Heterogeneity and Clinical Significance of ESR1 Mutations in ER-positive Metastatic Breast Cancer Patients Receiving Fulvestrant

Overview

Journal Nat Commun

Specialty Biology

Date 2016 May 14

PMID 27174596

Citations 162

Authors

Jill M Spoerke

Steven Gendreau

Kimberly Walter

Jiaheng Qiu

Timothy R Wilson

Heidi Savage

Junko Aimi

Mika K Derynck

Meng Chen

Iris T Chan

Lukas C Amler

Garret M Hampton

Stephen Johnston

Ian Krop

Peter Schmid

Mark R Lackner

Affiliations

Soon will be listed here.

Abstract

Mutations in ESR1 have been associated with resistance to aromatase inhibitor (AI) therapy in patients with ER+ metastatic breast cancer. Little is known of the impact of these mutations in patients receiving selective oestrogen receptor degrader (SERD) therapy. In this study, hotspot mutations in ESR1 and PIK3CA from ctDNA were assayed in clinical trial samples from ER+ metastatic breast cancer patients randomized either to the SERD fulvestrant or fulvestrant plus a pan-PI3K inhibitor. ESR1 mutations are present in 37% of baseline samples and are enriched in patients with luminal A and PIK3CA-mutated tumours. ESR1 mutations are often polyclonal and longitudinal analysis shows distinct clones exhibiting divergent behaviour over time. ESR1 mutation allele frequency does not show a consistent pattern of increases during fulvestrant treatment, and progression-free survival is not different in patients with ESR1 mutations compared with wild-type patients. ESR1 mutations are not associated with clinical resistance to fulvestrant in this study.

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