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Clinical implications of receptor conversions in breast cancer patients who have undergone neoadjuvant chemotherapy

  • Epidemiology
  • Published:
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Abstract

Purpose

In this study, we aimed to determine the incidence of receptor conversions after neoadjuvant chemotherapy (NAC) for breast cancer and assess the rate at which receptor conversion leads to changes in adjuvant therapy regimens.

Methods

We performed a retrospective review of female breast cancer patients treated with NAC at an academic breast center between January 2017 and October 2021. Patients with residual disease on surgical pathology and complete receptor status information for both pre-NAC and post-NAC specimens were included. Incidence of receptor conversions, defined as a change in at least one hormone receptor (HR) or HER2 status compared to preoperative specimens, was tabulated, and adjuvant therapy modalities were reviewed. Factors associated with receptor conversion were analyzed using chi-square tests and a binary logistic regression.

Results

Of the 240 patients with residual disease after NAC, 126 (52.5%) had receptor testing repeated. After NAC, 37 specimens (29%) had a receptor conversion. Receptor conversion resulted in the addition or removal of an adjuvant therapy in 8 patients (6%), indicating a number needed to screen of 16. Prior history of cancer, receipt of initial biopsy at an outside site, HR-positive tumors, and a pathologic stage of II or lower were factors associated with receptor conversions.

Conclusion

HR and HER2 expression profiles frequently change after NAC and drive adjustments in adjuvant therapy regimens. Repeat testing of HR and HER2 expression should be considered in patients who receive NAC, especially in patients with early stage, HR-positive tumors whose initial biopsies were performed externally.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to the presence of patient identifiers within the dataset but will be made available in a deidentified format from the corresponding author on reasonable request.

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Funding

This work was supported in part by the Shared Resource of the Colorado Cancer Center support grant P30CA046934, by Grant 2020141 from the Doris Duke Charitable Foundation and the University of Colorado School of Medicine Paul Calabresi K12 award (K12CA086913).

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Authors and Affiliations

  1. Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Aurora, CO, 80045, USA

    Sudheer Vemuru, Kathryn Colborn, Victoria Huynh, Laura Leonard, Gretchen Ahrendt, Nicole Christian & Sarah Tevis

  2. University of Colorado School of Medicine, Aurora, CO, USA

    Jin Huang & YooJin Yoon

  3. Surgical Outcomes and Applied Research (SOAR) Program and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA

    Kathryn Colborn

  4. Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Anosheh Afghahi

  5. Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Lauren McLemore & Sharon Sams

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  1. Sudheer Vemuru
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Contributions

The authors confirm contribution to the paper as follows: study conception and design: SV, JH, KC, YY, VH, LL, GA, NC, AA, LM, SS, ST; data collection: SV, JH, YY; analysis and interpretation of results: SV, KC, ST; draft manuscript preparation and critical revision: SV, JH, KC, YY, VH, LL, GA, NC, AA, LM, SS, ST. All authors reviewed the results and approved the final version of the manuscript.

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Correspondence to Sudheer Vemuru.

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Vemuru, S., Huang, J., Colborn, K. et al. Clinical implications of receptor conversions in breast cancer patients who have undergone neoadjuvant chemotherapy. Breast Cancer Res Treat 200, 247–256 (2023). https://doi.org/10.1007/s10549-023-06978-0

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