Abstract 5250: Notch signaling in ER+ breast cancer in response to endocrine therapy agents

Abstract

Abstract Breast cancer is the most frequent cancer in women in the world, and more than 70% of breast cancer cases are estrogen receptor α positive (ER+). Standard treatment for ER+ breast cancers is endocrine therapy that consists of selective estrogen receptor modulators (SERMs) such as tamoxifen in pre-menopausal patients; aromatase inhibitors (AIs); or selective estrogen receptor down-regulators (SERDs); fulvestrant, and treatment is dependent on the menopausal state of the patient. Many luminal tumors acquire resistance to therapy and recur, leading to disease progression and mortality. Resistance may result from the activation of quiescent signaling pathways that drive cancer stem cell (CSC) activity, such as the Notch signaling pathway. Previous studies demonstrate that activation of Notch via the NOTCH1 receptor recruits ERα in the absence of estrogen to facilitate transcription of estrogen responsive genes. However, NOTCH4 is often upregulated in resistant ER+ breast cancers, driving endocrine therapy resistance via breast CSC activity. We hypothesize that NOTCH4 promotes the transcription of estrogen-responsive genes in the absence of estrogen in a selective manner that is unlike NOTCH1. Understanding how NOTCH4 regulates the transcription of estrogen responsive genes upon treatment with endocrine therapy may suggest the need for combination therapy for ER+ breast cancer that includes a Notch targeted therapy. We have measured mRNA expression of classic estrogen responsive genes in ER+ breast cancer cell lines that either overexpress NOTCH1 or NOTCH4. Our data demonstrate differential expression of estrogen-responsive genes between NOTCH1 and NOTCH4 in the presence of tamoxifen. We have also measured Notch contribution to breast cancer stem cell activity through mammosphere formation assays using ER+ breast cancer cell lines in the presence of fulvestrant and Notch signaling inhibitors. The expression of classical estrogen responsive genes from mammospheres was altered in the presence of fulvestrant, Notch signaling inhibitors, or combinations of the two treatments. Further, combination treatment led to the disruption of mammosphere formation suggesting that combination therapy in the clinic may be suitable for the prevention of endocrine resistance by inhibition of BCSC activity through NOTCH4. Citation Format: Ciera S. Singleton, Lucio Miele, Judy S. Crabtree. Notch signaling in ER+ breast cancer in response to endocrine therapy agents [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5250.