Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
Cancer Res Treat. 2023 Oct;55(4):1210-1221. doi: 10.4143/crt.2022.1633. Epub 2023 Apr 4.
Patients with human epidermal growth factor receptor 2 (HER2)-low advanced breast cancer can benefit from trastuzumab deruxtecan. Given the unclear prognostic characteristics of HER2-low breast cancer, we investigated the prognostic characteristics of HER2-low expression from primary tumor to residual disease after neoadjuvant chemotherapy (NACT).
The data of HER2-negative patients receiving NACT at our center were collected. Pathological complete response (pCR) rate were compared between HER2-0 and HER2-low patients. The evolution of HER2 expression from primary tumor to residual disease and its impact on disease-free survival (DFS) were examined.
Of the 690 patients, 494 patients had HER2-low status, of which 72.3% were hormone receptor (HR)-positive (p < 0.001). The pCR rates of HER2-low and HER2-0 patients (14.2% vs. 23.0%) showed no difference in multivariate analysis regardless of HR status. No association was observed between DFS and HER2 status. Of the 564 non-pCR patients, 57 (10.1%) changed to HER2-positive, and 64 of the 150 patients (42.7%) with HER2-0 tumors changed to HER2-low. HER2-low (p=0.004) and HR-positive (p=0.010) tumors before NACT were prone to HER2 gain. HER2 gain patients had a better DFS compared with HER2-negative maintained patients (87.9% vs. 79.5%, p=0.048), and the DFS of targeted therapy group was better than that of no targeted therapy group (92.4% vs. 66.7%, p=0.016).
Although HER2-low did not affect the pCR rate and DFS, significant evolution of HER2-low expression after NACT creates opportunities for targeted therapy including trastuzumab.
人表皮生长因子受体 2（HER2）低表达的晚期乳腺癌患者可以从曲妥珠单抗 deruxtecan 治疗中获益。鉴于 HER2 低表达乳腺癌的预后特征尚不清楚，我们研究了新辅助化疗（NACT）后从原发肿瘤到残留疾病的 HER2 低表达的预后特征。
收集我院接受 NACT 的 HER2 阴性患者的数据。比较 HER2-0 和 HER2-低患者的病理完全缓解（pCR）率。检查从原发肿瘤到残留疾病的 HER2 表达演变及其对无病生存期（DFS）的影响。
在 690 例患者中，494 例患者为 HER2-低状态，其中 72.3%为激素受体（HR）阳性（p<0.001）。在多变量分析中，无论 HR 状态如何，HER2-低和 HER2-0 患者的 pCR 率（14.2%vs.23.0%）均无差异。DFS 与 HER2 状态之间没有关联。在 564 例非 pCR 患者中，有 57 例（10.1%）转为 HER2 阳性，150 例 HER2-0 肿瘤中有 64 例（42.7%）转为 HER2-低。NACT 前的 HER2-低（p=0.004）和 HR 阳性（p=0.010）肿瘤更倾向于出现 HER2 获得。与 HER2 阴性维持患者相比，HER2 获得患者的 DFS 更好（87.9%vs.79.5%，p=0.048），靶向治疗组的 DFS 优于无靶向治疗组（92.4%vs.66.7%，p=0.016）。
尽管 HER2-低不影响 pCR 率和 DFS，但 NACT 后 HER2-低表达的显著演变为包括曲妥珠单抗在内的靶向治疗创造了机会。
