Impact of immunohistochemical profile changes following neoadjuvant therapy in the treatment of breast cancer

Candás, Gabriela; García, Alejandra; Ocampo, María Delfina; Korbenfeld, Ernesto; Vuoto, Héctor D; Isetta, Juan; Cogorno, Lucas; Zimmermann, Agustina González; Sigal, Marca; Acevedo, Santiago; Berwart, Julia; Naveira, M.; Bemi, Agustina; Uriburu, Juan L

doi:10.3332/ecancer.2021.1162

Cited by 4 publications

(11 citation statements)

References 26 publications

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“…Several series have reported an interaction between the ER and HER2 pathways, with changes in HER2 status seen more commonly in ER+ tumours, and loss of HER2 corresponding to an increase in ER expression [11, 12, 22]. Resistance to HER2-targeted therapies accompanied by an increase in ER expression secondary to reactivation of ER signalling pathways has been demonstrated in vitro studies [35].…”

Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

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Receptor Status after Neoadjuvant Therapy of Breast Cancer: Significance and Implications

Shaaban¹,

Provenzano²

2022

Pathobiology

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Neoadjuvant chemotherapy (NACT) is now established in routine management of early breast cancer. Alterations in oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) following NACT are reported, with wide variation in results across series. In larger series, changes in ER status are identified in 5–23%, whilst changes in PR status are more frequent (14.5–67%). HER2 status changes less frequently with loss being more common than gain, and higher rates of change with immunohistochemistry are observed compared to in situ hybridization and following HER2-targeted therapy compared with chemotherapy alone. Triple negative is the most stable molecular subtype with combined ER, and HER2-positive cancers show the highest rate of change. Neoadjuvant endocrine therapy is used less commonly than NACT, and whilst loss of ER is rare, changes in PR status can occur in up to 40% of cases. There is relatively little published data on the impact of change in receptor status on survival outcomes. In patients whose tumours become ER or HER2 positive post-NACT, endocrine or anti-HER2 therapy can be initiated, although evidence from clinical trials is lacking. Most guidelines do not currently recommend routine retesting; however it should be considered in some circumstances.

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Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

“…Candas et al [12], performed a similar analysis on a series of 123 cases, 21% of which showed a change in status. Of 18 TN cancers without pCR, only one became HR+/HER2−.…”

Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

Receptor Status after Neoadjuvant Therapy of Breast Cancer: Significance and Implications

Shaaban¹,

Provenzano²

2022

Pathobiology

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“…There was consensus regarding the need for further immunohistochemistry following NAT in cases of residual disease. Indeed, results can differ in relation to the percutaneous biopsy material in up to 5% of cases [ 21 , 22 ]; therefore, confirming findings may significantly change the patient’s treatment and prognosis.…”

Section: Discussion and Consensusmentioning

confidence: 97%

“…of the Federal University of Maranhão, São Luís, MA, Brazil. 21 Advanced Center for Breast Diagnosis (CORA), Federal University of Goiás and the Dona Iris Women's and Maternity Hospital, Goiânia, GO, Brazil. 22 Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.…”

Section: Acknowledgementsmentioning

confidence: 99%

Management of early-stage triple-negative breast cancer: recommendations of a panel of experts from the Brazilian Society of Mastology

et al. 2022

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Background Triple-negative breast cancer (TNBC) is a heterogenous subtype involving different patterns of behavior and clinical course, demanding a complex, individualized sequence of treatment. The knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology regarding TNBC were evaluated and a consensus regarding management and treatment was reached. Methods Affiliates completed a survey involving 44 objective questions. In addition, a specialist meeting was held with 27 experts and 3 ad hoc consultants. The panelists completed the survey before and after brainstorming. Answers achieving 70% of agreement were considered consensual. The chi-square test was used to compare answers between panelists and affiliates and the Kappa coefficient to calculate agreement. Results Consensus among the panelists increased from 26 (59.1%) to 32 questions (72.7%) following brainstorming (p = 0.17), including 7/10 questions on systemic treatment. Among the affiliates, consensus was achieved for 24 questions (54.5%), resulting in moderate agreement (κ = 0.445). Neoadjuvant chemotherapy should be indicated for almost all cases (except cT1a-b N0) and should include platinum agents. When indicated, immunotherapy is part of the standard of care. The panel reaffirmed the concept of no ink on tumor as indicative of adequate margins and the possibility of sentinel lymph node biopsy for cN1 patients who become cN0 following neoadjuvant therapy. Controversies remain on combining immunotherapy with capecitabine/olaparib in pertinent cases. Conclusion Expert consensus was achieved for > 70% of the questions, with moderate agreement between panelists and affiliates. Educational interventions on systemic breast cancer treatment affected decision-making in 60% of the questions.

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“…Systemic therapies can be administered before (neoadjuvant) and/or after surgical resection (adjuvant). Neoadjuvant chemotherapy (NACT) is used as the initial treatment for patients with inoperable tumors, for operable tumors to downstage and allow more conservative surgical excisions (both in the breast and in the axilla), for early-stage tumors (especially triple-negative and HER2-positive), and in highly proliferative tumors, as they show better response to systemic therapy [1][2][3][4][5]. Information about response to neoadjuvant therapy response also allows adjuvant therapy decision.…”

Section: Introductionmentioning

confidence: 99%

Changes in Invasive Breast Carcinomas after Neoadjuvant Chemotherapy Can Influence Adjuvant Therapeutic Decisions

Jaime dos Santos,

Balabram,

Mara Reis Gomes

et al. 2024

Cancer Res Treat

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Purpose Neoadjuvant chemotherapy (NACT) can change invasive breast carcinomas (IBC) and influence the patients’ overall survival time (OS). We aimed to identify IBC changes after NACT and their association with OS.Materials and Methods IBC data in pre- and post-NACT samples of 86 patients were evaluated and associated with OS.Results Post-NACT tumors changed nuclear pleomorphism score (p=0.025); mitotic count (p=0.002); % of tumor-infiltrating inflammatory cells (p=0.016); presence of <i>in situ</i> carcinoma (p=0.001) and lymphovascular invasion (LVI; p=0.002); expression of estrogen (p=0.003), progesterone receptors (PR; p=0.019), and Ki67 (p=0.003). Immunohistochemical (IHC) profile changed in 26 tumors (30.2%, p=0.050). Higher risk of death was significatively associated with initial tumor histological grade III (hazard ratio [HR], 2.94), high nuclear pleomorphism (HR, 2.53), high Ki67 index (HR, 2.47), post-NACT presence of LVI (HR, 1.90), luminal B–like profile (HR, 2.58), pre- (HR, 2.26) and post-NACT intermediate mitotic count (HR, 2.12), pre- (HR, 4.45) and post-NACT triple-negative IHC profile (HR, 4.52). On the other hand, lower risk of death was significative associated with pre- (HR, 0.35) and post-NACT (HR, 0.39) estrogen receptor–positive, and pre- (HR, 0.37) and post-NACT (HR, 0.57) PR-positive. Changes in IHC profile were associated with longer OS (p=0.050). In multivariate analysis, pre-NACT grade III tumors and pre-NACT and post-NACT triple negative IHC profile proved to be independent factors for shorter OS.Conclusion NACT can change tumor characteristics and biomarkers and impact on OS; therefore, they should be reassessed on residual samples to improve therapeutic decisions.

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Impact of immunohistochemical profile changes following neoadjuvant therapy in the treatment of breast cancer

Cited by 4 publications

References 26 publications

Receptor Status after Neoadjuvant Therapy of Breast Cancer: Significance and Implications

Receptor Status after Neoadjuvant Therapy of Breast Cancer: Significance and Implications

Management of early-stage triple-negative breast cancer: recommendations of a panel of experts from the Brazilian Society of Mastology

Changes in Invasive Breast Carcinomas after Neoadjuvant Chemotherapy Can Influence Adjuvant Therapeutic Decisions

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