<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">JCT</journal-id><journal-title-group><journal-title>Journal of Cancer Therapy</journal-title></journal-title-group><issn pub-type="epub">2151-1934</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/jct.2016.710071</article-id><article-id pub-id-type="publisher-id">JCT-70922</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine&amp;Healthcare</subject></subj-group></article-categories><title-group><article-title>
 
 
  LKB1, A New Biomarker in Breast Cancer
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Hanine</surname><given-names>Lattouf</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Coralie</surname><given-names>Poulard</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Isabelle</surname><given-names>Treilleux</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Nader</surname><given-names>Hussein</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mona</surname><given-names>Diab-Assaf</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Muriel</surname><given-names>Le Romancer</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="aff3"><addr-line>Centre Léon Bérard, Pathology Department, Lyon, France</addr-line></aff><aff id="aff1"><addr-line>Inserm U1052, Centre de Recherche en Cancérologie de Lyon, Lyon, France</addr-line></aff><aff id="aff4"><addr-line>Laboratory of Molecular and Cellular Biology, Doctoral School of Sciences and Technologies, Lebanese University, Beirut, Lebanon</addr-line></aff><aff id="aff2"><addr-line>Department of Biochemistry and Molecular Biology, Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA</addr-line></aff><author-notes><corresp id="cor1">* E-mail:<email>muriel.leromancer@lyon.unicancer.fr(MLR)</email>;</corresp></author-notes><pub-date pub-type="epub"><day>22</day><month>09</month><year>2016</year></pub-date><volume>07</volume><issue>10</issue><fpage>690</fpage><lpage>699</lpage><history><date date-type="received"><day>June</day>	<month>13,</month>	<year>2016</year></date><date date-type="rev-recd"><day>Accepted:</day>	<month>September</month>	<year>25,</year>	</date><date date-type="accepted"><day>September</day>	<month>28,</month>	<year>2016</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  Breast cancer is the most common cancer in women worldwide. Estrogen signaling pathways have been identified as efficient targets of breast cancer therapy, giv
  en
   their key role in promoting breast tumor growth. Agents blocking estrogen-mediated pathways are routinely used in clinical applications in patients displaying estrogen-sensitive breast cancer subtypes
  ;
   however intrinsic or acquired resistance to treatment often occurs or develops, thus limiting their efficacy.
   
  This limitation has highlighted
   
  an imperative need to identify new predictive biomarkers.
   
  Recent findings have highlighted a role for the Liver Kinase B1 (LKB1) in breast cancer tumorigenesis. LKB1 is a serine/threonine kinase mutated in Peutz-Jeghers syndrome (PJS), implicated in many cellular processes including energy metabolism, cell polarization and cell cycle arrest and has also been shown to play an essential role as a tumor suppressor gene by negatively regulating the mTOR pathway.
   
  This review provides an overview of
   
  previous
   
  findings and ongoing research on LKB1, and substantiates the 
  use of this kinase as a potential
   
  prognostic and predictive biomarker of breast cancer
  .
 
</p></abstract><kwd-group><kwd>LKB1</kwd><kwd> Biomarker</kwd><kwd> Breast Cancer</kwd><kwd> Estrogen Signaling</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>Breast cancer (BC) is the most common cancer in women worldwide. In 2012, breast cancer was reported to cause the death of more than 522,000 women by the International Agency for Research on Cancer. Siegel et al. found that BC accounts for 29% of all new cancers in women in 2015 [<xref ref-type="bibr" rid="scirp.70922-ref1">1</xref>] . Estrogens stimulate the proliferation and the differentiation of breast epithelial cells through the activation of downstream mitogenic signaling pathways, namely via the estrogen receptors ERα and ERβ. These receptors function as ligand-dependent transcription factors [<xref ref-type="bibr" rid="scirp.70922-ref2">2</xref>] - [<xref ref-type="bibr" rid="scirp.70922-ref4">4</xref>] , acting either through the transcriptional regulation of genes (genomic pathway) or through membrane and cytoplasmic signaling cascades (non-genomic pathway). Current BC treatment options exclusively target the genomic signaling pathway. Even though ERα is expressed at low levels in normal mammary cells [<xref ref-type="bibr" rid="scirp.70922-ref5">5</xref>] , 70% of BC express high levels of ERα and are either treated by agents that suppress the function of the receptor (anti-estrogen) or the estrogen synthesis (aromatase inhibitors) [<xref ref-type="bibr" rid="scirp.70922-ref6">6</xref>] .</p><p>Despite the fact that ERα is a standard predictive marker used to prescribe endocrine therapy, about 40% of these patients initially display or eventually become resistant to treatment [<xref ref-type="bibr" rid="scirp.70922-ref7">7</xref>] [<xref ref-type="bibr" rid="scirp.70922-ref8">8</xref>] . This represents a burden on public healthcare and a serious issue to be considered when designing the treatment plan of the patients, highlighting an urgent need to identify new predictive markers of therapeutic response, to ensure a better survival rate for the patients. Therefore, the identification of new actors of estrogen signaling pathways should improve treatment specificity and thus overcome cancer drug resistance. For instance, it has been extensively shown that the PI3K/Akt/mTOR pathway is frequently activated in BC, leading to the use of the mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, in clinical trials [<xref ref-type="bibr" rid="scirp.70922-ref9">9</xref>] [<xref ref-type="bibr" rid="scirp.70922-ref10">10</xref>] . Although the latter has become a standard treatment in hormone-resistant BC, its use is accompanied with many side effects (stomatitis, rash, diarrhea, arthralgia/myalgia and anemia) and only 50% of patients respond to the treatment. LKB1 is a known regulator of both mTOR [<xref ref-type="bibr" rid="scirp.70922-ref11">11</xref>] [<xref ref-type="bibr" rid="scirp.70922-ref12">12</xref>] and estrogen signaling pathways [<xref ref-type="bibr" rid="scirp.70922-ref13">13</xref>] [<xref ref-type="bibr" rid="scirp.70922-ref14">14</xref>] , and given its role in BC tumorigenesis [<xref ref-type="bibr" rid="scirp.70922-ref15">15</xref>] , it may emerge as an attractive novel cancer biomarker.</p></sec>
<sec id="s2"><title>2. Breast cancer Subtypes and Therapies</title><p>Breast cancers can be classified into several subtypes based on their epidemiological risk factors, molecular markers and response to systemic and local therapies. Norum et al. presented an overview of the intrinsic molecular subtypes of breast cancer, as well as their prognostic and therapeutic implications [<xref ref-type="bibr" rid="scirp.70922-ref16">16</xref>] summarized in the <xref ref-type="table" rid="table1">Table 1</xref>. The most common breast cancer subtype is the luminal A, with the best prognosis, a low grade and an increased survival rate compared to other subtypes. Luminal A tumors are characterized by an estrogen receptor-positive (ERα+), a progesterone receptor-positive (PR+) and a human epidermal growth factor receptor 2-negative (HER2−) profile. The luminal B cancer subtype shares some similarities with the luminal A subtype. It is also ERα- and/or PR-positive, HER2-negative and has a high level of Ki67 expression, reflecting a high number of proliferating cancer cells. Endocrine therapy is usually the recommended treatment for these subtypes. It entails either targeting the estrogen signaling pathway, using ERα-blocking drugs in premonopausal women, primarily the selective estrogen receptor modulator tamoxifen, or inhibiting estrogen synthesis, using aromatase inhibitors in postmenopausal women, such as exemestane and anastrozole,</p></sec></body>
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