Abstract 5283: Vav2 oncoprotein up regulation may predict the aggressive subtype of ductal carcinoma in situ
Authors: Guvakova Marina A. , Jiang Yun Qing , Prabakaran Indira , Wan Fei , Mitra Nandita , Zhang Paul J. , Fraker Douglas L. 
Published: August 2015

Abstract
Background: A subset of patients with ductal carcinoma in situ (DCIS) will develop invasive breast cancer (IBC). To date, there are no effective predictive biomarkers for identifying this subset with worse prognosis whose lesions are essentially indistinguishable histologically from those with favorable outcomes. We hypothesized that measurable parameters that discriminate DCIS from DCIS with concurrent invasion may serve as diagnostic biomarkers (BM) of progressive cancer in situ (CIS).
Methods: Using a novel imaging-based method of tissue testing, we measured the relative expression levels of three candidate BM proteins specifically implicated in IBC progression - the insulin-like growth factor I receptor (IGF-IR), Ras-related protein 1 (Rap1), and Vav2 oncoprotein. Protein profiles were compared in 42 histologically normal mammary epithelial samples, 71 CIS (35 without/36 with invasion either on diagnostic biopsy or final surgical excision), and 98 IBC of known estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status. Groups were compared using one-way analysis of variance (ANOVA) followed by pair-wise t-tests with Tukey's correction for multiple testing. Receiver operating characteristic (ROC) curves were constructed to evaluate how well each BM can predict tumor type.
Results: The levels of the IGF-IR and Rap1 protein expression were significantly elevated in ER-positive (ER+/PR+/-/HER2 -) DCIS relative to normal epithelium (P&lt;0.0001). The IGF-IR protein expression was also significantly up regulated in HER2-positive (ER+/-/PR+/-/HER2+) DCIS relative to normal epithelium (P = 0.0002). IGF-IR and Rap1 protein expression levels were similar among DCIS patients without or with concurrent invasion. Vav2 up regulation in DCIS relative to normal group was not associated with steroid hormone receptor and HER2 status, but was associated with the presence of concurrent invasion, including microinvasion (invasive foci of less than 1 mm). DCIS with high Vav2 were more than twice as likely to progress to invasive cancers as DCIS with low Vav2 (odds ratio, 2.42; 95% CI, 1.26-4-65; P = 0.008). Furthermore, a ROC curve analysis revealed moderate ability of Vav2 protein expression measurements in DCIS to predict the existence of invasion concurrent with DCIS (area under the curve, 0.71; 95% CI, 0.59- 0.84).
Conclusions: This study describes the use of a novel imaging method for archival tissue testing, which may inform the status of protein BM in archived tissue and may help to stratify a women's individual risk for tumor invasiveness to avoid potential over- or under-treatment. Despite the apparent limitation of our study DCIS cohort size, our novel findings hold promise for utilizing Vav2 as a predictive BM of progressive DCIS and a target for cancer therapy.
Citation Format: Marina A. Guvakova, Yun Qing Jiang, Indira Prabakaran, Fei Wan, Nandita Mitra, Paul J. Zhang, Douglas L. Fraker. Vav2 oncoprotein up regulation may predict the aggressive subtype of ductal carcinoma in situ. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5283. doi:10.1158/1538-7445.AM2015-5283