O câncer de mama representa um grave problema de saúde pública. Dentre os fármacos empregados, destaca-se o paclitaxel, um agente citotóxico eficaz, porém associado a severos efeitos colaterais. A metformina hidrocloreto tem obtido resultados promissores para o tratamento de neoplasias, porém é bastante hidrofílica, fator limitante da biodisponibilidade. A rapamicina tem demonstrado sinergismo com paclitaxel e potente atividade antitumoral. Todavia, é um fármaco lipofílico e possui desvantagens. Sistemas nanoestruturados de fármacos como lipossomas PEGlados são largamente empregados para a melhora da farmacocinética e potencialização da ação terapêutica. Ademais, a funcionalização de lipossomas com anticorpos monoclonais pode permitir a entrega seletiva do fármaco encapsulado à célula alvo. No presente trabalho objetivou-se desenvolver e caracterizar lipossomas e imunolipossomas funcionalizados com trastuzumabe, contendo paclitaxel, metformina hidrocloreto e/ou rapamicina, bem como avaliar as formulações através de estudos in vitro e in vivo. Os resultados mostraram que a metformina hidrocloreto foi encapsulada com baixa eficiência, menor que 20%, ao passo que paclitaxel e rapamicina puderam ser co-encapsulados com adequados valores de eficiência de encapsulação, equivalente a 56,32% para paclitaxel e 73,31% para rapamicina, e tamanho de partícula nanométrico, de 136,95 nm em composição biocompatível baseada em SPC:Col:DSPE-PEG(2000). Os dois fármacos apresentaram liberação lenta, e foram convertidos às formas molecular e amorfa, respectivamente para paclitaxel e rapamicina quando encapsulados. Os imunolipossomas foram funcionalizados com elevada eficiência com trastuzumabe e mantiveram o tamanho nanométrico, com adequados valores de encapsulação dos fármacos. Ainda, mostrou-se o sinergismo entre paclitaxel e rapamicina coencapsulados em lipossomas em células triplo negativas (4T1) e houve sinergismo entre os dois fármacos, mediado pelo anticorpo em imunolipossomas frente à linhagem celular HER2 positiva (SKBR3), em virtude do aumento do uptake celular mediado pelo trastuzumabe. Finalmente, os resultados obtidos in vitro foram confirmados in vivo, sendo que os lipossomas com paclitaxel e rapamicina coencapsulados foram capazes de controlar o crescimento tumoral em modelo de câncer de mama triplo negativo, ao passo que o imunolipossoma com os dois fármacos permitiu o controle do crescimento de tumores xenográficos HER2 positivos, cuja média de volume tumoral correspondeu a 25,27%, 44,38% e 47,78% das médias dos volumes tumorais de controle negativo, positivo e lipossoma, respectivamente. Portanto, a formulação desenvolvida nesse trabalho tem potencial para ser avaliada em estudos clínicos. / Breast cancer represents a severe public health problem. Among the drugs used in the treatment, paclitaxel is an effective cytotoxic drug, but associated with side effects. Hydrocloride metformin has shown promising results for cancer treatment, however it is very hydrophilic, a limiting factor for bioavailability. Rapamycin has demonstrated synergism with paclitaxel and potent anticancer activity, though it is a lipophilic drug with drawbacks that compromise its bioavailability. Nanostructured drug delivery systems, such as PEGylated liposomes are largely employed for pharmacokinetics improvement and enhancement of therapeutic effect. Furthermore, the functionalization of liposomes with monoclonal antibodies enables the selective delivery of the loaded drug to the target cell. In the present work, we aimed to develop and characterize liposomes and immunoliposomes functionalized with trastuzumab, containing paclitaxel, hydrocloride metformin and/or rapamycin, as well as to evaluate the formulations through in vitro and in vivo studies. The results showed that hydrocloride metformin was encapsulated with low efficiency, less than 20%, on the other hand paclitaxel and rapamycin could be co-loaded with suitable values of encapsulation efficiency, 56.32% for paclitaxel and 73.31% for rapamycin and nanometric particle size, 136.95 nm, based on a SPC:Chol:DSPE-PEG(2000) composition. The two drugs displayed slow release, and were converted to molecular and amorphous form, respectively for paclitaxel and rapamycin when encapsulated. The immunoliposomes were developed with high efficiency with trastuzumab and kept the nanometric size, with adequate encapsulation of drugs. Moreover, herein it was shown the synergism between paclitaxel and rapamycin co-loaded in liposomes in triple negative cells (4T1) and there was synergism between the two drugs mediated by the antibody in immunoliposomes in the HER2-positive cell line (SKBR3), due to the improved cell uptake mediated by trastuzumab. Finally, the results obtained in vitro were confirmed in vivo. Co-loaded paclitaxel and rapamycin were able to control tumor growth in a triple negative breast cancer animal model, while the immunoliposome containing the two drugs allowed for better control of tumor growth in a HER2-positive breast xenograft model, whose average tumor volume corresponded to 25.27%, 44.38% and 47.78% of the tumor volumes of positive control, negative control and liposome, respectively. Therefore, the formulation developed herein has potential to be evaluated in clinical trials.

The oncogenic isoform of HER2, HER2Δ16, is expressed with HER2 in nearly 50% of HER2 positive breast tumors where HER2Δ16 drives metastasis and resistance to multiple therapeutic interventions including tamoxifen and trastuzumab. The research carried out in this dissertation investigated the molecular mechanisms underlying HER2Δ16 activity contributing to primary trastuzumab resistance. In recent years microRNAs have been shown to influence multiple aspects of tumorigenesis and tumor cell response to therapy. Accordingly, the HER2Δ16 oncogene alters microRNA expression to promote endocrine resistance. With the goal of identifying microRNA suppressors of HER2Δ16 oncogenic activity, we investigated the contribution of altered microRNA expression to HER2Δ16-mediated tumorigenesis and trastuzumab resistance. Using a gene array strategy to compare the microRNA expression profiles of MCF-7 to MCF-7/HER2Δ16 cells, we found that HER2Δ16 suppresses expression of the miR-7 tumor suppressor. Reestablishing miR-7 expression significantly inhibits HER2Δ16-mediated tumor cell proliferation and migration, as well as sensitizes HER2Δ16-expressing cells to trastuzumab treatment. We propose that miR-7 regulated pathways, including EGFR and Src kinase, represent targets for the therapeutic intervention of refractory and metastatic HER2Δ16-driven breast cancer. Research in the past decade in HER2-positive breast cancer has focused on elucidating the molecular basis of primary and acquired trastuzumab resistance. Our laboratory has shown that critical and clinically important resistance pathways may be deregulated and only revealed during drug treatment. To identify potential resistance pathways deregulated during trastuzumab treatment, we used a phosphoproteomic approach to profile a subset of phosphorylation events after HER2Δ16-overexpressing cells were treated with trastuzumab. We discovered trastuzumab treatment significantly induced activation of ribosomal p70S6 kinase 1 (p70S6K) and aberrant signaling activity of this kinase is implicated in several disease models due to its role in regulating protein synthesis, cell proliferation and survival. Our data indicates that trastuzumab activates p70S6K to promote prosurvival signaling in breast cancer cells with inherent resistance. We propose that p70S6K can be evaluated in HER2-positive breast cancer patients undergoing trastuzumab treatment as a biomarker to predict therapeutic response. Overall, our research establishes that HER2Δ16 expression is an important genetic event in HER2 tumorigenesis and drives trastuzumab refractory breast cancer. / acase@tulane.edu

Rationale: In the breast cancer setting, anti-cancer therapies, including Doxorubicin (DOX) and Trastuzumab (TRZ), are associated with an increased risk of cardiotoxicity. There is a need to develop prophylactic cardioprotective agents to mitigate the cardiotoxic side effects of these common anti-cancer drugs. Objective: To investigate whether the anti-oxidant, N-acetylcysteine amide (NACA), can attenuate the drug-induced heart failure caused by DOX+TRZ in a murine model. Methods: A total of 100 female mice received one of the following drug regimens: i) saline; ii) NACA; iii) DOX; iv) TRZ; v) DOX+TRZ; vi) NACA+DOX; vii) NACA+TRZ; and viii) NACA+DOX+TRZ. Serial echocardiography was performed over a 10-day study period, after which the mice were euthanized for histological and biochemical analyses. Results: In mice receiving DOX, left ventricular ejection fraction (LVEF) decreased from 73±4% to 43±2% at day 10. In mice receiving DOX+TRZ, LVEF decreased from 72±3% to 32±2% at day 10. Prophylactic administration of NACA to mice receiving DOX or DOX+TRZ was cardio-protective with an LVEF of 62±3% and 55±3% at day 10, respectively. Histological and biochemical analyses demonstrated loss of cellular integrity, increased oxidative stress (OS), and increased cardiac apoptosis in mice treated with DOX+TRZ which was attenuated by the prophylactic administration of NACA. Conclusion: NACA attenuates the cardiotoxic side effects of DOX+TRZ in a murine model of chemotherapy induced cardiac dysfunction by decreasing OS and apoptosis. / October 2015

Breast cancers with overexpression or amplification of the HER2 tyrosine kinase receptor are more aggressive, resistant to chemotherapy, and associated with a worse prognosis. Currently, these breast cancers are treated with the monoclonal antibody trastuzumab (Herceptin®). Unfortunately, not all patients respond to trastuzumab drug therapy; some patients show de novo resistance, while others acquire resistance during treatment. This thesis describes our RNAi studies to identify novel regulators of the HER2 signaling pathway in breast cancer. Three kinome-wide siRNA screens were performed on five HER2 amplified and seven HER2 non-amplified breast cancer cell lines, two normal breast cell lines, as well as two HER2-positive breast cancer cell lines with acquired trastuzumab resistance and their isogenic trastuzumab-sensitive controls. To understand the main kinase drivers of HER2 signaling, we performed a comprehensive screen that selected against growth inhibitors of the non-HER2 amplified breast cancer cell lines. This screen identified the loss of the HER2/HER3 heterodimer as the most prominent selective inhibitor of HER2-amplified breast cancers. In a trastuzumab sensitization screen on five trastuzumab-treated breast cancer cell lines, we identified several siRNA against the PI3K pathway as well as various other signaling pathways that inhibited proliferation. Finally, in a screen for acquired trastuzumab resistance, PKCη and its downstream targets were identified. Loss of PKCη resulted in a decrease in G1/S transition and upregulation of the cyclin dependent kinase inhibitor p27. Initial data suggest that PKCη promotes p27 ubiquitination and degradation. Taken together, these studies provide novel insight into the complex signaling of HER2-positive breast cancers and the mechanisms of resistance to trastuzumab therapy. This work describes how various kinases can modulate cell proliferation, and points to possible novel drug targets for the treatment of HER2-positive breast cancers.

Breast cancer is the main cause of cancer death in women. Improved treatments, prevention programs and earlier detection are reducing the rate of death; however, there is still a high percentage of mortality by this cancer. Identification of novel targets to predict response to specific treatments is a key goal for personalizing breast cancer therapy and to improve survival. Few years ago, PARP inhibitors appeared as a promising therapy, particularly in BRCA-mutated cancers. However, there was a clear need to conduct further preclinical and translational work to improve the rational development of PARP inhibition in breast cancer. In this work we described PARP1 expression in breast tumour samples and characterized the effects of its inhibition in preclinical models. We found that nuclear PARP1 protein overexpression was associated with malignant transformation and poor prognosis in breast cancer. PARP1 overexpression was more common in triple negative subtype, but was also detectable in small subsets of estrogen receptor positive and HER2 positive breast cancers. In preclinical models, PARP1 played distinct roles in different molecular subtypes of breast cancer. Moreover, we described that olaparib (novel PARP inhibitor) had antitumour effects in different breast cancer subtypes, and its combination with trastuzumab (anti-HER2 antibody) enhanced the antitumour effects of this therapy. / El càncer de mama és la principal causa de mort per càncer en dones. La millora dels tractaments i la detecció precoç estan reduint la taxa de mort, però segueix sent elevada. Identificar noves dianes per predir la resposta a tractaments és clau per millorar les teràpies contra aquest càncer i la supervivència. Els inhibidors de PARP van aparèixer com una teràpia prometedora, particularment en càncers BRCA-mutants, però, cal dur a terme més estudis preclínics i translacionals per fomentar un desenvolupament racional d’aquesta teràpia en càncer de mama. Aquest treball descriu l’expressió de PARP1 en mostres de tumors mamaris i caracteritza els efectes de la seva inhibició a models preclínics. Vam observar que la sobreexpressió nuclear de la proteïna PARP1 fou associada amb: la transformació maligna; mal pronòstic en càncer de mama; i fou més freqüent al subtipus triple-negatiu, però també es va detectar en un subgrup de càncers de mama receptors d’estrogen positius i HER2 positius. En models preclínics, PARP1 va exercir rols diferents als diferents subtipus de càncer de mama. Per altra banda, vam descriure que olaparib (inhibidor de PARP) té efectes antitumorals en els diversos subtipus, i combinat amb trastuzumab (anticòs anti-HER2) potencia els efectes antitumorals d’aquesta teràpia.

O câncer de mama representa um grave problema de saúde pública. Dentre os fármacos empregados, destaca-se o paclitaxel, um agente citotóxico eficaz, porém associado a severos efeitos colaterais. A metformina hidrocloreto tem obtido resultados promissores para o tratamento de neoplasias, porém é bastante hidrofílica, fator limitante da biodisponibilidade. A rapamicina tem demonstrado sinergismo com paclitaxel e potente atividade antitumoral. Todavia, é um fármaco lipofílico e possui desvantagens. Sistemas nanoestruturados de fármacos como lipossomas PEGlados são largamente empregados para a melhora da farmacocinética e potencialização da ação terapêutica. Ademais, a funcionalização de lipossomas com anticorpos monoclonais pode permitir a entrega seletiva do fármaco encapsulado à célula alvo. No presente trabalho objetivou-se desenvolver e caracterizar lipossomas e imunolipossomas funcionalizados com trastuzumabe, contendo paclitaxel, metformina hidrocloreto e/ou rapamicina, bem como avaliar as formulações através de estudos in vitro e in vivo. Os resultados mostraram que a metformina hidrocloreto foi encapsulada com baixa eficiência, menor que 20%, ao passo que paclitaxel e rapamicina puderam ser co-encapsulados com adequados valores de eficiência de encapsulação, equivalente a 56,32% para paclitaxel e 73,31% para rapamicina, e tamanho de partícula nanométrico, de 136,95 nm em composição biocompatível baseada em SPC:Col:DSPE-PEG(2000). Os dois fármacos apresentaram liberação lenta, e foram convertidos às formas molecular e amorfa, respectivamente para paclitaxel e rapamicina quando encapsulados. Os imunolipossomas foram funcionalizados com elevada eficiência com trastuzumabe e mantiveram o tamanho nanométrico, com adequados valores de encapsulação dos fármacos. Ainda, mostrou-se o sinergismo entre paclitaxel e rapamicina coencapsulados em lipossomas em células triplo negativas (4T1) e houve sinergismo entre os dois fármacos, mediado pelo anticorpo em imunolipossomas frente à linhagem celular HER2 positiva (SKBR3), em virtude do aumento do uptake celular mediado pelo trastuzumabe. Finalmente, os resultados obtidos in vitro foram confirmados in vivo, sendo que os lipossomas com paclitaxel e rapamicina coencapsulados foram capazes de controlar o crescimento tumoral em modelo de câncer de mama triplo negativo, ao passo que o imunolipossoma com os dois fármacos permitiu o controle do crescimento de tumores xenográficos HER2 positivos, cuja média de volume tumoral correspondeu a 25,27%, 44,38% e 47,78% das médias dos volumes tumorais de controle negativo, positivo e lipossoma, respectivamente. Portanto, a formulação desenvolvida nesse trabalho tem potencial para ser avaliada em estudos clínicos. / Breast cancer represents a severe public health problem. Among the drugs used in the treatment, paclitaxel is an effective cytotoxic drug, but associated with side effects. Hydrocloride metformin has shown promising results for cancer treatment, however it is very hydrophilic, a limiting factor for bioavailability. Rapamycin has demonstrated synergism with paclitaxel and potent anticancer activity, though it is a lipophilic drug with drawbacks that compromise its bioavailability. Nanostructured drug delivery systems, such as PEGylated liposomes are largely employed for pharmacokinetics improvement and enhancement of therapeutic effect. Furthermore, the functionalization of liposomes with monoclonal antibodies enables the selective delivery of the loaded drug to the target cell. In the present work, we aimed to develop and characterize liposomes and immunoliposomes functionalized with trastuzumab, containing paclitaxel, hydrocloride metformin and/or rapamycin, as well as to evaluate the formulations through in vitro and in vivo studies. The results showed that hydrocloride metformin was encapsulated with low efficiency, less than 20%, on the other hand paclitaxel and rapamycin could be co-loaded with suitable values of encapsulation efficiency, 56.32% for paclitaxel and 73.31% for rapamycin and nanometric particle size, 136.95 nm, based on a SPC:Chol:DSPE-PEG(2000) composition. The two drugs displayed slow release, and were converted to molecular and amorphous form, respectively for paclitaxel and rapamycin when encapsulated. The immunoliposomes were developed with high efficiency with trastuzumab and kept the nanometric size, with adequate encapsulation of drugs. Moreover, herein it was shown the synergism between paclitaxel and rapamycin co-loaded in liposomes in triple negative cells (4T1) and there was synergism between the two drugs mediated by the antibody in immunoliposomes in the HER2-positive cell line (SKBR3), due to the improved cell uptake mediated by trastuzumab. Finally, the results obtained in vitro were confirmed in vivo. Co-loaded paclitaxel and rapamycin were able to control tumor growth in a triple negative breast cancer animal model, while the immunoliposome containing the two drugs allowed for better control of tumor growth in a HER2-positive breast xenograft model, whose average tumor volume corresponded to 25.27%, 44.38% and 47.78% of the tumor volumes of positive control, negative control and liposome, respectively. Therefore, the formulation developed herein has potential to be evaluated in clinical trials.

Notre deuxième travail expérimental visait à élucider le rôle de la surcharge pondérale dans le développement de la cardiotoxicité des anthracyclines et du trastuzumab. Grâce à un modèle murin de surpoids modéré et de risque cardio-métabolique accru induits par programmation post-natale, nous avons mis en évidence le rôle potentiateur d’une surcharge pondérale sur le développement de la cardiotoxicité aux anthracyclines ; alors que la cardiotoxicité du trastuzumab ne semble pas être en revanche majorée par le surpoids. Nos travaux ont également permis de préciser les conditions dans lesquelles existent des potentialisations des effets lors de l’association doxorubicine et trastuzumab. / Cancer treatment has advanced considerably in recent years, allowing a reduction in mortality. Longer life expectancy of patients has helped to highlight the delayed onset of cardiovascular toxicity induced by these chemotherapies. The pathophysiological mechanisms responsible for these cardiac dysfunctions are complex, entangled and remain partially unknown. A better understanding of the phenomena involved in these cardiotoxicities is needed to prevent their occurrence. Therefore, we have developed two different experimental approaches to understand the pathophysiological mechanisms involved in the cardiac toxicity of anthracyclines and trastuzumab.A first experimental study aimed to clarify the role of iron in heart failure induced by anthracyclines. We have demonstrated that a tissular iron overload in mice prior to doxorubicin injection does not increase the cardiotoxicity of chemotherapy. On the contrary, the involvement of anti-radical defenses following the iron load could reduce cardiac oxidative damage generated by doxorubicin. In view of these data, the role of iron chelators in cardioprotection against anthracyclines has to be questioned.Our second experimental work was to elucidate the role of overweight in the development of anthracycline and trastuzumab cardiotoxicity. Using a mouse model of moderate overweight and of increased risk of cardiometabolic induced postnatal programming, we have highlighted the role of overweight on the development of anthracycline cardiotoxicity; whereas trastuzumab cardiotoxicity did not appear to be increased by overweight. Our work also clarified the conditions in which there are cumulative cardiac alterations when doxorubicin and trastuzumab are associated.

L’imagerie en oncologie a fait des progrès considérables ces dernières années avec l’introduction du CT scan spiralé, de la résonance magnétique, de la mammographie digitalisée et du PET scan. Des combinaisons de différentes techniques ont vu le jour, telles que le PET/CT, et améliorent encore les possibilités de stadification de la maladie cancéreuse ainsi que le monitoring de son évolution dans le temps, et notamment sous traitement.Parallèlement, de grands progrès thérapeutiques ont étés réalisés en oncologie, en particulier le développement de médicaments « ciblés » dont l’efficacité dépend de l’expression par la cellule tumorale d’une molécule cible jouant un rôle important dans sa survie et/ou sa prolifération. L’expression de la molécule cible est une condition nécessaire mais pas suffisante pour observer une réponse au traitement ciblé :l’échec de ce dernier peut aussi s’expliquer par des altérations moléculaires en amont ou en aval de la « cible ».Le cancer du sein dit « HER2 positif » représente 20 à 25% des cancers du sein. Celui-ci est caractérisé par l’expression membranaire, en quantités importantes, d’une protéine, appelée HER2, qui lui confère une biologie agressive et un mauvais pronostic. L’expression de HER2 au niveau de la tumeur, déterminée en routine clinique par immunohistochimie et/ou par hybridation in situ en fluorescence, est le seul biomarqueur validé aujourd’hui dans le cancer du sein HER2 positif pour prédire l’efficacité des traitements ciblés anti-HER2. Cette prédiction est toutefois peu satisfaisante en termes de valeur prédictive positive (50% environ). Après une revue de la litérature sur les études d’imagerie fonctionnelle, peu nombreuses, réalisées dans le cancer du sein HER2 positif, nous avons décidé d’explorer le rôle de l’imagerie moléculaire avec la technologie PET/CT dans l’individualisation de la prise en charge du cancer du sein HER2 positif avec deux radio traceurs (FDG et zirconium89-trastuzumab), et ce, dans deux contextes cliniques distincts :dans la maladie précoce soumise à un traitement neoadjuvant et dans le contexte métastatique, en cas de traitement par le T-DM1. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished

No description available.

Breast cancer is the most common cancer in a woman with a five-year survival of patients with metastatic disease is estimated at 23%. Ado-trastuzumab emtansine (T-DM1) is a HER2-antibody drug conjugate currently approved for the treatment of HER2-positive pre-treated metastatic breast cancer (BC). We report a case of recurrent metastatic breast cancer with unusually lengthy progression-free survival (PFS) on T-DM1 chemotherapy. She was diagnosed with Triple Positive Stage IIIC multifocal invasive ductal carcinoma of the left breast. After completing neoadjuvant chemotherapy, she underwent a bilateral mastectomy. Final pathology showed partial response. Postoperatively, she received adjuvant chemotherapy and radiation therapy. She was started on Q21 days trastuzumab following completion of adjuvant chemotherapy. Systemic imaging showed liver lesions and biopsy confirmed recurrence. She was started on T-DM1, endocrine therapy with anastrozole was continued. She is currently status post 45 cycles. T-DM1 was approved for the treatment (single-agent) of HER2-positive, metastatic BC based on phase III data from the EMILIA and TH3RESA study. Median PFS in the T-DM1 arm was 9.6 months. Herein, we present a case of a woman with recurrent triple positive metastatic BC with a lengthy progression-free survival on T-DM1 chemotherapy.