Abstract
The hormone receptor (HR) status and human epidermal growth hormone receptor 2 (HER2) status of patients with breast cancer may change following neoadjuvant chemotherapy (NCT). This prospective observational study aimed to evaluate the prognostic impact of receptor conversion in breast cancer patients treated with NCT.Of the 423 consecutive patients who had residual disease in the breast after NCT, 55 (13.0%) changed from HR (+) to HR (-), 23 (5.4%) changed from HR (-) to HR (+), 27 (6.4%) changed from HER2 (+) to HER2 (-), and 13 (3.1%) changed from HER2 (-) to HER2 (+). A total of 54 (12.8%) changed to the triple-negative (TN) tumor phenotype. The loss of HR positivity was an independent prognostic factor for worse disease-free survival (DFS) and worse overall survival (OS) in multivariate survival analysis. Furthermore, the switch to the TN phenotype after NCT was another independent prognostic factor for worse survival for both DFS and OS. In conclusion, patients with breast cancer may experience changes in HR status, HER2 status and tumor phenotype after NCT. The loss of HR positivity and the switch to the TN phenotype after NCT were associated with a worse patient outcome.
Highlights
Neoadjuvant chemotherapy (NCT) followed by definitive surgical resection is a commonly utilized therapeutic approach for locally advanced breast cancer and is likely to improve the operability of these patients by downstaging their primary tumors [1,2,3]
Previous studies have presented conflicting results regarding the conversion of the hormone receptor (HR) status and the human epidermal growth factor receptor 2 (HER2) status of patients with breast cancer during NCT
While several studies have suggested that the expression of these receptors is altered after NCT [6,7,8,9,10,11,12,13], others indicated that they remained stable [14,15,16,17]
Summary
Neoadjuvant chemotherapy (NCT) followed by definitive surgical resection is a commonly utilized therapeutic approach for locally advanced breast cancer and is likely to improve the operability of these patients by downstaging their primary tumors [1,2,3]. Previous studies have shown that NCT can alter the status of HR [6,7,8,9,10,11] and HER2 [8, 10,11,12,13]. The purpose of our study was to assess the discordance rate of the HR status and the HER2 status in patients with residual tumors after NCT and to evaluate the prognostic significance of multiple changes in these statuses
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