17β-Hydroxysteroid Dehydrogenase Type 14 Is a Predictive Marker for Tamoxifen Response in Oestrogen Receptor Positive Breast Cancer

Introduction: 17 beta-hydroxysteroid dehydrogenases (17 beta HSDs) are important enzymes regulating the pool of bioactive steroids in the breast. The current study was undertaken in order to evaluate implications of 17 beta HSD14 in breast cancer, measuring 17 beta HSD14 protein expression in breast tumours. Methods: An antibody targeting the 17 beta HSD14 antigen was generated and validated using HSD17B14-transfected cells and a peptide-neutralising assay. Tissue microarrays with tumours from 912 post-menopausal women diagnosed with lymph node-negative breast cancer, and randomised to adjuvant tamoxifen or no endocrine treatment, were analysed for 17 beta HSD14 protein expression with immunohistochemistry. Results: Results were obtained from 847 tumours. Patients with oestrogen positive tumours with high 17 beta HSD14 expression had fewer local recurrences when treated with tamoxifen (HR 0.38; 95% C.I. 0.19-0.77, p = 0.007) compared to patients with lower tumoural 17 beta HSD14 expression, for whom tamoxifen did not reduce the number of local recurrences (HR 1.19; 95% C.I. 0.54-2.59; p = 0.66). No prognostic importance of 17 beta HSD14 was seen for systemically untreated patients. Conclusions: Using a highly specific validated antibody for immunohistochemical analysis of a large number of breast tumours, we have shown that tumoural expression levels of 17 beta HSD14 can predict the outcome of adjuvant tamoxifen treatment in terms of local recurrence-free survival in patients with lymph node-negative ER+ breast cancer. The results need be verified to confirm any clinical relevance.