(A) OR were plotted against all possible cutoff points: the range of significant cutoffs was 39.4% with an optimal cutoff at 60.1 immunofluorescence expression values (vertical line). Dotted lines: 95% confidence interval (B) Waterfall plot showing correct and wrong classification of cases in accordance to pCR depending on PTEN immunofluorescence expression.
ARTICLE ABSTRACTBackground: The PI3K/AKT pathway and phosphatase and tensin homolog (PTEN) aberrations are common in breast cancer. We investigated the correlation between phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), PTEN, p4EBP1 (phosphorylated E4 binding protein 1), and pathologic complete response (pCR) in patients receiving neoadjuvant therapy.Experimental Design: We retrospectively evaluated PIK3CA, PTEN, and p4EBP1 protein expression in centrally HER2-positive patients (n = 181) who received epirubicin cyclophosphamide/trastuzumab followed by docetaxel/trastuzumab alone or concomitant/followed by capecitabine within the GeparQuattro study. PTEN was assessed using the automated quantitative immunofluorescence analysis and was analyzed as a dichotomic variable. p4EBP1 was assessed by immunohistochemistry and used as a continuous and dichotomic variable.Results: p4EBP1 was available from 137, PTEN from 108, and PIK3CA genotype from 83 patients. Overall, the pCR rate in PTEN-low tumors was 27.6%, and in PTEN-high tumors, it was 57.1% (P = 0.010). pCR rates were not statistically different between PIK3CA wild-type and mutant (35% vs. 22%) or p4EBP1 IRS ≤ 4 and IRS > 4 (39% vs. 33%). pCR rate was 57.1% (8/14) in PTEN-high/PIK3CA wild-type and decreased to 15.4% in PTEN-low/PIK3CA-mutant tumors (P = 0.023). In multivariable analysis adjusted for baseline parameters, PTEN independently predicted pCR in the following cohorts: overall [OR, 7.54; 95% confidence interval (CI), 2.03–28.06; P = 0.003], PIK3CA wild-type (OR, 23.81; 95% CI, 1.75–324.05; P = 0.017), p4EBP1 IRS > 4 (OR, 11.53; 95% CI, 1.84–72.24; P = 0.009), and hormone receptor–positive (OR, 40.91; 95% CI, 2.93–570.44; P = 0.006). p4EBP1 was independently predictive for pCR in PIK3CA wild-type tumors (OR, 0.14; 95% CI, 0.03–0.78; P = 0.025).Conclusions: The study showed the potential role of PIK3CA genotype, PTEN, and p4EBP in predicting pCR after anthracycline–taxane-based chemotherapy and anti-HER2 treatment. Clin Cancer Res; 22(11); 2675–83. ©2016 AACR.