Prognostic Value of the Evolution of HER2-Low Expression after Neoadjuvant Chemotherapy

Ma, Youzhao; Zhu, Mingda; Zhang, Jingyang; Lv, Minhao; Chen, Xiuchun; Liu, Zhenzhen

doi:10.4143/crt.2022.1633

Cited by 9 publications

(2 citation statements)

References 34 publications

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“…Several studies have recently investigated the transition of HER2 status, including the HER2-low concept, in both early and advanced settings [ 24 , 33 - 45 ]. The discordant rate of HER2 status between the primary tumor and residual disease after neoadjuvant chemotherapy was 21.4%-36.4% [ 24 , 33 - 35 , 42 ]. Similarly, when evaluating the HER2 status of the primary tumor and a paired recurrent lesion and/or metastatic lesion, substantial portions of tumors showed a discordant HER2 status, ranging from 27.6% to 38% [ 36 - 41 , 43 - 45 ].…”

Section: Characteristics Of Her2-low Tumorsmentioning

confidence: 99%

HER2-Low Breast Cancer: Now and in the Future

Kang,

Kim

2024

Cancer Res Treat

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Breast cancer is a heterogeneous disease, and its subtypes are characterized by hormone receptor and human epidermal growth factor receptor 2 (HER2) expression status. "HER2-low" tumors, which exhibit a low level of HER2 expression (immunohistochemistry 1+ or 2+ without gene amplification), were conventionally considered not amenable to anti-HER2 targeting agents based on the results of a phase III trial of trastuzumab. However, this perspective is being challenged by the emergence of novel anti-HER2 antibody-drug conjugates, such as trastuzumab-deruxtecan. These innovative therapies have demonstrated remarkable efficacy against HER2-low breast cancer, shedding new light on a previously overlooked category of breast cancer. Such promising results highlight the need for in-depth investigations of the biology and prognostic implications of HER2-low tumors. In this review, we comprehensively summarize the current evidence surrounding this topic and highlight areas that warrant further exploration and research in the future.

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Section: Characteristics Of Her2-low Tumorsmentioning

confidence: 99%

HER2-Low Breast Cancer: Now and in the Future

Kang,

Kim

2024

Cancer Res Treat

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“…Considerable attempts have been made to investigate the prognostic value of HER2-low status. Several studies revealed a better [2][3][4][5][6][7][8][9][10] or worse [11,12] prognosis for patients with HER2-low tumor when compared to those with HER2-zero (defined as IHC 0) tumor in various settings, while others hardly found any difference between HER2-low and HER2-zero tumors [13][14][15][16][17][18][19][20]. The biological behavior of a HER2-low tumor is yet to be elucidated, especially in those administered neoadjuvant chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

The Modified Neo-Bioscore System for Staging Breast Cancer Treated with Neoadjuvant Therapy Based on Prognostic Significance of HER2-Low Expression

Zhao,

Chen,

Wang

et al. 2024

JCM

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Background: Recently, the classification of HER2 status evolves from binary to ternary, and HER2-low expression may exhibit prognostic significance. We aimed to investigate whether HER2-low tumor is distinct from HER2-zero or HER2-positive tumors, and then to develop a modified staging system (mNeo-Bioscore) that incorporates HER2-low status into Neo-Bioscore. Patients and Methods: This cohort study was conducted using data from the prospective database on breast cancer patients between January 2014 and February 2019. Results: Among 259 patients enrolled in the study, the HER2-low tumor exhibited significantly lower histological grade, pathological staging and Ki-67 level than the other two groups. HER2-low patients and HER2-positive patients receiving concurrent HER2-directed therapy may have similar LRFS (p = 0.531) and OS (p = 0.853), while HER2-zero peers may have significantly worse LRFS (p = 0.006) and OS (p = 0.017). In particular, a similar trend was also found in the patients without pathological complete response after surgery. Incorporation of HER2-low status made improvement in fit: 5-year OS rate estimates ranged from 33.33% to 100% for mNeo-Bioscore vs 61.36% to 100% for Neo-Bioscore. Conclusions: This study demonstrated that HER2-low tumor may exhibit prognostic significance. The innovative mNeo-Bioscore, based on a new classification of HER2 status, may serve as a prognostic staging system superior to Neo-Bioscore.

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Preoperative Differentiation of HER2‐Zero and HER2‐Low from HER2‐Positive Invasive Ductal Breast Cancers Using BI‐RADS MRI Features and Machine Learning Modeling

Zhou,

Zhang,

Miao

et al. 2024

Magnetic Resonance Imaging

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BackgroundAccurate determination of human epidermal growth factor receptor 2 (HER2) is important for choosing optimal HER2 targeting treatment strategies. HER2‐low is currently considered HER2‐negative, but patients may be eligible to receive new anti‐HER2 drug conjugates.PurposeTo use breast MRI BI‐RADS features for classifying three HER2 levels, first to distinguish HER2‐zero from HER2‐low/positive (Task‐1), and then to distinguish HER2‐low from HER2‐positive (Task‐2).Study TypeRetrospective.Population621 invasive ductal cancer, 245 HER2‐zero, 191 HER2‐low, and 185 HER2‐positive. For Task‐1, 488 cases for training and 133 for testing. For Task‐2, 294 cases for training and 82 for testing.Field Strength/Sequence3.0 T; 3D T1‐weighted DCE, short time inversion recovery T2, and single‐shot EPI DWI.AssessmentPathological information and BI‐RADS features were compared. Random Forest was used to select MRI features, and then four machine learning (ML) algorithms: decision tree (DT), support vector machine (SVM), k‐nearest neighbors (k‐NN), and artificial neural nets (ANN), were applied to build models.Statistical TestsChi‐square test, one‐way analysis of variance, and Kruskal–Wallis test were performed. The P values <0.05 were considered statistically significant. For ML models, the generated probability was used to construct the ROC curves.ResultsPeritumoral edema, the presence of multiple lesions and non‐mass enhancement (NME) showed significant differences. For distinguishing HER2‐zero from non‐zero (low + positive), multiple lesions, edema, margin, and tumor size were selected, and the k‐NN model achieved the highest AUC of 0.86 in the training set and 0.79 in the testing set. For differentiating HER2‐low from HER2‐positive, multiple lesions, edema, and margin were selected, and the DT model achieved the highest AUC of 0.79 in the training set and 0.69 in the testing set.Data ConclusionBI‐RADS features read by radiologists from preoperative MRI can be analyzed using more sophisticated feature selection and ML algorithms to build models for the classification of HER2 status and identify HER2‐low.Level of Evidence4.Technical EfficacyStage 2.

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Prognostic Value of the Evolution of HER2-Low Expression after Neoadjuvant Chemotherapy

Cited by 9 publications

References 34 publications

HER2-Low Breast Cancer: Now and in the Future

HER2-Low Breast Cancer: Now and in the Future

The Modified Neo-Bioscore System for Staging Breast Cancer Treated with Neoadjuvant Therapy Based on Prognostic Significance of HER2-Low Expression

Preoperative Differentiation of HER2‐Zero and HER2‐Low from HER2‐Positive Invasive Ductal Breast Cancers Using BI‐RADS MRI Features and Machine Learning Modeling

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