Prognostic Value and Influence of Receptor Conversion on Treatment Regimen in Metastatic Breast Cancer at the First Time of Recurrence

Abstract

<b><i>Purpose:</i></b> At the first time of metastatic breast cancer recurrence, conversion of the receptors status may occur between primary lesions and metastatic lesions, including the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Whether the decision of the treatment regimen is based on the primary receptor status or that of metastatic lesions is still unclear. <b><i>Methods:</i></b> This study enrolled 411 female patients with a diagnosis of metastatic breast cancer at the first time of recurrence to explore the influence of receptor conversion on prognosis prediction and treatment regimen of patients with metastatic breast cancer. <b><i>Results:</i></b> ER and PR changes from negative to positive are both prognostic factors for patients with breast cancer. Patients receiving endocrine therapy showed a better survival after recurrence than those using chemotherapy alone in the ER or PR Prim– Met+ subgroup. Patients in the HER2 Prim– Met+ subgroup using HER2-targeted therapy in multilines showed a post-recurrence survival advantage. In the bone re-biopsy subgroup, the PR change from positive to negative appeared to be more frequent than at other re-biopsy sites. <b><i>Conclusions:</i></b> Patients with metastatic breast cancer should perform re-biopsy to clarify the receptor status of the first metastatic lesions, which may provide clinicians valuable evidence to conduct treatments with higher precision.

Preferences for the sequencing of first-line systemic treatments in metastatic hormone receptor-positive, HER2-negative breast cancer

“…Receptor conversion is a well-documented event in progressive MBC, which results in HR and HER2 status discordance between the primary tumor and metastatic site ( 21 ). An increasing number of guidelines recommend a re-biopsy of metastatic breast cancer to determine the receptor status and molecular subtype ( 22 ). In a study by Shen et al., nearly half of the patients were on regimens containing endocrine therapy as the first-line treatment according to the receptor status of metastatic sites when ER or PR changed from negative to positive, with post-recurrence survival significantly better than that based on the primary receptor status after chemotherapy alone.…”

“…In a study by Shen et al., nearly half of the patients were on regimens containing endocrine therapy as the first-line treatment according to the receptor status of metastatic sites when ER or PR changed from negative to positive, with post-recurrence survival significantly better than that based on the primary receptor status after chemotherapy alone. However, there was no statistically significant better prognosis in patients in the HER2 primary negative metastatic positive subgroup who received HER2-targeted therapy as multiline treatment ( 22 ). In another study by Lu et al., the 2-year post-recurrence survival rates of treatment-changed and treatment-unchanged patients were 48.1% and 90.0% respectively ( 23 ).…”

Noninflammatory presentation of cutaneous breast cancer: a retrospective case series at a single academic institution with review of the literature

“…It is prognostically relevant to note that our first patient had a history of triple-negative breast cancer and her recurrence stained positive for estrogen receptor and progesterone receptor. Various studies report receptor conversion rates between primary and recurrent tumors to be between 10-26.9% for estrogen receptor, 25-40% for progesterone receptor, and 3-22.4% for human epidermal growth factor receptor two [18][19][20]; conversion from negative to positive staining is generally a good prognostic sign [21].…”