Changes in ER, PR and HER2 receptors status after neoadjuvant chemotherapy in breast cancer

Yang, Yufeng; Liao, Ying‐Yang; Li, Le‐Qun; Xie, Shu-Rui; Xie, Yan-Fang; Peng, Ning-Fu

doi:10.1016/j.prp.2013.08.012

Cited by 41 publications

(24 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Cytotoxic, endocrine and biological agents may specifically target and kill sensitive BC subpopulations, leaving behind the resistant ones. This hypothesis was sustained by some studies, showing higher frequency of BC phenotype change in NAC-treated patients than in naïve controls [14,15]. The present work shows that most cases undergoing phenotype changes presented with advanced stage (pT3-4, pN+, cM+).…”

Section: Discussionsupporting

confidence: 83%

Neoadjuvant Chemotherapy Exerts Selection Pressure Towards Luminal Phenotype Breast Cancer

et al. 2017

View full text Add to dashboard Cite

Background: Breast cancer (BC) phenotype after neoadjuvant chemotherapy (NAC) has not been extensively described and few data exist on whether expression of the primary tumor hormone receptors, HER2 and Ki-67 changes as a result of chemotherapy. Materials and Methods: We analyzed specimens from all BC patients treated with anthracycline/taxane-based NAC at our Institution between January 2010 and March 2015 (n = 325). The expression of estrogen receptor (ER), progesterone receptor (PR), HER2 and Ki-67 was determined in pre- and post-NAC specimens. McNemar's test was used to compare paired proportions. Results: Among patients with residual disease after NAC, basal phenotype was luminal A, luminal B, HER2 positive and triple negative in 44, 111, 74 and 27 cases, respectively. PR-positive tumors decreased from 68.0% in the initial biopsy sample to 61.7% in the surgical specimen (p = 0.024). A Ki-67 of < 20% increased from 23.6% to 45% (p < 0.001). ER expression changed from positive to negative in 5% and from negative to positive in 16.7% of cases. Overall, 30% of cases underwent subtype changes, 79% of them towards luminal differentiation. Conclusions: The switch towards luminal phenotype suggests some kind of endocrine effect of NAC. Our findings raise renewed interest in combinatorial cytotoxic chemotherapy with concomitant or rather sequential endocrine therapy, either alone or with targeted agents.

show abstract

Section: Discussionsupporting

confidence: 83%

Neoadjuvant Chemotherapy Exerts Selection Pressure Towards Luminal Phenotype Breast Cancer

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The most plausible hypothesis is that the distribution of cancer cell types was altered, as chemo-and/or hormone-sensitive tumor cells were eliminated by certain types of treatment. Yang et al (19) demonstrated that chemo-sensitive tumor cells were targeted and killed in the setting of neoadjuvant chemotherapy; consequently, insensitive tumor cells with different biological properties survived in the residual lesion prior to surgery. Furthermore, Keen et al (20) revealed that tumor progression may induce genetic drift and also treatment-associated clone selection.…”

Section: Discussionmentioning

confidence: 99%

Alterations in three biomarkers (estrogen receptor, progesterone receptor and human epidermal growth factor 2) and the Ki67 index between primary and metastatic breast cancer lesions

et al. 2017

View full text Add to dashboard Cite

Abstract. In recurrent breast cancer, the tumor phenotype, as assessed by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) status, occasionally changes. This change, in addition to the Ki67 index were evaluated at sites of recurrence and the correlation between changes in tumor phenotype and survival were assessed in breast cancer patients. Comparisons in pathological parameters between primary and metastatic lesions were drawn between ER, PR, HER2, and the Ki67 index in 70 patients with recurrent breast cancer. The association between changes in tumor phenotype and patient survival was assessed. The hormone receptor status changed from positive, in the primary lesions, to negative, in the metastatic lesions in 19.8% (ER) and 39.5% (PR) of patients, respectively. Conversion from negative to positive status was confirmed in 27.2% (ER) and 31.2% (PR) of patients, respectively. A change in HER2 status from negative (primary lesion) to positive (metastatic lesion) occurred in seven patients (10%). The mean Ki67 index of primary lesions with positive hormone receptor status was significantly lower than at sites of recurrence with any hormone receptor status, from 10.9±9.8 standard deviation (SD) to 22.9±18.6 (P=0.031) and 12.2±10.5 SD to 27.4±20.9 (P=0.023), for ER and PR, respectively. The mean overall survival of patients with ER status conversion from positive to negative was 7.4±1.2 standard error (SE) years, and 14.8±1.4 SE years for patients who retained positive ER status (P=0.005, log-rank), with a hazard ratio of 3.44 (95% confidence interval, 1. 36-8.33). This difference in survival based upon change in ER status was similarly observed in patients with PR status conversion in the same direction. Thus, ER and PR status conversion at the time of recurrence strongly impact survival, particularly if the change is from positive (primary lesion) to negative (metastatic lesion). Monitoring the biological behavior of breast cancer may benefit a patient by allowing for a novel personalized treatment strategy.

show abstract

“…Earlier studies analyzed the concentration of ER in whole samples in cytosol of whole tissue extracts [33], which included non-tumorous components such as normal breast, stroma, inflammatory cells and also in situ disease. The cut-off values to define hormone positivity was variable at 1% [34] 5% [35] and 10% [36] with some studies using the Allred score (37) as per the current study. Finally, patient number varied from few numbers [33,38,39] to larger cohorts [34,35].…”

Section: Discussionmentioning

confidence: 81%

Impact of Neoadjuvant Chemotherapy on Breast Cancer Biomarkers: A Guide for Further Adjuvant Treatment

Eladawei¹

2019

CRJ

View full text Add to dashboard Cite

Introduction and objective: There is discrepancy in practice worldwide whether testing molecular profile on residual carcinoma is warranted and if treatment options should be modified according to final molecular profile of tumor. Therefore, the current study was conducted to evaluate potential changes in breast biomarkers; estrogen receptor, progesterone receptor, HER-2 and Ki67 expression before and after neoadjuvant chemotherapy in Egyptian patients with breast cancer. Patients and method: a hundred locally advanced (initial clinical stage IIB-IIIC) breast carcinoma patients were treated by one of two protocols of neoadjuvant chemotherapy. First protocol: 4 cycles of AC (adriamycin, cyclophosamide) repeated every 21 days, followed by 12 weeks of paclitaxel. Second protocol: FAC (fluorouracil, adriamycin, cyclophosamide) or FEC (fluorouracil, epirubicin, cyclophosamide) for 6 cycles to be repeated every 21 days. Immunohistochemisty of breast biomarkers were performed on both initial biopsies and also surgical resection specimens for each patient. Result: There was statistically significant change of ER (p=0.03). Fifty five tumors were initially negative and thirty nine became negative after neoadjuvant chemotherapy. The rate of conversion from negative to positive was 14%. Forty seven of tumors were initially negative progesterone receptors (PR) and sixty two became negative after neoadjuvant chemotherapy. PR status showed statistically significant change between before and after neoadjuvant chemotherapy (p=0.04). The rate of conversion of PR from positive to negative was 15%. There is no statistically significant change of HER-2 before and after neoadjuvant chemotherapy (p=0.98). There is statistically significant change from high to low Ki 67 index (p=0.006). Rate of conversion changes of Ki 67 from high to low was 20%. Conclusion: neoadjuvant chemotherapy change receptor status and reduce K i67 expression. This change in hormone receptor status from negative to positive offers new endocrine therapy to this group of patients. Accordingly, reevaluation of hormone receptors after neoadjuvant chemotherapy is required to guide further adjuvant treatment.

show abstract

Changes in ER, PR and HER2 receptors status after neoadjuvant chemotherapy in breast cancer

Cited by 41 publications

References 30 publications

Neoadjuvant Chemotherapy Exerts Selection Pressure Towards Luminal Phenotype Breast Cancer

Neoadjuvant Chemotherapy Exerts Selection Pressure Towards Luminal Phenotype Breast Cancer

Alterations in three biomarkers (estrogen receptor, progesterone receptor and human epidermal growth factor 2) and the Ki67 index between primary and metastatic breast cancer lesions

Impact of Neoadjuvant Chemotherapy on Breast Cancer Biomarkers: A Guide for Further Adjuvant Treatment

Contact Info

Product

Resources

About