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. 2025 Jun 9:15:1522460.
doi: 10.3389/fonc.2025.1522460. eCollection 2025.

HER2 and hormone receptor conversion after neoadjuvant therapy for breast cancer

Jing Wang #  1   2 , Xin Long #  3   4 , Mingxi Tang  1 , Xiuli Xiao  2
Affiliations

HER2 and hormone receptor conversion after neoadjuvant therapy for breast cancer

Jing Wang et al. Front Oncol. .

Abstract

Background: The expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) in residual lesions may be different compared with primary tumors of the breast after neoadjuvant therapy (NAT). Given the clinical implications of hormone receptor expression for breast cancer management, we assessed conversions in ER, PR, and HER2 in breast cancer patients after NAT.

Methods: Our study comprised 589 individuals with aggressive breast cancer who underwent NAT. We examined the ER, PR, and HER2 statuses in primary and residual breast cancers and investigated the relationship between receptor conversion and clinicopathological variables.

Results: The pathologic complete response (pCR) rate for the overall cohort was 38.7%, with pCR rates of 57.0%, 13.1%, and 33.3% for HER2-positive, Luminal, and triple-negative breast cancer (TNBC), respectively. Cases with negative hormone receptor expression were more likely to achieve pCR than positive cases. The highest pCR rates were seen in HER2-positive breast cancers, followed by HER2-zero and HER2-low tumors. After NAT, there were 26 (7.8%) cases of ER status conversion and 53 (16.0%) cases of PR status conversion. The conversion of hormone receptors was mainly from positive to negative. When cases were categorized as HER2-negative or positive, 15 (5.1%) cases had a conversion of HER2 status, predominantly positive to negative. When cases were classified as HER2-zero, -low, or -positive, HER2 status conversion happened in 54 (18.6%) cases and was mostly happened between HER2-zero and HER2-low. HER2 status before NAT correlated with ER and HER2 conversion.

Conclusion: Some breast cancer patients may show ER, PR, or HER2 status conversion after NAT. Residual lesions need to be immunohistochemically re-tested to reassess the patient's receptor expression status and to adjust the subsequent treatment regimen.

Keywords: breast cancer; estrogen receptor; human epidermal growth factor receptor 2; neoadjuvant therapy; progesterone receptor.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Rates of pCR by (A) subtype (HER2-overexpressing, Luminal, and TNBC); (B) hormone receptor status (ER-negative and ER-positive; PR-negative and PR-positive); and (C) HER2 status (zero, low, and positive).
Figure 2
Figure 2
IHC images of patients with receptor conversion: (A) ER; (B) PR and (C) HER2.
Figure 3
Figure 3
Conversion of hormone receptor expression between primary and residual tumors: (A) ER and (B) PR.
Figure 4
Figure 4
Conversion of HER2 expression between primary and residual tumors: (A) HER2 is categorized as negative or positive; (B) HER2 is categorized as zero, low, or positive.
Figure 5
Figure 5
Conversion of expression in HER2-negative patients between primary and residual tumors: (A) Luminal and (B) TNBC.
See this image and copyright information in PMC

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References

    1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. (2024) 74:229–63. doi: 10.3322/caac.21834 - DOI - PubMed
    1. Costa B, Amorim I, Gärtner F, Vale N. Understanding breast cancer: from conventional therapies to repurposed drugs. Eur J Pharm Sci. (2020) 151:105401. doi: 10.1016/j.ejps.2020.105401 - DOI - PubMed
    1. Gradishar WJ, Anderson BO, Abraham J, Aft R, Agnese D, Allison KH, et al. Breast cancer, version 3.2020, nccn clinical practice guidelines in oncology. J Natl Compr Canc Netw. (2020) 18:452–78. doi: 10.6004/jnccn.2020.0016 - DOI - PubMed
    1. Balic M, Thomssen C, Würstlein R, Gnant M, Harbeck N. St. Gallen/vienna 2019: A brief summary of the consensus discussion on the optimal primary breast cancer treatment. Breast Care (Basel). (2019) 14:103–10. doi: 10.1159/000499931 - DOI - PMC - PubMed
    1. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the ctneobc pooled analysis. Lancet. (2014) 384:164–72. doi: 10.1016/S0140-6736(13)62422-8 - DOI - PubMed

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