Prognostic and predictive value of TP53 mutations in node-positive breast cancer patients treated with anthracycline- or anthracycline/taxane-based adjuvant therapy: results from the BIG 02-98 phase III trial

• Published in: Breast cancer research : BCR Vol. 14; no. 3; p. R70
• Main Authors: Fernández-Cuesta, Lynnette, Oakman, Catherine, Falagan-Lotsch, Priscila, Smoth, Ke-Seay, Quinaux, Emmanuel, Buyse, Marc, Dolci, M Stella, Azambuja, Evandro De, Hainaut, Pierre, Dell'orto, Patrizia, Larsimont, Denis, Francis, Prudence A, Crown, John, Piccart-Gebhart, Martine, Viale, Giuseppe, Leo, Angelo Di, Olivier, Magali
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01.01.2012; BioMed Central
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - genetics; Adenocarcinoma - pathology; Adolescent; Adult; Aged; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Apoptosis - drug effects; Base Sequence; Breast Neoplasms - drug therapy; Breast Neoplasms - genetics; Breast Neoplasms - pathology; Chemotherapy, Adjuvant; Disease-Free Survival; Docetaxel; Doxorubicin - therapeutic use; Female; Genes, p53; Humans; Ki-67 Antigen - metabolism; Lymphatic Metastasis - genetics; Middle Aged; Mutation, Missense; Receptor, ErbB-2 - metabolism; Receptors, Estrogen - metabolism; Receptors, Progesterone - metabolism; Retrospective Studies; Sequence Analysis, DNA; Sequence Deletion; Survival Analysis; Taxoids - therapeutic use; Tumor Suppressor Protein p53 - genetics; Young Adult
• ISSN: 1465-5411; 1465-542X
• DOI: 10.1186/bcr3179

Pre-clinical data suggest p53-dependent anthracycline-induced apoptosis and p53-independent taxane activity. However, dedicated clinical research has not defined a predictive role for TP53 gene mutations. The aim of the current study was to retrospectively explore the prognosis and predictive values of TP53 somatic mutations in the BIG 02-98 randomized phase III trial in which women with node-positive breast cancer were treated with adjuvant doxorubicin-based chemotherapy with or without docetaxel. The prognostic and predictive values of TP53 were analyzed in tumor samples by gene sequencing within exons 5 to 8. Patients were classified according to p53 protein status predicted from TP53 gene sequence, as wild-type (no TP53 variation or TP53 variations which are predicted not to modify p53 protein sequence) or mutant (p53 nonsynonymous mutations). Mutations were subcategorized according to missense or truncating mutations. Survival analyses were performed using the Kaplan-Meier method and log-rank test. Cox-regression analysis was used to identify independent predictors of outcome. TP53 gene status was determined for 18% (520 of 2887) of the women enrolled in BIG 02-98. TP53 gene variations were found in 17% (90 of 520). Nonsynonymous p53 mutations, found in 16.3% (85 of 520), were associated with older age, ductal morphology, higher grade and hormone-receptor negativity. Of the nonsynonymous mutations, 12.3% (64 of 520) were missense and 3.6% were truncating (19 of 520). Only truncating mutations showed significant independent prognostic value, with an increased recurrence risk compared to patients with non-modified p53 protein (hazard ratio = 3.21, 95% confidence interval = 1.740 to 5.935, P = 0.0002). p53 status had no significant predictive value for response to docetaxel. p53 truncating mutations were uncommon but associated with poor prognosis. No significant predictive role for p53 status was detected. ClinicalTrials.gov NCT00174655.