Prospective evaluation of the conversion rate in the receptor status between primary breast cancer and metastasis: results from the GEICAM 2009-03 ConvertHER study

Eduardo Martínez de Dueñas, Ana Lluch Hernández, Angel Guerrero Zotano, Ramón María Pérez Carrión, José Ignacio Chacón López-Muñiz, Silvia Antolín Novoa, Angela López Rodríguez, José Alejandro Pérez Fidalgo, Jaime Ferrer Lozano, Octavio Burgués Gasión, Eva Carrasco Carrascal, Andrés Hernando Capilla, Isabel Blancas López-Barajas, Montserrat Muñoz Mateu, María Helena López de Ceballos Reyna, Amparo Oltra Ferrando, Noelia Martínez Jañez, Vicente Carañana Ballerini, Antonio Antón Torres, Gustavo Catalán, José Angel García Sáenz, Salomón Menjón, Ana María González-Angulo, Eduardo Martínez de Dueñas, Ana Lluch Hernández, Angel Guerrero Zotano, Ramón María Pérez Carrión, José Ignacio Chacón López-Muñiz, Silvia Antolín Novoa, Angela López Rodríguez, José Alejandro Pérez Fidalgo, Jaime Ferrer Lozano, Octavio Burgués Gasión, Eva Carrasco Carrascal, Andrés Hernando Capilla, Isabel Blancas López-Barajas, Montserrat Muñoz Mateu, María Helena López de Ceballos Reyna, Amparo Oltra Ferrando, Noelia Martínez Jañez, Vicente Carañana Ballerini, Antonio Antón Torres, Gustavo Catalán, José Angel García Sáenz, Salomón Menjón, Ana María González-Angulo

Abstract

The objective of this study was to determine the conversion rate of human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER) and progesterone receptor (PR) between primary tumors and metastatic lesions in advanced breast cancer. Patients with suspected diagnosis of locally recurrent or metastatic breast cancer, either at first relapse or after successive disease progressions, who had an appropriately preserved sample from a primary tumor and were scheduled for a biopsy of the recurrent lesion, were included. Blinded determinations of receptor status on paired samples were performed by immunohistochemistry and fluorescence in situ hybridization at a central laboratory and compared with those performed locally. Overall, 196 patients were included and 184 patients were considered evaluable. Reasons for non-evaluability included the inability to perform biopsy (n = 4) or biopsy results showing normal tissue (n = 3), benign disease (n = 3) or a second neoplasia (n = 2). Conversion rates determined at local level were higher than those determined centrally (HER2: 16 vs. 3 %, ER: 21 vs. 13 %, PR: 35 vs. 28 %, respectively). There was substantial agreement regarding the expression of HER2 in primary tumors and metastases, and ER at metastases, between local and central laboratories. PR at any site and ER at primary site showed moderate agreement. Oncologists altered their treatment plans in 31 % of patients whose tumor subtype had changed. These results reinforce the recommendation for performing confirmatory biopsies of metastases, not only to avoid misdiagnosis of breast cancer relapse, but also to optimize treatment (clinicaltrials.gov identifier: NCT01377363).

Figures

Fig. 1
Fig. 1
CONSORT diagram of the ConvertHER study

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Source: PubMed

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