Prognostic significance of receptor expression discordance between primary and recurrent breast cancers: a meta-analysis

Shiino, Sho; Ball, Graham; Syed, Binafsha Manzoor; Kurozumi, Sasagu; Green, Andrew; Tsuda, Hitoshi; Takayama, Shin; Suto, Akihiko; Rakha, Emad A.

doi:10.1007/s10549-021-06390-6

Cited by 14 publications

(11 citation statements)

References 53 publications

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“…Changes in the status of ER, PR, and HER2 status between CNB and excision specimens, between primary and metastatic tumours, and following neoadjuvant therapy have been the subject of many reviews and meta-analyses [91][92][93] including a review in this issue of the journal. Loss of ER or PR in recurrent tumours is associated with shorter outcome compared with receptor-positive concordance.…”

Section: Modification Of Er Pr and Her2 Status During Bc Evolutionmentioning

confidence: 99%

“…Loss of ER or PR in recurrent tumours is associated with shorter outcome compared with receptor-positive concordance. Contrasting this, gain of ER is associated with longer survival compared with receptor-negative concordance [93]. Despite the clinical evidence of the impact of the receptor discordance and the high rate of phenotypic drift reported in some studies, we advise investigating such discordant cases to exclude false-positive or -negative results.…”

Section: Modification Of Er Pr and Her2 Status During Bc Evolutionmentioning

confidence: 99%

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Assessment of Predictive Biomarkers in Breast Cancer: Challenges and Updates

et al. 2022

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The management of patients with breast cancer (BC) relies on the assessment of a defined set of well-established prognostic and predictive markers. Despite overlap, prognostic markers are used to assess the risk of recurrence and the likely benefit of systemic therapy, whereas predictive markers are used to determine the type of systemic therapy to be offered to an individual patient. In this review, we provide an update and present some challenges in the assessment of the main BC-specific molecular predictive markers, namely hormone receptors (oestrogen receptor [ER] and progesterone receptor [PR]), human epidermal growth factor receptor 2 (HER2), and KI67. As the main platform for assessing these markers in BC is immunohistochemistry (IHC), we address the cut-off values used to define positivity, the ER-low subgroup, the existence and significance of the ER−/PR+ phenotype, the use of PR in routine practice, and the role of hormone receptors in ductal carcinoma in situ. We discuss the newly introduced HER2-low class of BC and the clinical/biological difference between different HER2 groups (e.g., HER2 IHC score 3+ BCs vs. those with a HER2 IHC score 2+ with <i>HER2</i> gene amplification). The review concludes with an update on the applications of KI67 assessment in BC and observations on the role of immune checkpoint identification in BC.

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Section: Modification Of Er Pr and Her2 Status During Bc Evolutionmentioning

confidence: 99%

Section: Modification Of Er Pr and Her2 Status During Bc Evolutionmentioning

confidence: 99%

Assessment of Predictive Biomarkers in Breast Cancer: Challenges and Updates

et al. 2022

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“…In our study, there were 36 patients (11.8%) with unknown receptor status of ILRR, and we analyzed these patients using the receptor status of the primary tumor as a proxy. Receptor status of primary tumors and recurrent tumors are known to be discordant in a certain percentage of patients [ 39 ]. In our study ER, PR, and HER2 statuses were found to be discordant in 12.5%, 25.9%, and 7.7% of patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

A prediction model for distant metastasis after isolated locoregional recurrence of breast cancer

Murata

Yoshida

Shiino

et al. 2023

Breast Cancer Res Treat

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Purpose The impact of progesterone receptor (PR) status on the prognosis of breast cancer after isolated locoregional recurrence (ILRR) remains unclear. This study evaluated the impact of clinicopathologic factors, including PR status of ILRR, on distant metastasis (DM) after ILRR. Methods We retrospectively identified 306 patients with ILRR diagnosed at the National Cancer Center Hospital between 1993 and 2021 from the database. Cox proportional hazards analysis was performed to examine factors associated with DM after ILRR. We developed a risk prediction model based on the number of detected risk factors and estimated survival curves using the Kaplan–Meier method. Results During a median follow-up time of 4.7 years after ILRR diagnosis, 86 patients developed DM, and 50 died. Multivariate analysis revealed that seven risk factors were associated with poor distant metastasis-free survival (DMFS): estrogen receptor-positive/PR-negative/human epidermal growth factor receptor 2-negative ILRR, short disease-free interval, recurrence site other than ipsilateral breast, no-resection of ILRR tumor, chemotherapy for the primary tumor, nodal stage in the primary tumor, and no endocrine therapy for ILRR. The predictive model classified patients into 4 groups based on the number of risk factors: low-, intermediate-, high-, and the highest-risk groups with 0 to 1, 2, 3 to 4, and 5 to 7 factors, respectively. This revealed significant variation in DMFS among the groups. A higher number of the risk factors was associated with poorer DMFS. Conclusion Our prediction model, which considered the ILRR receptor status, may contribute to the development of a treatment strategy for ILRR.

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“…Despite these challenges, it is recommended that biomarker assessment on metastatic BC lesions is critical for the clinical care of patients with advanced BC. ASCO clinical practice guidelines recommend that all BC biomarkers be reassessed in recurrent or metastatic lesions, as biomarker status can change with disease progression and have therapeutic implications 39,40 . This specific issue of biomarker instability with disease progression may be especially relevant to BC with low levels of HER2 expression.…”

Section: Continued Diagnostic Challenges and Unresolved Questions In ...mentioning

confidence: 99%

The Significance of Recognition of Human Epidermal Growth Factor 2 Low in Breast Cancer Therapy

Tozbikian

2023

Advances in Anatomic Pathology

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In response to recent clinical trials that demonstrate the clinical benefit of antibody-drug conjugate drug therapy in breast cancer (BC) with human epidermal growth factor 2 (HER2) immunohistochemical scores of 1+ or 2+ and negative in situ hybridization results, a new concept of “HER2-low BC” has emerged to describe this newly relevant therapeutic category of BC. Clinical recognition of HER2-low BC has caused a paradigm shift in the therapeutic landscape and management of patients with BC and resulted in rapid changes in clinical practice guidelines. In addition the American Society of Clinical Oncology-College of American Pathologists (ASCO-CAP) recently updated their HER2 Guidelines Recommendations to specifically address HER2-low BC. A literature search in PubMed of peer-reviewed articles, regulatory communications, and relevant practice guidelines pertaining to HER2-low BC was conducted. In this review, we have summarized current published knowledge regarding the clinicopathologic and molecular features, diagnostic criteria, and most current guideline recommendations regarding HER2-low BC, and also highlight ongoing practical and diagnostic challenges when identifying HER2-low BC in routine clinical practice.

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Prognostic significance of receptor expression discordance between primary and recurrent breast cancers: a meta-analysis

Cited by 14 publications

References 53 publications

Assessment of Predictive Biomarkers in Breast Cancer: Challenges and Updates

Assessment of Predictive Biomarkers in Breast Cancer: Challenges and Updates

A prediction model for distant metastasis after isolated locoregional recurrence of breast cancer

The Significance of Recognition of Human Epidermal Growth Factor 2 Low in Breast Cancer Therapy

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