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KMID : 0939920230550041210
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대한암학회지
2023 Volume.55 No. 4 p.1210 ~ p.1221
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Prognostic Value of the Evolution of HER2-Low Expression after Neoadjuvant Chemotherapy
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Youzhao Ma
Mingda Zhu
Jingyang Zhang
Minhao Lv
Xiuchun Chen
Zhenzhen Liu
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Abstract
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Purpose : 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).
Materials and Methods : 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.
Results : 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).
Conclusion : 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.
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KEYWORD
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Breast neoplasms, Prognostic value, Evolution, HER2-low, HER2 gain, Disease-free survival, Neoadjuvant therapy
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