Breast Cancer Research and Treatment

, Volume 113, Issue 2, pp 301–306

HER-2/neu expression in primary and metastatic breast cancer

  • Elyse E. Lower
  • Eleanor Glass
  • Robbin Blau
  • Stacy Harman
Clinical Trial
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Abstract

Introduction Trastuzumab is a highly effective therapy for the treatment of HER-2/neu positive breast cancer. To maximize benefit and minimize unnecessary toxicity, patient selection is essential. Currently HER-2/neu analysis is routinely performed only for primary invasive breast cancers, and trastuzumab therapy is recommended based on primary analysis only. Methods Using immunohistochemistry, we performed a retrospective study comparing HER-2/neu expression in original primary to subsequent metastatic breast cancers. Results Tumors from 382 patients with metastatic breast cancer were studied. In 254 cases (66%) both primary and metastatic lesions were concordant. In 90 cases the primary lesion was HER-2/neu positive with the metastatic lesion negative; whereas, in 37 cases the primary lesion was HER-2/neu negative and the metastatic lesion positive. Primary HER-2/neu immunostaining was associated with a negative predictive value of 35.7%. Although all four groups were similar at diagnosis, survival differences were noted with the best survival experienced by patients with initial primary lesions HER-2/neu negative and subsequent metastatic lesions positive. Patients with hormone receptor and HER-2/neu positive primary lesions who received tamoxifen were more likely to have HER-2/neu positive metastasis. Conclusions The significant discordance between HER-2/neu expression in primary and metastatic tumors suggests that determination of HER-2/neu status in metastatic disease should be attempted.

Keywords

HER-2/neu Trastuzumab Breast cancer Estrogen receptor Metastatic disease 

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Elyse E. Lower
    • 1
    • 2
  • Eleanor Glass
    • 1
  • Robbin Blau
    • 1
  • Stacy Harman
    • 1
  1. 1.Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Oncology-Hematology Care, Inc.CincinnatiUSA

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