Abstract P4-10-32: Commensal gut microbiota influences efficacy of trastuzumab in patients with HER2-positive breast carcinoma
Authors: Tagliabue Elda , Modica Martina Di , Gargari Giorgio , Regondi Viola , Bonizzi Arianna , Arioli Stefania , Corsi Fabio , Guglielmetti Simone , Triulzi Tiziana 
Published: March 2020

Abstract
Although the clinical benefit of trastuzumab for the management of HER2-positive breast carcinomas (BCs) has been largely demonstrated, many women, even those reported to have tumors potentially most sensitive to trastuzumab (e.g., HER2-enriched by PAM50 and with infiltrating immune cells) do not respond to this agent. The relevance of immunity in the cytotoxic mechanism of action of trastuzumab supports the notion that the anti-tumor effect of this monoclonal antibody depends on host immune system activity. Since gut commensal bacteria reportedly contribute to the development and maintenance of the immune system and have immunomodulatory effects, we investigated whether a relationship between gut microbiota composition and the response to trastuzumab exists in patients with HER2-positive BC.
Stool samples were collected from 18 patients with primary HER2-positive BCs before the outset of neoadjuvant trastuzumab-based chemotherapy and analyzed by 16S rRNA gene profiling using Illumina Miseq platform. Gut microbiota β-diversity analysis by UniFrac algorithm revealed a heterogeneous microbiota composition mainly due to differences in the relative abundance of Bacteroides, Faecalibacterium and a genus belonging to Ruminococcaceae family. Unsupervised analysis identified two microbiota clusters that significantly discriminated patients according to pathological complete response (pCR) (p=0.0128, by Fisher test). No association between microbiota clusters and PAM50 molecular classification of tumor biopsies, as evaluated by gene expression, was observed. Moreover, HER2-enriched cases were distributed in the two microbiota clusters based on trastuzumab response. Differences in the intestinal microbiota between responsive (R) and non-responsive (NR) patients were assessed by LEfSe analysis: a significant higher and lower abundance of Clostridiales taxonomic order and Bacteroides taxonomic genus, respectively, was foundin R as compared to NR patients. Immune genes expressed in tumor biopsies that were found significantly correlated with these bacteria mainly belong to innate and adaptive immune response and cellular response to tumor necrosis factor pathways.
To investigate the causal role of gut microbiota in trastuzumab benefit, FVB mice bearing syngeneic mammary carcinoma overexpressing human HER2 were transplanted with fecal material from R and NR patients after intestinal flora depletion by the use of an antibiotic cocktail. The mouse response to trastuzumab treatment recapitulated the response observed in patients from which stool derived.
The obtained results support the contribution of gut microbiota in trastuzumab activity by influencing tumor immune microenvironment, independently of tumor intrinsic molecular characteristics. These data represent the proof-of-concept that manipulating gut microbes in resistant patients could be a new strategy to improve the response to trastuzumab.
Supported by AIRC
Citation Format: Elda Tagliabue, Martina Di Modica, Giorgio Gargari, Viola Regondi, Arianna Bonizzi, Stefania Arioli, Fabio Corsi, Simone Guglielmetti, Tiziana Triulzi. Commensal gut microbiota influences efficacy of trastuzumab in patients with HER2-positive breast carcinoma [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-10-32.