Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy.
Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Eur J Cancer. 2024 Apr;201:113920. doi: 10.1016/j.ejca.2024.113920. Epub 2024 Feb 10.
We have previously found that HER2 expression is dynamic, and can change from the primary breast tumor to matched recurrences. With this work, we aimed to assess the dynamics of HER2 during neoadjuvant treatment.(NAT).
We reviewed HER2 expression in pre- and post-treatment samples from consecutive patients with early-stage breast cancer that received NAT and underwent surgery at Dana-Farber Brigham Cancer Center between 01/2016-08/2022. The primary outcome was evolution of HER2 expression from pre- to post-NAT specimens in patients with residual disease.
Among 1613 patients receiving NAT, 1080 had residual disease at surgery. A total of 319 patients (29.5%) experienced a change in HER2 expression (HER2 0 vs. HER2-low vs. HER2-positive) from the pre-treatment sample to residual disease, with roughly equal distribution between decreased (50.5%) and increased HER2 expression (49.5%). Similar rates of change in HER2 expression were observed with anthracycline-based (31.8%) or taxane/platinum-based regimens (32.4%). Patients with HER2-0 or HER2-low tumors at diagnosis were likelier to experience a change in HER2 expression post-NAT compared to HER2-positive (32.3% vs. 21.3%, p < 0.001). Changes in HER2 expression post-NAT were prognostic among patients with HER2-positive tumors at diagnosis (3-year recurrence-free survival for change vs. no change: 71.6% vs. 89.6%, p = 0.006) but not among those with HER2-negative tumors at diagnosis (3-year recurrence-free survival for change vs. no change: 79.3% vs. 81.1%, p = 0.31).
Nearly 30% of patients with early-stage breast cancer showed a change in HER2 expression after NAT. Changes in HER2 expression post-NAT were only prognostic in the setting of HER2-positive tumors becoming HER2-negative at surgery.
我们之前发现 HER2 表达是动态的，并且可以从原发性乳腺癌转移到匹配的复发病灶。通过这项工作，我们旨在评估 HER2 在新辅助治疗（NAT）期间的动态变化。
我们回顾了 2016 年 1 月至 2022 年 8 月期间在达纳-法伯布列根癌症中心接受 NAT 并接受手术的早期乳腺癌连续患者的治疗前和治疗后样本中的 HER2 表达。主要结局是在残留疾病患者中，从治疗前样本到治疗后样本中 HER2 表达的演变。
在接受 NAT 的 1613 名患者中，1080 名患者在手术时仍有疾病残留。共有 319 名（29.5%）患者（HER20 与 HER2-低与 HER2-阳性）的 HER2 表达从治疗前样本到残留疾病发生变化，其中 HER2 表达减少（50.5%）和增加（49.5%）的分布大致相等。基于蒽环类药物（31.8%）或紫杉烷/铂类药物（32.4%）方案的患者中，HER2 表达变化的发生率相似。与 HER2 阳性肿瘤相比，诊断时为 HER2-0 或 HER2-低肿瘤的患者更有可能在 NAT 后发生 HER2 表达变化（32.3% vs. 21.3%，p<0.001）。诊断时为 HER2 阳性肿瘤的患者中，NAT 后 HER2 表达变化具有预后意义（变化与无变化的 3 年无复发生存率：71.6% vs. 89.6%，p=0.006），而诊断时为 HER2 阴性肿瘤的患者中则无（变化与无变化的 3 年无复发生存率：79.3% vs. 81.1%，p=0.31）。
近 30%的早期乳腺癌患者在接受 NAT 后出现 HER2 表达变化。NAT 后 HER2 表达变化仅在 HER2 阳性肿瘤在手术时变为 HER2 阴性的情况下具有预后意义。
