Identification of Patients with Early HR+ HER2− Breast Cancer at High Risk of Recurrence

Peter A. Fasching; Hans Kreipe; Lucia Del Mastro; Eva Ciruelos; Gilles Freyer; Agnieszka Korfel; Nadia Chouaki; Clemens Stoffregen; Francisco Sapunar; David Cameron

doi:10.1055/a-2238-3199

GebFra - DGGG-Gesellschaftsausgaben, Table of Contents

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2024; 84(02): 164-184
DOI: 10.1055/a-2238-3199

GebFra Science

Review

Identification of Patients with Early HR+ HER2− Breast Cancer at High Risk of Recurrence

Identifizierung von Patientinnen mit HR+, HER2− Brustkrebs im Frühstadium mit hohem Rezidivrisiko

Authors

Peter A. Fasching

¹Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Department of Gynecology and Obstetrics, Erlangen, Germany
Hans Kreipe

²Institute of Pathology, Hannover Medical School, Hannover, Germany
Lucia Del Mastro

³S. S. Sviluppo Terapie Innovative, Department of Medical Oncology, Ospedale Policlinico San Martino, Genoa, Italy

⁴Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
Eva Ciruelos

⁵SOLTI Breast Cancer Research Group, Barcelona, Spain

⁶Hospital Universitario 12 de Octubre, Madrid, Spain

⁷Centro Integral Oncológico Clara Campal HM (CIOCC), Madrid, Spain
Gilles Freyer

⁸Oncology Department, CITOHL, Lyon-Sud Hospital, Cancer Institute of Hospices Civils de Lyon (IC-HCL), Hospices Civils de Lyon, Lyon, France

⁹Lyon-Sud Medicine School, University of Lyon, University Claude Bernard Lyon 1, Lyon, France
Agnieszka Korfel

¹⁰Lilly Deutschland GmbH, Bad Homburg, Germany
Nadia Chouaki

¹¹Eli Lilly and Company, Neuilly-sur-Seine, France
Clemens Stoffregen

¹⁰Lilly Deutschland GmbH, Bad Homburg, Germany
Francisco Sapunar

¹²Eli Lilly and Company Limited, Windlesham, Surrey, UK
David Cameron

¹³University of Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, Western General Hospital, Edinburgh, UK

Abstract

Breast cancer incidence has increased in the last two decades and, simultaneously, survival has improved due to earlier detection and improved treatment options. Despite this improvement, locoregional recurrences and distant metastases occur in up to 10 and 30% of women diagnosed with early breast cancer, respectively. Around 70% of breast cancers are hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2−), and associated with a persistent risk of relapse up to 20 years after diagnosis/initial treatment. We conducted a narrative review by combining PubMed searches with our clinical experience to describe patient characteristics, biomarkers, and genomic profiling tools available to clinicians for the identification of patients with HR+, HER2− early breast cancer at high risk of recurrence and to provide recommendations to classify patients into recurrence risk categories. National and international treatment guidelines are also summarised. Accurate assessment of the risk of recurrence in these patients is crucial as the predicted risk guides treatment decisions; imprecise estimations can result in over- or undertreatment, with either scenario having negative consequences for patients. Multiple prognostic tools and factors are recommended for early breast cancer, and no single test provides accurate prognosis in isolation. Since no single test can provide accurate prognosis in isolation, a combination of tools should be used. Risk thresholds are important to guide optimised and balanced therapeutic decisions in HR+, HER2− early breast cancer. However, prognostic assessment should be performed on a case-by-case basis, making patient-specific prognostic approaches essential to avoid over- or undertreatment.

Zusammenfassung

Die Inzidenz von Brustkrebs ist in den letzten 2 Jahrzehnten gestiegen; gleichzeitig hat sich das Überleben durch frühere Erkennung und bessere Therapiemöglichkeiten verbessert. Trotz dieser Verbesserungen treten lokoregionäre Rezidive sowie Fernmetastasen bei bis zu 10 resp. 30% aller mit Brustkrebs im Frühstadium diagnostizierten Frauen auf. Rund 70% aller Brustkrebsfälle sind HR+ (hormonrezeptorpositiv), HER2− (humaner epidermaler Wachstumsfaktorrezeptor 2 negativ) und sind somit mit einem anhaltenden Rezidivrisiko assoziiert, das bis zu 20 Jahren nach der Diagnose/Erstbehandlung anhält. Wir führten eine narrative Übersichtsarbeit durch und kombinierten dabei unsere Suche in PubMed mit unseren klinischen Erfahrungen, um die Patientinnencharakteristika, Biomarker und Instrumente zur Analyse von Genomprofilen, die Klinikärztinnen und -ärzten zur Identifizierung von Patientinnen mit HR+, HER2− frühem Mammakarzinom mit einem hohen Rezidivrisiko zur Verfügung stehen, zu beschreiben und Empfehlungen zur Klassifizierung von Patientinnen gemäß ihrem Rezidivrisiko aufzustellen. Es wurden auch nationale und internationale Behandlungsrichtlinien zusammengefasst. Die korrekte Einschätzung des Rezidivrisikos ist für diese Patientinnen wichtig, weil das prognostizierte Risiko die nachfolgenden Therapieentscheidungen steuern wird; unpräzise Einschätzungen können zur Über- bzw. Untertherapie führen, und beide Szenarien haben negative Konsequenzen für Patientinnen. Es gibt zahlreiche prognostische Werkzeuge und Faktoren, die für die Analyse von Brustkrebs im Frühstadium empfohlen werden; es gibt aber keinen Test, der für sich genommen eine akkurate Prognose bieten kann. Da es keinen Test gibt, der für sich allein genommen imstande ist, eine akkurate Prognose zu bieten, sollte eine Kombination verschiedener Testverfahren verwendet werden. Risikoschwellen sind wichtig, da diese die Entscheidung für eine optimierte, ausgewogene Therapie bei HR+, HER2− frühem Mammakarzinom lenkt. Dennoch sollte jede prognostische Evaluierung individuell durchgeführt werden, da ein patientenspezifisches prognostisches Vorgehen wichtig ist, um eine Über- oder Untertherapie zu vermeiden.

Keywords

early breast cancer - HR+ - HER2− - risk of recurrence - prediction of risk

Schlüsselwörter

Brustkrebs im Frühstadium - HR+ - HER2− - Rezidivrisiko - Risikoprognose

Full Text

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