Downstream targets of the oestrogen receptor and endocrine resistance

The transcription factor c-Myc is an early downstream target of oestrogen action in breast cancer cells in culture and it has been speculated that aberrant c-Myc expression may mediate antioestrogen resistance. However, studies of c-Myc protein expression as either a prognostic or predictive marker in human breast cancer have been limited and contradictory, as have been studies of c-Myc expression during breast cancer evolution. In order to assess the relationship between c-Myc protein expression and outcome from breast cancer, a representative cohort of 292 women with invasive ductal carcinoma (IDC) and linked clinicopathological data was assembled and tissue microarrays (TMA) generated from the archived breast cancer specimens. Detailed assessments of the expression of cyclin D1, cyclin E, p21WAF1/Cip1 and p27Kip1 were also conducted and analysed in relation to c-Myc expression using immunohistochemistry. Changes in c-Myc protein expression in a TMA model of breast cancer evolution were also conducted. Finally the cell-cycle effects of low-level constitutive c-Myc expression and high-level inducible c-Myc expression were evaluated in MCF-7 cells in vitro. Key novel results obtained were that c-Myc protein expression changed from preferentially nuclear to preferentially cytoplasmic during the evolution of breast cancer. In women with early invasive breast carcinoma, a "high-risk" cytoplasmic predominant c-Myc expression pattern was defined (~13% of cases) that independently predicted for poor outcome generally, among ER positive cases and in ER postive cases treated with endocrine therapy. In vitro studies confirmed that c-Myc overexpression was associated with resistance to the anti-proliferative effects of anti-oestrogens with persistence of both cyclin D1-cdk4 and cyclin E-cdk2 activities in the face of anti-oestrogen treatment. Further novel findings were that high cyclin D1 expression (upper 10% of expressors) was an independent predictor of poor outcome among ER positive breast cancer cases. Amongst ER + PR positive cases, both "high-risk" c-Myc expression and high level cyclin D1 expression were independent predictors of poor outcome. In summary, these data indicate that aberrant expression of the cell cycle proteins c-Myc and cyclin D1 may result in poor breast cancer outcomes in hormone receptor positive breast cancer and reinforces the importance of the cell cycle as a potential site of therapeutic manipulation in endocrine-resistant breast cancer