Highlights
- •Low positive hormone receptor breast cancer responses to neoadjuvant chemotherapy were analysed.
- •Low positive hormone receptor breast cancer has worse survival than strong positive.
- •Low positive hormone receptor breast cancer mostly expresses basal-like features.
Abstract
Aim
To evaluate HER2-negative breast cancer (BC) with a low hormone receptor (HR) expression,
with regard to pathological complete response (pCR) and survival, in comparison to
triple-negative BC (TNBC) and strong HR-positive BC.
Methods
We compared negative [oestrogen (ER) and progesterone receptor (PR) <1%], low-positive
(ER and/or PR 1–9%) and strong-positive (ER or PR 10–100%) HR-expression in neoadjuvant
clinical trial cohorts (n = 2765) of BC patients. End-points were disease-free survival
(DFS), distant-disease free survival (DDFS) and overall survival (OS). We performed
RNA sequencing on available tumour tissue samples from patients with low-HR expression
(n = 38).
Results
Ninety-four (3.4%) patients had low HR-positive tumours, 1769 (64.0%) had strong HR-positive
tumours, and 902 (32.6%) had TNBC. There were no significant differences in pCR rates
between women with low HR-positive tumours (27.7%) and women with TNBC (35.5%). DFS
and DDFS were also not different [for DFS, hazard ratio 1.26, 95%-CI (confidence interval)
: 0.87–1.83, log-rank test p = 0.951; for DDFS, hazard ratio 1.17, 95%-CI: 0.78–1.76, log-rank test p = 0.774]. Patients with strong HR-positive tumours had a significantly lower pCR
rate (pCR 9.4%; odds ratio 0.38, 95%-CI: 0.23–0.63), but better DFS (hazard ratio
0.48, 95%-CI: 0.33–0.70) and DDFS (hazard ratio 0.49, 95%-CI: 0.33–0.74) than patients
with low HR-positive tumours. Molecular subtyping (RNA sequencing) of low HR-positive
tumours classified these predominantly into a basal subtype (86.8%).
Conclusion
Low HR-positive, HER2-negative tumours have a similar clinical behaviour to TNBC showing
high pCR rates and poor survival and also a basal-like gene expression signature.
Patients with low HR-positive tumours should be regarded as candidates for therapy
strategies targeting TNBC.
Keywords
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Article info
Publication history
Published online: March 17, 2021
Accepted:
February 13,
2021
Received in revised form:
February 8,
2021
Received:
December 3,
2020
Identification
Copyright
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