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JNCI Journal of the National Cancer Institute 2004 96(12):926-935; doi:10.1093/jnci/djh166
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© 2004 Oxford University Press

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Mechanisms of Tamoxifen Resistance: Increased Estrogen Receptor-HER2/neu Cross-Talk in ER/HER2–Positive Breast Cancer

Jiang Shou, Suleiman Massarweh, C. Kent Osborne, Alan E. Wakeling, Simale Ali, Heidi Weiss, Rachel Schiff

Affiliations of authors: The Breast Center (JS, SM, CKO, HW, RS) and the Departments of Medicine (JS, SM, CKO, HW, RS) and Molecular and Cellular Biology (CKO), Baylor College of Medicine, Houston, TX; Cancer and Infection Bioscience, AstraZeneca, Macclesfield, Cheshire, UK (AEW); Department of Cancer Medicine, Imperial College of Science, Technology & Medicine, London, UK (SA)

Correspondence to: Rachel Schiff, PhD, Breast Center, Baylor College of Medicine, One Baylor Plaza, MS 600, Houston, TX 77030 (e-mail: rschiff{at}breastcenter.tmc.edu)

Background: Patients receiving adjuvant tamoxifen whose tumors express high levels of both HER2/neu (HER2) and the estrogen receptor (ER) coactivator AIB1 often develop tamoxifen resistance. We used a breast cancer model system with high expression of AIB1 and HER2 to investigate the possible mechanisms underlying this resistance. Methods: MCF-7 breast cancer cells, which express high levels of AIB1, and a tamoxifen-resistant derivative cell line engineered to overexpress HER2 (MCF-7/HER2-18) were treated with estrogen, tamoxifen, epidermal growth factor (EGF), or heregulin in the absence or presence of the EGF receptor (EGFR) tyrosine kinase inhibitor gefitinib. We analyzed phosphorylation of signaling intermediates by immunoblotting, ER transcriptional activity with reporter gene constructs and immunoblot analysis of endogenous gene products, promoter assembly by chromatin immunoprecipitation (ChIP) assay, and tumor cell growth in vitro by anchorage-independent colony formation and in vivo using xenografts in nude mice. Results: MCF-7/HER2-18 tumors were completely growth inhibited by estrogen deprivation but were growth stimulated by tamoxifen. Molecular cross-talk between the ER and HER2 pathways was increased in the MCF-7/HER-2 cells compared with MCF-7 cells, with cross-phosphorylation and activation of both the ER and the EGFR/HER2 receptors, the signaling molecules AKT and ERK 1,2 mitogen-activated protein kinase (MAPK), and AIB1 itself with both estrogen and tamoxifen treatment. Tamoxifen recruited coactivator complexes (ER, AIB1, CBP, p300) to the ER-regulated pS2 gene promoter in MCF-7/HER2-18 cells and corepressor complexes (NCoR, histone deacetylase 3) in MCF-7 cells. Gefitinib pretreatment blocked receptor cross-talk, reestablished corepressor complexes with tamoxifen-bound ER on target gene promoters, eliminated tamoxifen's agonist effects, and restored its antitumor activity both in vitro and in vivo in MCF-7/HER2-18 cells. Conclusions: Tamoxifen behaves as an estrogen agonist in breast cancer cells that express high levels of AIB1 and HER2, resulting in de novo resistance. Gefitinib's ability to eliminate this cross-talk and to restore tamoxifen's antitumor effects should be tested in the clinic. [J Natl Cancer Inst 2004; 96:926–35]



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Editorial about this Article

Tamoxifen: Dr. Jekyll and Mr. Hyde?
Daniel F. Hayes
J Natl Cancer Inst 2004 96: 895-897. [Extract] [Full Text] [PDF]



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L. N. Harris, F. You, S. J. Schnitt, A. Witkiewicz, X. Lu, D. Sgroi, P. D. Ryan, S. E. Come, H. J. Burstein, B.-A. Lesnikoski, et al.
Predictors of Resistance to Preoperative Trastuzumab and Vinorelbine for HER2-Positive Early Breast Cancer
Clin. Cancer Res., February 15, 2007; 13(4): 1198 - 1207.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
P. Fan, J. Wang, R. J. Santen, and W. Yue
Long-term Treatment with Tamoxifen Facilitates Translocation of Estrogen Receptor {alpha} out of the Nucleus and Enhances its Interaction with EGFR in MCF-7 Breast Cancer Cells
Cancer Res., February 1, 2007; 67(3): 1352 - 1360.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
R. L. Kilker and M. D. Planas-Silva
Cyclin D1 Is Necessary for Tamoxifen-Induced Cell Cycle Progression in Human Breast Cancer Cells
Cancer Res., December 1, 2006; 66(23): 11478 - 11484.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
A. Belosay, A. M.H. Brodie, and V. C.O. Njar
Effects of Novel Retinoic Acid Metabolism Blocking Agent (VN/14-1) on Letrozole-Insensitive Breast Cancer Cells
Cancer Res., December 1, 2006; 66(23): 11485 - 11493.
[Abstract] [Full Text] [PDF]


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Mol. Endocrinol.Home page
P. Mussi, C. Yu, B. W. O'Malley, and J. Xu
Stimulation of Steroid Receptor Coactivator-3 (SRC-3) Gene Overexpression by a Positive Regulatory Loop of E2F1 and SRC-3
Mol. Endocrinol., December 1, 2006; 20(12): 3105 - 3119.
[Abstract] [Full Text] [PDF]


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Mol. Endocrinol.Home page
V. S. Likhite, F. Stossi, K. Kim, B. S. Katzenellenbogen, and J. A. Katzenellenbogen
Kinase-Specific Phosphorylation of the Estrogen Receptor Changes Receptor Interactions with Ligand, Deoxyribonucleic Acid, and Coregulators Associated with Alterations in Estrogen and Tamoxifen Activity
Mol. Endocrinol., December 1, 2006; 20(12): 3120 - 3132.
[Abstract] [Full Text] [PDF]


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Endocr Relat CancerHome page
S. Massarweh and R. Schiff
Resistance to endocrine therapy in breast cancer: exploiting estrogen receptor/growth factor signaling crosstalk
Endocr. Relat. Cancer, December 1, 2006; 13(Supplement_1): S15 - S24.
[Abstract] [Full Text] [PDF]


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Endocr Relat CancerHome page
J M W Gee, V E Shaw, S E Hiscox, R A McClelland, N K Rushmere, and R I Nicholson
Deciphering antihormone-induced compensatory mechanisms in breast cancer and their therapeutic implications
Endocr. Relat. Cancer, December 1, 2006; 13(Supplement_1): S77 - S88.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
G. E. Weitsman, L. Li, G. P. Skliris, J. R. Davie, K. Ung, Y. Niu, L. Curtis-Snell, L. Tomes, P. H. Watson, and L. C. Murphy
Estrogen Receptor-{alpha} Phosphorylated at Ser118 Is Present at the Promoters of Estrogen-Regulated Genes and Is Not Altered Due to HER-2 Overexpression.
Cancer Res., October 15, 2006; 66(20): 10162 - 10170.
[Abstract] [Full Text] [PDF]


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EndocrinologyHome page
R. Lupu and J. A. Menendez
Targeting Fatty Acid Synthase in Breast and Endometrial Cancer: An Alternative to Selective Estrogen Receptor Modulators?
Endocrinology, September 1, 2006; 147(9): 4056 - 4066.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
S. Massarweh, C. K. Osborne, S. Jiang, A. E. Wakeling, M. Rimawi, S. K. Mohsin, S. Hilsenbeck, and R. Schiff
Mechanisms of Tumor Regression and Resistance to Estrogen Deprivation and Fulvestrant in a Model of Estrogen Receptor-Positive, HER-2/neu-Positive Breast Cancer
Cancer Res., August 15, 2006; 66(16): 8266 - 8273.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
B. Moy and P. E. Goss
Estrogen Receptor Pathway: Resistance to Endocrine Therapy and New Therapeutic Approaches.
Clin. Cancer Res., August 15, 2006; 12(16): 4790 - 4793.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
H. Wu, L. Sun, Y. Zhang, Y. Chen, B. Shi, R. Li, Y. Wang, J. Liang, D. Fan, G. Wu, et al.
Coordinated Regulation of AIB1 Transcriptional Activity by Sumoylation and Phosphorylation
J. Biol. Chem., August 4, 2006; 281(31): 21848 - 21856.
[Abstract] [Full Text] [PDF]


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CarcinogenesisHome page
X. Lin, Y. Yu, H. Zhao, Y. Zhang, J. Manela, and D. A. Tonetti
Overexpression of PKC{alpha} is required to impart estradiol inhibition and tamoxifen-resistance in a T47D human breast cancer tumor model
Carcinogenesis, August 1, 2006; 27(8): 1538 - 1546.
[Abstract] [Full Text] [PDF]


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Ann OncolHome page
R. Kim, M. Kaneko, K. Arihiro, M. Emi, K. Tanabe, S. Murakami, A. Osaki, and K. Inai
Extranuclear expression of hormone receptors in primary breast cancer
Ann. Onc., August 1, 2006; 17(8): 1213 - 1220.
[Abstract] [Full Text] [PDF]


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The OncologistHome page
P. D. Ryan and P. E. Goss
Adjuvant Hormonal Therapy in Peri- and Postmenopausal Breast Cancer
Oncologist, July 1, 2006; 11(7): 718 - 731.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
V. C. Jordan
Pak up your breast tumor--and grow!
J Natl Cancer Inst, May 17, 2006; 98(10): 657 - 659.
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Proc. Natl. Acad. Sci. USAHome page
W. Xia, S. Bacus, P. Hegde, I. Husain, J. Strum, L. Liu, G. Paulazzo, L. Lyass, P. Trusk, J. Hill, et al.
A model of acquired autoresistance to a potent ErbB2 tyrosine kinase inhibitor and a therapeutic strategy to prevent its onset in breast cancer
PNAS, May 16, 2006; 103(20): 7795 - 7800.
[Abstract] [Full Text] [PDF]


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Mol. Endocrinol.Home page
S. Glaros, N. Atanaskova, C. Zhao, D. F. Skafar, and K. B. Reddy
Activation Function-1 Domain of Estrogen Receptor Regulates the Agonistic and Antagonistic Actions of Tamoxifen
Mol. Endocrinol., May 1, 2006; 20(5): 996 - 1008.
[Abstract] [Full Text] [PDF]


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JCOHome page
D. S. Oh, M. A. Troester, J. Usary, Z. Hu, X. He, C. Fan, J. Wu, L. A. Carey, and C. M. Perou
Estrogen-Regulated Genes Predict Survival in Hormone Receptor-Positive Breast Cancers
J. Clin. Oncol., April 10, 2006; 24(11): 1656 - 1664.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
M. P. Goetz, V. J. Suman, J. N. Ingle, A. M. Nibbe, D. W. Visscher, C. A. Reynolds, W. L. Lingle, M. Erlander, X.-J. Ma, D. C. Sgroi, et al.
A two-gene expression ratio of homeobox 13 and interleukin-17B receptor for prediction of recurrence and survival in women receiving adjuvant tamoxifen.
Clin. Cancer Res., April 1, 2006; 12(7 Pt 1): 2080 - 2087.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
R. M. O'Regan, C. Osipo, E. Ariazi, E. S. Lee, K. Meeke, C. Morris, A. Bertucci, M. A.B. Sarker, R. Grigg, and V. C. Jordan
Development and therapeutic options for the treatment of raloxifene-stimulated breast cancer in athymic mice.
Clin. Cancer Res., April 1, 2006; 12(7): 2255 - 2263.
[Abstract] [Full Text] [PDF]


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Mol. Endocrinol.Home page
W. R. Harrington, S. H. Kim, C. C. Funk, Z. Madak-Erdogan, R. Schiff, J. A. Katzenellenbogen, and B. S. Katzenellenbogen
Estrogen Dendrimer Conjugates that Preferentially Activate Extranuclear, Nongenomic Versus Genomic Pathways of Estrogen Action
Mol. Endocrinol., March 1, 2006; 20(3): 491 - 502.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
S. P. Linke, T. M. Bremer, C. D. Herold, G. Sauter, and C. Diamond
A Multimarker Model to Predict Outcome in Tamoxifen-Treated Breast Cancer Patients
Clin. Cancer Res., February 15, 2006; 12(4): 1175 - 1183.
[Abstract] [Full Text] [PDF]


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Molecular Cancer TherapeuticsHome page
S. K. Rayala, J. Mascarenhas, R. K. Vadlamudi, and R. Kumar
Altered localization of a coactivator sensitizes breast cancer cells to tumor necrosis factor-induced apoptosis.
Mol. Cancer Ther., February 1, 2006; 5(2): 230 - 237.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
A. E. Gururaj, S. K. Rayala, R. K. Vadlamudi, and R. Kumar
Novel Mechanisms of Resistance to Endocrine Therapy: Genomic and Nongenomic Considerations
Clin. Cancer Res., February 1, 2006; 12(3): 1001s - 1007s.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
I. Shin, T. Miller, and C. L. Arteaga
ErbB Receptor Signaling and Therapeutic Resistance to Aromatase Inhibitors
Clin. Cancer Res., February 1, 2006; 12(3): 1008s - 1012s.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
S. R.D. Johnston
Clinical Efforts to Combine Endocrine Agents with Targeted Therapies against Epidermal Growth Factor Receptor/Human Epidermal Growth Factor Receptor 2 and Mammalian Target of Rapamycin in Breast Cancer
Clin. Cancer Res., February 1, 2006; 12(3): 1061s - 1068s.
[Abstract] [Full Text] [PDF]


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JNMHome page
B. Van Den Bossche, S. Van Belle, F. De Winter, A. Signore, and C. Van de Wiele
Early Prediction of Endocrine Therapy Effect in Advanced Breast Cancer Patients Using 99mTc-Depreotide Scintigraphy
J. Nucl. Med., January 1, 2006; 47(1): 6 - 13.
[Abstract] [Full Text] [PDF]


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Endocr Relat CancerHome page
N. Normanno, M. Di Maio, E. De Maio, A. De Luca, A. de Matteis, A. Giordano, F. Perrone, and on behalf of the NCI-Naples Breast Cancer Group
Mechanisms of endocrine resistance and novel therapeutic strategies in breast cancer
Endocr. Relat. Cancer, December 1, 2005; 12(4): 721 - 747.
[Abstract] [Full Text] [PDF]


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Mol. Endocrinol.Home page
H. Leong, J. R. Sloan, P. D. Nash, and G. L. Greene
Recruitment of Histone Deacetylase 4 to the N-Terminal Region of Estrogen Receptor {alpha}
Mol. Endocrinol., December 1, 2005; 19(12): 2930 - 2942.
[Abstract] [Full Text] [PDF]


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Ann OncolHome page
H. J. Huang, P. Neven, M. Drijkoningen, R. Paridaens, H. Wildiers, E. Van Limbergen, P. Berteloot, F. Amant, I. Vergote, and M. R. Christiaens
Hormone receptors do not predict the HER2/neu status in all age groups of women with an operable breast cancer
Ann. Onc., November 1, 2005; 16(11): 1755 - 1761.
[Abstract] [Full Text] [PDF]


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JCOHome page
X. Cui, R. Schiff, G. Arpino, C. K. Osborne, and A. V. Lee
Biology of Progesterone Receptor Loss in Breast Cancer and Its Implications for Endocrine Therapy
J. Clin. Oncol., October 20, 2005; 23(30): 7721 - 7735.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
G. M. Springett, L. Bonham, A. Hummer, I. Linkov, D. Misra, C. Ma, G. Pezzoni, S. Di Giovine, J. Singer, H. Kawasaki, et al.
Lysophosphatidic Acid Acyltransferase-{beta} Is a Prognostic Marker and Therapeutic Target in Gynecologic Malignancies
Cancer Res., October 15, 2005; 65(20): 9415 - 9425.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
A. M. Sieuwerts, M. E. Meijer-van Gelder, M. Timmermans, A. M.A.C. Trapman, R. R. Garcia, M. Arnold, A. J.W. Goedheer, H. Portengen, J. G.M. Klijn, and J. A. Foekens
How ADAM-9 and ADAM-11 Differentially From Estrogen Receptor Predict Response to Tamoxifen Treatment in Patients with Recurrent Breast Cancer: a Retrospective Study
Clin. Cancer Res., October 15, 2005; 11(20): 7311 - 7321.
[Abstract] [Full Text] [PDF]


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Ann OncolHome page
A. Goldhirsch, J. H. Glick, R. D. Gelber, A. S. Coates, B. Thurlimann, H.-J. Senn, and and Panel Members
Meeting Highlights: International Expert Consensus on the Primary Therapy of Early Breast Cancer 2005
Ann. Onc., October 1, 2005; 16(10): 1569 - 1583.
[Abstract] [Full Text] [PDF]


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Mol. Cell. Biol.Home page
F. F. Zheng, R.-C. Wu, C. L. Smith, and B. W. O'Malley
Rapid Estrogen-Induced Phosphorylation of the SRC-3 Coactivator Occurs in an Extranuclear Complex Containing Estrogen Receptor
Mol. Cell. Biol., September 15, 2005; 25(18): 8273 - 8284.
[Abstract] [Full Text] [PDF]



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