Molecular Types and Neoadjuvant Chemotherapy in Patients with Breast Cancer- While Molecular Shifting is More Common in Luminal a Tumors, The Pathologic Complete Response is Most Frequently Observed in Her-2 Like Tumors

Salim, Derya Kivrak; Mutlu, Hasan; Eryılmaz, Melek Karakurt; Musri, Fatma Yalcin; Tural, Deniz; Gündüz, Şeyda; Çoşkun, Hasan Şenol

doi:10.7314/apjcp.2014.15.21.9379

“…This is in agreement with previous reports, which noted that triple negative and HER2+ subtypes were more sensitive to anthracycline-based neoadjuvant chemotherapies than luminal breast cancers. 26 , 27 Also, others reported that the response to neoadjuvant chemotherapy was significantly higher in patients with endocrine nonresponsive tumors, 28 with pCR rates of 24% in hormone receptor (HR)-negative and 8% in HR-positive tumors. 29 Patients with luminal B/HER2-subtypes had a higher pCR rate than those with the luminal B/ HER2+ subtypes (15.6% and 8.1%, respectively), which is in accordance with a recent report in which 25% of patients with luminal B/HER2- and only 8% with luminal B/ HER2+ subtypes achieved pCR after neoadjuvant chemotherapies.…”

Section: Discussionmentioning

confidence: 99%

Value of Breast Cancer Molecular Subtypes and Ki67 Expression for the Prediction of Efficacy and Prognosis of Neoadjuvant Chemotherapy in a Chinese Population

Wang

¹

,

Sang

²

,

Xu

³

et al. 2016

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The aim of the study was to determine the predictive role of breast cancer subtypes in the efficacy and prognosis of neoadjuvant chemotherapy (NCT) regimens combining taxanes and anthracyclines.Data from 240 patients with breast cancer who received surgery after 4 to 6 weeks of NCT were retrospectively analyzed. The patients were classified into luminal A, luminal B, HER2 overexpression, and triple negative breast cancer (TNBC) as well as low Ki67 (≤ 14%) and high Ki67 (> 14%) expression groups using immunohistochemistry. NCT outcome parameters were pathological complete response (pCR), clinical complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) 4 weeks after surgery. Long-term outcome parameters were disease-free survival (DFS) with a follow-up time of 3 to 56 months.pCR rates were 1.6%, 13.4%, 22.6%, and 23.8% in patients with luminal A, luminal B, HER2, and TNBC cancers, respectively. High pCR rates correlated with high Ki67 expression (> 40%) (P < 0.001, HR = 0.17, 95% CI: 0.074–0.37) and negative estrogen receptor (ER) status (P < 0.001, HR = 3.74, 95% CI: 1.71–8.12) in a multivariate analysis. However, the DFS rate of luminal A breast cancer was the highest compared to all other groups, but only significantly higher compared to luminal B (P = 0.035, HR = 1.480, 95% CI: 1.060–1.967) patients and correlated with Ki67 expression > 40% (P = 0.005).Luminal A type patients derived the least benefit from neoadjuvant chemotherapy but had better long-term prognoses. ER status and Ki67 expression served as efficacy predictors for NCT, whereas only Ki67 expression > 40% correlated with long-term treatment outcomes.

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“…This is in agreement with previous reports, which noted that triple negative and HER2þ subtypes were more sensitive to anthracycline-based neoadjuvant chemotherapies than luminal breast cancers. 26,27 Also, others reported that the response to neoadjuvant chemotherapy was significantly higher in patients with endocrine nonresponsive tumors, 28 with pCR rates of 24% in hormone receptor (HR)negative and 8% in HR-positive tumors. 29 Patients with luminal B/HER2-subtypes had a higher pCR rate than those with the luminal B/ HER2þ subtypes (15.6% and 8.1%, respectively), which is in accordance with a recent report in which 25% of patients with luminal B/HER2-and only 8% with luminal B/ HER2þ subtypes achieved pCR after neoadjuvant chemotherapies.…”

Section: Discussionmentioning

confidence: 99%

Value of breast cancer molecular subtypes and Ki67 expression for the prediction of efficacy and prognosis of neoadjuvant chemotherapy in a Chinese population.

Wang

¹

,

Xu

²

,

Sang³

et al. 2016

JCO

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The aim of the study was to determine the predictive role of breast cancer subtypes in the efficacy and prognosis of neoadjuvant chemotherapy (NCT) regimens combining taxanes and anthracyclines. Data from 240 patients with breast cancer who received surgery after 4 to 6 weeks of NCT were retrospectively analyzed. The patients were classified into luminal A, luminal B, HER2 overexpression, and triple negative breast cancer (TNBC) as well as low Ki67 (14%) and high Ki67 (> 14%) expression groups using immunohistochemistry. NCT outcome parameters were pathological complete response (pCR), clinical complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) 4 weeks after surgery. Long-term outcome parameters were disease-free survival (DFS) with a follow-up time of 3 to 56 months. pCR rates were 1.6%, 13.4%, 22.6%, and 23.8% in patients with luminal A, luminal B, HER2, and TNBC cancers, respectively. High pCR rates correlated with high Ki67 expression (> 40%) (P < 0.001, HR ¼ 0.17, 95% CI: 0.074-0.37) and negative estrogen receptor (ER) status (P < 0.001, HR ¼ 3.74, 95% CI: 1.71-8.12) in a multivariate analysis. However, the DFS rate of luminal A breast cancer was the highest compared to all other groups, but only significantly higher compared to luminal B (P ¼ 0.035, HR ¼ 1.480, 95% CI: 1.060-1.967) patients and correlated with Ki67 expression > 40% (P ¼ 0.005). Luminal A type patients derived the least benefit from neoadjuvant chemotherapy but had better long-term prognoses. ER status and Ki67 expression served as efficacy predictors for NCT, whereas only Ki67 expression > 40% correlated with long-term treatment outcomes. (Medicine 95(18):e3518) Abbreviations: AJCC = American Joint Committee on Cancer, CR = clinical complete response, DFS = disease-free survival, ECOG = Eastern Cooperative Oncology Group, ER = estrogen receptor, FEC = fluorouracil þ epirubicin þ cyclophosphamide, FISH = fluorescent in situ hybridization, HER2 = human epidermal growth factor receptor 2, IHC = immunohistochemistry, NCT = neoadjuvant chemotherapy, pCR = pathological complete response, PD = progressive disease, PgR = progesterone receptor, PR = partial response, RECIST = Response Evaluation Criteria in Solid Tumors, SD = stable disease, T = docetaxel monotherapy, TN = triple negative, TNBC = triple negative breast cancer, TX = docetaxel þ capecitabine.

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“…The general idea of receptor conversion and subsequent molecular subtype shifting throughout the disease progression process is being gradually understood and appreciated (Salim et al, 2014); the concept was accepted and confirmed by Hoefnage et al, Lindstrom et al and Ibrahim et al, They based their conclusions on comparing the primary tumor status with the status of their metastasis; however, these studies' results may be affected by the concept of tumor immunohistochemical heterogeneitythat could be more accepted on testing core biopsies from the primary tumor-as well as the possible effect of any neoadjuvent or post-operative therapy (Hoefnage et al, 2010), (Lindstrom et al, 2012) and ( Ibrahim et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Could the Breast Prognostic Biomarker Status Change During Disease Progression? An Immunohistochemical Comparison between Primary Tumors and Synchronous Nodal Metastasis

Esmail¹,

Abdel‐Salam²,

Ellah³

2015

Asian Pacific Journal of Cancer Prevention

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Background: Prognostic biomarkers in breast cancer are routinely investigated in the primary tumors to guide further management. However, it is proposed that the expression may change during the disease progression, and may result in a different immune profile in the metastatic nodes. This work aimed to investigate the expression of breast prognostic biomarkers in primary tumors and in its axillary nodal metastasis, to estimate the possible discordant expression. Materials and Methods: 60 paired primary and axillary nodal metastasis samples were collected from patients with primary breast cancer with positive nodal deposits, diagnosed at the Maadi Military Hospital, Cairo, Egypt, during the year 2013. ER, PR and HER2 expression was assessed by immunohistochemistry in all samples Results: 48.3% of the included cases showed concordant results for both ER and PR receptors between the primary tumor and its nodal metastasis while 51.7% showed discordant results and the discordance level was statistically significant. On the other hand, 70% of the cases showed concordant Her2 results between the primary tumors and the nodal deposits, 30% showed discordant results and the difference was significant. Conclusions: The study indicated that the discordance in ER and PR receptor expression between the primary breast tumor and their nodal metastasis may be significant. The possible switch in the biomarker status during the disease progression is worth noting and may change the patient therapeutic planning. So, whether the treatment selection should be based on biomarkers in the lymph node is a topic for further studies and future clinical trials.

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Molecular Types and Neoadjuvant Chemotherapy in Patients with Breast Cancer- While Molecular Shifting is More Common in Luminal a Tumors, The Pathologic Complete Response is Most Frequently Observed in Her-2 Like Tumors

Cited by 10 publications

References 35 publications

Value of Breast Cancer Molecular Subtypes and Ki67 Expression for the Prediction of Efficacy and Prognosis of Neoadjuvant Chemotherapy in a Chinese Population

Value of Breast Cancer Molecular Subtypes and Ki67 Expression for the Prediction of Efficacy and Prognosis of Neoadjuvant Chemotherapy in a Chinese Population

Value of breast cancer molecular subtypes and Ki67 expression for the prediction of efficacy and prognosis of neoadjuvant chemotherapy in a Chinese population.

Could the Breast Prognostic Biomarker Status Change During Disease Progression? An Immunohistochemical Comparison between Primary Tumors and Synchronous Nodal Metastasis

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