The Changes of the Histologic and Biologic Markers Induced by Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer

Abstract

Purpose: Neoadjuvant chemotherapy (NAC) has become the standard treatment for locally advanced breast cancer. The postoperatively adjuvant systemic treatment is based on the status of the histological and biological markers of either the pre-NAC or the post-NAC. There have been several reports that have demonstrated the changes of the histological and biological markers after NAC. The aim of this study is to investigate the effects of NAC on the expression of the histological and biological markers of breast cancer. Methods: We analyzed the paired pre-and post-NAC tumor specimens from 37 patients with stage IIIA, IIIB or IIIC breast cancer. All the patients received 2 to 6 cycles of anthracycline-containing NAC. Over 6 pieces of pre-NAC tumor specimens were taken by 14 G core needle from multiple sites of a tumor, and the post-NAC specimens were taken at the time of the operation. The histologic grade and immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), c-erbB2, p53, Ki67, CD31 and pglycoprotein were analyzed in the paired pre-and post-NAC tumor specimens from 37 patients. Results: Twenty five patients (67.6%) revealed significant changes of more than one marker. The markers that showed changes of more than two grades were as follows; histologic grade in 1, ER in 4, PR in 9, c-erbB2 in 4, p53 in 1, Ki67 in 4, CD31 in 9 and pglycoprotein in 5 patients. In 12 patients (32.4%), significant changes were found in the markers that can influence the decision-making for adjuvant treatment (i.e. ER, PR and cerbB2). The ER/PR status changed from positive to negative in 4 patients and c-erbB2 was changed from positive to negative in 3 patients. Among those patients, the strategy of adjuvant treatment was adjusted according to the changes. Conclusion: The specimens for the histologic and biologic markers of a tumor should be taken before NAC because NAC can have an influence on the expression of the prognostic markers of locally advanced breast cancers, and this may subsequently influence predicting the prognosis and making the decision for adjuvant systemic treatment.

Serum human epidermal growth factor receptor 2 levels as a real‐time marker for tumor burden in breast cancer patients

“…Interestingly, we found that the serum HER2 level was elevated in 15.8% of recurrent cases with an HER2-negative primary tumor, which had been considered false-positive cases in other studies. This conversion rate of serum HER2 in our study is very similar with the rate of tissue HER2 change after disease recurrence in other studies; HER2 status was found to change after disease recurrence in 7% to 32% of cases [2][3][4][5][6]23]. Taken together, these results suggest that elevated serum HER2 levels could reflect the conversion of tissue HER2 expression, and HER2 targeted therapy could be helpful in relapsed patients with HER2-negative primary tumors and elevated serum HER2 levels during the follow-up period.…”