RANK is a poor prognosis marker and a therapeutic target in ER ‐negative postmenopausal breast cancer

Abstract

Despite strong preclinical data, the therapeutic benefit of the RANKL inhibitor, denosumab, in breast cancer patients, beyond the bone, is unclear. Aiming to select patients who may benefit from denosumab, we hereby analyzed RANK and RANKL protein expression in more than 2,000 breast tumors (777 estrogen receptor‐negative, ER − ) from four independent cohorts. RANK protein expression was more frequent in ER − tumors, where it associated with poor outcome and poor response to chemotherapy. In ER − breast cancer patient‐derived orthoxenografts (PDXs), RANKL inhibition reduced tumor cell proliferation and stemness, regulated tumor immunity and metabolism, and improved response to chemotherapy. Intriguingly, tumor RANK protein expression associated with poor prognosis in postmenopausal breast cancer patients, activation of NFKB signaling, and modulation of immune and metabolic pathways, suggesting that RANK signaling increases after menopause. Our results demonstrate that RANK protein expression is an independent biomarker of poor prognosis in postmenopausal and ER − breast cancer patients and support the therapeutic benefit of RANK pathway inhibitors, such as denosumab, in breast cancer patients with RANK + ER − tumors after menopause. image The analyses of RANK and RANKL expression in large cohorts of breast cancer samples and functional studies in RANK+ breast cancer patient‐derived xenografts (PDXs) revealed a key role for RANK in postmenopausal women with estrogen receptor negative (ER ‐ ) breast cancer. RANK biology and prognostic value in breast cancer is determined by ER status and menopause. RANK protein expression in tumor cells is associated with ER ‐ breast cancer and poor survival in ER ‐ and postmenopausal ER ‐ breast cancer patients. RANK protein expression in tumor cells is associated with poor survival in postmenopausal breast cancer patients independent of ER expression, tumor grade, stage and size. RANK expression associates with poor response to chemotherapy in ER ‐ breast cancer and RANKL inhibition improves response to taxanes in ER ‐ breast PDXs.