Impact of Neoadjuvant Chemotherapy on Breast Cancer Biomarkers: A Guide for Further Adjuvant Treatment (original) (raw)
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Indian Journal of Surgery, 2021
Aims and background. Histological and immunohistochemical findings may vary in cases of breast cancer. Possible changes in tumor markers between biopsies performed before and after neoadjuvant chemotherapy are controversial and pose a challenge when a clinical decision is needed. The objectives of the present study were: (i) to compare the immunohistochemical expression of estrogen, progesterone and prolactin receptors and HER-2/neu in breast cancer before and after neoadjuvant chemotherapy; and (ii) to correlate the expression of these tumor markers with partial tumor response to neoadjuvant chemotherapy. Methods and study design. Immunohistochemical staining for breast tumor markers was performed in 90 cases of breast cancer. Statistical analysis was carried out using Fisher's exact test, McNemar's test, Spearman's correlation and the Kappa index with linear weighting (k). Results. Agreement between markers before and after neoadjuvant chemotherapy was fair to moderate (k = 0.37-0.51). The immunohistochemical expression of HER-2/neu and prolactin receptors showed a significant, albeit weak correlation before and after neoadjuvant chemotherapy (HER-2/neu, rho = 0.34; P = 0.0009; k = 0.35 [95% CI, 0.19-0.51]). Prolactin status changed in 28/90 cases (P = 0.001; McNemar's test), whereas no changes were found in estrogen or progesterone receptors. No association was found between tumor marker expression and tumor response. Conclusions. It seems prudent to reevaluate immunohistochemical markers such as HER-2/neu after neoadjuvant chemotherapy, since the findings will guide the strategy for implementation of adjuvant systemic treatment. No correlation was found between the tumor markers analyzed in the present study and partial tumor response to neoadjuvant chemotherapy.
International Journal of Advanced Research, 2019
This study was aimed to evaluate whether neoadjuvant chemotherapy (NACT) changes hormone receptor (ER, PR) status, Her-2/neu expression in carcinoma breast and role of outcome in planning adjuvant chemotherapy. Methods: 71 patients of locally advanced breast cancer (LABC), receiving NACT, were included. Core biopsy was done, to confirm invasive cancer, ER, PR and Her-2/neu expression before commencing NACT. Post treatment mastectomy specimen was analyzed for histopathology, ER, PR and Her-2/neu expression. Results: Immunohistochemistry (IHC) showed that ER positivity changed from 29.6% (n=21) to 28.2% (n=20) after treatment. While 70.4% (n=50) were ERbefore treatment which increased to 71.8% (n=51) post chemotherapy (p=0.99). Pre-NACT, PR was positive in 31.0% (n=22) which changed to 28.2% (n=20) after treatment. 69% (n=49) were PR before treatment which increased to 71.8% (n=51) post chemotherapy (p=0.99). Her-2/neu was positive in 71.8% (n=51) before treatment which became 70.4% (n=50) post-treatment (P= 0.88). 26.8% were ER + PR + (n=19), 66.2% were ER-PR-(n=47), 4.2% were ER-PR + (n=2) before NACT. Change in expression of hormone receptor status was noticed, ER + PR + decreased to 25.4% (n=18), ER-PRincreased to 69.0% (n=49), ER-PR + decreased to 2.8% (n=2), no change was noticed in ER + PRstatus. Tumor size was significantly reduced from pretreatment (39.37± 10.63 cms) to post-treatment (23.87±7.51 cms) (p < 0.05). Conclusion: On the basis of this study it was concluded that ER, PR and Her-2/neu status changes on IHC staining after NACT. So, IHC analysis on a post treatment tissue block should be repeated before planning adjuvant chemotherapy in patients of carcinoma breast.
The American Journal of Surgery, 2003
Background: Neoadjuvant chemotherapy may decrease tumor volume to allow breast conservation surgery. Its effect on estrogen and progesterone receptor (ER/PR) expression and hormone receptor (HR) status is controversial. Methods: From February 2001 to July 2002, 56 breast cancer patients treated with neoadjuvant chemotherapy and 56 non-neoadjuvant therapy (control) patients with adequate tissue samples were identified. Quantitative ER/PR expression was analyzed in preneoadjuvant or preoperative core biopsies and final surgical specimens. Changes between the two groups were compared to determine if alterations were due to neoadjuvant chemotherapy or tissue sampling. Results: The ER/PR expression changed in 34 (61%) neoadjuvant chemotherapy patients and 27 (48%) control patients. These expression changes resulted in HR status (positive/negative) alterations in 3 patients (5%) in both groups. Age, histology, chemotherapy regimen, and neoadjuvant response did not predict change. Conclusions: Hormone receptor status changed in 5% of neoadjuvant chemotherapy and control groups due to tissue sampling. As these changes may impact treatment, HR expression reanalysis in final surgical specimens is recommended.
IOSR Journals , 2019
Background: Breast cancer is a cancer with the highest incidence in women worldwide. It also has a very high mortalitydue to late treatment. The most common treatment of stage III breast cancer is administration of neoadjuvant chemotherapy (NACT), which aims to reduce tumor size and control micro metastasis. Immunohistochemical examination is an important factor in determining breast cancer subtypes and subsequent therapy. However, NACT has been reported to change the expression of immunohistochemical examinations of Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor-2 (HER-2) and Ki-67 examined from biopsy and mastectomy preparations, so the breast cancer subtypes and its histopathological grading change. Method: We graded the changes in immunohistochemical examinations of ER, PR, HER-2, Ki-67 and histopathological grading from 59 cases of stage III breast cancer after NACT administration. We analyzed the relationship between the changes in the expression of immunohistochemical examinations on the biopsy tissue specimens before NACT administration and from the tissue mastectomy after NACT administration associated with its histopathological grading with spearman correlation analysis. Findings: There were changes in the results of the expression of immunohistochemical examinations of ER, PR, HER-2, KI-67 and histopathological grading by 23.7%, 22.03%, 32.2%, 32.2% and 40.68% in stage III breast cancer patients who received NACT. There was a relationship with a weak correlation between the changes in immunohistochemical examinations of ER, PR, HER-2 and KI-67 with the changes in histopathological grading. The correlation coefficients between ER, PR, HER-2, Ki-67 and the histopathological grading were r=0.265, r=0.317, r=0.352 and r=0.335. Conclusions: Patients with stage III breast cancer who were treated with NACT experienced changes in the expression of immunohistochemical examinations of ER, PR, HER-2 and KI-67 and would experience changes in histopathological grading, causing changes in the breast cancer subtypes. The changes that occur must be interpreted carefully since it will change the subsequent therapy. Therefore, it is necessary to conduct further research on the therapy response to patients who experience changes in the expression.
Prognostic Value of Receptor Change After Neoadjuvant Chemotherapy in Breast Cancer Patients
European Journal of Breast Health
Points • Neoadjuvant chemotherapy might change the status of breast cancer biomarkers, including estrogen receptor (ER), progesterone receptor (PR), and HER-2. • Receptor status change, the ER (+) → (−) and PR (+) → (−) patients had significantly shorter overall survival. • There was no statistical relationship between the change of Ki-67 level and survival.
British journal of cancer, 2009
To evaluate the impact of change in the hormone receptor (HR) status (HR status conversion) on the long-term outcomes of breast cancer patients treated with neoadjuvant chemotherapy (NAC). We investigated 368 patients for the HR status of their lesions before and after NAC. On the basis of the HR status and the use/non-use of endocrine therapy (ET), the patients were categorised into four groups: Group A, 184 ET-administered patients with HR-positive both before and after NAC; Group B, 47 ET-administered patients with HR status conversion; Group C, 12 ET-naive patients with HR status conversion; Group D, 125 patients with HR-negative both before and after NAC. Disease-free survival in Group B was similar to that in Group A (hazard ratio, 1.16; P=0.652), but that in Group C was significantly lesser than that in Group A (hazard ratio, 6.88; P<0.001). A similar pattern of results was obtained for overall survival. Our results indicate that the HR status of tumours is a predictive fa...
Bali Medical Journal, 2019
Background: Breast cancer is cancer, with the highest incidence in women worldwide. It also has a very high mortality due to late treatment. The immunohistochemical examination is an important factor in determining breast cancer subtypes and subsequent therapy. However, neoadjuvant chemotherapy (NACT) has been reported to change the expression of immunohistochemical examinations of Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor-2 (HER-2), and Ki-67. This study aims to determine the relationship between hormonal, HER-2, and KI-67 changes after NCAT.Method: The immunohistochemical examinations were conducted on ER, PR, HER-2, Ki-67 and histopathological grading from 59 cases of stage III breast cancer after NACT administration. We analyzed the relationship between the changes in the expression of immunohistochemical examinations on the biopsy tissue specimens before NACT administration and from the tissue mastectomy after NACT administration...
Diagnostics, 2021
The adoption of neoadjuvant chemotherapy (NACT) for breast cancer (BC) is increasing. The need to repeat the biomarkers on a residual tumor after NACT is still a matter of debate. We verified estrogen receptors (ER), progesterone receptors (PR), Ki67 and human epidermal growth factor receptor 2 (HER2) status changes impact in a retrospective monocentric series of 265 BCs undergoing NACT. All biomarkers changed with an overall tendency toward a reduced expression. Changes in PR and Ki67 were statistically significant (p = 0.001). Ki67 changed in 114/265 (43.0%) cases, PR in 44/265 (16.6%), ER in 31/265 (11.7%) and HER2 in 26/265 (9.8%). Overall, intrinsic subtype changed in 72/265 (27.2%) cases after NACT, and 10/265 (3.8%) cases switched to a different adjuvant therapy accordingly. Luminal subtypes changed most frequently (66/175; 31.7%) but with less impact on therapy (5/175; 2.8%). Only 3 of 58 triple-negative BCs (5.2%) changed their intrinsic subtype, but all of them switched tr...
The Oncologist, 2007
The aim of this study was to detect and analyze changes in hormone receptor (HR) status after treatment of operable breast cancer with neoadjuvant chemotherapy (NCT). Patients were treated from 1982 to 2004 with different NCT combinations, mainly in successive prospective phase II trials. HR status before and after NCT was retested and reviewed in a blinded fashion by two pathologists, for 420 patients from a database of 710 patients. Among these 420 tumors, 145 (35%) were HR negative and 275 (65%) were HR positive before NCT. The HR status had changed after treatment in 98 patients (23%): 61 patients (42%) initially HR negative became HR positive. This HR-positive switch was significantly correlated with better overall survival (OS), compared with patients with unchanged HR-negative tumors. Moreover, this HR-positive switch also had an effect on disease-free survival (DFS). Conversely, 37 patients (13%) initially HR positive became HR negative after NCT. However, this group of prev...
Cancer Treatment Communications, 2015
Introduction: The effect of neoadjuvant chemotherapy (NAC) on the expression of receptor status in locally advanced breast cancer (LABC) is still under investigation. Aims of this study are to evaluate changes in hormone receptor (HR) and HER-2 status post-NAC and correlation with survival. Materials and methods: LABC patients who received NAC between 2001 and 2008 at Istanbul University were analyzed retrospectively. Patients with pathologic complete response (pCR) were excluded in analysis. Immunohistochemical (IHC) analyses was performed on both initial biopsies and surgical specimens. Results: The median age of 128 patients was 48 years and 55% of them were premenopausal. Most of the patients had invasive ductal (81%) and histologic grade (HG) III (81%) breast cancer. Partial pathologic response (pPR) rate was 86.7%. HR status changed in 36 patients (28%). The rates of ER, PR and HER-2 receptor positivity at diagnosis and after NAC were 44-32.8%, 43-29.7%, and 24-21%, respectively. Negative-to-positive change in HR status was observed in five patients. The 5-year overall survival (OS) was 76% in patients whose HR status converted to negative, compared with 91% in patients who remained HR-positive (po0.05). Multivariate Cox regression analysis showed that receptor status change was independently related to disease-free survival (DFS) (Hazard Ratio 6.88; p ¼0.002), whereas as it did not have any impact on OS (p ¼0.148). Conclusion: NAC induced changes in HR and HER-2 expression, predominantly from positive to negative. These changes were associated with shorter DFS. Postoperative re-evaluation of receptor status may have clinical significance.