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Wang W, Zhang J, Chang JY, Yao DS, Hu F, Liang YP, Shen Y, Liu YQ, Qi HH, Tong JB, Cai HF. The efficacy and safety of using pyrotinib combined with capecitabine as neoadjuvant therapy in elderly patients with HER2-positive breast cancer: a single-arm prospective clinical trial. Gland Surg 2023; 12:208-214. [PMID: 36915823 PMCID: PMC10005991 DOI: 10.21037/gs-23-11] [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: 12/01/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023]
Abstract
Background Pyrotinib combined with capecitabine has been approved for the treatment of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer in China. To date, the management of early-stage or locally advanced HER2-positive breast cancer in the clinic remains challenging. We conducted this trial to investigate the efficacy and safety of pyrotinib combined with capecitabine as neoadjuvant therapy (NAT) in elderly patients with HER2-positive breast cancer. Due to the stimulation of blood vessels by chemotherapy drugs, the elasticity of blood vessels in the elderly decreases, and then chemotherapy infusion is more likely to lead to phlebitis. Both pyrotinib and capecitabine can be taken to facilitate home treatment for elderly patients with HER2-positive breast cancer (BC). Methods From January 2020 to March 2021, patients aged between 70 and 81 years old with stage IIA-IIIB HER2-positive breast cancer were screened, enrolled, and assigned to receive six cycles of pyrotinib (320-400 mg, orally, once daily) plus capecitabine (1,250 mg/m2, orally, twice daily) on days 1-14 in every 21-day cycle. The primary endpoint was the objective response rate (ORR). Adverse events (AEs) were assessed in every neoadjuvant cycle. Surgery was performed after the last cycle, and the total pathological complete response (tpCR) was evaluated postoperatively. Results Of the 23 patients enrolled, the ORR was 100% (23/23; 95% confidence intervals: 85 to 100). All patients underwent surgery with a tpCR rate of 43.5% (10/23; 95% confidence intervals: 23 to 66). The most common AE was diarrhea, occurring in 19 of 23 patients (82.6%); most of these patients sustained mild diarrhea (Grade 1 or Grade 2) and only three had moderate diarrhea (Grade 3). The incidences of other AEs, including weakness, loss of appetite, leukopenia, nausea, vomiting, hand-foot syndrome, etc., were low and the symptoms were mild. No severe AEs (Grade 4 or 5) were observed throughout the treatment. Conclusion In our study, pyrotinib combined with capecitabine as neoadjuvant therapy in elderly women with HER2-positive breast cancer is safe and showed efficacy in this population, which may be widely used as a protocol for clinical neoadjuvant therapy.
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Affiliation(s)
- Wei Wang
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China.,School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Juan Zhang
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
| | - Jin-Yi Chang
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China.,School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - De-Shun Yao
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
| | - Fen Hu
- College of Life Sciences, North China University of Science and Technology, Tangshan, China
| | - Yong-Ping Liang
- Department of Medical Imaging (Ultrasound), Tangshan People's Hospital, Tangshan, China
| | - Yan Shen
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China.,School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Yu-Qi Liu
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China.,School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Huai-Hua Qi
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
| | - Jian-Bin Tong
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China.,Hunan Province Key Laboratory of Brain Homeostasis, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Hai-Feng Cai
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
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2
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Wang M, Ding Q, Gu J, Sfamenos SM, Huo L, Tang Z, Sun H, Robinson M, Tang G, Lim B, Wu Y, Albarracin CT, Sahin AA, Chen H. Breast Cancer With a HER2 FISH Group 2 Result: Should HER2 Tests be Repeated? Clin Breast Cancer 2023; 23:415-422. [PMID: 36878823 DOI: 10.1016/j.clbc.2023.02.006] [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: 12/21/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Breast cancer with fluorescence in situ hybridization (FISH) group 2 pattern (HER2 <4 and HER2/CEP17 ratio ≥2, a subset of monosomy CEP17) was historically considered HER2-positive, but mostly HER2-negative according to updated 2018 American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines unless 3+ by immunohistochemistry (IHC). Therapeutic relevance of this group remained elusive, therefore we assessed if repeat IHC and FISH can assist final HER2 classification. PATIENT AND METHODS We retrospectively reviewed HER2 FISH performed at our institution from 2014 to 2018 and identified 23 of 3554 (0.6%) breast cancer cases with at least one-time measurement of HER2 FISH categorized as group 2. Repeat HER2 tests were performed for cases with available alternative tumor samples and compared with initial testing following 2018 ASCO/CAP guidelines. RESULTS Only 1 of 23 group 2 cases was HER2-positive, 0/18 in primary and 1/5 in metastatic/recurrent tumors. Of 13 primary tumors with repeat HER2 results; 10 (77%) remained HER2-negative; 3 (23%) changed from HER2-negative (group 2 and IHC 2+) to HER2-positive (group 1 and IHC 2+). Among 8 of these 13 patients receiving neoadjuvant systemic therapy containing anti-HER2 agent, 3 (38%) achieved pathologic complete response (pCR). Two of 3 pCR cases were HER2-positive converters on repeat testing. Three pCR cases were ER-negative or -low positive and Ki67 ≥40%, while 5 partial responders were ER-positive and Ki67 <40% (P < .05). CONCLUSION Breast cancer with HER2 FISH group 2 result may represent heterogeneous populations of tumor cells being originated de novo or preferentially selected secondary to therapy. Repeat HER2 tests on alternative samples may be considered to guide anti-HER2 therapy.
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Affiliation(s)
- Minhua Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Qingqing Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jun Gu
- The University of Texas MD Anderson Cancer Center, School of Health Professions, Houston, TX
| | - Steven M Sfamenos
- The University of Texas MD Anderson Cancer Center, School of Health Professions, Houston, TX
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhenya Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hongxia Sun
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa Robinson
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bora Lim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yun Wu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Aysegul A Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hui Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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3
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Zhou S, Lv H, Li A, Li M, Zhong S, Lu H, Zhou X, Bai Q, Yang W. A clinicopathological study and survival analysis of 99 breast cancers with HER2/CEP17 ratio ≥ 2.0 and an average HER2 copy number < 4.0 per cell in China. BMC Cancer 2023; 23:84. [PMID: 36698078 PMCID: PMC9875391 DOI: 10.1186/s12885-023-10531-z] [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: 05/02/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Breast cancer patients of American Society of Clinical Oncology and the College of American Pathologists (ASCO/CAP) Group 2 were all HER2-negative according to the 2018 guideline, not HER2-positive as defined in the 2013 guideline. METHODS We aims to elucidate the unique clinicopathological features of ASCO/CAP Group 2 patients by comparing with classic HER2-nonamplified cancers, and reveal the efficacy of the former to anti-HER2 therapy. The clinicopathological features, treatment and prognosis information of 99 patients between 2014 and 2018 were collected. HER2 status was re-defined using the updated recommendations. RESULTS Of the 99 ASCO/CAP Group 2 tumors, 25.5% (25/99) tumors were immunohistochemical (IHC) 0/1+ and 74.7% (74/99) tumors were IHC 2+. According to the updated 2018 guideline, all of them were HER2 negative. When compared to ASCO/CAP Group 5, patients of ASCO/CAP Group 2 displayed higher ratio of histological grade 3 (P = .03), high Ki67 proliferation index (P = .03) and pN3 (more than 9 lymph nodes metastasis, P = .02), and lower estrogen receptor (ER) positivity (P = .04). There was no statistical difference in the survival of patients received anti-HER2 therapy and patients not received anti-HER2 therapy. CONCLUSIONS Patients of ASCO/CAP Group 2 did not received apparent benefit from anti-HER2 treatment. Although according to the updated guidelines and latest reports, HER2 is negative, but when compared with classic HER2-nonamplified cancers, patients of this group seemed to be more aggressive. We suggest that this group still be regarded as an independent category, in order to accumulate more cases in the future to expand the scope of research.
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Affiliation(s)
- Shuling Zhou
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Hong Lv
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Anqi Li
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Ming Li
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Siyuan Zhong
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Hongfen Lu
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Xiaoyan Zhou
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Qianming Bai
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
| | - Wentao Yang
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 P. R. China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai, 200032 P. R. China
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4
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Katayama A, Starczynski J, Toss MS, Shaaban AM, Provenzano E, Quinn CM, Callagy G, Purdie CA, Millican-Slater R, Purnell D, Chagla L, Oyama T, Pinder SE, Chan S, Ellis I, Lee AHS, Rakha EA. The frequency and clinical significance of centromere enumeration probe 17 alterations in HER2 immunohistochemistry-equivocal invasive breast cancer. Histopathology 2022; 81:511-519. [PMID: 35879836 PMCID: PMC9545957 DOI: 10.1111/his.14728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022]
Abstract
Background and aims Chromosome 17 alterations affect the assessment of HER2 gene amplification in breast cancer (BC), but its clinical significance remains unclear. This study aimed to identify the prevalence of centromere enumeration probe 17 (CEP17) alterations, and its correlation with response to neoadjuvant therapy (NAT) in BC patients with human epidermal growth factor receptor 2 (HER2) immunohistochemistry‐equivocal score. Methods and results A large BC cohort (n = 6049) with HER2 immunohistochemistry score 2+ and florescent in‐situ hybridisation (FISH) results was included to assess the prevalence of CEP17 alterations. Another cohort (n = 885) with available clinicopathological data was used to evaluate the effect of CEP17 in the setting of NAT. HER2‐amplified tumours with monosomy 17 (CEP17 copy number < 1.5 per nucleus), normal 17 (CEP17 1.5–< 3.0) and polysomy 17 (CEP17 ≥ 3.0) were observed in 16, 59 and 25%, respectively, compared with 3, 74 and 23%, respectively, in HER2‐non‐amplified tumours. There was no significant relationship between CEP17 alterations and pathological complete response (pCR) rate in both HER2‐amplified and HER2‐non‐amplified tumours. The independent predictors of pCR were oestrogen (ER) negativity in HER2‐amplified tumours [ER negative versus positive; odds ratio (OR) = 11.80; 95% confidence interval (CI) = 1.37–102.00; P = 0.02], and histological grade 3 in HER2 non‐amplified tumours (3 versus 1, 2; OR = 5.54; 95% CI = 1.61–19.00; P = 0.007). Conclusion The impacts of CEP17 alterations are not as strong as those of HER2/CEP17 ratio and HER2 copy number. The hormonal receptors status and tumour histological grade are more useful to identify BC patients with a HER2 immunohistochemistry‐equivocal score who would benefit from NAT.
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Affiliation(s)
- Ayaka Katayama
- Translational Medical Sciences Unit, School of Medicine, University of Nottingham, Nottingham, UK.,Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Jane Starczynski
- Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trust, Edgebaston, Birmingham, UK
| | - Michael S Toss
- Translational Medical Sciences Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Abeer M Shaaban
- Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trust, Edgebaston, Birmingham, UK.,Institute of Cancer and Genomic Sciences, The University of Birmingham, Edgebaston, Birmingham, UK
| | - Elena Provenzano
- Department of Histopathology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Cecily M Quinn
- Department of Histopathology, St. Vincent's University Hospital, Dublin, and School of Medicine, University College Dublin, Ireland
| | - Grace Callagy
- Discipline of Pathology, School of Medicine, Lambe Institute for Translational Research, NUI, Galway, Ireland
| | - Colin A Purdie
- Department of Breast Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | | | - David Purnell
- Histopathology department, University Hospitals of Leicester, Leicester, UK
| | - Leena Chagla
- Burney Breast Unit , St Helens and Knowsley Teaching Hospital NHS Trust, UK
| | - Tetsunari Oyama
- Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sarah E Pinder
- Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - Steve Chan
- Department of Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ian Ellis
- Translational Medical Sciences Unit, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, City Hospital Nottingham, UK
| | - Andrew H S Lee
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, City Hospital Nottingham, UK
| | - Emad A Rakha
- Translational Medical Sciences Unit, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, City Hospital Nottingham, UK
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5
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Cserni G, Francz M, Járay B, Kálmán E, Kovács I, Krenács T, Tóth E, Udvarhelyi N, Vass L, Vörös A, Krivokuca A, Kajo K, Kajová Macháleková K, Kulka J. Pathological Diagnosis, Work-Up and Reporting of Breast Cancer 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610373. [PMID: 35845921 PMCID: PMC9284216 DOI: 10.3389/pore.2022.1610373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/29/2022] [Indexed: 12/18/2022]
Abstract
This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future.
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Affiliation(s)
- Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
- Institute of Pathology, University of Szeged, Szeged, Hungary
- *Correspondence: Gábor Cserni,
| | - Monika Francz
- Department of Pathology, Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, “Jósa András” Teaching Hospital, Nyíregyháza, Hungary
| | | | - Endre Kálmán
- Institute of Pathology, University of Pécs, Pécs, Hungary
| | - Ilona Kovács
- Department of Pathology, University of Debrecen, “Kenézy Gyula” University Hospital, Debrecen, Hungary
| | - Tibor Krenács
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Erika Tóth
- Department of Pathology, National Institute of Oncology, Budapest, Hungary
| | - Nóra Udvarhelyi
- Department of Pathology, National Institute of Oncology, Budapest, Hungary
| | - László Vass
- Department of Pathology, Pest County “Flór Ferenc” University Teaching Hospital, Kistarcsa, Hungary
| | - András Vörös
- Institute of Pathology, University of Szeged, Szeged, Hungary
| | - Ana Krivokuca
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Karol Kajo
- Department of Pathology, St. Elisabeth Cancer Institute, Bratislava, Slovakia
| | | | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
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6
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Hoda RS, Zarei S, McIntire PJ, Sprague C, Mekhail Y, Carlson DL, Komforti MK, Downs-Kelly EP. Clinical and Pathologic Features Associated With Invasive Breast Carcinoma with 2018 American Society of Clinical Oncology/College of American Pathologists In Situ Hybridization Group 2 Results (Human Epidermal Growth Factor Receptor 2 [HER2]/Chromosome 17 Centromere [CEP17] Ratio ≥2.0 and Average HER2 Copy Number <4.0). Arch Pathol Lab Med 2021; 146:701-709. [PMID: 34559875 DOI: 10.5858/arpa.2021-0155-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The American Society of Clinical Oncology/College of American Pathologists updated the human epidermal growth factor receptor 2 (HER2) breast carcinoma testing guideline in 2018 to address issues from uncommon HER2 fluorescence in situ hybridization (FISH) results. Based on the 2013 American Society of Clinical Oncology/College of American Pathologists guideline, cases wherein the HER2/chromosome 17 centromere (CEP17) ratio of 2.0 or more with an average HER2 copy number of less than 4.0 were considered in situ hybridization (ISH) positive. Under the 2018 guideline, such cases are classified as ISH Group 2 and are no longer considered eligible for anti-HER2 therapy when the corresponding HER2 immunohistochemistry result is 0, 1+, or 2+. OBJECTIVE.— To assess the clinical, pathologic, and treatment aspects of patients with ISH Group 2 results. DESIGN.— We retrospectively reviewed HER2 FISH results at our center between January 2012 and December 2014 and identified and characterized cases with ISH Group 2 results. RESULTS.— Thirty-nine cases with ISH Group 2 results from 39 patients were reviewed. Twenty of 39 (51%) patients received anti-HER2 therapy. Patients treated with HER2-targeted therapy were less likely to have hormone receptor-positive tumors, compared with patients without anti-HER2 treatment, though not significantly (P = .30). The only significant difference between the 2 patient groups was receipt of cytotoxic chemotherapy treatment (P < .001). Overall, clinical outcome was similar between the 2 groups (P > .99). CONCLUSIONS.— This retrospective study with median follow-up of at least 6 years shows patients with ISH Group 2 tumors had similar clinical outcomes, irrespective of HER2-targeted therapy. Further analysis in the prospective setting would provide valuable data that would potentially inform clinical decision making.
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Affiliation(s)
- Raza S Hoda
- From the Robert J Tomsich Pathology & Laboratory Medicine Institute (Hoda, McIntire, Sprague, Komforti, Downs-Kelly)
| | - Shabnam Zarei
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio (Zarei)
| | - Patrick J McIntire
- From the Robert J Tomsich Pathology & Laboratory Medicine Institute (Hoda, McIntire, Sprague, Komforti, Downs-Kelly)
| | - Cathy Sprague
- From the Robert J Tomsich Pathology & Laboratory Medicine Institute (Hoda, McIntire, Sprague, Komforti, Downs-Kelly)
| | - Yasmin Mekhail
- Department of Diagnostic Radiology (Mekhail), Cleveland Clinic, Cleveland, Ohio
| | - Diane L Carlson
- Department of Pathology, Cleveland Clinic Florida, Weston, Florida (Carlson)
| | - Miglena K Komforti
- From the Robert J Tomsich Pathology & Laboratory Medicine Institute (Hoda, McIntire, Sprague, Komforti, Downs-Kelly)
| | - Erinn P Downs-Kelly
- From the Robert J Tomsich Pathology & Laboratory Medicine Institute (Hoda, McIntire, Sprague, Komforti, Downs-Kelly)
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7
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Wang C, Tsang JY, Poon IK, Shao Y, Li JJ, Shea KH, Hlaing T, Wong SI, Tse GM. An Evaluation of Clinicopathological Correlation and Outcome of Human Epidermal Growth Factor Receptor 2 Subgroups Reclassified According to the Latest ASCO/CAP Guideline. Clin Breast Cancer 2021; 22:e114-e122. [PMID: 34119429 DOI: 10.1016/j.clbc.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/25/2021] [Accepted: 05/08/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The latest American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guideline has updated the interpretation of uncommon human epidermal growth factor receptor 2 (HER2) in situ hybridization (ISH) patterns (groups 2-4) with concomitant HER2 immunohistochemistry, leading to changes in the diagnosis of these subgroups. We sought to assess the clinicopathological features and outcomes in these subgroups in detail with our local cohort. PATIENTS AND METHODS Clinicopathologic features of groups 2 to 4 were compared to the typical amplified group (group 1: HER2/CEP17 ≥ 2, HER2 ≥ 4) and non-amplified group (group 5: HER2/CEP17 < 2, HER2 < 4). RESULTS Group 2 (HER2/CEP17 ≥ 2, HER2 < 4) cases showed lower Ki67 expression and grade (P ≤ .002) than group 1 but no differences compared with group 5. Group 4 (HER2/CEP17 < 2, HER2 = 4-6) cases were associated with less necrosis, more estrogen receptor positivity, lower grade, more nodal metastases, and more special histotypes (P ≤ .037) than group 1, but higher grade and more nodal metastases (P ≤ .021) than group 5. Except for presenting as a larger tumor and of special histotypes, group 3 (HER2/CEP17 < 2, HER2 ≥ 6) cases showed no other significant differences from group 1, but were of higher grade and Ki67 level than groups 2, 4, and 5. Group 4, similar to group 5, showed worse survival than group 1 (disease-free survival: log-rank = 5.547, P = .019; overall survival: log-rank = 4.678, P = .031). The rate of relapse was similar in group 4 with and without anti-HER2 therapy, albeit with limited cases. CONCLUSION Our findings indicate more similarities among groups 2, 4, and 5 than between groups 1 and 3, supporting the HER2 categorization in the latest guideline. Additional studies may be warranted to assess the outcomes of these patients with different management approaches.
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Affiliation(s)
- Chao Wang
- Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Julia Y Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ivan K Poon
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yan Shao
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joshua J Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ka-Ho Shea
- Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Thazin Hlaing
- Department of Anatomic Pathology, Centro Hospitalar Conde de Sao Januario, Macau, People's Republic of China
| | - Sio-In Wong
- Department of Anatomic Pathology, Centro Hospitalar Conde de Sao Januario, Macau, People's Republic of China
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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8
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Katayama A, Miligy IM, Shiino S, Toss MS, Eldib K, Kurozumi S, Quinn CM, Badr N, Murray C, Provenzano E, Callagy G, Martyn C, Millican-Slater R, Purdie C, Purnell D, Pinder SE, Oyama T, Shaaban AM, Ellis I, Lee AHS, Rakha EA. Predictors of pathological complete response to neoadjuvant treatment and changes to post-neoadjuvant HER2 status in HER2-positive invasive breast cancer. Mod Pathol 2021; 34:1271-1281. [PMID: 33526875 PMCID: PMC8216906 DOI: 10.1038/s41379-021-00738-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 01/16/2023]
Abstract
The response of human epidermal growth factor receptor2 (HER2)- positive breast cancer (BC) patients to anti-HER2 targeted therapy is significant. However, the response is not uniform and a proportion of HER2-positive patients do not respond. This study aims to identify predictors of response in the neoadjuvant treatment and to assess the discordance rate of HER2 status between pre- and post-treatment specimens in HER2-positive BC patients. The study group comprised 500 BC patients treated with neoadjuvant chemotherapy (NACT) and/or neoadjuvant anti-HER2 therapy and surgery who had tumours that were 3+ or 2+ with HER2 immunohistochemistry (IHC). HER2 IHC 2+ tumours were classified into five groups by fluorescence in situ hybridisation (FISH) according to the 2018 ASCO/CAP guidelines of which Groups 1, 2 and 3 were considered HER2 amplified. Pathological complete response (pCR) was more frequent in HER2 IHC 3+ tumours than in HER2 IHC 2+/HER2 amplified tumours, when either in receipt of NACT alone (38% versus 13%; p = 0.22) or neoadjuvant anti-HER2 therapy (52% versus 20%; p < 0.001). Multivariate logistic regression analysis showed that HER2 IHC 3+ and histological grade 3 were independent predictors of pCR following neoadjuvant anti-HER2 therapy. In the HER2 IHC 2+/HER2 amplified tumours or ASCO/CAP FISH Group 1 alone, ER-negativity was an independent predictor of pCR following NACT and/or neoadjuvant anti-HER2 therapy. In the current study, 22% of HER2-positive tumours became HER2-negative by IHC and FISH following neoadjuvant treatment, the majority (74%) HER2 IHC 2+/HER2 amplified tumours. Repeat HER2 testing after neoadjuvant treatment should therefore be considered.
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Affiliation(s)
- Ayaka Katayama
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.256642.10000 0000 9269 4097Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Islam M. Miligy
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.411775.10000 0004 0621 4712Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Sho Shiino
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.272242.30000 0001 2168 5385Department of Breast Surgery, National Cancer Centre Hospital, Tokyo, Japan
| | - Michael S. Toss
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - Karim Eldib
- grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Sasagu Kurozumi
- grid.411731.10000 0004 0531 3030Department of Breast Surgery, International University of Health and Welfare, Narita, Japan ,grid.256642.10000 0000 9269 4097Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Cecily M. Quinn
- grid.412751.40000 0001 0315 8143Department of Histopathology, St. Vincent’s University Hospital, Dublin, and School of Medicine, University College Dublin, Dublin, Ireland
| | - Nahla Badr
- grid.411775.10000 0004 0621 4712Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt ,grid.6572.60000 0004 1936 7486Institute of Cancer and Genomic Sciences, The University of Birmingham, Edgebaston, Birmingham, UK
| | - Ciara Murray
- grid.412751.40000 0001 0315 8143Department of Histopathology, St. Vincent’s University Hospital, Dublin, and School of Medicine, University College Dublin, Dublin, Ireland
| | - Elena Provenzano
- grid.5335.00000000121885934Department of Histopathology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Grace Callagy
- grid.6142.10000 0004 0488 0789Discipline of Pathology, School of Medicine, Lambe Institute for Translational Research, NUI Galway, Galway, Ireland
| | - Cian Martyn
- grid.6142.10000 0004 0488 0789Discipline of Pathology, School of Medicine, Lambe Institute for Translational Research, NUI Galway, Galway, Ireland
| | | | - Colin Purdie
- grid.416266.10000 0000 9009 9462Department of Breast Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Dave Purnell
- grid.269014.80000 0001 0435 9078Histopathology department, University Hospitals of Leicester, Leicester, UK
| | - Sarah E. Pinder
- grid.13097.3c0000 0001 2322 6764Division of Cancer Studies, King’s College London, Guy’s Hospital, London, UK
| | - Tetsunari Oyama
- grid.256642.10000 0000 9269 4097Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Abeer M. Shaaban
- grid.6572.60000 0004 1936 7486Institute of Cancer and Genomic Sciences, The University of Birmingham, Edgebaston, Birmingham, UK
| | - Ian Ellis
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Andrew H. S. Lee
- grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Emad A. Rakha
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
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9
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Watanabe SN, Imai K, Nanjo H, Wakamatsu Y, Kimura Y, Katayose Y, Kamata S, Terata K, Takahashi E, Ibonai A, Yamaguchi A, Konno H, Yatsuyanagi M, Kudo C, Takashima S, Akagami Y, Nakamura R, Sato Y, Motoyama S, Nomura K, Minamiya Y. Rapid HER2 cytologic fluorescence in situ hybridization for breast cancer using noncontact alternating current electric field mixing. Cancer Med 2020; 10:586-594. [PMID: 33280268 PMCID: PMC7877363 DOI: 10.1002/cam4.3626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/07/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human epidermal growth factor receptor 2-in situ hybridization (HER2-ISH) is widely approved for diagnostic, prognostic biomarker testing of formalin-fixed paraffin-embedded tissue blocks. However, cytologic ISH analysis has a potential advantage in tumor samples such as pleural effusion and ascites that are difficult to obtain the histological specimens. Our aim was to evaluate the clinical reliability of a novel rapid cytologic HER2 fluorescence ISH protocol (rapid-CytoFISH). MATERIALS AND METHODS Using a new device, we applied a high-voltage/frequency, noncontact alternating current electric field to tissue imprints and needle rinses, which mixed the probe within microdroplets as the voltage was switched on and off (AC mixing). Cytologic samples (n = 143) were collected from patients with immunohistochemically identified HER2 breast cancers. The specimens were then tested using standard dual-color ISH using formalin-fixed paraffin-embedded tissue (FFPE-tissue DISH) for HER2-targeted therapies, CytoFISH, and rapid-CytoFISH (completed within 4 h). RESULTS All 143 collected cytologic specimens (50 imprinted cytology specimens from resected tumors and 93 liquid-based cytology specimens from needle rinses) were suitable for FISH analysis. The HER2/chromosome enumeration probe (CEP) 17 ratios did not significantly differ between FFPE-tissue DISH and either CytoFISH protocol. Based on HER2 scoring criteria, we found 95.1% agreement between FFPE-tissue DISH and CytoFISH (Cohen's kappa coefficient = 0.771 and 95% confidence interval (CI): 0.614-0.927). CONCLUSION CytoFISH could potentially serve as a clinical tool for prompt determination of HER2 status in breast cancer cytology. Rapid-CytoFISH with AC mixing will enable cancer diagnoses and HER2 status to be determined on the same day a patient comes to a clinic or hospital.
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Affiliation(s)
- Shin-Nosuke Watanabe
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Nanjo
- Department of Pathology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuki Wakamatsu
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | | | | | | | - Kaori Terata
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Eriko Takahashi
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Ayano Ibonai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Ayuko Yamaguchi
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hikari Konno
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Misako Yatsuyanagi
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Chiaki Kudo
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinogu Takashima
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | | | | | - Yusuke Sato
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoru Motoyama
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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10
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Zhang L, Wang Y, Zhang L, Xing H, Niu C, Yu Q, Tang L. Invasive Micropapillary Carcinoma with CEP17 Monosomy of the Bilateral Breast: A Rare Case Report and Review of the Literature. Onco Targets Ther 2020; 13:6425-6432. [PMID: 32753884 PMCID: PMC7342458 DOI: 10.2147/ott.s251934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/19/2020] [Indexed: 01/11/2023] Open
Abstract
Invasive micropapillary carcinoma (IMPC) is a novel type of breast cancer which is potentially very aggressive and may show early lymphatic infiltration. Monosomy of chromosome 17 (m17) is rare in breast cancer, and according to the 2018 guidelines of the American Society of Clinical Oncology/College of American Pathologists, the decision to administer trastuzumab treatment should be made based on positive human epidermal growth factor receptor 2 results by immunohistochemistry. Here, we report a rare case of bilateral local advanced IMPC involving m17. A 33-year-old woman found a mass measuring 30 mm on the left breast that increased to 100 mm over 3 months. A diagnosis of IMPC was made based on the findings of core needle biopsies of bilateral breast masses and left axillary lymph node, and m17 was detected by fluorescence in situ hybridization (FISH). The patient underwent 6 cycles of neoadjuvant chemotherapy (docetaxel, epirubicin, and cyclophosphamide) and left-side modified radical mastectomy, left axillary lymph node dissection, right breast-conserving surgery, and right sentinel lymph node biopsy. Postoperative pathologic analysis of both breasts revealed IMPC, and m17 was confirmed by FISH. The patient received radiotherapy and endocrine therapy but rejected trastuzumab treatment. The patient was still alive at the 30-month follow-up, without recurrence or metastasis. Our findings suggest that loss of chromosome 17 may influence prognosis or therapeutic response, which needs to be further confirmed.
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Affiliation(s)
- Le Zhang
- Department of Breast Surgery, The Third Hospital of Jilin University, Changchun, Jilin 130033, People's Republic of China
| | - Yuechen Wang
- Department of Breast Surgery, Tohoku University Hospital, Sendai, Miyagi 980-0000, Japan
| | - Leichao Zhang
- Department of Pathology, The Third Hospital of Jilin University, Changchun, Jilin 130033, People's Republic of China
| | - Hua Xing
- Department of Breast Surgery, The Third Hospital of Jilin University, Changchun, Jilin 130033, People's Republic of China
| | - Chunbo Niu
- Department of Pathology, The Third Hospital of Jilin University, Changchun, Jilin 130033, People's Republic of China
| | - Qiong Yu
- Department of Radiology, The Third Hospital of Jilin University, Changchun, Jilin 130033, People's Republic of China
| | - Lu Tang
- Department of Breast Surgery, The Third Hospital of Jilin University, Changchun, Jilin 130033, People's Republic of China
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11
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Liu Y, Wu S, Shi X, Mao F, Zeng X. Breast Cancer With a HER2 IHC2+ and FISH HER2/CEP17 Ratio ≥2.0 and an Average HER2 Gene Copy Number <4.0 per Tumor Cell: HER2 mRNA Overexpression Is a Rare Event. Front Oncol 2020; 10:985. [PMID: 32637359 PMCID: PMC7318106 DOI: 10.3389/fonc.2020.00985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/19/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: For breast cancer, accurately illustrating HER2 characteristics is a critical precondition for evaluating the prognosis and predicting the efficacy of anti-HER2 therapy. Our purpose was to expose HER2 mRNA expression through an in situ hybridization assay (RNAscope), to aid the identification of HER2 status in breast cancers with a previously controversial classification for patients suffering from a HER2 IHC2+ and HER2/CEP17 ≥2.0 and a <4.0 mean HER2 gene copy number/cell (entitled FISH group 2 by update 2018 HER2 testing guideline). Methods: A total of 8,983 cases of breast cancer with a known HER2 status detected by initial IHC, and a necessary reflex FISH assay for those with IHC2+, were retrospectively analyzed. Then, 41 cases of HER2 IHC2+ in the FISH group 2 were collected and a RNAscope was performed. Results: The incidence of breast cancers with IHC2+ and in the FISH group 2 was 0.46% (41/8,983) in our single-institutional study cohort. In most of the cases (27/41, 65.9%), low levels of HER2 mRNA expression (score 1 and 2 by RNAscope) were demonstrated. Only one case (1/41, 2.4%) of high-level HER2 mRNA expression (score 4 by RNAscope), harboring a FISH HER2/CEP17 ratio of 2.06 and an average HER2 copy number of 3.70, was revealed. One case with the highest FISH HER2/CEP17 ratio of 3.90, showed the lowest level of HER2 mRNA expression (score 1 by RNAscope). Two cases with the same highest average HER2 signals/cell (3.95) by FISH possessed score 3 and score 2 with RNAscope, respectively. No cases with a score of 0 by RNAscope occurred in our sample. In the majority of cases (35/41, 85.4%), hypodisomy of chromosome 17 (average CEP17 signals/cell ≤1.75) was observed. There was no significant relationship between the mRNA expression and FISH results (average HER2 signals/cell, average CEP17 copy number, or HER2/CEP17 ratio) and clinicopathological features (ER and PR statuses, Ki 67 index, tumor size, and lymph node metastasis) in our population. Conclusion: HER2 mRNA overexpression was not a feature in our group of patients. Based on our data, breast cancers with HER2 IHC2+ and in FISH group 2 support a categorization of HER2 negative.
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Affiliation(s)
- Yuanyuan Liu
- Molecular Pathology Research Center, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shafei Wu
- Molecular Pathology Research Center, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaohua Shi
- Molecular Pathology Research Center, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuan Zeng
- Molecular Pathology Research Center, Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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12
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Zhang H, Moisini I, Ajabnoor RM, Turner BM, Hicks DG. Applying the New Guidelines of HER2 Testing in Breast Cancer. Curr Oncol Rep 2020; 22:51. [PMID: 32346807 DOI: 10.1007/s11912-020-0901-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The human epidermal growth factor receptor 2 (HER2) is an important prognostic and predictive biomarker in the breast cancer. The American Society of Clinical Oncology/College of American Pathology (ASCO/CAP) has published HER2 testing guidelines in breast cancer. We herein reviewed the HER2 testing guidelines in breast cancer with a focus on the application of the current guidelines. RECENT FINDINGS The continual investigation of HER2 testing in breast cancer has resulted in updates in the HER2 testing guidelines. The current guidelines focus on the uncommon clinical scenarios and emphasize the coordination between immunohistochemistry and in situ hybridization results, in an effort to improve clarity and accuracy. The ASCO/CAP guidelines provide valuable recommendations to ensure the accurate evaluation of HER2 status in breast cancer patients through standardization. Additional studies, particularly those with long-term outcome data are still needed to validate the guideline recommendations, especially the uncommon cases.
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Affiliation(s)
- Huina Zhang
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Ioana Moisini
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Rana M Ajabnoor
- Department of Pathology, Faculty of medicine, King Abdulaziz University, Jeddah, 21589, Kingdom of Saudi Arabia
| | - Bradley M Turner
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - David G Hicks
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 626, Rochester, NY, 14642, USA.
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13
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Wang B, Ding W, Sun K, Wang X, Xu L, Teng X. Impact of the 2018 ASCO/CAP guidelines on HER2 fluorescence in situ hybridization interpretation in invasive breast cancers with immunohistochemically equivocal results. Sci Rep 2019; 9:16726. [PMID: 31723206 PMCID: PMC6854277 DOI: 10.1038/s41598-019-53003-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/25/2019] [Indexed: 11/09/2022] Open
Abstract
The American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) recently issued updated guidelines on human epidermal growth factor receptor 2 (HER2) testing by fluorescence in situ hybridization (FISH) in invasive breast cancers. In this study, we aimed to investigate the impact of the new recommendations on HER2 FISH interpretation in invasive breast cancers with immunohistochemically (IHC) equivocal results. 1810 breast cancer cases with IHC equivocal results were enrolled in this study between January 2012 and May 2019. Concomitant IHC was performed on the same tissue blocks detected by FISH testing. According to the 2018 guidelines, all the cases in ISH group 2 were categorized as HER2 negative; three of four cases in ISH group 3 were considered as HER2 positive, while the one scored IHC 1+ was reclassified as HER2 negative; Fifty-three previously ISH equivocal cases were redistributed into ten HER2-positive cases and forty-three HER2-negative cases. In conclusion, the utility of 2018 ASCO/CAP guidelines resulted in a slight decrease in HER2 positive rate, due to the reclassification of cases in ISH group 2 and group 4. The implementation of the new guidelines can reduce reflex FISH test and make the diagnosis of HER2 gene status more definitive.
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Affiliation(s)
- Bo Wang
- Department of Pathology, the first affiliated hospital of Zhejiang University, Qingchun Road 79#, Hangzhou, China
| | - Wei Ding
- Department of Pathology, the first affiliated hospital of Zhejiang University, Qingchun Road 79#, Hangzhou, China
| | - Ke Sun
- Department of Pathology, the first affiliated hospital of Zhejiang University, Qingchun Road 79#, Hangzhou, China
| | - Xiaoling Wang
- Department of Pathology, the first affiliated hospital of Zhejiang University, Qingchun Road 79#, Hangzhou, China
| | - Liming Xu
- Department of Pathology, the first affiliated hospital of Zhejiang University, Qingchun Road 79#, Hangzhou, China
| | - Xiaodong Teng
- Department of Pathology, the first affiliated hospital of Zhejiang University, Qingchun Road 79#, Hangzhou, China.
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14
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Hoda RS, Brogi E, Xu J, Ventura K, Ross DS, Dang C, Robson M, Norton L, Morrow M, Wen HY. Impact of the 2018 American Society of Clinical Oncology/College of American Pathologists HER2 Guideline Updates on HER2 Assessment in Breast Cancer With Equivocal HER2 Immunohistochemistry Results With Focus on Cases With HER2/CEP17 Ratio <2.0 and Average HER2 Copy Number ≥4.0 and <6.0. Arch Pathol Lab Med 2019; 144:597-601. [PMID: 31647316 DOI: 10.5858/arpa.2019-0307-oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The American Society of Clinical Oncology/College of American Pathologists HER2 testing guideline in breast cancer was updated in 2018 to address issues on interpretation of uncommon results using dual-probe in situ hybridization according to the 2013 guideline. OBJECTIVE.— To assess impact of the 2018 guideline on breast cancer with equivocal HER2 immunohistochemistry results. DESIGN.— We retrospectively reviewed HER2 fluorescence in situ hybridization (FISH) data (HER2/CEP17 ratio and average HER2 copy number per cell) of HER2 immunohistochemistry-equivocal (2+ or 1+ to 2+) breast cancers at our center between January 2014 and May 2018 and compared HER2 FISH results according to 2013 and 2018 guidelines. RESULTS.— A total of 1666 HER2 FISH results from 1421 patients with equivocal HER2 immunohistochemistry were reviewed. Based on the 2013 guideline, HER2 FISH results were amplified in 346 cases (20.8%), equivocal in 242 (14.5%), and nonamplified in 1078 (64.7%). Using the 2018 guideline, 258 cases (16%) were reclassified, including 242 previously equivocal test results (15%) and 16 previously positive results (1%) reclassified as negative. The subset of 2013 HER2-equivocal and 2018 HER2-nonamplified cases with HER2/CEP17 ratio lower than 2.0 and average HER2 copy number 4.0 or higher and lower than 6.0 showed higher incidence of micropapillary morphology compared with HER2-amplified cases. Despite most patients in this group not receiving HER2-targeted treatment, 96% had no evidence of disease at follow-up. CONCLUSIONS.— The 2018 guideline eliminated HER2 FISH-equivocal cases by reclassifying HER2-equivocal cases and cases with nonclassical amplification without HER2 overexpression as HER2 negative. As a consequence, we observed a considerable increase in HER2 FISH-negative cases and a slight decrease in HER2 FISH-positive cases.
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Affiliation(s)
- Raza S Hoda
- From the Departments of Pathology (Drs Hoda, Brogi, Xu, Ross, and Wen and Ms Ventura), Medicine (Drs Dang, Robson, and Norton), and Surgery (Dr Morrow), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Edi Brogi
- From the Departments of Pathology (Drs Hoda, Brogi, Xu, Ross, and Wen and Ms Ventura), Medicine (Drs Dang, Robson, and Norton), and Surgery (Dr Morrow), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jin Xu
- From the Departments of Pathology (Drs Hoda, Brogi, Xu, Ross, and Wen and Ms Ventura), Medicine (Drs Dang, Robson, and Norton), and Surgery (Dr Morrow), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katia Ventura
- From the Departments of Pathology (Drs Hoda, Brogi, Xu, Ross, and Wen and Ms Ventura), Medicine (Drs Dang, Robson, and Norton), and Surgery (Dr Morrow), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dara S Ross
- From the Departments of Pathology (Drs Hoda, Brogi, Xu, Ross, and Wen and Ms Ventura), Medicine (Drs Dang, Robson, and Norton), and Surgery (Dr Morrow), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chau Dang
- From the Departments of Pathology (Drs Hoda, Brogi, Xu, Ross, and Wen and Ms Ventura), Medicine (Drs Dang, Robson, and Norton), and Surgery (Dr Morrow), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark Robson
- From the Departments of Pathology (Drs Hoda, Brogi, Xu, Ross, and Wen and Ms Ventura), Medicine (Drs Dang, Robson, and Norton), and Surgery (Dr Morrow), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Larry Norton
- From the Departments of Pathology (Drs Hoda, Brogi, Xu, Ross, and Wen and Ms Ventura), Medicine (Drs Dang, Robson, and Norton), and Surgery (Dr Morrow), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Monica Morrow
- From the Departments of Pathology (Drs Hoda, Brogi, Xu, Ross, and Wen and Ms Ventura), Medicine (Drs Dang, Robson, and Norton), and Surgery (Dr Morrow), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hannah Y Wen
- From the Departments of Pathology (Drs Hoda, Brogi, Xu, Ross, and Wen and Ms Ventura), Medicine (Drs Dang, Robson, and Norton), and Surgery (Dr Morrow), Memorial Sloan Kettering Cancer Center, New York, New York
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15
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Gibbons-Fideler IS, Nitta H, Murillo A, Tozbikian G, Banks P, Parwani AV, Li Z. Identification of HER2 Immunohistochemistry-Negative, FISH-Amplified Breast Cancers and Their Response to Anti-HER2 Neoadjuvant Chemotherapy. Am J Clin Pathol 2019; 151:176-184. [PMID: 30339245 DOI: 10.1093/ajcp/aqy136] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives Either immunohistochemistry (IHC) or in situ hybridization (ISH) can be used to determine human epidermal growth factor receptor 2 (HER2) status. Breast cancers (BCs) with HER2 IHC-negative (IHC-) and ISH-amplified (ISH+) results have been rarely reported but not well studied. We investigated the frequency of HER2 IHC-/ISH+ BCs and their response to anti-HER2 neoadjuvant chemotherapy (NAC). Methods Seventeen BCs with HER2 IHC-/ISH+ results were identified from 1,107 consecutive invasive BCs (1.5%, 17/1,107). Results Gene protein assay confirmed the original HER2 IHC and ISH results. Increased HER2 RNA level was detected in HER2 IHC-/ISH+ cases compared with HER2 IHC-/ISH- cases. Eight patients had anti-HER2 NAC; three had pathologic complete response, and five had residual tumors. Conclusions A small percentage of patients (1.5%) showed discordant HER2 IHC and ISH results (IHC-/ISH+) and would have lost the opportunity for potentially beneficial anti-HER2-targeted therapy if only HER2 IHC testing had been used.
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Affiliation(s)
| | | | | | - Gary Tozbikian
- Department of Pathology, Wexner Medical Center at The Ohio State University, Columbus, OH
| | | | - Anil V Parwani
- Department of Pathology, Wexner Medical Center at The Ohio State University, Columbus, OH
| | - Zaibo Li
- Department of Pathology, Wexner Medical Center at The Ohio State University, Columbus, OH
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16
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Zare SY, Lin L, Alghamdi AG, Daehne S, Roma AA, Hasteh F, Dell'Aquila M, Fadare O. Breast cancers with a HER2/CEP17 ratio of 2.0 or greater and an average HER2 copy number of less than 4.0 per cell: frequency, immunohistochemical correlation, and clinicopathological features. Hum Pathol 2019; 83:7-13. [PMID: 30121371 DOI: 10.1016/j.humpath.2018.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/25/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022]
Abstract
The 2013 American Society of Clinical Oncology and College of American Pathologists (ASCO/CAP) guidelines classified breast cancers with a fluorescence in situ hybridization dual-probe HER2/CEP17 ratio of 2 or greater as "amplified," inclusive of cases with a HER2 copy number less than 4. The 2018 ASCO/CAP update assigns HER2/neu status for the latter group in a fashion that is highly dependent on the associated immunohistochemical findings. Herein, the authors define the frequency, immunohistochemical correlates, and other clinicopathological features of breast cancers with HER2/CEP17 ratio of 2 or greater and HER2/neu copy number less than 4 (group A), based on an analysis of an institutional cohort assessed for HER2/neu status by both florescence in situ hybridization and immunohistochemistry and scored using 2013 ASCO/CAP criteria. Group A cases were compared with a group B of HER2/neu-amplified breast cancers with a HER2/neu copy number of 4 or greater regarding a variety of clinicopathological features. One hundred sixty-nine (14%) of 1201 cases were HER2/neu amplified, 18 (10.7%) in group A and 151 (89.3%) in group B. By immunohistochemistry, 61.1% of group A cases were HER2/neu negative, 7 (38.9%) were equivocal, and none were positive. In contrast, 66.9% of group B cases were HER2 positive (3+). We could not demonstrate statistically significant differences between the 2 groups regarding standard clinicopathological variables. In summary, our group A cases account for 1.5% of breast cancers, and 10.7% of all HER2/neu-amplified cancers classified as such based on 2013 ASCO/CAP criteria. They are predominantly HER2/neu negative by immunohistochemistry, which suggests that they are biologically different from classically HER2/neu-amplified cases and which validates the 2018 ASCO/CAP guideline against automatically classifying such cases as HER2/neu amplified.
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Affiliation(s)
- Somaye Y Zare
- Department of Pathology, University of California San Diego, San Diego, CA, 92037 USA
| | - Leo Lin
- Department of Pathology, University of California San Diego, San Diego, CA, 92037 USA
| | - Abrar G Alghamdi
- Department of Pathology, University of California San Diego, San Diego, CA, 92037 USA
| | - Svenja Daehne
- Department of Pathology, University of California San Diego, San Diego, CA, 92037 USA
| | - Andres A Roma
- Department of Pathology, University of California San Diego, San Diego, CA, 92037 USA
| | - Farnaz Hasteh
- Department of Pathology, University of California San Diego, San Diego, CA, 92037 USA
| | - Marie Dell'Aquila
- Department of Pathology, University of California San Diego, San Diego, CA, 92037 USA
| | - Oluwole Fadare
- Department of Pathology, University of California San Diego, San Diego, CA, 92037 USA.
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17
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Johnson TA, Singla DK. Breast cancer drug trastuzumab induces cardiac toxicity: evaluation of human epidermal growth factor receptor 2 as a potential diagnostic and prognostic marker. Can J Physiol Pharmacol 2018; 96:647-654. [PMID: 29842793 DOI: 10.1139/cjpp-2018-0005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Breast cancer is one of the most prevalent forms of cancer in the United States and worldwide. Cancer occurs through the uncontrolled development of new abnormal cell growth. Clinicians and researchers strive to improve diagnostics and treatments in pursuit of remedying breast cancer, while limiting or removing any potential side effects that may arise. Unfortunately, traditional treatments, such as anthracyclines (i.e., doxorubicin), can damage the cardiovascular system. Recent strategies have utilized antibody-based compounds as singular treatments, or in conjunction with other treatments, with the aim to minimize side effects. The human epidermal growth factor receptor 2 (HER2) protein has been the target of numerous antibody-based breast cancer therapies, such as trastuzumab (TZM) and trastuzumab emtansine (T-DM1). This review will discuss the HER2 receptor as a diagnostic marker in targeting breast cancer using the therapeutic agents TZM and T-DM1, as well as discuss the induced cardiac toxicity following TZM and T-DM1 treatments.
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Affiliation(s)
- Taylor A Johnson
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA.,Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - Dinender K Singla
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA.,Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
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