Annals of Oncology Advance Access published online on November 6, 2007
Annals of Oncology, doi:10.1093/annonc/mdm509
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© 2007 European Society for Medical Oncology
Expression of ER, PgR, HER1, HER2, and response: a study of preoperative chemotherapy
1 Unit of Research in Medical Senology, Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan
2 Division of Pathology, European Institute of Oncology
3 School of Medicine, University of Milan, Milan, Italy
4 International Breast Cancer Study Group, Statistical Center, Dana-Farber Cancer Institute, and Frontier Science and Technology Research Foundation, Boston, MA, USA
5 Division of Senology, European Institute of Oncology, Milan
6 Department of Medicine, European Institute of Oncology, Milan, Italy
* Correspondence to: Dr M. Colleoni, Unit of Research in Medical Senology, Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. Tel: +39-02-57489439; Fax: +39-02-57489212; E-mail: marco.colleoni{at}ieo.it
Purpose: To identify the role of estrogen (ER), progesterone (PgR), epidermal growth factor 1 (HER1), and HER2 receptors in predicting response to preoperative chemotherapy.
Materials and methods: We reviewed the pretreatment biopsies of 485 patients with locally advanced breast cancer (cT2-T4, N0-2, M0) treated with preoperative chemotherapy. The incidence of pathological complete remission (pCR) and outcome were assessed with respect to clinical and pathological findings including ER/PgR status (absent versus expressed), HER1 (absent versus expressed) and HER2 (overexpressed versus none) expression.
Results: Patients with ER/PgR-absent tumors were 12.0 times [95% confidence interval (CI) 4.93–29.28] more likely to achieve a pCR (P < 0.0001). Predictors of disease-free survival (DFS) at the univariate analysis included HER1 [hazards ratio (HR) 1.6, 95% CI 1.04–2.32, P = 0.03] and HER2 (HR 1.6, 95% CI 1.08–2.38, P = 0.02) expression. A statistically significant difference in DFS was confirmed at the multivariate analysis for patients with ER/PgR-absent disease (HR 2.1, 95% CI 1.41–2.99, P = 0.0002).
Conclusions: The pCR rate is higher and outcome worse for patients with ER/PgR-absent tumors. HER1 and HER2 expression may have a prognostic role in locally advanced breast cancer and warrant further studies.
breast cancer, predictive factors, prognostic factors, primary chemotherapy
Received for publication July 13, 2007. Revision received October 1, 2007. Accepted for publication October 2, 2007.
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