A Study of Hormone Receptor Status in Breast Carcinoma and use of HER2-Targeted Therapy in a Tertiary Care Center of India

• Published in: Indian journal of medical and paediatric oncology Vol. 40; no. S 01; pp. S54 - S60
• Main Authors: Bhaskar, Sandeep, Rastogi, Kartick, Gupta, Shivani, Jindal, Arpita, Bhatnagar, Aseem Rai, Jain, Sandeep
• Format: Journal Article
• Language: English
• Published: A-12, 2nd Floor, Sector 2, Noida-201301 UP, India Thieme Medical and Scientific Publishers Pvt. Ltd 01.07.2019; Wolters Kluwer India Pvt. Ltd; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd
• Subjects: Age; Analysis; Breast cancer; C-erb B-2 protein; Cancer patients; Cancer therapies; Carcinoma; Care and treatment; Chemotherapy; Cytogenetics; estrogen receptor; Estrogens; fluorescent in situ hybridization; Genotype & phenotype; Hormones; Immunohistochemistry; Laboratories; Lapatinib; Medical prognosis; Original Article; Patients; Pertuzumab; Phenols (Class of compounds); Progesterone; progesterone receptor; Prognosis; Radiation therapy; Radiotherapy; Sex hormones; SMS (Short messaging service); Statistical analysis; targeted therapy; triple-negative breast cancer; India; fluorescent in situ hybridization; targeted therapy; triple-negative breast cancer; estrogen receptor; progesterone receptor; C-erb B-2 protein
• ISSN: 0971-5851; 0975-2129
• DOI: 10.4103/ijmpo.ijmpo_172_17

Abstract Aims: The aim is to study the hormone receptor status, association of HER2 expression with prognostic factors and use of HER2-targeted therapy in North Indian breast cancer patients. Subjects and Methods: Immunohistochemistry reports of 288 breast cancer patients registered in the department of Radiotherapy, SMS Medical College, Jaipur in 2015–2016 were analyzed for estrogen receptor (ER), progesterone receptor (PR), and c-erb B-2 protein (HER2/neu) expression. Equivocal HER2 (2+) was further confirmed by fluorescent in situ hybridization (FISH). Number of patients receiving HER2/neu-targeted therapy was also studied. Results: For ER, positive status was more common (56%), whereas for PR and HER2/neu, negative status was more common (59% and 60% resp.). HER2 status was unknown for 25% patients. The percentage of equivocal HER2 (immunohistochemistry 2+) cases showing amplification on FISH was also high (56.7%). The percentage of eligible cases for targeted therapy actually receiving it was low (28%). The percentage of triple negative phenotype (ER-/PR-/HER2-) was high (29.8%). Triple-negative breast cancer phenotype was more common in young-aged premenopausal women but was not statistically significant. All HER2/neu + cases were infiltrating ductal carcinoma. HER2/neu expression was significantly higher with large tumor size ( P = 0.001), high tumor grade ( P < 0.001), advanced stage ( P = 0.001), greater number of positive lymph nodes ( P = 0.02), and ER/PR negativity ( P < 0.001). Conclusions: Most of the breast cancer patients are ER and/or PR positive and HER2/neu negative. The percentage of triple-negative phenotype is higher. More than half of HER2/neu 2+ cases show amplification on FISH assay. The percentage of eligible patients actually receiving targeted therapy is low. HER2/neu protein expression is significantly higher with adverse features such as large tumor size, high grade, advanced stage, greater number of positive lymph nodes, and ER/PR negativity.