ArticleCureus2025
Exploring Human Epidermal Growth Factor Receptor 2 (HER2)-Low Early Breast Cancer in a Moroccan Population: Clinical Characteristics and Survival Outcomes.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
Breast cancers with low human epidermal growth factor receptor 2 (HER2) expression, classified as an immunohistochemistry (IHC) score of 1+ or 2+ without gene amplification, have recently drawn increased interest due to the emergence of novel anti-HER2 therapies. However, there is still debate over whether HER2-low tumors form a distinct category. This study set out to examine and compare the clinical characteristics and outcomes of early-stage breast cancer patients with HER2-zero and HER2-low expression. We reviewed medical records of stage I-III patients treated at Souss-Massa University Hospital Center in Morocco between 2016 and 2018. HER2-positive cases were excluded, leaving two comparison groups: HER2-zero and HER2-low. Using statistical methods, we assessed baseline characteristics and survival outcomes - disease-free survival (DFS) and overall survival (OS) - through Kaplan-Meier analysis, log-rank testing, and Cox regression models based on key prognostic factors like age, hormone receptor (HR) status, Ki-67 index, and lymph node involvement. Among 322 patients studied, we found 114 were HR-positive/HER2-zero, 95 HR-positive/HER2-low, 85 HR-negative/HER2-zero, and 28 HR-negative/HER2-low. Tumor size, nodal status, and histologic grade were similar across both groups. Notably, HER2-low tumors were more often HR-positive (95 (77.2) vs. 114 (57.3), p < 0.001), and HER2-zero tumors were more likely to have high Ki-67 levels (>20%) (95 (47.73) vs. 41 (33.33), p = 0.009). While certain subgroups, like HR-positive or high Ki-67 cases, showed better DFS in the HER2-low group, overall, there were no significant differences in DFS or OS. These results suggest HER2-low and HER2-zero breast cancers share largely similar features and outcomes; however, in certain subgroups, HER2-low tumors were associated with significantly better DFS, possibly reflecting differences in tumor biology. Further research is essential to clarify the biological role of HER2-low expression.
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