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Efficacy of endocrine therapy in relation to progesterone receptor and Ki67 expression in advanced breast cancer

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Abstract

We assessed whether progesterone receptor (PgR) and Ki67 in primary tumors and/or matched metastases are predictors of clinical benefit from first-line endocrine therapy (ET) in advanced breast cancer. We evaluated patients treated at our institute with first-line ET (2002–2011), excluding those receiving concomitant chemotherapy or trastuzumab or pretreated with >2 lines of chemotherapy. A cut-off of 20 % immunostained cells was used for PgR and Ki67. The main endpoint was time-to-progression (TTP). Groups were compared by the log-rank test and Cox multivariate analysis. In the 135 assessable patients (93 % were receiving an aromatase inhibitor; biomarker assessment had been performed on primary tumors in 77 cases, on metastases in 23 and on both in 35), median TTP was 16 months (median follow-up 43 months). The overall discordance rate between primary tumors and metastases was 23 % for Ki67 and 31 % for PgR. A longer median TTP (24 vs. 12 months, P = 0.012) was seen for PgR >20 % in metastases. Ki67 showed a trend for TTP prediction in the entire case series (P = 0.062). Patients with high Ki67 and low PgR in metastases had a median TTP of only 5 months. High Ki67 in primary tumors (P = 0.026) or metastases (P = 0.01) predicted disease progression at the first evaluation. PgR in metastases remained a significant independent predictor of TTP at multivariate analysis (HR 2.45). In an ER-high population, PgR >20 % in metastases identified patients with a long TTP on endocrine treatment, while Ki67 >20 % was associated with an increased risk of non-response.

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Acknowledgments

The authors wish to thank Ursula Elbling for editorial assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Oncology, Istituto Scientifico Romagnolo Per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014, Meldola, Italy

    Andrea Rocca, Alberto Farolfi, Roberta Maltoni, Elisabetta Melegari, Cristiano Ferrario, Lorenzo Cecconetto, Samanta Sarti, Alessio Schirone, Anna Fedeli, Elisabetta Pietri, Toni Ibrahim, Erika Montalto & Dino Amadori

  2. Unit of Biostatistics and Clinical Trials, IRST IRCCS, Meldola, Italy

    Elisa Carretta & Daniele Andreis

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  1. Andrea Rocca
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  2. Alberto Farolfi
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  12. Elisabetta Pietri
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  15. Dino Amadori
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Correspondence to Dino Amadori.

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Rocca, A., Farolfi, A., Maltoni, R. et al. Efficacy of endocrine therapy in relation to progesterone receptor and Ki67 expression in advanced breast cancer. Breast Cancer Res Treat 152, 57–65 (2015). https://doi.org/10.1007/s10549-015-3423-2

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  • DOI: https://doi.org/10.1007/s10549-015-3423-2

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