Abstract
Purpose: Organ-confined muscle-invasive bladder cancer is treated with cystectomy or bladder preservation techniques, including radiation therapy. There are currently no biomarkers to inform management decisions and aid patient choice. Previously we showed high levels of MRE11 protein, assessed by immunohistochemistry (IHC), predicted outcome after radiation therapy, but not cystectomy. Therefore, we sought to develop the MRE11 IHC assay for clinical use and define its relationship to clinical outcome in samples from 2 major clinical trials. Methods and Materials: Samples from the BCON and BC2001 randomized controlled trials and a cystectomy cohort were stained using automated IHC methods and scored for MRE11 in 3 centers in the United Kingdom. Results: Despite step-wise creation of scoring cards and standard operating procedures for staining and interpretation, there was poor intercenter scoring agreement (kappa, 0.32; 95% confidence interval, 0.17-0.47). No significant associations between MRE11 scores and cause-specific survival were identified in BCON (n = 132) and BC2001 (n = 221) samples. Reoptimized staining improved agreement between scores from BCON tissue microarrays (n = 116), but MRE11 expression was not prognostic for cause-specific survival. Conclusions: Manual IHC scoring of MRE11 was not validated as a reproducible biomarker of radiation-based bladder preservation success. There is a need for automated quantitative methods or a reassessment of how DNA-damage response relates to clinical outcomes.
| Original language | English |
|---|---|
| Pages (from-to) | 809-818 |
| Number of pages | 10 |
| Journal | International Journal of Radiation Oncology Biology Physics |
| Volume | 104 |
| Issue number | 4 |
| Early online date | 15 Mar 2019 |
| DOIs | |
| Publication status | Published - 15 Jul 2019 |
Bibliographical note
Funding Information:Disclosures: S.B., L.B., A.C., E.H., R.H., N.J., A.E.K., V.S., and C.W. report grant funding from Cancer Research UK during the conduct of the study. A.C. is a Senior Editor of IJROBP and reports nonfinancial support from ASCO and ESTRO; personal fees and nonfinancial support from Bayer PLC; grants from Prostate Cancer UK, Medical Research Council UK, and National Institute for Health Research UK; grants, personal fees, and nonfinancial support from Elekta AB; and personal fees from ASTRO, outside the submitted work. E.H. reports grants from Merck Sharp & Dohm, grants and nonfinancial support from AstraZeneca, grants from Janssen-Cilag, grants and nonfinancial support from Bayer, grants from Aventis Pharma Limited (Sanofi), and grants from Accuray Inc., outside the submitted work. R.H. reports grants and personal fees from MSD and Roche; personal fees from Bristol Myers Squibb and Janssen; and grants from Elekta, outside the submitted work. G.I. reports personal fees from Bayer Pharmaceuticals, outside the submitted work.This work was funded by CRUK Biomarkers and Imaging Discovery and Development grant (C15140/A13492). The BC2001 trial was supported by grants (C547/A2606, C547/A6845, C9764/A9904, and C1491/A9895) from Cancer Research UK. The work was also supported by CRUK grant C2094/A11365, CRUK grant C5529/A16895, CRUK grant C5255/A15935, an MRC studentship MR/K501256/1, CRUK funding to the Cancer Research Manchester Centre (C147/A18083, C147/A25254), the NIHR Manchester, NIHR Oxford (Molecular Diagnostics Theme/Multimodal Pathology Theme), and Royal Marsden/Institute of Cancer Research Biomedical Research Centres. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Disclosures: S.B., L.B., A.C., E.H., R.H., N.J., A.E.K., V.S., and C.W. report grant funding from Cancer Research UK during the conduct of the study. A.C. is a Senior Editor of IJROBP and reports nonfinancial support from ASCO and ESTRO; personal fees and nonfinancial support from Bayer PLC; grants from Prostate Cancer UK, Medical Research Council UK, and National Institute for Health Research UK; grants, personal fees, and nonfinancial support from Elekta AB; and personal fees from ASTRO, outside the submitted work. E.H. reports grants from Merck Sharp & Dohm, grants and nonfinancial support from AstraZeneca, grants from Janssen-Cilag, grants and nonfinancial support from Bayer, grants from Aventis Pharma Limited (Sanofi), and grants from Accuray Inc., outside the submitted work. R.H. reports grants and personal fees from MSD and Roche; personal fees from Bristol Myers Squibb and Janssen; and grants from Elekta, outside the submitted work. G.I. reports personal fees from Bayer Pharmaceuticals, outside the submitted work. This work was funded by CRUK Biomarkers and Imaging Discovery and Development grant ( C15140/A13492). The BC2001 trial was supported by grants (C547/A2606, C547/A6845, C9764/A9904, and C1491/A9895) from Cancer Research UK. The work was also supported by CRUK grant C2094/A11365, CRUK grant C5529/A16895, CRUK grant C5255/A15935, an MRC studentship MR/K501256/1, CRUK funding to the Cancer Research Manchester Centre ( C147/A18083, C147/A25254), the NIHR Manchester, NIHR Oxford (Molecular Diagnostics Theme/Multimodal Pathology Theme), and Royal Marsden/ Institute of Cancer Research Biomedical Research Centres. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.
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© 2019 The Authors
