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Happy 2008! | And Briefly About 2007 December 31, 2007

Posted by ramunas in breast cancer, BT Test, cancer genetics, DiaGenic, familial cancer, genetic testing, MammaPrint, Oncotype DX, PC Detect, prostate cancer, sporadic cancer, technology.

(artwork by Hollis Sigler, 1948-2001)

Happy New Year 2008! Especially to all people, who encountered and battled cancer. Also for those who work to help fight this disease. Lot of advances in our understanding about this condition were achieved this year. It is too naive think that we could completely eliminate cancer, but it is very realistic to think that we can (and will able) to better predict and control this disease.

2007 will be known in history as a breakthrough in understanding of our (Humans: Homo sapiens sapientis) genome variation and enormous success in genome wide association studies (GWAS) for complex disorders ) cancer included (e.g. see my post about breast cancer).

2008 will be definitely an exciting journey through a highway (yet in a desert) of personalized genomics:

(from a movie Electroma, 2007)

I believe that individual molecular profiles will soon help to improve the early detection of cancer : over 50 novel DNA methylation-based biomarkers of breast cancer (by Orion Genomics) can replace mamography in a near future.

(courtesy of Biotage)

Also 37 gene expression markers from peripheral blood (by DiaGenic) will be offered in UK by Opaldia from 2008 (also covered by EyeOnDna, GeneticsAndHealth and MedGadget).

A new BT Test (by Provista Life Sciences) is designed to complement other testing methods to aid doctors in more accurately diagnosing breast cancer in its early stages, when life-saving treatment is most effective (via). The BT Test utilizes a proprietary algorithm to evaluate the levels and relationship of multiple, cancer associated protein biomarkers in blood serum. This data is coupled with a patient’s personal medical profile to generate a comprehensive report designed to assist healthcare providers in making an earlier diagnosis of breast cancer (via).

Two gene-expression assays, Oncotype DX and MammaPrint, have been developed and extensivelly reviewed in 2007, to determine the risk of breast cancer recurrence in patients with stage I or II node-negative breast cancer. In the future, these tests may be useful in determining the need for systemic adjuvant therapy in such patients (ref.).

Unexpectedly, some years ago alterations in mitochondrial DNA – our reminder about The Seven Daughters of Eve – have been suspected to play an important role in the development and progression of cancer. Several mutations have been identified in a wide variety of human tumors, including breast, colorectal, ovarian, gastric, hepatic and esophageal cancers, as well as hematological malignancies [ref.]. Some studies this year points to the importance of the variants in D-loop in familial breast cancer.

Genomic alterations in a new cancer marker – nucleophosmin (NPM1) (by Ipsogen) – has an enormous impact in the biological study, diagnosis, prognostic stratification, and monitoring of minimal residual disease of various lymphomas and leukemias (especially acute myeloid leukemia (AML)). The discovery of NPM1 gene alterations also represents the rationale basis for development of molecular targeted drugs.

Panacea Pharmaceuticals (hm, what a name…) has initiated manufacturing of PC Detectsm kits, the Company’s diagnostic test for prostate cancer, under GMP condition. It based on detection of Human Aspartyl (Asparaginyl) beta-Hydroxylase (HAAH), a cancer biomarker. HAAH has been established as an excellent biomarker for many types of cancer, including prostate cancer. The protein is typically undetectable in sera from cancer-free individuals, thus, an elevated serum protein level of HAAH is highly diagnostic for cancer. PC Detectsm is recommended as an adjunct to the prostate specific antigen (PSA) test and the digital rectal examination (DRE), the currently recommended prostate cancer screening methods (ref.).

A booming field in micro-RNA and cancer field is expected to blossom in forthcoming years – microRNA-10b and breast cancer metastases is a recent example in Nature. It is truly biology’s Big Bang in our 21st century – The RNA revolution.

(photo from Economist)

Tumor immunology, with cancer immunoediting concept in ahead, T regulatory cells and advances in therapeutic cancer vaccines is an important future promise. Individualized cancer immunotherapy with RNA loaded dendritic cells (DC) vaccines (by Argos Therapeutics) is one of the opportunities and new generation of choices.


Mammaprint TIME’s November 30, 2007

Posted by ramunas in breast cancer, cancer genetics, genetic testing, MammaPrint.
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Amsterdam based Agendia’s 70 gene expression test MammaPrint® was awarded by TIME Magazine as one of five best innovations of the year 2007 in the health category.

“With MammaPrint, a genetic test of a tumor’s DNA, patients and doctors can get a better handle on how likely it is that the cancer will spread”

It’s also the first microarray test approved by the FDA.

As you may noticed, there are several guys (aka doctors) on the corporate page design. Accidentally, when I was browsing our local website about COPD, I was surprised to find the same “template-doctors” there 🙂

Gene-expression Profiling in Cancer | A Brief Review July 24, 2007

Posted by ramunas in breast cancer, cancer genetics, GeneSearch, MammaPrint, Oncotype DX, sporadic cancer, technology.

It seems I’m getting more and more interested in gene-expression profiling (GEP) oncotests. In the Internet the information about this topic is quite messy and dispersed, so here I will try to draw some focus on this emerging technology (what will be added to a Genetic testing section later).

So, if we want to make gene-expression profiling, or in the other words, to answer an important question – what genes are expressed in a particular cell type of an organism, at a particular time, under particular conditions? [ref.]- first we need to have a sample of a tumor tissue to analyze its RNA pattern (or more precisely, messenger RNA (mRNA)). Here, unlike in mutations search, we’re not interested in DNA. RNA is quite instable molecule, so you need be quite cute and smart to manage preserve and analyse it.

A breast cancer is currently a holy grail for gene-expression profiling research to identify genes associated with breast cancer and to measure their activity in tumor cells, i.e. obtain its gene expression profiles.

Several techniques for measuring gene expression are available: a) a microarray based analysis and b) reverse transcriptase-polymerase chain reaction (RT-PCR). To measure gene expressions with a microarray you need to have a “fresh” (or “unpreserved”) tumor tissue samples. Tumor samples are frequently preserved in this way in Europe. Whereas in the United States tumor samples are more commonly preserved in formalin and embedded in paraffin blocks. Microarray analysis cannot be done on tissue that has been preserved in this way [ref.]. Since our pathologists are accredited by College of American Pathologists, they’re using paraffin blocks as well. Instead, for formalin-fixed and paraffin embedded (FFPE) tumor tissue blocks RT-PCR can be used to measure gene expression.

Therefore its important to know, that because of this difference in common methods of tissue processing has led to the development of tests in Europe and the United States that are quite different from one another, and that are based on measurements of the activity of different sets of genes.

In Europe, using microarray analysis, researchers are studying the usefulness of at least two different groups, or “panels”, of genes in studies on early stage tumors from node negative patients. One is a 70-gene panel, and another is a 76-gene panel. 1,2 Only three genes are common to both panels, while all the others are unique to one test or the otherB. In spite of this difference, both panels have yielded results that appear to be promising,3 and a commercial test based on the 70-gene panel is already available in the United States under the name MammaPrint®. (via)

Based on 76-gene panel Johnson&Jonson’s companies Veridex research, a two genes expression The GeneSearch™ Breast Lymph Node (BLN) Assay test was recently approved dy FDA, and is based on RT-PCR (i.e. for analysis in FFPE).

Common use of FFPE and a need for gene expression profiling using RT-PCR has led researchers in the United States to investigate several other panels of genes that produce too much or too little protein in early stage, node-negative, and estrogen receptor-positive breast cancer cells. A 21-gene panel commercial Oncotype DX test is one of example, which recently was approved by TEC to inform decision making about adjuvant chemotherapy only for a women with estrogen receptor-positive, node-negative, tamoxifen-treated breast cancer.

Let’s have a closer look at these genes [ref.]:

Measurements of five of those 21 genes (Beta-actin, GAPDH, RPLPO, GUS, and TFRC ) are used as “controls” – that is, to verify that the test has not been contaminated or run improperly.

The other 16 genes, which produce their proteins at varying levels in different tumors, include:

  • genes associated with cell proliferation (Ki-67, STK15, Survivin, Cyclin B1, and MYBL2);
  • genes associated with cellular invasion (Stromolysin 3, and CathepsinL2);
  • genes associated with HER2 activity (GRB7 and HER2);
  • genes associated with estrogen activity (ER, PR, Bc12, and SCUBE2); and
  • three other genes with distinctly different activity in cancer cells (GSTM1, BAG1, and CD68).

This Oncotype DX panel has only a single gene overlap with the 70-gene MammaPrint® panel. The reason for such diversity between gene panels under investigation are because of differences in tissue preparation, differences in laboratory methodologies, and differences in measurement techniques. At present, these gene-expression profile tests have only been validated on stored sample tissue.

Whether one of the existing panels will prove to be significantly superior to others, or whether newer panels will emerge that have better predictive power remains to be seen. It is clear that additional validation studies and more clinical experience are needed to establish the reliability of gene expression profiling for predicting tumor recurrence and response to specific treatments (ref.)


Evidence-based Genetic Testing | Breast Cancer July 20, 2007

Posted by ramunas in breast cancer, cancer genetics, genetic testing, MammaPrint, Oncotype DX, sporadic cancer.

On 18th of July, Blue Cross and Blue Shield Association, the Technology Evaluation Center (TEC), which is assessing medical technologies through objective, scientific evidence-based, comprehensive reviews of clinical evidence, has announced final decision on several genetic oncological tests.

The Medical Advisory Panel (MAP) concluded that:

The use of Oncotype DX™ to inform decision making about adjuvant chemotherapy meets the Blue Cross and Blue Shield Association Technology Evaluation Center (TEC) criteria for women with estrogen receptor-positive, node-negative, tamoxifen-treated breast cancer;

  • all other uses of Oncotype DX™ do not meet TEC criteria;
  • use of MammaPrint® gene expression profiling does not meet the TEC criteria;
  • use of the Breast Cancer Gene Expression Ratio gene expression profiling does not meet the TEC criteria.
  • use of epidermal growth factor receptor (EGFR) mutation analysis to predict therapeutic sensitivity to erlotinib (Tarceva®) therapy (for non-small cell lung and pancreatic cancer) does not meet the TEC criteria. (via)

TEC five criteria are used to assess whether a technology improves health outcomes such as length of life, quality of life and functional ability.

On February a Dutch company Agendia’s DNA micro array-based in vitro diagnostic laboratory service MammaPrint® was approved by FDA for marketing in the U.S.. It determines the likelihood of breast cancer returning and metastasis within five to 10 years after a woman’s initial cancer. That was the first cleared molecular genetic expression test, already used in Europe from 2005. MammaPrint measures the expression (activity) of 70 genes that predict the chances of a relapse. Customized microarrays, manufactured by Agilent, are used. There is a nice open-access article on BMC Genomics describing its development and several covering articles on PubMed. Acctually, MammaPrint is commercialized version of a very known and depicted in most cancer genetics textbooks gene expression study by van’t Veer et al (2002).

However MammaPrint did not fit into TEC criteria. Could that because of a small sample size (clinical data from 302 patients)? We need to wait more for evidence data to accumulate and be sure for the relevance of this test.

Breast Cancer Gene Expression Ratio gene expression profiling, an approach developed by Massachusetts General Hospital (MGH) Cancer Center and Arcturus Bioscience, Inc., which is based on the ratio between the expression levels of two genes – HOXB13 and IL17BR, predicts the likelihood for a tumor to recur. The higher the expression level of HOXB13 and the lower the expression of IL17BR, the greater the chance of tumor recurrence (via). Unfortunately, this methodology also did not meet TEC criteria.

The same failure is for (EGFR) mutation analysis to predict response to tyrosine kinase inhibitors (TKI), like erlotinib, cause there are some data, that non-small cell lung and pancreatic cancer patients with a 15 bp exon 19 deletion could have a swift response on erlotinib (via).

Only Oncotype DX, a diagnostic multi-gene expression test from California based GenomicHealth company, that provides the likelihood of distant breast cancer recurrence in women with newly diagnosed, early stage invasive breast cancer and assesses the benefit from chemotherapy, has met quite strict TEC criteria. The assay is performed using formalin-fixed, paraffin-embedded (FFPE) tumor tissue and analyzes the expression of a panel of 21 genes using quantitative TaqMan® RT-PCR reactions in 384-well plates and the results are provided as a Recurrence Score™ (0-100) (via). They have done quite a lot of work on optimization and selection from 250 canditates genes (via).