Keywords
neoadjuvant chemotherapy
receptor conversion
chemoresistance
How to Cite
Abstract
Introduction. Neoadjuvant chemotherapy (NC) is employed as an important step in the treatment of patients with breast cancer (BC). We do not have much information about the conversion of estrogen receptor (ER) and/or progesterone receptor (PR) status in breast cancer (BC) patients after NC, or about its correlation with chemoresistance and prognosis. Not all clinics consistently determine receptor status after neoadjuvant chemotherapy (NC) and surgical intervention in breast cancer (BC) patients. However, this status may vary, making it critical to adjust the adjuvant treatment plan accordingly. Failure to do so may result in inadequate therapy and the development of chemoresistance.
Aim. To determine the effect of changes in receptor status at different stages of breast cancer treatment on the development of chemoresistance.
Materials and methods. Sixty patients with advanced breast cancer after neoadjuvant chemotherapy (NAC) were enrolled in the study and divided into two groups: the receptor-stable group (30 patients, with no conversion in ER and PR receptor status before and after NAC) and the receptor-conversion group (30 patients, with conversion in either ER or PR status). Univariate analysis was used to compare 5-year disease-free survival (DFS) between the groups.
Results. The estimated 5-year DFS rate for patients in the receptor-stable group was significantly higher (22 patients, 73.7%) compared to the receptor-conversion group (16 patients, 55.2%, P = 0.015). In contrast, the estimated 5-year overall survival (OS) rates for patients with or without receptor conversion were not statistically different (80.0% vs. 72.4%, log-rank test, P = 0.587). In the univariate Cox proportional hazards analysis, patients with receptor conversion had worse DFS (hazard ratio, 1.995; 95% confidence interval, 1.130–3.521, P = 0.031).
Conclusions. We strongly recommend testing patients’ biomarkers at different stages of treatment and paying closer attention to those with receptor conversion. These patients require an individualised approach to therapy as part of comprehensive treatment. It is essential to determine hormonal status after neoadjuvant therapy, using postoperative tissue samples, as hormonal status may change and, accordingly, treatment strategies may need to be adjusted. This approach can help prevent the development of chemoresistance.
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