title: Low expression of HER2 protein in breast cancer is biologically significant.
abstract: HER2 status is routinely tested using immunohistochemistry or FISH following the licensing of a therapeutic agent targeting HER2. However, neither of these methods provides quantitative information relating to the 70-80% of patients with levels of expression lower than the assay detection thresholds. In this study, radioimmunohistochemistry was used to detect quantitative HER2 protein expression in 178 breast cancers. Survival analysis was performed, as were correlations with known prognostic variables and with overexpression of other HER family members. It is demonstrated that the populations expressing very high and very low levels of HER2 are each associated with increased risk of cancer-specific death on survival analysis (p = 0.0043). The group with low levels of HER2 was more likely to be of higher grade, EGFR-positive and ER/HER3/HER4-negative. HER2-positive cases were frequently ER-negative/HER3-positive, whilst cases with normal HER2 expression were often ER-positive/HER4-positive. The aggressive nature of the tumour group with low HER2 expression may be explained by actions of other HER family members, particularly EGFR, but whether these or other factors have a negative regulatory effect on HER2 expression remains to be determined.
authors.affiliation: Endocrine Cancer Group, Section of Surgical and Translational Research, Glasgow University, UK. smtovey@doctors.org.uk
authors.forename: S M
authors.initials: SM
authors.lastname: Tovey
authors.forename: J R
authors.initials: JR
authors.lastname: Reeves
authors.forename: P
authors.initials: P
authors.lastname: Stanton
authors.forename: B W
authors.initials: BW
authors.lastname: Ozanne
authors.forename: J M S
authors.initials: JM
authors.lastname: Bartlett
authors.forename: T G
authors.initials: TG
authors.lastname: Cooke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000235:genetics*; D066246:ErbB Receptors / Q000235:genetics; D005260:Female; D015972:Gene Expression Regulation, Neoplastic / Q000235:genetics; D018773:Genes, erbB-1 / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D008875:Middle Aged; D011854:Radiochemistry / Q000379:methods; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics*; D020893:Receptor, ErbB-3 / Q000235:genetics; D066247:Receptor, ErbB-4; D016019:Survival Analysis
chemical_list: D066246:ErbB Receptors; D018719:Erb-b2 Receptor Tyrosine Kinases; D020893:Receptor, ErbB-3; D066247:Receptor, ErbB-4; C587689:ERBB4 protein, human