Anti-HER2 neoadjuvant treatment may have an impact on discordance between preoperative core needle biopsy and surgical specimen in early breast cancer

Abstract

I want to congratulate Meattini and their colleagues for their article in which they investigated concordance between preoperative core needle biopsy (CNB) and surgical specimen (SS) in evaluating biomarkers and molecular subtypes. 1 Meattini I. Bicchierai G. Saieva C. et al. Impact of molecular subtypes classification concordance between preoperative core needle biopsy and surgical specimen on early breast cancer management: single-institution experience and review of published literature. Eur J Surg Oncol. 2017; 43: 642-648 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar They reported that CNB showed good accuracy in evaluating hormonal receptors status, HER2, and breast cancer molecular subtypes. Concordance rate for HER2 assessment was 91% in current study. However, authors did not mention whether HER2 positive patients received anti-HER2 neoadjuvant treatment or not. Recent study by Wang et al. 2 Wang R.X. Chen S. Jin X. et al. Weekly paclitaxel plus carboplatin with or without trastuzumab as neoadjuvant chemotherapy for HER2-positive breast cancer: loss of HER2 amplification and its impact on response and prognosis. Breast Cancer Res Treat. 2016 Nov 24; ([Epub ahead of print]) Google Scholar explored the prevalence and prognostic impact of HER2 loss in breast cancer patients with HER2-positive disease treated with neoadjuvant weekly paclitaxel plus carboplatin with or without trastuzumab (PCH vs. PC). Of all 549 consecutive HER2-positive patients, 50.9% and 25.9% of patients were having pCR in PCH and PC cohorts, respectively (P < 0.001). Interestingly, HER2 loss were more frequent in PCH cohort with 19.8%, compared to 9.4% in PC cohort (P = 0.009). As authors discussed this issue, this biological discordance may be related to intra-tumoral heterogeneity. In conclusion, anti-HER2 neoadjuvant treatment may be a predictive factor for discordance of HER2 status between preoperative core needle biopsy and surgical specimen. Further research is needed for patients who were initially positive but subsequently had negative HER2 status due to neoadjuvant treatment. In reply to: Anti-HER2 neoadjuvant treatment may have an impact on discordance between preoperative core needle biopsy and surgical specimen in early breast cancerEuropean Journal of Surgical OncologyVol. 43Issue 6PreviewWe have read with interest the comment by Altundag about our paper.1 We agreed with the author, thus we quoted in the manuscript that patients who received primary systemic therapy (PST) were excluded from analysis, due to significant influence on the postoperative expression of biomarkers.2 Anyway, we are persuaded that the correlation between pre-operative core needle biopsy and definitive hystological result after PST needs further research. Studies about this issue may help to understand the mechanism underlining response to PST and biological agents, such as anti-human epidermal growth receptor factor 2 (HER2) therapies. Full-Text PDF