Association of Biomarker Discrepancy and Treatment Decision, Disease Outcome in Recurrent/Metastatic Breast Cancer Patients

Abstract

BackgroundBiomarker discrepancy between primary and recurrent/metastatic breast cancer is well known, however its impact on prognosis and treatment after relapse is still unclear. Current study aims to evaluate biomarkers discrepancy between primary and recurrent/metastatic lesions as well as to investigate its association with following treatment pattern and disease outcome.Patients and methodsWe retrospectively included consecutive breast cancer patients undergoing surgery in our center from Jan. 2009 to Dec. 2016 and reported disease recurrence. Patients with re-biopsy and paired biomarkers statuses on primary and recurrent/metastatic lesions were further analyzed. Kappa test was used to analyze the concordance rate of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) status. Post-recurrence survival (PRS) was compared between subgroups by Kaplan-Meier curve. Cox regression model was applied to identify impact factors for PRS.ResultsA total of 156 patients were finally included, of whom 70 and 86 had loco-regional and distant recurrence, respectively. Concordance rates of ER, PR and HER2 were 83.3%, 66.7%, and 97.1%, respectively, which was similarly distributed among different recurrent sites (all P > 0.05). Primary ER-positivity (vs ER-negativity, P = 0.014) and loco-regional recurrence (vs distant metastasis, P = 0.001) were independently associated with superior PRS, while patients with visceral metastasis (P < 0.001) had the worst disease outcome. Hormone receptor/HER2 status discrepancy was observed in 28 patients. Fifteen of them changed systemic treatment based on biomarker statuses of recurrent lesion, however, their PRS was not improved compared to those 13 patients who continued the same treatment according to primary biomarkers statuses (P = 0.298).ConclusionBiomarker discrepancy was observed between primary and recurrent/metastatic breast cancer lesions and had certain influence on treatment strategies after relapse. However, its impact on disease outcome wasn’t established in the current study, which deserves further evaluation.

Prognosis and Treatment of Metastatic Breast Cancer From A Real-World Scenario in China: A Retrospective Cohort Study

“…One of the crucial reasons may be that biomarker discrepancies were observed between primary and recurrent/metastatic breast cancer lesions and had a certain influence on treatment strategies after relapse and disease outcome. 35 , 36 …”

“…One of the crucial reasons may be that biomarker discrepancies were observed between primary and recurrent/ metastatic breast cancer lesions and had a certain influence on treatment strategies after relapse and disease outcome. 35,36 We further analyzed the PFS and tumor response according to the line of therapy in other subgroups. As expected, a major difference in PFS was seen in the subgroup analysis, including the highest survival rate for the luminal A subtype, followed by the luminal B and triple-negative subtypes.…”

Evaluation of tumour heterogeneity by 18F-fluoroestradiol PET as a predictive measure in breast cancer patients receiving palbociclib combined with endocrine treatment

“…Currently, there are no clinically available biomarkers for prescribing CDK4/6 inhibitors except for ER expression mainly from primary tumour tissues [ 9 , 15 ]. However, the expression status of ER in breast cancer may change during the course of disease progression or treatment [ 34 ]. ER status discordance rates between primary and metastatic breast cancer sites may reach approximately 32%, which might change the therapeutic strategy and sensitivity for breast cancer patients [ 35 ].…”

HER2-Low Status Is Not Accurate in Breast Cancer Core Needle Biopsy Samples: An Analysis of 5610 Consecutive Patients

“…At least 4 pieces of tumor tissue (0.1 × 1.0 cm per piece) were collected from each patient. The criteria for ER, PR and Ki67 IHC evaluation were adopted according to the latest American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines [ 19 ], and the procedure has been described in our previous studies [ 20 , 21 ].…”