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Farshid G, Armes J, Dessauvagie B, Gilhotra A, Kumar B, Mahajan H, Millar E, Pathmanathan N, Snell C. Development and Validation of a HER2-Low Focused Immunohistochemical Scoring System With High-Interobserver Concordance: The Australian HER2-Low Breast Cancer Concordance Study. Mod Pathol 2024; 37:100535. [PMID: 38852812 DOI: 10.1016/j.modpat.2024.100535] [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: 04/05/2024] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
The DESTINY Breast-04 trial revealed survival advantages of trastuzumab deruxtecan for women with metastatic HER2-low breast cancer (1+ or 2+ immunohistochemistry [IHC], without amplification). Although this trial applied the 2018 Americal Society of Clinial Oncology (ASCO)/College of American Pathologists (CAP) HER2 IHC scoring criteria, the subjectivity and imprecision in IHC scoring have raised concerns that patients' treatment may be misaligned. Our group of 9 experienced breast pathologists collated a deidentified set of 60 breast cancer core biopsies from 3 laboratories, evaluated with the Ventana 4B5 HER2 assay and mostly scored locally as HER2 0 or 1+. Based on ASCO/CAP 2018 criteria and our extensive experience of reporting HER2 IHC, we specified scoring conventions for cancers with low levels of HER2 protein expression, articulating specific scoring pitfalls. Each pathologist then reviewed digitized whole slide images of the IHC slides and scored the HER2 expression for each case. At a subsequent consensus workshop, we reviewed the cases jointly to establish consensus scores for each case and determine the percentage of HER2 expressing tumor cells. Consensus was reached on all cases, with 40 classified as 1+ and 3 as 2+ (not amplified), totaling 43 (71.7%) HER2-low cancers. The remaining cases were HER2 0. In 93.3% of cases (56/60), the consensus score matched with the majority opinion of pathologists' independent scores. Seven (41.2%) of the 17 cases reported locally as HER2 0 were classified as HER2 low. Conversely, among 32 cases with local scores of 1+, 7 (21.8%) were reclassified as ultralow or null. Individual pathologists' accuracy in matching the consensus scores ranged from 73.3% to 91.67% (mean, 80.74%). Among HER2-low cancers those in which <20% of the tumor cells expressed HER2 had the lowest concordance levels. Observers Cohen's κ coefficients for concordance were excellent for 4, good in 1, and moderate in the 4 observers. This reference set of cases with expert consensus HER2 scores will be invaluable for peer training and development of our national external quality assurance program for HER2-low cancers. For assessing breast cancers at the low end of HER2 protein expression, our targeted scoring criteria and explicit instruction on pitfalls improved pathologists' accuracy and concordance.
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Affiliation(s)
- Gelareh Farshid
- Discipline of Medicine, Adelaide University, Adelaide, South Australia, Australia; Discipline of Anatomical Pathology, SA Pathology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia.
| | - Jane Armes
- Sullivan Nicolaides Pathology, Birtinya, Queensland, Australia
| | - Benjamin Dessauvagie
- Clinipath Pathology, Sonic Healthcare Australia Pathology, Osborne Park, Western Australia, Australia; Pathology and Laboratory Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Amardeep Gilhotra
- Discipline of Anatomical Pathology, SA Pathology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
| | - Beena Kumar
- Anatomical Pathology and Diagnostic Genomics, Monash Health Pathology, Monash Health, Clayton, Victoria, Australia
| | - Hema Mahajan
- NSW Health Pathology, Department of Anatomical Pathology, Westmead Hospital, Sydney, New South Wales, Australia; School of Medicine, The University of Sydney, Camperdown, New South Wales, Australia; School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Ewan Millar
- NSW Health Pathology, Department of Anatomical Pathology, Westmead Hospital, Sydney, New South Wales, Australia; St George Hospital, Kogarah & School of Clinical Medicine, St George and Sutherland Campus, UNSW Medicine & Health, Sydney, New South Wales, Australia
| | - Nirmala Pathmanathan
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney Douglass Hanly Moir Pathology, Macquarie Park, Sydney, New South Wales, Australia
| | - Cameron Snell
- Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Meng P, Dalal H, Chen Y, Brueffer C, Gladchuk S, Alcaide M, Ehinger A, Saal LH. Digital PCR quantification of ultrahigh ERBB2 copy number identifies poor breast cancer survival after trastuzumab. NPJ Breast Cancer 2024; 10:14. [PMID: 38374091 PMCID: PMC10876644 DOI: 10.1038/s41523-024-00621-x] [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: 09/05/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024] Open
Abstract
HER2/ERBB2 evaluation is necessary for treatment decision-making in breast cancer (BC), however current methods have limitations and considerable variability exists. DNA copy number (CN) evaluation by droplet digital PCR (ddPCR) has complementary advantages for HER2/ERBB2 diagnostics. In this study, we developed a single-reaction multiplex ddPCR assay for determination of ERBB2 CN in reference to two control regions, CEP17 and a copy-number-stable region of chr. 2p13.1, validated CN estimations to clinical in situ hybridization (ISH) HER2 status, and investigated the association of ERBB2 CN with clinical outcomes. 909 primary BC tissues were evaluated and the area under the curve for concordance to HER2 status was 0.93 and 0.96 for ERBB2 CN using either CEP17 or 2p13.1 as reference, respectively. The accuracy of ddPCR ERBB2 CN was 93.7% and 94.1% in the training and validation groups, respectively. Positive and negative predictive value for the classic HER2 amplification and non-amplification groups was 97.2% and 94.8%, respectively. An identified biological "ultrahigh" ERBB2 ddPCR CN group had significantly worse survival within patients treated with adjuvant trastuzumab for both recurrence-free survival (hazard ratio, HR: 3.3; 95% CI 1.1-9.6; p = 0.031, multivariable Cox regression) and overall survival (HR: 3.6; 95% CI 1.1-12.6; p = 0.041). For validation using RNA-seq data as a surrogate, in a population-based SCAN-B cohort (NCT02306096) of 682 consecutive patients receiving adjuvant trastuzumab, the ultrahigh-ERBB2 mRNA group had significantly worse survival. Multiplex ddPCR is useful for ERBB2 CN estimation and ultrahigh ERBB2 may be a predictive factor for decreased long-term survival after trastuzumab treatment.
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Affiliation(s)
- Pei Meng
- Division of Oncology, Department of Clinical Sciences Lund, Lund University Cancer Center, Skåne University Hospital Comprehensive Cancer Center, SE-22381, Lund, Sweden
| | - Hina Dalal
- Division of Oncology, Department of Clinical Sciences Lund, Lund University Cancer Center, Skåne University Hospital Comprehensive Cancer Center, SE-22381, Lund, Sweden
| | - Yilun Chen
- SAGA Diagnostics AB, Scheelevägen 2, MV406, SE-22381, Lund, Sweden
| | - Christian Brueffer
- Division of Oncology, Department of Clinical Sciences Lund, Lund University Cancer Center, Skåne University Hospital Comprehensive Cancer Center, SE-22381, Lund, Sweden
- SAGA Diagnostics AB, Scheelevägen 2, MV406, SE-22381, Lund, Sweden
| | - Sergii Gladchuk
- Division of Oncology, Department of Clinical Sciences Lund, Lund University Cancer Center, Skåne University Hospital Comprehensive Cancer Center, SE-22381, Lund, Sweden
- SAGA Diagnostics AB, Scheelevägen 2, MV406, SE-22381, Lund, Sweden
| | - Miguel Alcaide
- SAGA Diagnostics AB, Scheelevägen 2, MV406, SE-22381, Lund, Sweden
| | - Anna Ehinger
- Division of Oncology, Department of Clinical Sciences Lund, Lund University Cancer Center, Skåne University Hospital Comprehensive Cancer Center, SE-22381, Lund, Sweden
- Department of Genetics and Pathology, Laboratory Medicine, Region Skåne, Lund, Sweden
| | - Lao H Saal
- Division of Oncology, Department of Clinical Sciences Lund, Lund University Cancer Center, Skåne University Hospital Comprehensive Cancer Center, SE-22381, Lund, Sweden.
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Aoyama J, Nojima Y, Sano D, Hirai Y, Kijima N, Aizawa Y, Takada K, Hatano T, Takahashi H, Nishimura G, Oridate N. Effect of HER2-targeted therapy on PDX and PDX-derived organoids generated from HER2-positive salivary duct carcinoma. Head Neck 2023. [PMID: 37184432 DOI: 10.1002/hed.27395] [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: 12/27/2022] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND We previously established a patient-derived xenograft (PDX) model, patient-derived organoids (PDOs), and PDX-derived organoids (PDXOs) for salivary duct carcinoma (SDC). Using these models, this study examined the therapeutic effect of human epidermal growth factor receptor 2 (HER2) blockade on HER2-positive SDC. METHODS The therapeutic effect of lapatinib was assessed in SDC PDXOs with regards to cell growth, receptor/downstream signaling molecule expression, phosphorylation levels, and apoptosis. Effect of lapatinib treatment was evaluated in vivo in SDC PDX mice. RESULTS The siRNA knockdown of HER2 and lapatinib suppressed cell proliferation in SDC PDXOs. Lapatinib inhibited the phosphorylation of HER2 and its downstream targets, and induced apoptosis in SDC PDXOs. Lapatinib also significantly reduced tumor volumes compared with that of the control in SDC PDX mice. CONCLUSION For the first time, we demonstrated the efficacy of anti-HER2 therapy in HER2-positive SDC using preclinical models of SDC PDX and PDXO.
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Affiliation(s)
- Jun Aoyama
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yusuke Nojima
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Daisuke Sano
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Otorhinolaryngology-Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Yuri Hirai
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Natsumi Kijima
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshihiro Aizawa
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kentaro Takada
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takashi Hatano
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideaki Takahashi
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Goshi Nishimura
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhiko Oridate
- Department of Biology and Function in Head and Neck, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Otorhinolaryngology-Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
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Shin J, Ham B, Seo JH, Lee SB, Park IA, Gong G, Kim SB, Lee HJ. Immune repertoire and responses to neoadjuvant TCHP therapy in HER2-positive breast cancer. Ther Adv Med Oncol 2023; 15:17588359231157654. [PMID: 36865681 PMCID: PMC9972050 DOI: 10.1177/17588359231157654] [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: 08/17/2022] [Accepted: 01/30/2023] [Indexed: 03/02/2023] Open
Abstract
Background Despite the introduction of trastuzumab, pathologic complete response (pCR) is not attained in approximately 30-40% of Human epithelial growth factor receptor-2-positive breast cancer. Tumor-infiltrating lymphocytes (TIL) have been suggested as a predictive marker of treatment response, albeit not always effective. We investigated the relationship between trastuzumab, docetaxel, carboplatin, and pertuzumab (TCHP) treatment and immune repertoire as a treatment response predictor. Design In all, 35 cases were divided into two experimental groups: 10 and 25 cases in the preliminary and main experiments, respectively. In the preliminary experiment, the biopsy tissues before TCHP treatment and the surgical tissues after TCHP treatment were compared. In the main experiment, the biopsy tissues before TCHP treatment were compared according to the TCHP treatment response. Methods The T-cell repertoire for TRA, TRB, TRG, and TRD, and B-cell repertoire for immunoglobulin heavy, immunoglobulin kappa, and immunoglobulin lambda were evaluated. Whole transcriptome sequencing was also performed. Results In the preliminary experiment, the density and richness of the T-cell receptor (TCR) and B-cell receptor (BCR) repertoires decreased after treatment, regardless of TCHP response. In the main experiment, the Shannon's entropy index, density, and length of CDR3 of the TCR and BCR repertoires did not differ significantly in patients who did and did not achieve pCR. The pCR and non-pCR subgroups according to the level of TILs revealed that the non-pCR/lowTIL group had a higher proportion of low-frequency clones than the pCR/lowTIL group in TRA (non-pCR/lowTIL versus pCR/lowTIL, 0.01-0.1%, 63% versus 45.3%; <0.01%, 32.9% versus 51.8%, p < 0.001) and TRB (non-pCR/lowTIL versus pCR/lowTIL, 0.01-0.1%, 26.5% versus 14.7%; <0.01%, 72.0% versus 84.1%, p < 0.001). Conclusions The role of the diversity, richness, and density of the TCR and BCR repertoires as predictive markers for TCHP response was not identified. Compositions of low-frequency clones could be candidates for predictive factors of TCHP response; however, validation studies and further research are necessary.
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Affiliation(s)
- Junyoung Shin
- Department of Pathology, Asan Medical Center,
University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Sae Byul Lee
- Department of Breast Surgery, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ah Park
- Department of Pathology, Kangbuk Samsung
Hospital, Seoul, Republic of Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center,
University of Ulsan College of Medicine, Seoul, Korea
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Chen R, Qi Y, Huang Y, Liu W, Yang R, Zhao X, Wu Y, Li Q, Wang Z, Sun X, Wei B, Chen J. Diagnostic value of core needle biopsy for determining HER2 status in breast cancer, especially in the HER2-low population. Breast Cancer Res Treat 2023; 197:189-200. [PMID: 36346486 PMCID: PMC9823013 DOI: 10.1007/s10549-022-06781-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/22/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE The status of human epidermal growth factor receptor 2 (HER2) is important for treatment decision-making of breast cancer and was commonly determined by core needle biopsy (CNB). The concordance of CNB with surgical excision biopsy (SEB) has been verified, but remain unclear according to the newly developed classification of HER2 status. Our study aimed to re-evaluate the diagnostic value of CNB for determining HER2 status in breast cancer, especially in the HER2-low population. METHODS Eligible breast cancer patients in West China Hospital between January 1, 2007 and December 31, 2021 were enrolled consecutively and data were extracted from the Hospital Information System. The agreement of HER2 status between CNB and SEB was calculated by concordance rate and κ statistics, as well as the sensitivity, specificity, positive, and negative predictive values (PPV & NPV). Logistic models were used to explore potential factors associated with the discordance between both tests. RESULTS Of 1829 eligible patients, 1097 (60.0%) and 1358 (74.2%) were consistent between CNB and SEB by pathological and clinical classifications, respectively, with κ value being 0.46 (0.43-0.49) and 0.57 (0.53-0.60). The sensitivity (50.9%-52.7%) and PPV (50.5%-55.2%) of CNB were especially low among IHC 1+ and 2+/ISH - subgroups by pathological classifications; however, it showed the highest sensitivity (77.5%) and the lowest specificity (73.9%) in HER2-low population by clinical classifications. Advanced N stages might be a stable indicator for the discordance between both tests. CONCLUSION The diagnostic value of CNB was limited for determining HER2 status in breast cancer, especially in HER2-low population.
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Affiliation(s)
- Ruixian Chen
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Yana Qi
- grid.13291.380000 0001 0807 1581Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Ya Huang
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Weijing Liu
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Ruoning Yang
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Xin Zhao
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Yunhao Wu
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
| | - Qintong Li
- grid.13291.380000 0001 0807 1581Departments of Obstetrics & Gynecology and Pediatrics, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu, China
| | - Zhu Wang
- grid.13291.380000 0001 0807 1581Laboratory of Molecular Diagnosis of Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Sun
- grid.13291.380000 0001 0807 1581Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Bing Wei
- grid.13291.380000 0001 0807 1581Department of Pathology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Jie Chen
- grid.13291.380000 0001 0807 1581Breast Center, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan China
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Futamura M, Ishihara K, Nagao Y, Ogiso A, Niwa Y, Nakada T, Kawaguchi Y, Ikawa A, Kumazawa I, Mori R, Kitazawa M, Hosono Y, Kuno M, Kawajiri M, Nakakami A, Takeuchi M, Morikawa A, Tokumaru Y, Katagiri Y, Asano Y, Mushika Y, Shimokawa T, Matsuhasih N. Neoadjuvant chemotherapy using nanoparticle albumin-bound paclitaxel plus trastuzumab and pertuzumab followed by epirubicin and cyclophosphamide for operable HER2-positive primary breast cancer: a multicenter phase II clinical trial (PerSeUS-BC04). Breast Cancer 2023; 30:293-301. [PMID: 36609911 PMCID: PMC9950177 DOI: 10.1007/s12282-022-01425-2] [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: 08/19/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Nanoparticle albumin-bound paclitaxel (nab-PTX) is a promising antibody partner for anti-human epidermal growth factor receptor 2 (HER2). We performed neoadjuvant chemotherapy (NAC) for HER2-positive breast cancer (BC) using nab-PTX plus trastuzumab (T-mab) and pertuzumab (P-mab), followed by epirubicin and cyclophosphamide (EC). METHODS In this multicenter phase II clinical trial (January 2019-July 2020), patients with stage I (T1c)-IIIB HER2-positive primary BC were treated with four cycles of nab-PTX plus T-mab and P-mab, followed by four cycles of EC. The primary endpoint was the pathological complete response (pCR) rate. Secondary endpoints were clinical response rate (RR), adverse events (AE), and tumor-infiltrating lymphocytes (TILs) in biopsy samples. RESULTS In total, 43 patients were enrolled (mean age, 54 years). Twenty-two patients had HER2, and 21 patients had luminal/HER2-subtypes. The overall pCR rate was 53.5% (23/43, 95% CI: 42.6-64.1%, p = 0.184), whilst the pCR for HER2 was 68.2% (15/22, 95% CI: 45.1-86.1) and 38.1% for luminal/HER2 (8/21, 95% CI: 18.1-61.6%). The RR was 100% [clinical (c) CR:25, partial response (PR): 18]. AEs (≥ G3) included neutropenia (23.3%), leukopenia (7.0%), liver dysfunction (7.0%), and peripheral neuropathy (4.7%) when nab-PTX was administered. EC administration resulted in leukopenia (34.2%), neutropenia (31.6%), and febrile neutropenia (15.8%). The TILs in preoperative biopsy samples were significantly higher in pCR compared to non-pCR samples. CONCLUSION Nab-PTX plus T-mab and P-mab induced a high pCR rate in HER2-positive BC, particularly in the HER2-subtype. Given that AEs are acceptable, this regimen is safe and acceptable as NAC for HER2-positive BC.
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Affiliation(s)
- Manabu Futamura
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | | | - Yasuko Nagao
- Department of Surgery, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Atsuko Ogiso
- Department of Surgery, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yoshimi Niwa
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Takumi Nakada
- Department of Breast Surgery, Gifu Municipal Hospital, Gifu, 500-8513 Japan
| | - Yoshihiro Kawaguchi
- Department of Breast Surgery, Asahi University Hospital, Gifu, 500-8523 Japan
| | - Ai Ikawa
- Department of Surgery, Takayama Red Cross Hospital, Takayama, 506-8550 Japan
| | - Iwao Kumazawa
- Department of Surgery, Gifu-Seino Medical Center, Ibi Hospital, Ibi, 501-0696 Japan
| | - Ryutaro Mori
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Mai Kitazawa
- Department of Breast Surgery, Asahi University Hospital, Gifu, 500-8523 Japan
| | - Yoshiki Hosono
- Department of Breast Surgery, Gifu Municipal Hospital, Gifu, 500-8513 Japan
| | - Masashi Kuno
- Department of Surgery, Gihoku Kosei Hospital, Gifu, 501-2105 Japan
| | - Mana Kawajiri
- Department of Surgery, Gihoku Kosei Hospital, Gifu, 501-2105 Japan
| | - Akira Nakakami
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Makoto Takeuchi
- Department of Breast Surgery, Central Japan International Medical Center, Minokamo, 505-8510 Japan
| | - Akemi Morikawa
- Department of Breast Surgery, Central Japan International Medical Center, Minokamo, 505-8510 Japan
| | - Yoshihisa Tokumaru
- Department of Breast Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Yasuo Katagiri
- Department of Pathology, Gifu University Hospital, Gifu, 501-1194 Japan
| | - Yoshimasa Asano
- Department of Surgery, Municipal Ena Hospital, Ena, 509-7201 Japan
| | - Yoshinori Mushika
- Department of Breast Surgery, Daiyukai General Hospital, Ichinomiya, 491-8551 Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, 614-8509 Japan
| | - Nobuhisa Matsuhasih
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu, 501-1194 Japan
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7
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Moss NS, Tosi U, Santomasso BD, Beal K, Modi S. Multifocal and pathologically-confirmed brain metastasis complete response to trastuzumab deruxtecan. CNS Oncol 2022; 11:CNS90. [PMID: 35674041 PMCID: PMC9280405 DOI: 10.2217/cns-2022-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/23/2022] [Indexed: 12/27/2022] Open
Abstract
Antibody-drug conjugates have transformed the treatment of HER2+ breast and other cancers. Unfortunately, the CNS remains a sanctuary site for many such patients in part due to poor macromolecule penetration across the blood-brain tumor barrier. Trastuzumab deruxtecan (T-DXd), a high-payload antibody-drug conjugate, was recently found to improve progression-free survival in HER2+ breast cancer patients versus prior-generation trastuzumab emtansine, prompting us to evaluate CNS activity in a woman with brain-only metastatic disease. T-DXd achieved complete response despite heavy pretreatment. Three persistent, previously-irradiated lesions were biopsy-proven to represent treatment effect. Subsequent recurrence occurred upon treatment holiday; partial response was observed with rechallenge. This case suggests T-DXd is active in HER2+ breast cancer brain metastases and supports further prospective evaluation.
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Affiliation(s)
- Nelson S Moss
- Department of Neurological Surgery & Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Umberto Tosi
- Department of Neurological Surgery & Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Bianca D Santomasso
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kathryn Beal
- Department of Radiation Oncology & Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Shanu Modi
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [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
| | - 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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9
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Updates on breast biomarkers. Virchows Arch 2022; 480:163-176. [PMID: 35029776 DOI: 10.1007/s00428-022-03267-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/13/2021] [Accepted: 12/30/2021] [Indexed: 12/22/2022]
Abstract
Recent advancements in breast cancer treatment have ushered in a new era of precision medicine. Novel trials have led to the approval of a growing list of personalized therapies and corresponding biomarkers. These advancements have shifted the pathologist's practice into a leading role in the management breast cancer. Understanding the complex algorithms and diagnostic modalities used to assess predictive and prognostic biomarkers is central for quality oncology care. ER and HER2 subcategorize breast cancers into treatment groups under which different biomarkers and therapies are indicated, while they also serve as predictive biomarkers for specific targeted treatments. This review will cover the evolution and latest updates of the CAP/ASCO guidelines relevant to these two important biomarkers in breast cancer. Still evolving concepts such as HER2 heterogeneity, HER2 "low," and HER2-mutated cancers have the potential to continue to change HER2 testing in breast cancers. In addition to ER and HER2, biomarkers used in specific clinical scenarios will be covered. In early-stage ER-positive/HER2-negative disease, multi-gene expression panels (such as OncotypeDX) have emerged as the new standard biomarker when determining if chemotherapy should be added to endocrine therapy. In the more aggressive ER-negative/HER2-positive or triple negative early-stage breast cancers, response to neoadjuvant therapy has proved to be a useful biomarker to help determine if additional therapy should be added for patients with an incomplete response. Ki67 has also recently emerged as a marker that can be used to identify the highest risk ER-positive and HER2-negative cancers if considering adding a cell cycle inhibitor (abemaciclib) to endocrine therapy. Importantly, in the metastatic setting, numerous predictive biomarkers have emerged, including recommendations for germline BRCA mutation testing for all metastatic patients (to determine if PARP inhibitor therapy is an option) and other ER-/HER2-dependent biomarkers such as PD-L1 (for potential immunotherapy in triple negative patients) and PIK3CA mutation status (for potential PI3K inhibitor therapy in ER-positive metastatic patients). Other less common biomarkers of targeted therapy options (e.g., MSI/MMR, TMB, NTRK) as well as comprehensive genomic profiling to identify uncommon targets are also available in the metastatic setting to determine additional treatment options.
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Horisawa N, Adachi Y, Takatsuka D, Nozawa K, Endo Y, Ozaki Y, Sugino K, Kataoka A, Kotani H, Yoshimura A, Hattori M, Sawaki M, Iwata H. The frequency of low HER2 expression in breast cancer and a comparison of prognosis between patients with HER2-low and HER2-negative breast cancer by HR status. Breast Cancer 2021; 29:234-241. [PMID: 34622383 DOI: 10.1007/s12282-021-01303-3] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The DESTINY-Breast04 clinical trial is currently investigating whether trastuzumab deruxtecan (T-DXd) is effective in HER2-low as well as HER2-positive breast cancer. This highlights the interest in treatment strategies for patients with HER2-low breast cancer. The current study was therefore designed to determine the frequency of HER2-low among all breast cancers, and to compare the prognosis of HER2-low patients with that of HER2-negative patients. METHODS We retrospectively reviewed the biological data from 4,918 of 4,977 primary breast cancer patients who attended our institute. We quantified the overall frequency of breast cancer patients with a new HER2-low subtype that was defined by an immunohistochemistry score of IHC1 + or IHC2 + /ISH-. We then compared the clinical characteristics and prognosis of HER2-low patients with that of patients who did not have HER2 amplification (HER2-0). RESULTS Low HER2 expression was found in 3169 (64.4%) patients; 2860 (58.1%) were HR-positive and 309 (6.3%) were HR-negative. Among HER2-0 patients, 681 (13.9%) were HR-positive and 157 (3.2%) were HR-negative. The HER2-0 group tended to have more poor prognostic factors than the HER2-low group, irrespective of HR status. There were no statistically significant differences between the prognosis of HER2-low and HER2-0 patients, regardless of HR status. However, patients in the HER2-low group tended to have better prognosis than those in the HER2-0 group. CONCLUSION HER2-low patients did not have a significantly different prognosis than HER2-0 patients, regardless of HR status. However, we should consider tailoring therapies for patients with HRE2-low early breast cancer according to their HR status.
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Affiliation(s)
- Nanae Horisawa
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan.
| | - Yayoi Adachi
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
| | - Daiki Takatsuka
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
| | - Kazuki Nozawa
- Department of Clinical Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
| | - Yuka Endo
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
| | - Yuri Ozaki
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
| | - Kayoko Sugino
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
| | - Ayumi Kataoka
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
| | - Haruru Kotani
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
| | - Akiyo Yoshimura
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
| | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
| | - Masataka Sawaki
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City, Aichi, 464-8681, Japan
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11
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The impact of 2018 ASCO-CAP HER2 testing guidelines on breast cancer HER2 results. An audit of 2132 consecutive cases evaluated by immunohistochemistry and in situ hybridization. Mod Pathol 2020; 33:1783-1790. [PMID: 32366941 DOI: 10.1038/s41379-020-0555-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 11/08/2022]
Abstract
The 2018 iteration of the ASCO-CAP HER2 testing guidelines proposes significant changes with an emphasis on the integration of concurrent immunohistochemistry (IHC) and in situ hybridization (ISH). We wished to evaluate the impact of these changes on clinical practice. Between Jan 2012 to Feb 2017, 2132 consecutive invasive breast carcinomas were evaluated with IHC and ISH for HER2. The sample tested was the breast primary or axillary nodes in all but 57 (2.7%) distant metastases. For 1824 cases with both dual-probe ISH and IHC results, the ISH subgroup was 1: 299 (16.4%), 2: 19 (1.0%), 1.0%, 3: 6 (0.3%), 4: 48 (2.6%) and 5: 1452 (79.6%). Ultimately 21% of group 2 and 4 cases and 80% of group 4 cases were positive. The change in HER2 status between the 2018 vs 2013 was: amplified in 323 (15.2%) vs 15.5%; not amplified in 1804 (84.6%) vs 82.2%; equivocal in 0 vs 2.3% previously. In 22 of 2127 cases (1.03%) the 2013 and 2018 results were discordant, all in groups 2-4. The discrepant cases included 15 of 331 (4.5%) of 2013 amplified cancers, now negative (all in groups 2 or 3) and 7 of 1796 (0.4%) 2013 nonamplified cases, now positive (all in group 4). Because of routine testing with both IHC and ISH, we found 6 of 1147 (0.52%) IHC negative (0 or 1+) cases were amplified by ISH. Further, 19 of 289 (6.6%) of IHC 3+ cases were nonamplified by ISH, circumstances not covered by these guidelines. In summary at the population level, the 2018 ASCO-CAP guidelines have a 99% agreement with the 2013 results. A major advantage is the abolishment of the clinically problematic equivocal category. Routine performance of both IHC and ISH uncovers a small proportion of cancers whose HER2 status is not addressed by these guidelines.
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