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03-02-2025 | Breast Cancer | Research

Pathologic complete response rates of patients with ER-low/HER2-negative breast cancer treated with neoadjuvant pembrolizumab plus chemotherapy in the neo-real study

Authors: Renata Colombo Bonadio, Monique Celeste Tavares, Flávia Cavalcanti Balint, Isadora Martins de Sousa, Ana Carolina Marin Comini, Fernanda Madasi, Jose Bines, Rafael Dal Ponte Ferreira, Daniela Dornelles Rosa, Candice Lima Santos, Zenaide Silva de Souza, Daniele Assad-Suzuki, Júlio Antônio Pereira de Araújo, Débora de Melo Gagliato, Carlos Henrique dos Anjos, Bruna M. Zucchetti, Anezka Ferrari, Mayana Lopes de Brito, Renata Cangussu, Maria Marcela Fernandes Monteiro, Paulo M. Hoff, Laura Testa, Maria del Pilar Estevez-Diz, Romualdo Barroso-Sousa

Published in: Breast Cancer Research and Treatment

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Abstract

Purpose

Estrogen receptor-low (ER-low) breast cancer (BC) present clinicopathological features and disease behavior resembling triple-negative breast cancer, but have been frequently excluded from pivotal trials designed for the latter. Since neoadjuvant pembrolizumab plus chemotherapy (P + CT) is the new standard of care for stage II-III triple-negative breast cancer (TNBC), we aimed to access the effectiveness of this therapy for ER-low tumors.

Methods

We evaluated patients with ER-low BC included in the Neo-Real/ GBECAM-0123 study, a real-world data study evaluating patients treated with neoadjuvant P + CT since July 2020 across ten cancer centers. The objective of this study was to evaluate the effectiveness of neoadjuvant P + CT through pathologic complete response (pCR).

Results

Twenty patients were included in this analysis. Median age was 40 years (range 28–64). Most patients had grade 3 tumors (n = 18, 90%), with a median Ki67 index of 75% (range 30–95%), and 70% had stage II tumors.
All the twenty patients were submitted to surgery, with a pCR observed in 12 cases (pCR rate of 60%). Receiving less than 6 cycles of pembrolizumab was associated with a trend towards worse pCR rates (20% vs 73.3%).

Conclusions

The clinicopathological features and the response to neoadjuvant P + CT observed in this ER-low BC cohort are similar to that observed in TNBC. Patients with stage II-III ER-low/HER2- BC should be treated with neoadjuvant P + CT following the treatment standards for TNBC, and proper adherence to the regimen is relevant to improve effectiveness.
Literature
1.
go back to reference Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S et al (2010) American society of clinical oncology/college of american pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 28(16):2784–2795CrossRefPubMedPubMedCentral Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S et al (2010) American society of clinical oncology/college of american pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 28(16):2784–2795CrossRefPubMedPubMedCentral
2.
go back to reference Allison KH, Hammond MEH, Dowsett M, McKernin SE, Carey LA, Fitzgibbons PL et al (2020) Estrogen and progesterone receptor testing in breast cancer: ASCO/CAP guideline update. J Clin Oncol 38(12):1346–1366CrossRefPubMed Allison KH, Hammond MEH, Dowsett M, McKernin SE, Carey LA, Fitzgibbons PL et al (2020) Estrogen and progesterone receptor testing in breast cancer: ASCO/CAP guideline update. J Clin Oncol 38(12):1346–1366CrossRefPubMed
3.
go back to reference Reinert T, Cascelli F, de Resende CAA, Gonçalves AC, Godo VSP, Barrios CH (2022) Clinical implication of low estrogen receptor (ER-low) expression in breast cancer. Front Endocrinol (Lausanne) 13:1015388CrossRefPubMed Reinert T, Cascelli F, de Resende CAA, Gonçalves AC, Godo VSP, Barrios CH (2022) Clinical implication of low estrogen receptor (ER-low) expression in breast cancer. Front Endocrinol (Lausanne) 13:1015388CrossRefPubMed
4.
go back to reference Iwamoto T, Booser D, Valero V, Murray JL, Koenig K, Esteva FJ et al (2012) Estrogen receptor (ER) mRNA and ER-related gene expression in breast cancers that are 1% to 10% ER-positive by immunohistochemistry. J Clin Oncol 30(7):729–734CrossRefPubMed Iwamoto T, Booser D, Valero V, Murray JL, Koenig K, Esteva FJ et al (2012) Estrogen receptor (ER) mRNA and ER-related gene expression in breast cancers that are 1% to 10% ER-positive by immunohistochemistry. J Clin Oncol 30(7):729–734CrossRefPubMed
5.
go back to reference Villegas SL, Nekljudova V, Pfarr N, Engel J, Untch M, Schrodi S et al (2021) Therapy response and prognosis of patients with early breast cancer with low positivity for hormone receptors-an analysis of 2765 patients from neoadjuvant clinical trials. Eur J Cancer 148:159–170CrossRefPubMed Villegas SL, Nekljudova V, Pfarr N, Engel J, Untch M, Schrodi S et al (2021) Therapy response and prognosis of patients with early breast cancer with low positivity for hormone receptors-an analysis of 2765 patients from neoadjuvant clinical trials. Eur J Cancer 148:159–170CrossRefPubMed
7.
8.
go back to reference Loi S, Curigliano G, Salgado R, Díaz RIR, Delaloge S, García CIR, Kok M, Saura C, Harbeck N, Mittendorf E, Yardley D, Pusztai L, Zaizar AS, Ungureanu A, Ades F, Chandra R, Nathani R, Pacius M, Spires T, Jenny W, McArthur H (2024) Abstract GS01–01: biomarker results in high-risk estrogen receptor positive, human epidermal growth factor receptor 2 negative primary breast cancer following neoadjuvant chemotherapy ± nivolumab: an exploratory analysis of checkmate 7FL. Cancer Res. https://doi.org/10.1158/1538-7445.SABCS23-GS01-01CrossRef Loi S, Curigliano G, Salgado R, Díaz RIR, Delaloge S, García CIR, Kok M, Saura C, Harbeck N, Mittendorf E, Yardley D, Pusztai L, Zaizar AS, Ungureanu A, Ades F, Chandra R, Nathani R, Pacius M, Spires T, Jenny W, McArthur H (2024) Abstract GS01–01: biomarker results in high-risk estrogen receptor positive, human epidermal growth factor receptor 2 negative primary breast cancer following neoadjuvant chemotherapy ± nivolumab: an exploratory analysis of checkmate 7FL. Cancer Res. https://​doi.​org/​10.​1158/​1538-7445.​SABCS23-GS01-01CrossRef
9.
go back to reference Bonadio RC, de Sousa IM, Balint FC, Comini ACM, Tavares MC, Madasi F et al (2024) Dose dense versus 3 weekly AC during neoadjuvant chemoimmunotherapy for triple negative breast cancer. NPJ Breast Cancer 10(1):73CrossRefPubMedPubMedCentral Bonadio RC, de Sousa IM, Balint FC, Comini ACM, Tavares MC, Madasi F et al (2024) Dose dense versus 3 weekly AC during neoadjuvant chemoimmunotherapy for triple negative breast cancer. NPJ Breast Cancer 10(1):73CrossRefPubMedPubMedCentral
11.
go back to reference Schmid P, Cortes J, Pusztai L, McArthur H, Kümmel S, Bergh J et al (2020) Pembrolizumab for early triple-negative breast cancer. N Engl J Med 382(9):810–821CrossRefPubMed Schmid P, Cortes J, Pusztai L, McArthur H, Kümmel S, Bergh J et al (2020) Pembrolizumab for early triple-negative breast cancer. N Engl J Med 382(9):810–821CrossRefPubMed
12.
go back to reference Cherifi F, Cabel L, Bousrih C, Volant E, Dalenc F, Mery B, AuvrayKuentz M, Alexandre M, Benistant L, Leheurteur M, Bailleux C, Debled M, Frenel J-S, Loirat D, Bidard FC, Aho S, Glenet A, Ribeiro Mourato JTL, Christy F, Emile G (2024) 238MO-PROMENADE: pembrolizumab for early triple negative ER-low breast caNcer, reAl worlD frEnch cohort. Ann Oncol. https://doi.org/10.1016/j.annonc.2024.08.181CrossRef Cherifi F, Cabel L, Bousrih C, Volant E, Dalenc F, Mery B, AuvrayKuentz M, Alexandre M, Benistant L, Leheurteur M, Bailleux C, Debled M, Frenel J-S, Loirat D, Bidard FC, Aho S, Glenet A, Ribeiro Mourato JTL, Christy F, Emile G (2024) 238MO-PROMENADE: pembrolizumab for early triple negative ER-low breast caNcer, reAl worlD frEnch cohort. Ann Oncol. https://​doi.​org/​10.​1016/​j.​annonc.​2024.​08.​181CrossRef
13.
go back to reference Sharma P, Stecklein SR, Yoder R, Staley JM, Schwensen K, O’Dea A et al (2024) Clinical and biomarker findings of neoadjuvant pembrolizumab and carboplatin plus docetaxel in triple-negative breast cancer: NeoPACT phase 2 clinical trial. JAMA Oncol 10(2):227–235CrossRefPubMed Sharma P, Stecklein SR, Yoder R, Staley JM, Schwensen K, O’Dea A et al (2024) Clinical and biomarker findings of neoadjuvant pembrolizumab and carboplatin plus docetaxel in triple-negative breast cancer: NeoPACT phase 2 clinical trial. JAMA Oncol 10(2):227–235CrossRefPubMed
Metadata
Title
Pathologic complete response rates of patients with ER-low/HER2-negative breast cancer treated with neoadjuvant pembrolizumab plus chemotherapy in the neo-real study
Authors
Renata Colombo Bonadio
Monique Celeste Tavares
Flávia Cavalcanti Balint
Isadora Martins de Sousa
Ana Carolina Marin Comini
Fernanda Madasi
Jose Bines
Rafael Dal Ponte Ferreira
Daniela Dornelles Rosa
Candice Lima Santos
Zenaide Silva de Souza
Daniele Assad-Suzuki
Júlio Antônio Pereira de Araújo
Débora de Melo Gagliato
Carlos Henrique dos Anjos
Bruna M. Zucchetti
Anezka Ferrari
Mayana Lopes de Brito
Renata Cangussu
Maria Marcela Fernandes Monteiro
Paulo M. Hoff
Laura Testa
Maria del Pilar Estevez-Diz
Romualdo Barroso-Sousa
Publication date
03-02-2025
Publisher
Springer US
Published in
Breast Cancer Research and Treatment
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-025-07628-3

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