Serum HER2 Research Articles

Enzyme-free and label-free detection of HER2 in human serum based on Ag+-released hybridization chain reaction signal amplification

The overexpression of human epidermal growth factor receptor 2 (HER2) has been linked to aggressive breast cancer and worse clinical outcomes. However, accurately measuring HER2 remains challenging, due to its low serum content. Herein, we developed a novel method for HER2 detection in serum by the combination of aptamer with C-Ag+-C structure, Ag+-released hybridization chain reaction (Ag+-HCR) and coprecipitation of Ag+ and gold nanoparticles (AuNPs) in the solution including Eosin Y (EY) and AgI colloids. Following the aptamer bound to HER2, signal amplification occurred through the release of numerous Ag+ by Ag+-HCR. This process subsequently induced AuNPs aggregation on the surface of AgI colloids, resulting in reduced fluorescence intensity of EY in the supernatant. The reduced value of EY fluorescence intensity in the supernatant was proportional to the level of HER2. Under optimized reaction conditions, a wide detection range was obtained between 0.09 and 9000 pg/mL with a limit of detection of 11.7 fg/mL in diluted human serum, and 96 serum samples in a 96-well plate could be measured simultaneously by a microtiter plate reader within 2 h. Moreover, the quantitative results of HER2 were consistent with those obtained using the enzyme-linked immunosorbent assay kit (r = 0.9995). Therefore, leveraging the delicate design of Ag+-HCR signal amplification, this enzyme-free, label-free, and effective method has demonstrated to be capable of detecting HER2 in serum due to its high sensitivity. Remarkably, this method may be extended to detect other cancer-related proteins and genes by replacing the corresponding target sequences.

Abstract PO4-14-06: Impact of Serum HER2 Extracellular Domain in Metastatic Breast Cancer Patients Treated with Trastuzumab Deruxtecan (T-DXd)

Abstract Background: Trastuzumab deruxtecan (T-DXd) is a standard of care as 2nd line and after prior chemotherapy for HER2 positive and low metastatic breast cancer (MBC), respectively, based on Destiny Breast03 and 04 results. However, biopsies over time during treatment have shown that HER2 expression is variable. The predictive factors of trastuzumab deruxtecan (T-DXd) for MBC with HER2 positive and low are unclear. The HER2 extracellular domain (HER2-ECD) has been confirmed as a prognosis marker and predictive marker of treatment for HER2-positive MBC. Especially, HER2-ECD is considered a promising biomarker in cases where HER2 expression in metastases is unconfirmed. We hypothesized that HER2-ECD could serve as a biomarker for T-DXd. Patients and methods: A retrospective study of consecutively treated patients in a single center between 2019-2023 with HER2-low and HER2-positive MBC was performed using chart review. HER2 status was diagnosed according to 2020 ASCO-CAP guidelines. HER2-ECD high was defined as >15.0 ng/ml. HER2-ECD was collected prior to T-DXd treatment. We compared overall response (ORR), progression-free survival (OFS), overall survival (OS), and disease control rate (DCR) at HER2-ECD high and low groups. Cox regression analyses were performed to assess the ORR. We used the Kaplan-Meier method to estimate the PFS and OS and the log-rank test to compare each treatment group. Results: A total of 41 MBC patients were included in this study. Patients with HER-positive and HER2-low were 34 and 7, respectively. Among HER2 positive (n=34), HER2-ECD high and low are 14 (41%) and 20 (59%) patients, respectively. Among HER2 low (n=7), HER2-ECD high and low are 3 (43%) and 4 (57%) patients, respectively. Twenty-six patients received T-DM1 prior to T-DXd treatment for MBC with HER2 positive, but no patients received CPT-11 before T-DXd for MBC with HER2 positive and low. The ORR of T-DXd was 89% and 52% in the HER2-ECD high and low groups, respectively (p< 0.001). All 6 cases with CR were HER2-ECD high. Among HER2 low group (n=7), ORR of T-DXd was 67% (2/3) and 25% (1/4) in HER2-ECD high and low groups, respectively. The median PFS in the HER2-ECD high group showed longer than the HER2-ECD low group, 21.8 vs. 8.0 months (HR 0.31; 95%CI, 0.13-0.78, p=0.012). Although there were no significant differences in OS, HER2 ECD high group tended to show longer OS (HR 0.23; 95%CI, 0.04-1.16, p=0.07). The DCR was 100% in the HER2 ECD high group and 87% in the low group. Conclusion: T-DXd showed significantly better response and prolonged PFS in the group with high HER2-ECD. HER2-ECD has the potential to become a biomarker for T-DXd. Further study is warranted to assess the HER2-ECD as a biomarker, especially for HER2 low MBC patients treated with T-DXd. Table. Association between the response and the HER2 status or HER2-ECD status Citation Format: Kazuki Nozawa, Maho Kusudo, Nari Kureyama, Akira Nakakami, Rie Komaki, Yuka Endo, Ayumi Kataoka, Haruru Kotani, Akiyo Yoshimura, Masaya Hattori, Masataka Sawaki, Hiroji Iwata. Impact of Serum HER2 Extracellular Domain in Metastatic Breast Cancer Patients Treated with Trastuzumab Deruxtecan (T-DXd) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-14-06.

Exploratory analysis of serum HER2 extracellular domain for HER2 positive gastric cancer treated with SOX plus trastuzumab.

The aim of this study was to explore the clinical utility of serum HER2 extracellular domain (sHER2 ECD) using data from a clinical trial evaluating trastuzumab combined S-1 plus oxaliplatin (SOX) in HER2 positive gastric cancer. sHER2 ECD were prospectively measured at baseline and subsequent treatment courses. Based on each quantile point of baseline sHER2 ECD levels and its early changes, patients were divided into two groups and compared clinical outcomes. 43 patients were enrolled, and 17 patients (39.5%) were positive for baseline sHER2 ECD. Higher baseline sHER2 ECD levels tended to have lower hazard ratios (HRs). When divided into two groups by baseline sHER2 ECD of 19.1ng/ml, median progression-free survival (PFS) and overall survival (OS) was longer in the higher group (mPFS: 16.8 vs 8.7months, p = 0.359. mOS: 35.5 vs 20.6months, p = 0.270), respectively. After initiation of treatment, sHER2 ECD significantly decreased up until the third cycle. Higher reduction rates of sHER2 ECD within 3 cycles also tended to have lower HRs. When divided into two groups by reduction rate of 42.5%, mPFS and mOS was longer in the higher reduced group (mPFS: 17.2 vs 8.7months, p = 0.095. mOS: 65.0 vs 17.8months, p = 0.047), respectively. Furthermore, higher reduction rates could surrogate higher objective response rates (ORR) (ORR: 90% vs 63.2% for 29.5%, p = 0.065. 100% vs 70% for 42.5%, p = 0.085), respectively. Baseline sHER2 ECD levels and its early decline may be useful biomarkers for SOX plus trastuzumab efficacy in HER2 positive gastric cancer.

Serum HER2 Level Predicts Therapeutic Efficacy and Prognosis in Advanced Breast Cancer Patients.

The purpose of this study was to investigate the therapeutic efficacy and prognosis of serum HER2 (sHER2) in patients with advanced breast cancer. We analyzed the sHER2 levels of 200 patients with advanced breast cancer receiving first or second line treatment, the tissue HER2 (tHER2) level was also analyzed. Indicators of therapeutic efficacy and prognosis were objective response rate (ORR), disease control rate (DCR), and time to progression (TTP). The baseline sHER2 level was high in 132 patients and low in 68 patients. The high level of sHER2 is correlated with molecular subtype (p=0.016), visceral metastasis (p<0.001), liver metastasis (p<0.001), tissue HER-2 (tHER2) (p=0.001), and, among tHER2-low tumors (59 patients), the baseline sHER2 high level was associated with a higher proportion of brain metastasis. The ORR of patients with baseline sHER2 high level is higher than those with baseline sHER2 low level (p=0.026). The TTP of patients with baseline sHER2 low level is longer than the patients with baseline sHER2 high level (p=0.024). For patients with baseline sHER2 high level, a significant decrease in sHER2 after two cycles of treatment indicates higher ORR, DCR, and an extension of TTP. After multiple cycles of treatment, for patients with tHER-2 positive and baseline sHER2 high level, the DCR in the sHER2 decrease in the negative group was higher than that in the continuous positive group (p=0.037). Patients with a rapid decline type of sHER2 dynamic change curve had higher ORR and prolonged TTP compared with patients with other types of sHER2 dynamic change curve. There is no correlation between OS and sHER2 levels. Our study showed that patients with advanced breast cancer had a high level of sHER2 at recurrence, regardless of whether they are tHER2 positive or negative. Dynamic detection of sHER2 can help predict therapeutic efficacy and prognosis, regardless of whether tHER-2 is positive or negative.

Serum HER2 Level Predicts Therapeutic Efficacy and Prognosis in Advanced Breast Cancer Patients [Letter

Serum HER2 Level Predicts Therapeutic Efficacy and Prognosis in Advanced Breast Cancer Patients [Letter

Evaluation of the influence of trastuzumab therapy on serum levels of HER-2 protein and breast cancer cell lines.

Breast cancer is a complex disease characterised by abnormal cell growth in breast tissue. Trastuzumab is a targeted therapy that inhibits the HER-2 receptor and suppresses tumour growth. We aimed to determine if the clinical course of the disease could be predicted by early changes in serum levels of human epidermal growth factor receptor 2 (HER-2/neu) following trastuzumab-based therapy. The study enrolled 120 women, divided into an experimental group (60 breast cancer patients receiving trastuzumab) and a control group (60 healthy women). Serum samples were collected before each weekly trastuzumab treatment. In addition, human breast cancer cell lines MCF-7 and AMJ13 were cultured in vitro and treated with trastuzumab. The study assessed cell viability using a cytotoxicity assay (methyl thiazolyl tetrazolium) and measured HER-2 protein levels. The half maximal inhibitory concentration (IC50) was determined to evaluate the effect of trastuzumab on breast cancer. The results showed that breast cancer patients had significantly lower serum levels of HER-2 compared to the control group. The cytotoxicity assay demonstrated that increasing trastuzumab concentration enhanced growth inhibition and cytotoxicity in the cell lines. There was a significant difference in IC50 between the MCF-7 and AMJ13 cell lines. The study provides valuable insights into the effects of trastuzumab on serum HER-2 levels and breast cancer cell lines. These findings have implications for resource allocation and treatment decisions in breast cancer management. By understanding the impact of trastuzumab on HER-2 levels and tumour cells, healthcare professionals can make more informed decisions regarding therapy options for patients.

Study the technical validity and feasibility of serum HER-2/Neu and its correlation with tissue HER-2 status in female breast cancer patients only

Background: Breast cancer is one of the leading causes of death in women worldwide. The future burden of breast cancer is predicted to increase over 3 million new cases and 1 million deaths in 2040. In India, it is being increasingly diagnosed at a younger age as compared to the west. Human epidermal growth factor receptor 2 (HER-2) transmembrane protein, with a molecular weight 185 kDa, plays a key role in cell growth and its overexpression favors cell proliferation by inhibiting apoptosis. HER-2 extracellular domain, released into blood before appearing into tissue, can be easily detected by enzyme-linked immunosorbent assay (ELISA) using serum. HER-2 has many roles in assisting diagnosis, targeted therapy, and evaluating prognosis. Aims and Objectives: The study aimed to monitor the serum HER-2 level and its correlation with tissue HER-2 status in breast cancer patients. Materials and Methods: We performed a prospective study on technical validity and feasibility of serum HER-2 level by ELISA in breast cancer patients and its correlation with tissue HER-2 status by immunohistochemistry (IHC) method. Results: We found the serum ELISA level was raised and within the reference range in all breast cancer patients. A higher level of serum HER-2 level was seen in high tumor stage, high Nottingham grade, and with axillary lymph node metastasis. Serum HER-2 level was significantly higher in IHC score 3+ as compared to score 2+and 1+. Conclusion: This study concluded that serum HER-2 ELISA is a valid and feasible test. Association of serum HER-2 level with tumor stage; Nottingham grade; and axillary nodal metastasis was significant. The correlation between serum HER-2 and tissue HER-2 was found significant. Thus, serum HER-2 may be used as an early diagnostic and prognostic biomarker to guide in clinical practice.

An ultra-sensitive fluorescent Aptamer sensor based on 2D MOF for detection of HER2 in serum

Reducing background signal and improving detection sensitivity is one of the main research directions of optical biosensors. Based on the structure and functional characteristics of MOFs, the optical sensing system is constructed, which does not require the pre-treatment of complex biological samples or the catalysis of biological enzymes, and can be directly used for the detection of HER2 in serum. In this paper, the fluorescence resonance energy transfer effect between Co/Fe-MOFs and HER2 Aptamer modified fluorescent group FAM was used to make FAM-Apt undergo fluorescence quenching. When the target is present, FAM-Apt specifically binds to HER2 and simultaneously disconnects from Co/Fe-MOFs surface. FAM was recovered, and a reproducible fluorescence sensing system was successfully constructed for the detection of HER2 in serum. The two-dimensional nanosheets and bimetallic structures of Co/Fe-MOFs have greater specific surface area and fluorescence quenching ability. The results showed that the sensor system had good reproducibility (RSD=2.4%), and the detection range of HER2 was 0.01–10 ng/mL under the best conditions, and the estimated detection limit was 6.67 pg/mL.

A multicenter phase II study of vaccines to prevent recurrence in patients with HER-2–positive breast cancer.

532 Background: Patients (pts) with early stage HER2-positive breast cancer are commonly treated with neoadjuvant HER2-targeted therapy. Pts who have residual invasive disease have a less favorable outcome and increased risk of recurrent disease than pts with a complete pathologic response (pCR). It also has been observed that pts who do not achieve a pCR have low or absent anti-HER-2 CD4 Th1 responses. We hypothesized that correcting anti-HER-2 CD4 Th1 response using vaccines will be safe, induce anti-tumor immunity in HER2-positive breast cancer and reduce the risk of recurrence. We conducted a multi-center, phase 2, randomized study to determine the safety, immunogenicity and recurrence free survival of two HER2 vaccines (multivalent anti-oncodriver DNA vaccine (WOKVAC) or HER-2-pulsed dendritic cell vaccine (DC1)). Methods: Pts with HER2-positive early breast cancer were eligible if they had residual invasive disease at surgery after receiving neoadjuvant chemotherapy plus HER2-targeted therapy. Patients were randomly assigned in a 1:1 ratio, with stratification according to residual cancer burden (RCB) (1+2 vs 3) to receive adjuvant HER2 vaccination with either DC1 or WOKVAC. For the initial vaccination phase, DC1 was delivered via US guided inguinal lymph node administration, weekly x 6 weeks and WOKVAC was given intradermally on weeks 1, 4, and 7. Booster vaccines were given at months 6, 9 and 12. The primary end point is to evaluate the safety and tolerability of each vaccine and assess immune response rate as measured by ELISPOT. Each treatment arm will be assessed separately. Secondary endpoints include recurrence-free survival. Exploratory analyses include the assessment of prognostic and predictive biomarkers including circulating tumor cells, serum HER2 levels, and other immune correlative biomarkers. Here we are reporting the initial safety results. Results: Total of 110 eligible pts (55 WOKVAC vs 55 DC1) were enrolled from 2/2018 to 12/2022 and received at least one dose of treatment and 38 pts pending completion of the booster phase. Most pts had clinical stage II/III 56/35 (82%) and 50% had positive node disease at diagnosis. 82% had hormone receptor positive disease. 37/38/8 patients had RCB 1/2/3. For patients without known RCB status, ypTNM was used to randomize (yp stage I/II/III = 13/13/1 pts). The most frequently observed treatment related adverse events (TRAE) were injection site pain/reaction (38%) and chills (34%), fever (25%) and fatigue (40%) for DC1 arm. For WOKVAC, the most common toxicities included injection site reaction (68%) and fatigue (37%). All of these were grade 1 and 2. Nine patients had events including new primary cancer (1), local recurrence (2), metastatic disease recurrence (6). Conclusions: Both DC1 and WOKVAC HER2 vaccines were well tolerated without significant toxicities. Updated results will be presented at the meeting including correlatives. Clinical trial information: NCT03384914 .

Electrochemical Cellulase-Linked ELASA for Rapid Liquid Biopsy Testing of Serum HER-2/neu.

Non-invasive liquid biopsy assays for blood-circulating biomarkers of cancer allow both its early diagnosis and treatment monitoring. Here, we assessed serum levels of protein HER-2/neu, overexpressed in a number of aggressive cancers, by the cellulase-linked sandwich bioassay on magnetic beads. Instead of traditional antibodies we used inexpensive reporter and capture aptamer sequences, transforming the enzyme-linked immuno-sorbent assay (ELISA) into an enzyme-linked aptamer-sorbent assay (ELASA). The reporter aptamer was conjugated to cellulase, whose digestion of nitrocellulose film electrodes resulted in the electrochemical signal change. ELASA, optimized relative aptamer lengths (dimer vs monomer and trimer), and assay steps allowed 0.1 fM detection of HER-2/neu in the 10% human serum in 1.3 h. Urokinase plasminogen activator and thrombin as well as human serum albumin did not interfere, and liquid biopsy analysis of serum HER-2/neu was similarly robust but 4 times faster and 300 times cheaper than both electrochemical and optical ELISA. Simplicity and low cost of cellulase-linked ELASA makes it a perspective diagnostic tool for fast and accurate liquid biopsy detection of HER-2/neu and of other proteins for which aptamers are available.

Abstract 2793: Preclinical pharmacokinetics in cynomolgus monkeys and first in human dose prediction of DB-1303, a HER2-targeting antibody-drug conjugate

Abstract Background: DB-1303 is a novel antibody-drug conjugate comprised of trastuzumab biosimilar, enzymatically cleavable peptide-linker, and a proprietary topoisomerase I inhibitor P1003. It is designed to have high plasma stability, low free payload in circulation and wide therapeutic index. Herein, the preclinical pharmacokinetics (PK) characteristics of DB-1303 in cynomolgus monkeys is reported, and human PK exposure in a first in human study was predicted using population PK model with allometric scaling. Material and Methods: The PK parameters of DB-1303 were obtained from single PK and repeated TK studies in female and male cynomolgus monkeys. Concentrations of DB-1303 ADC, total antibody and released payload P1003 were measured using ELISA or LC-MS/MS. In a PK study, single dose of DB-1303 at 1, 3 and 10 mg/kg were determined in cynomolgus monkeys via IV infusion. In TK studies, cynomolgus monkeys were intravenously administered with DB-1303 at 50, 80 mg/kg once every 3 weeks for 2 repeated doses, or 10, 40, 80 mg/kg once every 3 weeks (Q3W) for 3 repeated doses followed by a 4-week recovery. A population PK model was developed based on the collective PK/TK data in monkeys. Results: The non-compartment analysis PK parameters of three analytes (DB-1303 ADC, total antibody and released payload P1003) are summarized following single and multiple doses of DB-1303 in cynomolgus monkeys. To predict the human PK for DB-1303, a target mediated drug disposition (TMDD) model was constructed, incorporating binding to serum HER2 and subsequent elimination of the complex into a standard 2-compartmental PK model. The 2-compartment linear parameters were scaled from cynomolgus monkey population PK parameters using allometric scaling exponents of 1 for volumes and 1 for clearance. The binding of DB-1303 to HER2 was incorporated into the model and assumed to be the same for HER2 ECD and transmembrane domain. The PK profiles for DB-1303 in human at the proposed doses in the first in human study are predicted. The safety margins from the monkey HNSTD for each proposed human dose are calculated. Conclusions: DB-1303 exhibited favorable PK characteristics of DB-1303 in cynomolgus monkeys, and is predicted to have large safety margins at the selected doses in the first in human study. At the time of presentation, the first-in-human phase 1/2 study in patients with advanced solid tumors is in progress (NCT05150691). Citation Format: Rong Shi, Shengchao Lin, Yu Zhang, Bing Li, Haiqing Hua, Yang Qiu. Preclinical pharmacokinetics in cynomolgus monkeys and first in human dose prediction of DB-1303, a HER2-targeting antibody-drug conjugate [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2793.

An Evaluation of Fluorouracil plus Paclitaxel and Oxiliplatin as a First-Line Treatment for Advanced Gastric Squamous Cell Carcinoma.

To investigate the efficacy of fluorouracil (FU) combined with paclitaxel (PTX) and oxaliplatin (OXA) as the first-line treatment for advanced gastric signet ring cell carcinoma (SRCC) and its influence on human epidermal growth factor receptor 2 (HER-2) expression. We collected one hundred and sixty-eight patients with advanced gastric SRCC, including 87 patients treated with FU combined with PTX and OXA as the study group (SG) and 81 patients treated with FU combined with OXA as the control group (CG). We compared indicators such as efficacy and adverse reactions after treatment between the two groups and also detected serum HER-2 expression pre- and post-treatment. The incidence of adverse reactions differed insignificantly between SG and CG (P > 0.05). SG presented a notably higher objective response rate (ORR) and disease control rate (DCR) than that of CG (P < 0.05). After treatment, the serum HER-2 expression level of patients in both groups decreased significantly (P < 0.05), and that in SG was significantly declined compared to CG (P < 0.05). HER-2 was negatively correlated with the efficacy of both SG and CG. The 1-year survival rate in SG (29.89%) was significantly higher than that in CG (16.05%) (P < 0.05). The median OS and PFS were higher in DG than that in CG (P < 0.05). FU combined with PTX and OXA can effectively improve the efficacy of first-line treatment for advanced gastric SRCC while reducing HER-2 expression, without increasing the adverse reaction rate. This treatment is worthy of clinical promotion.

A "signal-on" photoelectrochemical sensor for human epidermal growth factor receptor 2 detection based on Y6/CdS organic-inorganic heterojunction.

A "signal-on" photoelectrochemical (PEC) immunosensor was successfully constructed for determination of human epidermal growth factor receptor 2 (HER2) based on organic-inorganic heterojunction Y6/CdS as photoactive material. Compared with single organic semiconductor, Y6, Y6/CdS exhibited higher photoelectric conversion efficiency due to the formation of heterojunction. In the presence of HER2, sandwich immune structure was formed between HER2 aptamer and anti-HER2 antibody (Ab) by specific recognition. The polydopamine (PDA) nanoparticles were used for signal amplification to enhance photocurrent intensity as PDA can act as electron donor to eliminate holes and promote electron-hole pairs separation. The developed PEC sensor displayed a wide detection range of 5-1000pgmL-1 and a low detection limit of 2.2pgmL-1 for HER2 (S/N = 3). The sensor was successfully used for the detection of HER2 in serum with recoveries between 94.8 and 104% and relative standard deviations (RSDs) in the range of 1.2-4.3%. Furthermore, the designed immunosensor possessed good stability, selectivity, and reproducibility, which can find potential clinical applications for disease diagnosis. A "signal-on" photoelectrochemical sensor was reported for human epidermal growth factor receptor 2 detection based on Y6/CdS organic-inorganic heterojunction.

Prognostic Value of the Serum HER2 Extracellular Domain Level in Breast Cancer: A Systematic Review and Meta-Analysis.

Simple SummaryWe performed a systematic review and meta-analysis evaluating the predictive value of the serum HER2 extracellular domain (sHER2 ECD) for breast cancer prognosis. Our review investigated 40 studies (12,229 patients) that assessed the impact of the sHER2 ECD levels on breast cancer prognosis and explored the clinical significance of sHER2 ECD levels in different treatment modalities. Our findings indicated that an elevated sHER2 was an unfavorable prognostic factor in breast cancer. More interestingly, sHER2 ECD was found to be a promising biomarker for predicting adverse clinical outcomes of trastuzumab-based treatment but did not affect the efficacy of tyrosine kinase inhibitors. In addition, the baseline cutoff value of sHER2 ECD in different treatment stages of breast cancer remains to be further explored. Overall, our study suggested that sHER2 ECD levels have important prognostic value in breast cancer and may be helpful for clinicians to select the appropriate anti-HER2 therapy for HER2-positive breast cancer, providing more evidence for guiding clinical practice.An elevated serum HER2 extracellular domain is associated with poor prognosis in breast cancer, but the relationship between sHER2 and the efficacy of different modalities remains controversial. Herein, we aimed to evaluate the prognostic value of serum HER2 extracellular domain (sHER2 ECD) in breast cancer and to identify its correlation with the efficacy of different treatment regimens. A systematic search of the PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted to identify studies exploring the association between HER2 ECD level and clinical outcomes among patients with breast cancer. Using the random effects models, pooled hazard ratios (HRs), and odds ratios (ORs) with 95% confidence intervals (CI), were calculated for progression-free survival (PFS), overall survival (OS), disease-free survival (DFS), and the objective response rate (ORR). Heterogeneity was further evaluated by subgroup and sensitivity analysis. Overall, 40 studies comprising 12,229 patients were included in this systematic review and meta-analysis. Elevated HER2 ECD levels were associated with worse PFS (HR 1.74, 95% CI 1.40–2.17; p < 0.001), and this effect was observed in patients treated with chemotherapy (HR 1.81, 95% CI 1.37–2.39; p < 0.001), endocrine therapy (HR 1.91, 95% CI 1.57–2.32; p < 0.001), and trastuzumab (HR 1.74, 95% CI 1.31–2.30; p < 0.001). However, this association was not present in patients treated with tyrosine kinase inhibitors (TKIs) (HR 1.44, 95% CI 0.85–2.43, p = 0.17). The HRs/ORs for an elevated HER2 ECD level for DFS, OS, and ORR were 2.73 (95% CI 2.17–3.42; p < 0.001), 2.13 (95% CI 1.77–2.57; p < 0.001), and 0.80 (95% CI 0.49–1.31; p = 0.381), respectively. An elevated sHER2 ECD was an unfavorable prognostic factor in breast cancer but did not affect the efficacy of tyrosine kinase inhibitors such as lapatinib. Detection of sHER2 ECD may be helpful for clinicians selecting the appropriate anti-HER2 therapy for patients with HER2-positive breast cancer.

Covalent Hemin/G4 complex-linked sandwich bioassay on magnetic beads for femtomolar HER-2/neu detection in human serum via direct electrocatalytic reduction of oxygen

Liquid biopsy assays for tumour biomarkers circulating in blood are perspective non-invasive tools for cancer diagnosis and treatment monitoring. Here, we suggest a simple, 1 h long electrochemical DNAzyme-linked aptamer- and immuno-sandwich magnetic assay for analysis of serum HER-2/neu protein overexpressed in several aggressive cancers. In the assay, we used a covalent hemin-guanine quadruplex (G4) complex as a novel O2-dependent electrocatalytic label that allowed 10 fM (aptamer-aptamer) and 1 fM (aptamer-antibody) detection of HER-2/neu in human serum. The O2 reactivity of the aptamer-conjugated label was detected at high-surface-area graphite electrodes displaying a high efficiency of O2 reduction electro-catalyzed by this DNAzyme. In contrast to the recognised H2O2 reactivity, the O2 reactivity of the covalent hemin/G4 complex depended only on ambient O2 present in solutions, and did not require adding such traditional reagents as hemin and H2O2, and solution de-aeration. Human serum albumin, urokinase plasminogen activator and thrombin did not interfere, and the assay was used for analysis of basal serum levels of HER-2/neu. Due to the simplicity and low cost, sandwich assays exploiting O2-linked electrocatalysis by the covalent hemin-G4 complexes represent a more advanced electrochemical ELISA platform for ultrasensitive and fast detection of low concentrations of proteins in complex biological matrices.

Abstract OT1-16-01: A multicenter phase II study of vaccines to prevent recurrence in patients with HER-2 positive breast cancer

Abstract Background: HER2-positive breast cancer patients are commonly treated with neoadjuvant therapy including HER2-targeted therapy. Patients who have residual invasive disease have less favorable outcomes with an increased risk of recurrent disease than patients with complete pathologic response (pCR). It has also been observed that these non-pCR patients have low or absent anti-HER-2 CD4 Th1 responses. We hypothesized that correcting the anti-HER-2 CD4 Th1 response using vaccines will increase interferon gamma production which we have shown is a potent inducer of apoptosis and senescence in HER2-positive breast cancer. This study will be evaluating safety and immunogenicity of two vaccines (multivalent anti-oncodriver DNA vaccine (WOKVAC) or HER-2-pulsed dendritic cell vaccine (DC1)). Methods: This is a multi-center, phase 2, randomized study to determine the safety and tolerability of HER2 vaccines (DC1 and WOKVAC), assess immunogenicity, and evaluate recurrence free survival. Patients with HER2-positive early breast cancer (stage I-III) are eligible if they have residual invasive disease in the breast or axilla at surgery after receiving neoadjuvant chemotherapy plus HER2 -targeted therapy. Patients are randomly assigned in a 1:1 ratio to receive 1 of 2 adjuvant HER2 vaccines, either DC1 or WOKVAC for 1 year. A permuted-block randomization scheme was used with stratification according to residual cancer burden (RCB) (1+2 vs 3). The primary end points are safety and immunogenicity (immune response rate measured by ELISPOT). Each treatment arm will be assessed separately. Any statistical comparison between arms is purely exploratory, as this study is neither designed nor powered for comparative hypotheses. Secondary endpoints include recurrence-free survival. Exploratory analyses include the assessment of prognostic and predictive biomarkers including circulating tumor cells, serum HER2 levels, and other immune markers. The enrollment began in 2018 and we plan to accrue the total of 110 patients. ClinicalTrials.gov Identifier: NCT03384914 Citation Format: Hyo S Han, Mary Disis, Robert Wesolowski, Carla Fisher, Shipra Gandhi, Nancy Chan, William Gwin, Keerthi Gogineni, Rosemarie Mick, Christina Sierra Rodriguez, Deanna Hogue, Hien Liu, Ricardo Costa, Brian Czerniecki. A multicenter phase II study of vaccines to prevent recurrence in patients with HER-2 positive breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-16-01.

Abstract OT1-02-02: A global, phase 2 study of ARX788 in patients with HER2-positive metastatic breast cancer whose disease is resistant or refractory to T-DM1, and/or T-DXd, and/or tucatinib-containing regimens

Abstract Background: The HER2 receptor is a cancer driver which is overexpressed on 15-20% of breast cancers. Though historically survival is poor with this disease subtype, HER2+ targeted therapy has improved survival in both early and advanced disease. In spite of this, most patients in the metastatic setting will eventually experience disease progression and death. Therefore, new therapeutic options and innovative treatments are needed for patients with recurrent or refractory disease. ARX788 is a next-generation antibody–drug conjugates (ADC) using a technology platform whereby a HER2 specific monoclonal antibody is conjugated with Amberstatin269, a potent cytotoxic tubulin inhibitor. Site-specific, high homogenous, and stable covalent conjugation in ARX788 leads to slow release and prolonged peak of serum pAF-AS269, which may contribute to the lower systemic toxicity, increased targeted delivery of payload to tumor cells, and lower effective dose compared to other HER2 ADCs.Methods: ACE-Breast-03 (NCT04829604) is a global, single arm, phase 2 study designed to assess anticancer activity and safety of ARX788 in patients with metastatic HER2 positive breast cancer. Patients whose disease is resistant or refractory to T-DM1, and/or T-DXd, and/or tucatinib-containing regimens are eligible. Patients must have adequate organ function and any brain metastasis must demonstrate radiographic stability and lack of steroid dependence. Approximately 200 subjects with advanced HER2-positive breast cancer will be enrolled. ARX788 will be administered as an intravenous (IV) infusion at 1.5 mg/kg as the initial dose on Day 1 of the first 4-week cycle and followed by 1.3 mg/kg at every subsequent 4-week cycle. Efficacy will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v 1.1 via imaging every 8 weeks (±7 days) on study and endpoints include objective response rate (ORR), duration of response (DOR), time to response (TTR), best overall response (BOR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). The safety and tolerability profile will be assessed. Blood samples will be collected at specified time points to determine serum concentrations of ARX788 (intact ADC), total antibody, and metabolite pAF-AS269. Biomarkers (e.g., cell-free DNA, serum HER2 extracellular domain, and circulating tumor cells) at baseline and on-treatment will be analyzed for exploratory research. Descriptive statistics will be used to evaluate anticancer activity, safety, and tolerability. The study is currently recruiting patients. Please contact breast03trialinquiry@ambrx.com for additional information. Citation Format: Janice Lu, Kevin M Kalinsky, Debu Tripathy, George W Sledge, William Gradishar, Ruth O’Regan, Joyce O’Shaughnessy, Shanu Modi, Joshua Drago, Haeseong Park, Amelia McCartney, Sophia Frentzas, Catherine Shannon, Katharine Cuff, Richard Eek, Miguel Idzwan Martin, Giuseppe Curigliano, Guy Jerusalem, Chiun-Sheng Huang, Michael Press, Matt Li, Dong Xu, Cynthia Song, Richard Huhn, Jinchun Yan, Sara Hurvitz. A global, phase 2 study of ARX788 in patients with HER2-positive metastatic breast cancer whose disease is resistant or refractory to T-DM1, and/or T-DXd, and/or tucatinib-containing regimens [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-02-02.

Expression of HER2/neu in gastric adenocarcinoma and its correlation with serum HER2/neu level and E-cadherin expression.

: To assess HER2/neu expressions and correlate with E-cadherin and Serum HER2 level in gastric carcinoma. 31 gastric biopsies and 1 resected specimen were taken in the study with patient details and stained with H and E for histopathological details following Lauren's classification. Immunohistochemistry for HER2 and E-cadherin expression was conducted followed by serum HER2/neu ELISA. Adenocarcinoma with 61% diffuse, 29% intestinal, and 10% other type were observed with predominant HER2 immunoexpression in intestinal-type than in diffuse-type adenocarcinoma. Other observations marked 44% as 3+/positive and 56% as 2+/equivocal in intestinal type while 26% cases as 3+/positive, 69% as 2+/equivocal, and 1% as 1+/negative were observed in diffuse type. The data presented 33% membranous positivity and 67% both membranous + cytoplasmic positivity in intestinal type while 2% showed membranous positivity, 47% both membranous + cytoplasmic, and 42% only cytoplasmic positivity in diffused type. On comparing the localization pattern of HER2 and E-cadherin, 25% of cases showed membranous staining while 50% of cases showed membranous with cytoplasmic staining for both. No cytoplasmic HER2 staining as well as no any staining for E-cadherin was shown by 6% cases. Thus, it can be concluded that cytoplasmic expression of HER2 in gastric adenocarcinoma (mainly diffuse type) may be due to shedding of its extracellular domain, leading to loss of membranous E-cadherin expression on immunohistochemistry. The loss of membranous expression of E-cadherin and increased serum HER2 ELISA were correlated well with these findings.

DNA-Generated Electric Current Biosensor for Epidermal Growth Factor Receptor 2 (HER2) Analysis.

Electrochemical biosensors have been applied in the detection of human serum biomarkers for clinical applications. A kind of signal amplifying method using deoxyribonucleic acid (DNA) as signal probe was developed to construct electrochemical biosensor for biomarker detection. In addition to its primary function as genetic material, DNA is also a potential source of molecular electronics that generate redox currents. As an example of this new function, DNA-generated redox currents were used for electrochemical detection of human epidermal growth factor receptor 2 (HER2), a clinically important biomarker for breast cancer. In order to induce the redox current, the phosphate backbone of the single-stranded DNA was reacted with molybdate to form redox molybdophosphate precipitate and generate electrochemical current. Within a certain range, the peak current is linearly proportional to the concentration of HER2, thus realizing the quantitative analysis of HER2 in human serum.

Determination of Significant Pretreatment Factors that Predict Survival in Indonesian Subjects with Breast Cancer

BACKGROUND: The determination of the pre-treatment’s survival predictive factors is very important as a basis for clinicians to educate and determine appropriate management for patients. AIM: This study aimed to determine the pre-treatment risk factors that predict survival in Indonesian subjects with breast cancer. METHODS: This was a cohort retrospective study conducted on breast cancer subjects visiting Sanglah General Hospital from 2016 to 2020. Data were collected from Indonesian Cancer Registry medical records such as age, tumor size, lymph nodes, metastasis, Karnofsky score, serum CA15-3 level, hormonal receptor status (ER/PR), HER2, Ki-67, LVI, tumor-infiltrating lymphocytes, cell type, histological grade, and survival status until December 2020. Data were tabulated and analyzed statistically using SPSS 25.0. RESULTS: The median survival of breast cancer in this study was 47 months (SD 4.851). Majority of breast cancer subjects with mortality outcome were those who had Karnofsky score less than 70, tumor size ≥5 cm with infiltration, presence of contralateral lymph node, with metastasis, serum CA15-3 level &gt;25 IU/mL, negative hormonal receptor, negative HER2 receptor, Ki67 higher than 14, negative lymphovascular invasion, negative tumor-infiltrating lymphocytes, and histological Grade 3. Age and pathological type were not significantly differed the breast cancer outcome. CONCLUSION: There were significant effects of tumor size, KGB status, metastasis, serum CA15-3 levels, hormone receptor, HER2 receptor, Karnofsky score, lymphovascular invasion, tumor-infiltrating lymphocytes, and histological grade on breast cancer subjects’ survival.