The same results for both study molecules were obtained even incorporating APR-246 in responders group patients achieving SD (not shown). Neither HER2 expression nor p53 status were independent predictors of OS and TTS at Cox regression analysis. Figure

3 Kaplan-Meier curves for overall survival according to p53 or HER2 status. Kaplan-Meier curves for overall survival showed no-significant separation between high vs low-espressors group for both p53 (left panel) and HER2 (right panel). Similar results were obtained for disease-free survival (not shown). Lastly, we also observed at cross-tabulation analysis a clear correlation between HER2 testing with IHC and FISH (p = 0.001). Mean ± SD FISH values in negative and positive groups were 1.51 ± 0.223 and 13.09 ± 9.98 respectively. Discussion Some preliminary comments about study limitations will facilitate the discussion of the results. First, presented data originate from a retrospective analysis that is naturally exposed to selection bias. Second, the relative small sample size could reduce the strength of statistical associations and dramatically affects survival analyses. Third, all patients did not receive the same

chemotherapy regimen both in term of schedule (weekly or every 3 weeks administrations) and in term Alpelisib research buy of associated drug (5 patient received an association of docetaxel plus capecitabine). Lastly, according to guidelines all HER2 positive patients (both patients why that achieve a response and patients who did not) received trastuzumab while negative-ones were treated with docetaxel (alone or in combination). The difference in treatment received and, notably, in the underlying cancer biology makes HER2 positive and negative groups as different populations so affecting our data interpretation. Within that specific experimental context, IHC-assessed nuclear p53 status failed to show any significant association with Navitoclax outcome and survival parameters. In fact, nuclear expression level of p53 did not differ between responders and not-responders

patients. Reasons for this phenomenon cannot be limited to the above mentioned study limitations, probably, should be seek in the mechanisms of action (MoA) of docetaxel and, to a lesser extent, in technical limitations of p53 determination by IHC. Docetaxel, a semi-synthetic analogue of paclitaxel, is a promoter of microtubule stabilization by direct binding leading to cell cycle arrest at G2/M and apoptosis [33–35]. The β-subunit of the tubulin heterodimer, the key component of cellular microtubules, represent the molecular target of docetaxel [36]. This unique MoA could offer a putative explanation for the lack of association between p53 status and docetaxel sensitivity. In fact, docetaxel is not a direct DNA-damaging drug and docetaxel-induced cell cycle arrest occurs in a late phase of cell cycle (G2/M transition).