1
|
Brevet M, Li Z, Parwani A. Computational pathology in the identification of HER2-low breast cancer: Opportunities and challenges. J Pathol Inform 2024; 15:100343. [PMID: 38125925 PMCID: PMC10730362 DOI: 10.1016/j.jpi.2023.100343] [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: 08/25/2023] [Revised: 09/18/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023] Open
Abstract
For the past 2 decades, pathologists have been accustomed to reporting the HER2 status of breast cancer as either positive or negative, based on HER2 IHC. Today, however, there is a clinical imperative to employ a 3-tier approach to interpreting HER2 IHC that can also identify tumours categorised as HER2-low. Meeting this need for a finer degree of discrimination may be challenging, and in this article, we consider the potential for the integration of computational approaches to support pathologists in achieving accurate and reproducible HER2 IHC scoring as well as outlining some of the practicalities involved.
Collapse
Affiliation(s)
| | - Zaibo Li
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Anil Parwani
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
2
|
Gu Y, Wang Z, Wang Y. Bispecific antibody drug conjugates: Making 1+1>2. Acta Pharm Sin B 2024; 14:1965-1986. [PMID: 38799638 PMCID: PMC11119582 DOI: 10.1016/j.apsb.2024.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 05/29/2024] Open
Abstract
Bispecific antibody‒drug conjugates (BsADCs) represent an innovative therapeutic category amalgamating the merits of antibody‒drug conjugates (ADCs) and bispecific antibodies (BsAbs). Positioned as the next-generation ADC approach, BsADCs hold promise for ameliorating extant clinical challenges associated with ADCs, particularly pertaining to issues such as poor internalization, off-target toxicity, and drug resistance. Presently, ten BsADCs are undergoing clinical trials, and initial findings underscore the imperative for ongoing refinement. This review initially delves into specific design considerations for BsADCs, encompassing target selection, antibody formats, and the linker-payload complex. Subsequent sections delineate the extant progress and challenges encountered by BsADCs, illustrated through pertinent case studies. The amalgamation of BsAbs with ADCs offers a prospective solution to prevailing clinical limitations of ADCs. Nevertheless, the symbiotic interplay among BsAb, linker, and payload necessitates further optimizations and coordination beyond a simplistic "1 + 1" to effectively surmount the extant challenges facing the BsADC domain.
Collapse
Affiliation(s)
- Yilin Gu
- Targeted Tracer Research and Development Laboratory, Institute of Respiratory Health, Frontiers Science Center for Disease-Related Molecular Network, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhijia Wang
- Targeted Tracer Research and Development Laboratory, Institute of Respiratory Health, Frontiers Science Center for Disease-Related Molecular Network, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuxi Wang
- Targeted Tracer Research and Development Laboratory, Institute of Respiratory Health, Frontiers Science Center for Disease-Related Molecular Network, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
- Frontiers Medical Center, Tianfu Jincheng Laboratory, Chengdu 610212, China
| |
Collapse
|
3
|
Tyburski H, Karakas C, Finkelman BS, Turner BM, Zhang H, Hicks DG. In ER-Positive, HER2-Negative Breast Cancers, HER2 mRNA Levels Correlate Better with Clinicopathologic Features and Oncotype DX Recurrence Score than HER2 Immunohistochemistry. J Transl Med 2024; 104:100309. [PMID: 38135156 DOI: 10.1016/j.labinv.2023.100309] [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: 09/19/2023] [Revised: 11/28/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
With the approval of trastuzumab deruxtecan for treating advanced human epidermal growth factor receptor-2 (HER2) low breast cancer (BC), it has become increasingly important to develop more accurate and reliable methods to identify HER2-low BC. In addition, HER2 immunohistochemistry (IHC) has limitations for quantification of HER2. We explored the relationship between HER2 IHC and mRNA levels and evaluated whether HER2 IHC scores and mRNA levels are associated with clinicopathologic features and Oncotype DX Recurrence Score (RS) in estrogen receptor (ER)-positive, HER2-negative BCs. A total of 750 BCs sent for Oncotype DX (ODX) testing were included in this study, and 559 with HER2 mRNA levels were available. There were no statistically significant differences between HER2 0 and HER2-low BC in clinicopathologic variables or ODX RS using HER2 IHC. There was a significant difference in median HER2 mRNA values between HER2 0 and HER2-low (8.7 vs 9.3, P < .001); however, the HER2 mRNA distribution had substantial overlap between these 2 groups with a suboptimal area under the receiver operating characteristic curve (area under the receiver operating characteristic curve = 0.68). A HER2 mRNA value of 9.2 was generated as the optimal cutoff for distinguishing HER2 0 and HER2-low BC. Comparing ER+ BCs with HER2 mRNA high (>9.2) and low (≤9.2) revealed a statistically significant difference in most clinicopathologic variables and ODX RS. From this large cohort of ER-positive, HER2-negative BC, our results demonstrated that HER2 mRNA levels correlated better with clinicopathologic features and recurrence risk as assessed by ODX RS than HER2 IHC scores. Our findings suggest that HER2 mRNA-detecting methods could potentially serve as a quantitative and reliable method for identifying a biologically meaningful group of HER2-low BC. Further study is needed to determine whether HER2 mRNA levels could be more reliable than IHC for identifying which patients will be most likely to benefit from trastuzumab deruxtecan.
Collapse
Affiliation(s)
- Haley Tyburski
- Class of 2024, University of Rochester, Rochester, New York
| | - Cansu Karakas
- Department of Pathology, University of Rochester Medical Center, Rochester, New York
| | - Brian S Finkelman
- Department of Pathology, University of Rochester Medical Center, Rochester, New York
| | - Bradley M Turner
- Department of Pathology, University of Rochester Medical Center, Rochester, New York
| | - Huina Zhang
- Department of Pathology, University of Rochester Medical Center, Rochester, New York.
| | - David G Hicks
- Department of Pathology, University of Rochester Medical Center, Rochester, New York.
| |
Collapse
|
4
|
Chen YY, Yang CF, Hsu CY. The impact of modified staining method on HER2 immunohistochemical staining for HER2-low breast cancer. Pathology 2024; 56:122-124. [PMID: 37657990 DOI: 10.1016/j.pathol.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Yen-Ying Chen
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Fen Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yi Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| |
Collapse
|
5
|
Wu Q, Xu L. Challenges in HER2-low breast cancer identification, detection, and treatment. TRANSLATIONAL BREAST CANCER RESEARCH : A JOURNAL FOCUSING ON TRANSLATIONAL RESEARCH IN BREAST CANCER 2024; 5:3. [PMID: 38751682 PMCID: PMC11093058 DOI: 10.21037/tbcr-23-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/27/2023] [Indexed: 05/18/2024]
Abstract
Recently, human epidermal growth factor receptor 2 (HER2)-low breast cancer (BC) has emerged as a novel subset within the category of HER2-negative BC, prompting a reassessment of the immunohistochemical negative scores of 0, 1+, and the 2+/in situ hybridization (ISH) negative phenotype. Recent clinical trials have provided compelling evidence of the substantial clinical advantages offered by novel antibody-drug conjugates (ADCs) that target HER2 in the treatment of these specific tumor cohorts. Notably, trastuzumab deruxtecan (T-Dxd), an ADC that specifically targets HER2, has recently received approval from the US Food and Drug Administration as the inaugural targeted therapeutic option for HER2-low BC. However, the classification of HER2-low BC as a distinct subtype, the methods for detecting HER2-low BC, and the optimal treatment approach for HER2-low BC remain subjects of ongoing debate and lack consensus. This comprehensive review aims to address these pertinent concerns, offering insights into the nuanced tumor biology underlying HER2-low BC and critically analyzing the current treatment pathways available. By synthesizing available evidence, the objective is to contribute to an enhanced understanding of HER2-low BC, providing a foundation for more informed clinical decisions and further advancements in tailored therapeutic approaches. As the medical community navigates these uncertainties, this review seeks to consolidate existing knowledge, fostering a collective effort toward establishing consensus in the diagnosis and treatment of HER2-low BC.
Collapse
Affiliation(s)
- Qian Wu
- Thyroid and Breast Surgery, Peking University First Hospital, Beijing, China
| | - Ling Xu
- Thyroid and Breast Surgery, Peking University First Hospital, Beijing, China
| |
Collapse
|
6
|
Jiang M, Liu J, Li Q, Xu B. The trichotomy of HER2 expression confers new insights into the understanding and managing for breast cancer stratified by HER2 status. Int J Cancer 2023; 153:1324-1336. [PMID: 37314204 DOI: 10.1002/ijc.34570] [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: 01/20/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 06/15/2023]
Abstract
Human epidermal growth factor receptor 2 (HER2) is a tyrosine kinase receptor that plays a carcinogenic role in breast cancer (BC) through gene amplification, mutation, or overexpression. Traditional methods of HER2 detection were divided into positive (immunohistochemistry (IHC) 3+/fluorescence in situ hybridization (FISH) amplification) and negative (IHC 2+/FISH-, IHC 1+, IHC 0) according to the dichotomy method. Anti-HER2-targeted therapies, such as trastuzumab and pertuzumab, have significantly improved the prognosis of HER2-positive patients. However, up to 75% to 85% of patients remain HER2-negative. In recent years, with the rapid development of molecular biology, gene detection technology, targeted therapy, and immunotherapy, researchers have actively explored the clinicopathological characteristics, molecular biological characteristics, treatment methods, and HER2 detection methods of HER2-low/zero breast cancer. With the clinical efficacy of new anti-HER2 targeted drugs, accurate classification of breast cancer is very important for the treatment choice. Therefore, the following review summarizes the necessity of developing HER2 detection methods, and the clinicopathological and drug treatment characteristics of patients with HER2-low/zero, to light the dawn of the treatment of breast cancer patients with HER2-low/zero expression.
Collapse
Affiliation(s)
- Mingxia Jiang
- 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
| | - Jiaxuan Liu
- 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
| | - 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
| |
Collapse
|
7
|
Turashvili G, Gao Y, Ai DA, Ewaz AM, Gjeorgjievski SG, Wang Q, Nguyen TTA, Zhang C, Li X. Low interobserver agreement among subspecialised breast pathologists in evaluating HER2-low breast cancer. J Clin Pathol 2023:jcp-2023-209055. [PMID: 37714693 DOI: 10.1136/jcp-2023-209055] [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: 07/11/2023] [Accepted: 08/24/2023] [Indexed: 09/17/2023]
Abstract
AIMS Metastatic HER2-low breast cancer (HLBC) can be treated by trastuzumab deruxtecan. Assessment of low levels of HER2 protein expression suffers from poor interobserver reproducibility. The aim of the study was to evaluate the interobserver agreement among subspecialised breast pathologists and develop a practical algorithm for assessing HLBC. METHODS Six breast pathologists (4 juniors, 2 seniors) evaluated 106 HER2 immunostained slides with 0/1+expression. Two rounds (R1, R2) of ring study were performed before and after training with a modified Ki-67 algorithm, and concordance was assessed. RESULTS Agreement with 5% increments increased from substantial to almost perfect (R1: 0.796, R2: 0.804), and remained substantial for three categories (<1% vs 1%-10% vs >10%) (R1: 0.768, R2: 0.764). Seniors and juniors had almost perfect agreement with 5% increments (R1: 0.859 and 0.821, R2: 0.872 and 0.813). For the three categories, agreement remained almost perfect among seniors (R1: 0.837, R2: 0.860) and substantial among juniors (R1: 0.792, R2: 0.768). Binary analysis showed suboptimal agreement, decreasing for both juniors and seniors from substantial (R1: 0.650 and 0.620) to moderate (R2: 0.560 and 0.554) using the 1% cut-off, and increasing from moderate to substantial (R1: 0.478, R2: 0.712) among seniors but remaining moderate (R1: 0.576, R2: 0.465) among juniors using the 10% cut-off. The average scoring time per case was higher (72 vs 92 s). CONCLUSIONS Subspecialised breast pathologists have suboptimal agreement for immunohistochemical evaluation of HLBC using the modified Ki-67 methodology. An urgent need remains for a new assay/algorithm to reliably evaluate HLBC.
Collapse
Affiliation(s)
- Gulisa Turashvili
- Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Yuan Gao
- Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Di Andy Ai
- Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Abdulwahab M Ewaz
- Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | | | - Qun Wang
- Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Thi T A Nguyen
- Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Chao Zhang
- General Dynamics Information Technology Inc, Falls Church, Virginia, USA
| | - Xiaoxian Li
- Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA
| |
Collapse
|
8
|
Guvakova MA. Automated Classification of Breast Cancer Across the Spectrum of ERBB2 Expression Focusing on Heterogeneous Tumors With Low Human Epidermal Growth Factor Receptor 2 Expression. JCO Clin Cancer Inform 2023; 7:e2300013. [PMID: 37437225 DOI: 10.1200/cci.23.00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/12/2023] [Accepted: 05/24/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE Although pharmaceutical companies conduct clinical trials of novel human epidermal growth factor receptor 2 (HER2)-low-directed drugs, diagnosing HER2-low cancer by immunohistochemistry (IHC) and in situ hybridization (ISH) remains challenging. This study investigates the performance of first-in-kind computerized intelligence to classify samples across gene expression levels and differentiate HER2-low tumors. MATERIALS AND METHODS We classified 251 samples: 142 primary invasive breast cancers (IBCs), 75 ductal carcinomas in situ (DCIS), and 34 mammaplasties (reference) using mRNA expression data from the QuantiGene Plex 2.0 assay. We used g3mclass probabilistic software to assess the number of classes in the assay data, the mean and the variance in each class, diagnostic cutoffs, and the prevalence of each class in the study population. RESULTS HER2-low (IHC score of 1+ or 2+/ISH-) accounted for 31% of IBC. First, we discovered that HER2-low tumors were represented by cases with normal ERBB2 transcript levels that were expected to produce physiologic levels of HER2 (70%) and cases with abnormally upregulated unamplified ERBB2 (30%). We termed the latter cancers ERBB2-up as they do not meet the standard definitions for ERBB2 overexpression and amplification. Second, HER2-low IBC classified as ERBB2-up had not only abnormally increased luminal growth and adhesion markers (ERBB2, ESR1, PGR, IGF1R, VAV2, VAV3, KRT8, CDH1) but also downregulated myoepithelial marker (KRT5). The vascularization (RAP1 and C3G), immune cell infiltration (VAV1), and mesenchymal transition (CDH2) markers were dysregulated. Finally, in the independent cohort of DCIS, 40% of HER2-low DCIS shared similar traits with HER2-low IBC except for rare downregulation of KRT5 and no change in C3G, VAV1, and CDH2. CONCLUSION We demonstrated how innovative bioinformatic tools could help diagnose cancer across the spectrum of ERBB2 expression to aid decision making for HER2-low.
Collapse
Affiliation(s)
- Marina A Guvakova
- Department of Surgery, Division of Endocrine & Oncologic Surgery, Harrison Department of Surgical Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
9
|
Zaakouk M, Quinn C, Provenzano E, Boyd C, Callagy G, Elsheikh S, Flint J, Millican-Slater R, Gunavardhan A, Mir Y, Makhija P, Di Palma S, Pritchard S, Tanchel B, Rakha E, Atallah NM, Lee AHS, Pinder S, Shaaban AM. Concordance of HER2-low scoring in breast carcinoma among expert pathologists in the United Kingdom and the republic of Ireland -on behalf of the UK national coordinating committee for breast pathology. Breast 2023; 70:82-91. [PMID: 37419078 PMCID: PMC10382984 DOI: 10.1016/j.breast.2023.06.005] [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: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Recent clinical evidence showed that breast cancer with low HER2 expression levels responded to trastuzumab deruxtecan therapy. The HER2-low cancers comprise immunohistochemistry (IHC) score 1+ and 2+ ISH non-amplified tumours, currently classified as HER2 negative. Little data exists on the reproducibility of pathologists reporting of HER2-low cancer. PATIENT AND METHODS Sixteen expert pathologists of the UK National Coordinating Committee for Breast Pathology scored 50 digitally scanned HER2 IHC slides. The overall level of agreement, Fleiss multiple-rater kappa statistics and Cohen's Kappa were calculated. Cases with low concordance were re-scored by the same pathologists after a washout period. RESULTS Absolute agreement was achieved in 6% of cases, all of which scored 3+. Poor agreement was found in 5/50 (10%) of cases. This was due to heterogeneous HER2 expression, cytoplasmic staining and low expression spanning the 10% cut-off value. Highest concordance (86%) was achieved when scores were clustered as 0 versus others. Improvement in kappa of overall agreement was achieved when scores 1+ and 2+ were combined. Inter-observer agreement was moderate to substantial in the whole cohort but fair to moderate in the HER2-low group. Similarly, consensus-observer agreement was substantial to almost perfect in the whole cohort and moderate to substantial in the HER2-low group. CONCLUSION HER2-low breast cancer suffers from lower concordance among expert pathologists. While most cases can reproducibly be classified, a small proportion (10%) remained challenging. Refining the criteria for reporting and consensus scoring will help select appropriate patients for targeted therapy.
Collapse
Affiliation(s)
- Mohamed Zaakouk
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Cancer Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Cecily Quinn
- Department of Histopathology, St Vincent's University Hospital, Elm Park, Ireland; UCD School of Medicine, Dublin, Ireland
| | - Elena Provenzano
- Addenbrookes Hospital and NIHR Cambridge Biomedical Research Centre, Cambridge, UK; Department of Histopathology, Addenbrookes Hospital, Cambridge, UK
| | - Clinton Boyd
- Histopathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Grace Callagy
- Discipline of Pathology, University of Galway, School of Medicine, Lambe Institute for Translational Research, Galway, Ireland
| | - Soha Elsheikh
- Department of Cellular Pathology, Royal Free Hospital, London, UK; Research Department of Pathology, University College London, Cancer Institute, London, UK
| | - Joe Flint
- Birmingham Tissue Analytics, University of Birmingham, UK
| | | | - Anu Gunavardhan
- Department of Histopathology, Glan Clwyd Hospital Betsi Cadwaladr University Health Board, Bodelwyddan, UK
| | - Yasmeen Mir
- Pathology, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | - Silvana Di Palma
- Cellular Pathology Department, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Susan Pritchard
- Pathology, Wythenshawe Hospital Manchester Foundation Trust, Manchester, UK
| | - Bruce Tanchel
- Cellular Pathology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Emad Rakha
- Histopathology Department, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - Nehal M Atallah
- Histopathology Department, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK; Department of Pathology, Faculty of Medicine, Menoufia University, Egypt
| | - Andrew H S Lee
- Histopathology Department, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - Sarah Pinder
- School of Cancer & Pharmaceutical Sciences, Kings College London, London, UK
| | - Abeer M Shaaban
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
| |
Collapse
|
10
|
Yue M, Wu S, Wang X, Cai L, Wang X, Yang H, Liu Y. RT-qPCR is helpful to distinguish the clinicopathological features of HER2 immunohistochemistry 0 and 1. Pathol Res Pract 2023; 247:154532. [PMID: 37267721 DOI: 10.1016/j.prp.2023.154532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 06/04/2023]
Abstract
The most commonly applied techniques to assess human epidermal growth factor receptor 2 (HER2) expression in breast cancer are immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). HER2 detection by reverse transcription quantitative polymerase chain reaction (RT-qPCR) can provide standardized, objective and automated assessment and reflect the HER2 expression continuity. Currently, there is lack of sufficient evidence to validate whether RT‑qPCR technique is more appropriate for the detection of HER2 low expression, especially ultra-low expression. Here, we primarily utilized RT-qPCR to differentiate HER2 true negative, ultra-low and 1 +, and compare the clinicopathological features and prognosis between RT-qPCR and IHC. 136 breast cancer cases with HER2 0 or 1 + were collected, also included 21 cases with HER2 2 + FISH negative as well as 25 cases with HER2 positive during the same period for comparative analysis. Compared the mRNA levels based on IHC/FISH scores. The receiver operating characteristic (ROC) curve was utilized to determine the threshold for reclassification, and the clinicopathological characteristics and prognosis differences among IHC true negative, ultra-low and 1 + after re-classification by RT-qPCR were analyzed. The mRNA level significantly differed between the IHC 0 and 1 + groups (p < 0.001). The IHC 0 group was further divided into true negative and ultra-low, there was no statistically significant difference in mRNA levels between true negative and ultra-low groups, while the difference between ultra-low and 1 + mRNA levels was statistically significant (p < 0.001). After reclassification of IHC true negative, ultra-low and 1 + by RT-qPCR, there were statistically significant differences in histological grade, ER, PR and TILs expression. There was no significant difference between DFS and OS in the two classification methods. RT-qPCR classification aids in distinguishing clinicopathological characteristics and can serve as a supplementary technique for detecting HER2-low by IHC.
Collapse
Affiliation(s)
- Meng Yue
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang 050011, Hebei, China
| | - Si Wu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang 050011, Hebei, China
| | - Xinran Wang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang 050011, Hebei, China
| | - Lijing Cai
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang 050011, Hebei, China
| | - Xiaoxiao Wang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang 050011, Hebei, China
| | - Huichai Yang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang 050011, Hebei, China
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang 050011, Hebei, China.
| |
Collapse
|
11
|
Liu Y. HER2-low breast cancer: insights on pathological testing. TRANSLATIONAL BREAST CANCER RESEARCH : A JOURNAL FOCUSING ON TRANSLATIONAL RESEARCH IN BREAST CANCER 2023; 4:15. [PMID: 38751479 PMCID: PMC11093042 DOI: 10.21037/tbcr-23-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/15/2023] [Indexed: 05/18/2024]
Abstract
Human epidermal growth factor receptor 2 (HER2) is an important biomarker for predicting prognosis and effectiveness of HER2-targeted therapy in breast cancer. The emergence of novel HER2 antibody-drug conjugate has led to a shift from the binary categorization of HER2 status (i.e., negative and positive) to a ternary categorization gradually (i.e., HER2 0, HER2 low expression and HER2 positive). The heterogeneity of HER2 low expression in breast cancer has also recently aroused widespread concern, and the heterogeneity of tumors has led to differences in the efficacy of HER2-targeted therapy. Therefore, it is crucial to accurately identify the HER2 expression status of breast cancer, which can provide a basis for patients to formulate personalized treatment strategies. In recent years, artificial intelligence (AI) has developed rapidly and been widely used in the pathological accurate diagnosis of breast cancer. The research results show that AI can significantly improve the consistency and accuracy of HER2 interpreted by pathologists in breast cancer. This has provoked many discussions on HER2-low breast cancer, such as quality control prior to HER2-low expression detection, the latest progress of tumor heterogeneity, and the application of AI. In this paper, we discuss the latest testing guidelines and advances on HER2-low breast cancer, aiming to standardize and improve the pathological testing of HER2-low breast cancer.
Collapse
Affiliation(s)
- Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
12
|
Sajjadi E, Guerini-Rocco E, De Camilli E, Pala O, Mazzarol G, Venetis K, Ivanova M, Fusco N. Pathological identification of HER2-low breast cancer: Tips, tricks, and troubleshooting for the optimal test. Front Mol Biosci 2023; 10:1176309. [PMID: 37077201 PMCID: PMC10106673 DOI: 10.3389/fmolb.2023.1176309] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
The introduction of novel anti-HER2 antibody-drug conjugates (ADC) for the treatment of HER2-low breast cancers has transformed the traditional dichotomy of HER2 status to an expanded spectrum. However, the identification of HER2-low (i.e., immunohistochemistry (IHC) score 1 + or IHC score 2+, without gene amplification) tumors is challenged by methodological and analytical variables that might influence the sensitivity and reproducibility of HER2 testing. To open all possible therapeutic opportunities for HER2-low breast cancer patients the implementation of more accurate and reproducible testing strategies is mandatory. Here, we provide an overview of the existing barriers that may trouble HER2-low identification in breast cancer and discuss practical solutions that could enhance HER-low assessment.
Collapse
Affiliation(s)
- Elham Sajjadi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Guerini-Rocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elisa De Camilli
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Oriana Pala
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giovanni Mazzarol
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mariia Ivanova
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- *Correspondence: Nicola Fusco,
| |
Collapse
|
13
|
Carretero-Barrio I, Caniego-Casas T, Rosas M, Sánchez MC, Martínez-Jáñez N, Chiva M, Sarrió D, Moreno-Bueno G, Palacios J, Pérez-Mies B. Evaluation of ERBB2 mRNA Expression in HER2-Equivocal (2+) Immunohistochemistry Cases. Cancers (Basel) 2023; 15:cancers15061688. [PMID: 36980575 PMCID: PMC10046044 DOI: 10.3390/cancers15061688] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/23/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Xpert Breast Cancer STRAT4 is a RT-qPCR platform that studies the mRNA expression of ESR1, PGR, MKI67 and ERBB2, providing a positive or negative result for each of these breast cancer biomarkers. Its concordance with immunohistochemistry (IHC) and in situ hybridization (ISH) has been previously demonstrated, but none of the previous works was focused on HER2-equivocal (2+) cases identified by IHC. Thus, we studied the concordance between IHC/ISH and STRAT4 results for 112 HER2 2+ IBC samples, using 148 HER2 0+, 1+ and 3+ (no-HER2 2+) samples for comparison. We found 91.3% accuracy for the determination of HER2 status globally, 99.3% for no-HER2 2+ samples and 80.7% for HER2 2+ samples. Regarding the other biomarkers, we obtained 96.4% accuracy for estrogen receptor, 84.1% for progesterone receptor and 58.2% for Ki67. Our results suggest that the use of ERBB2 mRNA for the evaluation of HER2 2+ cases is not a reliable reflex method to assess the ERBB2 amplification status.
Collapse
Affiliation(s)
- Irene Carretero-Barrio
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain; (I.C.-B.); (T.C.-C.); (M.R.)
- Faculty of Medicine, Universidad de Alcalá, 28801 Alcalá de Henares, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain; (D.S.); (G.M.-B.)
- Unidad de Patología Mamaria, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.C.S.); (N.M.-J.); (M.C.)
| | - Tamara Caniego-Casas
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain; (I.C.-B.); (T.C.-C.); (M.R.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain; (D.S.); (G.M.-B.)
| | - Marta Rosas
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain; (I.C.-B.); (T.C.-C.); (M.R.)
| | - María Concepción Sánchez
- Unidad de Patología Mamaria, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.C.S.); (N.M.-J.); (M.C.)
- Servicio de Ginecología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - Noelia Martínez-Jáñez
- Unidad de Patología Mamaria, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.C.S.); (N.M.-J.); (M.C.)
- Servicio de Oncología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - Miguel Chiva
- Unidad de Patología Mamaria, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.C.S.); (N.M.-J.); (M.C.)
- Servicio de Radiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain
| | - David Sarrió
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain; (D.S.); (G.M.-B.)
- Departamento de Bioquímica, Universidad Autónoma de Madrid (UAM), Instituto de Investigaciones Biomédicas ‘Alberto Sols’, Conexión Cáncer (UAM-CSIC), 28029 Madrid, Spain
| | - Gema Moreno-Bueno
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain; (D.S.); (G.M.-B.)
- Departamento de Bioquímica, Universidad Autónoma de Madrid (UAM), Instituto de Investigaciones Biomédicas ‘Alberto Sols’, Conexión Cáncer (UAM-CSIC), 28029 Madrid, Spain
- Fundación MD Anderson Internacional, 28033 Madrid, Spain
| | - José Palacios
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain; (I.C.-B.); (T.C.-C.); (M.R.)
- Faculty of Medicine, Universidad de Alcalá, 28801 Alcalá de Henares, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain; (D.S.); (G.M.-B.)
- Unidad de Patología Mamaria, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.C.S.); (N.M.-J.); (M.C.)
- Correspondence: (J.P.); (B.P.-M.); Tel.: +34-91-336-8337 (J.P. & B.P.-M.)
| | - Belén Pérez-Mies
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain; (I.C.-B.); (T.C.-C.); (M.R.)
- Faculty of Medicine, Universidad de Alcalá, 28801 Alcalá de Henares, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain; (D.S.); (G.M.-B.)
- Unidad de Patología Mamaria, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.C.S.); (N.M.-J.); (M.C.)
- Correspondence: (J.P.); (B.P.-M.); Tel.: +34-91-336-8337 (J.P. & B.P.-M.)
| |
Collapse
|
14
|
Tehrani Fateh S, Behgozin A, Yekani F, Geranpayeh L, Olfatbakhsh A, Moghadam S, Sarrami-Forooshani R, Salehi-Najafabadi A, Shekari F. Healthy Male Individuals Possess Higher Plasma HER-2 Level than Females. CELL JOURNAL 2023; 25:73-75. [PMID: 36680486 PMCID: PMC9868432 DOI: 10.22074/cellj.2022.562589.1134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Indexed: 01/22/2023]
Abstract
Considering HER2 as one of the well-known biomarkers in the cancer field, and published articles regarding serum levels of HER2, in this paper we tried to highlight the issue that most studies don't stratify the HER-2 concentration of individuals in terms of gender. In this brief survey, healthy individuals with no prior non-communicable diseases were categorized as males (n=34) and females (n=43), and all samples were evaluated for plasma HER-2 levels at once. Surprisingly, the plasma level of HER-2 of healthy male individuals (mean= 2.28 ± 0.21 ng/mL) was significantly (P<0.0001) higher than the plasma level of HER-2 of healthy females (mean: 0.06 ± 0.09 ng/mL), with no overlap. Therefore, we suggest that more studies are required to re-check the cutoff values for HER-2 plasma levels based on gender since the clinical implications of a unique HER-2 cutoff for both genders may be seriously concerning.
Collapse
Affiliation(s)
- Sepand Tehrani Fateh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Behgozin
- R&D Division, Tashkhis Fan Firoozeh (Firoozeh DiaTech), Tehran, Iran
| | - Farshid Yekani
- R&D Division, Tashkhis Fan Firoozeh (Firoozeh DiaTech), Tehran, Iran
| | - Loabat Geranpayeh
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Asiie Olfatbakhsh
- Breast Diseases Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Shiva Moghadam
- Breast Diseases Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | | | - Amir Salehi-Najafabadi
- R&D Division, Tashkhis Fan Firoozeh (Firoozeh DiaTech), Tehran, Iran ,Department of Microbiology, School of Biology, University College of Science, University of Tehran, Tehran, Iran ,P.O.Box: 1956836488R&D Division, Tashkhis Fan Firoozeh (Firoozeh DiaTech)TehranIranP.O.Box: 16635-148Department of Stem Cells and Developmental BiologyCell Science Research CenterRoyan Institute for
Stem Cell Biology and TechnologyACECRTehranIran
Emails: ,
| | - Faezeh Shekari
- R&D Division, Tashkhis Fan Firoozeh (Firoozeh DiaTech), Tehran, Iran ,Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell
Biology and Technology, ACECR, Tehran, Iran ,P.O.Box: 1956836488R&D Division, Tashkhis Fan Firoozeh (Firoozeh DiaTech)TehranIranP.O.Box: 16635-148Department of Stem Cells and Developmental BiologyCell Science Research CenterRoyan Institute for
Stem Cell Biology and TechnologyACECRTehranIran
Emails: ,
| |
Collapse
|
15
|
Current Biological, Pathological and Clinical Landscape of HER2-Low Breast Cancer. Cancers (Basel) 2022; 15:cancers15010126. [PMID: 36612123 PMCID: PMC9817919 DOI: 10.3390/cancers15010126] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
HER2-low breast cancer (BC) is a newly defined subset of HER2-negative BC that has HER2 immunohistochemical (IHC) score of 1+ or score of 2+/in situ hybridization (ISH) negative phenotype. Recent clinical trials have demonstrated significant clinical benefits of novel HER2 directing antibody-drug conjugates (ADCs) in treating this group of tumors. Trastuzumab-deruxtecan (T-Dxd), a HER2-directing ADC was recently approved by the U.S. Food and Drug Administration as the first targeted therapy to treat HER2-low BC. However, HER2-low BC is still not well characterized clinically and pathologically. This review aims to update the current biological, pathological and clinical landscape of HER2-low BC based on the English literature published in the past two years and to propose the future directions on clinical management, pathology practice, and translational research in this subset of BC. We hope it would help better understand the tumor biology of HER2-low BC and the current efforts for identifying and treating this newly recognized targetable group of BC.
Collapse
|