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Caveolin-1 and Sox-2 are predictive biomarkers of cetuximab response in head and neck cancer
Mehdi Bouhaddou, Rex H. Lee, Hua Li, Neil E. Bhola, Rachel A. O’Keefe, Mohammad Naser, Tian Ran Zhu, Kelechi Nwachuku, Umamaheswar Duvvuri, Adam B. Olshen, Ritu Roy, Aaron Hechmer, Jennifer Bolen, Stephen B. Keysar, Antonio Jimeno, Gordon B. Mills, Scott Vandenberg, Danielle L. Swaney, Daniel E. Johnson, Nevan J. Krogan, Jennifer R. Grandis
Mehdi Bouhaddou, Rex H. Lee, Hua Li, Neil E. Bhola, Rachel A. O’Keefe, Mohammad Naser, Tian Ran Zhu, Kelechi Nwachuku, Umamaheswar Duvvuri, Adam B. Olshen, Ritu Roy, Aaron Hechmer, Jennifer Bolen, Stephen B. Keysar, Antonio Jimeno, Gordon B. Mills, Scott Vandenberg, Danielle L. Swaney, Daniel E. Johnson, Nevan J. Krogan, Jennifer R. Grandis
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Research Article Therapeutics

Caveolin-1 and Sox-2 are predictive biomarkers of cetuximab response in head and neck cancer

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Abstract

The epidermal growth factor receptor (EGFR) inhibitor cetuximab is the only FDA-approved oncogene-targeting therapy for head and neck squamous cell carcinoma (HNSCC). Despite variable treatment response, no biomarkers exist to stratify patients for cetuximab therapy in HNSCC. Here, we applied unbiased hierarchical clustering to reverse-phase protein array molecular profiles from patient-derived xenograft (PDX) tumors and revealed 2 PDX clusters defined by protein networks associated with EGFR inhibitor resistance. In vivo validation revealed unbiased clustering to classify PDX tumors according to cetuximab response with 88% accuracy. Next, a support vector machine classifier algorithm identified a minimalist biomarker signature consisting of 8 proteins — caveolin-1, Sox-2, AXL, STING, Brd4, claudin-7, connexin-43, and fibronectin — with expression that strongly predicted cetuximab response in PDXs using either protein or mRNA. A combination of caveolin-1 and Sox-2 protein levels was sufficient to maintain high predictive accuracy, which we validated in tumor samples from patients with HNSCC with known clinical response to cetuximab. These results support further investigation into the combined use of caveolin-1 and Sox-2 as predictive biomarkers for cetuximab response in the clinic.

Authors

Mehdi Bouhaddou, Rex H. Lee, Hua Li, Neil E. Bhola, Rachel A. O’Keefe, Mohammad Naser, Tian Ran Zhu, Kelechi Nwachuku, Umamaheswar Duvvuri, Adam B. Olshen, Ritu Roy, Aaron Hechmer, Jennifer Bolen, Stephen B. Keysar, Antonio Jimeno, Gordon B. Mills, Scott Vandenberg, Danielle L. Swaney, Daniel E. Johnson, Nevan J. Krogan, Jennifer R. Grandis

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Figure 6

Validation of caveolin-1 and Sox-2 as biomarkers in HNSCC clinical samples from patients with known clinical responses to cetuximab.

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Validation of caveolin-1 and Sox-2 as biomarkers in HNSCC clinical sampl...
(A) Representative images of tumor sections from patients with progressive disease (PD; top) or complete response (CR; bottom), proxies for resistance and sensitivity, respectively. Cells are stained for caveolin-1 (purple), cytokeratin 5,6 (yellow), and DNA (blue). Image deconvolution was applied computationally to extract the caveolin-1–only part of the image. (B) Representative images of tumor sections from patients with progressive disease (top) or complete response (bottom), proxies for resistance and sensitivity, respectively. Cells were stained for Sox-2 (purple), keratin (yellow), and DNA (blue). Image deconvolution was applied computationally to extract the Sox-2–only part of the image. (C) CAV1 (top) and SOX2 (bottom) staining in nontumor tissue control samples (healthy human hepatocytes). (D) The percentage of cells positive for caveolin-1 staining was calculated for each tumor section and segregated by grouping: complete response, progressive disease, or controls (healthy human hepatocytes). (E) The percentage of cells positive for Sox-2 staining was calculated for each tumor section and segregated by grouping: complete response, progressive disease, or controls. (F) The within-tumor section difference between percentages of caveolin-1–positive and Sox-2–positive cells for patients experiencing complete response or progressive disease in response to cetuximab treatment. Gray dots denote tumor sections that may be misclassified according to this metric. When available, multiple tumor sections are included from the same patient (total tumor sections = 16, total patients = 9). Original magnification, ×20 (A–C).

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