Wander, S. | bioRxiv Science

bioRxiv2025

ESPWA: a deep learning-enabled tool for precision-based use of endocrine therapy in resource-limited settings

Immunohistochemistry for estrogen receptor (ER) expression is often unavailable in low-and-middle-income countries (LMICs), leading to empiric use of endocrine therapy (ET) and unnecessary toxicity in ER-negative patients. To address this unmet need, we developed ESPWA, a deep-learning model trained on 3448 H&E slides and tissue-matched ER status from breast cancer patients treated at Zanmi Lasante (ZL), Haiti. A model trained on The Cancer Genome Atlas (TCGA) exhibited substantial domain shift when applied to the ZL cohort, with AUROCs dropping from 0.846 on TCGA cross-validation to 0.671 on the ZL cohort. In contrast, ESPWA demonstrated improved performance on ZL cross-validation (AUROC=0.790; p=0.005). In an independent test set of 134 Haitian patients with parallel slides prepared and scanned in Mirebalais Hospital (Haiti) and Brigham and Womens Hospital, ESPWA was robust to variations in slide preparation, quality, and scanners, achieving AUROCs of 0.794 on BWH-prepared WSIs and 0.805 on Mirebalais-prepared WSIs. Prospective studies using ESPWA are underway in sub-Saharan Africa to evaluate its utility in informing precision-based use of ET.

cancer biology↗

bioRxiv2019

Reversion and non-reversion mechanisms of resistance to PARP inhibitor or platinum chemotherapy in BRCA1/2-mutant metastatic breast cancer

BackgroundLittle is known about mechanisms of resistance to PARP inhibitors and platinum chemotherapy in patients with metastatic breast cancer and BRCA1/2 mutations. Further investigation of resistance in clinical cohorts may point to strategies to prevent or overcome treatment failure. Patients and MethodsWe obtained tumor biopsies from metastatic breast cancer patients with BRCA1/2 deficiency before and after acquired resistance to PARP inhibitor or platinum chemotherapy. Whole exome sequencing was performed on each tumor, germline DNA, and circulating tumor DNA. Tumors underwent RNA sequencing, and immunohistochemical staining for RAD51 foci on tumor sections was performed for functional assessment of intact homologous recombination. ResultsPre- and post-resistance tumor samples were sequenced from 8 patients (4 with BRCA1 and 4 with BRCA2 mutation; 4 treated with PARP inhibitor and 4 with platinum). Following disease progression on DNA-damaging therapy, four patients (50%) acquired at least one somatic reversion alteration likely to result in functional BRCA1/2 protein detected by tumor or circulating tumor DNA sequencing. Two patients with germline BRCA1 deficiency acquired genomic alterations anticipated to restore homologous recombination through increased DNA end resection: loss of TP53BP1 in one patient and amplification of MRE11A in another. RAD51 foci were acquired post-resistance in all patients with genomic reversion, consistent with reconstitution of homologous recombination. All patients whose tumors demonstrated RAD51 foci post-resistance were intrinsically resistant to subsequent lines of DNA-damaging therapy. ConclusionsGenomic reversion in BRCA1/2 was the most commonly observed mechanism of resistance, occurring in 4 of 8 patients. Novel sequence alterations leading to increased DNA end resection were seen in two patients, and may be targetable for therapeutic benefit. The presence of RAD51 foci by immunohistochemistry was consistent with BRCA1/2 protein functional status from genomic data and predicted response to later DNA-damaging therapy, supporting RAD51 focus formation as a clinically useful biomarker.

cancer biology↗