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Effect of level of hormone-receptor expression on treatment outcomes of “triple-positive” early-stage breast cancer

  • Epidemiology
  • Published:
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Abstract

Purpose

Breast cancer that overexpresses the human epidermal growth factor receptor-2 (HER2) and both estrogen (ER) and progesterone (PR) receptors is recently recognized as a subtype (triple-positive) with distinctive behavior and response to treatment. In this study, we investigate the treatment outcomes and the beneficial effect of anti-HER2 treatment in relation to level of hormone-receptor (HR) expression.

Methods

Consecutive breast cancer patients with triple-positive disease, diagnosed, treated and followed at our institution between 2006 and 2016 were enrolled. Disease-free survival (DFS) was studied in relation to the level of HR-positivity.

Results

During the study period, a total of 312 were enrolled; median age (range) was 47 (20–83) years. Fifty (16.0%) of the enrolled patients received adjuvant chemotherapy without trastuzumab (cohort A). All remaining patients were treated with both chemotherapy and trastuzumab and were divided into two groups: Cohort B with both ER and PR scores ≥ 50% (n = 130, 41.7%) and Cohort C with ER and/or PR < 50% (n = 132, 42.3%). After a median follow-up of 47 months, 14 (28.0%), 30 (23.1%) and 20 (15.2%) patients in cohorts A, B, and C had an event in a form of local/system relapse or death while disease-free. The estimated 5-year DFS was 56.2%, 75.4%, and 80.8%, respectively, and at 7 year was 56.2%, 67.1%, and 78.0%, respectively (p < 0.001).

Conclusions

HER2-positive tumors are not homogeneous; stronger ER/PR co-expression may weaken the beneficial effect of anti-HER2 therapy. Such findings may have potential implication on modifying anti-HER2 treatment based on the strength of HR expression.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AC:

Adriamycin and cyclophosphamide

ASCO:

American Society of Clinical Oncology

BCS:

Breast-conserving surgery

BMI:

Body mass index

CAP:

College of American Pathologists

CPG:

Clinical practice guidelines

DCIS:

Ductal carcinoma in situ

DFS:

Disease-free survival

ER:

Estrogen receptor

FISH:

Fluorescence in situ hybridization

HER2:

Human epidermal growth factor receptor-2

HR:

Hormone receptor

IHC:

Immune histochemical staining

IRB:

Institutional Review Board

MRM:

Modified radical mastectomy

PR:

Progesterone receptor

LCIS:

Lobular carcinoma in situ

LVI:

Lymphovascular invasion

OS:

Overall survival

TPBC:

Triple-positive breast cancer

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Internal Medicine, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O.Box 1269, Amman, 11941, Jordan

    Hikmat Abdel-Razeq, Sara Edaily, Mourad Salam, Yacob Saleh, Osama Salama, Rawan Mustafa, Yosra Al-Masri & Rayan Bater

  2. School of Medicine, University of Jordan, Amman, Jordan

    Hikmat Abdel-Razeq

  3. Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan

    Sereen Iweir & Ayat Taqash

  4. Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan

    Maher Sughayer

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  1. Hikmat Abdel-Razeq
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Correspondence to Hikmat Abdel-Razeq.

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Abdel-Razeq, H., Edaily, S., Iweir, S. et al. Effect of level of hormone-receptor expression on treatment outcomes of “triple-positive” early-stage breast cancer. Breast Cancer Res Treat 185, 459–467 (2021). https://doi.org/10.1007/s10549-020-05942-6

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