The prognostic and predictive impact of low estrogen receptor expression in early breast cancer: a systematic review and meta-analysis

Paakkola, Nelly-Maria; Karakatsanis, Andreas; Mauri, Davide; Foukakis, Theodoros; Valachis, Antonios

doi:10.1016/j.esmoop.2021.100289

Cited by 30 publications

(17 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, Pakkola et al. ( 31 ) confirmed these results in a meta-analysis that ERlo breast cancer was associated with worse DFS than ERhi breast cancer, and there was no statistically significant difference between ERlo and ERneg breast cancer in terms of DFS and OS. It is important to emphasize that even though this trend was demonstrated in other studies ( 32 , 33 ), there are some conflicting reports.…”

Section: Prognosismentioning

confidence: 84%

Clinical implication of low estrogen receptor (ER-low) expression in breast cancer

Reinert¹,

Cascelli

Resende

et al. 2022

Front. Endocrinol.

View full text Add to dashboard Cite

Breast cancer is a heterogeneous disease, and the estrogen receptor (ER) remains the most important biomarker in breast oncology. Most guidelines set a positive expression threshold of 1% staining in immunohistochemistry (IHC) to define ER positivity. However, different expression levels may be associated with diverse degrees of sensitivity to endocrine therapy as ER expression may impact breast cancer molecular biology as a continuous variable. ER-lo tumors, defined as those with 1-10% ER expression, represent a relatively small subgroup of breast cancer patients, with an estimated prevalence of 2-7%. These tumors are similar to ERneg disease in their molecular landscape, clinicopathological characteristics, prognosis, and response to therapy. Nevertheless, a proportion may retain some degree of ER signaling dependency, and the possibility of responding to some degree to endocrine therapy cannot be completely ruled out. This review article discusses the most important considerations regarding the definition of ER positivity, pathology assessment, prognosis, and therapeutic implication of ERlo breast cancer from the medical oncology perspective.

show abstract

Section: Prognosismentioning

confidence: 84%

Clinical implication of low estrogen receptor (ER-low) expression in breast cancer

Reinert¹,

Cascelli

Resende

et al. 2022

Front. Endocrinol.

View full text Add to dashboard Cite

show abstract

“…It is possible that chemoprevention through hormonal therapy may play a role in preventing BC in LFS carriers, and future studies should evaluate this as a potential preventive treatment. Treatment-oriented classification of subgroups of BC has evolved in the last decade ( 28 , 29 , 44 , 45 ). Previous published LFS BC studies considered ER-positive cut off greater than or equal to 1% ( 9 , 25 – 27 ), nevertheless, updated guidelines ( 28 , 29 ) incorporated the concept of ER-low-positive due to its potential impact in prognosis and predictive role in neoadjuvant chemotherapy response ( 44 ).…”

Section: Discussionmentioning

confidence: 99%

“…Treatment-oriented classification of subgroups of BC has evolved in the last decade ( 28 , 29 , 44 , 45 ). Previous published LFS BC studies considered ER-positive cut off greater than or equal to 1% ( 9 , 25 – 27 ), nevertheless, updated guidelines ( 28 , 29 ) incorporated the concept of ER-low-positive due to its potential impact in prognosis and predictive role in neoadjuvant chemotherapy response ( 44 ). Our study observed 6.5% (3/45) of ER-low-positive IBCs.…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Phenotype Associated With Li-Fraumeni Syndrome: A Brazilian Cohort Enriched by TP53 p.R337H Carriers

et al. 2022

View full text Add to dashboard Cite

Breast cancer (BC) is the most prevalent malignancy in women with Li-Fraumeni syndrome (LFS). The literature on BC in LFS is limited due to its rarity worldwide. A TP53 founder pathogenic variant (c.1010G>A; p.R337H) is responsible for the higher prevalence of this syndrome among women of Brazilian ancestry.PurposeThe aim of the study was to describe the BC phenotype expressed by Brazilian female LFS carriers and compare the data between p.R337H and other TP53 germline pathogenic/likely pathogenic variants (non-p.R337H carriers).MethodsWe searched for cases of TP53 germline pathogenic/likely pathogenic variant carriers affected by BC included between 2015 and 2020 in the BLiSS (Brazilian Li-Fraumeni Study) registry at the Sírio-Libanês Hospital.ResultsAmong 163 adult female carriers from the registry, 91 (56%) had received a BC diagnosis, including 72 p.R337H carriers. BC was the first cancer diagnosed in 90% of cases. Early onset BC (age ≤45 years) was diagnosed in 78.2% of cases (11.5% <31 years; 66.7% 31–45 years; 21.8% >45 years). The median age of BC diagnosis for p.R337H carriers was 39.5 years (range 20–69 years) compared to 34 years (range 21–63 years) for non-p.R337H carriers (p = 0.009). In total, 104 breast tumors were observed in 87 women. Bilateral BC was observed in 29.3% of cases. Histology was available for 96 tumors, comprising 69 invasive breast carcinomas, which were mostly invasive ductal carcinomas (95.6%), 25 ductal in situ carcinomas and 2 soft-tissue sarcomas. Overall, 90.5% of invasive breast carcinomas were hormone receptor (HR)-positive, 39.5% were human epidermal growth factor receptor 2 (HER2)-positive, and 32.8% showed HR and HER2 co-expression. In addition, 55.4% of patients opted for contralateral prophylactic mastectomy after a first BC diagnosis. There were no significant differences in the risk of developing contralateral BC or in the immunohistochemical profile between p.R337H and non-p.R337H groups.ConclusionsThe expressed phenotype of p.R337H is similar to that of other TP53 pathogenic/likely pathogenic variants, except for an average older age at the onset of disease; however, this is still younger than the general population.

show abstract

“…Finally, the TNBC population also included patients with 1-9% of ER expression. It has been consistently reported that tumours with the so-called ERlow phenotype share clinical features and behaviours more with "pure" TN [42,43], thus fuelling a vivid debate regarding the most clinically relevant ER cut-off for defining TNBC. Importantly, both in our study and BMSO's, TNBC was defined by adopting a 10% cut-off for ER negativity, thus generating two orders of considerations.…”

Section: Discussionmentioning

confidence: 99%

Incorporating weekly carboplatin in anthracycline and paclitaxel-containing neoadjuvant chemotherapy for triple-negative breast cancer: propensity-score matching analysis and TIL evaluation

et al. 2022

View full text Add to dashboard Cite

Background The generation of data capturing the risk-benefit ratio of incorporating carboplatin (Cb) to neoadjuvant chemotherapy (NACT) for triple-negative breast cancer (TNBC) in a clinical practice setting is urgently needed. Tumour-infiltrating lymphocytes (TILs) have an established role in TNBC receiving NACT, however, the role of TIL dynamics under NACT exposure in patients receiving the current standard of care is largely uncharted. Methods Consecutive TNBC patients receiving anthracycline-taxane [A-T] +/− Cb NACT at three Institutions were enrolled. Stromal-TILs were evaluated on pre-NACT and residual disease (RD) specimens. In the clinical cohort, propensity-score-matching was used to control selection bias. Results In total, 247 patients were included (A-T = 40.5%, A-TCb = 59.5%). After propensity-score-matching, pCR was significantly higher for A-TCb vs A-T (51.9% vs 34.2%, multivariate: OR = 2.40, P = 0.01). No differences in grade ≥3 haematological toxicities were observed. TILs increased from baseline to RD in the overall population and across A-T/A-TCb subgroups. TIL increase from baseline to RD was positively and independently associated with distant disease-free survival (multivariate: HR = 0.43, P = 0.05). Conclusions We confirmed in a clinical practice setting of TNBC patients receiving A-T NACT that the incorporation of weekly Cb significantly improved pCR. In addition, A-T +/− Cb enhanced immune infiltration from baseline to RD. Finally, we reported a positive independent prognostic role of TIL increase after NACT exposure.

show abstract

The prognostic and predictive impact of low estrogen receptor expression in early breast cancer: a systematic review and meta-analysis

Cited by 30 publications

References 30 publications

Clinical implication of low estrogen receptor (ER-low) expression in breast cancer

Clinical implication of low estrogen receptor (ER-low) expression in breast cancer

Breast Cancer Phenotype Associated With Li-Fraumeni Syndrome: A Brazilian Cohort Enriched by TP53 p.R337H Carriers

Incorporating weekly carboplatin in anthracycline and paclitaxel-containing neoadjuvant chemotherapy for triple-negative breast cancer: propensity-score matching analysis and TIL evaluation

Contact Info

Product

Resources

About