Prognostic impact of discordance between triple-receptor measurements in primary and recurrent breast cancer

Liedtke, Cornelia; Broglio, Kristine; Moulder, Stacy L.; Hsu, Limin; Kau, Shu Wan; Symmans, W. Fraser; Albarracin, Constance T.; Meric‐Bernstam, Funda; Woodward, Wendy A.; Theriault, Richard L.; Kiesel, L.; Hortobágyi, Gabriel N.; Pusztai, Lajos; González-Angulo, Ana M.

doi:10.1093/annonc/mdp263

Cited by 271 publications

(220 citation statements)

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“…Moreover, we report here for the first time a statistically significant correlation between previous systemic treatments and modifications in receptors' expression. Several studies have addressed the issue of concordance/ discordance in receptors expression between primary tumor and metastases [9,[12][13][14][15][16][17][18][19][20][21][22][23][24]. Published studies have found discordance rates for ER status ranging from 10.2% to 56%, PR status ranging from 24.8% to 48.6%, and HER2 status ranging from 2.9% to 16%.…”

Section: Discussionmentioning

confidence: 99%

Discordances in Estrogen Receptor Status, Progesterone Receptor Status, and HER2 Status Between Primary Breast Cancer and Metastasis

et al. 2013

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Background. The primary aim of this retrospective study was to investigate intraindividual correlation of estrogen receptor (ER) status, progesterone receptor (PR) status, and HER2 status between primary breast cancer and metastatic breast cancer (mBC). Secondary aims included patients' characteristics, overall survival, feasibility of histopathological evaluation in the metastatic setting, and predictive factors associated with receptors status discordance. Methods. Patients with either biopsy of metastatic relapse or surgery of metastasis were identified. Demographics, tumor characteristics, treatment characteristics, and ER, PR, and HER2 statuses were retrospectively obtained in patients' reports. Receptors statuses were assessed by immunohistochemistry with a positivity cutoff of more than 10% for ER and PR. HER2 was considered as positive if overexpression was scored at 3ϩ in immunohistochemistry or if amplification ratio was Ͼ2 in fluorescent in situ hybridization. Results. From a cohort of 489 patients with mBC, 269 patients had histopathological samples of metastatic relapse. Histopathological analysis of the specimen confirmed the diagnosis of mBC in 235 patients. Discordance in one or more receptors between primary breast cancer and mBC was found in 99 patients (42%). A switch in receptor status was identified for ER in 17% of tumors (p ϭ 4 ϫ 10), and HER2 in 4% of lesions (p ϭ .16). Exposure to chemotherapy and to anthracycline-based chemotherapy was statistically associated with switches in ER status. Seven (2%) second malignancies and three benign diseases (1%) were diagnosed. Conclusions. This study confirms that discordance in ER and PR receptor expression between the primary breast tumor and the corresponding metastatic lesions is high, whereas HER2 status remains relatively constant. Chemotherapy, and specifically anthracycline-based chemotherapy, was associated with switch in ER status. These results were obtained in a selected population of patients; further studies are warranted to confirm these data and to determine the interest of systematic rebiopsy in the metastatic setting. TheOncologist2013;18: 667-674 Implications for Practice: Discordance in estrogen receptor and progesterone receptor expression between the primary breast tumor and the corresponding metastatic lesion was high (17% and 29%, respectively), whereas HER2 status remained stable (4% of discordance). Previous chemotherapy, and specifically anthracycline-based chemotherapy, was associated with a switch in estrogen receptor status. Further studies are warranted to confirm these data and to determine the interest of systematic rebiopsy in the metastatic setting. In the era of a more personalized approach to medicine and of genomic investigations of tumors, reliable and recent evaluation of tumor prognostic and predictive factors remains a challenge. INTRODUCTIONThe treatment of metastatic breast cancer (mBC) is complex with few recognized therapeutic standards, particularly after the first line of treatment. Multiple fa...

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Section: Discussionmentioning

confidence: 99%

Discordances in Estrogen Receptor Status, Progesterone Receptor Status, and HER2 Status Between Primary Breast Cancer and Metastasis

et al. 2013

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“…In other studies, the discordance in HER2 status between primary tumor and recurrence vary from 50% (in CTC) down to 6% [7][8][9][10][16][17][18]. However the data from studies based on CTC cannot be compared with standard morphological methods.…”

Section: Discussionmentioning

confidence: 99%

“…A large retrospective study of triple negative disease, based on 789 patients, showed intra-individual discordance regarding HER2 status of 13.6% [9]. One study showed good correlation (97%) in HER2 status between primary breast cancer and circulating tumor cells, collected at the same time point.…”

Section: Introductionmentioning

confidence: 99%

HER2 status in a population-derived breast cancer cohort: discordances during tumor progression

Wilking

Karlsson

Skoog

et al. 2010

Breast Cancer Res Treat

104

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“…Only full published papers were included because the study required detail on the number of changes in receptor status. Of multiple articles published from the same institution, only the article with the largest sample size was chosen (e.g., of the two studies from University of Texas MD Anderson Cancer Center [4,16], we used the later study [4]). If necessary, we e-mailed the authors of studies for additional data needed for the metaanalysis.…”

Section: Meta-analysis Of Primary Tumors and Metastatic Lesionsmentioning

confidence: 99%

Discordance in Hormone Receptor Status Among Primary, Metastatic, and Second Primary Breast Cancers: Biological Difference or Misclassification?

et al. 2014

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Introduction. Discordance in hormone receptor status has been observed between two breast tumors of the same patients; however, the degree of heterogeneity is debatable with regard to whether it reflects true biological difference or the limited accuracy of receptor assays. Methods. A Bayesian misclassification correction method was applied to data on hormone receptor status of two primary breast cancers from the Surveillance, Epidemiology, and End Results database between 1990 and 2010 and to data on primary breast cancer and paired recurrent/metastatic disease assembled from a meta-analysis of the literature published between 1979 and 2014. Results. The sensitivity and specificity of the estrogen receptor (ER) assay were estimated to be 0.971 and 0.920, respectively. After correcting for misclassification, the discordance in ER between two primary breast cancers was estimated to be 1.2% for synchronous ipsilateral pairs, 5.0% for synchronous

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Prognostic impact of discordance between triple-receptor measurements in primary and recurrent breast cancer

Cited by 271 publications

References 20 publications

Discordances in Estrogen Receptor Status, Progesterone Receptor Status, and HER2 Status Between Primary Breast Cancer and Metastasis

Discordances in Estrogen Receptor Status, Progesterone Receptor Status, and HER2 Status Between Primary Breast Cancer and Metastasis

HER2 status in a population-derived breast cancer cohort: discordances during tumor progression

Discordance in Hormone Receptor Status Among Primary, Metastatic, and Second Primary Breast Cancers: Biological Difference or Misclassification?

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