Estrogen/progesterone receptor and HER2 discordance between primary tumor and brain metastases in breast cancer and its effect on treatment and survival
| Autor: | David Roberge, Jing Li, Steve Braunstein, Drexell Hunter Boggs, Laurie E. Gaspar, Emil Lou, Supriya K. Jain, Jessica W. Lee, Hany Soliman, Laura Masucci, Jill Remick, Arjun Sahgal, John P. Kirkpatrick, William Sperduto, William G. Breen, Jason Chan, Toshimichi Nakano, Diana D. Shi, Paul D. Brown, James B. Yu, Minesh P. Mehta, Helen A. Shih, Veronica Chiang, Paul W. Sperduto, John M. Buatti, Daniel N. Cagney, Kristin A. Plichta, Nan Lin, Michael D. Chuong, Tim J. Kruser, Eric Nesbit, Ashlyn S. Everett, Ryan Shanley, Shane Mesko, Cheng-Chia Wu, Ayal A. Aizer, Hidefumi Aoyama, John Bryant, Tony J. C. Wang |
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| Rok vydání: | 2020 |
| Předmět: |
Oncology
Cancer Research medicine.medical_specialty Receptor Status Receptor ErbB-2 medicine.drug_class Clinical Trials and Supportive Activities Oncology and Carcinogenesis Clinical Investigations Estrogen receptor Breast Neoplasms Metastasis breast cancer ErbB-2 Breast cancer Clinical Research brain metastases Internal medicine Receptors Biomarkers Tumor 2.1 Biological and endogenous factors Humans Medicine Oncology & Carcinogenesis Aetiology Receptor Progesterone Cancer Retrospective Studies Tumor Brain Neoplasms business.industry Neurosciences Estrogens medicine.disease Primary tumor Good Health and Well Being Estrogen Hormone receptor estrogen/progesterone/HER2 receptor discordance Neurology (clinical) Receptors Progesterone business Biomarkers |
| Zdroj: | Neuro Oncol Neuro-oncology, vol 22, iss 9 |
| ISSN: | 1523-5866 1522-8517 |
| Popis: | Background Breast cancer treatment is based on estrogen receptors (ERs), progesterone receptors (PRs), and human epidermal growth factor receptor 2 (HER2). At the time of metastasis, receptor status can be discordant from that at initial diagnosis. The purpose of this study was to determine the incidence of discordance and its effect on survival and subsequent treatment in patients with breast cancer brain metastases (BCBM). Methods A retrospective database of 316 patients who underwent craniotomy for BCBM between 2006 and 2017 was created. Discordance was considered present if the ER, PR, or HER2 status differed between the primary tumor and the BCBM. Results The overall receptor discordance rate was 132/316 (42%), and the subtype discordance rate was 100/316 (32%). Hormone receptors (HR, either ER or PR) were gained in 40/160 (25%) patients with HR-negative primary tumors. HER2 was gained in 22/173 (13%) patients with HER2-negative primary tumors. Subsequent treatment was not adjusted for most patients who gained receptors—nonetheless, median survival (MS) improved but did not reach statistical significance (HR, 17–28 mo, P = 0.12; HER2, 15–19 mo, P = 0.39). MS for patients who lost receptors was worse (HR, 27–18 mo, P = 0.02; HER2, 30–18 mo, P = 0.08). Conclusions Receptor discordance between primary tumor and BCBM is common, adversely affects survival if receptors are lost, and represents a missed opportunity for use of effective treatments if receptors are gained. Receptor analysis of BCBM is indicated when clinically appropriate. Treatment should be adjusted accordingly. Key Points 1. Receptor discordance alters subtype in 32% of BCBM patients. 2. The frequency of receptor gain for HR and HER2 was 25% and 13%, respectively. 3. If receptors are lost, survival suffers. If receptors are gained, consider targeted treatment. |
| Databáze: | OpenAIRE |
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