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Nakatani S, Hayashi T, Yamamoto K, Maeda H. Impact of loss of HER2 positivity following neoadjuvant therapy in HER2-positive breast cancer patients on long-term prognosis: A systematic review and meta-analysis. Cancer Treat Rev 2025; 135:102923. [PMID: 40112659 DOI: 10.1016/j.ctrv.2025.102923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 03/12/2025] [Accepted: 03/14/2025] [Indexed: 03/22/2025]
Abstract
AIMS The primary objective was to assess the impact of HER2 loss after neoadjuvant therapy on the long-term prognosis of patients with HER2-positive breast cancer. METHODS We extracted relevant studies from PubMed and Cochrane Library and performed systematic review and meta-analysis. The key eligibility criteria for the studies were as follows: included HER2-positive early breast cancer cases undergoing neoadjuvant therapy, available data on HER2 status before and after neoadjuvant therapy, and reported recurrence-related outcomes (disease-free survival/invasive disease-free survival/relapse-free survival) or overall survival. RESULTS Of 915 studies that were initially identified, 8 met the eligibility criteria and were included in the meta-analysis for the recurrence-related outcomes (1,917 patients with HER2 loss: 411 [21.4 %] or HER2 retained: 1,506 [78.6 %]); 4 of them reported data on overall survival (606 patients with HER2 loss: 243 [40.1 %] or HER2 retained: 363 [59.9 %]). The average follow-up duration, based on data from five out of eight studies that reported this information, was 51.6 months. HER2 loss was significantly associated with worse recurrence-related outcomes (hazards ratio [HR] 1.85, 95 % confidence interval [CI] 1.31-2.61, p = 0.0005) and worse overall survival (HR 2.37, 95 % CI 1.27-4.41, p = 0.0065). No heterogeneity or publication bias was observed in the meta-analysis. CONCLUSIONS This study demonstrated that compared with patients with HER2 retained, those with HER2 loss had significantly higher risk of disease recurrence and worse prognosis. These findings implied the possible use of HER2 loss as a prognostic factor in patients with HER2-positive early breast cancer. Reassessment of HER2 status after neoadjuvant therapy could be valuable in predicting prognosis and may lead to reconsideration of the rational subsequent treatment.
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Affiliation(s)
- Shunsuke Nakatani
- Regulatory Science, Graduate School of Pharmaceutical Sciences, Meiji Pharmaceutical University, Japan; Daiichi Sankyo Co., Ltd, Japan
| | | | - Keiko Yamamoto
- Regulatory Science, Graduate School of Pharmaceutical Sciences, Meiji Pharmaceutical University, Japan; MSD K.K, Japan
| | - Hideki Maeda
- Regulatory Science, Graduate School of Pharmaceutical Sciences, Meiji Pharmaceutical University, Japan.
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Yousef EM, Alswilem AM, Alfaraj ZS, Alhamood DJ, Ghashi GK, Alruwaily HS, Al Yahya SS, Alsaeed E. Incidence and Prognostic Significance of Hormonal Receptors and HER2 Status Conversion in Recurrent Breast Cancer: A Retrospective Study in a Single Institute. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:563. [PMID: 40282854 PMCID: PMC12028628 DOI: 10.3390/medicina61040563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2025] [Revised: 03/18/2025] [Accepted: 03/20/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: Changes in biomarker status are not rare and usually occur in an unfavorable direction. Evaluating changes in biomarker status is advantageous for assessing treatment options and prognosticating patients. Currently, only a few studies have explored the association between biomarker conversion and breast cancer relapse. In this study, we sought to determine the incidence of receptor conversions in patients diagnosed with recurrent breast cancer in comparison to their corresponding primary tumors and to evaluate possible influencing factors. Moreover, we aimed to assess the prognostic significance of biomarker conversion, if any was detected, in breast cancer patients. Materials and Methods: A retrospective cohort study was conducted among breast cancer patients treated at King Khalid University Hospital, Riyadh, Saudi Arabia. Data were collected from recurrent breast cancer patients about different parameters to assess the incidence of hormonal receptors and human epidermal growth factor 2 (HER2) status conversion between primary and recurrent tumors. The calculation of progression-free survival (PFS)/ relapse-free survival (RFS) and the overall survival (OS) was conducted to assess the prognostic value of the assessed biomarker conversion. Results: Progesterone receptor (PR) conversion had the highest incidence (29.9%), followed by HER2 (23%) and estrogen receptor (ER) (12.6%). Menopausal status and concurrent receptor conversion were significant factors influencing receptor status changes. However, no significant associations were found between receptor conversion and other clinical factors, including tumor stage and histological subtype. The survival analysis revealed no statistically significant differences in OS or RFS between patients with and without receptor conversion. Conclusions: Receptor conversion, particularly for PR and HER2, is common in recurrent breast cancer, emphasizing the importance of re-biopsy at recurrence to ensure accurate treatment decisions. While receptor conversion does not significantly impact survival outcomes in this cohort, further large-scale prospective studies are warranted to validate these findings and explore their clinical implications in breast cancer management.
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Affiliation(s)
- Einas M. Yousef
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | | | - Zahrah S. Alfaraj
- College of Medicine, Dar Aluloom University, Riyadh 13314, Saudi Arabia; (Z.S.A.); (D.J.A.); (G.K.G.); (H.S.A.); (S.S.A.Y.)
| | - Danya J. Alhamood
- College of Medicine, Dar Aluloom University, Riyadh 13314, Saudi Arabia; (Z.S.A.); (D.J.A.); (G.K.G.); (H.S.A.); (S.S.A.Y.)
| | - Ghfran K. Ghashi
- College of Medicine, Dar Aluloom University, Riyadh 13314, Saudi Arabia; (Z.S.A.); (D.J.A.); (G.K.G.); (H.S.A.); (S.S.A.Y.)
| | - Hanan S. Alruwaily
- College of Medicine, Dar Aluloom University, Riyadh 13314, Saudi Arabia; (Z.S.A.); (D.J.A.); (G.K.G.); (H.S.A.); (S.S.A.Y.)
| | - Shouq S. Al Yahya
- College of Medicine, Dar Aluloom University, Riyadh 13314, Saudi Arabia; (Z.S.A.); (D.J.A.); (G.K.G.); (H.S.A.); (S.S.A.Y.)
| | - Eyad Alsaeed
- Department of Radiation Oncology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia;
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Chen Z, Cao H, Zhang J, Zhong W, Teng X. The impact of preoperative treatment on mismatch repair protein and HER2 expression in colorectal cancer: an analysis of paired samples. BMC Cancer 2024; 24:1407. [PMID: 39548392 PMCID: PMC11566055 DOI: 10.1186/s12885-024-13120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 10/28/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of cancer-related mortality, highlighting the necessity for multifaceted treatment strategies, including preoperative treatment (PT), which can enhance surgical outcomes and provide prognostic insights. This study aims to clarify the impact of PT-induced changes in mismatch repair (MMR) and human epidermal growth factor receptor 2 (HER2) expression, potentially informing tailored treatment strategies and improving clinical outcomes for CRC patients. METHODS This retrospective study analyzed 120 paired samples from CRC patients who underwent preoperative treatment, comparing pre- and post-treatment specimens. A control group of 60 untreated surgical specimens was also included. Immunohistochemistry assessed MMR proteins (MSH6, MSH2, MLH1, PMS2) and HER2 expression. MSI status was determined in samples with low MMR expression. RESULTS Compared to pre-treatment samples, post-treatment samples exhibited lower levels of MSH6, MSH2, and total MMR expression, along with higher levels of HER2 expression. However, when compared to the untreated control group, there were no significant differences in the expression of MSH6, total MMR, and HER2. All samples that exhibited weak MMR expression and those that shifted to deficient mismatch repair (dMMR) status following treatment had stable microsatellite status. No clear clinicopathological characteristics or prognostic factors were found to be associated with changes in MMR and HER2 expression, except for the use of fluorouracil or capecitabine, which was related to changes in total MMR scores. ypTNM stage and TRG scores were identified as independent factors affecting disease progression in our study. CONCLUSIONS PT is associated with a reduction in MMR expression, notably for the MSH2 protein, while it does not appear to influence HER2 expression.
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Affiliation(s)
- Zhen Chen
- Department of Pathology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79, Qingchun Road, Hangzhou, 310000, China
| | - Hui Cao
- Department of Pathology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79, Qingchun Road, Hangzhou, 310000, China
| | - Jing Zhang
- Department of Pathology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79, Qingchun Road, Hangzhou, 310000, China
| | - Weixiang Zhong
- Department of Pathology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79, Qingchun Road, Hangzhou, 310000, China
| | - Xiaodong Teng
- Department of Pathology, The First Affiliated Hospital of Zhejiang University School of Medicine, No.79, Qingchun Road, Hangzhou, 310000, China.
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Tchou J, Gottipati S, Goldbach M, Baxter M, Venters S, Balassanian R, Vohra P, Gonzalves D, Ahmad Z, Nayak A, Boughey JC, Mukhtar RA, Chen YY. Change in Biomarker Profile After Neoadjuvant Chemotherapy is Prognostic and Common Among Patients with HER2+ Breast Cancer. Ann Surg Oncol 2024; 31:8093-8101. [PMID: 39117925 PMCID: PMC11467097 DOI: 10.1245/s10434-024-15889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Rates of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) for breast cancer have improved, especially among human epidermal growth factor 2-positive (HER2+) and triple-negative subtypes. The frequency and significance of biomarker profile change in residual disease are unclear. This study aimed to determine the rate of biomarker profile changes after NAC and the impact on clinical outcomes in a contemporary cohort. METHODS Upon institutional review board approval, the study identified 634 consecutive patients treated with NAC between 2010 and 2022 at two academic institutions. The study cohort was focused on patients with residual disease who underwent biomarker profile retesting. Biomarker profile change for each subtype was compared across groups using Fisher-Irwin tests. Cox Proportional Hazards Model and Kaplan-Meier plots were performed to evaluate the association of changed versus unchanged biomarker profile with event-free survival. RESULTS Biomarker retesting was performed for 259 (61.4 %) of 422 patients with residual disease. Biomarker profile change occurred in 18.1 % overall and was significantly higher among those with pre-NAC HER2+ disease (32.7 %, 17/52) than among those with HER2-disease (14.5 %, 30/207) (p = 0.004). Conversion of pre-NAC biomarker profiles of HR+HER2- and HR+HER2+ to triple-negative breast cancer (TNBC) post-NAC may be associated with worse event-free survival, hazard ratios of 2.23 (95 % confidence interval [CI], 0.90-5.53; p = 0.08), trending toward significance, and 36.7 (95 % CI, 2.2-610.8; p = 0.01), respectively. CONCLUSIONS The results from one of the largest contemporary cohorts demonstrated that biomarker profile change in patients with residual disease after NAC was common. Furthermore, specific biomarker profile change in residual disease may have prognostic value. These findings strengthen the rationale for routine re-testing of biomarkers in residual disease after NAC.
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MESH Headings
- Humans
- Female
- Receptor, ErbB-2/metabolism
- Neoadjuvant Therapy
- Biomarkers, Tumor/metabolism
- Middle Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/metabolism
- Follow-Up Studies
- Survival Rate
- Prognosis
- Neoplasm, Residual
- Receptors, Progesterone/metabolism
- Adult
- Receptors, Estrogen/metabolism
- Aged
- Neoplasm Staging
- Chemotherapy, Adjuvant
- Triple Negative Breast Neoplasms/drug therapy
- Triple Negative Breast Neoplasms/pathology
- Triple Negative Breast Neoplasms/metabolism
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
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Affiliation(s)
- Julia Tchou
- Division of Breast Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Soumy Gottipati
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Macy Goldbach
- Division of Breast Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Molly Baxter
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Sara Venters
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ron Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Poonam Vohra
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Diego Gonzalves
- Division of Breast Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zahra Ahmad
- Division of Breast Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anupma Nayak
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Rita A Mukhtar
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Yunn-Yi Chen
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
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Gedfew M, Getie A, Akalu TY, Ayenew T. Recurrence and associated factors of breast cancer among women in sub saharan africa, systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108528. [PMID: 39029209 DOI: 10.1016/j.ejso.2024.108528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/24/2024] [Accepted: 06/30/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Recurrence of breast cancer is a critical indicator of disease progression and survival rates. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of recurrence and associated factors of breast cancer in Sub Saharan Africa. METHODS We conducted a thorough search of the following international databases between January 1 and February 7, 2024: PubMed, EMBASE, CINAHL, Google Scholar, Science Direct, and the Cochrane Library. A data extraction format was used by two authors to independently extract all required data. STATA Version 14 was used to evaluate the quantitative data and the Cochrane Q test statistics and I2 test were used to evaluate the heterogeneity among the included studies using a random effects meta-analysis model. RESULTS The overall prevalence of breast cancer recurrence is 27.44 % (95%CI: 26.41, 28.46). The highest prevalence was found in Uganda (89.927 % (87.0, 92.851)), followed by Tanzania (82.174 % (77.228, 87.120)). Involved deep surgical margin (OR: 3.62, 95 % CI: 2.11, 5.12), positive lymph node status (OR: 6.85, 95 % CI: 1.42, 12.3)), and histological grade III (OR: 7.43, 95 % CI: 3.56, 11.3)) were all significantly associated factors. CONCLUSION The pooled prevalence of breast cancer recurrence in this review was significantly high. Histological grade III, positive lymph node statuses, clinical staging III, and involved deep surgical margin were associated factors. Therefore, frequent monitoring, regular screenings, imaging tests, and consultations with oncologists, take extra care to ensure clear and deep surgical margins using advanced imaging techniques are highly recommended.
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Affiliation(s)
- Mihretie Gedfew
- Nursing Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Addisu Getie
- Nursing Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Tadesse Yirga Akalu
- Nursing Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Temesgen Ayenew
- Nursing Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
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Chen X, Ji L, Qian X, Xiao M, Li Q, Li Q, Wang J, Fan Y, Luo Y, Lan B, Chen S, Ma F, Xu B, Zhang P. Evolution and prognostic significance of HER-2 conversion from primary to residual disease in HER-2 negative patients with breast cancer after neoadjuvant chemotherapy. Am J Cancer Res 2024; 14:3859-3872. [PMID: 39267660 PMCID: PMC11387869 DOI: 10.62347/dgtd7801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/07/2024] [Indexed: 09/15/2024] Open
Abstract
This study aimed to analyze HER-2 zero or HER-2 low conversion in HER-2 negative patients after neoadjuvant chemotherapy (NAC) and evaluate its prognostic significance. HER-2 negative patients with breast cancer with residual disease after NAC and paired pre- and post-therapeutic HER-2 testing results were analyzed retrospectively. HER-2 low, defined as immunohistochemistry (IHC) scores of 1+ or 2+/in situ hybridization (ISH), were not amplified. HER-2 zero is defined as an IHC score of 0. A total of 571 patients were enrolled, including primary HER-2 zero (n=201, 35.2%) and HER-2 low (n=370, 64.8%). The overall HER-2 change rate was 32.4%. Multivariable logistic regression showed that patients with hormone receptor-positive status before NAC was significantly associated with the conversion of HER-2 zero to low (OR=3.436, P < 0.0001). The median follow-up time was 50.0 months. In patients who are primary HER-2 zero, HER-2 zero to low was significantly associated with better disease-free survival (DFS) than constant HER-2 zero (HR=0.49, P=0.01) after adjustment (4-year DFS 80.1% vs 55.7%, Log-rank P=0.033). Subgroup analysis revealed that among patients who are primary HER-2 zero with hormone receptor-positive, HER-2 zero to low had a significantly better DFS than constant HER-2 zero (Log-rank P=0.037). In contrast, patients with hormone receptor-negative status did not. In conclusion, almost one-third of patients who are HER-2 negative underwent HER-2 zero or HER-2 low conversion after NAC. HER-2 zero to low conversion was associated with better DFS in patients who are HER-2 zero. These results provide a valuable reference for the potential application of anti-HER-2 ADC in an adjuvant setting for patients with residual disease after NAC.
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Affiliation(s)
- Xi Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Lei Ji
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Xiaoyan Qian
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Min Xiao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Qing Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Qiao Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Jiayu Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Ying Fan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Bo Lan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Shanshan Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Pin Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
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Lee S, Kim JY, Lee SJ, Hwang CS, Lee HJ, Kim KB, Lee JH, Shin DH, Choi KU, Lee CH, Huh GY, Kim A. Impact of Neoadjuvant Chemotherapy (NAC) on Biomarker Expression in Breast Cancer. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:737. [PMID: 38792920 PMCID: PMC11123214 DOI: 10.3390/medicina60050737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: This study aimed to explore biomarker change after NAC (neoadjuvant chemotherapy) and to investigate biomarker expression as a prognostic factor in patients with residual disease (RD) after NAC. Materials and Methods: We retrospectively evaluated 104 patients with invasive breast cancer, who underwent NAC and surgery at Pusan National University Hospital from 2015 to July 2022. The expression of the biomarker was assessed, and the overall survival (OS) and disease-free survival (DFS) were investigated. Results: After NAC, 24 patients (23.1%) out of 104 total patients had a pathological complete response (pCR). We found that changes in at least one biomarker were observed in 41 patients (51.2%), among 80 patients with RD. In patients with RD after NAC (n = 80), a subtype change was identified in 20 patients (25.0%). Any kind of change in the HER2 status was present 19 (23.7%) patients. The hormone receptor (HR)+/HER2+ subtype was significantly associated with better disease-free survival (DFS) (HR, 0.13; 95% CI, 0.02-0.99; p = 0.049). No change in p53 was associated with better DFS, and negative-to-positive change in p53 expression after NAC was correlated with worse DFS (p < 0.001). Negative-to-positive change in p53 was an independent, worse DFS factor in the multivariate analysis (HR,18.44; 95% CI, 1.86-182.97; p = 0.013). Conclusions: Biomarker change and subtype change after NAC were not infrequent, which can affect the further treatment strategy after surgery. The expression change of p53 might have a prognostic role. Overall, we suggest that the re-evaluation of biomarkers after NAC can provide a prognostic role and is needed for the best decision to be made on further treatment.
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Affiliation(s)
- Suji Lee
- Department of Pathology, Pusan National University Hospital, Biomedical Research Institution, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
- Department of Pathology, School of Medicine, Pusan National University, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
| | - Jee Yeon Kim
- Department of Pathology, School of Medicine, Pusan National University, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
- Department of Pathology, Yangsan Pusan National University Hospital, Medical Research Institute, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
| | - So Jeong Lee
- Department of Pathology, Seegene Medial Foundation Busan, Joongangdaero 297, Busan 48792, Republic of Korea
| | - Chung Su Hwang
- Department of Pathology, School of Medicine, Pusan National University, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
- Department of Pathology, Yangsan Pusan National University Hospital, Medical Research Institute, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
| | - Hyun Jung Lee
- Department of Pathology, School of Medicine, Pusan National University, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
- Department of Pathology, Yangsan Pusan National University Hospital, Medical Research Institute, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
| | - Kyung Bin Kim
- Department of Pathology, Pusan National University Hospital, Biomedical Research Institution, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
- Department of Pathology, School of Medicine, Pusan National University, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
| | - Jung Hee Lee
- Department of Pathology, School of Medicine, Pusan National University, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
- Department of Pathology, Yangsan Pusan National University Hospital, Medical Research Institute, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
| | - Dong Hoon Shin
- Department of Pathology, School of Medicine, Pusan National University, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
- Department of Pathology, Yangsan Pusan National University Hospital, Medical Research Institute, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
| | - Kyung Un Choi
- Department of Pathology, Pusan National University Hospital, Biomedical Research Institution, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
- Department of Pathology, School of Medicine, Pusan National University, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
| | - Chang Hun Lee
- Department of Pathology, Pusan National University Hospital, Biomedical Research Institution, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
- Department of Pathology, School of Medicine, Pusan National University, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
| | - Gi Yeong Huh
- Department of Pathology, Pusan National University Hospital, Biomedical Research Institution, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
- Department of Pathology, School of Medicine, Pusan National University, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
| | - Ahrong Kim
- Department of Pathology, Pusan National University Hospital, Biomedical Research Institution, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
- Department of Pathology, School of Medicine, Pusan National University, Beomeori, Mulgeum-eop, Yangsan 50612, Republic of Korea
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Wang M, Wei Z, Kong J, Zhao H. Comprehensive evaluation of the relationship between biomarker profiles and neoadjuvant chemotherapy outcomes for breast cancer patients. Diagn Pathol 2024; 19:53. [PMID: 38509525 PMCID: PMC10953119 DOI: 10.1186/s13000-024-01451-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/23/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Accurately predicting the response to neoadjuvant chemotherapy (NAC) in breast cancer patients is crucial for guiding treatment strategies and enhancing clinical outcomes. Current studies have primarily focused on a limited set of biomarkers. More importantly, the results of many studies are in conflict. To address this, we conducted a comprehensive evaluation of the predictive value of a diverse range of clinically available molecular biomarkers in breast cancer, including HER2, ER, PR, TOPO II, EGFR, Ki67, CK5/6, AR, and p53. Additionally, we assessed changes in these biomarkers after NAC administration. METHODS Our study involved 189 patients with invasive breast cancer who underwent NAC at our institute. We examined biomarker profiles in core-needle biopsies taken before NAC and in surgical specimens obtained after NAC. We examined the association between these biomarkers and NAC outcomes, focusing on two main aspects: the rate of pathological complete response (pCR) and the reduction in tumor size. We used Chi-square and Mann-Whitney U tests to compare biomarker status changes between pCR and non-pCR patients. Linear regression analysis was employed to evaluate the relationship between biomarker status and tumor shrinkage rate. Additionally, we compared the expression status of these biomarkers before and after NAC using Chi-square and Wilcoxon signed-rank tests. RESULTS AND CONCLUSIONS Our results demonstrated significant differences in the expression levels of HER2, ER, PR, TOPO II, EGFR, and Ki67 between pCR and non-pCR patients, underscoring their potential as predictive markers for NAC outcomes. Importantly, our results have shed light on the contentious issue surrounding TOPO II in NAC outcome prediction. We have provided evidence that establishes a significantly positive association between TOPO II expression level and the pCR rate. Notably, tumor size was identified as a relevant predictive factor for achieving pCR. Regarding biomarker profiles, only Ki67 levels and TOPO II status exhibited changes following NAC, resolving previous controversies. While the ER and PR status remained unchanged, their expression values exhibited a slight but significant decrease post-NAC. Our results provide clarity and insights into the value and potential of using these biomarkers to predict NAC responses and prognosis in breast cancer patients.
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Affiliation(s)
- Mijia Wang
- The Second Hospital of Dalian Medical University, Dalian, 116023, China.
| | - Zhendong Wei
- The Second Hospital of Dalian Medical University, Dalian, 116023, China
| | - Jixia Kong
- The Second Hospital of Dalian Medical University, Dalian, 116023, China
| | - Haidong Zhao
- The Second Hospital of Dalian Medical University, Dalian, 116023, China.
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9
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Vemuru S, Huang J, Colborn K, Yoon Y, Huynh V, Leonard L, Ahrendt G, Christian N, Afghahi A, McLemore L, Sams S, Tevis S. Clinical implications of receptor conversions in breast cancer patients who have undergone neoadjuvant chemotherapy. Breast Cancer Res Treat 2023; 200:247-256. [PMID: 37233961 PMCID: PMC11044989 DOI: 10.1007/s10549-023-06978-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE In this study, we aimed to determine the incidence of receptor conversions after neoadjuvant chemotherapy (NAC) for breast cancer and assess the rate at which receptor conversion leads to changes in adjuvant therapy regimens. METHODS We performed a retrospective review of female breast cancer patients treated with NAC at an academic breast center between January 2017 and October 2021. Patients with residual disease on surgical pathology and complete receptor status information for both pre-NAC and post-NAC specimens were included. Incidence of receptor conversions, defined as a change in at least one hormone receptor (HR) or HER2 status compared to preoperative specimens, was tabulated, and adjuvant therapy modalities were reviewed. Factors associated with receptor conversion were analyzed using chi-square tests and a binary logistic regression. RESULTS Of the 240 patients with residual disease after NAC, 126 (52.5%) had receptor testing repeated. After NAC, 37 specimens (29%) had a receptor conversion. Receptor conversion resulted in the addition or removal of an adjuvant therapy in 8 patients (6%), indicating a number needed to screen of 16. Prior history of cancer, receipt of initial biopsy at an outside site, HR-positive tumors, and a pathologic stage of II or lower were factors associated with receptor conversions. CONCLUSION HR and HER2 expression profiles frequently change after NAC and drive adjustments in adjuvant therapy regimens. Repeat testing of HR and HER2 expression should be considered in patients who receive NAC, especially in patients with early stage, HR-positive tumors whose initial biopsies were performed externally.
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Affiliation(s)
- Sudheer Vemuru
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Aurora, CO, 80045, USA.
| | - Jin Huang
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn Colborn
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
- Surgical Outcomes and Applied Research (SOAR) Program and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | - YooJin Yoon
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Victoria Huynh
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
| | - Laura Leonard
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
| | - Nicole Christian
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
| | - Anosheh Afghahi
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren McLemore
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sharon Sams
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
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10
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He Y, Zhang J, Chen H, Zhou Y, Hong L, Ma Y, Chen N, Zhao W, Tong Z. Clinical significance and prognostic value of receptor conversion after neoadjuvant chemotherapy in breast cancer patients. Front Surg 2023; 9:1037215. [PMID: 36684294 PMCID: PMC9852345 DOI: 10.3389/fsurg.2022.1037215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/25/2022] [Indexed: 01/09/2023] Open
Abstract
The hormone receptor (HR) status and human epidermal growth hormone receptor 2 (HER2) status of patients with breast cancer may change following neoadjuvant chemotherapy (NAC). We retrospectively analyzed the clinical data of 294 patients with stage II/III breast cancer to evaluate the clinical significance and prognostic value of receptor transformation after NAC in breast cancer patients. Pathological complete response after NAC was achieved in 10.7% of patients. HR, estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67 conversion rates were 9.2%, 6.5%, 13.0%, 4.4%, and 33.7%, respectively. Patients with stable HR (P = 0.01) and HER2 (P = 0.048) expression had more favorable overall survival (OS). Low or reduced Ki-67 expression was associated with better disease-free survival (DFS) (P < 0.001) and OS (P < 0.01). Multivariate analysis showed that the number of lymph nodes after NAC, HR conversion, and radiotherapy were independent prognostic factors for overall survival. HR conversion implied a higher risk of death [hazard ratio, 2.56 (95% confidence interval: 1.19-5.51); P = 0.016]. Patients with HR conversion after NAC who received endocrine therapy had better DFS (P = 0.674) and OS (P = 0.363) than those who did not receive endocrine therapy, even if the HR changed from positive to negative. In conclusion, pathological testing should be performed before and after NAC, and even patients with HR conversion after NAC might benefit from endocrine therapy.
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Affiliation(s)
- Yang He
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,Department of Breast Cancer, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Jing Zhang
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,Department of Integrative Oncology, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Hui Chen
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,Department of Oncology, Characteristic Medical Center of PAP, Tianjin, China
| | - Ying Zhou
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,Department of Integrative Oncology, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Liping Hong
- Center for Precision Cancer Medicine and Translational Research, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Yue Ma
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Nannan Chen
- Department of Breast Cancer, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
| | - Weipeng Zhao
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Zhongsheng Tong
- Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,Correspondence: Zhongsheng Tong
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11
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Deep learning-based system for automatic prediction of triple-negative breast cancer from ultrasound images. Med Biol Eng Comput 2023; 61:567-578. [PMID: 36542320 PMCID: PMC9852203 DOI: 10.1007/s11517-022-02728-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
To develop a deep-learning system for the automatic identification of triple-negative breast cancer (TNBC) solely from ultrasound images. A total of 145 patients and 831 images were retrospectively enrolled at Peking Union College Hospital from April 2018 to March 2019. Ultrasound images and clinical information were collected accordingly. Molecular subtypes were determined from immunohistochemical (IHC) results. A CNN with VGG-based architecture was then used to predict TNBC. The model's performance was evaluated using randomized k-fold stratified cross-validation. A t-SNE analysis and saliency maps were used for model visualization. TNBC was identified in 16 of 145 (11.03%) patients. One hundred fifteen (80%) patients, 15 (10%) patients, and 15 (10%) patients formed the train, validation, and test set respectively. The deep learning system exhibits good efficacy, with an AUC of 0.86 (95% CI: 0.64, 0.95), an accuracy of 85%, a sensitivity of 86%, a specificity of 86%, and an F1-score of 0.74. In addition, the internal representation features learned by the model showed clear differentiation across molecular subtype groups. Such a deep learning system can automatically predict triple-negative breast cancer preoperatively and accurately. It may help to get to more precise and comprehensive management.
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12
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Wang L, Jiang Q, He MY, Shen P. HER2 changes to positive after neoadjuvant chemotherapy in breast cancer: A case report and literature review. World J Clin Cases 2022; 10:260-267. [PMID: 35071526 PMCID: PMC8727267 DOI: 10.12998/wjcc.v10.i1.260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/10/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND As the most common cancer in women, breast cancer is the leading cause of death. Most patients are initially diagnosed as stage I-III. Among those without distant metastases, 64% are local tumors and 27% are regional tumors. Patients in stage IIA-IIIC and those who meet the breast-conserving criterion with the exception of tumor size can consider neoadjuvant chemotherapy (NACT). It is worth noting that the status of tumor cell biomarkers is not consistently static. Endocrine-related estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) encoded by erythroblastic leukemia viral oncogene homolog 2 gene can all alter from positive to negative or vice versa, especially in luminal B subtype after NACT. In addition, determination of HER2 status currently mainly relies on immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), but FISH is commonly used when the result of IHC is uncertain. HER2 is regarded as negative when the IHC result is 0/1+ without the addition of FISH. To the best of our knowledge, this is the first report of a case harboring HER2 status transformation and IHC1+ with positive amplification by FISH after NACT.
CASE SUMMARY A 49-year-old woman discovered a mass in her right breast and underwent diagnostic workup. Biopsies of the right breast lesion and axillary lymph nodes were obtained. The results pointed to invasive ductal carcinoma with the IHC result for ER (80%), PR (60%), Ki-67 (20%) and ambiguous expression of HER2 (IHC 2+) with negative amplification by FISH (HER2/CEP17 ratio of 1.13). She underwent surgery after NACT. The pathological findings of the surgically resected sample supported invasive ductal carcinoma with the tumor measuring 1.1 cm × 0.8 cm × 0.5 cm and had spread to one of fifteen dissected lymph nodes. Retesting of the specimen showed that the tumor was positive for ER (2+, 85%) and PR (2+, 10%) but negative for HER2 by IHC (1+). Also Ki-67 had dropped to 2%. The patient was regularly monitored every 3 mo without evidence of recurrence.
CONCLUSION Biomarker status should be reassessed after NACT especially in luminal subtypes.
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Affiliation(s)
- Luo Wang
- Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Qi Jiang
- Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Meng-Ye He
- Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Peng Shen
- Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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13
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Chen Y, Liu X, Yu K, Sun X, Xu S, Qiu P, Lv Z, Zhang X, Guo A, Xu Y. Impact of hormone receptor, HER2, and Ki-67 status conversions on survival after neoadjuvant chemotherapy in breast cancer patients: a retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:93. [PMID: 35282081 PMCID: PMC8848398 DOI: 10.21037/atm-21-6924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022]
Abstract
Background The discordance of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 cell nuclear proliferation antigen status in patients with locally advanced breast cancer pre- and post-neoadjuvant chemotherapy (NAC) is quite common. This study aimed to assess the frequency of changes in receptor status after NAC in patients with invasive ductal breast cancer and the prognostic impact of such changes. Methods The study comprised 670 patients who were diagnosed with invasive ductal breast carcinoma and treated with both NAC and surgery from 2012–2017. Hormone receptor (HR; including ER and PR), HER2, and Ki-67 status was assessed before NAC and in residual invasive tumor cells of the surgical specimens. The prognostic impact of receptor conversions in breast cancer patients treated with NAC was evaluated in this retrospective study. Results The conversion of ER was related to overall survival (OS; P=0.008) and disease-free survival (DFS; P=0.004). Patients whose ER status was always positive had the best prognosis, and those who were always negative had the worst prognosis. Similar results were also found for PR status, as the conversion of PR status was also related to OS (P<0.001) and DFS (P<0.001). At the same time, the conversion of Ki-67 status was related to OS (P=0.042) and DFS (P=0.037), and patients whose Ki-67 status was ≤20% persistently after NAC had the best survival among the 4 groups, while those whose Ki-67 status changed from ≤20% to >20% after NAC had the worst survival. Nevertheless, there was no statistical significance in the conversion of HER2 status. In multivariate Cox regression analyses, PR conversion and post-neoadjuvant pathological lymph node stage (ypN) were independent prognostic factors for DFS (P=0.008, <0.001) and OS (P=0.002, <0.001). Conclusions Changes in receptor status between pre-treatment and residual disease after NAC are common. Moreover, these alterations have an impact on the survival outcome of invasive ductal breast cancer patients. Thus, receptor status should be re-evaluated routinely before and after NAC to guide individualized treatment.
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Affiliation(s)
- Yuhai Chen
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaoyan Liu
- Department of Breast Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Keda Yu
- Department of Breast Surgery, Shanghai Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiangyu Sun
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shouping Xu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Pengfei Qiu
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Zhidong Lv
- Breast Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinwen Zhang
- Center of Implant Dentistry, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease, Shenyang, China
| | - Ayao Guo
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yingying Xu
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
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14
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Shiino S, Ball G, Syed BM, Kurozumi S, Green AR, Tsuda H, Takayama S, Suto A, Rakha EA. Prognostic significance of receptor expression discordance between primary and recurrent breast cancers: a meta-analysis. Breast Cancer Res Treat 2022; 191:1-14. [PMID: 34613502 PMCID: PMC8758639 DOI: 10.1007/s10549-021-06390-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/06/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE This meta-analysis aimed to investigate whether receptor (estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor 2 [HER2]) discordances between primary and recurrent breast cancers affect patients' survival. METHODS Search terms contained ER, PR, and HER2 status details in both primary and recurrent tumors (local recurrence or distant metastasis) in addition to survival outcome data (overall survival [OS] or post-recurrence survival [PRS]). RESULTS Loss of ER or PR in recurrent tumors was significantly associated with shorter OS as compared with receptor-positive concordance (hazard ratio [HR], 1.67; 95% confidence interval [% CI] 1.37-2.04; p < 0.00001 and HR, 1.45; 95% CI 1.21-1.75; p < 0.0001, respectively). Similar trends were observed in groups with only distant metastasis. Gain of ER was a significant predictor of longer PRS as compared with receptor-negative concordance (HR, 0.76; 95% CI 0.59-0.97; p = 0.03). Gain of PR was not a significant predictor of longer survival compared with receptor-negative concordance, but it could be related to better OS at distant metastasis. Both HER2 of loss and gain could be related to poor outcomes. CONCLUSION This meta-analysis showed that receptor conversion in recurrent tumors may affect patient survival as compared with receptor concordance.
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Affiliation(s)
- Sho Shiino
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Graham Ball
- School of Science & Technology, John Van Geest Cancer Research Centre, Nottingham Trent University, Clifton Campus, Clifton Lane, Nottingham, UK
| | - Binafsha M Syed
- Head of Clinical Research Division, Medical Research Centre, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Sasagu Kurozumi
- Department of Breast Surgery, International University of Health and Welfare, Narita, Japan
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Andrew R Green
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Shin Takayama
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiko Suto
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Emad A Rakha
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.
- Department of Histopathology, Nottingham University Hospital NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
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15
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Elghazaly H, Rugo HS, Azim HA, Swain SM, Arun B, Aapro M, Perez EA, Anderson BO, Penault-Llorca F, Conte P, El Saghir NS, Yip CH, Ghosn M, Poortmans P, Shehata MA, Giuliano AE, Leung JWT, Guarneri V, Gligorov J, Gulluoglu BM, Abdel Aziz H, Frolova M, Sabry M, Balch CM, Orecchia R, El-Zawahry HM, Al-Sukhun S, Abdel Karim K, Kandil A, Paltuev RM, Foheidi M, El-Shinawi M, ElMahdy M, Abulkhair O, Yang W, Aref AT, Bakkach J, Bahie Eldin N, Elghazawy H. Breast-Gynaecological & Immuno-Oncology International Cancer Conference (BGICC) Consensus and Recommendations for the Management of Triple-Negative Breast Cancer. Cancers (Basel) 2021; 13:2262. [PMID: 34066769 PMCID: PMC8125909 DOI: 10.3390/cancers13092262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
Background: The management of patients with triple-negative breast cancer (TNBC) is challenging with several controversies and unmet needs. During the 12th Breast-Gynaecological & Immuno-oncology International Cancer Conference (BGICC) Egypt, 2020, a panel of 35 breast cancer experts from 13 countries voted on consensus guidelines for the clinical management of TNBC. The consensus was subsequently updated based on the most recent data evolved lately. Methods: A consensus conference approach adapted from the American Society of Clinical Oncology (ASCO) was utilized. The panellists voted anonymously on each question, and a consensus was achieved when ≥75% of voters selected an answer. The final consensus was later circulated to the panellists for critical revision of important intellectual content. Results and conclusion: These recommendations represent the available clinical evidence and expert opinion when evidence is scarce. The percentage of the consensus votes, levels of evidence and grades of recommendation are presented for each statement. The consensus covered all the aspects of TNBC management starting from defining TNBC to the management of metastatic disease and highlighted the rapidly evolving landscape in this field. Consensus was reached in 70% of the statements (35/50). In addition, areas of warranted research were identified to guide future prospective clinical trials.
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Affiliation(s)
- Hesham Elghazaly
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Hope S. Rugo
- Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco, CA 94158, USA
| | - Hamdy A. Azim
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza 12613, Egypt; (H.A.A.); (H.M.E.-Z.)
| | - Sandra M. Swain
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, MedStar Health, Washington, DC 20007, USA;
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Matti Aapro
- Breast Center, Clinique de Genolier, 1272 Genolier, Switzerland;
| | - Edith A. Perez
- Department of Hematology & Oncology, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Benjamin O. Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98195, USA;
| | - Frederique Penault-Llorca
- Department of Pathology, Clermont Auvergne University, INSERM U1240 “Molecular Imaging and Theranostic Strategies”, Center Jean Perrin, Montalembert, 63000 Clermont-Ferrand, France;
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy; (P.C.); (V.G.)
| | - Nagi S. El Saghir
- Department of Internal Medicine, Division of Hematology Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, Kuala Lumpur 47500, Malaysia;
| | - Marwan Ghosn
- Hematology and Oncology Department, Saint Joseph University, Beirut 1104 2020, Lebanon;
| | - Philip Poortmans
- Iridium Kankernetwerk and Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk-Antwerp, Belgium;
| | - Mohamed A. Shehata
- Clinical oncology Department, Menoufia University, Shebin Elkom 51132, Egypt;
| | - Armando E. Giuliano
- Department of Surgery, Surgical Oncology Division, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Jessica W. T. Leung
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Istituto Oncologico Veneto IOV IRCCS, 35128 Padova, Italy; (P.C.); (V.G.)
| | - Joseph Gligorov
- Institut Universitaire de Cancérologie AP-HP. Sorbonne Université, INSERM U938, 75013 Paris, France;
| | - Bahadir M. Gulluoglu
- Breast & Endocrine Surgery Unit, Marmara University School of Medicine, University Hospital, Istanbul 34722, Turkey;
| | - Hany Abdel Aziz
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Mona Frolova
- Federal State Budgetary Institution “NN Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 127994 Moscow, Russia;
| | - Mohamed Sabry
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Charles M. Balch
- Surgical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Roberto Orecchia
- Scientific Directorate, IRCCS European Institute of Oncology (IEO), and University of Milan, 20122 Milan, Italy;
| | - Heba M. El-Zawahry
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza 12613, Egypt; (H.A.A.); (H.M.E.-Z.)
| | | | - Khaled Abdel Karim
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Alaa Kandil
- Department of Clinical Oncology, Alexandria School of Medicine, Alexandria 21131, Egypt;
| | - Ruslan M. Paltuev
- Russian Association of Oncological Mammology, Department of Breast Tumours of Federal State Budgetary Institution “Petrov Research Institute of Oncology”, 197758 Saint Petersburg, Russia;
| | - Meteb Foheidi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 22384, Saudi Arabia;
| | - Mohamed El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
- Vice President of Galala University, Galala University, Suez 435611, Egypt
| | - Manal ElMahdy
- Department of Pathology, Ain shams University, Cairo 11566, Egypt;
| | - Omalkhair Abulkhair
- Oncology Department, Alfaisal university, Alhabib Hospital, Riyad 11533, Saudi Arabia;
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China;
| | - Adel T. Aref
- The School of Public Health, University of Adelaide, Adelaide 5005, Australia;
| | - Joaira Bakkach
- Biomedical Genomics & Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, Abdel Malek Essaadi University, Tangier 90000, Morocco;
| | - Nermean Bahie Eldin
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
| | - Hagar Elghazawy
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt; (H.A.A.); (M.S.); (K.A.K.); (N.B.E.); (H.E.)
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16
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Mohan SC, Walcott-Sapp S, Lee MK, Srour MK, Kim S, Amersi FF, Giuliano AE, Chung AP. Alterations in Breast Cancer Biomarkers Following Neoadjuvant Therapy. Ann Surg Oncol 2021; 28:5907-5917. [PMID: 33748896 DOI: 10.1245/s10434-021-09814-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/09/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Biomarker changes in patients with residual disease (RD) after neoadjuvant systemic therapy (NAT) have unclear consequences. This study examined the prevalence of biomarker [hormone receptor (HR) and HER2] change and its effect on disease-free survival (DFS) and overall survival (OS). PATIENTS AND METHODS A total of 303 patients treated with NAT from 2008 to 2016 were identified from a prospective database. Biomarker status at diagnosis was determined and retested after NAT in patients with RD. DFS and OS were compared among three groups: no biomarker change, clinically insignificant change in either ER or PR without alteration in HR status, and clinically significant change in at least one biomarker with resultant change in HR or HER2 status. Subgroups with no change and HR change were examined [HR+HER2- no change, triple negative (TN) no change, HR+HER2- to TN, TN to HR+HER2]. RESULTS Overall, 61.4% of patients had RD. Of these, 32.8% had changes in at least one biomarker. At median follow up of 5.48 years, no biomarker change was associated with improved DFS compared with changes in HR or HER2 status (p = 0.043). In addition, no biomarker change (p = 0.005) and clinically insignificant changes in biomarker status (p = 0.019) were associated with improved OS compared with clinically significant changes in HR or HER2 status. Among subgroups, HR+HER2- to TN was associated with worse DFS (p = 0.029) and OS (p = 0.008) compared with HR+HER2- no change. CONCLUSIONS Among those with RD, biomarker status change was common and impacted survival in subgroups of HR+ or TN disease. Retesting biomarkers after NAT has prognostic implications.
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Affiliation(s)
| | - Sarah Walcott-Sapp
- Marion-Louise Saltzman Women's Center, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
| | - Minna K Lee
- Division of Surgical Oncology, Department of Surgery, Cedars Sinai Medical Center, West Hollywood, CA, USA
| | - Marissa K Srour
- Division of Surgical Oncology, Department of Surgery, Cedars Sinai Medical Center, West Hollywood, CA, USA
| | - Sungjin Kim
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Samuel Oschin Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Farin F Amersi
- Division of Surgical Oncology, Department of Surgery, Cedars Sinai Medical Center, West Hollywood, CA, USA
| | - Armando E Giuliano
- Division of Surgical Oncology, Department of Surgery, Cedars Sinai Medical Center, West Hollywood, CA, USA
| | - Alice P Chung
- Division of Surgical Oncology, Department of Surgery, Cedars Sinai Medical Center, West Hollywood, CA, USA.
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17
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Yi ZB, Yu P, Zhang S, Wang WN, Han YQ, Ouyang QC, Yan M, Wang XJ, Hu XC, Jiang ZF, Huang T, Tong ZS, Wang SS, Yin YM, Li H, Yang RX, Yang HW, Teng YE, Sun T, Cai L, Li HY, Chen X, He JJ, Liu XL, Yang SE, Wang JY, Fan JH, Qiao YL, Xu BH. Profile and outcome of receptor conversion in breast cancer metastases: a nation-wide multicenter epidemiological study. Int J Cancer 2020; 148:692-701. [PMID: 32700765 DOI: 10.1002/ijc.33227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022]
Abstract
Although receptor status including estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) of the primary breast tumors was related to the prognosis of breast cancer patients, little information is yet available on whether patient management and survival are impacted by receptor conversion in breast cancer metastases. Using data from the nation-wide multicenter clinical epidemiology study of advanced breast cancer in China (NCT03047889), we report the situation of retesting ER, PR and HER2 status for breast cancer metastases and evaluate the patient management and prognostic value of receptor conversion. In total, 3295 patients were analyzed and 1583 (48.0%) patients retesting receptor status for metastasis. Discordance in one or more receptors between the primary and the metastatic biopsy was found in 37.7% of women. Patients who remained hormone receptor (HR) positive in their metastases had similar progression-free survival of first-line and second-line treatment compared to patients with HR conversion (P > .05). In multivariate analysis, patients who showed ER conversion from negative to positive had longer disease-free survival (DFS) than patients who remained negative in their metastases (hazard ratio, 2.05; 95% confidence interval [CI], 1.45-2.90; P < .001). Patients with PR remained positive and had longer DFS than patients with PR conversion from negative to positive (hazard ratio, 0.56; 95% CI, 0.38-0.83; P = .004). Patients with PR conversion have shorter overall survival than patients with PR remained positive or negative (P = .016 and P = .041, respectively). Our findings showed that the receptors' conversions were common in metastatic breast cancer, and the conversion impacted the survival.
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Affiliation(s)
- Zong-Bi Yi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei Yu
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Su Zhang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Na Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Qun Han
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qu-Chang Ouyang
- Department of Breast Cancer Medical Oncology, Hunan Cancer Hospital, Changsha, China
| | - Min Yan
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Xiao-Jia Wang
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xi-Chun Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ze-Fei Jiang
- Department of Breast Cancer, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhong-Sheng Tong
- Department of Breast Oncology, Key Laboratory of Breast Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Shu-Sen Wang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yong-Mei Yin
- Department of Medical Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Li
- Department of Breast Surgery, Sichuan Province Tumor Hospital, Chengdu, Sichuan, China
| | - Run-Xiang Yang
- Department of Medical Oncology, Yunnan Cancer Hospital, Kunming Medical University, Kunming, China
| | - Hua-Wei Yang
- Department of Breast Surgery, Cancer Hospital, Guangxi Medical University, Guangxi, China
| | - Yue-E Teng
- Departments of Medical Oncology and Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Tao Sun
- Department of Medical Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Key Laboratory of Liaoning Breast Cancer Research, Shenyang, China
| | - Li Cai
- The 4th Department of Internal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hong-Yuan Li
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Xi Chen
- Department of Medicine Oncology, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Jian-Jun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xin-Lan Liu
- Department of Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Shun-E Yang
- Department of Breast Cancer and Lymphoma, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Jia-Yu Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin-Hu Fan
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing-He Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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Rey-Vargas L, Mejía-Henao JC, Sanabria-Salas MC, Serrano-Gomez SJ. Effect of neoadjuvant therapy on breast cancer biomarker profile. BMC Cancer 2020; 20:675. [PMID: 32682413 PMCID: PMC7368678 DOI: 10.1186/s12885-020-07179-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Breast cancer clinical management requires the assessment of hormone receptors (estrogen (ER) and progesterone receptor (PR)), human epidermal growth factor receptor 2 (HER2) and cellular proliferation index Ki67, by immunohistochemistry (IHC), in order to choose and guide therapy according to tumor biology. Many studies have reported contradictory results regarding changes in the biomarker profile after neoadjuvant therapy (NAT). Given its clinical implications for the disease management, we aimed to analyze changes in ER, PR, HER2, and Ki67 expression in paired core-needle biopsies and surgical samples in breast cancer patients that had either been treated or not with NAT. METHODS We included 139 patients with confirmed diagnosis of invasive ductal breast carcinoma from the Colombian National Cancer Institute. Variation in biomarker profile were assessed according to NAT administration (NAT and no-NAT treated cases) and NAT scheme (hormonal, cytotoxic, cytotoxic + trastuzumab, combined). Chi-squared and Wilcoxon signed-rank test were used to identify changes in biomarker status and percentage expression, respectively, in the corresponding groups. RESULTS We did not find any significant variations in biomarker status or expression values in the no-NAT group. In cases previously treated with NAT, we did find a statistically significant decrease in Ki67 (p < 0.001) and PR (p = 0.02605) expression. When changes were evaluated according to NAT scheme, we found a significant decrease in both Ki67 status (p = 0.02977) and its expression values (p < 0.001) in cases that received the cytotoxic treatment. CONCLUSIONS Our results suggest that PR and Ki67 expression can be altered by NAT administration, whereas cases not previously treated with NAT do not present IHC biomarker profile variations. The re-evaluation of these two biomarkers after NAT could provide valuable information regarding treatment response and prognosis for breast cancer patients.
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Affiliation(s)
- Laura Rey-Vargas
- Grupo de investigación en biología del cáncer, Instituto Nacional de Cancerología, Calle 1a #9-85, Bogotá D. C, Colombia.,Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | | | - Silvia J Serrano-Gomez
- Grupo de investigación en biología del cáncer, Instituto Nacional de Cancerología, Calle 1a #9-85, Bogotá D. C, Colombia.
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Bovbjerg ML, Cheyney M. Current Resources for Evidence-Based Practice, July 2020. J Obstet Gynecol Neonatal Nurs 2020; 49:391-404. [PMID: 32574584 PMCID: PMC7305877 DOI: 10.1016/j.jogn.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of whether it is ethical not to offer doula care to all women, and commentaries on reviews focused on folic acid and autism spectrum disorder, and timing of influenza vaccination during pregnancy.
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