Abstract
BackgroundThe estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) statuses are frequently discordant between the primary tumor and metastatic lesions in metastatic breast cancer. This can have important therapeutic implications.Patients and methodsIn all, 541 patients with available receptor statuses from both primary tumor and metastatic lesion treated at Heidelberg and Tuebingen University Hospitals between 1982 and 2018 were included.ResultsStatistically significant discordance rates of 14% and 32% were found for ER and PR. HER2 status was statistically insignificantly discordant in 15% of patients. Gain in HER2 positivity was associated with an improved overall survival, whereas loss of HR positivity was associated with worse overall survival. Antiendocrine treatment differed in 20% of cases before and after biopsy and HER2-directed treatment in 14% of cases.ConclusionsReceptor statuses are discordant between primary tumor and metastasis in a considerable fraction of patients with metastatic breast cancer. Next to a highly presumed predictive value with respect to efficacy of endocrine and HER2-targeted therapy, discordance seems to provide prognostically relevant information. Where feasible, metastatic lesions should be biopsied in accordance with current guidelines.
Highlights
With 2.1 million new diagnoses predicted for 2018, breast cancer represents the most prevalent type of cancer in women worldwide [1]
We found that clinically used biomarkers were highly unstable between the primary tumor and the metastatic lesion
We found that 13% and 15% of 543 patients from Heidelberg and Tuebingen University Hospitals with metastatic breast cancer had a discordance of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status between their primary tumor and metastasis
Summary
With 2.1 million new diagnoses predicted for 2018, breast cancer represents the most prevalent type of cancer in women worldwide [1]. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) statuses of primary breast cancer tissue are used clinically to approximate biological subtypes, to predict outcome, and to guide therapy decisions, especially for endocrine and HER2targeted regimens [4, 5]. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) statuses are frequently discordant between the primary tumor and metastatic lesions in metastatic breast cancer. Metastatic lesions should be biopsied in accordance with current guidelines
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