Probes for HER2

The HER2 splice variant characterized by the deletion of exon 16 and denominated as d16HER2, is associated with HER2-positive breast cancer (BC) aggressiveness, stemness, and trastuzumab susceptibility and is considered to be a "flag" of HER2 dependence. However, with the exception of quantitative real-time PCR analysis, easily reproducible assays are still lacking to clinically detect and quantify the d16HER2 expression. Further, no data on d16HER2 expression and its potential role are available in HER2-positive gastrointestinal malignancies. Here, we used a novel RNA in situ hybridization technique (BaseScope) to discriminate d16HER2 variant expression from the wild type isoform (WTHER2) and to assess their levels across different HER2-positive histological samples. Our results demonstrate the existence of outliers, with d16HER2 mRNA high scores restricted to HER2-positive gastric cancer (GC) and colorectal cancer (CRC) coupled with increased d16HER2 expression compared with BC. Consistent with previously reported data on BC, experiments performed in HER2-positive GC patient-derived xenografts suggest that increased d16HER2 expression is associated with a clinical benefit/response to single-agent trastuzumab. Therefore, d16HER2 may be considered as a "flag" of HER2 dependence in GC and can be clinically investigated as a marker of trastuzumab susceptibility in several other HER2-driven cancers, including CRC. As a clinical proof-of-concept, we indicate that high d16HER2 mRNA scores are exclusively found in patients with a long-term benefit from trastuzumab exceeding 12 months (clinical "outliers"), and that d16HER2 expression is also increased in circulating tumor-released exosomes obtained from baseline plasma samples of long-term responders.

The androgen receptor (AR) is a nuclear steroid receptor that binds to testosterone and dihydrotestosterone and regulates the transcription of genes leading to cell growth, differentiation and survival. AR serves as an important oncogenic signal in prostate cancers and apocrine breast cancers. Salivary duct carcinoma (SDC) is a rare subtype of head and neck cancer that is defined by an apocrine phenotype, with AR positivity by immunohistochemistry (IHC) in up to 98% of cases [1]. A recent clinical trial with leuprorelin acetate and bicalutamide has shown promising activity with an overall response rate of 42% in AR-positive salivary gland cancers, but further analyses of clinicopathological factors or biomarkers including AR expression intensity, HER2 expression, EGFR expression and HRAS mutation did not show any significant association with outcomes [2].