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. 2020 Aug;183(1):137-144.
doi: 10.1007/s10549-020-05746-8. Epub 2020 Jul 1.

Estrogen, progesterone, and human epidermal growth factor receptor 2 discordance between primary and metastatic breast cancer

Vincent Walter  1 , Chiara Fischer  2   3 , Thomas M Deutsch  2   3 , Catherine Ersing  1 , Juliane Nees  2 , Florian Schütz  2 , Carlo Fremd  3 , Eva-Maria Grischke  1 , Peter Sinn  4 , Sara Y Brucker  1 , Andreas Schneeweiss  3   5 , Andreas D Hartkopf  1 , Markus Wallwiener  6
Affiliations

Estrogen, progesterone, and human epidermal growth factor receptor 2 discordance between primary and metastatic breast cancer

Vincent Walter et al. Breast Cancer Res Treat. 2020 Aug.

Abstract

Background: The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) statuses are frequently discordant between the primary tumor and metastatic lesions in metastatic breast cancer. This can have important therapeutic implications.

Patients and methods: In all, 541 patients with available receptor statuses from both primary tumor and metastatic lesion treated at Heidelberg and Tuebingen University Hospitals between 1982 and 2018 were included.

Results: Statistically significant discordance rates of 14% and 32% were found for ER and PR. HER2 status was statistically insignificantly discordant in 15% of patients. Gain in HER2 positivity was associated with an improved overall survival, whereas loss of HR positivity was associated with worse overall survival. Antiendocrine treatment differed in 20% of cases before and after biopsy and HER2-directed treatment in 14% of cases.

Conclusions: Receptor statuses are discordant between primary tumor and metastasis in a considerable fraction of patients with metastatic breast cancer. Next to a highly presumed predictive value with respect to efficacy of endocrine and HER2-targeted therapy, discordance seems to provide prognostically relevant information. Where feasible, metastatic lesions should be biopsied in accordance with current guidelines.

Keywords: Distant metastasis; Estrogen receptor (ER); Human epidermal growth factor receptor 2 (HER2); Metastatic breast cancer; Progesterone receptor (PR); Receptor status discordance.

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Conflict of interest statement

All other authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Overall survival by HR status change in months
Fig. 2
Fig. 2
Overall survival by HER2 status change in months
See this image and copyright information in PMC

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