Changes In HER2 And Hormonal Receptors Biomarkers After Neoadjuvant Chemotherapy For Breast Cancer And Impact On Adjuvant Therapy Selection

Paula Ferreira Pinto; Mariana Peyroteo; Luís Castro; Rita Canotilho; Ana Margarida Correia; Catarina Baía; Cátia Ribeiro; Pedro Antunes; Paulo Reis; Joaquim Abreu de Sousa

doi:10.34635/rpc.1027

Paula Ferreira Pinto Surgical Oncology Department, IPO Porto, Porto, Portugal http://orcid.org/0000-0003-2075-2827
Mariana Peyroteo Surgical Oncology Department, IPO Porto, Porto, Portugal http://orcid.org/0000-0002-0941-2533
Luís Castro General Surgery Department, Hospital Egas Moniz – Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal http://orcid.org/0000-0001-9575-9826
Rita Canotilho Surgical Oncology Department, IPO Porto, Porto, Portugal http://orcid.org/0000-0003-3914-0679
Ana Margarida Correia Surgical Oncology Department, IPO Porto, Porto, Portugal http://orcid.org/0000-0003-0112-7401
Catarina Baía Surgical Oncology Department, IPO Porto, Porto, Portugal http://orcid.org/0000-0002-0696-5212
Cátia Ribeiro Surgical Oncology Department, IPO Porto, Porto, Portugal
Pedro Antunes Surgical Oncology Department, IPO Porto, Porto, Portugal
Paulo Reis Surgical Oncology Department, IPO Porto, Porto, Portugal
Joaquim Abreu de Sousa Surgical Oncology Department, IPO Porto, Porto, Portugal http://orcid.org/0000-0002-4988-6987

Abstract

Introduction: Breast cancer biological subtype has an important impact in the definition of the treatment strategy and the prognosis. However, the influence of neoadjuvant chemotherapy in the immunohistochemistry profile of the tumor is not well clarified. This study aims to evaluate the incidence of immunohistochemistry profile changes after neoadjuvant chemotherapy and the impact of these changes in adjuvant therapeutic decisions.

Methods: Retrospective review of all breast cancer patients consecutively treated with neoadjuvant therapy followed by surgery between January 2013 and July 2019. Only patients with complete information on hormone receptors (HR) and human epidermal growth factor 2 (HER2) status on both pre-chemotherapy biopsy and post-chemotherapy surgical specimen were included.

Results: During the study period, a total of 655 patients with 662 carcinomas were submitted to neoadjuvant therapy and surgical treatment. From this original cohort, 37.9% didn’t have a complete immunohistochemistry profile, 22.7% had a complete pathological response and one patient had only neoadjuvant hormonal therapy, and was excluded from the study. From the 260 analyzed tumors, 99.2% of the patients were female, with a median age of 50 years. The majority of tumors were cT2 (38.8%) and cT3 (39.2%), as well as cN+ (71.5%). The most common biological subtype at diagnosis was HR-positive/HER2 negative in 50.8% of cases, followed by HR negative/HER2 negative in 27.3%, HR-positive/HER2 positive in 15.4% and HR negative/HER2 positive in 6.5%. There was a change in biological subtype in 10% of patients, namely 5.7% of changes in HER2 profile and 4.2% changes in HR. The changes in progesterone receptors were the only statistically significant between the biopsy and surgical specimen analysis (p<0.001). From the group where immunohistochemistry markers changed, in 42.3% there was a change in adjuvant treatment. In all cases in which HER2 or RH status changed from negative to positive, there was a modification in adjuvant treatment. In most cases in which HR and/or HER2 status changed from positive to negative, adjuvant therapy was performed according to the pre-chemotherapy biopsy findings.

Conclusion: Immunohistochemistry markers changed in 10% of breast cancer patients after neoadjuvant chemotherapy. The main therapeutic modifications were made when there was a change in receptor status from negative to positive. Therefore, it is important to reconsider the evaluation of biological markers in surgical specimens, mainly in patients with negative receptors at diagnosis, so that adjuvant therapies can be adjusted accordingly.

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