title: Prospective evaluation of the conversion rate in the receptor status between primary breast cancer and metastasis: results from the GEICAM 2009-03 ConvertHER study.
abstract: The objective of this study was to determine the conversion rate of human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER) and progesterone receptor (PR) between primary tumors and metastatic lesions in advanced breast cancer. Patients with suspected diagnosis of locally recurrent or metastatic breast cancer, either at first relapse or after successive disease progressions, who had an appropriately preserved sample from a primary tumor and were scheduled for a biopsy of the recurrent lesion, were included. Blinded determinations of receptor status on paired samples were performed by immunohistochemistry and fluorescence in situ hybridization at a central laboratory and compared with those performed locally. Overall, 196 patients were included and 184 patients were considered evaluable. Reasons for non-evaluability included the inability to perform biopsy (n = 4) or biopsy results showing normal tissue (n = 3), benign disease (n = 3) or a second neoplasia (n = 2). Conversion rates determined at local level were higher than those determined centrally (HER2: 16 vs. 3 %, ER: 21 vs. 13 %, PR: 35 vs. 28 %, respectively). There was substantial agreement regarding the expression of HER2 in primary tumors and metastases, and ER at metastases, between local and central laboratories. PR at any site and ER at primary site showed moderate agreement. Oncologists altered their treatment plans in 31 % of patients whose tumor subtype had changed. These results reinforce the recommendation for performing confirmatory biopsies of metastases, not only to avoid misdiagnosis of breast cancer relapse, but also to optimize treatment (clinicaltrials.gov identifier: NCT01377363).
authors.affiliation: Hospital Provincial de Castellón, Avda. Doctor Clara, 19, 12002, Castellón de la Plana, Spain.
authors.forename: Eduardo Martínez
authors.initials: EM
authors.lastname: de Dueñas
authors.forename: Ana Lluch
authors.initials: AL
authors.lastname: Hernández
authors.forename: Angel Guerrero
authors.initials: AG
authors.lastname: Zotano
authors.forename: Ramón María Pérez
authors.initials: RM
authors.lastname: Carrión
authors.forename: José Ignacio Chacón
authors.initials: JI
authors.lastname: López-Muñiz
authors.forename: Silvia Antolín
authors.initials: SA
authors.lastname: Novoa
authors.forename: Angela López
authors.initials: AL
authors.lastname: Rodríguez
authors.forename: José Alejandro Pérez
authors.initials: JA
authors.lastname: Fidalgo
authors.forename: Jaime Ferrer
authors.initials: JF
authors.lastname: Lozano
authors.forename: Octavio Burgués
authors.initials: OB
authors.lastname: Gasión
authors.forename: Eva Carrasco
authors.initials: EC
authors.lastname: Carrascal
authors.forename: Andrés Hernando
authors.initials: AH
authors.lastname: Capilla
authors.forename: Isabel Blancas
authors.initials: IB
authors.lastname: López-Barajas
authors.forename: Montserrat Muñoz
authors.initials: MM
authors.lastname: Mateu
authors.forename: María Helena López
authors.initials: MH
authors.lastname: de Ceballos Reyna
authors.forename: Amparo Oltra
authors.initials: AO
authors.lastname: Ferrando
authors.forename: Noelia Martínez
authors.initials: NM
authors.lastname: Jañez
authors.forename: Vicente Carañana
authors.initials: VC
authors.lastname: Ballerini
authors.forename: Antonio Antón
authors.initials: AA
authors.lastname: Torres
authors.forename: Gustavo
authors.initials: G
authors.lastname: Catalán
authors.forename: José Angel García
authors.initials: JA
authors.lastname: Sáenz
authors.forename: Salomón
authors.initials: S
authors.lastname: Menjón
authors.forename: Ana María
authors.initials: AM
authors.lastname: González-Angulo
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor; D001706:Biopsy; D001943:Breast Neoplasms / Q000378:metabolism* / Q000473:pathology; D047628:Estrogen Receptor alpha / Q000378:metabolism*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000378:metabolism* / Q000473:pathology; D009367:Neoplasm Staging; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D047628:Estrogen Receptor alpha; D018719:Erb-b2 Receptor Tyrosine Kinases; D011980:Receptors, Progesterone; C506487:ESR1 protein, human; C508053:ERBB2 protein, human