensibilisation au docetaxel, démontrant l’importance de la régulation de cette voie dans la résistance à la chimiothérapie. En parallèle de ce travail, nous avons établi un modèle de cancer de la prostate résistant au docetaxel chez la souris. L’obtention de ce modèle est cruciale pour réaliser la validation préclinique des thérapies visant à contourner les mécanismes de résistance au docetaxel. Les tumeurs obtenues dans ce nouveau modèle sont caractérisées par une sous-expression de SHISA3 et par l’expression des marqueurs d’EMT. Ce modèle nous permettra de valider in vivo le potentiel thérapeutique de l’association d’un inhibiteur de la voie du TGFβ avec le docetaxel. De manière intéressante, nous avons observé in vivo que l’expression de SHISA3 est corrélée à la réponse au traitement par docetaxel. Ces résultats suggèrent que SHISA3 pourrait être un biomarqueur de réponse à la chimiothérapie. / Prostate cancer is the most common cancer in men and the third leading cause of cancer mortality in France. Since 2004, docetaxel is the standard treatment for metastatic castration-resistant prostate cancer (mCRPC). However, nearly half of treated patients develop resistance to chemotherapy. The aim of my thesis is to identify molecular predictors to select patients who will respond to docetaxel chemotherapy. My second goal is to identify new therapeutic targets to overcome this resistance, by studying the molecular mechanisms involved in the development of resistance.To this purpose, genes and microRNAs expression profiles were established in several cellular models of docetaxel-resistant prostate cancer. The integration of these high-throughput data suggested that the epithelial-mesenchymal transition (EMT) was involved in the mechanism of docetaxel resistance. Deciphering the EMT mechanism observed in our cellular models allowed the identification of SHISA3 as a new regulator of this process. SHISA3 is highly under-expressed in docetaxel resistant cells which present a mesenchymal phenotype. Interestingly, SHISA3 is also down-regulated in a large variety of human tumors. The inhibition of SHISA3 in sensitive cells induced a complete EMT, characterized by loss of cellular junctions, expression of mesenchymal transcription factors, and increased migratory capacity. The study of its mechanism of action allowed us to highlight the interaction of SHISA3 with TGFβRII. We showed in docetaxel-resistant cells that pharmacological inhibition of the TGFβ signalling pathway induces sensitization to docetaxel, demonstrating the importance of the regulation of this pathway in the resistance to chemotherapy.In parallel, we developed a docetaxel-resistant prostate cancer model in mice. The establishment of this model is critical for the preclinical validation of new targeted therapies. Tumors obtained from this new model are characterized by the under-expression of SHISA3 and the expression of EMT markers. This model will allow the validation of the therapeutic potential of co-treatment with docetaxel and TGFβ signalling pathway inhibitors in vivo. Interestingly, we observed that SHISA3 expression is correlated with response to docetaxel treatment in vivo. These results suggest that SHISA3 could be a biomarker of response to docetaxel chemotherapy.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O Câncer de mama (CM) é hoje o tipo de câncer mais incidente entre as mulheres, com a estimativa de 53 mil novos casos para o ano de 2013, segundo o Instituto Nacional do Câncer (INCA). É considerada uma doença de bom prognóstico, principalmente quando diagnosticada na sua fase mais precoce. A evolução no diagnóstico, e nas técnicas de tratamento para o CM, que incluem a quimioterapia e/ou radioterapia, aumentaram a expectativa de sobrevida para este tipo de câncer. Uma das complicações tardias induzidas pelo tratamento desta doença é a cardiotoxicidade. O termo cardiotoxicidade abrange uma série de efeitos colaterais, que incluem arritmias, alterações na pressão arterial, isquemia do miocárdio, trombose ou insuficiência cardíaca. É, por isso, fundamental entender os mecanismos envolvidos no desenvolvimento da toxicidade cardíaca para o sucesso do tratamento dos pacientes com CM. Este trabalho teve como objetivo avaliar os efeitos cardíacos tardios induzidos pela irradiação e quimioterapia, simulando um tratamento para o CM, em ratas Wistar. Ratas Wistar, com aproximadamente 3 meses de idade, foram divididas em: grupo controle, grupo que recebeu quimioterapia + irradiação (TC+IR), e grupo que recebeu apenas irradiação (IR). A quimioterapia foi administrada em 4 ciclos, com intervalo de 1 semana entre eles. A irradiação na região do coração foi realizada em dose única, de 20Gy, em um campo de 2x2 cm2. Os ratos foram submetidos à eutanásia 5 meses após o término dos tratamentos, para que os efeitos tardios pudessem ser avaliados. Vários estudos foram conduzidos: ecocardiografia para observar as alterações funcionais do coração; PCR em tempo real para detectar alterações no nível mRNA de procolágeno tipo I, TGF-β1, angiotensinogênio, renina, ECA, AT1, VEGF e razão Bax/;bcl2, no tecido do ventrículo esquerdo (VE); Além de ensaios histológicos para avaliar o aspecto do tecido cardíaco do VE. Resultados e discussão Os resultados obtidos indicam um processo de remodelamento cardíaco após os tratamentos para o CM. Sugere-se que este remodelamento inicie-se com a diminuição de vasos no VE, causada pelos tratamentos, conforme os resultados da estereologia e do PCR para VEGF. Em seguida mostrou-se hipertrofia dos cardiomiócitos, o aumento da expressão de procolágeno e TGF-β1 e de tecido conjuntivo neste tecido. E associado a estes resultados, mostrou-se a participação dos sistema renina angiotensina cardíaco neste processo de remodelamento. Porém, apesar de todas estas alterações terem ocorrido em ambos os grupos tratados, apenas o grupo que recebeu irradiação e quimioterapia concomitantemente apresentou alteração da função cardíaca, na ecocardiografia. Sugere-se, desta forma, que a associação destas terapias seja mais lesiva ao coração, do que a irradiação aplicada exclusivamente. Conclusão Os objetivos do trabalho foram alcançados, e pode-se entender melhor as vias envolvidas na cardiotoxicidade. Este é um estudo inédito, o assunto abordado é recente, e de sumo importância para o desenvolvimento de novas estratégias de tratamento para o CM, onde sejam consideradas as complicações cardíacas tardias envolvidas. / Breast cancer (BC) is today the most frequent type of cancer among women, there were estimated 53 000 new cases for the year 2013, according to the National Cancer Institute (INCA). It is considered a disease of good prognosis, especially when diagnosed in early stages. The developments in the diagnosis, and treatment techniques for the BC, which include chemotherapy and/or radiotherapy, increased the survival rates for this type of cancer. One late complication induced by BC treatment is the cardiotoxicity. The cardiotoxicity term comprises different cardiotoxic side effects, which includes arrhythmia, blood pressure alterations, myocardial ischemia, thrombosis or congestive heart failure. It is, therefore, essential to understand the mechanisms involved in the development of cardiac toxicity for the successful treatment of patients with BC. This study aimed to evaluate the late cardiac effects induced by irradiation and chemotherapy, simulating a treatment for BC in Wistar rats. Wistar rats, about 3 months old, were divided into control group; a group receiving chemotherapy + irradiation (TC+IR), and a group that received only irradiation (IR). Chemotherapy was administered in 4 cycles, with an one week interval between them. The irradiation at the heart area was performed in a single dose of 20 Gy, and a field of 2x2 cm2. The rats were euthanized 5 months after the end of treatments, so the late effects could be evaluated. Several studies were conducted: echocardiography to observe the heart functional changes, real-time PCR to detect alterations in mRNA level of procollagen type I, TGF-β1, angiotensinogen, renin, ACE, AT1, VEGF and Bax/bcl2 ratio, in the left ventricle (LV) tissue; The LV cardiac tissue was also evaluated by assays. The results indicate a process of cardiac remodeling after the BC. It is suggested that this remodeling starts with a reduction of the cardiac vessels, induced by treatments, according the results of stereology, and the PCR for VEGF. Then, it was showed a cardiomyocyte hypertrophy, an increased expression of TGF-β1 and procollagen, and increased connective tissue in the LV. Associated with these results, it was indicated the involvement of the cardiac renin-angiotensin system in the remodeling process. However, even though all these changes have occurred in both treated groups, only the group receiving concurrent radiation and chemotherapy had a decrease in the cardiac function, showed by echocardiography. It is suggested that the combination of these therapies to the heart is more detrimental than the irradiation applied alone. The aims of this work were achieved, and it is possible to better understand the pathways involved in cardiotoxicity. This is a novel study, the subject issue is recent, and of high impact in the development of new treatment strategies for BC where the involved cardiac complications are considered.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O Câncer de mama (CM) é hoje o tipo de câncer mais incidente entre as mulheres, com a estimativa de 53 mil novos casos para o ano de 2013, segundo o Instituto Nacional do Câncer (INCA). É considerada uma doença de bom prognóstico, principalmente quando diagnosticada na sua fase mais precoce. A evolução no diagnóstico, e nas técnicas de tratamento para o CM, que incluem a quimioterapia e/ou radioterapia, aumentaram a expectativa de sobrevida para este tipo de câncer. Uma das complicações tardias induzidas pelo tratamento desta doença é a cardiotoxicidade. O termo cardiotoxicidade abrange uma série de efeitos colaterais, que incluem arritmias, alterações na pressão arterial, isquemia do miocárdio, trombose ou insuficiência cardíaca. É, por isso, fundamental entender os mecanismos envolvidos no desenvolvimento da toxicidade cardíaca para o sucesso do tratamento dos pacientes com CM. Este trabalho teve como objetivo avaliar os efeitos cardíacos tardios induzidos pela irradiação e quimioterapia, simulando um tratamento para o CM, em ratas Wistar. Ratas Wistar, com aproximadamente 3 meses de idade, foram divididas em: grupo controle, grupo que recebeu quimioterapia + irradiação (TC+IR), e grupo que recebeu apenas irradiação (IR). A quimioterapia foi administrada em 4 ciclos, com intervalo de 1 semana entre eles. A irradiação na região do coração foi realizada em dose única, de 20Gy, em um campo de 2x2 cm2. Os ratos foram submetidos à eutanásia 5 meses após o término dos tratamentos, para que os efeitos tardios pudessem ser avaliados. Vários estudos foram conduzidos: ecocardiografia para observar as alterações funcionais do coração; PCR em tempo real para detectar alterações no nível mRNA de procolágeno tipo I, TGF-β1, angiotensinogênio, renina, ECA, AT1, VEGF e razão Bax/;bcl2, no tecido do ventrículo esquerdo (VE); Além de ensaios histológicos para avaliar o aspecto do tecido cardíaco do VE. Resultados e discussão Os resultados obtidos indicam um processo de remodelamento cardíaco após os tratamentos para o CM. Sugere-se que este remodelamento inicie-se com a diminuição de vasos no VE, causada pelos tratamentos, conforme os resultados da estereologia e do PCR para VEGF. Em seguida mostrou-se hipertrofia dos cardiomiócitos, o aumento da expressão de procolágeno e TGF-β1 e de tecido conjuntivo neste tecido. E associado a estes resultados, mostrou-se a participação dos sistema renina angiotensina cardíaco neste processo de remodelamento. Porém, apesar de todas estas alterações terem ocorrido em ambos os grupos tratados, apenas o grupo que recebeu irradiação e quimioterapia concomitantemente apresentou alteração da função cardíaca, na ecocardiografia. Sugere-se, desta forma, que a associação destas terapias seja mais lesiva ao coração, do que a irradiação aplicada exclusivamente. Conclusão Os objetivos do trabalho foram alcançados, e pode-se entender melhor as vias envolvidas na cardiotoxicidade. Este é um estudo inédito, o assunto abordado é recente, e de sumo importância para o desenvolvimento de novas estratégias de tratamento para o CM, onde sejam consideradas as complicações cardíacas tardias envolvidas. / Breast cancer (BC) is today the most frequent type of cancer among women, there were estimated 53 000 new cases for the year 2013, according to the National Cancer Institute (INCA). It is considered a disease of good prognosis, especially when diagnosed in early stages. The developments in the diagnosis, and treatment techniques for the BC, which include chemotherapy and/or radiotherapy, increased the survival rates for this type of cancer. One late complication induced by BC treatment is the cardiotoxicity. The cardiotoxicity term comprises different cardiotoxic side effects, which includes arrhythmia, blood pressure alterations, myocardial ischemia, thrombosis or congestive heart failure. It is, therefore, essential to understand the mechanisms involved in the development of cardiac toxicity for the successful treatment of patients with BC. This study aimed to evaluate the late cardiac effects induced by irradiation and chemotherapy, simulating a treatment for BC in Wistar rats. Wistar rats, about 3 months old, were divided into control group; a group receiving chemotherapy + irradiation (TC+IR), and a group that received only irradiation (IR). Chemotherapy was administered in 4 cycles, with an one week interval between them. The irradiation at the heart area was performed in a single dose of 20 Gy, and a field of 2x2 cm2. The rats were euthanized 5 months after the end of treatments, so the late effects could be evaluated. Several studies were conducted: echocardiography to observe the heart functional changes, real-time PCR to detect alterations in mRNA level of procollagen type I, TGF-β1, angiotensinogen, renin, ACE, AT1, VEGF and Bax/bcl2 ratio, in the left ventricle (LV) tissue; The LV cardiac tissue was also evaluated by assays. The results indicate a process of cardiac remodeling after the BC. It is suggested that this remodeling starts with a reduction of the cardiac vessels, induced by treatments, according the results of stereology, and the PCR for VEGF. Then, it was showed a cardiomyocyte hypertrophy, an increased expression of TGF-β1 and procollagen, and increased connective tissue in the LV. Associated with these results, it was indicated the involvement of the cardiac renin-angiotensin system in the remodeling process. However, even though all these changes have occurred in both treated groups, only the group receiving concurrent radiation and chemotherapy had a decrease in the cardiac function, showed by echocardiography. It is suggested that the combination of these therapies to the heart is more detrimental than the irradiation applied alone. The aims of this work were achieved, and it is possible to better understand the pathways involved in cardiotoxicity. This is a novel study, the subject issue is recent, and of high impact in the development of new treatment strategies for BC where the involved cardiac complications are considered.

Purpose: Platinum chemotherapy can be considered to treat metastatic castration-resistant prostate cancer (mCRPC) with features of neuroendocrine differentiation. However, platinum compounds are generally only applied after the failure of multiple prior-line treatment options. This study investigated whether acquired resistance against ionizing radiation or docetaxel chemotherapy—two commonly applied treatment modalities in prostate cancer—influences the cisplatin (CDDP) tolerance in mCRPC cell line models. Methods: Age-matched parental as well as radio- or docetaxel-resistant DU145 and PC-3 cell lines were treated with CDDP and their sensitivity was assessed by measurements of growth rates, viability, apoptosis, metabolic activity and colony formation ability. Results: The data suggest that docetaxel resistance does not influence CDDP tolerance in all tested docetaxel-resistant cell lines. Radio-resistance was associated with sensitization to CDDP in PC-3, but not in DU145 cells. In general, DU145 cells tolerated higher CDDP concentrations than PC-3 cells regardless of acquired resistances. Furthermore, non-age-matched treatment-naïve PC-3 cells exhibited significantly different CDDP tolerances. Conclusion: Like patients, different mCRPC cell lines exhibit significant variability regarding CDDP tolerance. The presented in vitro data suggest that previous radiation treatment may be associated with a moderate sensitization to CDDP in an isogenic and age-matched setting. Therefore, previous radiotherapy or docetaxel chemotherapy might be no contraindication against initiation of platinum chemotherapy in selected mCRPC patients.

Die Dissertationsarbeit untersucht genetische Varianten in Zellkulturmodellen des metastatischen und kastrationsresistenten Prostatakarzinoms. Außerdem werden Mechanismen der Chemoresistenz, insbesondere der Resistenz gegen Cisplatin und Docetaxel in diesen Zelllinien untersucht. / This Dissertation evaluates genetic variants found in cell culture models of metastatic castration resistant prostate cancer. Furthermore, mechanisms of resistance against the chemotherapeutic drugs cisplatin and docetaxel are investigated in these cell lines.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Les nanotechnologies appliquées à la médecine, et plus particulièrement à l’oncologie, ont permis le développement d’une nouvelle classe d’entités, appelées communément nanomédicaments ou médicaments vectorisés. Ce projet de recherche a pour objectif d’encapsuler du docétaxel dans un vecteur lipidique unilamellaire furtif, puis de greffer en surface le trastuzumab afin d’en améliorer le profil pharmacocinétique, notamment en optimisant la spécificité de la phase de distribution. Les résultats obtenus montrent qu’il est possible de développer un immunoliposome furtif de 140 nm encapsulant 90 % de docétaxel avec un taux de greffage de trastuzumab de 30 %. L’approche en cytométrie de flux que nous avons développée et appliquée a permis une quantification absolue du nombre d’anticorps présents en surface. In vitro, un double screening en culture 2D et en sphéroïde 3D a démontré la supériorité antiproliférative de l’immunoliposome comparativement à tous les autres traitements, indépendamment du statut Her2 des lignées étudiées. Les études in vivo ont confirmé cette supériorité, y compris comparativement au T-DM1, l’antibody-drug conjugate de référence dans la pathologie. Les études de biodistribution ont montré que l’accumulation de notre forme vectorielle dépendait de la taille et du degré de vascularisation des tumeurs, plus que statut Her2 tumoral. En conclusion, nous avons démontré l’intérêt thérapeutique de développer des formes vectorielles dans la prise en charge du cancer du sein, comparativement aux traitements standard. Une optimisation de la phase de distribution explique la supériorité antiproliférative obtenue avec l’immunoliposome. / The application of nanotechnology in medicine, especially oncology, has allowed for the development of a new class of entities, commonly called nanomedicine or vectorized medicine.This research project aims to encapsulate docetaxel in a stealthy, unilamellar, lipidic vector, then graft trastuzumab onto its surface to improve its pharmacokinetic profile, specifically by optimizing the specificity of the distribution phase.The results show that it is possible to develop a stealthy immunoliposome of 140 nm encapsulating 90% docetaxel and a trastuzumab grafting rate of 30 %. The flow cytometry approach that we developed and applied allowed for an absolute quantification of the number of antibodies present on the surface. In vitro, a double screening in 2D culture and in 3D spheroid showed the antiproliferative superiority of the immunoliposome compared to all the other treatments, regardless of the Her2 status in the cells studied. In vivo studies have confirmed said superiority compared to T-DM1; the benchmark antibody-drug conjugate for this pathology. Biodistribution studies have shown that the accumulation of our vector depends moreover on the size and degree of tumor vascularization than its Her2 status. In conclusion, we have demonstrated the therapeutic value of developing vector forms in the management of breast cancer therapy compared to standard treatments. The optimization of the distribution phase explains the antiproliferative superiority obtained by using the immunoliposome.

Dans le cancer du sein non métastatique, l'approche néoadjuvante permet d'étudier les paramètres liés à la tumeur et/ou à l'hôte influençant l'efficacité des traitements. Les protéines de la famille MDR et plus particulièrement ABCB1 sont impliqués dans les mécanismes de résistance aux anthracyclines et taxanes. Les corrélations entre efficacité (réponse histologique), polymorphisme d'ABCB1 (patientes et tumeurs) et pharmacocinétique de la doxorubicine et du docétaxel ont été étudiées dans le cadre d'un essai thérapeutique. Dans cette étude, le polymorphisme de l'exon 26 d'ABCB1 (rs1045642) est le seul qui influence la pharmacocinétique du docétaxel et ceci uniquement chez les patientes non ménopausées. Les patientes porteuses du génotype CC (40%) ont une valeur moyenne de l'AUC du docétaxel statistiquement inférieure à celles porteuses des génotypes CT (45%) et TT (15%) (p<0.0001). Par ailleurs il a été constaté chez les patientes non ménopausées une corrélation statistiquement significative entre des taux d'AUC bas du docétaxel et le diplotype 2677GG-3435CC ainsi que l'haplotype 61AA-1236CC-2677GG-3435CC. Il n'a pas été trouvé de lien entre les différents polymorphismes d'ABCB1 et la pharmacocinétique de la doxorubicine. Il existe par ailleurs une relation négative entre l'AUC du docétaxel et l'obtention d'une réponse complète histologique. Il semble exister donc une valeur minimale d'AUC du docétaxel afin d'obtenir une réponse. Par ailleurs, nous avons retrouvé un lien entre réponse tumorale et le polymorphisme d'ABCB1 (génotype C3435T, TT vs CT et CC)