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Corianò M, Tommasi C, Dinh ATL, Needham J, Aziz H, Joharatnam-Hogan N, Cunningham N, Waterhouse J, Sun M, Turkes F, Pellegrino B, McGrath S, Okines A, Parton M, Turner N, Johnston S, Musolino A, Ring A, Battisti NML. The emerging predictive and prognostic role of HER2 in HER2-negative early breast cancer: a retrospective study. Breast Cancer Res Treat 2024; 206:603-614. [PMID: 38743174 DOI: 10.1007/s10549-024-07336-4] [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: 03/10/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Many patients with early breast cancer (eBC) undergoing neoadjuvant chemotherapy do not achieve pathological complete response (pCR), which is a prognostic factor. We examined the role of HER2-low expression in predicting pCR and prognosis in HER2-negative eBC. METHODS We evaluated patients with stage I-III HER2-negative BC, treated between 2013 and 2023 at The Royal Marsden NHS Foundation Trust, London. Tumors were classified based on estrogen receptor (ER) status and into HER2-low and HER2-zero subgroups. We analyzed pCR rates, relapse-free survival (RFS) and overall survival (OS). RESULTS 754 patients were included in the analysis. pCR rate was 8.9% in the ER+ /HER2-low, 16.5% in the ER+ /HER2-zero, 38.9% in the ER- ER-/HER2-low and 35.9% in the ER-/HER2-zero eBC (p < 0.001). Multivariable analysis showed a significantly lower pCR rate in HER2-low compared to HER2-zero BC in the ER+ subgroup. At a median follow-up of 63.8 months (59.9-67.4), we observed longer OS in HER2-low compared to HER2-zero patients in the overall and in the ER+ population. There was no predictive or prognostic impact of HER2-low status in the ER- population. CONCLUSION This study supports the interpretation of HER2 status as a possible prognostic and predictive biomarker for HER2-negative eBC, especially among patients with ER+ disease.
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Affiliation(s)
- Matilde Corianò
- Department of Medicine and Surgery, Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Chiara Tommasi
- Department of Medicine and Surgery, Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - Anh Thi Lan Dinh
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
- Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Jazmine Needham
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Hala Aziz
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Niamh Cunningham
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jasmin Waterhouse
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Mingze Sun
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
- University College London Medical School, London, UK
| | - Fiona Turkes
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Benedetta Pellegrino
- Department of Medicine and Surgery, Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - Sophie McGrath
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Alicia Okines
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Marina Parton
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Nicholas Turner
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Stephen Johnston
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Antonino Musolino
- Department of Medicine and Surgery, Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - Alistair Ring
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
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Park WK, Nam SJ, Kim SW, Lee JE, Yu J, Lee SK, Ryu JM, Chae BJ. The Prognostic Impact of HER2-Low and Menopausal Status in Triple-Negative Breast Cancer. Cancers (Basel) 2024; 16:2566. [PMID: 39061205 PMCID: PMC11274797 DOI: 10.3390/cancers16142566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/07/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
TNBC is noted for its aggressive behavior and poor prognosis. Recently developed HER2 target agents have shown potential benefit even in HER2-low expressing breast cancers. This study retrospectively analyzed 2542 non-metastatic TNBC patients from 2008 to 2020, revealing that 26.0% were HER2-low. Data on demographics, tumor characteristics, pathologic complete response (pCR) rates and disease-free survival (DFS), distant metastasis-free survival (DMFS), overall survival (OS), and breast cancer-specific survival (BCSS) were analyzed. The HER2-low group, compared to the HER2-0 group, showed significantly better DFS, DMFS, OS, BCSS (p = 0.0072, p = 0.0096, p = 0.0180, and p = 0.0001, respectively) with older age and higher rates of postmenopausal status (p < 0.0001). No significant differences in pCR rates were observed. Multivariate analyses identified HER2 status as a significant prognostic factor for DFS (p = 0.048), DMFS (p = 0.018), OS (p = 0.049), and BCSS (p = 0.008). Subgroup analysis revealed that these effects varied with menopausal status, showing more pronounced benefits in postmenopausal women. Our findings suggest that HER2-low TNBC patients exhibit a distinct clinical profile and improved survival compared to HER2-0 TNBC patients, especially in postmenopausal patients. Further research on estrogen and HER2 interaction is needed.
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Affiliation(s)
- Woong Ki Park
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (W.K.P.); (S.J.N.); (S.W.K.); (J.E.L.); (J.Y.); (S.K.L.); (J.M.R.)
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (W.K.P.); (S.J.N.); (S.W.K.); (J.E.L.); (J.Y.); (S.K.L.); (J.M.R.)
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (W.K.P.); (S.J.N.); (S.W.K.); (J.E.L.); (J.Y.); (S.K.L.); (J.M.R.)
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (W.K.P.); (S.J.N.); (S.W.K.); (J.E.L.); (J.Y.); (S.K.L.); (J.M.R.)
| | - Jonghan Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (W.K.P.); (S.J.N.); (S.W.K.); (J.E.L.); (J.Y.); (S.K.L.); (J.M.R.)
| | - Se Kyung Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (W.K.P.); (S.J.N.); (S.W.K.); (J.E.L.); (J.Y.); (S.K.L.); (J.M.R.)
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (W.K.P.); (S.J.N.); (S.W.K.); (J.E.L.); (J.Y.); (S.K.L.); (J.M.R.)
| | - Byung Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (W.K.P.); (S.J.N.); (S.W.K.); (J.E.L.); (J.Y.); (S.K.L.); (J.M.R.)
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul 06351, Republic of Korea
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Schettini F, Nucera S, Brasó-Maristany F, De Santo I, Pascual T, Bergamino M, Galván P, Conte B, Seguí E, García Fructuoso I, Gómez Bravo R, Rivera P, Rodríguez AB, Martínez-Sáez O, Ganau S, Sanfeliu E, González-Farre B, Vidal Losada MJ, Adamo B, Cebrecos I, Mension E, Oses G, Jares P, Vidal-Sicart S, Mollà M, Muñoz M, Prat A. Unraveling the clinicopathological and molecular changes induced by neoadjuvant chemotherapy and endocrine therapy in hormone receptor-positive/HER2-low and HER2-0 breast cancer. ESMO Open 2024; 9:103619. [PMID: 38943737 PMCID: PMC11261254 DOI: 10.1016/j.esmoop.2024.103619] [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: 12/28/2023] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND The characterization and comparison of gene expression and intrinsic subtype (IS) changes induced by neoadjuvant chemotherapy (NACT) and endocrine therapy in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2 (HER2)-low versus HR+/HER2-0 breast cancer (BC) has not been conducted so far. Most evidence on the association of HER2 status with pathologic responses and prognosis in HR+/HER2-negative BC is controversial and restricted to NACT-treated disease. Similarly, a temporal heterogeneity in HER2 status has been described only with NACT. METHODS We retrospectively recruited a consecutive cohort of 186 patients with stage I-IIIB HR+/HER2-negative BC treated with neoadjuvant therapy (NAT). Available diagnostic biopsies and surgical samples were characterized for main pathological features, PAM50 IS and ROR-P score, and gene expression. Associations with pathologic complete response, residual cancer burden-0/I, event-free survival (EFS) and overall survival (OS) based on HER2 status were assessed. Pre/post pathologic/molecular changes were analyzed in matched samples. RESULTS The HER2-low (62.9%) and HER2-0 (37.1%) cohorts did not differ significantly in main baseline features, treatments administered, breast-conserving surgery, pathologic complete response and residual cancer burden-0/I rates, EFS, and OS. NAT induced, regardless of HER2 status, a significant reduction of estrogen receptor/progesterone receptor and Ki67 levels, a down-regulation of PAM50 proliferation- and luminal-related genes/signatures, an up-regulation of selected immune genes, and a shift towards less aggressive IS and lower ROR-P. Moreover, 25% of HER2-0 changed to HER2-low and 34% HER2-low became HER2-0. HER2 shifts were significant after NACT (P < 0.001), not neoadjuvant endocrine therapy (P = 0.063), with consistent ERBB2 mRNA level dynamics. HER2 changes were not associated with EFS/OS. CONCLUSIONS HER2-low and HER2-0 status change after NAT in ∼30% of cases, mostly after NACT. Targeted adjuvant strategies should be investigated accordingly. Molecular downstaging with current chemo/endocrine agents and immunotherapy should not rely on HER2 immunohistochemical levels in HR+/HER2-negative BC. Instead, HER2-low-targeted approaches should be explored to pursue more effective and/or less toxic dimensional downstaging.
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Affiliation(s)
- F Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain.
| | - S Nucera
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Department of Human Pathology "G. Barresi", University of Messina, Messina
| | - F Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona. https://twitter.com/fara_bm
| | - I De Santo
- Medical Oncology Unit, Ave Gratia Plena Hospital, San Felice a Cancello (CE), Italy
| | - T Pascual
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain; SOLTI Cooperative Research Group, Barcelona. https://twitter.com/TomasPascualMD
| | - M Bergamino
- Medical Oncology Department, Catalan Institute of Oncology, Badalona. https://twitter.com/MilanaBeSirven
| | - P Galván
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona
| | - B Conte
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - E Seguí
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - I García Fructuoso
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - R Gómez Bravo
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - P Rivera
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A B Rodríguez
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - O Martínez-Sáez
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona. https://twitter.com/OlgaMartnezSez1
| | - S Ganau
- Department of Radiology, Diagnosis Imaging Center, Hospital Clinic of Barcelona, Barcelona
| | - E Sanfeliu
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona; Department of Pathology, Biomedical Diagnostic Center, Hospital Clinic of Barcelona, Barcelon
| | - B González-Farre
- Department of Pathology, Biomedical Diagnostic Center, Hospital Clinic of Barcelona, Barcelon
| | - M J Vidal Losada
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain; SOLTI Cooperative Research Group, Barcelona; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona. https://twitter.com/MVidalMD
| | - B Adamo
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - I Cebrecos
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona; Department of Obstetrics and Gynecology, Hospital Clinic of Barcelona, Barcelona
| | - E Mension
- Department of Obstetrics and Gynecology, Hospital Clinic of Barcelona, Barcelona
| | - G Oses
- Radiation Oncology Department, Hospital Clínic de Barcelona, Barcelona
| | - P Jares
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona; Department of Pathology, Biomedical Diagnostic Center, Hospital Clinic of Barcelona, Barcelon
| | - S Vidal-Sicart
- Department of Nuclear Medicine, Diagnosis Imaging Center, Hospital Clinic of Barcelona, Barcelona
| | - M Mollà
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Radiation Oncology Department, Hospital Clínic de Barcelona, Barcelona
| | - M Muñoz
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain; SOLTI Cooperative Research Group, Barcelona; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona. https://twitter.com/MuozMateu
| | - A Prat
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona; Institute of Cancer and Blood Diseases, Hospital Clinic of Barcelona, Barcelona; Breast Cancer Unit, Institute of Oncology Barcelona (IOB) - Quirónsalud, Barcelona; Reveal Genomic, Barcelona, Spain.
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Guan D, Shi Q, Zheng Y, Zheng C, Meng X. Real-World Data on Pathological Response and Survival Outcomes After Neoadjuvant Chemotherapy in HER2-Low Breast Cancer Patients. Clin Breast Cancer 2024; 24:463-472.e2. [PMID: 38744585 DOI: 10.1016/j.clbc.2024.04.006] [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: 09/29/2023] [Revised: 01/01/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Data on the pathological responses and survival outcomes after neoadjuvant chemotherapy (NACT) in human epidermal growth factor receptor-2 (HER2)-low breast cancer (BC) are lacking. This study aims to investigate this topic in the real world. METHODS Clinicopathological data from 819 HER2-negative BC patients who underwent NACT between 2010 and 2020 were retrospectively retrieved from the Shanghai Jiaotong University Breast Cancer Database. These patients were categorized into HER2-low and HER2-0 groups. Logistic analyses were conducted to identify predictors of complete pathological response (pCR) and breast pCR. Cox regression analyses were conducted to assess the factors associated with disease-free survival (DFS) and overall survival (OS). Kaplan-Meier (K-M) curves were generated to compare DFS and OS between HER2-low BC and HER2-0 BC. RESULTS Of the 819 BC patients, 669 (81.7%) had HER2-low tumors, and 150 (18.3%) had HER2-0 tumors. HER2-low BC had a significantly higher ratio of ER ≥ 10%, PR ≥ 20%, and Ki67 ≥ 15% than HER2-0 BC. A significantly higher breast pCR rate was observed in HER2-low BC than in HER2-0 BC (13.6% and 7.3%, respectively, P = .036). Age, HER2 status (low or 0), Ki67, and surgery options were associated with breast pCR in HER2-negative BC. In HER2-low BC, the pCR rate of ER ≥ 10% BC was significantly lower than that of ER < 10% BC, but the DFS and OS of ER 10% BC were significantly higher. The K-M curve showed no significant differences in DFS or OS between HER2-low and HER2-0 BC. Cox regression revealed that ER expression and histological grade (III vs. I∼II) were significantly associated with survival in HER2-low BC. CONCLUSIONS In this real-world data (RWD) study, a significantly higher breast pCR rate was found in HER2-low BC than in HER2-0 BC, although there was no significant difference in survival. Moreover, ER expression had a significant prognostic impact on HER2-low BC.
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Affiliation(s)
- Dandan Guan
- Suzhou Medical College of Soochow University, Soochow, China; General Surgery, Cancer Center, Department of Breast Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China; Key Laboratory for diagnosis and treatment of upper limb edema and stasis of breast cancer, Hangzhou, Zhejiang, China
| | - Qingyang Shi
- Department of Urinary Surgery, Haining branch of Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Jiaxing, Zhejiang, China
| | - Yajuan Zheng
- General Surgery, Cancer Center, Department of Breast Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China; Key Laboratory for diagnosis and treatment of upper limb edema and stasis of breast cancer, Hangzhou, Zhejiang, China
| | - Chaopeng Zheng
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xuli Meng
- General Surgery, Cancer Center, Department of Breast Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China; Key Laboratory for diagnosis and treatment of upper limb edema and stasis of breast cancer, Hangzhou, Zhejiang, China.
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Schmidt M, Lehr HA, Almstedt K. HER2-low and HER2-zero in breast cancer between prognosis, prediction and entity. Oncotarget 2024; 15:418-420. [PMID: 38900671 PMCID: PMC11197969 DOI: 10.18632/oncotarget.28598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Indexed: 06/22/2024] Open
Affiliation(s)
- Marcus Schmidt
- Correspondence to:Marcus Schmidt, Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg-University, Mainz 55131, Germany email
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Zhao S, Wang Y, Zhou A, Liu X, Zhang Y, Zhang J. Neoadjuvant chemotherapy efficacy and prognosis in HER2-low and HER2-zero breast cancer patients by HR status: a retrospective study in China. PeerJ 2024; 12:e17492. [PMID: 38827304 PMCID: PMC11143972 DOI: 10.7717/peerj.17492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/09/2024] [Indexed: 06/04/2024] Open
Abstract
Background The promising efficacy of novel anti-HER2 antibody-drug conjugates (ADC) in HER2-low breast cancer has made HER2-low a research hotspot. However, controversy remains regarding the neoadjuvant chemotherapy (NAC) efficacy, prognosis, and the relationship with hormone receptor (HR) status of HER2-low. Methods A retrospective analysis was conducted on 975 patients with HER2-negative breast cancer undergoing NAC at Tianjin Medical University Cancer Institute and Hospital, evaluating pathological complete response (pCR) rate and prognosis between HER2-low and HER2-zero in the overall cohort and subgroups. Results Overall, 579 (59.4%) and 396 (40.6%) patients were HER2-low and HER2-zero disease, respectively. Compared with HER2-zero, the HER2-low cohort consists of more postmenopausal patients, with lower histological grade and higher HR positivity. In the HR-positive subgroup, HER2-low cases remain to exhibit lower histological grade, while in the HR-negative subgroup, they show higher grade. The HER2-low group had lower pCR rates than the HER2-zero group (16.4% vs. 24.0%). In the HR-positive subgroup, HER2-low consistently showed lower pCR rate (8.1% vs. 15.5%), and served as an independent suppressive factor for the pCR rate. However, no significant difference was observed in the pCR rates between HER2-low and HER2-zero in the HR-negative breast cancer. In the entire cohort and in stratified subgroups based on HR and pCR statuses, no difference in disease-free survival were observed between HER2-low and HER2-zero. Conclusions In the Chinese population, HER2-low breast cancer exhibits distinct characteristics and efficacy of NAC in different HR subgroups. Its reduced pCR rate in HR-positive subgroup is particularly important for clinical decisions. However, HER2-low is not a reliable factor for assessing long-term survival outcomes.
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Affiliation(s)
- Shaorong Zhao
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yuyun Wang
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Angxiao Zhou
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xu Liu
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yi Zhang
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jin Zhang
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Polidorio N, Montagna G, Sevilimedu V, Le T, Morrow M. Do HER2-Low Tumors Have a Distinct Clinicopathologic Phenotype? Ann Surg Oncol 2024; 31:2231-2243. [PMID: 38158494 PMCID: PMC11177575 DOI: 10.1245/s10434-023-14800-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: 10/16/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Breast cancer subtypes, distinguished by hormone receptor (HR) and HER2 status, have different clinicopathologic features. With recognition of the clinical relevance of HER2-low, there is debate as to whether this is a distinct subtype. Our study aimed to determine whether HER2-low breast cancers have specific clinicopathologic features that differ from those of HER2-negative and HER2-positive cancers. PATIENTS AND METHODS A total of 11,072 patients undergoing upfront surgery from 1998 to 2010 were identified from a single-institution prospectively maintained database. HER2 status was classified by immunohistochemistry (IHC)/fluorescence in situ hybridization (FISH) as HER2 negative (41.2%), HER2 low (45%; IHC 1+ or 2+ with negative FISH), and HER2 positive (13.7%), and stratified by HR status. Univariate (UVA) and multivariable multinomial logistic regression analysis (MVA) were performed to determine associations among variables and subtypes. RESULTS Compared with HER2-negative tumors, HER2 low was associated with lymphovascular invasion [odds ratio (OR) 1.2, 95% confidence interval (CI) 1.06-1.36; p = 0.003], multifocality (OR 1.26, 95% CI 1.12-1.42; p < 0.001), nodal micrometastasis (OR 1.15, 95% CI 1.02-1.31; p = 0.024), and lower rates of ≥ 3 positive nodes (OR 0.77, 95% CI 0.66-0.90, p = 0.001). When stratified by HR expression, in both HR-positive and HR-negative tumors, age and multifocality were associated with HER2 low on UVA. On MVA, no variables were independently associated with both HR-negative and HR-positive/HER2-low tumors compared with HER2-negative tumors. In contrast, HER2-positive tumors, regardless of HR status, were associated with multifocality and an extensive intraductal component. CONCLUSION Clinicopathologic features of HER2-low tumors appear to be primarily related to HR status. Our findings do not support the characterization of HER2 low as a separate subtype.
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Affiliation(s)
- Natália Polidorio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tiana Le
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Khoury T, Mendicino L, Payne Ondracek R, Yao S, Davis W, Omilian AR, Kwan ML, Roh JM, D’Addario L, Valice E, Fernandez D, Ergas IJ, Chua AV, Ambrosone CB, Kushi LH. Clinical, Epidemiologic, and Pathologic Significance of ERBB2-Low Expression in Breast Cancer. JAMA Netw Open 2024; 7:e243345. [PMID: 38517439 PMCID: PMC10960203 DOI: 10.1001/jamanetworkopen.2024.3345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/28/2024] [Indexed: 03/23/2024] Open
Abstract
Importance It is unclear whether breast cancer (BC) with low ERBB2 expression (ERBB2-low) is a distinct clinical, pathological, and epidemiological entity from BC classified as no ERBB2 expression (ERBB2-negative). Objective To evaluate the clinical, pathological, and epidemiologic features of BC with ERBB2-low expression compared with ERBB2-negative BC in a large population study. Design, Setting, and Participants This cohort study was conducted as part of the Pathways Study, a prospective, racially and ethnically diverse cohort study of women with BC enrolled between 2006 and 2013 in Kaiser Permanente Northern California (KPNC). The hematoxylin and eosin slides underwent centralized pathology review, including the percentage of tumor infiltrating lymphocytes (TILs). Breast biomarker results were extracted from pathology reports, and women were included if they had a documented ERBB2 value that was not classified ERBB2-positive. Data were analyzed from February 2023 through January 2024. Exposure Clinical and tumor characteristics associated with BC and ERBB2-low or ERBB2-negative status. Main Outcome and Measures ERBB2-low was defined as immunohistochemistry score of 1+ or 2+ (negative by in situ hybridization); ERBB2-negative was defined as immunohistochemistry score of 0+. Other data were collected by self-report or extraction from electronic health records, including BC risk factors, tumor characteristics, treatment modality, and survival outcomes, with recurrence-free survival (RFS) as the primary outcome and overall survival (OS) and BC-specific mortality (BCSM) as secondary outcomes. The clinical, pathological, and epidemiological variables were compared between ERBB2-low and ERBB2-negative BC. Results Of 2200 eligible patients (all female; with mean [SD] age, 60.4 [11.9] years), 1295 (57.2%) had tumors that were ERBB2-low. Hormone receptors were positive in 1956 patients (88.9%). The sample included 291 Asian patients (13.2%), 166 Black patients (7.5%), 253 Hispanic patients (11.5%), 1439 White patients (65.4%), and 51 patients (2.3%) who identified as other race or ethnicity (eg, American Indian or Alaska Native and Pacific Islander). Within the hormone receptor-negative group, patients whose tumors had ERBB2-low staining, compared with those with ERBB2-negative tumors, had better OS (hazard ratio [HR], 0.54; 95% CI, 0.33-0.91; P = .02), RFS (HR, 0.53; 95% CI, 0.30-0.95; P = .03), and BCSM (HR, 0.43; 95% CI, 0.22-0.84; P = .01). In multivariable survival analysis stratified by hormone receptor status and adjusted for key covariates, patients with ERBB2-low and hormone receptor-negative tumors had lower overall mortality (HR, 0.48; 95% CI, 0.27-0.83; P = .009), RFS (HR, 0.45; 95% CI, 0.24-0.86; P = .02), and BCSM (subdistribution HR, 0.21; 95% CI, 0.10-0.46; P < .001) compared with patients with ERBB2-negative and hormone receptor-negative tumors. Within the hormone receptor-negative subtype, patients with ERBB2-low and high TILs tumors had better survival across all 3 outcomes compared with patients with ERBB2-negative and low TILs tumors. Additionally, patients with ERBB2-low and low TILs tumors had better BCSM (subdistribution HR, 0.36; 95% CI, 0.14-0.92; P = .03). Conclusions and Relevance These findings suggest that there were clinical, pathological, and epidemiological differences between ERBB2-low and ERBB2-negative BC, raising the possibility that ERBB2-low might be a unique biologic entity.
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Affiliation(s)
- Thaer Khoury
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Lucas Mendicino
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Rochelle Payne Ondracek
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Warren Davis
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Angela R. Omilian
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Marilyn L. Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Janise M. Roh
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Lia D’Addario
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Emily Valice
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Daniel Fernandez
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Isaac J. Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Alfredo V. Chua
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland
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9
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Yue M, Wu S, Liu C, Cai L, Wang X, Jia Y, Han D, Liu Y. Clinicopathological features and prognostic analysis of HER2 low and fibrotic focus in HER2-negative breast cancer. Breast Cancer Res Treat 2024; 203:373-381. [PMID: 37843776 DOI: 10.1007/s10549-023-07103-x] [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: 06/07/2023] [Accepted: 08/20/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the clinicopathological features and prognostic significance of HER2 low, fibrotic focus (FF), and tumor-infiltrating lymphocytes (TILs) in patients with HER2-negative breast cancer. METHODS We retrospectively reviewed the data of 293 patients with HER2-negative, stage I-II, invasive breast cancer of non-specific types. The HER2-negative cases were classified into HER2 low and HER2 0. Digital analysis of hematoxylin-eosin stained whole slide images was used to evaluate the FF expression. TILs were also evaluated using the Whole Slide Image. Furthermore, the association between HER2 low, FF, and TILs as well as their prognostic significance were analyzed. RESULTS The study cohort included 178 cases (60.8%) with HER2 low and 115 cases (39.2%) with HER2 0. Older age, lower Nottingham histological grade (NHG), estrogen receptor (ER) positivity, progesterone receptor (PR) positivity, and hormone receptor (HR) positivity were all associated with HER2 low. FF was correlated with older age, intermediate and low NHG, vascular invasion, HR positivity, HER2 low status, high Ki67 expression, and low TILs. Univariate survival analysis showed that FF was significantly associated with shorter progression-free survival (PFS). Stratified analysis indicated that in the HR-negative and HR-positive groups, HER2 status and TILs did not affect PFS. DFS was longer in patients without FF compared to those with FF in the HR-positive (hazard ratio [HR] = 0.313) and HER2 low (HR = 0.272) groups. DFS was also significantly longer in patients without FF compared to those with FF in the HR-negative (HR = 0.069) and HER2 0 groups (HR = 0.129). CONCLUSION The results indicated that the HER2 low status and the TILs expression did not impact prognosis. However, patients with FF exhibited distinct biological characteristics and prognostic significance, particularly in the HR-negative and HER2 0 groups. This provides a rationale for accurate diagnosis and treatment of HER2-negative breast cancer.
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Affiliation(s)
- Meng Yue
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang, 050011, Hebei, China
| | - Si Wu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang, 050011, Hebei, China
| | - Chang Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang, 050011, Hebei, China
| | - Lijing Cai
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang, 050011, Hebei, China
| | - Xinran Wang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang, 050011, Hebei, China
| | - Ying Jia
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang, 050011, Hebei, China
| | - Dandan Han
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang, 050011, Hebei, China
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang, 050011, Hebei, China.
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10
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Ivanova M, Porta FM, D'Ercole M, Pescia C, Sajjadi E, Cursano G, De Camilli E, Pala O, Mazzarol G, Venetis K, Guerini-Rocco E, Curigliano G, Viale G, Fusco N. Standardized pathology report for HER2 testing in compliance with 2023 ASCO/CAP updates and 2023 ESMO consensus statements on HER2-low breast cancer. Virchows Arch 2024; 484:3-14. [PMID: 37770765 PMCID: PMC10791807 DOI: 10.1007/s00428-023-03656-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023]
Abstract
Since the release of the DESTINY-Breast04 (DB-04) trial findings in June 2022, the field of pathology has seen a renaissance of HER2 as a predictive biomarker in breast cancer. The trial focused on patients with metastatic breast cancer who were classified as "HER2-low," i.e., those with immunohistochemistry (IHC) HER2 1 + or 2 + and negative in situ hybridization (ISH) results. The study revealed that treating these patients with trastuzumab deruxtecan (T-DXd) instead of the oncologist's chosen chemotherapy led to outstanding improvements in survival. This has challenged the existing binary HER2 pathological classification system, which categorized tumors as either positive (overexpression/amplification) or negative, as per the ASCO/CAP 2018 guideline reaffirmed by ASCO/CAP 2023 guideline update. Given that DB-04 excluded patients with HER2 IHC score 0 status, the results of the ongoing DB-06 trial may shed further light on the potential benefits of T-DXd therapy for these patients. Roughly half of all breast cancers are estimated to belong to the HER2-low category, which does not represent a distinct or specific subtype of cancer. Instead, it encompasses a diverse group of tumors that exhibit clinical, morphological, immunohistochemical, and molecular variations. However, HER2-low offers a distinctive biomarker status that identifies a specific therapeutic regimen (i.e., T-DXd) linked to a favorable prognosis in breast cancer. This unique association emphasizes the importance of accurately identifying these tumors. Differentiating between a HER2 IHC score 0 and score 1 + has not been clinically significant until now. To ensure accurate classification and avoid misdiagnosis, it is necessary to adopt standardized procedures, guidelines, and specialized training for pathologists in interpreting HER2 expression in the lower spectrum. Additionally, the utilization of artificial intelligence holds promise in supporting this endeavor. Here, we address the current state of the art and unresolved issues in assessing HER2-low status, with a particular emphasis on the score 0. We explore the dilemma surrounding the exclusion of HER2-zero patients from potentially beneficial therapy based on traditional HER2 testing. Additionally, we examine the clinical context, considering that DB-04 primarily involved heavily pretreated late-stage metastatic breast cancers. We also delve into emerging evidence suggesting that extrapolating HER2-low status from the original diagnosis may lead to misleading results. Finally, we provide recommendations for conducting high-quality testing and propose a standardized pathology report in compliance with 2023 ASCO/CAP updates and 2023 ESMO consensus statements on HER2-low breast cancer.
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Affiliation(s)
- Mariia Ivanova
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Francesca Maria Porta
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Marianna D'Ercole
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Carlo Pescia
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Elham Sajjadi
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Giulia Cursano
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Elisa De Camilli
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Oriana Pala
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Giovanni Mazzarol
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Konstantinos Venetis
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Elena Guerini-Rocco
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
- Division of New Drugs and Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Giuseppe Viale
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Nicola Fusco
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy.
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy.
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11
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Dai Q, Feng K, Liu G, Cheng H, Tong X, Wang X, Feng L, Wang Y. Prognostic Impact of HER2-Low and HER2-Zero in Resectable Breast Cancer with Different Hormone Receptor Status: A Landmark Analysis of Real-World Data from the National Cancer Center of China. Target Oncol 2024; 19:81-93. [PMID: 38265547 DOI: 10.1007/s11523-023-01030-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND The prognostic impact of HER2-low on overall survival (OS) and disease-free survival (DFS) in patients with resectable breast cancer (BC) remains controversial, partly resulting from the hormone receptor (HR) status. OBJECTIVE To investigate the prognostic impact of HER2-low in different HR subgroups. PATIENTS AND METHODS We retrospectively retrieved medical records of treatment-naive primary HER2-low and HER2-zero BC patients who were diagnosed with invasive ductal carcinoma and underwent surgery in the Cancer Hospital of the Chinese Academy of Medical Sciences from January 2009 to September 2017 (n = 7371). We compared the clinicopathologic features and performed Cox regression and landmark survival analyses to explore the prognostic impact of HER2-low on survival outcomes during distinct post-surgery intervals-36 months, 60 months, and 120 months. RESULTS HER2-low BC, compared to HER2-zero BC, exhibited less aggressive clinicopathologic features, such as smaller invasion size, lower grade, increased nerve invasion, higher HR positivity, and a higher proportion of low-Ki67 cases. In the HR-positive subgroup, HER2-low demonstrated improved OS (p = 0.046) and DFS (p = 0.026) within 60 months. Conversely, HER2-low displayed worse DFS (p = 0.046) in the HR-negative subgroup after 36 months from surgery. The findings remained robust in uni- and multi-variable Cox models. CONCLUSIONS HER2-low BCs manifested less aggressive clinicopathologic features than the HER2-zero cases. The prognostic impact of HER2-low in resectable BCs exhibits variability contingent upon the patients' HR status.
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Affiliation(s)
- Qichen Dai
- Department of Breast Surgery, National Cancer Center|National Clinical Research Center for Cancer|Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Kexin Feng
- Department of Breast Surgery, National Cancer Center|National Clinical Research Center for Cancer|Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Gang Liu
- Department of Breast Surgery, National Cancer Center|National Clinical Research Center for Cancer|Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Han Cheng
- Department of Breast Surgery, National Cancer Center|National Clinical Research Center for Cancer|Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiangyu Tong
- Department of Breast Surgery, National Cancer Center|National Clinical Research Center for Cancer|Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiang Wang
- Department of Breast Surgery, National Cancer Center|National Clinical Research Center for Cancer|Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Lin Feng
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center| National Clinical Research Center for Cancer| Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Yipeng Wang
- Department of Breast Surgery, National Cancer Center|National Clinical Research Center for Cancer|Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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12
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Atallah NM, Haque M, Quinn C, Toss MS, Makhlouf S, Ibrahim A, Green AR, Alsaleem M, Rutland CS, Allegrucci C, Mongan NP, Rakha E. Characterisation of luminal and triple-negative breast cancer with HER2 Low protein expression. Eur J Cancer 2023; 195:113371. [PMID: 37897865 DOI: 10.1016/j.ejca.2023.113371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Breast cancer (BC) expressing low levels of human epidermal growth factor receptor 2 (HER2 Low) is an emerging category that needs further refining. This study aims to provide a comprehensive clinico-pathological and molecular profile of HER2 Low BC including response to therapy and patient outcome in the adjuvant and neoadjuvant settings. METHODS Two different independent and well-characterised BC cohorts were included. Nottingham cohort (A) (n = 5744) and The Cancer Genome Atlas (TCGA) BC cohort (B) (n = 854). The clinical, molecular, biological and immunological profile of HER2 Low BC was investigated. Transcriptomic and pathway enrichment analyses were performed on the TCGA BC cohort and validated through next-generation sequencing in a subset of Nottingham cases. RESULTS Ninety percent of HER2 Low tumours were hormone receptor (HR) positive (HR+), enriched with luminal intrinsic molecular subtype, lacking significant expression of HER2 oncogenic signalling genes and of favourable clinical behaviour compared to HER2 negative (HER2-) BC. In HR+ BC, no significant prognostic differences were detected between HER2 Low and HER2- tumours. However, in HR- BC, HER2 Low tumours were less aggressive with longer patient survival. Transcriptomic data showed that the majority of HR- /HER2 Low tumours were of luminal androgen receptor (LAR) intrinsic subtype, enriched with T-helper lymphocytes, activated dendritic cells and tumour associated neutrophils, while most HR-/HER2- tumours were basal-like, enriched with tumour associated macrophages. CONCLUSION HER2 Low BC is mainly driven by HR signalling in HR+ tumours. HR-/HER2 Low tumours tend to be enriched with LAR genes with a unique immune profile.
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Affiliation(s)
- Nehal M Atallah
- Translational Medical Science, School of Medicine, the University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK; Department of Pathology, Faculty of Medicine, Menoufia University, Egypt
| | - Maria Haque
- School of Veterinary Medicine and Sciences, University of Nottingham, Sutton Bonington, UK
| | - Cecily Quinn
- University College Dublin, School of Medicine, St Vincent's Hospital, Elm Park, Dublin, Ireland
| | - Michael S Toss
- Translational Medical Science, School of Medicine, the University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK; Histopathology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Shorouk Makhlouf
- Translational Medical Science, School of Medicine, the University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK; Department of Pathology, Faculty of Medicine, Assiut University, Egypt
| | - Asmaa Ibrahim
- Translational Medical Science, School of Medicine, the University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK; Department of Pathology, Suez Canal University, Egypt
| | - Andrew R Green
- Translational Medical Science, School of Medicine, the University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mansour Alsaleem
- School of Veterinary Medicine and Sciences, University of Nottingham, Sutton Bonington, UK; Unit of Scientific Research, Applied College, Qassim University, Saudi Arabia
| | - Catrin S Rutland
- School of Veterinary Medicine and Sciences, University of Nottingham, Sutton Bonington, UK
| | - Cinzia Allegrucci
- School of Veterinary Medicine and Sciences, University of Nottingham, Sutton Bonington, UK; Nottingham Breast Cancer Research Centre, Biodiscovery Institute, Nottingham, UK
| | - Nigel P Mongan
- School of Veterinary Medicine and Sciences, University of Nottingham, Sutton Bonington, UK; Department of Pharmacology, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Emad Rakha
- Translational Medical Science, School of Medicine, the University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK; Department of Pathology, Faculty of Medicine, Menoufia University, Egypt; Pathology Department, Hamad Medical Corporation, Doha, Qatar.
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13
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Park WK, Nam SJ, Kim SW, Lee JE, Yu J, Ryu JM, Chae BJ. The Impact of HER2-Low Expression on Oncologic Outcomes in Hormone Receptor-Positive Breast Cancer. Cancers (Basel) 2023; 15:5361. [PMID: 38001620 PMCID: PMC10670388 DOI: 10.3390/cancers15225361] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Breast cancer is a prevalent malignancy with increasing incidence, particularly in Asian countries. Classification based on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status is pivotal in determining treatment. Recent advances have challenged the traditional dichotomy in HER2 classification, prompting investigation into the HER2-low subtype's characteristics and outcomes. This retrospective study analyzed 10,186 non-metastatic hormone receptor (HR)-positive, HER2-negative breast cancer cases treated from 2008 to 2020. Data encompassed clinical, pathological, and treatment information. Oncologic outcomes included disease-free survival (DFS), overall survival (OS), and breast cancer-specific survival (BCSS). In total, 56.5% were HER2-low cases. Differences in patient characteristics were noted, with more BRCA1/2 mutations and higher mastectomy rates in the HER2-low group (p = 0.002, p < 0.001, respectively). Fewer received adjuvant chemotherapy or radiation therapy, and fewer histologic and nuclear grade 1 tumors were identified (all p < 0.001). With a median follow-up of 64 months (range: 13-174), HER2-low cases exhibited better DFS, OS, and BCSS than HER2-0 cases (p = 0.012, p = 0.013, and p = 0.013, respectively). Notably, the prognosis differed between premenopausal and postmenopausal subgroups, with BCSS benefitting premenopausal patients (p = 0.047) and DFS and OS benefitting postmenopausal patients in the HER2-low group (p = 0.004, p = 0.009, respectively). Multivariate analysis confirmed HER2 status as an independent predictor of these outcomes (p = 0.010, p = 0.008, and p = 0.014, respectively). This extensive single-center study elucidates the favorable prognosis associated with HER2-low status in HR-positive breast cancer. However, this effect differs among premenopausal and postmenopausal patients, necessitating further research into the underlying tumor biology.
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Affiliation(s)
| | | | | | | | | | | | - Byung Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (W.K.P.); (S.J.N.); (S.W.K.); (J.E.L.); (J.Y.); (J.M.R.)
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14
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Wu Q, Yang F, Liu Y, Zhang H, Zhang S, Xin L, Xu L. Analysis of clinicopathological characteristics and prognostic factors of early-stage human epidermal growth factor receptor 2 (HER2)-low breast cancer: Compared with HER2-0 breast cancer. Cancer Med 2023; 12:19560-19575. [PMID: 37772432 PMCID: PMC10587975 DOI: 10.1002/cam4.6571] [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: 03/05/2023] [Revised: 07/21/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE To investigate the clinicopathological characteristics and prognostic factors of early-stage breast cancer (EBC) with human epidermal growth factor receptor 2 (HER2)-low expression. METHODS The clinicopathological data and follow-up information of EBC patients with HER2-low and HER2-0 expression treated at the Breast Disease Center of Peking University First Hospital from January 2014 to December 2017 were analyzed. The prognosis between HER2-low and HER2-0 expression groups and with different hormone receptor (HR) expression were compared by statistics. Meanwhile, the expression of Ki67, androgen receptor (AR), TOPIIa, P53, PTEN, and CK5/6 were also analyzed with the HER2-low expression and prognosis. RESULTS Retrospectively analyzed 1253 cases of EBC, including 583 (46.5%) cases of HER2-low breast cancer (BC) and 366 (29.2%) HER2-0 BC cases. Among the HER2-low BC patients, 487 (83.5%) were HR-positive, while 96 (16.5%) were HR-negative. Among the HER2-0 BC patients, 265 (72.4%) were HR-positive, while 101 (27.6%) were HR-negative. Median follow-up time was 53 months. The 5-year disease-free survival of HER2-low BC patients was 90.2% (95% confidence interval [CI]: 87.2-93.1), and the 5-year overall survival was 95.4% (95% CI: 93.3-97.6). Cox regression analysis showed that T stage, lymphovascular invasion, and/or perineural invasion were prognostic factors of HER2-low BC patients. However, the 5-year disease-free survival and overall survival of patients in the HER2-low and HER2-0 groups were not significantly different in all patients, but a tendency of better prognosis in HER2-low group was seen in HR-negative tumors. CONCLUSION HER2-low EBC patients accounted for 46.5% of the patient population. T stage, lymphovascular invasion, and/or perineural invasion were factors affecting the prognosis of BC patients with low HER2 expression. No significant difference in prognosis was noted between HER2-low and HER2-0 EBC patients. But in HR-negative tumors, a tendency of better prognosis was seen in HER2-low versus HER2-0.
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Affiliation(s)
- Qian Wu
- Thyroid and Breast SurgeryPeking University First HospitalBeijingChina
| | - Fan Yang
- Thyroid and Breast SurgeryPeking University First HospitalBeijingChina
- Department of Hepatobiliary and Pancreatic SurgeryThe First Affiliated Hospital, Zhejiang University School of MedicineHangzhouChina
| | - YinHua Liu
- Thyroid and Breast SurgeryPeking University First HospitalBeijingChina
| | - Hong Zhang
- Department of PathologyPeking University First HospitalBeijingChina
- Department of PathologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shuang Zhang
- Department of PathologyPeking University First HospitalBeijingChina
- Department of PathologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ling Xin
- Thyroid and Breast SurgeryPeking University First HospitalBeijingChina
| | - Ling Xu
- Thyroid and Breast SurgeryPeking University First HospitalBeijingChina
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Yang M, Sun J, Liu L, Kong X, Lin D, Zhou H, Gao J. Clinicopathological characteristics of HER2-low breast cancer: a retrospective study. Sci Rep 2023; 13:12382. [PMID: 37524746 PMCID: PMC10390573 DOI: 10.1038/s41598-023-39372-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
Human Epidermal Growth Factor Receptor-2 (HER2)-negative breast cancers (BCs) contain HER2-low and HER2-zero ones. HER2-low breast cancer has been receiving wide-spread concerns as the marvelous effect of novel anti-HER2 antibody-drug conjugates, however, the characteristic remains unknown. Our aim was to explore the differences of clinicopathological indicators and survival outcomes between HER2-low and HER2-0 breast cancers. We retrospectively analyzed 501 invasive breast cancer patients with complete data on HER2 status from 2017 to 2021 in our single center, of whom 415 HER2 negative patients were included for subsequent analysis. Each cohort was further divided into hormone receptor (HR) positive and HR negative subgroup. Clinicopathological factors and survival outcomes were collected and compared between HER2-low BCs and HER2-0 BCs. HER2-low BCs was obviously higher in HR positive BCs, with 277 (90.5%) HER2-low HR positive patients, 29 (9.5%) HER2-low HR negative patients, 68 (62.4%) HER2-0 HR positive patients and 41 (37.6%) HER2-0 HR negative patients (P < 0.001). Significant differences between HER2-low BCs and Her2-0 BCs were observed in lymph node ratio (LNR) (mean rank, 215 vs. 188 P = 0.014), estrogen receptor (ER)expression (90.5% vs. 62.4% P < 0.001), progesterone receptor (PR) expression (84.3% vs. 56.9% P < 0.001), Ki-67 expression (46.4% vs. 61.5% P < 0.001), androgen receptor (AR) expression (68% vs. 50.5% P < 0.001), adjuvant chemotherapy (69% vs. 79.8% P = 0.03). HER2-low BCs had lower histological grade than HER2-0 BCs, with grade I-II (68.7% vs. 43.1%) and grade III (22.2% vs. 43.1%) P < 0.01. No statistical differences were detected between the two groups for DFS and DDFS. Our results demonstrated that HR and AR status was closely related to HER2-low breast cancers. Further exploration about survival prognosis of HER2-low breast cancer is badly needed.
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Affiliation(s)
- Man Yang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Jiale Sun
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Liqiong Liu
- Department of Nursing, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, 518100, Guangdong, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dongcai Lin
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Hong Zhou
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Jidong Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
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Caliskan Yildirim E, Atag E, Coban E, Umit Unal O, Celebi A, Keser M, Uzun M, Keskinkilic M, Tanrikulu Simsek E, Sari M, Yavuzsen T. The effect of low HER2 expression on treatment outcomes in metastatic hormone receptor positive breast cancer patients treated with a combination of a CDK4/6 inhibitor and endocrine therapy: A multicentric retrospective study. Breast 2023; 70:56-62. [PMID: 37343321 PMCID: PMC10382953 DOI: 10.1016/j.breast.2023.06.006] [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: 05/09/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND CDK4/6 inhibitors combined with endocrine therapy have significantly improved treatment outcomes for metastatic hormone receptor-positive (HR+) breast cancer patients. However, the impact of low HER2 expression on treatment response and progression-free survival (PFS) remains unclear. METHODS This multicenter retrospective study included 204 HR+ breast cancer patients treated with a combination of CDK4/6 inhibitor and endocrine therapy. HER2-zero disease was detected in 138 (68%) and HER2-low disease in 66 (32%) patients. Treatment-related characteristics and clinical outcomes were analyzed, with a median follow-up of 22 months. RESULTS The objective response rate (ORR) was 72.7% in the HER2 low group and 66.6% in the HER2 zero group (p = 0.54). Median PFS was not significantly different between the HER2-low and HER2 zero groups (19 months vs.18 months, p = 0.89), although there was a trend toward longer PFS in the HER2-low group for first-line treatment (24 months progression-free survival rate 63% vs 49%). In recurrent disease, the median PFS was 25 months in the HER2-low group and 12 months in the HER2-zero group (p = 0.08), while in de novo metastatic disease, the median PFS was 18 months in the HER2-low group and 27 months in the HER2-zero group (p = 0.16). The order of CDK4/6 inhibitor use and the presence of visceral metastasis were identified as independent variables affecting PFS. CONCLUSION Low HER2 expression did not significantly impact treatment response or PFS in HR+ breast cancer patients treated with a CDK4/6 inhibitor and endocrine therapy. Because of the conflicting results in the literature, further prospective studies are needed to evaluate the clinical significance of HER2 expression in HR+ breast cancer.
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Affiliation(s)
- Eda Caliskan Yildirim
- Dokuz Eylul University, Department of Internal Medicine, Division of Medical Oncology, Izmir, Turkey.
| | - Elif Atag
- Dokuz Eylul University, Department of Internal Medicine, Division of Medical Oncology, Izmir, Turkey
| | - Ezgi Coban
- Haydarpasa Numune Training and Research Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Olcun Umit Unal
- Health Sciences University Izmir Faculty of Medicine, Department of Internal Medicine, Izmir, Turkey
| | - Abdussamet Celebi
- Marmara University Pendik Training and Research Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Murat Keser
- Health Sciences University Tepecik Training and Research Hospital, Department of Medical Oncology, Izmir, Turkey
| | - Mehmet Uzun
- Dokuz Eylul University, Department of Internal Medicine, Division of Medical Oncology, Izmir, Turkey
| | - Merve Keskinkilic
- Dokuz Eylul University, Department of Internal Medicine, Division of Medical Oncology, Izmir, Turkey
| | - Eda Tanrikulu Simsek
- Haydarpasa Numune Training and Research Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Murat Sari
- Marmara University Pendik Training and Research Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Tugba Yavuzsen
- Dokuz Eylul University, Department of Internal Medicine, Division of Medical Oncology, Izmir, Turkey
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Jin Y, Lan A, Dai Y, Jiang L, Liu S. Comparison of the pCR Rate and DFS Among Breast Cancer Patients with Different Hormone Receptor and HER2 Statuses. BREAST CANCER (DOVE MEDICAL PRESS) 2023; 15:327-335. [PMID: 37153867 PMCID: PMC10162099 DOI: 10.2147/bctt.s407896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
Background Recent studies have investigated the features of breast cancer (BC) with low human epidermal growth factor receptor 2 (HER2) expression or HER2-0 expression. However, the results were inconsistent. In this study, we investigated the differences in the pathological complete response (pCR) rate and disease-free survival (DFS) between HER2-low and HER2-0 BC patients and between subgroups. Methods HER2-negative BC patients who received neoadjuvant chemotherapy between January 2013 and December 2019 in our hospital were retrospectively reviewed. First, the pCR rate and DFS were compared between HER2-low and HER2-0 patients and among different hormone receptor (HR) and HER2 statuses. Subsequently, DFS was compared between different HER2 status populations with or without pCR. Finally, a Cox regression model was used to identify the prognostic factors. Results Overall, 693 patients were selected: 561 were HER2-low, and 132 were HER2-0. Between the two groups, there were significant differences in N stage (P = 0.008) and HR status (P = 0.007). No significant difference in the pCR rate (12.12% vs 14.39%, P = 0.468) or DFS was observed, independent of HR status. HR+/HER2-low patients had a significantly worse pCR rate (P < 0.001) and longer DFS (P < 0.001) than HR-/HER2-low or HER2-0 patients. In addition, a longer DFS was found in HER2-low patients versus HER2-0 patients among those who did not achieve pCR. Cox regression showed that N stage and HR status were prognostic factors in the overall and HER2-low populations, while no prognostic factor was found in the HER2-0 group. Conclusion This study suggested that HER2 status is not associated with the pCR rate or DFS. Longer DFS was found only among patients who did not achieve pCR in the HER2-low versus HER2-0 population. We speculated that the interaction of HR and HER2 might have played a crucial role in this process.
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Affiliation(s)
- Yudi Jin
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Department of Pathology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer Hospital, Chongqing, 400030, People’s Republic of China
| | - Ailin Lan
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Yuran Dai
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Linshan Jiang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Shengchun Liu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Correspondence: Shengchun Liu, Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China, Email
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