Srivarshini Cherukupalli Mohan1, Sarah Walcott-Sapp2, Minna K Lee1, Marissa K Srour1, Sungjin Kim3, Farin F Amersi1, Armando E Giuliano1, Alice P Chung4. 1. Division of Surgical Oncology, Department of Surgery, Cedars Sinai Medical Center, West Hollywood, CA, USA. 2. Marion-Louise Saltzman Women's Center, Einstein Medical Center Philadelphia, Philadelphia, PA, USA. 3. Biostatistics and Bioinformatics Research Center, Cedars-Sinai Samuel Oschin Comprehensive Cancer Center, Los Angeles, CA, USA. 4. Division of Surgical Oncology, Department of Surgery, Cedars Sinai Medical Center, West Hollywood, CA, USA. alice.chung@cshs.org.
Abstract
INTRODUCTION: Biomarker changes in patients with residual disease (RD) after neoadjuvant systemic therapy (NAT) have unclear consequences. This study examined the prevalence of biomarker [hormone receptor (HR) and HER2] change and its effect on disease-free survival (DFS) and overall survival (OS). PATIENTS AND METHODS: A total of 303 patients treated with NAT from 2008 to 2016 were identified from a prospective database. Biomarker status at diagnosis was determined and retested after NAT in patients with RD. DFS and OS were compared among three groups: no biomarker change, clinically insignificant change in either ER or PR without alteration in HR status, and clinically significant change in at least one biomarker with resultant change in HR or HER2 status. Subgroups with no change and HR change were examined [HR+HER2- no change, triple negative (TN) no change, HR+HER2- to TN, TN to HR+HER2]. RESULTS: Overall, 61.4% of patients had RD. Of these, 32.8% had changes in at least one biomarker. At median follow up of 5.48 years, no biomarker change was associated with improved DFS compared with changes in HR or HER2 status (p = 0.043). In addition, no biomarker change (p = 0.005) and clinically insignificant changes in biomarker status (p = 0.019) were associated with improved OS compared with clinically significant changes in HR or HER2 status. Among subgroups, HR+HER2- to TN was associated with worse DFS (p = 0.029) and OS (p = 0.008) compared with HR+HER2- no change. CONCLUSIONS: Among those with RD, biomarker status change was common and impacted survival in subgroups of HR+ or TN disease. Retesting biomarkers after NAT has prognostic implications.
INTRODUCTION: Biomarker changes in patients with residual disease (RD) after neoadjuvant systemic therapy (NAT) have unclear consequences. This study examined the prevalence of biomarker [hormone receptor (HR) and HER2] change and its effect on disease-free survival (DFS) and overall survival (OS). PATIENTS AND METHODS: A total of 303 patients treated with NAT from 2008 to 2016 were identified from a prospective database. Biomarker status at diagnosis was determined and retested after NAT in patients with RD. DFS and OS were compared among three groups: no biomarker change, clinically insignificant change in either ER or PR without alteration in HR status, and clinically significant change in at least one biomarker with resultant change in HR or HER2 status. Subgroups with no change and HR change were examined [HR+HER2- no change, triple negative (TN) no change, HR+HER2- to TN, TN to HR+HER2]. RESULTS: Overall, 61.4% of patients had RD. Of these, 32.8% had changes in at least one biomarker. At median follow up of 5.48 years, no biomarker change was associated with improved DFS compared with changes in HR or HER2 status (p = 0.043). In addition, no biomarker change (p = 0.005) and clinically insignificant changes in biomarker status (p = 0.019) were associated with improved OS compared with clinically significant changes in HR or HER2 status. Among subgroups, HR+HER2- to TN was associated with worse DFS (p = 0.029) and OS (p = 0.008) compared with HR+HER2- no change. CONCLUSIONS: Among those with RD, biomarker status change was common and impacted survival in subgroups of HR+ or TN disease. Retesting biomarkers after NAT has prognostic implications.
Authors: Napa Parinyanitikul; Xiudong Lei; Mariana Chavez-MacGregor; Shuying Liu; Elizabeth A Mittendorf; Jennifer K Litton; Wendy Woodward; Amy Hong Zhang; Gabriel N Hortobagyi; Vicente Valero; Funda Meric-Bernstam; Ana M Gonzalez-Angulo Journal: Clin Breast Cancer Date: 2014-10-02 Impact factor: 3.225
Authors: Elizabeth A Mittendorf; Yun Wu; Maurizio Scaltriti; Funda Meric-Bernstam; Kelly K Hunt; Shaheenah Dawood; Francisco J Esteva; Aman U Buzdar; Huiqin Chen; Sameena Eksambi; Gabriel N Hortobagyi; Jose Baselga; Ana M Gonzalez-Angulo Journal: Clin Cancer Res Date: 2009-11-17 Impact factor: 12.531
Authors: N Niikura; A Tomotaki; H Miyata; T Iwamoto; M Kawai; K Anan; N Hayashi; K Aogi; T Ishida; H Masuoka; K Iijima; S Masuda; K Tsugawa; T Kinoshita; S Nakamura; Y Tokuda Journal: Ann Oncol Date: 2015-12-23 Impact factor: 32.976
Authors: T Hirata; C Shimizu; K Yonemori; A Hirakawa; T Kouno; K Tamura; M Ando; N Katsumata; Y Fujiwara Journal: Br J Cancer Date: 2009-10-06 Impact factor: 7.640