Neoadjuvant Chemotherapy Exerts Selection Pressure Towards Luminal Phenotype Breast Cancer

Giulia Galli, Giacomo Bregni, Stefano Cavalieri, Luca Porcu, Paolo Baili, Amash Hade, Francesca Di Salvo, Milena Sant, Roberto Agresti, Massimiliano Gennaro, Secondo Folli, Maria C. De Santis, Biagio Paolini, Maria L. Carcangiu, Filippo De Braud, Serena Di Cosimo

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Breast cancer (BC) phenotype after neoadjuvant chemotherapy (NAC) has not been extensively described and few data exist on whether expression of the primary tumor hormone receptors, HER2 and Ki-67 changes as a result of chemotherapy.Materials and Methods: We analyzed specimens from all BC patients treated with anthracycline/taxane-based NAC at our Institution between January 2010 and March 2015 (n = 325).The expression of estrogen receptor (ER), progesterone receptor (PR), HER2 and Ki-67 was determined in pre-and post-NAC specimens.McNemar's test was used to compare paired proportions.Results: Among patients with residual disease after NAC, basal phenotype was luminal A, luminal B, HER2 positive and triple negative in 44, 111, 74 and 27 cases, respectively.PR-positive tumors decreased from 68.0% in the initial biopsy sample to 61.7% in the surgical specimen (p = 0.024).A Ki-67 of < 20% increased from 23.6% to 45% (p < 0.001).ER expression changed from positive to negative in 5% and from negative to positive in 16.7% of cases.Overall, 30% of cases underwent subtype changes, 79% of them towards luminal differentiation.Conclusions: The switch towards luminal phenotype suggests some kind of endocrine effect of NAC.Our findings raise renewed interest in combinatorial cytotoxic chemotherapy with concomitant or rather sequential endocrine therapy, either alone or with targeted agents.

Original languageEnglish
Pages (from-to)391-394
Number of pages4
JournalBreast Care
Volume12
Issue number6
DOIs
Publication statusPublished - Dec 1 2017

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Breast Neoplasms
Phenotype
Pressure
Drug Therapy
Progesterone Receptors
Estrogen Receptors
Anthracyclines
Neoplasms
Hormones
Biopsy
Therapeutics

Keywords

  • Breast cancer
  • Chemotherapy, neoadjuvant
  • Endocrine therapy
  • Residual disease

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Galli, G., Bregni, G., Cavalieri, S., Porcu, L., Baili, P., Hade, A., ... Di Cosimo, S. (2017). Neoadjuvant Chemotherapy Exerts Selection Pressure Towards Luminal Phenotype Breast Cancer. Breast Care, 12(6), 391-394. https://doi.org/10.1159/000479582

Neoadjuvant Chemotherapy Exerts Selection Pressure Towards Luminal Phenotype Breast Cancer. / Galli, Giulia; Bregni, Giacomo; Cavalieri, Stefano; Porcu, Luca; Baili, Paolo; Hade, Amash; Di Salvo, Francesca; Sant, Milena; Agresti, Roberto; Gennaro, Massimiliano; Folli, Secondo; De Santis, Maria C.; Paolini, Biagio; Carcangiu, Maria L.; De Braud, Filippo; Di Cosimo, Serena.

In: Breast Care, Vol. 12, No. 6, 01.12.2017, p. 391-394.

Research output: Contribution to journalArticle

Galli G, Bregni G, Cavalieri S, Porcu L, Baili P, Hade A et al. Neoadjuvant Chemotherapy Exerts Selection Pressure Towards Luminal Phenotype Breast Cancer. Breast Care. 2017 Dec 1;12(6):391-394. https://doi.org/10.1159/000479582
Galli, Giulia ; Bregni, Giacomo ; Cavalieri, Stefano ; Porcu, Luca ; Baili, Paolo ; Hade, Amash ; Di Salvo, Francesca ; Sant, Milena ; Agresti, Roberto ; Gennaro, Massimiliano ; Folli, Secondo ; De Santis, Maria C. ; Paolini, Biagio ; Carcangiu, Maria L. ; De Braud, Filippo ; Di Cosimo, Serena. / Neoadjuvant Chemotherapy Exerts Selection Pressure Towards Luminal Phenotype Breast Cancer. In: Breast Care. 2017 ; Vol. 12, No. 6. pp. 391-394.
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AU - Galli, Giulia

AU - Bregni, Giacomo

AU - Cavalieri, Stefano

AU - Porcu, Luca

AU - Baili, Paolo

AU - Hade, Amash

AU - Di Salvo, Francesca

AU - Sant, Milena

AU - Agresti, Roberto

AU - Gennaro, Massimiliano

AU - Folli, Secondo

AU - De Santis, Maria C.

AU - Paolini, Biagio

AU - Carcangiu, Maria L.

AU - De Braud, Filippo

AU - Di Cosimo, Serena

PY - 2017/12/1

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N2 - Background: Breast cancer (BC) phenotype after neoadjuvant chemotherapy (NAC) has not been extensively described and few data exist on whether expression of the primary tumor hormone receptors, HER2 and Ki-67 changes as a result of chemotherapy.Materials and Methods: We analyzed specimens from all BC patients treated with anthracycline/taxane-based NAC at our Institution between January 2010 and March 2015 (n = 325).The expression of estrogen receptor (ER), progesterone receptor (PR), HER2 and Ki-67 was determined in pre-and post-NAC specimens.McNemar's test was used to compare paired proportions.Results: Among patients with residual disease after NAC, basal phenotype was luminal A, luminal B, HER2 positive and triple negative in 44, 111, 74 and 27 cases, respectively.PR-positive tumors decreased from 68.0% in the initial biopsy sample to 61.7% in the surgical specimen (p = 0.024).A Ki-67 of < 20% increased from 23.6% to 45% (p < 0.001).ER expression changed from positive to negative in 5% and from negative to positive in 16.7% of cases.Overall, 30% of cases underwent subtype changes, 79% of them towards luminal differentiation.Conclusions: The switch towards luminal phenotype suggests some kind of endocrine effect of NAC.Our findings raise renewed interest in combinatorial cytotoxic chemotherapy with concomitant or rather sequential endocrine therapy, either alone or with targeted agents.

AB - Background: Breast cancer (BC) phenotype after neoadjuvant chemotherapy (NAC) has not been extensively described and few data exist on whether expression of the primary tumor hormone receptors, HER2 and Ki-67 changes as a result of chemotherapy.Materials and Methods: We analyzed specimens from all BC patients treated with anthracycline/taxane-based NAC at our Institution between January 2010 and March 2015 (n = 325).The expression of estrogen receptor (ER), progesterone receptor (PR), HER2 and Ki-67 was determined in pre-and post-NAC specimens.McNemar's test was used to compare paired proportions.Results: Among patients with residual disease after NAC, basal phenotype was luminal A, luminal B, HER2 positive and triple negative in 44, 111, 74 and 27 cases, respectively.PR-positive tumors decreased from 68.0% in the initial biopsy sample to 61.7% in the surgical specimen (p = 0.024).A Ki-67 of < 20% increased from 23.6% to 45% (p < 0.001).ER expression changed from positive to negative in 5% and from negative to positive in 16.7% of cases.Overall, 30% of cases underwent subtype changes, 79% of them towards luminal differentiation.Conclusions: The switch towards luminal phenotype suggests some kind of endocrine effect of NAC.Our findings raise renewed interest in combinatorial cytotoxic chemotherapy with concomitant or rather sequential endocrine therapy, either alone or with targeted agents.

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KW - Chemotherapy, neoadjuvant

KW - Endocrine therapy

KW - Residual disease

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