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Katayama A, Miligy IM, Shiino S, Toss MS, Eldib K, Kurozumi S, Quinn CM, Badr N, Murray C, Provenzano E, Callagy G, Martyn C, Millican-Slater R, Purdie C, Purnell D, Pinder SE, Oyama T, Shaaban AM, Ellis I, Lee AHS, Rakha EA. Predictors of pathological complete response to neoadjuvant treatment and changes to post-neoadjuvant HER2 status in HER2-positive invasive breast cancer. Mod Pathol 2021; 34:1271-1281. [PMID: 33526875 PMCID: PMC8216906 DOI: 10.1038/s41379-021-00738-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 01/16/2023]
Abstract
The response of human epidermal growth factor receptor2 (HER2)- positive breast cancer (BC) patients to anti-HER2 targeted therapy is significant. However, the response is not uniform and a proportion of HER2-positive patients do not respond. This study aims to identify predictors of response in the neoadjuvant treatment and to assess the discordance rate of HER2 status between pre- and post-treatment specimens in HER2-positive BC patients. The study group comprised 500 BC patients treated with neoadjuvant chemotherapy (NACT) and/or neoadjuvant anti-HER2 therapy and surgery who had tumours that were 3+ or 2+ with HER2 immunohistochemistry (IHC). HER2 IHC 2+ tumours were classified into five groups by fluorescence in situ hybridisation (FISH) according to the 2018 ASCO/CAP guidelines of which Groups 1, 2 and 3 were considered HER2 amplified. Pathological complete response (pCR) was more frequent in HER2 IHC 3+ tumours than in HER2 IHC 2+/HER2 amplified tumours, when either in receipt of NACT alone (38% versus 13%; p = 0.22) or neoadjuvant anti-HER2 therapy (52% versus 20%; p < 0.001). Multivariate logistic regression analysis showed that HER2 IHC 3+ and histological grade 3 were independent predictors of pCR following neoadjuvant anti-HER2 therapy. In the HER2 IHC 2+/HER2 amplified tumours or ASCO/CAP FISH Group 1 alone, ER-negativity was an independent predictor of pCR following NACT and/or neoadjuvant anti-HER2 therapy. In the current study, 22% of HER2-positive tumours became HER2-negative by IHC and FISH following neoadjuvant treatment, the majority (74%) HER2 IHC 2+/HER2 amplified tumours. Repeat HER2 testing after neoadjuvant treatment should therefore be considered.
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Affiliation(s)
- Ayaka Katayama
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.256642.10000 0000 9269 4097Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Islam M. Miligy
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.411775.10000 0004 0621 4712Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Sho Shiino
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.272242.30000 0001 2168 5385Department of Breast Surgery, National Cancer Centre Hospital, Tokyo, Japan
| | - Michael S. Toss
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - Karim Eldib
- grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Sasagu Kurozumi
- grid.411731.10000 0004 0531 3030Department of Breast Surgery, International University of Health and Welfare, Narita, Japan ,grid.256642.10000 0000 9269 4097Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Cecily M. Quinn
- grid.412751.40000 0001 0315 8143Department of Histopathology, St. Vincent’s University Hospital, Dublin, and School of Medicine, University College Dublin, Dublin, Ireland
| | - Nahla Badr
- grid.411775.10000 0004 0621 4712Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt ,grid.6572.60000 0004 1936 7486Institute of Cancer and Genomic Sciences, The University of Birmingham, Edgebaston, Birmingham, UK
| | - Ciara Murray
- grid.412751.40000 0001 0315 8143Department of Histopathology, St. Vincent’s University Hospital, Dublin, and School of Medicine, University College Dublin, Dublin, Ireland
| | - Elena Provenzano
- grid.5335.00000000121885934Department of Histopathology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Grace Callagy
- grid.6142.10000 0004 0488 0789Discipline of Pathology, School of Medicine, Lambe Institute for Translational Research, NUI Galway, Galway, Ireland
| | - Cian Martyn
- grid.6142.10000 0004 0488 0789Discipline of Pathology, School of Medicine, Lambe Institute for Translational Research, NUI Galway, Galway, Ireland
| | | | - Colin Purdie
- grid.416266.10000 0000 9009 9462Department of Breast Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Dave Purnell
- grid.269014.80000 0001 0435 9078Histopathology department, University Hospitals of Leicester, Leicester, UK
| | - Sarah E. Pinder
- grid.13097.3c0000 0001 2322 6764Division of Cancer Studies, King’s College London, Guy’s Hospital, London, UK
| | - Tetsunari Oyama
- grid.256642.10000 0000 9269 4097Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Abeer M. Shaaban
- grid.6572.60000 0004 1936 7486Institute of Cancer and Genomic Sciences, The University of Birmingham, Edgebaston, Birmingham, UK
| | - Ian Ellis
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Andrew H. S. Lee
- grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Emad A. Rakha
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
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Rakha EA, Tan PH, Varga Z, Tse GM, Shaaban AM, Climent F, van Deurzen CHM, Purnell D, Dodwell D, Chan T, Ellis IO. Prognostic factors in metaplastic carcinoma of the breast: a multi-institutional study. Br J Cancer 2014; 112:283-9. [PMID: 25422911 PMCID: PMC4453452 DOI: 10.1038/bjc.2014.592] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/06/2014] [Accepted: 11/01/2014] [Indexed: 12/18/2022] Open
Abstract
Background: Metaplastic breast carcinoma (MBC) is a rare type of breast cancer that has basal-like characteristics and is perceived to have poorer prognosis when compared with conventional no specific type/ductal carcinomas (ductal/NST). However, current data on MBC are largely derived from small case series or population-based reports. This study aimed to assess the clinicopathological features and outcome of MBC identified through an international multicentre collaboration. Methods: A large international multicentre series of MBC (no=405) with histological confirmation and follow-up information has been included in this study. The prognostic value of different variables and outcome has been assessed and compared with grade, nodal status and ER/HER2 receptor-matched ductal/NST breast carcinoma. Results: The outcome of MBC diagnosed in Asian countries was more favourable than those in Western countries. The outcome of MBC is not different from matched ductal/NST carcinoma but the performance of the established prognostic variables in MBC is different. Lymph node stage, lymphovascular invasion and histologic subtype are associated with outcome but tumour size and grade are not. Chemotherapy was associated with longer survival, although this effect was limited to early-stage disease. In this study no association between radiotherapy and outcome was identified. Multivariate analysis of MBC shows that histologic subtype is an independent prognostic feature. Conclusions: This study suggests that MBC is a heterogeneous disease. Although the outcome of MBC is not different to matched conventional ductal/NST breast carcinoma, its behaviour is dependent on the particular subtype with spindle cell carcinoma in particular has an aggressive biological behaviour. Management of patients with MBC should be based on validated prognostic variables.
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Affiliation(s)
- E A Rakha
- Department of Histopathology, Nottingham University Hospitals NHS Trust, and the University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - P H Tan
- Department of Pathology, Singapore General Hospital, College Road, Singapore, Singapore
| | - Z Varga
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH-8091 Zurich, Switzerland
| | - G M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - A M Shaaban
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - F Climent
- Department of Pathology-IDIBELL, Bellvitge University Hospital-ICS, L'Hospitalet de Llobregat, Barcelona, Spain
| | - C H M van Deurzen
- Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Purnell
- Department of Cellular Pathology, UHL Glenfield Hospital, Leicester, UK
| | - D Dodwell
- St James's Institute Of Oncology, St James's University Hospital, Leeds, UK
| | - T Chan
- Department of Pathology, Kwong Wah Hospital, Kowloon, Hong Kong
| | - I O Ellis
- Department of Histopathology, Nottingham University Hospitals NHS Trust, and the University of Nottingham, Nottingham City Hospital, Nottingham, UK
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