Inflammatory Breast Cancer A Role for Stroma

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1 Inflammatory Breast Cancer A Role for Stroma Wendy A. Woodward, MD-PhD Professor, Radiation Oncology Deputy Director, MW IBC Clinic UT MD Anderson Cancer Center

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3 Is the normal breast different in IBC? Remote breast tissue in TNBC has more stem cells and better DNA repair Correlated to not breast feeding Gene expression in the remote breast tissue is enriched for stem cell gene expression (Atkinson et al, BCRT 2013)

4 Patient normal tissues Cohort 1: Manual review, FFPE Isolated triple positive stem marked cells N >1% staining in 1 field P-value Non-IBC IBC 8 8 CD68 positive cells N >1% staining in 1 field P-value Non-IBC IBC 8 7 Total Triple positive stem marked cells Cohort 2: Automated review, OCT frozen N Mean (Min, Max) P-value Non-IBC (2.92, 23.8) IBC (7.34, 48.2) CD68 positive cells N Mean (Min, Max) P-value Non-IBC (0.23, 14.3) 0.07 IBC (0.3, 35.4) Reddy, Atkinson, under review

5 Cancer Stem Cell Signature is Significantly Higher in IBC P<0.05 Reddy, Atkinson et al, under review

6 Pre-treatment with MSC-CM promotes skin invasion 20 * p= Number of Mice No MSC-CM MSC-CM Representative clinical case Xenograft mouse model pre-treated with MSC-CM Skin Involvement No Skin Involvment Increased local invasion Promoted IBC phenotype: skin thickening, edema and erythema Lacerda et al, Breast Cancer Research, 2015

7 Go or Grow? Tumor initiation N. of cells injected 100x x10 3 Control (SUM149) 16/18 5/20 MSC-CM (pre-treated SUM149) 13/18 0/20 p value (elda lim dil analysis) Time for Palpable Tumor Time for Resection *** p< *** p= Time for Palpable Tumor (Days) vs 95.1 days vs days 0 Time for Tumor Volume of 300 mm3 (Days) Control 100K MSC-CM 100K Control 20K Control 100K MSC-CM 100K Control 20K Lacerda et al, Breast Cancer Research, 2015

8 MSC promote metastasis development Bioimaging of mets (Luciferase) 0% MSC 7/19 10% MSC 12/17 0% MSC 10% MSC p = 0.05 MSC co-injection increased spontaneous metastasis development after primary tumor resection (p=0.05) 30 days actuarial metastasis free survival was 47% (0% MSC) vs. 74% (10% MSC), p=0.05 Lacerda et al, Breast Cancer Research, 2015

9 Crosstalk with Macrophages? IBC normal breast tissues have increased macrophages Failed involution after breast feeding Obesity Chronic inflammation MSCs expected in response to injury Do the macrophages educate the MSCs to promote migratory/go IBC phenotype?

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11 A B C D

12 A B C * D E * Wolfe et al, Oncotarget, 2016

13 IgG Wolfe et al, Oncotarget, 2016

14 Modeling Pathology IBC No mass; more diffusely spread as clusters of tumor cells through the breast Could normal cells prime the breast tissue to promote migration from the earliest tumor cells after initiation? Short term in vivo experiment (4 days) Mice with a fully developed mammary gland Primed the gland with pro-tumor normal cells (3 days) versus control

15 Modeling Pathology

16 SUM149 alone: M#2 E-Cadherin Smooth Muscle Actin F4/80

17 SUM149+MSC2+Macrophage2: M#2 E-Cadherin Smooth Muscle Actin F4/80

18 Modeling Pathology Stromal priming appears to promote greater dispersion of tumor clusters over growth of solid nodules Primed glands have less organized SMA More diffuse macrophage infiltrate in the normal gland and tumor Does stroma alter treatment resistance?

19 Macrophages MSC Surviving Fraction Cells only MSC-1 co-culture MSC-2 co-culture PM37 (μm) IL4 and IL13 pstat6 (Y641) STAT6 Actin Dose (Gy) THP1 cells PRKCZ Protein (F532 Median) IDO mrna (Fold-Change) Surviving Fraction DMSO Control shcontrol Cells only PM37 M2-THP1 co-culture M2-THP1+PM37 co-culture Control Fit PM37 Fit M2-THP1 co-culture Fit M2-THP1+PM37 co-culture Fit IFNγ Surviving Fraction Kynurenine production Absorbance (490 nm) shprkcz Cells only PM37 M2-THP1 co-culture M2-THP1+PM37 co-culture Control Fit PM37 Fit M2-THP1 co-culture Fit M2-THP1+PM37 co-culture Fit Rahal et al, IJROBP Dose (Gy) Dose (Gy)

20 Conclusions Significant prelim correlations between protumor stroma and IBC phenotype Remote breast tissue is distinct in IBC MSCs promote skin invasion in SUM149 and PDX macrophage dependent Priming normal gland with pro-tumor MSC and macrophages results in dispersed clusters of tumor cells, more IBC-like growth pattern Pro-tumor MSC and macrophages promote radiation resistance stat dependent mechanism

21 Thank You! Morgan Welch IBC Program Adam Wolfe Bisrat Debeb Wei Xu Rachel Atkinson Richard Larson Li Li Jay Reddy Sayo Lopez Omar Rahal Dan Smith Nelda Fikes Vicente Valero Danielle Rasberry Cedric Byrd Thomas Buchholz Randa El-Zein Chad Barnnett Anita Vines Naoto Ueno Chandra Bartholomeusz Kazuharu Kai Naoki Niikura Jason Lee Xuemei Xie Xiaoping Wang Dongwei Zhang James Reuben Antonio Giordano Simone Anfossi Hui Gao Evan Cohen Sanda Tin Lara Landry Savitri Krishnamurthy Anthony Lucci Gildy Babiera Danielle Walsh Jie Willey Juanita Lara Pam Alizadeh Summer Jackson Yun Gong Charla Parker Le-Petross Huong Wei Yang Ali Dadbin Hiroko Masuda Monica Reyes Takae Brewer Abeena Brewster and many, many others International IBC Consortium Massimo Cristofanilli Stephan Van Laere François Bertucci Hideko Yamauchi, Shaheenah Dawood Sofia D Merajver Patrice Viens Peter B Vermeulen Collaborators Walter Hittelman The IBC Network Terry Arnold, Lori Grennan Funding Agencies Sandra M Swain Luc Y Dirix Paul H Levine Melanie Royce Mike Diehl All of the IBC patients and advocates National Institutes of Health R01CA and 1R01CA State of Texas Grant for Rare and Aggressive Breast Cancer Research Program. MD Anderson Cancer Center Support (core) Grant CA Susan G. Komen for the Cure Postdoctoral Fellowships PDF , KG101478, and KG The IBC Network