- Gallagher, Rosa I;
- Wulfkuhle, Julia;
- Wolf, Denise M;
- Brown-Swigart, Lamorna;
- Yau, Christina;
- O’Grady, Nicholas;
- Basu, Amrita;
- Lu, Ruixiao;
- Campbell, Michael J;
- Magbanua, Mark J;
- Coppé, Jean-Philippe;
- Investigators, I-SPY 2;
- Asare, Smita M;
- Sit, Laura;
- Matthews, Jeffrey B;
- Perlmutter, Jane;
- Hylton, Nola;
- Liu, Minetta C;
- Symmans, W Fraser;
- Rugo, Hope S;
- Isaacs, Claudine;
- DeMichele, Angela M;
- Yee, Douglas;
- Pohlmann, Paula R;
- Hirst, Gillian L;
- Esserman, Laura J;
- van ‘t Veer, Laura J;
- Petricoin, Emanuel F
Molecular subtyping of breast cancer is based mostly on HR/HER2 and gene expression-based immune, DNA repair deficiency, and luminal signatures. We extend this description via functional protein pathway activation mapping using pre-treatment, quantitative expression data from 139 proteins/phosphoproteins from 736 patients across 8 treatment arms of the I-SPY 2 Trial (ClinicalTrials.gov: NCT01042379). We identify predictive fit-for-purpose, mechanism-of-action-based signatures and individual predictive protein biomarker candidates by evaluating associations with pathologic complete response. Elevated levels of cyclin D1, estrogen receptor alpha, and androgen receptor S650 associate with non-response and are biomarkers for global resistance. We uncover protein/phosphoprotein-based signatures that can be utilized both for molecularly rationalized therapeutic selection and for response prediction. We introduce a dichotomous HER2 activation response predictive signature for stratifying triple-negative breast cancer patients to either HER2 or immune checkpoint therapy response as a model for how protein activation signatures provide a different lens to view the molecular landscape of breast cancer and synergize with transcriptomic-defined signatures.