Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site

Lower, Elyse E.; Khan, Shahjahan; Kennedy, Diane; Baughman, Robert P.

doi:10.2147/bctt.s137709

Cited by 34 publications

(29 citation statements)

References 21 publications

(40 reference statements)

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“…The conversions were mainly losses in ER and PR expression, while the majority of HER2 conversions were gains. Overall, the discordance rates (and discordance-rate orders of the three receptors) observed in this study were similar to those in previous reports; [4][5][6] as frequently reported, losses of receptor expression exceeded the gains. 7,8 According to most studies, PR has the highest discordance rate, followed by ER and HER2.…”

Section: Discussionsupporting

confidence: 91%

The Prognostic Impact of Hormonal Receptor and HER-2 Expression Discordance in Metastatic Breast Cancer Patients

Yang¹,

Li²,

Li³

et al. 2020

OTT

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These authors contributed equally to this work Background: Hormone receptor (HR) and human epidermal growth factor receptor (HER2) discordance between primary and metastatic breast cancer lesions is common. However, its impact on long-term survival remains unclear. We aimed to determine the prognostic value of this discordance in patients with metastaticf breast cancer (MBC). Methods: A total of 270 patients with MBC who were underwent re-biopsy of progressive metastases at Zhejiang Cancer Hospital from January 1, 2012 to December 31, 2015 with patients consent and then review their primary tumors pathological findings. The HR and HER2 status in both primary and progressive metastatic lesions was determined by immunohistochemistry and/or fluorescence in situ hybridization. The discordance rates were correlated with the clinicopathologic characteristics, metastatic lesions, salvage treatment, and survival analysis in this population. Results: A total of 142 (52.6%) MBC patients were diagnosed with discordant HR and HER2 status. Alterations in estrogen receptor (ER), progesterone receptor (PR), and HER2 status were observed in 20.70%, 37.78%, and 11.48% cases, respectively. Chemotherapy (P=0.0192) and endocrine therapy (P=0.048) significantly affected the conversion of HR status. Endocrine therapy was positively correlated with PR discordance (P=0.002), while ER discordance was associated with adjuvant chemotherapy (P=0.031). Survival analysis showed that ER status alterations between primary and metastatic lesions were associated with overall survival (P=0.002). The clinical prognosis was significantly worse with HR losses than with persistent HR positivity (P=0.023). In Cox multivariate analysis, the loss of HR expression and conversion to triple negative were independent prognostic indicators. Conclusion: Discordance in HR status between primary and metastatic lesions may impact the prognosis of MBC, and HR conversion has independent prognostic value.

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Section: Discussionsupporting

confidence: 91%

The Prognostic Impact of Hormonal Receptor and HER-2 Expression Discordance in Metastatic Breast Cancer Patients

Yang¹,

Li²,

Li³

et al. 2020

OTT

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“…According to this notion, metastatic disease evolution is associated with altering tumor biology. This concept is supported by a recent study showing that discordance continues also from the first to second metastases [ 30 ]. Interestingly, tumors in which heparanase expression was different between the primary tumor and its metastases exhibited inferior prognosis compared with tumors in which heparanase expression was stable (Figure 1B ).…”

Section: Discussionsupporting

confidence: 53%

Prognostic significance of heparanase expression in primary and metastatic breast carcinoma

et al. 2017

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High levels of heparanase are detected in many types of tumors, associated with bad prognosis. Typically, heparanase levels are evaluated in a biopsy taken from the primary lesion, whereas its expression by the resulting metastases is most often unresolved. This becomes critically important as anti-heparanase compounds enter advanced clinical trials. Here, we examined the expression of heparanase in pairs of primary and the resulting distant metastases of breast carcinoma. Interestingly, we found that heparanase expression in the metastatic lesion does not always reflect its expression in the primary tumor. Accordingly, in some cases, the primary lesion was stained positive for heparanase while the metastasis stained negative, and vice versa. Heparanase discordance occurred in 38% of the patients, higher than that reported for hormone receptors, and was associated with bad prognosis. Thus, examination of heparanase levels in the tumor metastases should be evaluated for most efficient precision medicine applying heparanase inhibitors. Furthermore, we found that in stage I breast cancer patients strong heparanase staining is associated with shorter overall survival. Thus, heparanase levels can assist in the diagnosis and in determining the necessity and type of treatment in early stage breast cancer.

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“…The tumor subtype may switch between primary BC and metastatic cancer. 33,35,55 A change in subtype can have an impact on survival, particularly if the change is from a primary lesion to a metastatic lesion. Monitoring the biological behavior is recommended in several studies as it can exclude secondary malignancy, which might change therapeutic strategy.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, studies show that the tumor subtype may change between the primary BC and the metastatic cancer sites. 33,36 The brain was actually found to be one of the most common sites in which there is a receptor switch. 36 As such it is necessary that a biopsy is made of the recurrent or metastatic lesion for reassessment of biological features, to determine the subsequent treatment.…”

Section: Mri Imaging Features and Their Correlation To Bc Subtypementioning

confidence: 99%

Breast Cancer Brain Metastasis: The Potential Role of MRI Beyond Current Clinical Applications

Hadjipanteli

Doolan

Kyriacou

et al. 2020

CMAR

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Breast cancer brain metastasis (BCBM) represents a major clinical challenge. Can MRI help in advancements in the management of BCBM? This review discusses MRI developments and the corresponding potential advancements in BCBM management. Methods: An exhaustive literature search was undertaken to identify studies which look into the potential of MRI in BCBM management. Seven hundred and eighty-four studies published from September 1984 to May 2020 were identified. Three topics are covered where MRI is not clinically established yet: 1) the prognosis of BCBM; 2) the screening of BC patients for BCBM development, and 3) the assessment of imaging features correlated to BC subtype. Results: Thirty-six studies were considered eligible for the purposes of this review. Ongoing progress is made with the identification of different BCBM characteristics and MRI metrics that might be related to prognosis. Progress has been made with the identification of different BCBM characteristics, including BCBM location, degree of edema, white matter disruption, tumor edge sharpness, and temporal muscle thickness. A more accurate prediction of prognosis could lead to more suitable patient management and treatment. The use of MRI in BCBM screening of the high-risk breast cancer population remains a controversial subject. To date, there are no results from clinical trials; however, there is a rising number of relatively small studies that show concern on this subject and support BCBM screening. It is important to oncologists to be able to assess the tumor subtype non-invasively. MRI features, which have shown some correlation with subtype, include the number of tumors, location, and their distribution in the brain. Advanced tools and metrics have been produced to carry out radiological characteristics analysis on MRI images. Assessing MRI features in more detail could provide a more personalized management of patients. Conclusion: Developments in the use of MRI have the potential to improve BCBM management.

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Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site

Cited by 34 publications

References 21 publications

<p>The Prognostic Impact of Hormonal Receptor and HER-2 Expression Discordance in Metastatic Breast Cancer Patients</p>

<p>The Prognostic Impact of Hormonal Receptor and HER-2 Expression Discordance in Metastatic Breast Cancer Patients</p>

Prognostic significance of heparanase expression in primary and metastatic breast carcinoma

<p>Breast Cancer Brain Metastasis: The Potential Role of MRI Beyond Current Clinical Applications</p>

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