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HER-2 status may change in breast cancer metastases
Fabi A. Clin Cancer Res. 2011;doi:10.1158/1078-0432.CCR-10-1920.
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Researchers from Regina Elena Cancer Institute in Rome have found that HER-2 status was discordant between the primary breast cancer and the metastases in 10% of the cases.
In patients whose HER-2 status changed from negative in the primary breast cancer to positive in the metastases, the time to progression was longer in patients who were treated with trastuzumab (Herceptin, Genentech).
“Although HER-2 is usually evaluated in primary breast cancer, knowledge of HER-2 status in metachronous metastatic dissemination could be of potential value for therapeutic decision-making,” the researchers wrote. “It has recently been reported that HER-2 status is mostly unchanged between primary tumors and their synchronous lymph node metastases, but may be discordant in 6% to 48% of metachronous metastases.”
The researchers analyzed HER-2 status by immunohistochemistry, silver in situ hybridization and fluorescence in situ hybridization in tissues collected from 137 patients with invasive breast cancer who were diagnosed between 1999 and 2007. They constructed tissue microarrays of the breast cancer tissue and its metachronous metastases.
Of the 137 primary breast cancers studied, 114 were infiltrating ductal carcinomas, 14 were invasive lobular carcinomas and nine were other histotypes. Sixty patients were node-negative and 77 were node-positive. Eighty-two of the cancers were ER- and PR-positive, and HER-2 status was positive in 25 patients.
Researchers found that the HER-2 status was discordant in 14 cases. Twelve were negative in the primary tumors but positive in the metastases, whereas two were positive in the primary tumor and negative in the metastases. The status changed more frequently in tumors that were positive for hormone receptors. When the patients were treated with trastuzumab, patients whose HER-2 status changed from negative to positive had a longer time to progression than those who were untreated.
“These data not only underline the importance of testing HER-2 status in metastases … but also open up the possibility of significantly improving the prognosis of these subsets of patients,” the researchers wrote.
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