ArticleBMC cancer2023
Distribution, dynamic evolution, and clinical outcomes of patients with advanced breast cancer according to HER2 expression.
Article in BMC cancer, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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11 citing papers in PubMed, 18 citations in OpenAlex.
- Trastuzumab treatment is associated with ferroptosis-related alterations in HER2-positive breast cancer organoids.Cancer chemotherapy and pharmacology · 2026Article
- HER2/neu Expression in Low-Grade Serous Ovarian Carcinoma: A Pilot Two-Center Retrospective Study.Journal of clinical medicine · 2026Article
- Differences in survival outcomes between HER2-low and HER2-zero breast cancer across heterogeneous HR expression patterns: a real-world study.World journal of surgical oncology · 2025Article
- Exploring immune activation patterns in HER2-low and HER2-ultralow breast cancer subtypes.The oncologist · 2025Article
- Real-world treatment patterns and outcomes of patients with hormone receptor-positive/HER2-low metastatic breast cancer treated with chemotherapy.The oncologist · 2025Article
- Concordance of HER2 status between primary tumor and circulating tumor cells in breast cancer.Discover oncology · 2024Article
- Article
- HER2-Low Breast Cancer: Now and in the Future.Cancer research and treatment · 2024Review
- Open questions, current challenges, and future perspectives in targeting human epidermal growth factor receptor 2-low breast cancer.ESMO open · 2024Review
- Low and Ultra-Low HER2 in Human Breast Cancer: An Effort to Define New Neoplastic Subtypes.International journal of molecular sciences · 2023Review
- HER2-low breast cancer: evolution of HER2 expression from primary tumor to distant metastases.BMC cancer · 2023Article
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundNovel antibody‒drug conjugates (ADC) have shown great efficacy in HER2-low advanced breast cancer. However, the clinical features of HER2-low disease still need to be clarified. The current study aims to evaluate the distribution and dynamic change in HER2 expression in patients with disease recurrence and the clinical outcome of those patients.
methodsPatients with pathologically diagnosed relapsed breast cancer between 2009 and 2018 were included. Samples were considered HER2-zero when the immunohistochemistry (IHC) score was 0, HER2-low when the IHC score was 1 + or 2 + with negative fluorescence in situ hybridization (FISH) results, and HER2-positive when the IHC score was 3 + or the FISH results were positive. Breast cancer-specific survival (BCSS) was compared among the three HER2 groups. Changes in HER2 status were also evaluated.
resultsA total of 247 patients were included. Among recurrent tumors, 53 (21.5%) were HER2-zero, 127 (51.4%) were HER2-low, and 67 (27.1%) were HER2-positive. The HER2-low subtype represented 68.1% of the HR-positive breast cancer group and 31.3% of the HR-negative group (P < 0.001). This three-group classification of HER2 status was prognostic in advanced breast cancer (P = 0.0011), with HER2-positive patients having the best clinical outcome after disease recurrence (P = 0.024), while only marginal survival advantages were observed in HER2-low patients versus HER2-zero patients (P = 0.051). In the subgroup analysis, the survival difference was observed only in patients with HR-negative recurrent tumors (P = 0.0006) or with distant metastasis (P = 0.0037). The overall discordance rate of HER2 status between primary and recurrent tumors was 38.1%, with 25 (49.0%) primary HER2-zero patients and 19 (26.8%) HER2-positive patients shifting to HER2-low at recurrence.
conclusionNearly half of the advanced breast cancer patients had HER2-low disease, which indicates a poorer prognosis than HER2-positive disease and marginally better outcomes than HER2-zero disease. During disease progression, one-fifth of tumors convert to HER2-low entities, and the corresponding patients may benefit from ADC treatment.
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