US20150133418A1 - Ulipristal acetate for prevention and treatment of breast tumors - Google Patents

Ulipristal acetate for prevention and treatment of breast tumors Download PDF

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US20150133418A1
US20150133418A1 US14/403,304 US201314403304A US2015133418A1 US 20150133418 A1 US20150133418 A1 US 20150133418A1 US 201314403304 A US201314403304 A US 201314403304A US 2015133418 A1 US2015133418 A1 US 2015133418A1
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upa
cells
breast
hbe
treatment
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Michele Resche-Rigon
Delphine Levy
Erin GAINER
Anne Gompel
Patricia Forgez
Laudine Desreumaux-Communal
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Institut National de la Sante et de la Recherche Medicale INSERM
Laboratoire HRA Pharma SAS
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0034—Urogenital system, e.g. vagina, uterus, cervix, penis, scrotum, urethra, bladder; Personal lubricants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0034—Urogenital system, e.g. vagina, uterus, cervix, penis, scrotum, urethra, bladder; Personal lubricants
    • A61K9/0036—Devices retained in the vagina or cervix for a prolonged period, e.g. intravaginal rings, medicated tampons, medicated diaphragms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0034—Urogenital system, e.g. vagina, uterus, cervix, penis, scrotum, urethra, bladder; Personal lubricants
    • A61K9/0039—Devices retained in the uterus for a prolonged period, e.g. intrauterine devices for contraception
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

  • the present invention relates to prevention and therapy of breast tumor with ulipristal acetate.
  • UPA Ulipristal acetate
  • UPA formerly known as CDB-2914, designates 17 ⁇ -acetoxy-11 ⁇ -[4-N,N-dimethylamino-phenyl)-19-norpregna-4,9-diene-3,20-dione, represented by formula I:
  • UPA has been approved for emergency contraception (under tradename EllaOne®), and for treatment of uterine fibroids (under tradename Esmya®).
  • Various other potential clinical applications have been proposed in Chabbert-Buffet et al, Human Reproduction, 2005, 11(3): 293-307.
  • antiprogestins such as mifepristone and onapristone were developed for breast cancer treatment.
  • Administration of mifepristone or onapristone in a second or third line of treatment in 123 postmenopausal women with metastatic breast cancers induced objective response rate and disease stabilization in 11% and 43% of the patients, respectively (Romieu et al. 1987, Bull Cancer 74(4): 455-461; Klijn, et al. 1989, Cancer Res 49(11): 2851-2856).
  • clinical studies were not sustained because of the anti-glucocorticoid and liver toxic side effects of mifepristone and onapristone, respectively.
  • the inventors now propose a method for preventing or treating a breast tumor in a patient, which method comprises administering ulipristal acetate (UPA) or any of its metabolites.
  • UPA ulipristal acetate
  • ulipristal acetate or any of its metabolites for use in preventing or treating a breast tumor in a patient.
  • the patient carries a mutation in BRCA1 and/or BRCA2 gene.
  • ulipristal acetate or any of its metabolites is used in preventing a breast tumor in a patient that carries a mutation in BRCA1 and/or BRCA2 gene.
  • ulipristal acetate (UPA) or any of its metabolites is used in treating a breast tumor in a patient, wherein the breast tumor preferably is a breast carcinoma.
  • the “patient” means any subject in need of the preventive or curative treatment of the invention, preferably a woman. However men are also encompassed, since they may be susceptible to breast tumors as well.
  • the patient has been diagnosed to carry a mutation in BRCA1 and/or BRCA2 gene.
  • BRCA1 and BRCA2 are tumor suppressor genes.
  • the mutational events of the BRCA1 or BRCA2 locus can involve deletions, insertions, and point mutations within the coding sequence and the non-coding sequence. Deletions may be the entire gene or only a portion of the gene. Point mutations may result in stop codons, frameshift mutations, or amino acid substitutions. Somatic mutations are those which occur only in certain tissues, e.g., in the tumor tissue, and are not inherited in the germline. Germline mutations can be found in any of a body's tissues or cells and are inherited. If only a single allele is mutated, a predisposition to breast cancer is indicated.
  • the patient may carry one copy or two copies of BRCA1 or BRCA2 predisposing alleles.
  • BRCA1 or BRCA2 predisposing alleles are recessive to wild-type alleles; that is, cells that contain at least one wild-type BRCA1 or BRCA2 allele are not cancerous.
  • cells that contain one wild-type BRCA1 or BRCA2 allele and one predisposing allele may occasionally suffer the loss of the wild-type allele, either by random mutation or by chromosome loss during cell division. All the progeny of such a mutant cell lack the wild-type function of BRCA1 or BRCA2 and may develop into tumors.
  • the predisposing alleles of BRCA1 or BRCA2 are susceptible to cancer, and the susceptibility is inherited in a dominant fashion.
  • mutant alleles are nonsense or frameshift and produce truncated proteins which are predicted to vary in length from 5% to 99% of the full-length protein. Many of these mutations reside in exon 11 of BRCA1 gene which comprises 61% of the BRCA1 coding region.
  • the full-length BRCA1 cDNA sequence and the coding regions of BRCA1 gene have been described in U.S. Pat. No. 5,747,282.
  • the mutations in BRCA1 or BRCA2 may be detected by any method known in the art.
  • BRACAnalysis® uses a combination of two traditional technologies—Sanger sequencing and PCR—to identify mutations associated with a significant risk of breast cancer in the BRCA1 and BRAC2 genes.
  • SSCP single stranded conformational polymorphism
  • tumor refers to the presence of cells possessing characteristics such as atypical growth or morphology, including uncontrolled proliferation, immortality, metastatic potential, rapid growth and proliferation rate, and certain characteristic morphological features. “Tumor” includes both benign and malignant (i.e. cancerous) neoplasms. Adenomas and cysts are encompassed. Breast cancers include breast carcinomas. Breast cancer can begin in different areas of the breast—the ducts, the lobules, or in some cases, the tissue in between. In the context of the present invention, any type of breast tumor or breast cancer is encompassed, including non-invasive, invasive, recurrent, and metastatic breast cancers.
  • the patient has been diagnosed with a Hereditary Breast and Ovarian Cancer (HBOC).
  • HBOC Hereditary Breast and Ovarian Cancer
  • Prevention means that UPA or any of its metabolites is administered in a patient who is asymptomatic or does not show a breast tumor. More particularly the patient may be at risk of developing such breast tumor, e.g. in view of the family history or of the BRCA1 and/or BRCA2 gene status. Such prevention aims at reducing the risk of developing a breast cancer.
  • “Therapeutic treatment” or “treating” means that UPA or any of its metabolites is administered in a patient who has been diagnosed with a breast tumor.
  • the treatment alleviates the symptoms of the disease, slows down the progression of the disease, may lead to a remission or to a complete cure of the disease.
  • UPA was shown to antagonize the proliferation of tumor cells, in particular in lobules and galactophores (or ductal cells), in particular in BRCA1 mutant cells.
  • the patient who may be at risk of developing a breast tumor, but not necessarily, may be further in need of a contraception. This is particularly useful when the patient has no regular contraception. If so, UPA or any of its metabolites, may be proposed in a form and dosage adapted to provide both regular contraception and breast tumor prevention.
  • the patient may have uterine fibroids, and be both in need of a treatment against uterine fibroids and in need of a therapeutic or preventive treatment against a breast tumor. In that case, UPA or any of its metabolites, may also be proposed in a form and dosage adapted to provide both treatment against uterine fibroids and prevention or treatment of a breast tumor.
  • Ulipristal acetate is preferably used.
  • metabolites of UPA could be used as well.
  • Metabolites of ulipristal acetate include those described in Attardi et al, Journal of Steroid Biochemistry & Molecular Biology, 2004, 88: 277-288, e.g. monodemethylated CDB-2914 (CDB-3877); didemethylated CDB-2914 (CDB-3963); 17alpha-hydroxy CDB-2914 (CDB-3236); aromatic A-ring derivative of CDB-2914 (CDB-4183).
  • the metabolite is monodemethylated CDB-2914 (CDB-3877).
  • UPA or its metabolites may be administered by various routes, e.g., orally, intravenously, or transdermally.
  • a preferred administration route is the oral route.
  • An injection at the site of the tumor is also possible.
  • Other routes of administration are encompassed, including the vaginal or intrauterine route.
  • Devices, in particular vaginal or intrauterine devices, allowing sustained release of UPA or its metabolites may be particularly useful.
  • Subcutaneous implants may be further contemplated.
  • Oral solid dosage forms are preferentially compressed tablets, that may be coated or uncoated, or capsules.
  • Capsules are solid dosage forms using preferentially either a hard or soft gelatine shell as a container for the mixture of the active ingredient and inert ingredients. Procedures for production and manufacture of hard gelatin and soft elastic capsules are well known in the art.
  • Compressed tablets may contain any excipients which are diluents to increase the bulk of the active ingredient so that production of a compressed tablet of practical size is possible. Binders, which are agents which impart cohesive qualities to powdered materials are also necessary. Starch, gelatine, sugars such as lactose or dextrose, and natural and synthetic gums are used. Disintegrants are necessary in the tablets to facilitate break-up of the tablet. Disintegrants include starches, clays, celluloses, algins, gums and crosslinked polymers. Lastly small amounts of materials known as lubricants and glidants are included in the tablets to prevent adhesion to the tablet material to surfaces in the manufacturing process and to improve the flow characteristics of the powder material during manufacture. Colloidal silicon dioxide is most commonly used as a glidant and compounds such as talc or stearic acids are most commonly used as lubricants. Procedures for the production and manufacture of compressed tablets are well known by those skilled in the art.
  • ulipristal acetate or a metabolite thereof is used in form of an uncoated tablet wherein ulipristal acetate or a metabolitie thereof is mixed with excipients that are lactose monohydrate, povidone (polyvinylpyrolidone), croscarmellose sodium, and magnesium stearate (e.g. as described in international patent application WO2010/066749). Long term treatments are preferred, e.g. for a period of at least 3 months.
  • the treatment may be maintained several years.
  • UPA may be administered from a few days, to several months or years, e.g. during at least 3 months to about 5 years.
  • Dosage may be adapted depending on the specific condition and severity of the tumor, and the gender and weight of the patient.
  • a typical dosage would range from 0.1 mg to 150 mg, preferably between 5 and 80 mg, still preferably between 10 and 50 mg.
  • Daily administration(s) are preferred.
  • FIG. 1 UPA effects on MMTV reporter gene transactivation.
  • FIG. 2 UPA effects on PR target gene expression.
  • FIG. 3 UPA effects on GRE reporter gene transactivation.
  • FIG. 4 UPA effects on GR target gene expression.
  • FIG. 5 UPA effect on hormone mediated cell 1 proliferation.
  • FIG. 6 UPA effects on hormone mediated cell apoptosis.
  • FIG. 7 PR, ER and Ki67 expressions in breast tissue xenografts.
  • ER, PR and Ki67 expression were analyzed by immunohistochemistry.
  • A Representative image for ER and PR labeling in original breast tissue before and in treated grafts in mice.
  • B Ki67 expression in C, E2, E2+P, E2+P+UPA treatment groups of grafted tissues. Magnification ⁇ 400.
  • FIG. 8 shows induction of mitotic index (Ki67 positive cells percentage) in lobular cells of grafted tissues that carry BRCA1 mutations (BRCA1 +/+ ) or not (BRCA1 +/ ⁇ ), in response to various treatments. mean ⁇ SEM.
  • FIG. 9 shows induction of mitotic index (Ki67 positive cells percentage) in ductal cells of grafted tissues that carry BRCA1 mutations (BRCA1 +/+ ) or not (BRCA1 +/ ⁇ ), in response to various treatments. mean ⁇ SEM.
  • progesterone receptor antagonist ulipristal acetate UPA
  • CDB-3877 CDB
  • 17 ⁇ estradiol (E2), progesterone (P), dexamethasone (DEX) and mifepristone/RU-486 (RU) were purchased from Sigma (St Quentin Fallavier, France).
  • T-47D and MCF-7 cell lines were respectively maintained in RPMI 1640 and in DMEM medium supplemented with 10% fetal calf serum (PAA Laboratory, Les Mureaux, France).
  • T-47D cell line was derived from a human ductal breast carcinoma and constitutively expressed high amounts of PR (progesterone receptor) and ER (estradiol receptor).
  • PR progesterone receptor
  • ER estradiol receptor
  • Normal human breast epithelial cell (HBE) primary cultures were obtained from 20 women (aged 17-50 years). The procedure used to culture HBE cells is described in detail by Gompel and colleagues (Gompel, et al., 1986, J Clin Endocrinol Metab 63(5): 1174-1180).
  • HBE cells were maintained in HAM F10 medium (PAA Laboratory, Les Mureaux, France) containing hydrocortisone (5 ng/ml), Triiodo-L-thyronine (6.5 ng/ml), choleratoxin (10 ng/ml), transferrin (5 mg/ml), insulin (0.010 U/ml), epidermal growth factor (10 ng/ml) (Sigma, St Quentin Fallavier, France) and 5% human serum (Etableau für du Sang). HBE primary cultures express epithelial markers as well as low levels of estradiol receptor (ER) and estradiol induced PR (Malet, et al., 1991. J Clin Endocrinol Metab 73(1): 8-17; Courtin, et al., 2011, Breast Cancer Res Treat.).
  • ER estradiol receptor
  • PR estradiol induced PR
  • cells were cultured for 24 h in serum and phenol red free medium. Then treatments were carried out in a phenol red free medium containing 5% dextran-charcoal stripped serum. Cells were treated with P or DEX (100 nM), alone or in combination with UPA, RU (1 nM to 1 pM) or CDB-3877 (100 nM). Control cells were treated with ethanol, at 10 1:1000 final ethanol concentration alone as vehicle or E2 (10 nM).
  • GRE/PRE reporter gene plasmids containing glucocorticoid and progesterone responsive elements
  • the MMTV-Luc is a Mouse Mammary Tumor Virus Long Terminal Repeat promoter containing one GRE/PRE palindrome and three GRE/PRE hemi-palindromes upstream to firefly luciferase gene in pFC31 vector
  • the GRELuc contains six copies of GRE/PRE palindrome upstream to firefly luciferase gene in pBL vector.
  • HBE cells were transfected with human PR isoforms hPR-A and hPR-B expression plasmids constructed in POP3 vectors.
  • Rous Sarcoma Virus promoter upstream to beta galactosidase gene (pRSV- ⁇ -Gal) was transfected in each experiment as control. Transfections were performed according to the manufacturer instructions using Lipofectamine or Lipofectamine LTX Reagents (Invitrogen, Cergy-Pontoise, France) for breast cancer cell lines or HBE cells, respectively. After 24 h of transfection, breast cancer and HBE cells were treated with hormones for 24 h or 48 h, respectively. At the end of the experiment, cells were lysed and luciferase activity was determined using the Luciferase Assay System (Promega, Charbonistics-les-bains, France). Beta galactosidase activity was assessed using the Galacto Star kit (Applied Biosystems, Courtaboeuf, France) to normalize luciferase activity data.
  • pRSV- ⁇ -Gal Rous Sarcoma Virus promoter upstream to beta galactosidase gene (p
  • Gene expression values were normalized to the housekeeping gene 36B4. Time of steroid treatment was chosen to get the optimal stimulation for a given gene.
  • ALPL and G0S8 mRNA were analyzed after 6 h of treatment.
  • IEX-1, FASN, and BCL2 were analyzed after 24 h of treatment.
  • Cyclin A mRNA was analyzed after 24 h for GR responses or 48 h for PR responses.
  • the total cell lysate was added to 5 ml of Ecolite scintillation liquid (MP biomedical, Illkirch, France) and radioactivity was counted with a ⁇ -counter HIDEX 300SL (ScienceTec, Courtaboeuf, France).
  • Results were expressed in mean ⁇ SEM. To determine the statistical significance of treatments, One-way ANOVA and Tukey-Kramer multiple comparisons tests were performed to compare the relative efficiency of each treatment with the Instat 3 software (GraphPad, USA). When only two treatments were compared, an unpaired t test was performed. p ⁇ 0.05 was considered as significant.
  • HBE human breast epithelial cells
  • T-47D breast cancer cell line normal human breast epithelial cells
  • P progesterone
  • FIG. 1 B HBE cells were co-transfected with hPR-A and hPR-B expression plasmids ( FIG. 1 B).
  • UPA and RU-486 (RU) inhibited P induced MMTV11 Luc transactivation in a dose dependent manner from 1 000 to 10 nM.
  • HBE cells were then also transfected with only hPR-A or hPR-B, to discriminate UPA actions between PR isoforms. No difference with increasing the levels of each PR isoform was seen on UPA antagonist performance ( FIG. 1 C, D).
  • UPA and RU displayed similar and potent PR antagonist actions from 1 000 to 10 nM ( FIG. 1 E).
  • Fatty acid synthase is implicated in normal breast cells differentiation as well as in mammary tumor progression.
  • An up3 regulation of FASN mRNA by progestins through PR was previously demonstrated in normal and tumoral breast cells in vitro and in vivo.
  • UPA was able to prevent P induction of FASN mRNA expression in HBE as in T-47D cells.
  • P down regulated cyclin A mRNA expression in normal breast cells and in T-47-D cells FIG. 2 B), as previously reported in MDA-MB-231 breast cancer cells transfected by PR (Lin, et al., 2003, Endocrinology 144(12): 5650-5657.).
  • UPA did not reverse BCL2 mRNA down-regulation induced by P in HBE cells, whereas UPA antagonized the P inhibitory effect on this transcript in T-47D cells (p ⁇ 0.01) ( FIG. 2 C).
  • Tissue non-specific alkaline phosphatase (ALPL) is a P responsive gene implicated in metastasis of breast cancer.
  • ALPL alkaline phosphatase
  • IEX-1 immediate early response 3
  • G0S8 regulator of G-protein signaling 2
  • IEX-1 and GOS8 were characterized as glucocorticoid responsive genes.
  • IEX-1 mRNA expression was down-regulated by DEX and UPA did not antagonize this response in HBE and MCF-7 cells.
  • Apoptosis was measured by quantification of sub-G1 percentage 1 of cells by flow cytometry analysis. P exerted an intense pro-apoptotic effect in HBE cells, in contrast to DEX which displayed anti-apoptotic features ( FIG. 6 A). When combined with UPA, both hormones activities were reversed. Similarly, P increased the percentage of sub-G1 cells and UPA tended to inhibit this effect in T-47D cells ( FIG. 6 B). In MCF-7, DEX showed a pro-apoptotic ability which was totally inhibited by UPA ( FIG. 6 C). UPA had no apoptotic or survival properties by itself, but counteracted most of the P and DEX effects in HBE, T-47D, and MCF-7 cells.
  • mice Four weeks old ovariectomized female NMRInu/nu 20 athymic mice were purchased from Janvier laboratory (Le Genest Saint Isle, France). Breast tissues samples were obtained from 6 women (aged 29-42 years). Human mammary gland tissue was cut into 2 ⁇ 2 ⁇ 2 mm fragments and 4 fragments were then subcutaneously xenografted onto the back of 4 mice per group.
  • treatment groups were performed: control, E2, E2+P and E2+P+UPA. Treatments were administered by grafting steroid pellets onto the neck of each mouse. The experimental conditions were initially determined by using a dose range of hormones mixed with cholesterol into the pellets. Blood sample assays were performed after 2 weeks and 4 weeks of treatment to measure plasmatic hormonal concentrations.
  • mice were grafted on the first day of experiment with cholesterol, E2 and/or UPA containing pellets and on the fourteen day with cholesterol or progesterone containing pellets in control and E2 groups, or in E+P and E2+P+UPA groups, respectively. Twenty eight days after the start of experiment, mice were sacrificed. Blood was collected for each mouse, and serum was frozen at ⁇ 20° C. until hormone concentrations.
  • Estradiol was measured by radioimmunoassay using Clinical Assays Estradiol-2 (Sorin Biomedica Diagnostics SpA, Saluggia, Italia). Progesterone levels were evaluated by UPLC-MSMS using Acquity UPLC and Quattro Premier XE (Waters, Milford Mass., USA).
  • UPA concentrations were measured using LC-MS/MS technique by MPI Research (State College, Pa., USA).
  • Mitotic index was calculated using the Ki67 antibody, and was determined for each breast tissue grafted into mice. Immunohistochemical analyses were performed using the BOND-MAX workstation (Leica, Nanterre, France). Paraffin sections of breast tissue xenografts were de-waxed and rehydrated before antigen retrieval using citrate retrieval solution (pH 6.0) for Ki67 antibody or EDTA retrieval solution (pH 9.0) for PR and ERalpha antibodies, for 30 min.
  • the inventors developed an in vivo model to study UPA in long term administration on breast tissue.
  • Human normal breast tissues samples were xenografted in athymic mice treated with E2, or E2+P, or E2+P+UPA, or cholesterol (control) (see experimental procedure).
  • E2 pellets were grafted at the beginning of the experiment, whereas P pellets were grafted at the fourteenth day.
  • UPA pellets were grafted at the beginning of the experiment to mimic a chronic treatment.
  • E2, P, and UPA concentrations in mice serum were measured to validate the treatment method.
  • E2 concentrations in mice serum was 36.88 ⁇ 4.25 pg/ml (mean ⁇ SEM) corresponding to the low range of the physiological E2 levels reported in follicular phase.
  • the P level was 13.05 ⁇ 1.14 ng/ml (mean ⁇ SEM) equivalently to the average P plasma levels in women during the mid-luteal phase.
  • UPA concentration was 63.49 ⁇ 10.46 ng/ml (mean ⁇ SEM) in the same range that observed in clinical use.
  • Hormones levels were undetectable in control mice (E2 ⁇ 0.8pg/m1; P ⁇ 0.4 ng/ml; UPA ⁇ 0.5 ng/ml). As shown in FIG.
  • estradiol receptor (ER) and PR expressions were maintained in the treated engrafted breast fragments at the end of the experiment compared to the original breast tissue before grafts.
  • ER estradiol receptor
  • PR expressions were maintained in the treated engrafted breast fragments at the end of the experiment compared to the original breast tissue before grafts.
  • the mitotic Ki67expression marker in order to determine the breast tissue proliferative activity in glandular lobules and ducts according to the treatment ( FIG. 7 B, C).
  • the rate of mitotic cells was low and homogeneous, at 1.7 ⁇ 0.4% in the lobules and 1.8 ⁇ 0.6% in ducts.
  • the proliferative activity was slightly but not significantly increased in lobules of E2 treated group when compared to the control group ( FIG. 7 B, C).
  • Xenografts were performed as described above (Example 2). Usually, 4 breast tissue fragments from a patient not carrying BRCA1 mutations and 4 breast fragments from a patient carrying BRCA1 mutations were grafted in the same mouse, on the left and right part of the spine respectively. The same groups were formed.
  • the inventors used the same model as described in the above section to investigate the effects of hormones on the proliferation of human breast tissue collected in patient carrying BRCA1 mutations.
  • a higher variability regarding ERa expression was observed in both lobular and ductal structures of patients with BRCA1 mutations before being grafted.
  • the basal expression level of PR was lower in patients carrying BRCA1 mutation compared to patients with a wild type allele in the lobular structures.
  • the BRCA1 status did not impact PR expression level in ductal structures.
  • the proliferative status measure through the expression of Ki67 was higher in lobular cells from BRCA1 patients, but lower in the ductal cells, compared to wild type patients.
  • HBCx-34 The xenograft model used in this study was HBCx-34.
  • HBCx-34 is a mammary ductal carcinoma with wild type P53, no HER2 overexpression and PR and ERa overexpression.
  • the tumor is highly responsive to adriamycine/cyclophosphamide and responsive to docetaxel and capecitabine.
  • HBCx-34 has got no cachectic property.
  • HBCx-34 tumors (P14.0.0/2) were transplanted subcutaneously onto 5-10 mice (donor mice, passage (n ⁇ 1), female athymic nude mice (Hsd:Athymic Nude-Fox1nu), 6- to 9-week-old, Harlan Laboratories (Gannat, France)). When these tumors reached 1000 to 2000 mm3 (between 60 to 78 days), donor mice were sacrificed by cervical dislocation, tumors were aseptically excised and dissected. After removing necrotic areas, tumors were cut into fragments measuring approximately 20 mm3 and transferred for 10 min maximum in sterile DMEM/F12culture medium, without any additional components, before grafting.
  • mice Healthy mice aged 6 to 9 weeks and weighing at least 20 g were included in the study. Mice were anaesthetized with ketamine/xylazine, and then skin was aseptized with a chlorhexidine solution, incised at the level of the interscapular region, and a 20 mm3 tumor fragment was placed in the subcutaneous tissue. Skin was closed with clips.
  • mice were allocated to different groups according to their tumor volume to give homogenous mean and median tumor volume in each treatment arms.
  • mice were observed for physical appearance, behavior and clinical changes. Animals were weighted biweekly during all the experimental period. Toxicity of the different treatments was determined as body weight loss.
  • Tumor volume was evaluated biweekly during all the experimental period. Tumors were collected at the end of treatment, weight and processed for analysis.
  • Mean tumor volumes (TV) at initiation of treatment were 112.2 ⁇ 7.1 and 102.4 ⁇ 7.7 mm 3 in control and UPA-treated groups respectively.
  • UPA exerted an antitumor activity; the mean TV was increased 2.17-fold in the UPA treated mice (mean TV at sacrifice: 332.0 ⁇ 61.0 mm 3 ).
  • the ratio of TV in treated vs. control group (T/C) was 53%.

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