Prognostic impact of reduced HER2 protein expression in post-neoadjuvant therapy resection specimens: A single institution experience and review of the literature.

Autor: Mogica JP; Department of Oncology, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA., Tang H; Department of Pathology, Yale University School of Medicine, New Haven, CT, USA., Liang Y; Department of Pathology, Yale University School of Medicine, New Haven, CT, USA., Zhong M; Department of Pathology, Yale University School of Medicine, New Haven, CT, USA., Hui P; Department of Pathology, Yale University School of Medicine, New Haven, CT, USA., Harigopal M; Department of Pathology, Yale University School of Medicine, New Haven, CT, USA., Krishnamurti U; Department of Pathology, Yale University School of Medicine, New Haven, CT, USA., Fischbach NA; Department of Oncology, Yale University School of Medicine, New Haven, CT, USA., Zhan H; Department of Pathology, Yale University School of Medicine, New Haven, CT, USA. Electronic address: haiying.zhan@yale.edu.
Jazyk: angličtina
Zdroj: Breast (Edinburgh, Scotland) [Breast] 2023 Dec; Vol. 72, pp. 103586. Date of Electronic Publication: 2023 Oct 03.
DOI: 10.1016/j.breast.2023.103586
Abstrakt: Background: Retesting for Human epidermal growth factor receptor-2 (HER2) in post-neoadjuvant therapy resection is variable, and data is conflicting regarding the prognostic significance of changes in HER2 expression pre and post therapy.
Methods: We identified 104 patients with localized HER2 IHC 3+ breast cancer who received neoadjuvant trastuzumab(T)/pertuzumab(P) containing chemotherapy at Yale Cancer Center between 2012 and 2022. Patients were divided into 3 cohorts by response and HER2 IHC in the residual disease: Cohort 1 pathologic complete response (pCR), Cohort 2 pre-treatment IHC 3+/post treatment IHC 1+/2+, and Cohort 3 pre-treatment IHC 3+/post-treatment IHC 3+. Kaplan-Meier survival analysis was performed to assess recurrence free survival at 36 months.
Results: The overall pCR rate was 62.5% (65/104), while 37.5% (39/104) of patients had residual disease (RD). Among patients with RD, 58.9% (23/39) remained IHC 3+ and 41.1% (16/39) had reduced HER2 expression IHC1+ or 2+. In patients with HER2 IHC 3+ RD, 26% (6/23) developed local recurrence or distant metastasis while none of patients with post NAT HER2 IHC 1+ or 2+ RD had relapse (p = 0.0309). In patients with pCR, 6.15% (4/65) had recurrence. Kaplan-Meier survival analysis revealed superior disease-free survival in patients with reduced HER2 IHC expression compared to those with remained IHC 3+ (log rank p = 0.004).
Conclusion: We conclude that reduced HER2 expression by IHC following neoadjuvant treatment was associated with lower recurrence rates in HER2 IHC 3+ breast cancer. If confirmed, RD HER2 IHC expression could be used as a prognostic biomarker to stratify patients in adjuvant trials and identify patients who may benefit from more intensive adjuvant therapy and post therapy surveillance.
Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest regarding the publication of this paper.
(Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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