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Chandekar KR, Satapathy S, Dharmashaktu Y, Ballal S, Ranjan P, Batra A, Gogia A, Mathur S, Bal C. Somatostatin receptor-targeted theranostics in patients with estrogen receptor-positive metastatic breast cancer-a prospective exploratory study. Breast Cancer Res Treat 2025; 211:363-373. [PMID: 40000538 DOI: 10.1007/s10549-025-07651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 02/11/2025] [Indexed: 02/27/2025]
Abstract
PURPOSE Somatostatin receptor (SSTR) expression has been reported in estrogen receptor-positive (ER +) metastatic breast cancer (mBC) by pathology and immunohistochemistry studies. We aimed to investigate whether SSTR could be a viable target for PET imaging and potential theranostics in ER + mBC. METHODS Thirty prospectively recruited patients with ER + mBC underwent PET/CT imaging with [18F]FDG and [68Ga]Ga-DOTATATE (within three weeks). Detection rates (per-patient, per-region), number of lesions detected, SUVmax values, Krenning scores, SSTR-FDG visual scores, and PET-based staging with both radiotracers were compared. RESULTS [18F]FDG and [68Ga]Ga-DOTATATE PET/CT had similar per-patient detection rates (100% vs 96.7%, P = 1.0). Per-region and per-lesion analyses revealed comparable detection of local/breast lesions, nodal, and skeletal metastases. However, [18F]FDG outperformed [68Ga]Ga-DOTATATE in detecting visceral/other metastases (235 vs 128 lesions, P = 0.003). [68Ga]Ga-DOTATATE resulted in a lower PET-based M-stage compared to [18F]FDG in 10% of patients, although T-/N-stages were concordant in all patients. HER2- patients showed a trend of higher [68Ga]Ga-DOTATATE lesional SUVmax values compared to the HER2 + sub-group (median 9.0 vs 3.8, P = 0.078). 3/30 (10%) participants had a patient-level Krenning score ≥ 3 ([68Ga]Ga-DOTATATE uptake higher than liver background in majority of the lesions), potentially making them suitable for SSTR-targeted radionuclide therapy. CONCLUSIONS SSTR-targeted theranostics may represent a novel potential alternative in a subset of patients with ER + mBC. Its generalized applicability is limited by poor sensitivity for visceral metastases and significant inter-lesion heterogeneity. Future studies must identify how tumor subtype, proliferation, and prior systemic therapies impact SSTR expression levels in these patients to ensure meaningful clinical translation. CLINICAL TRIAL REGISTRATION Clinical Trials Registry-India: CTRI/2023/03/051025 (prospectively registered on 23.03.2023).
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Affiliation(s)
- Kunal Ramesh Chandekar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Swayamjeet Satapathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Yamini Dharmashaktu
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sanjana Ballal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Piyush Ranjan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Atul Batra
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Geyer CE, Loibl S. Switching to T-DM1 remains justified in patients with HER2-negative residual invasive breast cancer after neoadjuvant therapy. Breast 2025; 81:104450. [PMID: 40148195 PMCID: PMC12144936 DOI: 10.1016/j.breast.2025.104450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2025] [Accepted: 03/18/2025] [Indexed: 03/29/2025] Open
Abstract
Reductions in HER2-protein IHC intensity and HER2-gene amplification in residual invasive breast cancer following neoadjuvant therapy for HER2-positive breast cancer have been described and are associated with worse outcomes. T-DM1 requires initial binding to HER2 for activity, so concerns have been raised regarding T-DM1 activity when changes are sufficient to classify residual disease as HER2-negative. The KATHERINE trial assessed HER2 status of residual disease from 845 patients with HER2-positive status on pretherapy biopsies, of which 70 were negative on retesting. With 8 years of median follow-up, 7-year IDFS was 60.3 % with trastuzumab compared to 95.2 % with T-DM1, consistent with clinically meaningful benefit from T-DM1 in these 70 patients.
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Affiliation(s)
- Charles E Geyer
- NSABP Foundation, Pittsburgh, PA, USA; UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
| | - Sibylle Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany; Centre for Haematology and Oncology Bethanien, Goethe University, Frankfurt, Germany
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Movahed F, Navaei O, Taghlidi S, Nurzadeh M, Gharaati ME, Rabiei M. Radiolabeled HER2-targeted molecular probes in breast cancer imaging: current knowledge and future prospective. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2025; 398:6129-6141. [PMID: 39751821 DOI: 10.1007/s00210-024-03691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 11/27/2024] [Indexed: 01/04/2025]
Abstract
Breast cancer is the most frequent non-dermatologic malignancy in women. Breast cancer is characterized by the expression of the human epidermal growth factor receptor type 2 (HER2), and the presence or lack of estrogen receptor (ER) and progesterone receptor (PR) expression. HER2 overexpression is reported in about 20 to 25% of breast cancer patients, which is usually linked to cancer progression, metastases, and poor survival. Immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) are the gold standards for determining HER2 status, even though IHC has largely focused on quantifying HER2+ status versus "other" HER2 status (including variants with low or no expression). Recent findings regarding the beneficial therapeutic effects of anti-HER2 monoclonal antibodies (mAb) in HER2low metastatic patients lead to changes in the classic definition of advanced breast cancer, and methods for precise assessment of HER2 status are being developed. As a result, various radiolabeled HER-targeted mAbs and antibody fragments have been designed to avoid repeated biopsies with potential bias due to tumor heterogeneity, including single-chain variable fragment (scFv), F(ab')2, affibody, and nanobody. These small targeting radiotracers displayed favorable biodistributions, clearance, and stability, allowing for higher image quality, shorter circulation half-life, and lower immunogenicity. This study aimed to comprehensively review the application of radiolabeled anti-HER2 antibody fragments in breast cancer in vivo imaging and provide a better understanding of targeted HER2 quantification.
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Affiliation(s)
- Fatemeh Movahed
- Department of Gynecology and Obstetrics, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ouldouz Navaei
- Department of Biotechnology, Università Milano-Bicocca Milano, Milan, Italy
| | - Shiva Taghlidi
- Medicine and Surgery, Università Degli Studi Di Milano-Bicocca, Milan, Italy
| | - Maryam Nurzadeh
- Department of Fetomaternal, Faculty of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Eslami Gharaati
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rabiei
- Obstetrics and Gynecology Department, Tehran University of Medical Sciences, Tehran, Iran.
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Chen YF, Zhang QH, Zhang ZW, Zhou YJ, Liu CC, Shao ZM, Yu KD. SNX10 deficiency impairs sensitivity to anti-HER2 antibody-drug conjugates via altering HER2 trafficking in HER2-positive breast cancer. Proc Natl Acad Sci U S A 2025; 122:e2417586122. [PMID: 40228127 PMCID: PMC12037019 DOI: 10.1073/pnas.2417586122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 03/10/2025] [Indexed: 04/16/2025] Open
Abstract
Antibody-drug conjugates (ADCs) are a rapidly developing therapeutic approach in cancer treatment that has shown remarkable efficacy in breast cancer. Despite the promising efficacy of anti-HER2 ADCs, many patients are still experiencing disease progression under treatment. Here, by analyzing the transcriptome data from patient-derived organoid models, I-SPY2 trial, and resistant cell lines, we identified that SNX10 deficiency conferred anti-HER2 ADCs resistance in HER2-positive breast cancer. Low levels of SNX10 attenuated HER2 recycling and promoted HER2 trafficking into lysosomes. Furthermore, we found the underlying mechanism of SNX10 in HER2 traffic by regulating the endosomal RAB11A. We propose that SNX10 deficiency contributes to the inhibition of HER2 recycling as well as the decrease of cell-surface HER2 and causes anti-HER2 ADC resistance.
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Affiliation(s)
- Yu-Fei Chen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Cancer Institute, Shanghai200032, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Key Laboratory of Breast Cancer in Shanghai, Shanghai200032, People’s Republic of China
| | - Qing-Hua Zhang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Cancer Institute, Shanghai200032, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Key Laboratory of Breast Cancer in Shanghai, Shanghai200032, People’s Republic of China
| | - Zhong-Wei Zhang
- Department of Intensive Care Unit, Fudan University Shanghai Cancer Center, Shanghai200032, People’s Republic of China
| | - Yu-Jie Zhou
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Cancer Institute, Shanghai200032, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Key Laboratory of Breast Cancer in Shanghai, Shanghai200032, People’s Republic of China
| | - Cui-Cui Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Cancer Institute, Shanghai200032, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Key Laboratory of Breast Cancer in Shanghai, Shanghai200032, People’s Republic of China
| | - Zhi-Ming Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Cancer Institute, Shanghai200032, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Key Laboratory of Breast Cancer in Shanghai, Shanghai200032, People’s Republic of China
| | - Ke-Da Yu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Cancer Institute, Shanghai200032, People’s Republic of China
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Konishi T, Kumamaru H, Niikura N, Sagara Y, Miyashita M, Iwamoto T, Sanuki N, Tanakura K, Nagahashi M, Yoshida M, Kawashima M, Kinoshita T, Sasada S, Kinukawa N, Saji S, Ishida T, Taira N. Annual report of National Clinical Database-Breast Cancer Registry in 2021: characteristics categorized by body mass index and menopause status. Breast Cancer 2025:10.1007/s12282-025-01698-3. [PMID: 40259174 DOI: 10.1007/s12282-025-01698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Accepted: 03/23/2025] [Indexed: 04/23/2025]
Abstract
The Japanese Breast Cancer Society initiated the breast cancer registry in 1975 and migrated the registry to the National Clinical Database-Breast Cancer Registry (NCD-BCR) in 2012. This annual report presents 2021 data on the NCD-BCR. We analyzed data from 98,540 breast cancer (BC) cases registered in 2021. In 2021, 99.4% of BC cases were females with a median age of 61. Most (57.5%) were diagnosed at early stages (Stage 0 or I). Breast-conserving surgery was performed in 42.8% of cases. Sentinel lymph node biopsy was performed in 67.8%, followed by radiotherapy in 71.0% of those post-conserving surgery. Regarding postoperative systemic therapy, 63.1% received endocrine therapy, 28.2% received chemotherapy, and 14.9% received molecular-targeted therapy. ER positivity was observed in 75.2%, HER2 in 13.6%, and Ki67 ≥30% in 29.1% of cases. The median age of premenopausal cases was 46 (interquartile range, 42-49) years and the median BMI was 21.5 (19.7-24.2) kg/m2 whereas the median age of postmenopausal cases was 69 (61-76) years and the median BMI was 23.0 (20.6-25.9) kg/m2. In premenopausal cases, cases with normal BMI were more likely to be found at checkups without subjective symptoms and in the early stage than those with high BMI. The tendency of ER, PgR, HER2, and Ki67 status on BMI differed by menopause status; premenopausal cases with a lower BMI showed higher proportions of ER- and PgR-positive cancer and lower proportions of cancer with high Ki67. These nationwide descriptive statistics would help clinical explanation and further research on breast cancer.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113‑8655, Japan
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259‑1193, Japan
| | - Yasuaki Sagara
- Department of Breast Surgical Oncology, Social Medical Corporation Hakuaikai, Sagara Hospital, 3-28 Matsubara, Kagoshima, 892-833, Japan
| | - Minoru Miyashita
- Department of Breast and Endocrine Surgical Oncology, Tohoku University Graduate School of Medicine, Seiryo‑Machi, Aoba‑Ku, Sendai, 980‑8574, Japan
| | - Takayuki Iwamoto
- Department of Breast and Thyroid Surgery, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Naoko Sanuki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kenta Tanakura
- Plastic and Reconstructive Surgery, Mitsui Memorial Hospital, 1 Kanda‑Izumicho, Chiyoda‑Ku, Tokyo, 101‑8643, Japan
| | - Masayuki Nagahashi
- Department of Surgery, Division of Breast and Endocrine Surgery, School of Medicine, Hyogo Medical University, 1‑1 Mukogawa, Nishinomiya, Hyogo, 663‑8501, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5‑1‑1 Tsukiji, Chuo‑Ku, Tokyo, 104‑0045, Japan
| | - Masahiro Kawashima
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Shinsuke Sasada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Naoko Kinukawa
- Department of Healthcare Quality Assessment, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113‑8655, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Takanori Ishida
- Department of Breast and Endocrine Surgical Oncology, Tohoku University Graduate School of Medicine, Seiryo‑Machi, Aoba‑Ku, Sendai, 980‑8574, Japan
| | - Naruto Taira
- Department of Breast and Thyroid Surgery, Kawasaki Medical School Hospital, Kurashiki, Japan
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Ren W, Xi X, Zhang X, Wang K, Liu M, Wang D, Du Y, Sun J, Zhang G. Predicting molecular subtypes of breast cancer based on multi-parametric MRI dataset using deep learning method. Magn Reson Imaging 2025; 117:110305. [PMID: 39681144 DOI: 10.1016/j.mri.2024.110305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 12/07/2024] [Accepted: 12/07/2024] [Indexed: 12/18/2024]
Abstract
PURPOSE To develop a multi-parametric MRI model for the prediction of molecular subtypes of breast cancer using five types of breast cancer preoperative MRI images. METHODS In this study, we retrospectively analyzed clinical data and five types of MRI images (FS-T1WI, T2WI, Contrast-enhanced T1-weighted imaging (T1-C), DWI, and ADC) from 325 patients with pathologically confirmed breast cancer. Using the five types of MRI images as inputs to the ResNeXt50 model respectively, five base models were constructed, and then the outputs of the five base models were fused using an ensemble learning approach to develop a multi-parametric MRI model. Breast cancer was classified into four molecular subtypes based on immunohistochemical results: luminal A, luminal B, human epidermal growth factor receptor 2-positive (HER2-positive), and triple-negative (TN). The whole dataset was randomly divided into a training set (n = 260; 76 luminal A, 80 luminal B, 50 HER2-positive, 54 TN) and a testing set (n = 65; 20 luminal A, 20 luminal B, 12 HER2-positive, 13 TN). Accuracy, sensitivity, specificity, receiver operating characteristic curve (ROC) and area under the curve (AUC) were calculated to assess the predictive performance of the models. RESULTS In the testing set, for the assessment of the four molecular subtypes of breast cancer, the multi-parametric MRI model yielded an AUC of 0.859-0.912; the AUCs based on the FS-T1WI, T2WI, T1-C, DWI, and ADC models achieved respectively 0.632-0. 814, 0.641-0.788, 0.621-0.709, 0.620-0.701and 0.611-0.785. CONCLUSION The multi-parametric MRI model we developed outperformed the base models in predicting breast cancer molecular subtypes. Our study also showed the potential of FS-T1WI base model in predicting breast cancer molecular subtypes.
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Affiliation(s)
- Wanqing Ren
- Department of Radiology, Jinan Third People's Hospital, Jinan, China
| | - Xiaoming Xi
- School of Computer Science and Technology, Shandong Jianzhu University, Jinan, China
| | - Xiaodong Zhang
- Postgraduate Department, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
| | - Kesong Wang
- School of Computer Science and Technology, Shandong Jianzhu University, Jinan, China
| | - Menghan Liu
- Department of Health Management, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Dawei Wang
- Department of Health Management, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yanan Du
- Department of Health Management, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jingxiang Sun
- Postgraduate Department, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China; Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Guang Zhang
- Department of Health Management, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
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Lin YH, Ho YS, Huang BM, Liao YC, Cheng TC, Lin YC, Tu SH, Yen Y, Chen LC. Mechanisms of reduced efficacy of HER2-targeted therapy in HER2-low breast cancer by long-term nicotine exposure in patient-derived xenograft mouse tumor models. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2025; 294:118071. [PMID: 40112628 DOI: 10.1016/j.ecoenv.2025.118071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 03/14/2025] [Accepted: 03/14/2025] [Indexed: 03/22/2025]
Abstract
The effects of long-term nicotine exposure on the treatment of HER2-positive breast cancer have only been studied epidemiologically, leaving the molecular mechanisms unclear. Therefore, it's challenging for clinicians to devise effective treatments based on this correlation. Our investigation explores the effects of prolonged nicotine exposure on the interaction between α9-nAChR and HER2 in HER2-positive breast cancer cells, highlighting its impact on anti-HER2 drug therapy efficacy. We used fluorescence resonance energy transfer (FRET) analysis to compare HER2 + tumor samples from smokers and non-smokers, finding a more vital interaction between α9-nAChR and HER2 in non-smoker's breast tumor tissues. A simulated study on the breast cancer patient-derived xenograft (PDX) tumor mouse model (n = 6 per group) revealed that long-term nicotine exposure significantly reduced this interaction compared to controls. Due to the poorer response of low HER2 tumors to trastuzumab in clinical practice, most patients require combination chemotherapy and have a worse prognosis. Therefore, this study chose HER2-low PDX models to simulate nicotine exposure and explore treatment strategies. Mice subjected to prolonged nicotine exposure exhibited faster tumor growth and reduced trastuzumab efficacy compared to controls (*p < 0.05). Our results demonstrate that extended nicotine exposure weakens α9-nAChR and HER2 interaction, reducing the effectiveness of HER2-targeted therapy, fostering drug resistance, and underscoring the carcinogenic risks of nicotine.
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Affiliation(s)
- Yu-Hsuan Lin
- Department of Biological Science & Technology, College of Life Sciences, China Medical University, Taichung 406040, Taiwan
| | - Yuan-Soon Ho
- Institute of Biochemistry and Molecular Biology, College of Life Sciences, China Medical University, Taichung 406040, Taiwan
| | - Bu-Miin Huang
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; Department of Biomedical Sciences, National Chung Cheng University, Chiayi 621301, Taiwan
| | - You-Cheng Liao
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110031, Taiwan
| | - Tzu-Chun Cheng
- Institute of Biochemistry and Molecular Biology, College of Life Sciences, China Medical University, Taichung 406040, Taiwan
| | - Ying-Chi Lin
- Department of Biological Science & Technology, College of Life Sciences, China Medical University, Taichung 406040, Taiwan
| | - Shih-Hsin Tu
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Yun Yen
- TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Li-Ching Chen
- Department of Biological Science & Technology, College of Life Sciences, China Medical University, Taichung 406040, Taiwan.
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Morita M, Tsunashima R, Yoshinami T, Ishida M, Iwasaku M, Kitano S, Kato C, Sakaguchi K, Takayama K, Naoi Y. A 5-year review of genomic medicine in breast cancer: insights from C-CAT data on 3776 Japanese patients. Breast Cancer 2025; 32:314-328. [PMID: 39630210 DOI: 10.1007/s12282-024-01656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 11/21/2024] [Indexed: 02/21/2025]
Abstract
BACKGROUND In Japan, despite 5 years since CGP tests were covered by insurance in 2019, low drug accessibility rates remain a critical issue. We evaluated drug accessibility in 3776 breast cancer from the C-CAT database using two criteria: the proportion first linked to PMDA-approved drugs with phase III trial evidence for breast cancer through CGP tests but not existing Companion diagnostics [CDx] (*), and the proportion first linked to PMDA-approved drugs including based on phase I and II trial evidence (**). Additionally, cases linked to investigational drugs for non-PMDA-approved drugs were counted. METHODS We identified the top 100 genetic alterations in Japanese breast cancer via CGP tests, listing corresponding drugs from C-CAT reports. Drug accessibility was re-evaluated through simulations with updated evidence levels by a member of the expert panel at Osaka University (EP-EL in OUH). RESULTS Results showed the proportion improved to 28.4% under the newest EP-EL in OUH, including 3.4% for HER2-negative cases eligible for HER2-targeted therapy due to ERBB2 amplification and 25.0% for ER-positive, HER2-negative cases eligible for capivasertib-fulvestrant therapy due to PIK3CA, AKT1, and PTEN alterations (*). However, in part, initial false negatives for HER2 status and practical difficulties in using CGP tests as a CDx for capivasertib exist. Including mutations like TMB-H, MSI-H, BRAF V600E mutation, and NTRK fusions raised the proportion to 37.9% (**), but lacking drugs with phase III trials evidence. CONCLUSION These findings highlight the ongoing difficulties in demonstrating clear clinical utility of CGP tests in Japan, emphasizing the need for broad discussions on its future direction.
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Affiliation(s)
- Midori Morita
- Division of Endocrine & Breast Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Ryo Tsunashima
- Department of Breast and Endocrine Surgery, Rinku General Medical Center, Izumisano, Japan
| | - Tetsuhiro Yoshinami
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masaki Ishida
- Department of Cancer Genome Medical Center, Kyoto Prefectural University of Medicine, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Masahiro Iwasaku
- Department of Cancer Genome Medical Center, Kyoto Prefectural University of Medicine, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Sae Kitano
- Division of Endocrine & Breast Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Chikage Kato
- Division of Endocrine & Breast Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Koichi Sakaguchi
- Division of Endocrine & Breast Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Koichi Takayama
- Department of Cancer Genome Medical Center, Kyoto Prefectural University of Medicine, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan
| | - Yasuto Naoi
- Division of Endocrine & Breast Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-Cho, Kamigyo-Ku, Kyoto, Japan.
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9
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Nagahashi M, Kumamaru H, Kinukawa N, Iwamoto T, Kawashima M, Kinoshita T, Konishi T, Sagara Y, Sasada S, Saji S, Sanuki N, Tanakura K, Niikura N, Miyashita M, Yoshida M, Ishida T, Taira N. Breast cancer statistics for Japan in 2022: annual report of the national clinical database-breast cancer registry-clinical implications including chemosensitivity of breast cancer with low estrogen receptor expression. Breast Cancer 2025; 32:217-226. [PMID: 39910023 PMCID: PMC11842403 DOI: 10.1007/s12282-025-01671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Accepted: 01/23/2025] [Indexed: 02/07/2025]
Abstract
This is an annual report by the Japanese Breast Cancer Society, which provides statistics on the clinical data on breast cancer in Japan, extracted from the National Clinical Database-Breast Cancer Registry (NCD-BCR). This report includes an update of 102,453 breast cancer cases at 1339 institutions registered in the NCD-BCR in 2022. Among the 101,793 female patients, the median age at cancer diagnosis was 62 years (interquartile range, 50-73 years), and 29.4% of the patients were premenopausal. Of these patients, 15,437 (15.2%) and 42,936 (42.2%) were diagnosed with stage 0 and I disease, respectively. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) were positive in 78.7%, 69.4%, and 12.8% of the patients, respectively. Of the 97,154 patients without distant metastasis, 40,521 (41.7%) underwent breast-conserving surgery, and 5780 (5.9%) patients underwent some form of breast reconstruction procedures at the time of mastectomy. A total of 66,894 (68.9%) patients were treated with sentinel lymph node biopsy and 7155 (7.4%) patients were treated with sentinel lymph node biopsy followed by axillary node dissection. In the group of patients treated with breast-conserving surgery (n = 40,521), 29,500 (72.8%) received whole-breast irradiation. In the group of patients who underwent mastectomy (n = 54,476), 6226 (11.4%) received radiation therapy to the chest wall. Of the 13,950 patients receiving preoperative chemotherapy with or without molecular targeted therapy, 4308 (30.9%) achieved a pathological complete response, with the highest rate of 60.5% in patients with the hormone receptor-negative/HER2-positive subtype.
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Affiliation(s)
- Masayuki Nagahashi
- Department of Surgery, Division of Breast and Endocrine Surgery, School of Medicine, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Naoko Kinukawa
- Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takayuki Iwamoto
- Breast and Thyroid Surgery, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan
| | - Masahiro Kawashima
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-Ku, Tokyo, 152-8902, Japan
| | - Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yasuaki Sagara
- Department of Breast and Thyroid Surgical Oncology, Hakuaikai Medical Corporation, Sagara Hospital, 3-28 Matsubara, Kagoshima, 892-0833, Japan
| | - Shinsuke Sasada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Naoko Sanuki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kenta Tanakura
- Plastic and Reconstructive Surgery, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-Ku, Tokyo, 101-8643, Japan
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Minoru Miyashita
- Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Takanori Ishida
- Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Naruto Taira
- Breast and Thyroid Surgery, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan
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Li X, Zhang X, Yin S, Nie J. Challenges and prospects in HER2-positive breast cancer-targeted therapy. Crit Rev Oncol Hematol 2025; 207:104624. [PMID: 39826885 DOI: 10.1016/j.critrevonc.2025.104624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 12/29/2024] [Accepted: 01/15/2025] [Indexed: 01/22/2025] Open
Abstract
Breast cancer remains the most prevalent malignancy among women globally and ranks as the leading cause of cancer-related mortality in this demographic. Approximately 13 %-15 % of all breast cancer cases are classified as HER2-positive, a subtype associated with a particularly unfavorable prognosis. A large number of patients with HER2-positive breast cancer continue to face disease progression after receiving standardized treatment. Given these challenges, a thorough exploration into the mechanisms underlying drug resistance in HER2-targeted therapy is imperative. This review focuses on the factors related to drug resistance in HER2-targeted therapy, including tumor heterogeneity, antibody-binding efficacy, variations in the tumor microenvironment, and abnormalities in signal activation and transmission. Additionally, corresponding strategies to counteract these resistance mechanisms are discussed, to advance therapeutic efficacy and clinical benefits in the management of HER2-positive breast cancer.
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Affiliation(s)
- Xiyin Li
- Department of Breast Cancer, Peking University Cancer Hospital Yunnan, Yunnan Cancer Hospital, the Third Affiliated Hospital, Kunming Medical University, 519 Kunzhou Road, Kunming, Yunnan 650118, China.
| | - Xueying Zhang
- Department of Breast Cancer, Peking University Cancer Hospital Yunnan, Yunnan Cancer Hospital, the Third Affiliated Hospital, Kunming Medical University, 519 Kunzhou Road, Kunming, Yunnan 650118, China.
| | - Saige Yin
- Department of Anatomy and Histology and Embryology, Faculty of Basic Medical Science, Kunming Medical University, Kunming, Yunnan 650118, China.
| | - Jianyun Nie
- Department of Breast Cancer, Peking University Cancer Hospital Yunnan, Yunnan Cancer Hospital, the Third Affiliated Hospital, Kunming Medical University, 519 Kunzhou Road, Kunming, Yunnan 650118, China.
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11
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Danzinger S, Spornberger VH, Vietzen H, Tendl-Schulz K, Pfeiler G, Singer CF, Seifert M. Influence of histopathological changes after neoadjuvant chemotherapy on the survival of breast cancer patients. Cancer Treat Res Commun 2025; 43:100886. [PMID: 40031096 DOI: 10.1016/j.ctarc.2025.100886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 02/04/2025] [Accepted: 02/18/2025] [Indexed: 03/05/2025]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NACT) is an established form of therapy for early breast cancer (BC). The aim of our study was to analyze histopathological parameters before and after receiving NACT and to determine the influence of these changes on prognosis of BC patients. MATERIAL AND METHODS We retrospectively analyzed data of patients with primary early BC, diagnosed between January 2012 and December 2019, and NACT, followed by primary surgery. Patients achieving pathological complete response (pCR) were excluded. For the outcome analysis, disease-free survival (DFS) and overall survival (OS) were defined. RESULTS A total of 237 tumors were analyzed in the study. The conversion rates of tumor grade, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki67 status, and BC subtype were 34.6 %, 3.4 %, 14.3 %, 4.6 %, 30.0 %, and 28.7 %, respectively. After a median follow-up of 58.03 months, we found an association between consistently negative ER/PR with the worst prognosis (DFS and OS) (ER p < 0.0001 for both; PR p = 0.0003, p = 0.0004, respectively). The conversion from Ki67 ≥14 % to <14 % led to an improved outcome compared to a constant Ki67 ≥14 % (DFS p = 0.003, OS p = 0.001). Tumor residuals with a non-triple-negative (nTN) subtype (TN → nTN) showed a better prognosis than those with TN subtype (nTN → TN) (DFS and OS p < 0.0001). CONCLUSIONS After NACT, tumor grade and Ki67 showed the highest conversion rates between primary biopsy and tumor residual. Depending on changes in ER, PR, Ki67, and subtype, we found significant differences in the prognosis of the patients.
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Affiliation(s)
- Sabine Danzinger
- Department of Obstetrics and Gynecology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Verena Heiss Spornberger
- Department of Obstetrics and Gynecology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Hannes Vietzen
- Center for Virology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
| | - Kristina Tendl-Schulz
- Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Georg Pfeiler
- Department of Obstetrics and Gynecology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Michael Seifert
- Department of Obstetrics and Gynecology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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12
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Zhang X, Yang C, Chen Y, Zhang J, Li P, Huang N, Chen Y, Liang M, Lv W, Yuan Z, Li J, Wang K. Differences in HER2-0 and HER2-low Breast Cancer: Androgen Receptor and Programmed Death Ligand 1 as Predictive Factors. J Breast Cancer 2025; 28:23-36. [PMID: 40047088 PMCID: PMC11885850 DOI: 10.4048/jbc.2024.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 01/09/2025] [Accepted: 02/11/2025] [Indexed: 03/09/2025] Open
Abstract
PURPOSE Human epidermal growth factor receptor 2 (HER2)-low breast cancer has the potential to emerge as a distinct subtype. Several studies have compared the differences between HER2-low and HER2-0 breast cancers, but no consensus has been reached. Additionally, a biomarker to predict pathological complete response (pCR) rates in patients with HER2-low breast cancer remains to be identified. METHODS We collected data from 777 patients across three centers, stratifying them into HER2-low and HER2-0 groups. We compared differences in survival and pCR rates between the two groups and investigated potential biomarkers that could reliably predict pCR. RESULTS The study found that patients with HER2-0 breast cancer had higher pCR rates compared to patients with HER2-low tumors (289 patients [30.1%] vs. 475 patients [18.1%], p < 0.0001). Survival analysis showed no significant advantage for HER2-low tumors over HER2-0 breast cancers. Binary logistic analysis revealed that androgen receptor (AR) expression predicts poorer pCR rates in both the overall patient group and the HER2-0 breast cancer group (overall patients: odds ratio [OR], 0.479; 95% confidence interval [CI], 0.250-0.917; p = 0.026 and HER2-0 patients: OR, 0.267; 95% CI, 0.080-0.892; p = 0.032). In contrast, programmed death ligand 1 (PD-L1) expression was associated with more favorable pCR rates in the overall patient group (OR, 3.199; 95% CI, 1.020-10.037; p = 0.046). CONCLUSION There is currently insufficient evidence to classify HER2-low breast cancer as a distinct subtype. Our study revealed that AR expression, along with negative PD-L1 expression, contributes to lower pCR rates.
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Affiliation(s)
- Xiaoqi Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ciqiu Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yitian Chen
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Junsheng Zhang
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Peiyong Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Medical University, Zhanjiang, China
| | - Na Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yilin Chen
- School of Medicine, South China University of Technology, Guangzhou University Town, Guangzhou, China
| | - Minting Liang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Weiming Lv
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhongyu Yuan
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jie Li
- Department of Breast and Thyroid Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
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13
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Zhang L, Cui QX, Zhou LQ, Wang XY, Zhang HX, Zhu YM, Sang XQ, Kuai ZX. MRI-based vector radiomics for predicting breast cancer HER2 status and its changes after neoadjuvant therapy. Comput Med Imaging Graph 2024; 118:102443. [PMID: 39427545 DOI: 10.1016/j.compmedimag.2024.102443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/24/2024] [Accepted: 09/30/2024] [Indexed: 10/22/2024]
Abstract
PURPOSE To develop a novel MRI-based vector radiomic approach to predict breast cancer (BC) human epidermal growth factor receptor 2 (HER2) status (zero, low, and positive; task 1) and its changes after neoadjuvant therapy (NAT) (positive-to-positive, positive-to-negative, and positive-to-pathologic complete response; task 2). MATERIALS AND METHODS Both dynamic contrast-enhanced (DCE) MRI data and multi-b-value (MBV) diffusion-weighted imaging (DWI) data were acquired in BC patients at two centers. Vector-radiomic and conventional-radiomic features were extracted from both DCE-MRI and MBV-DWI. After feature selection, the following models were built using the retained features and logistic regression: vector model, conventional model, and combined model that integrates the vector-radiomic and conventional-radiomic features. The models' performances were quantified by the area under the receiver-operating characteristic curve (AUC). RESULTS The training/external test set (center 1/2) included 483/361 women. For task 1, the vector model (AUCs=0.73∼0.86) was superior to (p<.05) the conventional model (AUCs=0.68∼0.81), and the addition of vector-radiomic features to conventional-radiomic features yielded an incremental predictive value (AUCs=0.80∼0.90, p<.05). For task 2, the combined MBV-DWI model (AUCs=0.85∼0.89) performed better than (p<.05) the conventional MBV-DWI model (AUCs=0.73∼0.82). In addition, for the combined DCE-MRI model and the combined MBV-DWI model, the former (AUCs=0.85∼0.90) outperformed (p<.05) the latter (AUCs=0.80∼0.85) in task 1, whereas the latter (AUCs=0.85∼0.89) outperformed (p<.05) the former (AUCs=0.76∼0.81) in task 2. The above results are true for the training and external test sets. CONCLUSIONS MRI-based vector radiomics may predict BC HER2 status and its changes after NAT and provide significant incremental prediction over and above conventional radiomics.
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Affiliation(s)
- Lan Zhang
- Imaging Center, Harbin Medical University Cancer Hospital, Haping Road No. 150, Nangang District, Harbin, 150081, China
| | - Quan-Xiang Cui
- Imaging Center, Harbin Medical University Cancer Hospital, Haping Road No. 150, Nangang District, Harbin, 150081, China
| | - Liang-Qin Zhou
- Imaging Center, Harbin Medical University Cancer Hospital, Haping Road No. 150, Nangang District, Harbin, 150081, China
| | - Xin-Yi Wang
- Imaging Center, Harbin Medical University Cancer Hospital, Haping Road No. 150, Nangang District, Harbin, 150081, China
| | - Hong-Xia Zhang
- Imaging Center, Harbin Medical University Cancer Hospital, Haping Road No. 150, Nangang District, Harbin, 150081, China
| | - Yue-Min Zhu
- CREATIS, CNRS UMR 5220-INSERM U1206-University Lyon 1-INSA Lyon-University Jean Monnet Saint-Etienne, Lyon 69621, France
| | - Xi-Qiao Sang
- Division of Respiratory Disease, Fourth Affiliated Hospital of Harbin Medical University, Yiyuan Street No. 37, Nangang District, Harbin, 150001, China
| | - Zi-Xiang Kuai
- Imaging Center, Harbin Medical University Cancer Hospital, Haping Road No. 150, Nangang District, Harbin, 150081, China.
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Zhao Y, Chen X, Wang Y, Zhang X, Ye Y, Xu S, Zhou L, Lin Y, Lu J, Yin W. Stable or at least once HER2-low status during neoadjuvant chemotherapy confers survival benefit in patients with breast cancer. Ann Med 2024; 56:2409343. [PMID: 39376056 PMCID: PMC11463024 DOI: 10.1080/07853890.2024.2409343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/04/2024] [Accepted: 06/20/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Temporal heterogeneity in human epidermal growth factor receptor 2 (HER2) status may be associated with the prognosis of breast cancer. We aimed to clarify the relationship of HER2-low transition during neoadjuvant therapy with survival outcomes under the new classification of HER2 status. METHODS This retrospective study was conducted based on the prospective database of breast cancer patients treated with neoadjuvant therapy from September 2013 to August 2020. RESULTS This analysis enrolled 185 patients, including 44 patients with HER2-zero tumours, 93 patients with HER2-low tumours and 48 patients with HER2-positive tumours after neoadjuvant therapy. Nearly, 57.6% of HER2-zero tumours turned into HER2-low tumours after neoadjuvant therapy, while 25.0% of HER2-low patients changed to HER2-zero or HER2-positive tumours. We found that at least once diagnosis as HER2-low breast cancer was related to hormone receptor status (p < .001) and Ki-67 expression (p = .036). Patients ever diagnosed as HER2-low tumours had favourable clinicopathological features (less Ki-67 expression, lower pathological staging, etc.) as well as significantly better locoregional relapse-free survival (LRFS; p = .007) and overall survival (OS; p = .026) compared with those never exhibiting HER2-low expression. Furthermore, the 6-year OS rates were 94.2% (95% confidence interval (CI) 83.1-98.1), 88.7% (74.4-95.2) and 78.1% (65.4-86.6) for patients with stable, once and none HER2-low expression, respectively (adjusted HR, 0.514 [95%CI, 0.294-0.897], p = .019). CONCLUSIONS Our study first indicated in patients across all expression levels of HER2 that stable or at least once HER2-low status may confer favourable attributes including less malignant biological behaviour and long-term survival benefit for breast cancer receiving neoadjuvant therapy.
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Affiliation(s)
- Yingying Zhao
- Department of Breast Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xinru Chen
- Department of Breast Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yaohui Wang
- Department of Breast Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xueqing Zhang
- Department of Pathology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yumei Ye
- Department of Breast Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shuguang Xu
- Department of Breast Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Liheng Zhou
- Department of Breast Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yanping Lin
- Department of Breast Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingsong Lu
- Department of Breast Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjin Yin
- Department of Breast Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
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15
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Ouyang W, Liu Y, Cao J, Chen J. Trastuzumab Deruxtecan in HER2-Positive Breast Cancer with HER2 Loss After Dual-Target Adjuvant Therapy: A Case Report. Am J Ther 2024:00045391-990000000-00223. [PMID: 39451010 DOI: 10.1097/mjt.0000000000001795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2024]
Affiliation(s)
- Wei Ouyang
- Department of Oncology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, China
- Department of Medical Oncology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Yixin Liu
- Department of Oncology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, China
| | - Jun Cao
- Department of Nephrology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, China
| | - Jinghua Chen
- Department of Medical Oncology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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16
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Jiang N, Saftics A, Romano E, Ghaeli I, Resto C, Robles V, Das S, Van Keuren-Jensen K, Seewaldt VL, Jovanovic-Talisman T. Multiparametric profiling of HER2-enriched extracellular vesicles in breast cancer using Single Extracellular VEsicle Nanoscopy. J Nanobiotechnology 2024; 22:589. [PMID: 39342336 PMCID: PMC11438238 DOI: 10.1186/s12951-024-02858-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 09/14/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Patients with HER2-positive breast cancer can significantly benefit from HER2-directed therapy - such as the monoclonal antibody trastuzumab. However, some patients can develop therapy resistance or change HER2 status. Thus, we urgently need new, noninvasive strategies to monitor patients frequently. Extracellular vesicles (EVs) secreted from tumor cells are emerging as potential biomarker candidates. These membrane-delimited nanoparticles harbor molecular signatures of their origin cells; report rapidly on changes to cellular status; and can be frequently sampled from accessible biofluids. RESULTS Using Single Extracellular VEsicle Nanoscopy (SEVEN) platform that combines affinity isolation of EVs with super-resolution microscopy, here we provide multiparametric characterization of EVs with ~ 8 nm precision and molecular sensitivity. We first interrogated cell culture EVs affinity-enriched in tetraspanins CD9, CD63, and CD81; these transmembrane proteins are commonly found on EV membranes. SEVEN robustly provided critical parameters of individual, tetraspanin-enriched EVs: concentration, size, shape, molecular cargo content, and heterogeneity. Trastuzumab-resistant cells (vs. trastuzumab-sensitive) secreted more EVs. Additionally, EVs from trastuzumab-resistant cells had lower tetraspanin density and higher HER2 density. We also evaluated EVs affinity-enriched in HER2; we found that these EVs (vs. tetraspanin-enriched) were larger and more elongated. We further optimized analytical sample processing to assess a rare population of HER2-enriched EVs from patient plasma. In breast cancer patients with elevated HER2 protein expression (vs. controls), HER2-enriched EVs had distinct characteristics including typically increased number of tetraspanin molecules and larger size. Importantly, these EVs were on average 25-fold more abundant compared to no cancer controls. CONCLUSIONS SEVEN revealed unique characteristics of HER2-enriched EVs in cultured cells and complex biological fluid. In combination with current clinical approaches, this method is well poised to support precise therapeutic decisions.
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Affiliation(s)
- Nan Jiang
- Department of Cancer Biology and Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Andras Saftics
- Department of Cancer Biology and Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Eugenia Romano
- Department of Cancer Biology and Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ima Ghaeli
- Department of Cancer Biology and Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Cristal Resto
- Deprtment of Population Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Vanessa Robles
- Deprtment of Population Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Saumya Das
- Cardiology Division and Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Victoria L Seewaldt
- Deprtment of Population Sciences, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Tijana Jovanovic-Talisman
- Department of Cancer Biology and Molecular Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Yan S, Zhao W, Dong Y, Wang H, Xu S, Yu T, Tao W. Unveiling the mysteries of HER2-low expression in breast cancer: pathological response, prognosis, and expression level alterations. World J Surg Oncol 2024; 22:248. [PMID: 39267055 PMCID: PMC11396454 DOI: 10.1186/s12957-024-03530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 09/08/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND The novel anti-HER2 antibody drug conjugates (ADCs) can effectively improve the long-term survival of patients with HER2-low expression breast cancer. However, pathological responses to neoadjuvant therapy (NAT) within HER2-low expression breast cancer, the relationship between pathological response and prognosis and the transformation of HER2 status are all now poorly understood. METHODS The patients with HER2-0 and HER2-low expression breast cancer receiving NAT at Harbin Medical University Cancer Hospital between Jan. 2014 and Nov. 2018 were retrospectively explored. HER2 low expression refers to the IHC 1 + or 2 + and FISH negative. The Kappa test was utilized for analyzing the consistency rate of HER2 expression. To evaluate disease-free survival (DFS) and overall survival (OS), this research employed both the Kaplan-Meier analysis and the Cox regression. RESULTS In this study, 178 patients with HER2-0 and 344 patients with HER2-low expression breast cancer were included. In comparison with the HER2-0 group, it is shown that patients in the HER2-low group have more possibility to be younger compared to those 50 years old (P < 0.014), have more premenopausal patients (P < 0.001), a higher proportion of hormone receptor (HR) positive patients (P < 0.001), and less proportion of stage III V patients (P < 0.034). When NAT was finished, the pCR rate became 23.6% in the HER2-0 group while 22.1% in the HER2-low group, and there was also a higher pCR rate in HR- patients in comparison with that in HR + patients (P < 0.01). Considering HER2 expression inconsistency, the overall HER2 inconsistency rate was 30.4% (Kappa = 0.431, P < 0.01). Among patients initially diagnosed as HER2-0, 34% (N = 61) were re-diagnosed as HER2-low after NAT. After stratification by HR expression status, HR+/HER2-0 patients transformed to HER2-low after NAT in 37%, and 32% of HR- patients changed from HER2-0 to HER2-low. In this survival analysis, there were both better DFS rates (P = 0.009) and OS rates (P = 0.026) in the HR-/HER2-low patients in comparison with the HR-/HER2-0 patients, while the HER2-0 and HER2-low patients in the HR + group had no significant survival difference. Additionally, for non-pCR patients, there was better DFS (P = 0.029) and OS (P = 0.038) in the HER2-low group in comparison with that of the HER2-0 group, while no significant survival difference exists between pCR patients. CONCLUSION After HR stratification, there are unique clinical characteristics and prognostic outcomes in HER2-low expression breast cancer, which indicates the potential to become a specific molecular subtype of breast cancer. The significant instability of HER2-low expression status between primary tumor and residual invasive disease suggests that multiple detections of HER2 status should be emphasized in NAT strategies.
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Affiliation(s)
- Shuai Yan
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Nangang District, Harbin, 150001, P.R. China
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin Medical University, Harbin, China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Harbin Medical University, Harbin, China
- The Cell Transplantation Key Laboratory of National Health Commission, Harbin Medical University, Harbin, 150001, Heilongjiang, P.R. China
| | - Wenxi Zhao
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Nangang District, Harbin, 150001, P.R. China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Harbin Medical University, Harbin, China
- The Cell Transplantation Key Laboratory of National Health Commission, Harbin Medical University, Harbin, 150001, Heilongjiang, P.R. China
| | - Yuhan Dong
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Nangang District, Harbin, 150001, P.R. China
| | - Hongyue Wang
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Nangang District, Harbin, 150001, P.R. China
| | - Shouping Xu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Tong Yu
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Nangang District, Harbin, 150001, P.R. China
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Harbin Medical University, Harbin, China
- The Cell Transplantation Key Laboratory of National Health Commission, Harbin Medical University, Harbin, 150001, Heilongjiang, P.R. China
| | - Weiyang Tao
- Department of Breast Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Nangang District, Harbin, 150001, P.R. China.
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin Medical University, Harbin, China.
- Key Laboratory of Acoustic, Optical and Electromagnetic Diagnosis and Treatment of Cardiovascular Diseases, Harbin Medical University, Harbin, China.
- The Cell Transplantation Key Laboratory of National Health Commission, Harbin Medical University, Harbin, 150001, Heilongjiang, P.R. China.
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18
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Funakushi R, Kuba S, Morita M, Akashi M, Eguchi S. Human Epidermal Growth Factor Receptor Type 2 (HER2)-Positive Metastatic Breast Cancer With HER2-Negative Conversion: A Case Report and Treatment With Cyclin-Dependent Kinase (CDK) 4/6 Inhibitor for the Luminal Type. Cureus 2024; 16:e69771. [PMID: 39429386 PMCID: PMC11491141 DOI: 10.7759/cureus.69771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2024] [Indexed: 10/22/2024] Open
Abstract
A 37-year-old woman was diagnosed with stage IIIA, estrogen receptor (ER)-positive/human epidermal growth factor receptor type 2 (HER2)-positive breast cancer. The patient received neoadjuvant chemotherapy with epirubicin and cyclophosphamide, followed by docetaxel, trastuzumab, and pertuzumab. The surgical specimen remained ER-positive/HER2-positive. Liver metastasis was detected after the completion of postoperative adjuvant trastuzumab and pertuzumab. A liver biopsy following treatment with trastuzumab emtansine (T-DM1) and trastuzumab deruxtecan (T-Dxd) revealed HER2-negative status. Cyclin-dependent kinase (CDK) 4/6 inhibitor combination endocrine therapy has been continued for 16 months to date while maintaining tumor shrinkage. It is essential to perform a rebiopsy during treatment to optimize therapy based on the subtype.
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Affiliation(s)
- Ryo Funakushi
- School of Medical Sciences, Nagasaki University, Nagasaki, JPN
| | - Sayaka Kuba
- Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Michi Morita
- Breast and Endocrine Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
| | - Momoko Akashi
- Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Susumu Eguchi
- Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
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19
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Laokulrath N, Gudi M, Salahuddin SA, Chong APY, Ding C, Iqbal J, Leow WQ, Tan BY, Tse G, Rakha E, Tan PH. Human epidermal growth factor receptor 2 (HER2) status in breast cancer: practice points and challenges. Histopathology 2024; 85:371-382. [PMID: 38845396 DOI: 10.1111/his.15213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 08/09/2024]
Abstract
Human epidermal growth factor receptor 2 (HER2)-enriched breast cancer benefits significantly from anti-HER2 targeted therapies. This highlights the critical need for precise HER2 immunohistochemistry (IHC) interpretation serving as a triage tool for selecting patients for anti-HER2 regimens. Recently, the emerging eligibility of patients with HER2-low breast cancers for a novel HER2-targeted antibody-drug conjugate (T-DXd) adds challenges to HER2 IHC scoring interpretation, notably in the 0-1+ range, which shows high interobserver and interlaboratory staining platform variability. In this review, we navigate evolving challenges and suggest practical recommendations for HER2 IHC interpretation.
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Affiliation(s)
- Natthawadee Laokulrath
- Department of Pathology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Mihir Gudi
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | | | | | - Cristine Ding
- Division of Anatomical Pathology, Changi General Hospital, Singapore
| | - Jabed Iqbal
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Wei Qiang Leow
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Gary Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Emad Rakha
- Cellular Pathology Department, School of Medicine, University of Nottingham, Nottingham, UK
| | - Puay Hoon Tan
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
- Luma Medical Centre, Singapore
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20
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Bischoff H, Espié M, Petit T. Unveiling Neoadjuvant Therapy: Insights and Outlooks for HER2-Positive Early Breast Cancer. Curr Treat Options Oncol 2024; 25:1225-1237. [PMID: 39153019 PMCID: PMC11416367 DOI: 10.1007/s11864-024-01252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2024] [Indexed: 08/19/2024]
Abstract
OPINION STATEMENT This perspective underscores the evolution and significance of neoadjuvant therapy in breast cancer, tracing its history and efficacy in improving outcomes. It delves into the correlation between achieving complete response and long-term survival, emphasizing the predictive value of treatment response estimation. Neoadjuvant chemotherapy in HER2-positive early breast cancer, particularly with taxanes and anti-HER2 therapies, emerges as a cornerstone, offering enhanced breast conservation rates and prognostic insights. The focus on individualized care, tailored to treatment response, underscores the need for adaptive strategies. Additionally, the article discusses the ongoing debate surrounding anthracyclines' role and the benefits of dual HER2 blockade. Ultimately, advocating for a personalized approach, guided by treatment response assessment, ensures optimal outcomes in HER2-positive breast cancer management.
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Affiliation(s)
| | - Marc Espié
- Medical Oncology Department, Hôpital Saint Louis, Paris, France
| | - Thierry Petit
- Medical Oncology Department, ICANS, Strasbourg, France
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21
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Chen X, Ji L, Qian X, Xiao M, Li Q, Li Q, Wang J, Fan Y, Luo Y, Lan B, Chen S, Ma F, Xu B, Zhang P. Evolution and prognostic significance of HER-2 conversion from primary to residual disease in HER-2 negative patients with breast cancer after neoadjuvant chemotherapy. Am J Cancer Res 2024; 14:3859-3872. [PMID: 39267660 PMCID: PMC11387869 DOI: 10.62347/dgtd7801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/07/2024] [Indexed: 09/15/2024] Open
Abstract
This study aimed to analyze HER-2 zero or HER-2 low conversion in HER-2 negative patients after neoadjuvant chemotherapy (NAC) and evaluate its prognostic significance. HER-2 negative patients with breast cancer with residual disease after NAC and paired pre- and post-therapeutic HER-2 testing results were analyzed retrospectively. HER-2 low, defined as immunohistochemistry (IHC) scores of 1+ or 2+/in situ hybridization (ISH), were not amplified. HER-2 zero is defined as an IHC score of 0. A total of 571 patients were enrolled, including primary HER-2 zero (n=201, 35.2%) and HER-2 low (n=370, 64.8%). The overall HER-2 change rate was 32.4%. Multivariable logistic regression showed that patients with hormone receptor-positive status before NAC was significantly associated with the conversion of HER-2 zero to low (OR=3.436, P < 0.0001). The median follow-up time was 50.0 months. In patients who are primary HER-2 zero, HER-2 zero to low was significantly associated with better disease-free survival (DFS) than constant HER-2 zero (HR=0.49, P=0.01) after adjustment (4-year DFS 80.1% vs 55.7%, Log-rank P=0.033). Subgroup analysis revealed that among patients who are primary HER-2 zero with hormone receptor-positive, HER-2 zero to low had a significantly better DFS than constant HER-2 zero (Log-rank P=0.037). In contrast, patients with hormone receptor-negative status did not. In conclusion, almost one-third of patients who are HER-2 negative underwent HER-2 zero or HER-2 low conversion after NAC. HER-2 zero to low conversion was associated with better DFS in patients who are HER-2 zero. These results provide a valuable reference for the potential application of anti-HER-2 ADC in an adjuvant setting for patients with residual disease after NAC.
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Affiliation(s)
- Xi Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Lei Ji
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Xiaoyan Qian
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Min Xiao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Qing Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Qiao Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Jiayu Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Ying Fan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Bo Lan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Shanshan Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Pin Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
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22
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Kang S, Kim SB. HER2-Low Breast Cancer: Now and in the Future. Cancer Res Treat 2024; 56:700-720. [PMID: 38291745 PMCID: PMC11261208 DOI: 10.4143/crt.2023.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/28/2024] [Indexed: 02/01/2024] Open
Abstract
Breast cancer is a heterogeneous disease, and its subtypes are characterized by hormone receptor and human epidermal growth factor receptor 2 (HER2) expression status. "HER2-low" tumors, which exhibit a low level of HER2 expression (immunohistochemistry 1+ or 2+ without gene amplification), were conventionally considered not amenable to anti-HER2 targeting agents based on the results of a phase III trial of trastuzumab. However, this perspective is being challenged by the emergence of novel anti-HER2 antibody-drug conjugates, such as trastuzumab-deruxtecan. These innovative therapies have demonstrated remarkable efficacy against HER2-low breast cancer, shedding new light on a previously overlooked category of breast cancer. Such promising results highlight the need for in-depth investigations of the biology and prognostic implications of HER2-low tumors. In this review, we comprehensively summarize the current evidence surrounding this topic and highlight areas that warrant further exploration and research in the future.
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Affiliation(s)
- Sora Kang
- Division of Hemato-oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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23
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Kutlu Y, Cekin R, Aydin SG, Shbair ATM, Bilici A, Arici S, Oven BB, Acikgoz O, Ozcan E, Olmez OF, Cakir A, Seker M. Prognostic significance of HER2 loss after HER2-targeted neoadjuvant treatment in patients with HER2-positive locally advanced breast cancer. Curr Probl Cancer 2024; 50:101102. [PMID: 38735211 DOI: 10.1016/j.currproblcancer.2024.101102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024]
Abstract
Loss of human epidermal growth factor receptor 2 (HER2) expression can be seen in almost 25-30 % patients after HER2 receptor directed neoadjuvant treatment. These patients have unclear clinical outcomes in previous studies. We aimed to investigate the importance of HER2 loss, additionally with predictive factors for the loss of HER2. This was a retrospective and multicenter study that included 272 HER2-positive BC patients with no pathological complete response who received neoadjuvant chemotherapy plus HER2-targeted treatments. The factors that may affect the loss of HER2 detected by immunohistochemistry(IHC) and the association with survival were analyzed.The rate of HER2 loss after neoadjuvant treatments(NAT) was 27.9 % (n = 76). Disease recurrence was observed in 18(23.7 %) patients with HER2 loss, while it was detected in 62 (31.7 %) patients without HER2 loss(p = 0.23). Pre and post-NAT ER status, and post-NAT ki-67 status had a significant impact on disease-free survival(DFS) (p = 0.0012, p = 0.004, and p = 0.04, respectively).There were no significant association between DFS and loss of HER2 (p = 0.64) and dual anti-HER2 blockade (p = 0.21). Pre-NAT clinical stage (HR:1.65 p = 0.013), post-NAT LN status (HR:3.18, p = 0.02) and pre-NAT ER status (HR:0.24, p = 0.041) were significant independent prognostic factors for DFS while post-NAT residual disease in axillar tissue was an independent prognostic factor for OS (HR:1.54 p = 0.019). Moreover, age (<40 years vs ≥40 years) (p = 0.031) and tumor grade (p = 0.004) were predictive factors for HER2 loss. Our results showed that HER2 loss did not affect survivals. However, young age and being high grade tumor may predict HER2 loss.
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Affiliation(s)
- Yasin Kutlu
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey.
| | - Ruhper Cekin
- Department of Medical Oncology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Sabin Goktas Aydin
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Abdallah T M Shbair
- Department of Medical Oncology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Bilici
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Serdar Arici
- Department of Medical Oncology, Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Bala Basak Oven
- Department of Medical Oncology, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Ozgur Acikgoz
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Erkan Ozcan
- Department of Medical Oncology, Trakya University Faculty of Medicine, Istanbul, Turkey
| | - Omer Fatih Olmez
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Asli Cakir
- Department of Pathology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Mesut Seker
- Department of Medical Oncology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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24
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Bossuyt V, Provenzano E, Symmans WF, Webster F, Allison KH, Dang C, Gobbi H, Kulka J, Lakhani SR, Moriya T, Quinn CM, Sapino A, Schnitt S, Sibbering DM, Slodkowska E, Yang W, Tan PH, Ellis I. A dedicated structured data set for reporting of invasive carcinoma of the breast in the setting of neoadjuvant therapy: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2024; 84:1111-1129. [PMID: 38443320 DOI: 10.1111/his.15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024]
Abstract
AIMS The International Collaboration on Cancer Reporting (ICCR), a global alliance of major (inter-)national pathology and cancer organisations, is an initiative aimed at providing a unified international approach to reporting cancer. ICCR recently published new data sets for the reporting of invasive breast carcinoma, surgically removed lymph nodes for breast tumours and ductal carcinoma in situ, variants of lobular carcinoma in situ and low-grade lesions. The data set in this paper addresses the neoadjuvant setting. The aim is to promote high-quality, standardised reporting of tumour response and residual disease after neoadjuvant treatment that can be used for subsequent management decisions for each patient. METHODS The ICCR convened expert panels of breast pathologists with a representative surgeon and oncologist to critically review and discuss current evidence. Feedback from the international public consultation was critical in the development of this data set. RESULTS The expert panel concluded that a dedicated data set was required for reporting of breast specimens post-neoadjuvant therapy with inclusion of data elements specific to the neoadjuvant setting as core or non-core elements. This data set proposes a practical approach for handling and reporting breast resection specimens following neoadjuvant therapy. The comments for each data element clarify terminology, discuss available evidence and highlight areas with limited evidence that need further study. This data set overlaps with, and should be used in conjunction with, the data sets for the reporting of invasive breast carcinoma and surgically removed lymph nodes from patients with breast tumours, as appropriate. Key issues specific to the neoadjuvant setting are included in this paper. The entire data set is freely available on the ICCR website. CONCLUSIONS High-quality, standardised reporting of tumour response and residual disease after neoadjuvant treatment are critical for subsequent management decisions for each patient.
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Affiliation(s)
- Veerle Bossuyt
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena Provenzano
- Department of Histopathology, Addenbrookes Hospital, Cambridge, UK
| | - W Fraser Symmans
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fleur Webster
- International Collaboration on Cancer Reporting, Surry Hills, NSW, Australia
| | - Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Chau Dang
- Memorial Sloan Kettering Cancer Center, West Harrison, NY, USA
| | - Helenice Gobbi
- Department of Surgical Clinic, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Sunil R Lakhani
- Centre for Clinical Research, and Pathology Queensland, University of Queensland, Brisbane, Qld, Australia
| | - Takuya Moriya
- Department of Pathology, Kawasaki Medical School, Okayama, Japan
| | - Cecily M Quinn
- Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College, Dublin, Ireland
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stuart Schnitt
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - D Mark Sibbering
- University Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, UK
| | - Elzbieta Slodkowska
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Ian Ellis
- Department of Histopathology, Nottingham City Hospital, London, UK
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25
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Kuruoglu FE, Ekici ZM, Nak D, Ozyigit MO, Kupeli ZA, Koca D. Investigation of efficacy of two different chemotherapy protocols used in neoadjuvant chemotherapy in clinical stages II-IV canine malignant mammary tumours. Vet Comp Oncol 2024; 22:284-294. [PMID: 38600051 DOI: 10.1111/vco.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
The first aim of this study is to demonstrate the clinical efficacy and reliability of two different neoadjuvant chemotherapy (NAC) protocols consisting of doxorubicin/cyclophosphamide (AC) and paclitaxel in dogs with clinical stages II-IV canine malignant mammary tumours (CMTs). Secondly, to determine the Luminal A, Luminal B, HER2-positive and triple-negative molecular subtypes and their value in predicting clinical response to NAC in biopsy samples, and thirdly, to reveal the changes in Ki-67, human epidermal growth factor receptor type 2 (HER2), oestrogen receptor (ER), and progesterone receptor (PgR) expression levels induced by NAC. Thirty dogs with clinical stages II-IV CMTs (T1-3N0-1M0) according to the modified TNM system were included in the study. Dogs in group-1 (n = 15) AC combination and dogs in group-2 (n = 15) were administered paclitaxel. Partial response (PR) was the most common clinical response in both treatment groups (66.66% and 86.66%, respectively). There was no difference between the groups regarding clinical response parameters (p = .001). The rate of treatment responders was higher than the rate of non-responders in both groups (p < .001). The adverse effects observed in both groups were mostly limited to grades 1 and 2 and all were easy to manage. The most frequently detected molecular subtype was Luminal A (59.25%). Complete response (CR) was achieved in 33.33% of dogs with triple-negative CMT in the AC group and 14.29% of the Luminal A subtype in the paclitaxel group. Alterations in Ki-67, HER2, ER, and PgR expressions after chemotherapy were not statistically significant (p > .05). As a result, we have shown that these neoadjuvant chemotherapy protocols are effective and safe alternative treatment options for CMTs.
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Affiliation(s)
- Fikriye Ecem Kuruoglu
- Department of Obstetrics and Gynecology, Veterinary Faculty, Bursa Uludag University, Bursa, Turkey
| | - Zeynep Merve Ekici
- Department of Obstetrics and Gynecology, Veterinary Faculty, Bursa Uludag University, Bursa, Turkey
| | - Deniz Nak
- Department of Obstetrics and Gynecology, Veterinary Faculty, Bursa Uludag University, Bursa, Turkey
| | - Musa Ozgur Ozyigit
- Department of Department of Pathology, Veterinary Faculty, Bursa Uludag University, Bursa, Turkey
| | - Zehra Avci Kupeli
- Department of Department of Pathology, Veterinary Faculty, Bursa Uludag University, Bursa, Turkey
| | - Davut Koca
- Department of Obstetrics and Gynecology, Veterinary Faculty, Bursa Uludag University, Bursa, Turkey
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Eissler N, Altena R, Alhuseinalkhudhur A, Bragina O, Feldwisch J, Wuerth G, Loftenius A, Brun N, Axelsson R, Tolmachev V, Sörensen J, Frejd FY. Affibody PET Imaging of HER2-Expressing Cancers as a Key to Guide HER2-Targeted Therapy. Biomedicines 2024; 12:1088. [PMID: 38791050 PMCID: PMC11118066 DOI: 10.3390/biomedicines12051088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/27/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) is a major prognostic and predictive marker overexpressed in 15-20% of breast cancers. The diagnostic reference standard for selecting patients for HER2-targeted therapy is based on the analysis of tumor biopsies. Previously patients were defined as HER2-positive or -negative; however, with the approval of novel treatment options, specifically the antibody-drug conjugate trastuzumab deruxtecan, many breast cancer patients with tumors expressing low levels of HER2 have become eligible for HER2-targeted therapy. Such patients will need to be reliably identified by suitable diagnostic methods. Biopsy-based diagnostics are invasive, and repeat biopsies are not always feasible. They cannot visualize the heterogeneity of HER2 expression, leading to a substantial number of misdiagnosed patients. An alternative and highly accurate diagnostic method is molecular imaging with radiotracers. In the case of HER2, various studies demonstrate the clinical utility and feasibility of such approaches. Radiotracers based on Affibody® molecules, small, engineered affinity proteins with a size of ~6.5 kDa, are clinically validated molecules with favorable characteristics for imaging. In this article, we summarize the HER2-targeted therapeutic landscape, describe our experience with imaging diagnostics for HER2, and review the currently available clinical data on HER2-Affibody-based molecular imaging as a novel diagnostic tool in breast cancer and beyond.
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Affiliation(s)
| | - Renske Altena
- Department of Oncology-Pathology, Karolinska Institutet, 17164 Solna, Sweden
- Medical Unit Breast, Endocrine Tumors and Sarcoma, Theme Cancer, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, 17164 Solna, Sweden
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, 14157 Huddinge, Sweden
| | - Ali Alhuseinalkhudhur
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, 75310 Uppsala, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, 75310 Uppsala, Sweden
| | - Olga Bragina
- Department of Nuclear Therapy and Diagnostic, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634055 Tomsk, Russia
- Research Centrum for Oncotheranostics, Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, 634050 Tomsk, Russia
| | | | | | | | | | - Rimma Axelsson
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, 14157 Huddinge, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 14152 Stockholm, Sweden
| | - Vladimir Tolmachev
- Department of Immunology, Genetics and Pathology, Uppsala University, 75310 Uppsala, Sweden
| | - Jens Sörensen
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, 75310 Uppsala, Sweden
| | - Fredrik Y. Frejd
- Affibody AB, 17165 Solna, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, 75310 Uppsala, Sweden
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27
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Cui Y, Ran R, Da Y, Zhang H, Jiang M, Qi X, Zhang W, Niu L, Zhou Y, Zhou C, Tang X, Wang K, Yan Y, Ren Y, Dong D, Zhou Y, Wang H, Gong J, Hu F, Zhao S, Zhang H, Zhang C, Yang J. The combination of breast cancer PDO and mini-PDX platform for drug screening and individualized treatment. J Cell Mol Med 2024; 28:e18374. [PMID: 38722288 PMCID: PMC11081008 DOI: 10.1111/jcmm.18374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/05/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
The majority of advanced breast cancers exhibit strong aggressiveness, heterogeneity, and drug resistance, and currently, the lack of effective treatment strategies is one of the main challenges that cancer research must face. Therefore, developing a feasible preclinical model to explore tailored treatments for refractory breast cancer is urgently needed. We established organoid biobanks from 17 patients with breast cancer and characterized them by immunohistochemistry (IHC) and next generation sequencing (NGS). In addition, we in the first combination of patient-derived organoids (PDOs) with mini-patient-derived xenografts (Mini-PDXs) for the rapid and precise screening of drug sensitivity. We confirmed that breast cancer organoids are a high-fidelity three-dimension (3D) model in vitro that recapitulates the original tumour's histological and genetic features. In addition, for a heavily pretreated patient with advanced drug-resistant breast cancer, we combined PDO and Mini-PDX models to identify potentially effective combinations of therapeutic agents for this patient who were alpelisib + fulvestrant. In the drug sensitivity experiment of organoids, we observed changes in the PI3K/AKT/mTOR signalling axis and oestrogen receptor (ER) protein expression levels, which further verified the reliability of the screening results. Our study demonstrates that the PDO combined with mini-PDX model offers a rapid and precise drug screening platform that holds promise for personalized medicine, improving patient outcomes and addressing the urgent need for effective therapies in advanced breast cancer.
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Affiliation(s)
- Yuxin Cui
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Department of Medical OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Ran Ran
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Department of Medical OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Yanyan Da
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Center for Molecular Diagnosis and Precision MedicineThe First Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityNanchangJiangxiChina
| | - Huiwen Zhang
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Meng Jiang
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Department of Medical OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Xin Qi
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Department of Medical OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Wei Zhang
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Ligang Niu
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Yuhui Zhou
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Can Zhou
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Xiaojiang Tang
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Ke Wang
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Yu Yan
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Yu Ren
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Danfeng Dong
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Department of Medical OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Yan Zhou
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Department of Medical OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Hui Wang
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Department of Medical OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Jin Gong
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Department of Medical OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Fang Hu
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Department of Medical OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Shidi Zhao
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Department of Medical OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Huimin Zhang
- Department of Breast SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Chengsheng Zhang
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Center for Molecular Diagnosis and Precision MedicineThe First Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityNanchangJiangxiChina
| | - Jin Yang
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
- Department of Medical OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
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28
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Kim KE, Lee HW, Bae SU. Rectal metastasis arising from breast cancer: a case report. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2024; 20:41-45. [PMID: 38988018 PMCID: PMC11261180 DOI: 10.14216/kjco.24007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/03/2024] [Accepted: 05/25/2024] [Indexed: 07/12/2024]
Abstract
Breast cancer is the most common cancer among women worldwide. Breast cancer often metastasizes to the regional lymph nodes, bone, brain, liver, and lungs, whereas gastrointestinal tract metastases are rare. Herein, we present a rare case of rectal metastasis from breast cancer that occurred during palliative chemotherapy. A 69-year-old female with a history of invasive ductal carcinoma, negative for hormonal receptors and positive for human epidermal growth factor receptor 2 (HER2) receptor, underwent various treatments, including neoadjuvant chemotherapy, breast-conserving surgery, and adjuvant therapy. Eight months postoperatively, the patient experienced axillary lymph node recurrence, requiring palliative chemotherapy. Despite ongoing treatment, metastatic lesions were confirmed in the lungs and pleura. During palliative chemotherapy, the patient developed anal pain, and subsequent examination revealed an infiltrating rectal lesion. Despite histological confirmation of metastatic breast carcinoma and tubular adenoma, a multidisciplinary decision was made regarding palliative chemotherapy over surgical intervention. Eribulin was administered, but due to the patient's inability to tolerate the treatment, she passed away 3 months after rectal lesion diagnosis. Although breast cancer metastasis to the rectum is rare, clinicians should consider the possibility of rectal involvement and perform a digital rectal examination if anal symptoms are present.
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Affiliation(s)
- Kyeong Eui Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu,
Korea
| | - Hye Won Lee
- Department of Pathology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu,
Korea
| | - Sung Uk Bae
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu,
Korea
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29
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Peng DM, Li J, Qiu JX, Zhao L. Neoadjuvant pertuzumab plus trastuzumab in combination with chemotherapy for human epidermal growth factor receptor 2 positive breast cancer: a real-world retrospective single-institutional study in China. World J Surg Oncol 2024; 22:88. [PMID: 38582875 PMCID: PMC10998413 DOI: 10.1186/s12957-024-03365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/28/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION Real-world studies on neoadjuvant dual anti-HER2 therapy combined with chemotherapy for breast cancer (BC) are scarce in China. This study aimed to evaluate the efficacy and safety of neoadjuvant dual anti-HER2 therapy combined with chemotherapy in a real-world setting. Moreover, differences in estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and proliferation cell nuclear antigen (Ki-67) expression pre- and post-neoadjuvant therapy were analyzed. METHODS Clinical and pathological data of patients with HER2-positive BC who received neoadjuvant dual anti-HER2 therapy combined with chemotherapy at Liaoning Cancer Hospital & Institute, China, between September 2021 and September 2023, were retrospectively reviewed. RESULTS Among 179 included patients, a pathologic complete response (pCR) was achieved in 109 patients (60.9%). The univariate analysis results indicated that the hormone receptor (HR) status (P = 0.013), HER2 status (P = 0.003), and cycles of targeted treatment (P = 0.035) were significantly correlated with pCR. Subsequent multivariable analysis showed that HR negative and HER2 status 3 + were independent predictive factors of pCR. Anemia was the most common adverse event (62.0%), and the most common grade 3-4 adverse event was neutropenia (6.1%). The differences in HER2 (34.5%) and Ki-67 (92.7%) expression between core needle biopsy and the residual tumor after neoadjuvant therapy were statistically significant, whereas the differences were insignificant in terms of ER or PR status. CONCLUSIONS The combination of neoadjuvant trastuzumab and pertuzumab with chemotherapy showed good efficiency, and the toxic side effects were tolerable in patients with BC. In cases where pCR was not achieved after neoadjuvant therapy, downregulation of HER2 and Ki-67 expressions was observed.
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Affiliation(s)
- Dong-Mei Peng
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, NO, Shenyang, 110042, P.R. China
| | - Juan Li
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, NO, Shenyang, 110042, P.R. China
| | - Jia-Xin Qiu
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, NO, Shenyang, 110042, P.R. China
| | - Lin Zhao
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, NO, Shenyang, 110042, P.R. China.
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30
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Zhao L, Xing Y, Liu C, Ma S, Huang W, Cheng Z, Zhao J. Detection of HER2 expression using 99mTc-NM-02 nanobody in patients with breast cancer: a non-randomized, non-blinded clinical trial. Breast Cancer Res 2024; 26:40. [PMID: 38459598 PMCID: PMC10924314 DOI: 10.1186/s13058-024-01803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/03/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND 99mTc radiolabeled nanobody NM-02 (99mTc-NM-02) is a novel single photon emission computed tomography (SPECT) probe with a high affinity and specificity for human epidermal growth factor receptor 2 (HER2). In this study, a clinical imaging trial was conducted to investigate the relationship between 99mTc-NM-02 uptake and HER2 expression in patients with breast cancer. METHODS Thirty patients with pathologically confirmed breast cancer were recruited and imaged with both 99mTc-NM-02 SPECT/computed tomography (CT) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT. According to the treatment conditions before recruitment, patients were divided into two groups, the newly diagnosed group (n = 24) and the treated group (n = 6). The maximal standard uptake value (SUVmax) of 18F-FDG and SUVmax and mean SUV (SUVmean) of 99mTc-NM-02 in the lesions were determined to analyze the relationship with HER2 expression. RESULTS No meaningful relationship was observed between 18F-FDG uptake and HER2 expression in 30 patients with breast cancer. 99mTc-NM-02 uptake was positively correlated with HER2 expression in the newly diagnosed group, but no correlation was observed in the treated group. 99mTc-NM-02 uptake in HER2-positive lesions was lower in those with effective HER2-targeted therapy compared with the newly diagnosed group. 99mTc-NM-02 SPECT/CT detected brain and bone metastases of breast cancer with a different imaging pattern from 18F-FDG PET/CT. 99mTc-NM-02 showed no non-specific uptake in inflamed tissues and revealed intra- and intertumoral HER2 heterogeneity by SPECT/CT imaging in 9 of the 30 patients with breast cancer. CONCLUSIONS 99mTc-NM-02 SPECT/CT has the potential for visualizing whole-body HER2 overexpression in untreated patients, making it a promising method for HER2 assessment in patients with breast cancer. TRIAL REGISTRATION NCT04674722, Date of registration: December 19, 2020.
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Affiliation(s)
- Lingzhou Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Yan Xing
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Changcun Liu
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Shaofei Ma
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Wenhua Huang
- Nanomab Technology Limited, No. 333, North Chengdu Road, Jingan District, Shanghai, 200041, China
| | - Zhen Cheng
- State Key Laboratory of Drug Research, Molecular Imaging Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, No. 555, Zuchongzhi Road, Pudong New District, Shanghai, 201203, China.
- Shandong Laboratory of Yantai Drug Discovery, Bohai Rim Advanced Research Institute for Drug Discovery, No. 198, Binhai East Road, High-Tech District, Yantai, 264000, Shandong, China.
| | - Jinhua Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China.
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Iwamoto T, Kumamaru H, Niikura N, Sagara Y, Miyashita M, Konishi T, Sanuki N, Tanakura K, Nagahashi M, Hayashi N, Yoshida M, Watanabe C, Kinukawa N, Toi M, Saji S. Survival trends and patient characteristics between 2004 and 2016 for breast cancer in Japan based on the National Clinical Database-Breast Cancer Registry. Breast Cancer 2024; 31:185-194. [PMID: 38319565 DOI: 10.1007/s12282-024-01545-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/07/2024] [Indexed: 02/07/2024]
Abstract
This is a prognostic report by the Japanese Breast Cancer Society on breast cancer extracted from the National Clinical Database-Breast Cancer Registry of Japan. Here, we present a summary of 457,878 breast cancer cases registered between 2004 and 2016. The median follow-up duration was 5.6 years. The median age at the start of treatment was 59 years (5-95%: 38-82 years) and increased from 57 years between 2004 and 2008 to 60 years between 2013 and 2016. The proportion of patients with Stage 0-II disease increased from 74.5% to 78.3%. The number of cases with estrogen and progesterone receptor positivity increased from 74.8% to 77.9% and 60.5% to 68.1%, respectively. Regarding (neo-)adjuvant chemotherapy, the taxane (T) or taxane-cyclophosphamide (C) regimen increased by 2.4% to 8.2%, but the (fluorouracil (F)) adriamycin (A)-C-T/(F) epirubicin (E)C-T and (F)AC/(F)EC regimens decreased by 18.6% to 15.2% and 13.5% to 5.0%, respectively. Regarding (neo-)adjuvant anti-human epidermal growth factor-2 (HER2)-targeted therapy, the use of trastuzumab increased from 4.6% to 10.5%. The rate of sentinel lymph node biopsy increased from 37.1% to 60.7%, while that of axillary dissection decreased from 54.5% to 22.6%. Improvements in disease-free and overall survival were observed in patients with HER2-positive breast cancer, but there was no apparent trend in patients with hormone receptor-positive, HER2-negative, or triple-negative breast cancers.
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Affiliation(s)
- Takayuki Iwamoto
- Breast and Thyroid Surgery, Kawasaki Medical School Hospital, Okayama, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Yasuaki Sagara
- Department of Breast Surgical Oncology, Social Medical Corporation Hakuaikai, Sagara Hospital, Kagoshima, Japan
| | - Minoru Miyashita
- Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, Miyagi, Japan
| | - Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoko Sanuki
- Radiation Therapy Department, Yokkaichi Municipal Hospital, Mie, Japan
| | - Kenta Tanakura
- Plastic and Reconstructive Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masayuki Nagahashi
- Department of Surgery, Division of Breast and Endocrine Surgery, School of Medicine, Hyogo Medical University, Hyogo, Japan
| | - Naoki Hayashi
- Department of Surgery, Division of Breast Surgical Oncology, Showa University, Tokyo, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Chie Watanabe
- School of Nursing and Rehabilitation Sciences, Showa University, Tokyo, Japan
| | - Naoko Kinukawa
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan
| | - Masakazu Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
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Lumish M, Chui MH, Zhou Q, Iasonos A, Sarasohn D, Cohen S, Friedman C, Grisham R, Konner J, Kyi C, Rubinstein M, Troso-Sandoval T, Aghajanian C, Makker V. A phase 2 trial of zanidatamab in HER2-overexpressed advanced endometrial carcinoma and carcinosarcoma (ZW25-IST-2). Gynecol Oncol 2024; 182:75-81. [PMID: 38262242 PMCID: PMC11264355 DOI: 10.1016/j.ygyno.2023.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE HER2 overexpression is associated with decreased overall survival in metastatic endometrial cancer. Trastuzumab with chemotherapy has demonstrated efficacy for first-line management of advanced HER2+ endometrial carcinoma, but HER2-directed therapy in the recurrent setting is limited. Zanidatamab (ZW25), a humanized, bispecific antibody that simultaneously binds the 2 distinct HER2 epitopes bound by trastuzumab and pertuzumab, has demonstrated safety and activity in HER2+ tumors. Here, we report the results of a phase 2, open-label study evaluating the efficacy and safety of zanidatamab in patients with HER2+ metastatic endometrial carcinoma/carcinosarcoma who received prior treatment. METHODS We enrolled 16 patients with HER2+ endometrial carcinoma/carcinosarcoma after progression on ≤2 lines of therapy on a single-arm phase 2 study of zanidatamab. The primary endpoint was overall response rate (ORR; complete or partial response) by Response Evaluation Criteria in Solid Tumors version 1.1. HER2 immunohistochemistry and fluorescence in situ hybridization (FISH) were performed on pretreatment samples. Intratumor HER2 genetic heterogeneity was assessed. RESULTS This study did not meet its primary efficacy endpoint. Although a clinical benefit rate of 37.5% was observed by 24 weeks, only 1 patient achieved a partial response (ORR, 6.2%). Eight patients had HER2 intratumor heterogeneity or lacked HER2 amplification by FISH. Decreased HER2 expression on repeat pretreatment samples was observed in 3 (75%) of 4 patients evaluated. CONCLUSIONS We observed a low response rate to zanidatamab in recurrent HER2+ endometrial carcinoma/carcinosarcoma, which may be driven by downregulation of HER2 expression. Repeat HER2 testing should be considered prior to second-line HER2-directed therapy. CLINICALTRIALS govidentifier: NCT04513665.
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Affiliation(s)
- Melissa Lumish
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - M Herman Chui
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Qin Zhou
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Alexia Iasonos
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Debra Sarasohn
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Seth Cohen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Claire Friedman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Rachel Grisham
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Jason Konner
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Chrisann Kyi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Maria Rubinstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Tiffany Troso-Sandoval
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Carol Aghajanian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Vicky Makker
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America.
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Sagara Y, Kumamaru H, Niikura N, Miyashita M, Konishi T, Iwamoto T, Sanuki N, Tanakura K, Nagahashi M, Hayashi N, Yoshida M, Kinukawa N, Watanabe C, Toi M, Saji S. 2020 Annual Report of National Clinical Database-Breast Cancer Registry: 10-year mortality of elderly breast cancer patients in Japan. Breast Cancer 2024; 31:179-184. [PMID: 38180641 DOI: 10.1007/s12282-023-01532-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024]
Abstract
The Japanese Breast Cancer Society initiated the breast cancer registry in 1975, which transitioned to the National Clinical Database-Breast Cancer Registry in 2012. This annual report presents data from 2020 and analyzes the ten-year mortality rates for those aged 65 and older. We analyzed data from 93,784 breast cancer (BC) cases registered in 2020 and assessed 10-year mortality rates for 36,279 elderly patients diagnosed between 2008 and 2012. In 2020, 99.4% of BC cases were females with a median age of 61. Most (65%) were diagnosed at early stages (Stage 0 or I). Breast-conserving surgery rates varied with stages: 58.5% at cStage I, 30.8% at cStage II, and 13.1% at cStage III. Sentinel lymph node biopsy was done in 73.6% of cases, followed by radiotherapy in 70% of those post-conserving surgery and chemotherapy in 21.1% post-surgery. Pathology showed that 63.4% had tumors under 2.0 cm, 11.7% had pTis tumors, and 77.3% had no axillary lymph node metastasis. ER positivity was seen in 75.1%, HER2 in 14.3%, and 30% had a Ki67 positivity rate above 30%. Across all stages and subtypes, there was a trend where the 10-year mortality rates increased for individuals older than 65 years. In Stage I, many deaths were not directly linked to BC and, for those with HER2-type and triple-negative BC, breast cancer-related deaths increased with age. Within Stage II, patients older than 70 years with luminal-type BC often experienced deaths not directly linked to BC, whereas patients below 80 years with HER2-type and triple-negative BC, likely had breast cancer-related deaths. In Stage III, breast cancer-related deaths were more common, particularly in HER2 and triple-negative BC. Our prognostic analysis underscores distinct mortality patterns by stage, subtype, and age in elderly BC patients. It highlights the importance of personalized treatment strategies, considering subtype-specific aggressiveness, age-related factors, and comorbidities.
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Affiliation(s)
- Yasuaki Sagara
- Department of Breast and Thyroid Surgical Oncology, Hakuaikai Medical Corporation, Sagara Hospital, 3-28 Matsubara, Kagoshima, 892-0833, Japan.
- Department of Breast Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113‑8655, Japan
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan
| | - Minoru Miyashita
- Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, Seiryo‑Machi, Aoba‑Ku, Sendai, 980‑8574, Japan
| | - Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takayuki Iwamoto
- Breast and Thyroid Surgery, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Naoko Sanuki
- Radiation Therapy Department, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Kenta Tanakura
- Plastic and Reconstructive Surgery, Mitsui Memorial Hospital, 1 Kanda‑Izumicho, Chiyoda‑Ku, Tokyo, 101‑8643, Japan
| | - Masayuki Nagahashi
- Division of Breast and Endocrine Surgery, Department of Surgery, School of Medicine, Hyogo Medical University, 1‑1 Mukogawa, Nishinomiya, Hyogo, Japan
| | - Naoki Hayashi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9‑1 Akashicho, Chuo‑Ku, Tokyo, 104‑8560, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5‑1‑1 Tsukiji, Chuo‑Ku, Tokyo, 104‑0045, Japan
| | - Naoko Kinukawa
- Department of Healthcare Quality Assessment, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113‑8655, Japan
| | - Chie Watanabe
- School of Nursing and Rehabilitation Sciences, Showa University, Tokyo, Japan
| | - Masakazu Toi
- Tokyo Metropolitan Komagome Hospital, 3 Chome-18 Honkomagome, Bunkyo City, Tokyo, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Khan SU, Fatima K, Aisha S, Malik F. Unveiling the mechanisms and challenges of cancer drug resistance. Cell Commun Signal 2024; 22:109. [PMID: 38347575 PMCID: PMC10860306 DOI: 10.1186/s12964-023-01302-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/30/2023] [Indexed: 02/15/2024] Open
Abstract
Cancer treatment faces many hurdles and resistance is one among them. Anti-cancer treatment strategies are evolving due to innate and acquired resistance capacity, governed by genetic, epigenetic, proteomic, metabolic, or microenvironmental cues that ultimately enable selected cancer cells to survive and progress under unfavorable conditions. Although the mechanism of drug resistance is being widely studied to generate new target-based drugs with better potency than existing ones. However, due to the broader flexibility in acquired drug resistance, advanced therapeutic options with better efficacy need to be explored. Combination therapy is an alternative with a better success rate though the risk of amplified side effects is commonplace. Moreover, recent groundbreaking precision immune therapy is one of the ways to overcome drug resistance and has revolutionized anticancer therapy to a greater extent with the only limitation of being individual-specific and needs further attention. This review will focus on the challenges and strategies opted by cancer cells to withstand the current therapies at the molecular level and also highlights the emerging therapeutic options -like immunological, and stem cell-based options that may prove to have better potential to challenge the existing problem of therapy resistance. Video Abstract.
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Affiliation(s)
- Sameer Ullah Khan
- Division of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Holcombe Blvd, Houston, TX, 77030, USA.
- Division of Cancer Pharmacology, CSIR-Indian Institute of Integrative Medicine, Srinagar-190005, Jammu and Kashmir, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India.
| | - Kaneez Fatima
- Division of Cancer Pharmacology, CSIR-Indian Institute of Integrative Medicine, Srinagar-190005, Jammu and Kashmir, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India
| | - Shariqa Aisha
- Division of Cancer Pharmacology, CSIR-Indian Institute of Integrative Medicine, Srinagar-190005, Jammu and Kashmir, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India
| | - Fayaz Malik
- Division of Cancer Pharmacology, CSIR-Indian Institute of Integrative Medicine, Srinagar-190005, Jammu and Kashmir, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India.
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Barzi A, Weipert CM, Espenschied CR, Raymond VM, Wang-Gillam A, Nezami MA, Gordon EJ, Mahadevan D, Mody K. ERBB2 (HER2) amplifications and co-occurring KRAS alterations in the circulating cell-free DNA of pancreatic ductal adenocarcinoma patients and response to HER2 inhibition. Front Oncol 2024; 14:1339302. [PMID: 38406801 PMCID: PMC10885695 DOI: 10.3389/fonc.2024.1339302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose Despite accumulating data regarding the genomic landscape of pancreatic ductal adenocarcinoma (PDAC), olaparib is the only biomarker-driven FDA-approved targeted therapy with a PDAC-specific approval. Treating ERBB2(HER2)-amplified PDAC with anti-HER2 therapy has been reported with mixed results. Most pancreatic adenocarcinomas have KRAS alterations, which have been shown to be a marker of resistance to HER2-targeted therapies in other malignancies, though the impact of these alterations in pancreatic cancer is unknown. We describe two cases of ERBB2-amplified pancreatic cancer patients treated with anti-HER2 therapy and provide data on the frequency of ERBB2 amplifications and KRAS alterations identified by clinical circulating cell-free DNA testing. Methods De-identified molecular test results for all patients with pancreatic cancer who received clinical cell-free circulating DNA analysis (Guardant360) between 06/2014 and 01/2018 were analyzed. Cell-free circulating DNA analysis included next-generation sequencing of up to 73 genes, including select small insertion/deletions, copy number amplifications, and fusions. Results Of 1,791 patients with pancreatic adenocarcinoma, 36 (2.0%) had an ERBB2 amplification, 26 (72.2%) of whom had a KRAS alteration. Treatment data were available for seven patients. Two were treated with anti-HER2 therapy after their cell-free circulating DNA result, with both benefiting from therapy, including one with a durable response to trastuzumab and no KRAS alteration detected until progression. Conclusion Our case series illustrates that certain patients with ERBB2-amplified pancreatic adenocarcinoma may respond to anti-HER2 therapy and gain several months of prolonged survival. Our data suggests KRAS mutations as a possible mechanism of primary and acquired resistance to anti-HER2 therapy in pancreatic cancer. Additional studies are needed to clarify the role of KRAS in resistance to anti-HER2 therapy.
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Affiliation(s)
- Afsaneh Barzi
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, CA, United States
| | | | | | | | - Andrea Wang-Gillam
- Division of Oncology, Siteman Cancer Center, St. Louis, MO, United States
| | | | - Eva J. Gordon
- Private Health Management, Inc., Los Angeles, CA, United States
| | - Daruka Mahadevan
- Division of Hematology and Oncology, Department of Medicine, University of Texas Health, San Antonio, San Antonio, TX, United States
| | - Kabir Mody
- Division of Hematology-Oncology, Department of Medicine, Mayo Clinic, Jacksonville, FL, United States
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Pfob A, Cai L, Schneeweiss A, Rauch G, Thomas B, Schaefgen B, Kuemmel S, Reimer T, Hahn M, Thill M, Blohmer JU, Hackmann J, Malter W, Bekes I, Friedrichs K, Wojcinski S, Joos S, Paepke S, Degenhardt T, Rom J, Rody A, van Mackelenbergh M, Banys-Paluchowski M, Große R, Reinisch M, Karsten MM, Sidey-Gibbons C, Wallwiener M, Golatta M, Heil J. Minimally Invasive Breast Biopsy After Neoadjuvant Systemic Treatment to Identify Breast Cancer Patients with Residual Disease for Extended Neoadjuvant Treatment: A New Concept. Ann Surg Oncol 2024; 31:957-965. [PMID: 37947974 PMCID: PMC10761434 DOI: 10.1245/s10434-023-14551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Breast cancer patients with residual disease after neoadjuvant systemic treatment (NAST) have a worse prognosis compared with those achieving a pathologic complete response (pCR). Earlier identification of these patients might allow timely, extended neoadjuvant treatment strategies. We explored the feasibility of a vacuum-assisted biopsy (VAB) after NAST to identify patients with residual disease (ypT+ or ypN+) prior to surgery. METHODS We used data from a multicenter trial, collected at 21 study sites (NCT02948764). The trial included women with cT1-3, cN0/+ breast cancer undergoing routine post-neoadjuvant imaging (ultrasound, MRI, mammography) and VAB prior to surgery. We compared the findings of VAB and routine imaging with the histopathologic evaluation of the surgical specimen. RESULTS Of 398 patients, 34 patients with missing ypN status and 127 patients with luminal tumors were excluded. Among the remaining 237 patients, tumor cells in the VAB indicated a surgical non-pCR in all patients (73/73, positive predictive value [PPV] 100%), whereas PPV of routine imaging after NAST was 56.0% (75/134). Sensitivity of the VAB was 72.3% (73/101), and 74.3% for sensitivity of imaging (75/101). CONCLUSION Residual cancer found in a VAB specimen after NAST always corresponds to non-pCR. Residual cancer assumed on routine imaging after NAST corresponds to actual residual cancer in about half of patients. Response assessment by VAB is not safe for the exclusion of residual cancer. Response assessment by biopsies after NAST may allow studying the new concept of extended neoadjuvant treatment for patients with residual disease in future trials.
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Affiliation(s)
- André Pfob
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany.
| | - Lie Cai
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bettina Thomas
- Coordination Centre for Clinical Trials (KKS), University Heidelberg, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Toralf Reimer
- Department of Gynecology/Breast Unit, University Hospital Rostock, Rostock, Germany
| | - Markus Hahn
- Department of Gynecology/Breast Unit, University Hospital Tuebingen, Tübingen, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology/Breast Unit, Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - John Hackmann
- Department of Gynecology/Breast Unit, Marienhospital, Witten, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Medical Faculty, Breast Cancer Center, University of Cologne, Cologne, Germany
| | - Inga Bekes
- Department of Gynecology/Breast Unit, University Hospital Ulm, Ulm, Germany
| | - Kay Friedrichs
- Department of Gynecology/Breast Unit, Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Sebastian Wojcinski
- Department of Gynecology and Obstetrics, Breast Cancer Center, Klinikum Bielefeld Mitte GmbH, Bielefeld, Germany
| | - Sylvie Joos
- Radiologische Allianz Hamburg, Hamburg, Germany
| | - Stefan Paepke
- Frauenklinik, Interdisziplinäres Brustzentrum des Klinikums rechts der Isar der Technischen Universität München, Munich, Germany
| | - Tom Degenhardt
- Department of Gynecology/Breast Unit, University Hospital Munich, Munich, Germany
| | - Joachim Rom
- Department of Gynecology/Breast Unit, Klinikum Frankfurt-Höchst, Frankfurt, Germany
| | - Achim Rody
- Department of Gynecology/Breast Unit, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | | | - Regina Große
- Department of Gynecology/Breast Unit, University Hospital Halle, Halle, Germany
| | | | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Chris Sidey-Gibbons
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Michael Golatta
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Breast Unit, Klinikum Sankt Elisabeth, Heidelberg, Germany
| | - Joerg Heil
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Breast Unit, Klinikum Sankt Elisabeth, Heidelberg, Germany
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Yan M, Yao J, Zhang X, Xu D, Yang C. Machine learning-based model constructed from ultrasound radiomics and clinical features for predicting HER2 status in breast cancer patients with indeterminate (2+) immunohistochemical results. Cancer Med 2024; 13:e6946. [PMID: 38234171 PMCID: PMC10905683 DOI: 10.1002/cam4.6946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/25/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND We aimed to predict human epidermal growth factor receptor 2 (HER2) 2+ status in patients with breast cancer by constructing and validating machine learning models utilizing ultrasound (US) radiomics and clinical features. METHODS We analyzed 203 breast cancer cases immunohistochemically determined as HER2 2+ and used fluorescence in situ hybridization (FISH) as the confirmation method. From each case, the study analyzed 840 extracted radiomics features and 11 clinicopathologic features. Cases were randomly split into training (n = 141) and validation sets (n = 62) at a 7:3 ratio. Univariate logistic regression analysis was first performed on the 11 clinicopathologic characteristics. The least absolute shrinkage and selection operator (LASSO) and decision tree (DT) techniques were employed for post-feature selection. Finally, 19 radiomics features were utilized in logistic regression (LR) and Naive Bayesian (NB) classifiers. Model performance was gauged using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. RESULTS Our models exhibited notable diagnostic efficacy in differentiating HER2-positive from negative breast cancer cases. In the validation sets, the LR model outperformed the NB model with an AUC of 0.860 and accuracy of 83.8% compared to NB's AUC of 0.684 and accuracy of 79.0%. The LR model demonstrated higher sensitivity (92.3% vs. 46.2%) while the NB model had a better specificity (91.8% vs. 63.3%) in the validation set. CONCLUSIONS Machine learning models grounded on radiomics efficiently predicted IHC HER2 2+ status in breast cancer patients, suggesting potential enhancements in clinical decision-making for treatment and management.
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Affiliation(s)
- Meiying Yan
- Department of ultrasound, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Jincao Yao
- Department of ultrasound, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Xiao Zhang
- Zhejiang Chinese Medical University, Hangzhou, China
- Department of ultrasound, the First People's Hospital of Hangzhou Lin'an District, Hangzhou, China
| | - Dong Xu
- Department of ultrasound, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Chen Yang
- Department of ultrasound, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
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Jaime dos Santos B, Balabram D, Mara Reis Gomes V, Costa Café de Castro C, Henrique Costa Diniz P, Araújo Buzelin M, Buzelin Nunes C. Changes in Invasive Breast Carcinomas after Neoadjuvant Chemotherapy Can Influence Adjuvant Therapeutic Decisions. Cancer Res Treat 2024; 56:178-190. [PMID: 37536712 PMCID: PMC10789950 DOI: 10.4143/crt.2023.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/30/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE Neoadjuvant chemotherapy (NACT) can change invasive breast carcinomas (IBC) and influence the patients' overall survival time (OS). We aimed to identify IBC changes after NACT and their association with OS. MATERIALS AND METHODS IBC data in pre- and post-NACT samples of 86 patients were evaluated and associated with OS. RESULTS Post-NACT tumors changed nuclear pleomorphism score (p=0.025); mitotic count (p=0.002); % of tumor-infiltrating inflammatory cells (p=0.016); presence of in situ carcinoma (p=0.001) and lymphovascular invasion (LVI; p=0.002); expression of estrogen (p=0.003), progesterone receptors (PR; p=0.019), and Ki67 (p=0.003). Immunohistochemical (IHC) profile changed in 26 tumors (30.2%, p=0.050). Higher risk of death was significatively associated with initial tumor histological grade III (hazard ratio [HR], 2.94), high nuclear pleomorphism (HR, 2.53), high Ki67 index (HR, 2.47), post-NACT presence of LVI (HR, 1.90), luminal B-like profile (HR, 2.58), pre- (HR, 2.26) and post-NACT intermediate mitotic count (HR, 2.12), pre- (HR, 4.45) and post-NACT triple-negative IHC profile (HR, 4.52). On the other hand, lower risk of death was significative associated with pre- (HR, 0.35) and post-NACT (HR, 0.39) estrogen receptor-positive, and pre- (HR, 0.37) and post-NACT (HR, 0.57) PR-positive. Changes in IHC profile were associated with longer OS (p=0.050). In multivariate analysis, pre-NACT grade III tumors and pre-NACT and post-NACT triple negative IHC profile proved to be independent factors for shorter OS. CONCLUSION NACT can change tumor characteristics and biomarkers and impact on OS; therefore, they should be reassessed on residual samples to improve therapeutic decisions.
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Affiliation(s)
- Bárbara Jaime dos Santos
- Laboratory of Mammary Pathology, Department of Anatomical Pathology and Forensic Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Débora Balabram
- Department of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Virginia Mara Reis Gomes
- Laboratory of Mammary Pathology, Department of Anatomical Pathology and Forensic Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carolina Costa Café de Castro
- Laboratory of Mammary Pathology, Department of Anatomical Pathology and Forensic Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Henrique Costa Diniz
- Department of Medical Clinic, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marcelo Araújo Buzelin
- Institute of Teaching and Research of Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | - Cristiana Buzelin Nunes
- Laboratory of Mammary Pathology, Department of Anatomical Pathology and Forensic Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Miyashita M, Kumamaru H, Niikura N, Sagara Y, Konishi T, Iwamoto T, Sanuki N, Tanakura K, Nagahashi M, Hayashi N, Yoshida M, Watanabe C, Kinukawa N, Toi M, Saji S. Annual report of the Japanese Breast Cancer Registry for 2019. Breast Cancer 2024; 31:16-23. [PMID: 38044372 DOI: 10.1007/s12282-023-01526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023]
Abstract
This is an annual report by the Japanese Breast Cancer Society regarding the clinical data on breast cancer extracted from the National Clinical Database-Breast Cancer Registry (NCD-BCR) of Japan. Here, we present an updated summary of 98,300 breast cancer cases registered in 2019. The median age at cancer diagnosis was 61 years (interquartile range 49-72 years), and 30.6% of the breast cancer patients were premenopausal. Of the 93,840 patients without distant metastases, 14,118 (15.0%) and 42,047 (44.8%) were diagnosed with stage 0 and I disease, respectively. Breast-conserving surgery was performed in 42,080 (44.8%) patients. Regarding axillary procedures, 62,677 (66.8%) and 7371 (7.9%) patients underwent sentinel node biopsy and axillary node dissection after biopsy, respectively. Whole breast irradiation was administered to 29,795 (70.8%) of the 42,080 patients undergoing breast-conserving surgery. Chest wall irradiation was administered to 5524 (11.1%) of the 49,637 patients who underwent mastectomy. Of the 6912 clinically lymph node-negative patients who received preoperative therapy, 5250 (76.0%) and 427 (6.2%) underwent sentinel node biopsy and axillary node dissection after biopsy, respectively; however, 602 (8.7%) patients initially underwent axillary node dissection without biopsy.
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Affiliation(s)
- Minoru Miyashita
- Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113‑8655, Japan
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259‑1193, Japan
| | - Yasuaki Sagara
- Department of Breast Surgical Oncology, Social Medical Corporation Hakuaikai, Sagara Hospital, 3-28 Matsubara, Kagoshima, 892-833, Japan
| | - Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113-8655, Japan
| | - Takayuki Iwamoto
- Breast and Thyroid Surgery, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan
| | - Naoko Sanuki
- Radiation Therapy Department, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Kenta Tanakura
- Plastic and Reconstructive Surgery, Mitsui Memorial Hospital, 1 Kanda‑Izumicho, Chiyoda‑Ku, Tokyo, 101‑8643, Japan
| | - Masayuki Nagahashi
- Department of Surgery, Division of Breast and Endocrine Surgery, School of Medicine, Hyogo Medical University, 1‑1 Mukogawa, Nishinomiya, Hyogo, 663‑8501, Japan
| | - Naoki Hayashi
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5‑1‑1 Tsukiji, Chuo‑Ku, Tokyo, 104‑0045, Japan
| | - Chie Watanabe
- School of Nursing and Rehabilitation Sciences, Showa University, 1865 Tokaichibacho, Midori-Ku, Yokohama-Shi, Kanagawa, 226-8555, Japan
| | - Naoko Kinukawa
- Department of Healthcare Quality Assessment, University of Tokyo, 7‑3‑1 Hongo, Bunkyo‑Ku, Tokyo, 113‑8655, Japan
| | - Masakazu Toi
- Tokyo Metropolitan Komagome Hospital, 3 Chome-18 Honkomagome, Bunkyo City, Tokyo, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
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Mogica JP, Tang H, Liang Y, Zhong M, Hui P, Harigopal M, Krishnamurti U, Fischbach NA, Zhan H. Prognostic impact of reduced HER2 protein expression in post-neoadjuvant therapy resection specimens: A single institution experience and review of the literature. Breast 2023; 72:103586. [PMID: 37812963 PMCID: PMC10568274 DOI: 10.1016/j.breast.2023.103586] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/17/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
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.
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Affiliation(s)
- Jan Paredes Mogica
- Department of Oncology, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Haiming Tang
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Yuanxin Liang
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Minghao Zhong
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Malini Harigopal
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Uma Krishnamurti
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Neal A Fischbach
- Department of Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Haiying Zhan
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
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Antolín Novoa S, Escrivá-de-Romaní S, Tolosa Ortega P, Oliva Fernández L, López López R, López González A, de la Morena Barrio P, Echavarria Díaz-Guardamino I, Alés Martinez JE, Garate Z, González-Cortijo L. Real world data on the demographic and clinicopathological profile and management of patients with early-stage HER2-positive breast cancer and residual disease treated with adjuvant trastuzumab emtansine (KARMA study). Cancer Treat Res Commun 2023; 37:100772. [PMID: 37995519 DOI: 10.1016/j.ctarc.2023.100772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/17/2023] [Accepted: 10/29/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Trastuzumab emtansine (T-DM1) significantly improves invasive disease-free survival and reduces the risk of recurrence in patients with HER2-positive early breast cancer (EBC) with residual disease (RD). The KARMA study aimed to describe the characteristics and management of these patients in clinical practice in Spain. MATERIAL AND METHODS We conducted a multicentre retrospective study in patients with HER2-positive EBC with RD following neoadjuvant treatment (NeoT) and who had received ≥1 dose of T-DM1 as adjuvant treatment. The primary endpoint was the evaluation of sociodemographic and clinicopathological characteristics of these patients. RESULTS A total of 114 patients were included (March-July 2020). At diagnosis, most tumours were infiltrating ductal carcinoma (IDC) (93.9 %), grade 2 (56.1 %), and hormone receptor (HR)-positive (79.8 %). Over 75 % of patients had disease in operable clinical stages (T1-3 N0-1). In the neoadjuvant setting, 86.8 % of patients received trastuzumab plus pertuzumab, and 23.6 % achieved radiological complete response. Breast-conserving surgery was performed in 55.8 % of patients. Surgical specimens showed that 89.5 % of patients had IDC, 49.1 % grade 2, 84.1 % HR-positive, and 8.3 % HER2-negative disease. Most patients had RD classified as RCB-II and Miller/Payne grade 3/4. Grade 3 treatment-related adverse events (trAEs) occurred in 5.3 % of patients. No grade 4/5 AEs occurred. Over 95 % of patients were free of invasive-disease during T-DM1 adjuvant treatment. CONCLUSION The KARMA study describes the characteristics of patients with HER2-positive EBC with RD after NeoT and the real-life management of a T-DM1 adjuvant regimen, which showed a manageable safety profile in line with the KATHERINE trial data.
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Affiliation(s)
- Silvia Antolín Novoa
- Breast Cancer Department, Hospital Universitario de A Coruña, As Xubias, 84, 15006 La Coruña, Spain.
| | - Santiago Escrivá-de-Romaní
- Vall d'Hebrón Institute of Oncology (VHIO), Hospital Universitario Vall d'Hebron, Calle de Natzaret, 115-117, 08035 Barcelona, Spain
| | - Pablo Tolosa Ortega
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain
| | - Lucía Oliva Fernández
- Intercentre Clinical Management Unit of Integral Oncology of Málaga, Hospital Regional Universitario de Málaga, Avenida de Carlos Haya, 84, 29010 Málaga, Spain; Biomedical Research Institute of Malaga (IBIMA), Hospital Universitario Virgen de la Victoria, Campus de Teatinos, s/n, 29010 Málaga, Spain
| | - Rafael López López
- Medical Oncology Dept. University Clinical Hospital and Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana, s/n, 15706 Santiago de Compostela, Spain; Centre for Biomedical Research in Networks on Cancer (CIBERONC), Avenida Monforte de Lemos, 3-5, Pabellón 11. Planta 0, 28029 Madrid, Spain
| | - Ana López González
- Department of Medical Oncology, Complejo asistencial Universitario de León. Calle Altos de Nava, s/n, 24071 León, Spain
| | - Pilar de la Morena Barrio
- Department of Hematology and Medical Oncology, Hospital General Universitario Morales Meseguer, Avenida Marqués de Los Vélez, s/n, 30008 Murcia, Spain
| | - Isabel Echavarria Díaz-Guardamino
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CIBERONC, Calle del Doctor Esquerdo, 46, 28007 Madrid, Spain
| | | | - Zita Garate
- Roche Pharma Spain, Calle de la Ribera del Loira, 50, 28042 Madrid, Spain
| | - Lucia González-Cortijo
- Department of Medical Oncology, Hospital Universitario Quirónsalud Madrid, Calle Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid, Spain
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Ma Y, Zhu M, Zhang J, Lv M, Chen X, Liu Z. Prognostic Value of the Evolution of HER2-Low Expression after Neoadjuvant Chemotherapy. Cancer Res Treat 2023; 55:1210-1221. [PMID: 37024094 PMCID: PMC10582545 DOI: 10.4143/crt.2022.1633] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/02/2023] [Indexed: 04/08/2023] Open
Abstract
PURPOSE Patients with human epidermal growth factor receptor 2 (HER2)-low advanced breast cancer can benefit from trastuzumab deruxtecan. Given the unclear prognostic characteristics of HER2-low breast cancer, we investigated the prognostic characteristics of HER2-low expression from primary tumor to residual disease after neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS The data of HER2-negative patients receiving NACT at our center were collected. Pathological complete response (pCR) rate were compared between HER2-0 and HER2-low patients. The evolution of HER2 expression from primary tumor to residual disease and its impact on disease-free survival (DFS) were examined. RESULTS Of the 690 patients, 494 patients had HER2-low status, of which 72.3% were hormone receptor (HR)-positive (p < 0.001). The pCR rates of HER2-low and HER2-0 patients (14.2% vs. 23.0%) showed no difference in multivariate analysis regardless of HR status. No association was observed between DFS and HER2 status. Of the 564 non-pCR patients, 57 (10.1%) changed to HER2-positive, and 64 of the 150 patients (42.7%) with HER2-0 tumors changed to HER2-low. HER2-low (p=0.004) and HR-positive (p=0.010) tumors before NACT were prone to HER2 gain. HER2 gain patients had a better DFS compared with HER2-negative maintained patients (87.9% vs. 79.5%, p=0.048), and the DFS of targeted therapy group was better than that of no targeted therapy group (92.4% vs. 66.7%, p=0.016). CONCLUSION Although HER2-low did not affect the pCR rate and DFS, significant evolution of HER2-low expression after NACT creates opportunities for targeted therapy including trastuzumab.
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Affiliation(s)
- Youzhao Ma
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Mingda Zhu
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jingyang Zhang
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Minhao Lv
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Xiuchun Chen
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Zhenzhen Liu
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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Zhu S, Lu Y, Fei X, Shen K, Chen X. Pathological complete response, category change, and prognostic significance of HER2-low breast cancer receiving neoadjuvant treatment: a multicenter analysis of 2489 cases. Br J Cancer 2023; 129:1274-1283. [PMID: 37604930 PMCID: PMC10575949 DOI: 10.1038/s41416-023-02403-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND HER2-low breast cancers (BC) show a good response to novel anti-HER2 antibody-drug conjugates (ADCs) in advanced setting. Nevertheless, little is known about the response, category change, and prognosis of HER2-low BC receiving neoadjuvant treatment (NAT). METHODS Consecutive invasive BC patients who underwent ≥ 4 cycles of NAT and surgery from January 2009 to December 2020 were retrospectively reviewed. HER2-low was defined as IHC 1+ or 2+ and FISH negative. Concordance rates of HER2 and other biomarkers were analyzed by Kappa test. Kaplan-Meier analysis and Cox regression were used to assess the recurrence-free interval (RFI) and overall survival (OS). RESULTS A total of 2489 patients were included, of whom 1023 (41.1%) had HER2-low tumors. HER2-low patients had a higher ER positivity rate than HER2-0 patients (78.5% vs. 63.6%, P < 0.001), and a similar breast pathological complete response (pCR) rate (20.6% vs. 21.8%, P = 0.617). Among non-pCR cases, 39.5% of HER2-0 tumors changed to HER2-low, and 14.3% of HER2-low tumors changed to HER2-0 after NAT. Low concordance rates of HER2-low status were found in both ER-positive (Kappa = 0.368) and ER-negative (Kappa = 0.444) patients. Primary HER2-low patients had a significantly better RFI than HER2-0 patients (P = 0.014), especially among ER-positive subset (P = 0.016). Moreover, HER2-low category change was associated with RFI in ER-positive subset (adjusted P = 0.043). CONCLUSIONS Compared with HER2-0 patients, HER2-low patients had a high proportion of ER-positive tumor and a similar pCR rate, which were related with better prognosis, especially in residual cases after NAT. A remarkable instability of HER2-low status was found between the primary and residual tumor, indicating re-testing HER2 status after NAT in the new era of anti-HER2 ADCs therapy.
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Affiliation(s)
- Siji Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yujie Lu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Garutti M, Cucciniello L, Arpino G, Fabi A, Livi L, Munzone E, Staropoli N, Zamagni C, Zambelli A, Puglisi F. Risk-Based Therapeutic Strategies for HER2-Positive Early Breast Cancer: A Consensus Paper. Clin Breast Cancer 2023; 23:e458-e469. [PMID: 37543499 DOI: 10.1016/j.clbc.2023.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023]
Abstract
Breast cancer represents the most commonly diagnosed neoplasm worldwide and the HER2-positive subtype accounts for nearly 1 in 5 breast cancers. The majority of patients with breast cancer present with an early-stage disease upon diagnosis, which is thus susceptible to virtually curative treatment strategies. For a stage, I T1a/b N0 HER2-positive disease, upfront surgery followed by adjuvant therapy is the preferred approach. However, there is some uncertainty regarding the appropriate management of stage cT1c cN0, as both the neoadjuvant approach and upfront surgery have been proven to be feasible therapeutic options. The aim of this Delphi consensus was to define the best strategies for the treatment of early HER2-positive breast cancer. This work may help clinicians in the management of early HER2-positive breast cancer.
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Affiliation(s)
- Mattia Garutti
- CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy.
| | - Linda Cucciniello
- CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alessandra Fabi
- Precision Medicine in Breast Cancer Unit, Department of Woman and Child Health and Public Health, IRCCS, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicoletta Staropoli
- Medical Oncology and Translational Medical Oncology Units, Department of Experimental and Clinical Medicine, Magna Graecia University, AOU Materdomini Catanzaro, Campus Salvatore Venuta, Catanzaro, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Zambelli
- Department of Biomedical Sciences Humanitas University and IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Fabio Puglisi
- CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
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Rodríguez M, González DM, El-Sharkawy F, Castaño M, Madrid J. Complete pathological response in patients with HER2 positive breast cancer treated with neoadjuvant therapy in Colombia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:396-405. [PMID: 37871573 PMCID: PMC10637353 DOI: 10.7705/biomedica.6665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/16/2023] [Indexed: 10/25/2023]
Abstract
Introduction Breast cancer is the most common type of cancer and the leading cause of death by cancer in women in Colombia. Approximately 15 to 20% of breast cancers overexpress HER2. Objective To analyze the relationship between multiple clinical and histological variables and pathological complete response in patients with HER2-positive breast cancer undergoing neoadjuvant therapy in a specialized cancer center in Colombia. Materials and methods We performed a retrospective analysis of non-metastatic HER2-positive breast cancer patients who received neoadjuvant therapy between 2007 and 2020 at the Instituto de Cancerología Las Americas Auna (Medellín, Colombia). Assessed parameters were tumor grade, proliferation index, estrogen receptor, progesterone receptor, HER2 status, type of neoadjuvant therapy, pathologic complete response rates, and overall survival. Results Variables associated with low pathologic complete response rates were tumor grades 1-2 (OR = 0.55; 95% CI = 0.37-0.81; p = 0.03), estrogen receptor positivity (OR =0.65; 95%; CI = 0.43-0.97; p=0.04), and progesterone receptor positivity (OR = 0.44; 95% CI = 0.29-0.65; p = 0.0001). HER2 strong positivity (score 3+) was associated with high pathological complete response rates (OR = 3.3; 95% CI = 1.3-8.35; p=0.013). Five-year overall survival was 91.5% (95% CI = 82.6-95.9) in patients with pathological complete response and 73.6% (95% CI = 66.4-79.6) in patients who did not achieve pathological complete response (p = 0.001). Additionally, the pathological complete response rate was three times higher in patients receiving combined neoadjuvant chemotherapy with anti-HER2 therapy than in those with chemotherapy alone (48% versus 16%). Conclusions In patients with HER2-positive breast cancer, tumor grade 3, estrogen receptor negativity, progesterone receptor negativity, strong HER2 positivity (score 3+), and the use of the neoadjuvant trastuzumab are associated with higher pathological complete response rates.
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Affiliation(s)
- Mauricio Rodríguez
- Departamento de Cirugía Oncológica, Universidad de Antioquia, Medellín, Colombia.
| | - Diego M González
- Departamento de Cirugía Oncológica, Universidad de Antioquia, Medellín, Colombia; Instituto de Cancerología Las Américas Auna, Medellín, Colombia.
| | - Farah El-Sharkawy
- Department of Pathology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America.
| | - Mileny Castaño
- Instituto de Cancerología Las Américas Auna, Medellín, Colombia.
| | - Jorge Madrid
- Departamento de Cirugía Oncológica, Universidad de Antioquia, Medellín, Colombia.
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Ren X, Zhang X, Ma X, Yang C, Li J, Liu B, Shi C, Liu Y. Changes in HER2 status and survival outcomes in patients with non-pathological complete response after neoadjuvant targeted treatment. Medicine (Baltimore) 2023; 102:e34903. [PMID: 37773875 PMCID: PMC10545330 DOI: 10.1097/md.0000000000034903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/03/2023] [Indexed: 10/01/2023] Open
Abstract
To study the changes in human epidermal growth factor receptor 2 (HER2) expression in patients with HER2-positive breast cancer before and after neoadjuvant treatment. The clinicopathologic data of 499 patients with HER2-positive breast cancer who completed neoadjuvant treatment and surgery at the Fourth Hospital of Hebei Medical University from 2018 to 2021 were retrospectively analyzed. According to the new adjuvant regimen, 298 patients were divided into the trastuzumab + pertuzumab combined chemotherapy group (dual target group), and 201 patients were divided into the trastuzumab combined chemotherapy group (single target group).The effect of different neoadjuvant regimens on HER2 status was analyzed by comparing HER2 expression before and after treatment. A total of 255 of 499 neoadjuvant patients with HER2-positive breast cancer achieved a pathological complete response (pCR). pCR was achieved in 60.07% (179/298) of the dual target group and 37.81% (76/201) of the single target group, and the difference was statistically significant (χ² = 23.795, P < .001). Among 244 cases of HER2-positive breast cancer that did not reach pCR (non-pCR), there was a certain negative conversion rate of HER2 expression after neoadjuvant treatment, and the overall negative conversion rate was 13.11% (32/244). The negative conversion rates of the dual target group was 17.65% (21/119) and single target group was 8.80% (11/125), (χ² = 4.188, P = .041). The DFS of 499 patients in the pCR group was 98.43% (251/255), which was significantly higher than that in the non-pCR group 92.21% (225/244), (χ² = 8.536, P = .003). Only 2 (0.20%) of 32 patients with negative HER2 had recurrence and metastasis. Neoadjuvant treatment had an effect on the expression status of HER2, especially in the dual target group. For patients with negative HER2, the optimal treatment strategy remains to be explored, but continued anti-HER2 treatment is still recommended.
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Affiliation(s)
- Xiaofei Ren
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang City, Hebei, China
- Department of Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang City, Hebei, China
| | - Xiangmei Zhang
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang City, Hebei, China
- Department of Hematology, Fourth Hospital of Hebei Medical University, Shijiazhuang City, Hebei, China
| | - Xiangmin Ma
- Research Center, Fourth Hospital of Hebei Medical University, Shijiazhuang City, Hebei, China
| | - Chao Yang
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang City, Hebei, China
- Department of Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang City, Hebei, China
| | - Jingping Li
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang City, Hebei, China
- Department of Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang City, Hebei, China
| | - Beichen Liu
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang City, Hebei, China
- Department of Breast Surgery, Handan Central Hospital, Handan City, Hebei, China
| | - Chao Shi
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang City, Hebei, China
- Department of Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang City, Hebei, China
| | - Yunjiang Liu
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang City, Hebei, China
- Department of Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang City, Hebei, China
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Pei H, Han Z, Du D, Fan Y, Si H, Chang W, Wang Y, Li L, Tang B. Combined Molecular and Morphological Imaging of CTCs for HER2-Targeted Chemotherapy Guidance. Anal Chem 2023; 95:13235-13241. [PMID: 37606014 DOI: 10.1021/acs.analchem.3c02333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Since biomolecules change dynamically with tumor evolution and drug treatment, it is necessary to confirm target molecule expression in real time for effective guidance of subsequent chemotherapy treatment. However, current methods to confirm target proteins require complex processing steps and invasive tissue biopsies, limiting their clinical utility for targeted treatment monitoring. Here, CTCs, as a promising liquid biopsy source, were used to molecularly characterize the target protein HER2. To accurately identify CTCs, we specifically proposed a combined molecular and morphological imaging method, rather than using specific biomarker alone or morphology analysis, we identified CTCs as CK19+/CD45-/HE+. On the basis of the accurate identification of CTCs, we further analyzed the target protein HER2 in clinical patients at the single-CTC level. Comparative analysis of the clinical results of patient pathological tissue and paired blood samples showed that CTCs had a heterogeneous HER2 expression at the single-cell level and showed results inconsistent with the immunohistochemistry results in some cases. CTC-based analysis could help clinicians have a more comprehensive understanding of patient target protein expression. We believe that CTC-based target protein studies are of great significance for the precise management of targeted therapy.
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Affiliation(s)
- Haimeng Pei
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, People's Republic of China
| | - Zhaojun Han
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, People's Republic of China
| | - Dexin Du
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, People's Republic of China
| | - Yuanyuan Fan
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, People's Republic of China
| | - Haibin Si
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, People's Republic of China
| | - Wendi Chang
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, People's Republic of China
| | - Yiguo Wang
- Department of Gastroenterology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong 250012, People's Republic of China
| | - Lu Li
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, People's Republic of China
| | - Bo Tang
- College of Chemistry, Chemical Engineering and Materials Science, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Institute of Molecular and Nano Science, Shandong Normal University, Jinan 250014, People's Republic of China
- Laoshan Laboratory,168 Wenhai Middle Road, Aoshanwei Jimo, Qingdao 266237, People's Republic of China
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Santos MMD, Frasson AL, Silva VDD, Maciel ADCA, Watte G, Werutsky G, Reinert T, Fay AP. Core Needle Biopsy Accuracy for Androgen Receptor Expression in Invasive Breast Cancer. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e535-e541. [PMID: 37846186 PMCID: PMC10579921 DOI: 10.1055/s-0043-1772486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/04/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE Breast cancer (BC) biomarkers, such as hormone receptors expression, are crucial to guide therapy in BC patients. Antiandrogens have been studied in BC; however, limited data are available on androgen receptor (AR) expression test methodology. We aim to report the core needle biopsy (CNB) accuracy for AR expression in BC. METHODS Patients diagnosed with stage I-III invasive BC from a single institution were included. Androgen receptor expression was evaluated by immunohistochemistry (IHC) using 1 and 10% cutoff and the AR expression in surgical specimens (SS) was the gold standard. Kappa coefficients were used to evaluate the intraprocedural agreement. RESULTS A total of 72 patients were included, with a mean age of 61 years old and 84% were Luminal A or B tumors. The prevalence of AR expression in all BC samples was 87.5% using a cutoff ≥ 10% in SS. With a cutoff value ≥ 1%, CNB had an accuracy of 95.8% (Kappa value = 0.645; 95% confidence interval [CI]: 0.272-1.000; p < 0.001) and 86.1% (Kappa value = 0.365; 95% CI: 0.052-0.679; p < 0.001) when ≥ 10% cutoff was used for AR positivity. Androgen receptor expression in CNB (cutoff ≥ 1%) had a sensitivity of 98.5%, specificity of 60%, positive predictive value of 97.0%, and a negative predictive value of 76.9% in the detection of AR expression in SS. CONCLUSION Core needle biopsy has good accuracy in evaluating AR expression in BC. The accuracy of CNB decreases with higher cutoff values for AR positivity.
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Affiliation(s)
- Marcelle Morais dos Santos
- Department of Breast Surgery, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Antonio Luiz Frasson
- Department of Breast Surgery, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - Guilherme Watte
- Department of Medical Oncology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gustavo Werutsky
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Tomás Reinert
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Oncoclínicas, Porto Alegre, RS, Brazil
| | - André Poisl Fay
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Oncoclínicas, Porto Alegre, RS, Brazil
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Hu Y, Mao L, Wang M, Li Z, Li M, Wang C, Ji L, Zeng H, Zhang X. New insights into breast microcalcification for poor prognosis: NACT cohort and bone metastasis evaluation cohort. J Cancer Res Clin Oncol 2023; 149:7285-7297. [PMID: 36917189 DOI: 10.1007/s00432-023-04668-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/23/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVES The study aimed to analyze the poor prognosis of microcalcification in breast cancer (BC), including the pathological complete response (pCR) to neoadjuvant chemotherapy (NACT) and the risk of bone metastases. MATERIALS AND METHODS 313 breast cancer patients received NACT to evaluate pCR and 1182 patients from a multicenter database to assess bone metastases were retrospectively included. Two groups were divided according to the presence or absence of mammography microcalcification. Clinical data, image characteristics, neoadjuvant treatment response, bone involvement, and follow-up information were recorded. The pCR and bone metastases were compared between subgroups using the Mann-Whitney and χ2 tests and logistic regression, respectively. RESULTS Mammographic microcalcification was associated with a lower pCR than uncalcified BC in the NACT cohort (20.6% vs 31.6%, P = 0.029). Univariate and multivariate analysis suggested that calcification was a risk factor for poor NACT response [OR = 1.780, 95%CI (1.065-2.974), P = 0.028], [OR = 2.352, 95%CI (1.186-4.667), P = 0.014]. Microcalcification was more likely to be necrosis on MRI than those without microcalcification (53.0% vs 31.7%, P < 0.001), multivariate analysis indicated that tumor necrosis was also a risk factor for poor NACT response [OR = 2.325, 95%CI (1.100-4.911), P = 0.027]. Age, menopausal status, breast density, mass, molecular, and pathology type were not significantly associated with non-pCR risk assessment. In a multicenter cohort of 1182 patients with pathologically confirmed BC, those with microcalcifications had a higher proportion of bone metastases compared to non-calcified BC (11.6% vs 4.9%, P < 0.001). Univariate and multivariate analysis showed that microcalcification was an independent risk factor for bone metastasis [OR = 2.550, 95%CI (1.620-4.012), P < 0.001], [OR = 2.268(1.263-4.071), P = 0.006)]. Osteolytic bone metastases predominated but there was no statistical difference between the two groups (78.9% vs 60.7%, P = 0.099). Calcified BC was mainly involved in axial bone, but was more likely to involve the whole-body bone than non-calcified BC (33.8% vs 10.7%, P = 0.021). CONCLUSION This study provides important insights into the poor prognosis of microcalcification, not only in terms of poor response to NACT but also the risk factor of bone metastases.
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Affiliation(s)
- Yangling Hu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lijuan Mao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mengyi Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhenqiu Li
- Department of Radiology, The Panyu Fifth Hospital, Guangzhou, China
| | - Meizhi Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chaoyang Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lin Ji
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hui Zeng
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Xiaoling Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Fan S, He L, Sang D. Combination therapy with antibody‑drug conjugate RC48 (disitamab vedotin) and zimberelimab (PD‑1 inhibitor) successfully controlled recurrent HER2‑positive breast cancer resistant to trastuzumab emtansine: A case report. Oncol Lett 2023; 26:359. [PMID: 37545624 PMCID: PMC10398622 DOI: 10.3892/ol.2023.13945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/16/2023] [Indexed: 08/08/2023] Open
Abstract
Options for later-line therapy are limited for patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer who have exhibited resistance to several systemic treatments. Antibody drug conjugates (ADCs) and immune checkpoint inhibitors are novel approaches for HER2-positive breast cancer, but few reports have been published regarding the efficacy of their combinations, particularly in patients with prior ADC failure. The present report describes a case of recurrent metastatic HER2-positive breast cancer, which responded poorly to several perioperative systemic therapies, including chemotherapies, HER2-targeted antibodies, small molecule inhibitors and trastuzumab emtansine (an ADC), along with post-surgical radiotherapy. Following failure of front-line therapies for recurrent cancer located in the chest wall, combination treatment with another HER2-targeted ADC, disitamab vedotin (120 mg), and zimberelimab (240 mg), a fully humanized anti-programmed cell death protein-1 (PD-1) antibody, administered intravenously every 2 weeks, was initiated. The tumor lesions improved slightly after two cycles of treatment and shrunk markedly, and almost disappeared at the end of the sixth cycle of therapy. The patient is still in remission at present. The present findings suggest the potential efficacy of HER2-targeted ADCs combined with PD-1 inhibitors for patients with HER2-positive breast cancer, including those resistant to prior HER2-targeted ADCs.
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Affiliation(s)
- Shanmin Fan
- Department of Medical Oncology, Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing 100022, P.R. China
| | - Lianxiang He
- Medical Affairs Department, Guangzhou Gloria Bioscience Co., Ltd., Beijing 100005, P.R. China
| | - Die Sang
- Department of Medical Oncology, Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing 100022, P.R. China
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