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Biopsy needed to confirm switched biomarker status between primary, recurrent breast cancer

Thompson AM. Breast Cancer Research. 2010;doi:10.1186/bcr2771.

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Mounting evidence exists that patients with relapsed breast cancer should undergo confirming tissue sampling to identify changes in biomarker status that might influence disease treatment.

According to background information of the retrospective Breast Recurrence in Tissues Study – or BRITS – historically, ER, PR, and HER2 status taken from the primary cancer were used to direct treatment upon recurrence; however, this approach is no longer considered appropriate. Instead, new tissue should be tested upon disease recurrence, the researchers wrote.

“While the time needed to obtain such a biopsy may raise patient concerns, avoiding misdiagnosis based on clinical opinion in 8.8% to 10% of women supports tissue biopsy in the absence of imaging techniques sufficiently mature to replace pathology assessment,” they wrote.

In the study, matched tissue samples from primary and recurrent breast cancer tissue were prospectively collected from 205 women at 20 centers. Paired samples from 137 women were eligible for analysis. The mean age of patients was 62.2 years and the mean time to first recurrence of breast cancer was 93.2 months.

On average, 9 years passed between biopsy of the original tissue from the primary cancer and biopsy used for BRITS.

The biopsies indicated that a switch in receptor status occurred for ER in 14 patients (10.2%; P=.98), for PR in 34 patients (24.8%; P=.003) and for HER2 in four patients (2.9%; P=.074). This switch in biomarker status resulted in a change of treatment plan for 17.5% of patients, or one in six.

“This large prospective study has demonstrated that the management of relapsed breast cancer should include tissue sampling to avoid misdiagnosis of one in 12 patients, to confirm diagnosis of recurrent breast cancer, to identify switches of ER, PR and HER2 status in locally recurrent or metastatic breast cancer and to influence the planned treatment for one in six patients,” the researchers concluded.

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