Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?

C Simmons, N Miller, W Geddie, D Gianfelice, M Oldfield, G Dranitsaris, M J Clemons, C Simmons, N Miller, W Geddie, D Gianfelice, M Oldfield, G Dranitsaris, M J Clemons

Abstract

Background: Decisions about systemic treatment of women with metastatic breast cancer are often based on estrogen receptor (ER), progesterone receptor (PgR), and Her2 status of the primary tumor. This study prospectively investigated concordance in receptor status between primary tumor and distant metastases and assessed the impact of any discordance on patient management.

Materials and methods: Biopsies of suspected metastatic lesions were obtained from patients and analyzed for ER/PgR and Her2. Receptor status was compared for metastases and primary tumors. Questionnaires were completed by the oncologist before and after biopsy to determine whether the biopsy results changed the treatment plan.

Results: Forty women were enrolled; 35 of them underwent biopsy, yielding 29 samples sufficient for analysis; 3/29 biopsies (10%) showed benign disease. Changes in hormone receptor status were observed in 40% (P = 0.003) and in Her2 status in 8% of women. Biopsy results led to a change of management in 20% of patients (P = 0.002).

Conclusions: This prospective study demonstrates the presence of substantial discordance in receptor status between primary tumor and metastases, which led to altered management in 20% of cases. Tissue confirmation should be considered in patients with clinical or radiological suspicion of metastatic recurrence.

Figures

Figure 1.
Figure 1.
(A) Organization chart of participants. (B) Organization chart of results.
Figure 2.
Figure 2.
(A) Percentage change in positivity of estrogen receptor (ER). (B) Percentage change in positivity of progesterone receptor (PgR).

References

    1. Brennan MJ, Donegan WL, Appleby DE. The variability of estrogen receptors in metastatic breast cancer. Am J Surg. 1979;137:260–262.
    1. Allegra JC, Barlock A, Huff KK, Lippman ME. Changes in multiple or sequential estrogen receptor determination in breast cancer. Cancer. 1980;45:792–794.
    1. Holdaway IM, Bowditch JV. Variation in receptor status between primary and metastatic breast cancer. Cancer. 1983;52:479–485.
    1. Hull DF, Clark GM, Osborne CK, et al. Multiple estrogen receptor assays in human breast cancer. Cancer Res. 1983;43:413–416.
    1. Raemaekers JM, Beex LV, Koenders AJ, et al. Concordance and discordance of estrogen and progesterone receptor content in sequential biopsies of patients with advanced breast cancer: relation to survival. Eur J Cancer Clin Oncol. 1984;20:1011–1018.
    1. Gross GE, Clark GM, Chamness GC, et al. Multiple progesterone receptor assays in human breast cancer. Cancer Res. 1984;44:836–849.
    1. Mobbs BG, Fish EB, Pritchard KI, et al. Estrogen and progesterone receptor content of primary and secondary breast cancer: influence of time and treatment. Eur J of Cancer Clin Oncol. 1987;23(6):819–826.
    1. Rasmussen BB, Thorpe SM, Nørgaard T, et al. Immunohistochemical detection of estrogen receptors in paraffin sections from primary and metastatic breast cancer. Pathol Res Pract. 1989;185:856–859.
    1. Hawkins RA, Tesdale AL, Anderson ED, et al. Does the oestrogen receptor concentration of a breast cancer change during systemic therapy? Br J Cancer. 1990;61:877–880.
    1. Johnston SR, Saccani-Jotti G, Smith IE, et al. Changes in estrogen receptor, progesterone receptor, and pS2 expression in tamoxifen-resistant human breast cancer. Cancer Res. 1995;55:3331–3338.
    1. Li BD, Byskosh A, Molteni A, Duda RB. Estrogen and progesterone receptor concordance between primary and recurrent breast cancer. J Surg Oncol. 1994;57(2):71–77.
    1. Kuukasjarvi T, Kononen J, Helin H, et al. Loss of ER in recurrent breast cancer is associated with poor response to endocrine therapy. J Clin Oncol. 1996;14:2584–2589.
    1. Umekita Y, Sagara Y, Yoshida H. Estrogen receptor mutations and changes in estrogen receptor and progesterone receptor protein expression in metastatic or recurrent breast cancer. Jpn J Cancer Res. 1998;89:27–32.
    1. Bachleitner-Hofmann T, Pichler-Gebhard B, Rudas M, et al. Pattern of hormone receptor status of secondary contralateral breast cancers in patients receiving adjuvant tamoxifen. Clin Cancer Res. 2002;8:3427–3432.
    1. Gutierrez MC, Detre S, Johnston S, et al. Molecular changes in tamoxifen-relapsed breast cancer: relationship between ER, HER2 and P38-MAP-kinase. J Clin Oncol. 2005;23(11):2469–2476.
    1. Robertson J, Gutteridge E, Cheung KL, et al. Oestrogen receptor expression in human breast cancer during long-term fulvestrant treatment. Proceedings of ASCO. 2004;22(Suppl):14S. (Abstr 536)
    1. Franco A, Col N, Chlebowski RT, et al. Discordance in estrogen (ER) and progestin receptor (PR) status between primary metastatic breast cancer: a meta-analysis. ASCO Annual Meeting Proceedings (Post-Meeting Edition). J Clin Oncol 2004; 22: 14S (Abstr 539)
    1. Lower EE, Glass EL, Bradley DA, et al. Impact of metastatic ER and PR status on survival. Breast Cancer Res Treat. 2005;90:65–70.
    1. Lipton A, Leitzel K, Ali SM, et al. Serum HER-2/neu conversion to positive at the time of cancer progression in metastatic breast patients treated with letrozole vs. tamoxifen. Cancer. 2005;104(2):257–263.
    1. Regitnig P, Schippinger W, Lindbauer M, et al. Change of HER-2/neu status in a subset of distant metastases from breast carcinomas. J Pathol. 2004;203(4):918–926.
    1. Fehm T, Jäger W, Kraemer S, et al. Changes of serum Her2 status during clinical course of metastatic breast cancer patients. Anticancer Res. 2004;24(6):4205–4210.
    1. Broom R, Tang P, Simmons C, et al. Changes in estrogen receptor (ER), progesterone receptor (PR) and HER-2/neu status with time: discordance between primary and metastatic breast pathology samples. Proceedings of ASCO. 2007;25(Suppl) Part I, 18S (Abstr 1024)
    1. McFarlane R, Speers C, Masoudi H, Chia S. Molecular changes in the primary breast cancer versus the relapsed/metastatic lesion from a large population-based database and tissue microarray series. Proceedings of ASCO. 2008;26(Suppl) (Abstr 1000)
    1. Broglio K, Moulder SL, Hsu L, et al. Prognostic impact of discordance/concordance of triple-negative expression between primary tumor and metastasis in patients with metastatic breast cancer. Proceedings of ASCO. 2008;26(Suppl) (Abstr 1001)
    1. Agulnik M, Oza AM, Pond GR, Siu LL. The impact and perception of mandatory tumour biopsies for correlative studies in clinical trials of novel anticancer agents. J Clin Oncol. 2006;24(30):4801–4807.
    1. Hanna W, O'Malley FP, Barnes P, et al. Updated recommendations from the Canadian National Consensus Meeting on HER2/neu testing in breast cancer. Curr Oncol. 2007;14(4):149–153.
    1. Wolff AC, Hammond ME, Schwartz JN, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol. 2007;25(1):118–145.
    1. Goss PE. Factors mediating endocrine therapy response and resistance. Proceedings of ASCO 2008; 26 (Suppl): 15S. Session discussant (Abstr 1000 & 1001)
    1. Piccart-Gebhart MJ. Adjuvant ovarian suppression combined with tamoxifen or anastrozole, alone or in combination with zoledronic acid, in premenopausal women with hormone-responsive, stage I and II breast cancer: first efficacy results from ABCSG-12. Proceedings of the ASCO 2008; 26 (Suppl): 15S. Plenary session discussant (Abstr 248)
    1. Rhodes A, Jasani B, Barnes DM, et al. Reliability of immunohistochemical demonstration of oestrogen receptors in routine practice: interlaboratory variance in the sensitivity of detection and evaluation of scoring systems. J Clin Pathol. 2000;53:125–130.
    1. Kurbel S. Selective reduction of estrogen receptor (ER) positive breast cancer occurrence by estrogen receptor modulators supports etiological distinction between ER positive and ER negative breast cancers. Med Hypotheses. 2005;64:1182–1187.

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