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01-11-2021 | Breast Cancer | Epidemiology

HER2-low status and response to neoadjuvant chemotherapy in HER2 negative early breast cancer

Authors: Luciana de Moura Leite, Marcelle Goldner Cesca, Monique Celeste Tavares, Debora Maciel Santana, Erick Figueiredo Saldanha, Paula Tavares Guimarães, Daniella Dias Silva Sá, Maria Fernanda Evangelista Simões, Rafael Lima Viana, Francisca Giselle Rocha, Simone Klog Loose, Sinara Figueiredo Silva, Rafaela Pirolli, Camilla Albina Zanco Fogassa, Bruna Raphaeli Silva Mattos, Fernando Augusto Batista Campos, Solange Moraes Sanches, Vladmir Cláudio Cordeiro de Lima, Noam Falbel Pondé

Published in: Breast Cancer Research and Treatment | Issue 1/2021

Abstract

Purpose

Knowledge on whether low expressions of HER2 have prognostic impact in early-stage breast cancer (BC) and on its response to current chemotherapy protocols can contribute to medical practice and development of new drugs for this subset of patients, changing treatment paradigms. This study aims to evaluate the impact of HER2-low status on response to neoadjuvant chemotherapy (NACT) and survival outcomes in early-stage HER2-negative BC.

Methods

Records from all BC patients treated with NACT from January 2007 to December 2018 in a single cancer center were retrospectively reviewed. HER2-negative (immunohistochemistry [IHC] 0, + 1, or + 2 non-amplified by in situ hybridization [ISH]) patients were included. HER2-low was defined by IHC + 1 or + 2 ISH non-amplified and HER2-0 by IHC 0. The coprimary objectives were to compare pathological complete response (pCR) and relapse-free survival (RFS) between luminal/HER2-low versus luminal/HER2-0 populations and between triple negative (TNBC)/HER2-low versus TNBC/HER2-0.

Results

In total, 855 HER2-negative patients were identified. The median follow-up was 59 months. 542 patients had luminal subtype (63.4%) and 313 had TNBC (36.6%). 285 (33.3%) were HER2-low. Among luminal patients, 145 had HER2 IHC + 1 (26.8%) and 91 had IHC + 2/ISH non-amplified (16.8%). In TNBC, 36 had HER2 IHC + 1 (11.5%) and 13 had IHC + 2/ISH non-amplified (4.2%). Most patients had locally advanced tumors, regardless of subtype or HER2-low status. For luminal disease, pCR was achieved in 13% of HER2-low tumors versus 9.5% of HER2-0 (p = 0.27). Similarly, there was no difference in pCR rates among TNBC: 51% versus 47% in HER2-low versus HER2-0, respectively (p = 0.64). HER2-low was also not prognostic for RFS, with 5-year RFS rates of 72.1% versus 71.7% (p = 0.47) for luminal HER2-low/HER2-0, respectively, and 75.6% versus 70.8% (p = 0.23) for TNBC HER2-low/HER2-0.

Conclusion

Our data does not support HER2-low as a biologically distinct BC subtype, with no prognostic value on survival outcomes and no predictive effect for pCR after conventional NACT.

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Title: HER2-low status and response to neoadjuvant chemotherapy in HER2 negative early breast cancer
Authors: Luciana de Moura Leite
Marcelle Goldner Cesca
Monique Celeste Tavares
Debora Maciel Santana
Erick Figueiredo Saldanha
Paula Tavares Guimarães
Daniella Dias Silva Sá
Maria Fernanda Evangelista Simões
Rafael Lima Viana
Francisca Giselle Rocha
Simone Klog Loose
Sinara Figueiredo Silva
Rafaela Pirolli
Camilla Albina Zanco Fogassa
Bruna Raphaeli Silva Mattos
Fernando Augusto Batista Campos
Solange Moraes Sanches
Vladmir Cláudio Cordeiro de Lima
Noam Falbel Pondé
Publication date: 01-11-2021
Publisher: Springer US
Keywords: Breast Cancer
Breast Cancer
Trastuzumab
Cytostatic Therapy
Published in: Breast Cancer Research and Treatment / Issue 1/2021
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-021-06365-7

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