Alteration of Estrogen Receptor, Progesterone Receptor, and HER-2 Expression in Breast Cancer after Neoadjuvant Chemotherapy

Jong Won Lee; Wonshik Han; Eunyoung Ko; Jihyoung Cho; So-Youn Jung; Eun-Kyu Kim; Bhumsuk Keam; Seock-Ah Im; Ho-chang Lee; In Ae Park; Seung Keun Oh; Yeo-Kyu Youn; Sung-Won Kim; Ki-Tae Hwang; Dong-Young Noh

doi:10.4048/jbc.2007.10.3.206

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Lee, Han, Ko, Cho, Jung, Kim, Keam, Im, Lee, Park, Oh, Youn, Kim, Hwang, and Noh: Alteration of Estrogen Receptor, Progesterone Receptor, and HER-2 Expression in Breast Cancer after Neoadjuvant Chemotherapy

Original Article

Journal of Breast Cancer

Journal of Breast Cancer 2007; 10(3): 206-210.

Published online: 30 September 2007

DOI: https://doi.org/10.4048/jbc.2007.10.3.206

Alteration of Estrogen Receptor, Progesterone Receptor, and HER-2 Expression in Breast Cancer after Neoadjuvant Chemotherapy

Jong Won Lee, Wonshik Han, Eunyoung Ko, Jihyoung Cho, So-Youn Jung, Eun-Kyu Kim, Bhumsuk Keam¹, Seock-Ah Im¹, Ho-chang Lee², In Ae Park², Seung Keun Oh, Yeo-Kyu Youn, Sung-Won Kim, Ki-Tae Hwang, Dong-Young Noh

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

¹Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

²Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.

dynoh@plaza.snu.ac.kr

Received 2 May 2007 Accepted 21 June 2007

Abstract

Purpose

We aimed to assess the concordance of the immunohistochemical profiles of core biopsy before administrating neoadjuvant chemotherapy with that of the surgical specimens after a definitive operation for breast cancer.

Methods

We retrospectively reviewed the estrogen receptor (ER), progesterone receptor (PR), and HER-2 expressions in 130 consecutive patients who received neoadjuvant chemotherapy and were followed by surgery during the period between February 2002 and March 2006. The pathologic complete tumor response rate for this group was 4.6% (6/130). Both the pre- and post-operative immunohistochemical profiles were available in 32 of the 124 patients (25.8%). Immunohistochemical staining was done on the core biopsies before chemotherapy and on the surgical specimens after operation.

Results

There were 12 markers from 11 patients that were altered out of the 96 total markers (ER, PR, or HER-2) from 32 patients: 2 ER (2/12, 16.7%), 4 PR (4/12, 33.3%), and 6 HER-2 (6/12, 50.0%). One patient simultaneously had changes in the expressions of PR and HER-2. Conversion of the hormone receptor status occurred in 3 patients (3/32, 9.4%): this was positive to negative in two, and vice versa in one. In addition, there were 6 conversions (6/32, 18.8%) of the HER-2 status from negative to positive.

Conclusion

The hormone receptor status changed in 9.4% of the 32 patients and the HER-2 status changed in 18.8% of the 32 patients after neoadjuvant chemotherapy. We have concluded that conducting only a single immunohistochemical study about ER, PR, and HER-2 may not be enough to exactly estimate the tumor marker status in the neoadjuvant setting.

Keywords: Breast cancer, Neoadjuvant chemotherapy, Tumor marker expression, Steroid hormone receptor, HER-2

Figures and Tables

Table 1

Clinicopathologic characteristics

Table 2

Treatment characteristics

PR=partial response; SD=stable disease; PD=progressive disease; BCS=breast conserving surgery.

Table 3

Alteration patterns of ER and PR expression on IHC after neoadjuvant chemotherapy (n=32)

ER=estrogen receptor; PR, progesterone receptor; IHC=immunohistochemistry.

^*Hormone receptor (+)=ER (+) and/or PR (+); ^†Hormone receptor (-)=ER (-) and PR (-).

Table 4

Alteration patterns of HER-2 on IHC after neoadjuvant chemotherapy

IHC=immunohistochemistry.

^*Conversion=(- or 1+) to (2+ or 3+) or vice versa.

Table 5

Clinicopathologic characteristics of 11 female patients who experienced receptor expression changes after neoadjuvant chemotherapy

Pt=patient's number; Dx=histologic diagnosis; NG=nuclear grade; HG=histologic grade; CTx=chemotherapy; Op=operation type; ER=estrogen receptor; PR, progesterone receptor; IDC=infiltrating ductal carcinoma; MC=medullary carcinoma; IMC=invasive micropapillary carcinoma; PR=partial response; SD=stable disease; PD=progressive disease; BCS=breast conserving surgery; MRM=modified radical mastectomy; NA=not available.

^*One patient (pt 3) simultaneously experienced PR down-expression and HER-2 up-expression.

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