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The Androgen Receptor in Breast Cancer: Biology and Treatment Considerations

  • Systemic Therapy (J O'Shaughnessy, Section Editor)
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Abstract

The androgen receptor (AR) is expressed in 70–90% of invasive breast cancers. Despite the ubiquitous expression of AR in both primary and metastatic breast cancers, the clinical significance of this hormone receptor as a prognostic/predictive marker and its functional role in tumorigenesis remains poorly understood. This review summarizes the recent progress made in understanding the role of the AR as a prognostic/predictive marker in breast cancer and the underlying mechanisms by which the androgen-signaling pathway may be involved in breast cancer pathogenesis. In addition, this review examines the available clinical data for the use of androgen-blocking agents in the treatment of breast cancer and explores the ongoing development of newer AR-targeted agents in this setting.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Perou CM, Sorlie T, Eisen MB, et al. Molecular portraits of human breast tumours. Nature. 2000;406:747–52.

    Article  PubMed  CAS  Google Scholar 

  2. Sorlie T, Perou CM, Tibshirani R, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 2001;98:10869–74.

    Article  PubMed  CAS  Google Scholar 

  3. Sorlie T, Tibshirani R, Parker J, et al. Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci U S A. 2003;100:8418–23.

    Article  PubMed  CAS  Google Scholar 

  4. Soreide JA, Lea OA, Varhaug JE, et al. Androgen receptors in operable breast cancer: relation to other steroid hormone receptors, correlations to prognostic factors and predictive value for effect of adjuvant tamoxifen treatment. Eur J Surg Oncol. 1992;18:112–8.

    PubMed  CAS  Google Scholar 

  5. Kimura N, Mizokami A, Oonuma T, et al. Immunocytochemical localization of androgen receptor with polyclonal antibody in paraffin-embedded human tissues. J Histochem Cytochem. 1993;41:671–8.

    Article  PubMed  CAS  Google Scholar 

  6. Lea OA, Kvinnsland S, Thorsen T. Improved measurement of androgen receptors in human breast cancer. Cancer Res. 1989;49:7162–7.

    PubMed  CAS  Google Scholar 

  7. Birrell SN, Hall RE, Tilley WD. Role of the androgen receptor in human breast cancer. J Mammary Gland Biol Neoplasia. 1998;3:95–103.

    Article  PubMed  CAS  Google Scholar 

  8. Toth-Fejel S, Cheek J, Calhoun K, et al. Estrogen and androgen receptors as comediators of breast cancer cell proliferation: providing a new therapeutic tool. Arch Surg. 2004;139:50–4.

    Article  PubMed  CAS  Google Scholar 

  9. Goldenberg IS, Waters N, Ravdin RS, et al. Androgenic therapy for advanced breast cancer in women. A report of the cooperative breast cancer group. JAMA. 1973;223:1267–8.

    Article  PubMed  CAS  Google Scholar 

  10. Ingle JN, Twito DI, Schaid DJ, et al. Combination hormonal therapy with tamoxifen plus fluoxymesterone versus tamoxifen alone in postmenopausal women with metastatic breast cancer. An updated analysis. Cancer. 1991;67:886–91.

    Article  PubMed  CAS  Google Scholar 

  11. Manni A, Arafah BM, Pearson OH. Androgen-induced remissions after antiestrogen and hypophysectomy in stage IV breast cancer. Cancer. 1981;48:2507–9.

    Article  PubMed  CAS  Google Scholar 

  12. Tormey DC, Lippman ME, Edwards BK, et al. Evaluation of tamoxifen doses with and without fluoxymesterone in advanced breast cancer. Anna Intern Med. 1983;98:139–44.

    CAS  Google Scholar 

  13. Doane AS, Danso M, Lal P, et al. An estrogen receptor-negative breast cancer subset characterized by a hormonally regulated transcriptional program and response to androgen. Oncogene. 2006;25:3994–4008.

    Article  PubMed  CAS  Google Scholar 

  14. Traina TA, Wolff A, Giri D et al. Androgen receptor inhibition can stabilize disease in patients with AR(+), ER(-)/PR (-) metastatic breast cancer. IMPAKT Annual Meeting 2009 Brussels, Belgium 2009.

  15. Agoff SN, Swanson PE, Linden H, et al. Androgen receptor expression in estrogen receptor-negative breast cancer. Immunohistochemical, clinical, and prognostic associations. Am J Clin Pathol. 2003;120:725–31.

    Article  PubMed  CAS  Google Scholar 

  16. Cauley JA, Lucas FL, Kuller LH, et al. Elevated serum estradiol and testosterone concentrations are associated with a high risk for breast cancer. Study of osteoporotic fractures research group. Ann Intern Med. 1999;130:270–7.

    PubMed  CAS  Google Scholar 

  17. Hankinson SE, Willett WC, Manson JE, et al. Plasma sex steroid hormone levels and risk of breast cancer in postmenopausal women. J Natl Cancer Inst. 1998;90:1292–9.

    Article  PubMed  CAS  Google Scholar 

  18. Veronesi U, Pizzocaro G. Breast cancer in women subsequent to cystic disease of the breast. Surg Gynecol Obstet. 1968;126:529–32.

    PubMed  CAS  Google Scholar 

  19. Bryan RM, Mercer RJ, Bennett RC, et al. Androgen receptors in breast cancer. Cancer. 1984;54:2436–40.

    Article  PubMed  CAS  Google Scholar 

  20. Gonzalez LO, Corte MD, Vazquez J, et al. Androgen receptor expresion in breast cancer: relationship with clinicopathological characteristics of the tumors, prognosis, and expression of metalloproteases and their inhibitors. BMC Cancer. 2008;8:149.

    Article  PubMed  Google Scholar 

  21. Gonzalez-Angulo AM, Stemke-Hale K, Palla SL, et al. Androgen receptor levels and association with PIK3CA mutations and prognosis in breast cancer. Clin Cancer Res. 2009;15:2472–8.

    Article  PubMed  CAS  Google Scholar 

  22. Kuenen-Boumeester V, Van der Kwast TH, Claassen CC, et al. The clinical significance of androgen receptors in breast cancer and their relation to histological and cell biological parameters. Eur J Cancer. 1996;32A:1560–5.

    Article  PubMed  CAS  Google Scholar 

  23. Peters AA, Buchanan G, Ricciardelli C, et al. Androgen receptor inhibits estrogen receptor-alpha activity and is prognostic in breast cancer. Cancer Res. 2009;69:6131–40.

    Article  PubMed  CAS  Google Scholar 

  24. Rakha EA, El-Sayed ME, Green AR, et al. Biologic and clinical characteristics of breast cancer with single hormone receptor positive phenotype. J Clin Oncol. 2007;25:4772–8.

    Article  PubMed  Google Scholar 

  25. Isola JJ. Immunohistochemical demonstration of androgen receptor in breast cancer and its relationship to other prognostic factors. J Pathol. 1993;170:31–5.

    Article  PubMed  CAS  Google Scholar 

  26. Luo X, Shi YX, Li ZM, Jiang WQ. Expression and clinical significance of androgen receptor in triple negative breast cancer. Chin J Cancer. 2010;29:585–90.

    PubMed  CAS  Google Scholar 

  27. Ogawa Y, Hai E, Matsumoto K, et al. Androgen receptor expression in breast cancer: relationship with clinicopathological factors and biomarkers. Int J Clin Oncol. 2008;13:431–5.

    Article  PubMed  CAS  Google Scholar 

  28. Moinfar F, Okcu M, Tsybrovskyy O, et al. Androgen receptors frequently are expressed in breast carcinomas: potential relevance to new therapeutic strategies. Cancer. 2003;98:703–11.

    Article  PubMed  CAS  Google Scholar 

  29. •• Hu R, Dawood S, Holmes MD, et al. Androgen receptor expression and breast cancer survival in postmenopausal women. Clin Cancer Res 2011;17:1867-74. This is the largest prospective study (Nurses’ Health Study) to date studying AR expression in relation to clinicopathologic features and breast cancer outcomes, and it suggests an improvement in breast cancer-specific, recurrence-free, and overall-survival rates in the subgroup of patients with AR(+)/ER(+) breast cancer.

    Article  PubMed  CAS  Google Scholar 

  30. Collins LC, Cole KS, Marotti JD, et al. Androgen receptor expression in breast cancer in relation to molecular phenotype: results from the Nurses’ Health Study. Modern pathology: an official journal of the United States and Canadian Academy of Pathology, Inc. 2011;24:924–31.

    Google Scholar 

  31. Farmer P, Bonnefoi H, Becette V, et al. Identification of molecular apocrine breast tumours by microarray analysis. Oncogene. 2005;24:4660–71.

    Article  PubMed  CAS  Google Scholar 

  32. Naderi A, Hughes-Davies L. A functionally significant cross-talk between androgen receptor and ErbB2 pathways in estrogen receptor negative breast cancer. Neoplasia. 2008;10:542–8.

    PubMed  CAS  Google Scholar 

  33. Micello D, Marando A, Sahnane N, et al. Androgen receptor is frequently expressed in HER2-positive, ER/PR-negative breast cancers. Virchows Arch. 2010;457:467–76.

    Article  PubMed  CAS  Google Scholar 

  34. Niemeier LA, Dabbs DJ, Beriwal S, et al. Androgen receptor in breast cancer: expression in estrogen receptor-positive tumors and in estrogen receptor-negative tumors with apocrine differentiation. Modern pathology: an official journal of the United States and Canadian Academy of Pathology, Inc. 2010;23:205–12.

    CAS  Google Scholar 

  35. Park S, Koo J, Park HS, et al. Expression of androgen receptors in primary breast cancer. Annals of oncology: official journal of the European Society for Medical Oncology/ESMO. 2010;21:488–92.

    Article  CAS  Google Scholar 

  36. Park S, Koo JS, Kim MS, et al. Androgen receptor expression is significantly associated with better outcomes in estrogen receptor-positive breast cancers. Annals of oncology: official journal of the European Society for Medical Oncology/ESMO. 2011;22:1755–62.

    Article  CAS  Google Scholar 

  37. Vranic S, Tawfik O, Palazzo J, et al. EGFR and HER-2/neu expression in invasive apocrine carcinoma of the breast. Modern pathology: an official journal of the United States and Canadian Academy of Pathology, Inc. 2010;23:644–53.

    CAS  Google Scholar 

  38. Gonzalez LO, Corte MD, Junquera S, Bongera M, Rodriguez JC, Vizoso FJ. Expression of androgen receptor and two androgen-induced proteins (apolipoprotein D and pepsinogen C) in ductal carcinoma in situ of the breast. Histopathology. 2007;50:866–74.

    Article  PubMed  CAS  Google Scholar 

  39. Yu Q, Niu Y, Liu N, et al. Expression of androgen receptor in breast cancer and its significance as a prognostic factor. Annals of oncology: official journal of the European Society for Medical Oncology/ESMO. 2011;22:1288–94.

    Article  CAS  Google Scholar 

  40. Hanley K, Wang J, Bourne P, et al. Lack of expression of androgen receptor may play a critical role in transformation from in situ to invasive basal subtype of high-grade ductal carcinoma of the breast. Hum Pathol. 2008;39:386–92.

    Article  PubMed  CAS  Google Scholar 

  41. Castellano I, Allia E, Accortanzo V, et al. Androgen receptor expression is a significant prognostic factor in estrogen receptor positive breast cancers. Breast Cancer Res Treat. 2010;124:607–17.

    Article  PubMed  CAS  Google Scholar 

  42. He J, Peng R, Yuan Z, et al. Prognostic value of androgen receptor expression in operable triple-negative breast cancer: a retrospective analysis based on a tissue microarray. Med Oncol 2011.

  43. Agrawal AK, Jelen M, Grzebieniak Z, et al. Androgen receptors as a prognostic and predictive factor in breast cancer. Folia histochemica et cytobiologica/Polish Academy of Sciences, Polish Histochemical and Cytochemical Society. 2008;46:269–76.

    PubMed  Google Scholar 

  44. Persijn JP, Korsten CB, Engelsman E. Oestrogen and androgen receptors in breast cancer and response to endocrine therapy. Br Med J. 1975;4:503.

    Article  PubMed  CAS  Google Scholar 

  45. Koo JS, Jung W, Jeong J. The predictive role of E-cadherin and androgen receptor on in vitro chemosensitivity in triple-negative breast Cancer. Jpn J Clin Oncol. 2009;39:560–8.

    Article  PubMed  Google Scholar 

  46. • Loibl S, Muller BM, von Minckwitz G, et al. Androgen receptor expression in primary breast cancer and its predictive and prognostic value in patients treated with neoadjuvant chemotherapy. Breast Cancer Res Treat 2011. This is a retrospective investigation of the GeparTrio cohort that suggests patients with AR(-) tumors experience a higher rate of pCR than those with an AR(+) tumors, and that patients with AR(+) tumors have a better survival outcomes, particularly among patients who did not acheive a pCR.

  47. Sanga S, Broom BM, Cristini V, et al. Gene expression meta-analysis supports existence of molecular apocrine breast cancer with a role for androgen receptor and implies interactions with ErbB family. BMC Med Genomics. 2009;2:59.

    Article  PubMed  Google Scholar 

  48. Teschendorff AE, Miremadi A, Pinder SE, et al. An immune response gene expression module identifies a good prognosis subtype in estrogen receptor negative breast cancer. Genome Biol. 2007;8:R157.

    Article  PubMed  Google Scholar 

  49. Weigelt B, Horlings HM, Kreike B, et al. Refinement of breast cancer classification by molecular characterization of histological special types. J Pathol. 2008;216:141–50.

    Article  PubMed  CAS  Google Scholar 

  50. •• Lehmann BD, Bauer JA, Chen X, et al. Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. The Journal of clinical investigation 2011;121:2750-67. The authors describe a subpopulation of tumors, termed luminal androgen receptor (LAR) subtype, characterized by AR signaling and responsive to AR blockade and PI3K/mTOR inhibition.

    Article  PubMed  CAS  Google Scholar 

  51. Bernardo GM, Lozada KL, Miedler JD, et al. FOXA1 is an essential determinant of ERalpha expression and mammary ductal morphogenesis. Development. 2010;137:2045–54.

    Article  PubMed  CAS  Google Scholar 

  52. Hurtado A, Holmes KA, Ross-Innes CS, et al. FOXA1 is a key determinant of estrogen receptor function and endocrine response. Nat Genet. 2011;43:27–33.

    Article  PubMed  CAS  Google Scholar 

  53. Wang Q, Li W, Zhang Y, et al. Androgen receptor regulates a distinct transcription program in androgen-independent prostate cancer. Cell. 2009;138:245–56.

    Article  PubMed  CAS  Google Scholar 

  54. •• Ni M, Chen Y, Lim E, et al. Targeting androgen receptor in estrogen receptor-negative breast cancer. Cancer cell 2011;20:119-31. This study examined the network of signaling pathways that work in concert with AR to regulate cell proliferation in preclinical models of breast cancer.

    Article  PubMed  CAS  Google Scholar 

  55. Robinson JL, Macarthur S, Ross-Innes CS, et al. Androgen receptor driven transcription in molecular apocrine breast cancer is mediated by FoxA1. EMBO J. 2011;30:3019–27.

    Article  PubMed  CAS  Google Scholar 

  56. Koziczak M, Hynes NE. Cooperation between fibroblast growth factor receptor-4 and ErbB2 in regulation of cyclin D1 translation. J Biol Chem. 2004;279:50004–11.

    Article  PubMed  CAS  Google Scholar 

  57. Turashvili G, Bouchal J, Burkadze G, et al. Wnt signaling pathway in mammary gland development and carcinogenesis. Pathobiology: journal of immunopathology, molecular and cellular biology. 2006;73:213–23.

    Article  CAS  Google Scholar 

  58. Yang F, Li X, Sharma M, et al. Linking beta-catenin to androgen-signaling pathway. J Biol Chem. 2002;277:11336–44.

    Article  PubMed  CAS  Google Scholar 

  59. Aleskandarany MA, Rakha EA, Ahmed MA, et al. Clinicopathologic and molecular significance of phospho-Akt expression in early invasive breast cancer. Breast Cancer Res Treat. 2011;127:407–16.

    Article  PubMed  CAS  Google Scholar 

  60. Doane AS, Moynahan ME, Zhang L, et al. PIK3CA mutation is frequent in class A estrogen receptor negative breast cancer and contributes to the distinct molecular profile. Breast Cancer Research and Treatment 2006:S293.

  61. Naderi A, Chia KM, Liu J. Synergy between inhibitors of androgen receptor and MEK has therapeutic implications in estrogen receptor-negative breast cancer. Breast Cancer Research: BCR. 2011;13:R36.

    Article  PubMed  CAS  Google Scholar 

  62. Naderi A, Liu J. Inhibition of androgen receptor and Cdc25A phosphatase as a combination targeted therapy in molecular apocrine breast cancer. Cancer Lett. 2010;298:74–87.

    Article  PubMed  CAS  Google Scholar 

  63. Zou X, Tsutsui T, Ray D, et al. The cell cycle-regulatory CDC25A phosphatase inhibits apoptosis signal-regulating kinase 1. Mol Cell Biol. 2001;21:4818–28.

    Article  PubMed  CAS  Google Scholar 

  64. Gucalp A, Tolaney SM, Isakoff SJ, et al. TBCRC 011: Targeting the androgen receptor (AR) for the treatment of AR+/ER-/PR- metastatic breast cancer (MBC). ASCO Meeting Abstracts 2011;29:TPS122.

    Google Scholar 

  65. de Bono JS, Logothetis CJ, Molina A, et al. Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med;364:1995-2005.

  66. • Basu B, Ang JE, Crawley D, et al. Phase I study of abiraterone acetate (AA) in patients (pts) with estrogen receptor- (ER) or androgen receptor (AR) -positive advanced breast carcinoma resistant to standard endocrine therapies. ASCO Meeting Abstracts 2011;29:2525. This phase I study established the RP2D of abiraterone acetate in women and demonstrated activity in ER(+)/AR(+) breast tumors.

    Google Scholar 

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Correspondence to Tiffany A. Traina.

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Gucalp, A., Traina, T.A. The Androgen Receptor in Breast Cancer: Biology and Treatment Considerations. Curr Breast Cancer Rep 4, 56–65 (2012). https://doi.org/10.1007/s12609-011-0059-z

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